Switching Medigap Plans

I decided to start a new thread because I realized if I go down to a Plan G high deductible from a F I can’t go back because of the fact I can’t pass medical underwriting. I know I can’t pass because I just tried. Luckily Nevada has the birthday rule so I can change then without underwriting.

My motivation is cost because mine goes up 20/month every year and it’s now 200/month. A high deductible G plan would cost 52/month. Combined with part b at 170 and D at 12 it’s expensive for someone on a income of 32k/ year and I want to keep my savings for true emergencies and not spend it on monthly bills.

Keep in mind that I was under a ton of stress when initially choosing a medigap plan because I was expecting not to have to make that decision until I was 70 due to my husband being younger and my ability to stay on my state employee plan.

All of a sudden I am getting divorced, selling a house, buying a condo and having to pick a plan for life. For those of you who know more than me about the various medigap plans is there any reason this is a bad idea?

I don't know what I would do in your situation. Purely by looking at the cost, if you switch to HD-G, the deductible is $2700, which is $2467 more than the Plan G deductible.

You will be saving $148 a month; $1776 a year, but risking paying $2467 a year. That is $691 more than if you stay with Plan G.

So, if you do not see doctors a lot, you can save $1776. But, if you do, you may end up paying $691 more a year. I hope my math is correct.
 
This is not such a good deal.

As one is still stuck with the same Carrier (ins company). So if Moo is bad , it's still bad when a person moves to a lesser paying plan..

I'm thrown off by the effective date of 11 months ago.... as in the past.

I'm still not sure MoO is bad. Every insurance company raises rates. If MoO does close books and opens a new company, what's to say I couldn't sign up with that new company in a different plan and get a lower premium?

I asked a question in another thread and did not get many qualified answers. Since I'm new on Medicare, my question was, what were your medicare premiums when you started and what are they now? What company are you with?

The SHIP chart in Illinois shows MoO premiums from age 65-75 as an average increase, actually lower than UHC. The chart was posted in another thread and I'll try to find it and post it here.
 
I'm still not sure MoO is bad. Every insurance company raises rates. If MoO does close books and opens a new company, what's to say I couldn't sign up with that new company in a different plan and get a lower premium?
I've been told MoO does not allow that and even if they did you would still need to be able to pass underwriting. Why does MoO have 5 subsidiaries? The only reason I can think of is to be able to attract new business with lower rates.
 
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I asked a question in another thread and did not get many qualified answers. Since I'm new on Medicare, my question was, what were your medicare premiums when you started and what are they now? What company are you with?
I don't recall whether or not I responded to your question on that thread, so...

At age 71 I changed to MoO Plan N. My monthly premium was $87.89 and after four years is now $123.08. DW is a year younger and moved to MoO Plan N at the same time. Her initial premium was $76.91 and is now $106.05.
 
I don't recall whether or not I responded to your question on that thread, so...

At age 71 I changed to MoO Plan N. My monthly premium was $87.89 and after four years is now $123.08. DW is a year younger and moved to MoO Plan N at the same time. Her initial premium was $76.91 and is now $106.05.

Sorry, I edited, I see after 4 years. Not bad.
 
About 8.5% increase per year. And FWIW, MoO "closed the book" on our company 12 months after we signed on with them.

Does that upset you about closing the book? Does it change your coverage or benefits?
 
Does that upset you about closing the book? Does it change your coverage or benefits?
No impact to coverage or benefits. It doesn't upset me as I knew from my research it would happen at some point. It does make me want to closely monitor my rate increases.
 
Thank you for this correction! It turns out that Arizona is one of four states that are issue-age only.

Arizona also offers a few community rated plans, AARP UHC is one of them and the one I have.
 
Fortunately here in Oregon the birthday rule applies and one is able to switch between carriers without medical underwriting (I have plan G). Its interesting that Insurance companies continue to play the close the book increase rates game even here in Oregon. I guess Ins companies just count on people being lazy and/or not caring to compare rates. Fortunately its easy to switch and have done so several times already as rates have been increased.
 
Fortunately here in Oregon the birthday rule applies and one is able to switch between carriers without medical underwriting (I have plan G). Its interesting that Insurance companies continue to play the close the book increase rates game even here in Oregon. I guess Ins companies just count on people being lazy and/or not caring to compare rates.

Some things that are easy for the 65 year old folks look like huge obstacles to the average 85 year old.
 
If you can change your plan every year and if you're healthy now, I would definitely go on a high deductible plan G. If/when you get sick, change over to a standard plan G, but I don't know your state's premiums, I imagine they are higher because of being able to change plans every year.
In New York we can change Medigap plans any time we wish, without underwriting. That’s why we pay much more than other states, and why the HD plan is more popular.

My eye doctor billing group told me that the services are sento to Medicare and the Medigap plan, implying that I don’t have to track the deductible manually.
 
In New York we can change Medigap plans any time we wish, without underwriting. That’s why we pay much more than other states, and why the HD plan is more popular.
I think the main reason you currently pay more in NY is that it's one of the few states which mandates "community rated" pricing. That means that for people enrolled in any given Medigap plan in your area, they will all pay the same regardless of their age. However, if you reach a ripe old age, you'll be paying less than enrollees of the same age in most other states.
 
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In New York we can change Medigap plans any time we wish, without underwriting. That’s why we pay much more than other states, and why the HD plan is more popular.

My eye doctor billing group told me that the services are sento to Medicare and the Medigap plan, implying that I don’t have to track the deductible manually.

I track mine on the Medigap plan's website just to make sure they are doing it right?

Interesting, I assumed that NY had some sort of "birthday rule" like CA. In NY you could just go with the HD and then switch if you saw large part B expenses looming (like for chemotherapy).
 
The thing about HD plans is you have to keep track of and pay all the bills yourself. As you get older it's a bit more difficult,and hospital billing is a nightmare. 3 years ago they put me into collection for $30,for a bill they never sent.
 
The thing about HD plans is you have to keep track of and pay all the bills yourself. As you get older it's a bit more difficult,and hospital billing is a nightmare. 3 years ago they put me into collection for $30,for a bill they never sent.
LOL... I have to pay the $20 per visit on my plan...

Got a dun letter about one a month ago... called and said that I never got the bill.. 3 texts and 3 phone calls and I STILL had not gotten a bill... just arrived yesterday... was going to pay tonight but they do not have a guest option so will call tomorrow and waste time giving them my CC number...

BTW, I did hang up on the calls as they called and then said 'you are 6th in line for a rep'... REALLY (should put this in peeve)... you are calling ME and want ME to wait for YOU?
 
My eye doctor billing group told me that the services are sento to Medicare and the Medigap plan, implying that I don’t have to track the deductible manually.
I will never understand why physician's billing process invoices supplemental plans directly. The insurance company that provides supplemental plans ignore these invoices. They only pay (after meeting the Part B deductible, plus whatever other user deductible associated expenses with the supplemental plan is met) after Medicare forwards the remaining 20% portion to signify it's a Medicare-approved medical expense. I've had this discussion with my PCP billing manager but they continue to insist on doing this. I guess it makes them feel better.
 
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I will never understand why physician's billing process invoices supplemental plans directly. The insurance company that provides supplemental plans ignore these invoices. They only pay (after meeting the Part B deductible, plus whatever other user deductible associated expenses with the supplemental plan is met) after Medicare forwards the remaining 20% portion to signify it's a Medicare-approved medical expense. I've had this discussion with my PCP billing manager but they continue to insist on doing this. I guess it makes them feel better.

That's odd. Medicare has been doing "crossover" to Medigap plans for years. It may not work 100% but I think it is close
 
The thing about HD plans is you have to keep track of and pay all the bills yourself. As you get older it's a bit more difficult,and hospital billing is a nightmare. 3 years ago they put me into collection for $30,for a bill they never sent.
You're right. Hospital billing is a nightmare. They should be compelled by law to at least provide a complete detailed machine readable (not just machine printable) bill. If it were machine readable, it could be loaded into an app and compared to Medicare to validate that they're not billing you for something they didn't properly file. More on that later.

I'm new to Medicare this year and have AARP/UHC Plan-N (so have a $20 max doctor copay). I didn't "have to" do it, but I analyzed every one of 178 charge codes I've incurred this year.

What I discovered is that if you do what you're "supposed to do", it mostly works.

And what you're supposed to do is ignore the bill from providers until after you see it *correctly submitted* to Medicare, and passed to Medicare Supplemental. Usually they submit correctly to Medicare, and anything owed is passed to your Medicare Supplemental company automatically. You're responsible for what medigap doesn't pay, so after you get the medigap eob, you look for the provider bill to pay.

At the beginning of the year, anything that gets passed to your Medicare Supplemental company, you pay up until $240 (your deductible). This is true of G, N, etc. After that, in my case, I still have to pay up to $20 for office visits, because I have N.

Because I'm still a programmer (even though I've been retired a decade), I wrote a thing that matches the download from Medicare.gov with the download from uhc.com. It loads the payments I've made to providers too, so I can detect that the bill/claim are complete. I only review claims that aren't complete.

One thing to watch for is the provider not sending something through to Medicare. In my case, there was a claim that had maybe 10 codes, and only 8 were submitted to Medicare. That was NOT so easy to figure out! The provider's bill wasn't downloadable, so when they started making noises about me having to pay, I had to go line-by-line on their paper bill, comparing to the Medicare codes. Then write the facility and tell them to submit ALL the codes to Medicare, not just a subset. I probably could have skipped the analysis, but the problem was that this was the beginning of the year, so I wasn't sure if it was part of the deductible. This problem is going to be the same for everyone on traditional Medicare (G, N).

The other thing I ran into is Medicare rejecting something that should be paid. I'm still working through one of those. This example is a lab test that some bureaucrat decided wasn't a valid test to do in some cases, so it's rejected in all cases. The first appeal didn't work, and I'm on to the second level. It's not a lot of money, but I figure they give me the option to appeal, I'll appeal.

Hopefully my cognitive skills will remain high enough, long enough for me to get these algorithms in a mobile app...right now it's only on Windows desktop.
 
The other thing I ran into is Medicare rejecting something that should be paid. I'm still working through one of those. This example is a lab test that some bureaucrat decided wasn't a valid test to do in some cases, so it's rejected in all cases. The first appeal didn't work, and I'm on to the second level. It's not a lot of money, but I figure they give me the option to appeal, I'll appeal.

Absolutely you should appeal. In my experience the rejection is usually due to a mismatch between the diagnosis code (ICD) and the procedure code (CPT) which is how the provider communicates the justification for the charge.

I think it is helpful to monitor claims on the Medicare website. If there is a rejected claim you want to address it within the appeal period.
 
As far as cost go. Plan F HD. Cigna/now Medco.
At 76 2024 $66/month,for 2025 will be $69/month. If I were to do it again might choose plan N. Medicare itself is very good,just did a pacemaker and 2 ER visits,well over 100K,have not hit F-HD deductible quite yet.
 
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I think it is helpful to monitor claims on the Medicare website. If there is a rejected claim you want to address it within the appeal period.
I've found the Medicare website to have the data pretty quickly, but they take their time publishing the MSN. And you can't submit an appeal until after you have the MSN in hand. Then you have 120 days to file an appeal. So you find out Medicare didn't pay fairly quickly, and you have to manage the supplier (which I did by just paying the bill). Then you wait months for the MSN to arrive before you can appeal. I think they're counting on people saying "to heck with it!"
 
Oh I thought you could appeal from a claim. I just looked and I get a eMSN every 60 days. I once made the mistake of trying to reason with a supplier about their error before submitting an appeal. I pay clean claims right away, usually before they are billed. I am in no rush to pay the others until everything is resolved.
 

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