Medicare - Who here is on it?

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musical comedy
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Medicare - Who here is on it?

Postby musical comedy » Tue Jun 06, 2017 1:01 pm

I'm just wondering if anyone here has a Medigap policy.

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Re: Medicare - Who here is on it?

Postby Srhorselady » Tue Jun 06, 2017 7:32 pm

Yep! I'm fairly happy with it. The important thing to remember is that, by law, every plan A F G etc is the same as every other plan A F G no matter what insurance company sells it and no matter the price. So pick the plan you want (F and G are the most comprehensive if I remember correctly) and then find the cheapest insurance company you are comfortable with. Quality of the Insurance Company is important in terms of customer service etc. Prices are set by the individual insurance companies usually based on zip code and gender. Oh if you plan on moving etc make sure what ever insurance company can service you in other states etc. Good luck.

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Re: Medicare - Who here is on it?

Postby Srhorselady » Tue Jun 06, 2017 7:33 pm

Forgot to mention you also have to buy a separate prescription (part D) plan from another company also.

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Re: Medicare - Who here is on it?

Postby musical comedy » Tue Jun 06, 2017 7:49 pm

Here's my problem/question.

The company I retired from gives me $2700/year to use for Medical/Dental. The catch is that I have to buy at least one thing through the company that handles this, which is AON Hewitt.

I bought a Medigap Plan G through them. It's probably $20 a month more than if I were to have bought it on the open market.

Now...here's the thing that I wonder about. This year I am dealing with medical issues. I have really racked up lot of dollars on doctors and tests. A LOT!! As you know, Medicare really cheats the doctors. They only pay a portion of what the doctor charges and then only 80% of that. The other 20% either is paid by the patient or goes to the Medigap if you have it.

This year so far, Medigap has picked up $688 for me. That included a lot of expensive tests (MRI, CT Scan, etc.) plus lots of doctor visits and lab work. Even if I were to continue to spend like that for the rest of the year, it still would be less than what I'm paying for Medigap premium which is $190/month.

So...when would it be advantageous to have a Medigap?

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Re: Medicare - Who here is on it?

Postby kande50 » Tue Jun 06, 2017 10:04 pm

musical comedy wrote:So...when would it be advantageous to have a Medigap?


I don't know, but was under the impression that unless we want to pick up the extra charges ourselves then we need a medigap policy?

I got one of the Blue Cross ones because I don't really want to have to pick up any of my medical bills, which was at least partly because I can find enough excuses to avoid doctor visits without having to pay every time I go.

For all I know, it might be more economical to pay more out of pocket, but I haven't really looked into it. I'm thinking that if the costs to me were only going to be what medicare wouldn't pay for tests then it might not be that much, but if I needed surgeries or extensive hospitalizations it could be a lot more?

I did however, decide to gamble and go without prescription and dental coverage, but that's because I'm willing to take generic drugs and have no plans to have extensive dental work done.

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Re: Medicare - Who here is on it?

Postby Srhorselady » Tue Jun 06, 2017 11:32 pm

I have a Plan F and it covers everything not covered by Medicare. That includes copays, the 20%, plus anything Medicare doesn't cover. I don't currently have a lot of medical bills and what I am paying for my gap insurance IS probably more than it is paying currently. However, my father died last year and I was his executor. I am very thankful he had a gap policy. You wouldn't dream how many things are not covered my Medicare when you are in the hospital. Some doctors don't take Medicare and the gap policy covers them. Also they qualify some procedures as "out patient" and Medicare didn't cover all of them. It would have been very difficult without the secondary insurance. Itwas difficult dealing with all of them and making sure the various medical billing entities billed everyone correctly. Also your gap policy is fairly expensive. Mine went up about $25 this year but it is still about $50 less than yours.

BTW on the part D prescription plans. I pay cash and do not use my Rx insurance plan for ALL my prescriptions except one. That one prescription will put me in the donut hole which means I could (with insurance it is $45 a month cash over $300) have to pay 45% of the total cost of the drug by the end of the year. That is a government thing not the insurance company. Luckily all my other Rx's are relatively cheap. As you get older if you have chronic diseases you end up with more Rx's. I am diabetic, but not yet on insulin. Metformin is cheap but not the next level oral drugs. So if you develop a chronic disease think about part D.

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Re: Medicare - Who here is on it?

Postby musical comedy » Wed Jun 07, 2017 12:17 am

Srhorselady wrote:I have a Plan F and it covers everything not covered by Medicare. That includes copays, the 20%, plus anything Medicare doesn't cover. I don't currently have a lot of medical bills and what I am paying for my gap insurance IS probably more than it is paying currently. However, my father died last year and I was his executor. I am very thankful he had a gap policy. You wouldn't dream how many things are not covered my Medicare when you are in the hospital. Some doctors don't take Medicare and the gap policy covers them. Also they qualify some procedures as "out patient" and Medicare didn't cover all of them. It would have been very difficult without the secondary insurance. Itwas difficult dealing with all of them and making sure the various medical billing entities billed everyone correctly. Also your gap policy is fairly expensive. Mine went up about $25 this year but it is still about $50 less than yours. I am going to disagree with you here. I think you are wrong. Plan G is the same as Plan F except Plan F pays the deductible (which is just a couple hundred dollars). None of the medicap policies pay for things that are no medicare approved. I wish you were right, but I am pretty darn sure you aren't. Medigap only pays for services that Medicare pays for, so just the 20% that Medicare doesn't cover. This could be a lot I guess if someone has a big operation or ends up with a long hospital stay. What attracted me to it was the benefit for Skilled Care. If you exceed Medicare for skilled care, the cost per day is extreme. If you think you are correct that Medigap covers things that Medicare doesn't, could you show me some evidence of that? I'm not a all challenging you, but I want to know this because I was told otherwise.

Yes, as I said, I know my charges are higher because the administrator of my company's plan is getting a kick back. Also, aren't I older than you? Each year older the price goes up, so expect another $25 hike next year.


BTW on the part D prescription plans. I pay cash and do not use my Rx insurance plan for ALL my prescriptions except one. That one prescription will put me in the donut hole which means I could (with insurance it is $45 a month cash over $300) have to pay 45% of the total cost of the drug by the end of the year. That is a government thing not the insurance company. Luckily all my other Rx's are relatively cheap. As you get older if you have chronic diseases you end up with more Rx's. I am diabetic, but not yet on insulin. Metformin is cheap but not the next level oral drugs. So if you develop a chronic disease think about part D.
Forgive me here, but I drew a blank. I didn't understand what you wrote. I have the cheapest Part D you can get. It's just $18 a month for Humana. It has a $400 deductible which I never hit. DH is on Metforum, Insulin and recently Genuva. <sigh> Yet he still eats sugar.

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Re: Medicare - Who here is on it?

Postby musical comedy » Wed Jun 07, 2017 1:27 pm

To clarify what I wrote earlier. There are doctors that are Medicare Participating Doctors and Medicare Non-Participating Doctors. Participating Doctors "ACCEPT ASSIGNMENT". That means they accept the low amount that Medicare pays. The Non-Participating Doctors still accept Medicare (i.e. they submit claims) but they charge over what Medicare dictates. This extra amount will be picked up by Medigap. There are also doctors that just flat out have nothing to do with Medicare. Lots of doctors accept no health care provider. Mostly psychiatrists don't. Medigap won't pay for those doctors.

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Re: Medicare - Who here is on it?

Postby Srhorselady » Wed Jun 07, 2017 7:39 pm

Sorry I feel older than dirt sometimes so assume everyone is younger :) . It's been 3 years since I did my Medicare insurance research so I could be remembering wrong. I know that somehow Dad's bills were all covered, but his situation was a little odd since he had insurance coverage, but not Medicare part B, only Medicare A, so that may have been why his was covered.

On the Rx part D. I have Silverscripts which has no deductible (cost went up this year too $mid 20s now). I take Farziga which is Tier 3 and get a 90 day supply which is cheaper. When the total cost of all the drugs I buy through the insurance hits the government set limit approx $3000+, I end up in the "donut hole". The figure used for this donut hole calculation includes both what I pay for the drug (approximately $45/month) AND what the insurance pays so by using this one drug I can end up in or very close to the donut hole before the end of the calendar year. Being in the donut hole changes the calculation used on how much I have to pay for my Farziga so that instead of paying the set amount I have to pay a percentage of the total cost. So I try VERY hard to stay out of the donuthole by paying cash for my cheap drugs.

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Re: Medicare - Who here is on it?

Postby galopp » Fri Jun 09, 2017 12:06 am

I have plan F through Mutual of Omaha (its 170$, and picks up the 20% that isn't covered) and my part D is $12 a month (through Humana but applies to purchases through Walmart :-( ). Most everything has been paid except some chiro visits, and I had open heart quadruple bypass this spring (no high blood pressure or high cholesterol, just breathing problems) out of no where (after going up Manchu Picchu as well!!!)

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Re: Medicare - Who here is on it?

Postby musical comedy » Fri Jun 09, 2017 12:51 am

galopp wrote:I have plan F through Mutual of Omaha (its 170$, and picks up the 20% that isn't covered) and my part D is $12 a month (through Humana but applies to purchases through Walmart :-( ). Most everything has been paid except some chiro visits, and I had open heart quadruple bypass this spring (no high blood pressure or high cholesterol, just breathing problems) out of no where (after going up Manchu Picchu as well!!!)
Ooo Galopp, sorry to hear of your operation, but glad you are fine now. Mine is Mutual of Omaha as well for $190 but I'm a year to two older than you and then with that darn surcharge. My humana is something like $18 for the cheapest. Again, through that darn place I have to use.


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