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Periodic Contributor

All Plan G Medigap insurance plans the same? How to know if our Drs will accept the plan?

My husband and I are both signing up for Medicare in June (I will turn 65 and he plans to drop his employer coverage and go total Medicare in June, too). We have decided on Plan G (no Medicare Advantage). My questions are: 1. If all plan G insurance plans cover the same things why the difference in price? 2. How do we know if our Drs will accept the plan we choose? I called and all they could tell me is that they do accept medicare... NOTHING about which plans they accept. Do they accept all if they are not in an HMO or PPO? 3.  Does anyone use CSI (Central States Indemnity)? We have a friend who has had hip surgery, back surgery, stroke with nursing home rehabilitation for a couple of months, endarterectomy, and her insurance paid EVERY PENNY with CSI. 4. Is anyone happy with UHC or Mutual of Omaha? We can't afford to make a mistake!!  HELP! lol

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Periodic Contributor

Thanks so much for the responses! We are happy (I think?) with our choices. We took traditional medicare with a G plan from Mutual of Omaha. We had our first claim and after some difficulty making the people at Medicare understand that we no longer have primary insurance at my husband's work, they are paying.

 

Another quick question... (remember there are NO silly questions!) How do we pay the 198.00 deductible? Is it taken from our SS checks as our Medicare payment is, or will individual practitioners bill us? This is our first claim and we are trying to learn to navigate this crazy system! 

 

Thank you in advance! (I'm sure you will laugh because I'm sure the answer is so obvious to you who have been there but I have "googled" and I'm at a loss)!

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Bronze Conversationalist

@VivianR375175 

How do we pay the 198.00 deductible? Is it taken from our SS checks as our Medicare payment is, or will individual practitioners bill us? This is our first claim and we are trying to learn to navigate this crazy system! 

 

You pay your deductible AFTER the claim has been adjudicated by Medicare. Refer to your MSN for your responsibility.

 

Your provider will bill you AFTER the claim has been adjudicated.

 

This is a deductible, not a premium, it is NOT deducted from your SSA benefit.

 

The system is not crazy, it is actually quite simple. The biggest adjustment is getting used to paying AFTER you get a bill. Under no circumstances should you EVER pay at point of service.

 

 


Bark less. Wag more.
Periodic Contributor

Thank you!!

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Newbie

When you go to the Dr. or hospital and are billed,  Medicare will not pay the first 198.00. If your 1st Dr. visit (once on medicare) is say $150.00, You pay the whole $150.00 which is applied towards your $198.00 deductible. The next Dr. viisit you have, charges say $110.00, you pay $48.00  and Medicare and plan G pick up $62.00 meaning you have met the $198.00. 

Your Dr. visits from then on are paid by Medicare and your plan G. You start the process over again every January 1st. So no, the $198.00 is not taken out of your ss check. But the monthly Part B premium that we ALL pay, will be taken out of your SS check automatically. Hope this helps.            

Contributor

Hello,

 

I cound not help but repy to your post.  I sell Medicare Supplements and Medicare Advantage in the state of Iowa but just wanted to put in my 2 cents.  Your asking great questions.  Supplements are nice in that any doctor who accepts Medicare will accept your plan independent of the Insurance carrier.  Only Medicare Advantage makes you purchase through a network. Be sure to shop all the plan N Plans.  By law letter plans have to offer the same services, they only differ in the price you pay. Second, in your initial enrollment, which you should be in because you are new to Medicare, they can only rate on age not pre-existing medical condition. Lastly in my community there are allot of good agents, absolutely no reason to purchase over the phone, I would find a local agent.  Most of us pride ourselves on helping and are happy to answer any questions. Just make sure they can shop all the different carriers so they can get you the best rates.  You pay the same whether you buy through and agent or not.  I hope that helps.  You can reach back out if you have any questions.  Thanks. Jon

Jon Kelderman
Honored Social Butterfly


@jonk9464 wrote:

Hello,

 

 Second, in your initial enrollment, which you should be in because you are new to Medicare, they can only rate on age not pre-existing medical condition.

 

Lastly in my community there are allot of good agents, absolutely no reason to purchase over the phone, I would find a local agent.  Most of us pride ourselves on helping and are happy to answer any questions. Just make sure they can shop all the different carriers so they can get you the best rates.  You pay the same whether you buy through and agent or not.  I hope that helps.  You can reach back out if you have any questions.  Thanks. Jon


I agree with you wholeheartedly about finding a good, knowledgeable local agent to help a new Medicare beneficiary tread the muddled Medicare waters.

 

However, rating, initial or otherwise, aren't always based on the age the beneficiary is at the time of sign up -

Costs of Medigap policies

Each insurance company decides how it will set the price, or Premium, for its Medigap policies. It’s important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future.

Medigap policies can be priced or "rated" in 3 ways:

It's Always Something . . . . Roseanna Roseannadanna
Bronze Conversationalist

@VivianR375175 you ask a lot of questions. Good for you. Too often folks turning 65 fail to conduct due diligence.

 

Any provider that accepts Medicare will also take ANY Medicare supplement (Medigap) plan. Asking a provider or their staff if they take a specific Medigap plan or carrier is a waste of time. Most of the office staff will tell you we take carriers A and B but not X, Y or Z.

 

Those type of answers indicate they are referring to an Advantage plan, not Medigap.

 

Providers don't file with the supplement carrier. They file with Medicare. Claim is reviewed and adjudicated by Medicare. Once approved, Medicare pays their part then transmits the final disposition to the Medigap carrier via crossover.

 

Medigap carrier receives an adjudicated claim that explicitly states what Medicare approved and what they paid. The supplement carrier then pays their part.

 

If the provider takes assignment claim payments by Medicare and the supplement carrier go direct to the provider.

 

A seamless operation with no glitches once the claim leaves Medicare. All Medigap carriers pay claims in 3 to 5 business days.

 

Price differences in the G plan reflect what the carrier believes the market will bear. In Georgia an age 65 female will see rates ranging from $114 to $244. All benefits are identical.

 

If your friend had an F plan it is supposed to pay all deductibles and coinsurance after Medicare pays their part. If a G plan, it pays everything EXCEPT the Part B deductible.

 

There is nothing exceptional about CSI. The claim would be handled in the exact same fashion had the issuing carrier been BX, Aetna, Humana or New Era.

 

You should look for a carrier that has offered plans in your state for at least 5 years, preferably 10 years or longer.

 

All of the carriers you mentioned with exception of UHC and possibly Bankers Fidelity have most likely written business in your state for less than 5 years.

 


Bark less. Wag more.
Honored Social Butterfly

@VivianR375175 wrote:

 My questions are:

1. If all plan G insurance plans cover the same things why the difference in price?

 

2. How do we know if our Drs will accept the plan we choose? I called and all they could tell me is that they do accept medicare... NOTHING about which plans they accept. Do they accept all if they are not in an HMO or PPO?

 

3.  Does anyone use CSI (Central States Indemnity)? We have a friend who has had hip surgery, back surgery, stroke with nursing home rehabilitation for a couple of months, endarterectomy, and her insurance paid EVERY PENNY with CSI.

 

4. Is anyone happy with UHC or Mutual of Omaha? We can't afford to make a mistake!!  HELP! lol


1. If all plan G insurance plans cover the same things why the difference in price?

Medicare Medigap coverage is just what it says - it is GAP insurance.

It picks up some or all of your out of pocket cost.

Medicare.gov - What's Medicare Supplement Insurance (MEDIGAP) 

 

Yes, Medigap plans are standardized in their contractual coverage

Medicare.gov - How To Compare Medigap Policies 

 

Pricing varies by the insurer, the state in which you reside and how the specific Medigap policy is rated in your state.  Since medical care is locally provided, it is affected by medical inflation in the area and other cost differences.  It is higher in areas that have little medical competition among providers.  It also varies by the health and age of the plan participants to a certain degree.

Medicare.gov - Medigap costs 

Rating Methods:

Medicare.gov - Cost of Medigap Policies 

 

2. How do we know if our Drs will accept the plan we choose? I called and all they could tell me is that they do accept medicare... NOTHING about which plans they accept. Do they accept all if they are not in an HMO or PPO?

 

Medicare MEDIGAP policies are completely different than Medicare Advantage plans.  Don't confuse them.  A Medigap plan is TRADITIONAL Medicare GAP insurance.  Now why do some people pick one over - see my comments at the end of this reply. *

 

A Medicare Advantage plan is a private insurance policy of different types (HMO, PPO, etc.) that takes the place of Traditional Medicare.  They give the same benefits of traditional Medicare but in a different way; they sometimes also offer additional benefits which traditional Medicare does not offer.  A Medicare Advantage plan works with contracted networks of providers and you get your best cost by staying inside this network of providers.

 

A Medigap plan works with the providers that have signed up to accept traditional Medicare rates.

You can find out if a specific provider is under this umbrella by checking out the

Medicare.gov Physician Compare.

 

Double check with the physician and ask them if they accept traditional Medicare assignment.  Most do, but some don't -  This page explains the difference.  If you are picking a new doctor and they do accept traditional Medicare - ask them if they are accepting NEW (traditional) Medicare patients.  Some may limit their number of Medicare patients so they don't take any new ones from time to time..

Medicare.gov - Your Medicare Costs 

 

In most instances with assignment, when you sign up for Medicare Part A & B and pick a Medigap plan, the doctor will make note of both your Medicare number and your Medigap Plan.  Medicare will also have the gap insurance noted on your file and the doctor will file once with Medicare and the claim will be process by Medicare and then sent on to your Gap provider and they will process their part.  You will get (2) EOB - one from Medicare and one from your gap provider but the doc only has to file once with Medicare.

 

3.  Does anyone use CSI (Central States Indemnity)? We have a friend who has had hip surgery, back surgery, stroke with nursing home rehabilitation for a couple of months, endarterectomy, and her insurance paid EVERY PENNY with CSI.

 

4. Is anyone happy with UHC or Mutual of Omaha? We can't afford to make a mistake!!  HELP! lol

 

Every Medigap plan has the same defined benefits - you will not get one that pays 100% anymore (can't buy Plan F or C anymore) but Plan G is the closest - look at the chart

Medicare.gov - How to compare Medigap policies 

 

Look to a Medicare insurance broker in your area - they can help you with specific companies -

======================

 

* Picking a Medicare plan - Medicare Advantage OR Traditional Medicare with a Medigap plan:

Pluses and minuses to both - pick the best based on your own (individual - not couple) situation.

 

EVERYBODY pays the Part B premium regardless of type of Medicare plan coverage.

 

The main difference in the Medicare plans are:

you can either pay in premiums each month - escalating as time goes by (Medigap with traditional Medicare)

OR

you pay it in co-pays / co-insurance as you need to use a Medicare Advantage plan

 

This list is by no means complete:

 

Medicare Advantage:

POSITIVES

low to NO premiums

can change policies every year based on your health needs

sometimes provides extra benefits which traditional Medicare does not cover

has an annual out of pocket limit

 

NEGATIVES

network of providers - so if you are out of the area, it causes a problem

has copays and coinsurance -

 

Traditional Medicare with a Medigap plan

POSITIVES

Depending upon the Medigap plan picked - no to stated limited out of pocket

can see physicians out of your area as long as they accept assignment

 

NEGATIVES

premiums will escalate over time depending on Medical inflation, rating method of the insurer and pool of participants

sometimes it is hard to change Medigap plans - depends on state rules, underwriting of any health condition, or even denial

traditional Medicare has no limit to annual out of pocket - thus the reason why some sort of Medigap is a good idea - but watch the premiums and the potential escalation of premiums depending upon the Medigap plan.

==================

 

I posted this to you in another thread:  IMO, this is where many people make a mistake - they pick the absolute BEST Medigap plan which limits just about all of their out of pocket with little consideration as to how premium increases will affect their ability to pay for them in the future.

 

Your state law defines how easy, how hard or even if you can change Medigap plans is also something to consider if premiums begin to escalate too much.

 

If you are worried about how premiums might increase down the road like when you are 80 instead of 65 - consider the Plan F or Plan G High Deductible Medigap plan.

 

The Plan F  and G - High Deductible plans -  are available.  Compare the coverage and the current premium of these plans to the others because in the long run (over your lifetime) if you can afford the $ 2340 per year deductible which these Medigap plans have and most likely not all at the same time - they are good values. 

Medicare.gov - How to Compare Medigap Coverage 

 

 

It's Always Something . . . . Roseanna Roseannadanna
Honored Social Butterfly


@GailL1 wrote:
@VivianR375175 wrote:

 My questions are:

1. If all plan G insurance plans cover the same things why the difference in price?

 

2. How do we know if our Drs will accept the plan we choose? I called and all they could tell me is that they do accept medicare... NOTHING about which plans they accept. Do they accept all if they are not in an HMO or PPO?

 

3.  Does anyone use CSI (Central States Indemnity)? We have a friend who has had hip surgery, back surgery, stroke with nursing home rehabilitation for a couple of months, endarterectomy, and her insurance paid EVERY PENNY with CSI.

 

4. Is anyone happy with UHC or Mutual of Omaha? We can't afford to make a mistake!!  HELP! lol


1. If all plan G insurance plans cover the same things why the difference in price?

Medicare Medigap coverage is just what it says - it is GAP insurance.

It picks up some or all of your out of pocket cost.

Medicare.gov - What's Medicare Supplement Insurance (MEDIGAP) 

 

Yes, Medigap plans are standardized in their contractual coverage

Medicare.gov - How To Compare Medigap Policies 

 

Pricing varies by the insurer, the state in which you reside and how the specific Medigap policy is rated in your state.  Since medical care is locally provided, it is affected by medical inflation in the area and other cost differences.  It is higher in areas that have little medical competition among providers.  It also varies by the health and age of the plan participants to a certain degree.

Medicare.gov - Medigap costs 

Rating Methods:

Medicare.gov - Cost of Medigap Policies 

 

2. How do we know if our Drs will accept the plan we choose? I called and all they could tell me is that they do accept medicare... NOTHING about which plans they accept. Do they accept all if they are not in an HMO or PPO?

 

Medicare MEDIGAP policies are completely different than Medicare Advantage plans.  Don't confuse them.  A Medigap plan is TRADITIONAL Medicare GAP insurance.  Now why do some people pick one over - see my comments at the end of this reply. *

 

A Medicare Advantage plan is a private insurance policy of different types (HMO, PPO, etc.) that takes the place of Traditional Medicare.  They give the same benefits of traditional Medicare but in a different way; they sometimes also offer additional benefits which traditional Medicare does not offer.  A Medicare Advantage plan works with contracted networks of providers and you get your best cost by staying inside this network of providers.

 

A Medigap plan works with the providers that have signed up to accept traditional Medicare rates.

You can find out if a specific provider is under this umbrella by checking out the

Medicare.gov Physician Compare.

 

Double check with the physician and ask them if they accept traditional Medicare assignment.  Most do, but some don't -  This page explains the difference.  If you are picking a new doctor and they do accept traditional Medicare - ask them if they are accepting NEW (traditional) Medicare patients.  Some may limit their number of Medicare patients so they don't take any new ones from time to time..

Medicare.gov - Your Medicare Costs 

 

In most instances with assignment, when you sign up for Medicare Part A & B and pick a Medigap plan, the doctor will make note of both your Medicare number and your Medigap Plan.  Medicare will also have the gap insurance noted on your file and the doctor will file once with Medicare and the claim will be process by Medicare and then sent on to your Gap provider and they will process their part.  You will get (2) EOB - one from Medicare and one from your gap provider but the doc only has to file once with Medicare.

 

3.  Does anyone use CSI (Central States Indemnity)? We have a friend who has had hip surgery, back surgery, stroke with nursing home rehabilitation for a couple of months, endarterectomy, and her insurance paid EVERY PENNY with CSI.

 

4. Is anyone happy with UHC or Mutual of Omaha? We can't afford to make a mistake!!  HELP! lol

 

Every Medigap plan has the same defined benefits - you will not get one that pays 100% anymore (can't buy Plan F or C anymore) but Plan G is the closest - look at the chart

Medicare.gov - How to compare Medigap policies 

 

Look to a Medicare insurance broker in your area - they can help you with specific companies -

======================

 

* Picking a Medicare plan - Medicare Advantage OR Traditional Medicare with a Medigap plan:

Pluses and minuses to both - pick the best based on your own (individual - not couple) situation.

 

EVERYBODY pays the Part B premium regardless of type of Medicare plan coverage.

 

The main difference in the Medicare plans are:

you can either pay in premiums each month - escalating as time goes by (Medigap with traditional Medicare)

OR

you pay it in co-pays / co-insurance as you need to use a Medicare Advantage plan

 

This list is by no means complete:

 

Medicare Advantage:

POSITIVES

low to NO premiums

can change policies every year based on your health needs

sometimes provides extra benefits which traditional Medicare does not cover

has an annual out of pocket limit

 

NEGATIVES

network of providers - so if you are out of the area, it causes a problem

has copays and coinsurance -

 

Traditional Medicare with a Medigap plan

POSITIVES

Depending upon the Medigap plan picked - no to stated limited out of pocket

can see physicians out of your area as long as they accept assignment

 

NEGATIVES

premiums will escalate over time depending on Medical inflation, rating method of the insurer and pool of participants

sometimes it is hard to change Medigap plans - depends on state rules, underwriting of any health condition, or even denial

traditional Medicare has no limit to annual out of pocket - thus the reason why some sort of Medigap is a good idea - but watch the premiums and the potential escalation of premiums depending upon the Medigap plan.

==================

 

I posted this to you in another thread:  IMO, this is where many people make a mistake - they pick the absolute BEST Medigap plan which limits just about all of their out of pocket with little consideration as to how premium increases will affect their ability to pay for them in the future.

 

Your state law defines how easy, how hard or even if you can change Medigap plans is also something to consider if premiums begin to escalate too much.

 

If you are worried about how premiums might increase down the road like when you are 80 instead of 65 - consider the Plan F or Plan G High Deductible Medigap plan.

 

The Plan F  and G - High Deductible plans -  are available.  Compare the coverage and the current premium of these plans to the others because in the long run (over your lifetime) if you can afford the $ 2340 per year deductible which these Medigap plans have and most likely not all at the same time - they are good values. 

Medicare.gov - How to Compare Medigap Coverage 

 

 


Apparently "Viv" is all set..........but thanks once again for your thoughtfulness & thoroughness :} 

 

 

 

( " China if You're Listening - Get Trumps Tax Returns " )

" )
" - Anonymous

Periodic Contributor

No one? We have narrowed down to 3: CSI, Mutual of Omaha, or Transamerica... maybe 4 Banker's Fidelity? Does anyone have either exception service from or terrible service from any of these companies? How do they pay? Can you see the Drs you choose? All the important factors for us. Thanks in advance!
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