Community Chat

[Carmie]

---

@NicksmomESQ wrote:

---

@Carmie wrote:

@NicksmomESQ No, New York providers cannot bill you the excess fee. You can look it up under the MOM Law.

The other states are PA, CT, MA, OH, VT, RI and  MN.

---

@Carmie  Does this mean you would not need to pay for a supplement above basic Medicare? Or am I confused?

---

No, you would still need a supplement.  Plan C would be the best one to purchase in these states.

example...doctor's charge is $400.  Medicare allows $320 and pays 80% of the allowance which equals $256.  The supplement would pay $64 which is 20%. At that point $320 would be paid to the doctor.  

In the MOM states, the doctor would be considered paid in full and could not bill the patient the difference between the $400 billed and the $320 Medicare allowance. The doctor has to write off the $80.

In the Non MOM states the doctor could balance bill the patient the $80 excess fee. Some supplemental plans cover that fee.  You would not need a supplement to cover the excess that fee if you lived in NY, but you do need a supplement to pay 20% of the Medicare allowed amount. 

[NicksmomESQ]

 @Carmie  Thank you so much for sharing your knowledge of Medicare with us. It’s difficult to navigate through all the information that’s being thrown at us. You’ve made it a lot easier!!

[CelticCrafter]

@deepwaterdotter & @conlt - we were told, just last month, that F will be going away next year.

We were also told that a supplement doesn't fall under the open enrollment rules and the only time you are guaranteed a supplement, no questions asked is the very first time you become eligible to apply for it.

Any time after that, the insurance company can ask health questions and either charge accordingly or deny you completely.

[peachesncream]

DH and I are in a Medicare HMO, administered through United Health Care. I would say we are very pleased with the quality of care we've received, and the help we get through their support staff at United. 

We love our doctors. We use network doctors, but all (so far) have been excellent. This includes our primary care doctors (internists), dermatologist, opthamologist, etc. 

Our monthly premium for the HMO is zero. 

My DH is diabetic, and this condition requires a lot of supervision and care, testing, etc. I can only imagine how much money the HMO has saved us - it is incalculable. Medications are also covered; he takes 5 medications, and right now he is on generics, which are free. He does pay for test strips - that's all. Quarterly blood tests are free. 

We travel to visit grandchildren, and have occasionally needed to see a doctor. Those costs have been covered, with a co-pay of $35 plus some co-pays on medication - all quite reasonable. We haven't been hospitalized while traveling, though.

I feel quite comfortable using an HMO, as long as it's run by a recognized health insurance company - such as Aetna (which we used to use), or United Health Care, or Humana, etc.

[Bridgegal]

---

@Carmie wrote:

---

@deepwaterdotter wrote:

@conlt  I think Part F has been replaced by Part G.  I agree that this is the best option if available.

---

True, unless you live in one of the states where the doctor is not allowed to charge the Medicare B excess fee, then Plan C is the best.  And Plan C also covers the Medicare Part B deductible.  A bonus.

I think Plan H, F and C are being phased out.  If you have them, you will be grandfathered, but new apps won't be allowed.

Plans C, D F and G are the only plans that cover a skilled nursing facility at 100% for days 21 to 100.  If you don't have one of these plans you will owe 170.50 a day for these days.  This fee goes up every year and I can say, I have heard more families cry over the phone when they  heard that their loved one only had benefits for 20 days in a Skilled nursing facility covered at 100%.

Some Advantage Plan will also cover 100 days in full...you gotta check.

---

        One reason why long term care insurance is helpful.   

[Carmie]

---

@peachesncream wrote:

DH and I are in a Medicare HMO, administered through United Health Care. I would say we are very pleased with the quality of care we've received, and the help we get through their support staff at United. 

We love our doctors. We use network doctors, but all (so far) have been excellent. This includes our primary care doctors (internists), dermatologist, opthamologist, etc. 

Our monthly premium for the HMO is zero. 

My DH is diabetic, and this condition requires a lot of supervision and care, testing, etc. I can only imagine how much money the HMO has saved us - it is incalculable. Medications are also covered; he takes 5 medications, and right now he is on generics, which are free. He does pay for test strips - that's all. Quarterly blood tests are free. 

We travel to visit grandchildren, and have occasionally needed to see a doctor. Those costs have been covered, with a co-pay of $35 plus some co-pays on medication - all quite reasonable. We haven't been hospitalized while traveling, though.

I feel quite comfortable using an HMO, as long as it's run by a recognized health insurance company - such as Aetna (which we used to use), or United Health Care, or Humana, etc.

---

You are extremely fortunate to have such a wonderful Advantage Plan available  to you.  I live in PA, and we have no such program available for free or at any cost.

Most of out insurance companies here no longer offer Advantage Plans and the ones that do have discontinued the " good" ones.

My sister pays $90 a month for her Advantage Plan.  There is a $35 copay for her PCP and $50 copay for specialists, if in network.  She has a $500 deductible for out of network providers. If she goes to the hospital, she must pay $200 a day for the first 6 days.

The RX copays are pretty high for genetic drugs as well as non generic drugs. She gets a an injection for Prolia...cost $250.

All of this " wonderful" coverage is provided to her by United Health Care.

i am just amazed at how different these plans are based on where you live.  Something is wrong with this picture. 

The free plans as well as all Advantage Plans are funded by your Medicare Part B payment of  $135.50 for most people.

How can any insurance company provide such comprehensive benefits on $135.50 a month?

This is wonderful for people who have these plans, but I am surprised there is not an outcry that only certain people can have this almost free insurance.  

Sooner or later, the bottom is going to drop out somewhere.

[nomless]

---

@deepwaterdotter wrote:

@conlt  I think Part F has been replaced by Part G.  I agree that this is the best option if available.

---

Wrong. Yes, there is a Plan G, and there is a Plan F. Plan  F is being phased out. Plan G will continue. But G is not replacing F.....it just will continue to exist, whereas Plan F will not.

It is also wrong to say that Plan G is the best option. The best option is defined by each person's needs and budget.

Those who need Medicare info are best served by talking to a certified Medicare advisor, rather than to posters on a shopping forum. Incorrect info has been and will continue to  be posted.

[Cats3000]

I have said this over and over again.  THIS iisn't the place to get the kind of help you need.  Everyone has different needs and different financial situation. I also DO NOT RECOMMEND that you go to a sales pitch meeting or to someone who has "skin in the game"

Every state has "SHIP COUNSELORS".  These are people who are specially trained to offer help with Medicare and the various options and plans.  They DO NOT SELL ANYTHING.  They talk to you, get some background on you and your needs and help you find the best plan.

If you haven't already done that, you really should before you sign anything.

You can do a search on "Ship Counselors" and find the closest one to where you live.

[Carmie]

@Cats3000    I agree that SHIP counselors are wonderful and helpful.  I have worked beside them for many years in my state and have helped them field questions at booths at the mall and hotels and other places set up for them to meet people in person.

They are volunteers and have no stake in the game. In some states they are not called SHIP, they are called APPRISE in PA.  You can find your state's info at payingforseniorcare.com

I can answer questions about supplements and Medicare, but can only give generic info about Advantage Plans and explain how they work.  You would need someone locally who is able to view the specific plans available in your area.

Oops, I forgot to add that SHIP cannot tell you what type of insurance to buy or what is best for your situation.  They can just explain the benefits and prices of plans you are interested in.

They have pamphlets and brochures, but you have to figure out what is best for yourself. They cannot help you choose.

You need a health insurance license to promote any plans or give any type of advisement on what will work best for anyone and their situations.

[Helen852]

@Carmie   Thanks for you insight on this topic.  It is very difficult to navigate. Luckily when I became eligible, the company I retired from offers a service through a company to help navigate. I was able to compare supplements and advantage plans.( I'm in New York State.)  Problem I ran into was that many of my doctors would not accept the Plan that I was interested in,and let me tell you there were at least 8 of them.  I ended up with an advantage plan that all but my prior PCP accepts.   I didn't want to make the same mistake my mother made 20 years earlier and not choose one without scripts or Part D.  My mother has a supplement but never signed up for Part D, needless to say, the penalty is extremely steep.  We go through Good RX for the scripts she needs.  

In addition to what is deducted from my SS check my premium is $73, which is reimbursed through my former company.  I have co pays and co insurances, but I couldn't find a plan that didn't have a $0 premium that my doctors would accept.  

I recently had cataract surgery. So I upgraded my lenses to HD so those were $350 each; and my co pay or deductible for the surgery is $300 per eye.  Granted I could have gotten the lenses that Medicare would pay for, but then I'd still need glasses.  But yet I know other people who didn't pay anything for their surgery.  Oh well .... I have 20/20 vision now and only need glasses for reading!