topic Medi gap in Wellness

Medi gap

goldensrbest — Thu, 31 Aug 2017 16:07:22 GMT

I would like to hear from some one that actually has medi gap,not any advantage plans ,please.

Re: Medi gap

kaydee50 — Thu, 31 Aug 2017 16:22:02 GMT

We have UnitedHealthCare thru AARP. But since I moved recently I may change plans. We do take the high deductible "F" plan. Fortunately, we have not had to use it yet!!!

Re: Medi gap

meem120 — Thu, 31 Aug 2017 16:40:40 GMT

I have AARP. Plan F. My plan does not have a high deductible. I was hospitalized last year with a severe case of pneumonia. Did not receive one bill from doctor or hospital. Everything was covered, including 30 days of IV antibiotics.

Re: Medi gap

Carmie — Thu, 31 Aug 2017 16:51:07 GMT

Ok, I am not 65 yet, so I don't have a Medigap policy, but my DH will be getting one in a few months.

He is planning on taking the Traditional Medicare Plan and Medigap Supplemental Plan C that I have chosen for him,

My reasoning for this choice.

I prefer Traditional Medicare to an Advantage Plan. It's more expensive, but I believe it is A better choice for us the long run.

With Plan C and Medicare, he will not be responsible for any deductibles, copayments or coinsurance.... ever! We travel a lot and this insurance can go everywhere with us. There are no referrals needed. It covers foreign expenses.... important for travelers. Even Cruise ship medical expenses are foreign expenses.

Plan C covers the Skilled Nursing copay up to day 100, which IMO is very important, many people end up needing for than 21 days in a SNF.

We live in PA which is a state where the providers are not allowed to charge an excess fee, if we lived in a state where they could, I'd choose Plan F if I could afford it only if there were many providers who did not accept Medicare payments. For most people Plan C is okay and preferred.

it would be possible down the road to switch to an Advantage Plan if we changed our minds. It's cost prohibitive to switch from an Advantage Plan to a Traditional Plan because the Supplement Plans are more expensive with the late penalties attached...way more expensive.

i have serviced Advantage Plans and Supplemental Plans as a Customer Service Rep, so I know all of the ins and outs of Insurance.

If you can afford a SUpplemental Plan, they are the better Plans for most people. Not everyone can afford them and have no choice but to go with an Advantage Plan. Those plans can end up,costing you a lot of money if you get really sick.

A family member of mine lost her RX Plan that she had through a retirement Plan through her deceased spouse's employer. She paid $20 a month for the RX coverage. When She lost it, she could not afford to go with another RX plan on the market plus pay for her supplemental plan.

The requirement Plan offered an Advantage Plan PPO for $90 a month that included RX, so she opted to take it.

She Is very ill and sees many specialists at $40 a visit. She spent 7 days as in inpatient this past year and has a $200 a day copay = $1400 bill. She gets those shots for osteoprorsis, but now can't because they are not covered.

she is getting a shoulder replacement in Oct and is hoping she will not have to be inpatient for that. It seems every time she needs medical attention, she has to check to see if it is covered and how much of it she will have to pay out of her pocket. Her out of pocket bills are more than what she would have paid for the whole year to keep her Traditional Coverage.

her monthly income is low. As soon as open enrollment come around again, I will be looking for a better Advantage Plan for her. She can't go back to Her Supplemental Plan because she will be charged an even higher price now. Some areas have better Advantage Plans than we do in our area and at better prices. In our area, they stink.

whatever you choose, plan on choosing and keeping this coverage for a lifetime. What may work today, may not work when you are older. Buy insurance for an older, very sick person even though you might be young and healthy now.

If you have the publication " Medicare and You" there is a chart showing the plan that is easy to read and understand to help you. It is also online on the Medicare website. It's a very good tool.

Re: Medi gap

Upnorth1 — Thu, 31 Aug 2017 17:09:53 GMT

Carmie, I agree with you completely. We have the same plan thru BCBS for all the reasons you mentioned. Our monthly premium did go up some this year, but I would still never change. I have had numerous major surgeries and have not paid any out of pocket, for hospital, Drs, pt, etc. plus we spend half the year in warmer climate and it goes with us.

Re: Medi gap

Mom2Dogs — Thu, 31 Aug 2017 17:26:51 GMT

@Carmie....I don't want to hijack this thread but can you tell me....

IF you have Plan C or F...along with medicare does that mean if the patient goes to the doctor for the flu or cold, etc that they pay zero co pay and nothing toward the deductible?...(kind of like those visits are free but of course I understand those plans cost more.)

DH has Plan N/Medical Mutual and so far since he has had the plan (2 years) we have paid out very little but he has not had any serious illness either.

We do have the Medicare and You book, I am going to get it out and read it.....and thank you!

Re: Medi gap

wonderfulworld — Thu, 31 Aug 2017 17:29:40 GMT

Plan F is being discontinued in the next few years. My insurance provider recommended plan G. She said that those who have plan F will be able to continue with it but the premiums are expected to rise quickly. I think it is in 2020.

Re: Medi gap

Elbelle — Thu, 31 Aug 2017 17:38:22 GMT

Carmie, you seem to know a lot about it. May I ask another related question? Once you determine which supp plan you want, how should we choose which company to buy it from? The plans are all the same, but what other criteria should we look at when deciding on who to buy it from? Thanks!

Re: Medi gap

Carmie — Thu, 31 Aug 2017 18:19:27 GMT

Plans C pays for ALL Deductibles and coinsurance for Medicare covered services. That means if Medicare covered your service, it will be paid 100% between Medicare and your Supplemental Plans. This includes office visits, diagnostic, inpatient and outpatient claims... everything! ( there are some mental health services that would not be paid 100%) but none of the Plans would pay them 100% anyway.

If your provider does not accept Medicare, which is allowed in some states, you would have to pay the excess fee that is over and above what Medicare allows up to 15% only. Some states do not allow the doctor to bill you this fee. Those states are CT, MA, MN, NY, OH, PA, RI and VT.

Most people in those states where a provider can bill excess fees choose only providers who accept and never see a bill for an excess fee.

Not all Supplemental Plans cover deductibles or coinsurance in full. Some supplemental plans don't cover much at all.... like Plan A and B ( not to be confused with Medicare Parts A and B)

There are a few differences in the Supplemental Plans offered. From experience, I think a Supplemental Plan that covers the coinsurance for SNF days 21 through 100 is VERY important and will be even more so as time goes on as knee, shoulder and other body part replacements are being done more frequently. We are living longer too.

RIght now the SNF coinsurance is about $164 a day if you are there more than 21 days.

This benefit is one of the fastest growing one used and important IMO. Just something to think about.

i don't think it matters where you purchase your supplemental insurance. i would just compare prices and reputation with the major companies like BCBS, AETNA! United Healthcare, Humana, etc.

All of these plans are regulated by the Feds and they monitor all of the policies, so there is very little fraud or lazy claim processing going on.

Let me add that you MUST choose a Medicare part D plan with a Traditional/ Supplemental Plan. You must do so right away or you may not be able to add it later.

If you do not take maintenance RX drugs, pick the lowest cost plan you can. This coverage can be upgraded or changed each year. So if you find that you need better RX coverage in the future, it will be available to purchase with no penalties added.

Re: Medi gap

geezerette — Thu, 31 Aug 2017 18:22:24 GMT

@wonderfulworld wrote:
Plan F is being discontinued in the next few years. My insurance provider recommended plan G. She said that those who have plan F will be able to continue with it but the premiums are expected to rise quickly. I think it is in 2020.

I chose Plan G.

The only time the insurance companies are required to accept you without underwriting is when you are first eligible and sign up for Medicare. If you choose a plan that covers less and then later decide you want a plan that covers more, they can charge you higher premiums or deny you coverage completely based on your age and/or medical condition at that time. Since I can afford the premiums, I chose Plan G, which covers everything except the yearly Medicare deductible, even though I am healthy and could afford the co-pays and deductibles of the other, cheaper plans. If I decide at a later date to choose a cheaper plan, there is no underwriting for that.

I chose Plan G, rather than Plan C (which covers everything plus the yearly Medicare deductible), because when looking at the premium comparisons, paying the yearly Medicare deductible myself was cheaper than paying the Plan C premiums. And those years I don't use the insurance, I don't pay the deductible either.

Even though all the plans cover the same expenses, not all plans are offered in all areas. Plan G was not offered by many of the insurance companies that contacted me, and so of course, those people tried to convince me to go with another plan that they did offer. Also, the premiums vary from company to company.

ETA: I would suggest doing your homework comparing companies before choosing. Many of the company representatives I spoke with before I signed up told my blatantly false information about the various plans. I don't know if it was intentional or just that the reps were uninformed. Figure out why you would need this insurance coverage, along with how much you can afford (and are likely to be able to continue to afford in the future) and then choose the best plan for your personal situation.

Re: Medi gap

Mom2Dogs — Thu, 31 Aug 2017 18:18:20 GMT

I am going to print this thread, it is very helpful information....there is so much to know and when it comes my time I want to make an informed decision and we may revisit my DH policy.

again thank you.

Re: Medi gap

Carmie — Thu, 31 Aug 2017 18:26:08 GMT

@geezerette You made some wise well thought out decisions. In my area, Plan G is more expensive than Plan C. It varies.

Also, downgrading to a lesser plan in the future might not save you money for the premiums. Insurance companies always charge more if you are out of your 6 mo personal open enrollment. So in essence, it might not be prudent to downgrade when the monthly premiums might be higher if you do.

Re: Medi gap

geezerette — Thu, 31 Aug 2017 18:52:47 GMT

@Carmie wrote:
@geezerette You made some wise well thought out decisions. In my area, Plan G is more expensive than Plan C. It varies.

Also, downgrading to a lesser plan in the future might not save you money for the premiums. Insurance companies always charge more if you are out of your 6 mo personal open enrollment. So in essence, it might not be prudent to downgrade when the monthly premiums might be higher if you do.

@Carmie

Interesting that the plan premiums are reversed. This is why it is so important to check out prices for your specific area and compare companies.

Yes, I realize what you are saying and I can't imagine switching to a lesser plan for myself. What I was trying to point out is that during the initial enrollment period is the only time that you are guaranteed enrollment without underwriting and for the "going" premium price. Once that initial period is over, all bets are off, so to speak.

Also, those looking at MediGap coverage need to decide whether you want drug coverage as well. They are separate policies. Even though there are only two choices for those, the drug policies were actually more confusing for me than the medical policies. Maybe because I don't take any prescription drugs, all those pricing tiers were mind-boggling.

Re: Medi gap

gidgetgh — Thu, 31 Aug 2017 18:54:28 GMT

My husband has Plan F through Blue Cross of Georgia.

No co-pays, no deductible.

My husband has Parkinson's Disease and in 2015 had colon cancer. He had surgery for that and spent two weeks in rehab after the surgery.

For all of this, we've never received one medical bill or had to pay one penny toward his medical care, except for the premiums.

Prescriptions though are another story.

Re: Medi gap

Mom2Dogs — Thu, 31 Aug 2017 19:59:55 GMT

@Carmie....I am reading about supplemental policies and see the term 'original' medicare....are there two different Medicare plans?

Re: Medi gap

pepes mom — Thu, 31 Aug 2017 20:21:12 GMT

momtodogs: There is original Medicare, in which you can just carry that or add a Medigap policy and then there's the Medicare Advantage plans.

I am on disability. I have Medicare parts A and B and a Medigap Plan F through Mutual Of Omaha. I was in the hospital 2 years ago for a kidney stone. Upon CT scan, they found a HUGE blood clot in my renal vein. I didn't receive any paperwork regarding my hospital stay. Everything was paid for.

Due to finding that clot, I am now on Coumadin for life. I get bloodwork every 2 weeks. I have never received a bill for that either.

Re: Medi gap

Carmie — Thu, 31 Aug 2017 21:11:18 GMT

@Mom2Dogs wrote:
@Carmie....I am reading about supplemental policies and see the term 'original' medicare....are there two different Medicare plans?

Original or a Traditional Medicare is the Medicare that has been around since 1965. This plan was setup for people on SS, but it did not cover every medical bill at100%. Then insurance companies started to sell insurance to cover the "gap" so that coverage could cover these out of pocket expenses called Medigap supplemental policies.

At the time, the policies were not regulated and varied greatly.

Then the Advantage Plans were offered in addition to Original Medicare around 1997. Now people could choose between two types of Medicare... Original and Advantage.

Re: Medi gap

geezerette — Thu, 31 Aug 2017 21:35:48 GMT

Medicare “Advantage” is a version of Medicare that was started some time ago and it is what used to be called an “HMO”, or a managed plan. With this you still need Medicare Parts A and B from the government. But this is where the two Medicares differ. With Original you are responsible for the 20% not covered by Parts A and B.

With Advantage, an insurance company will accept from the government the money from your Parts A and B and you do not have that 20% responsibility, and typically you have less out-of-pocket expenses for co-pay and deductibles. However, the trade-off is that also typically your options are limited for medical care. You are limited to a network of doctors/hospitals, etc. Your insurance company has more control over who you see and when, just like in any managed plan.

Many people like it because it usually is less expensive than Original Medicare. But others do not like it if they don't have the access to the type of care they want. It is something to research carefully.

Re: Medi gap

Carmie — Thu, 31 Aug 2017 22:44:49 GMT

@geezerette wrote:

Medicare “Advantage” is a version of Medicare that was started some time ago and it is what used to be called an “HMO”, or a managed plan. With this you still need Medicare Parts A and B from the government. But this is where the two Medicares differ. With Original you are responsible for the 20% not covered by Parts A and B.

With Advantage, an insurance company will accept from the government the money from your Parts A and B and you do not have that 20% responsibility, and typically you have less out-of-pocket expenses for co-pay and deductibles. However, the trade-off is that also typically your options are limited for medical care. You are limited to a network of doctors/hospitals, etc. Your insurance company has more control over who you see and when, just like in any managed plan.

Many people like it because it usually is less expensive than Original Medicare. But others do not like it if they don't have the access to the type of care they want. It is something to research carefully.

Some parts of what you wrote are true and some are not. Advantage plans are not all managed Plans. Some are HMO and some are PPO. PPO plans are not managed care. There are usually out of pocket expenses for services that the patient must pay for. They cannot get a Medigap policy to pay for these fees. You do not have Medicare Parts A and B with Advantage Plans, but you still have the Medicare B payment taken from your SS check.

Most Advantage Plans have deductibles for an inpatient hospital stay. Some are $200 a day or more for each day up to about day seven. So if you are in the hospital for one week, you would owe $1400.

if you had Original Medicare you would owe $1316. Then if you went home and were readmitted within the same benefit period, you would not have to pay the deductible again.

Most Advantage plans would charge a deductible each time you are admitted and not just once during a benefit period.

With Advantage plans you have to pay out of pocket each time to go to your doctor and if the doctor is a specialist, the out of pocket is higher then your PCP. Some of these fees are a hefty $40 to $70 a visit.

People who really like Advantage Plans are mostly healthy people. The plans also can include vision, RX, dental, hearing aid and gym memberships which appeal to people. This type of coverage is less expensive to buy, but not always a good value if someone is very sick and sees many specialists or is in and out of the hospital a lot. There are MANY copays and deductibles involved in Advantage Plans.

The problem with Advantage Plans is that you are locked into them for life if you choose them. Yes, you can always switch back to Original Medicare, but you will not be able to get a Medigap or RX policy that is affordable. Some companies will not even offer you a Medigap policy when you switch.

The Advantage Plans out there are better in some states than others. Florida sells some really great Plans, probably because they have a larger senior population. In Pennsylvania, they are awful.

You have to be really careful and do your homework before you decide. Advantage plans are not all bad I will admit, but, they vary greatly and can be tricky. I would never feel comfortable with an Advantage HMO Plan for myself because I travel and they are too managed and complicated.

Re: Medi gap

Mom2Dogs — Thu, 31 Aug 2017 22:53:51 GMT

.....I am aware of Medicare and Medicare Advantage, my husband had medicare advantage at one time.... I have just never heard the term 'original' medicare that is what was confusing me...why can't they just use the words Medicare and Medicare Advantage...it would make things a bit easier to understand.