Wellness

[goldensrbest]

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

[kaydee50]

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!!!

[meem120]

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. 

[Carmie]

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.

[Upnorth1]

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. 

[Mom2Dogs]

@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!

[wonderfulworld]

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. 

[Elbelle]

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!

[Carmie]

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.  

[geezerette]

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@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. 

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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.