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Message 21 of 26

@somarco wrote:

 

 

If you can't afford a Medigap plan you can't afford to get sick when you have an Advantage plan.

 


Love it - Is that an original ?  The perfect UNDERinsured statement.

Copyright it ! 

I wish I could give you more than just one Kudo !

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Message 22 of 26

@billdz 

 

Your questions:

1) Why might Medigap be a better option in the future "when you might be using more health care dollars"?

 

Original Medicare + a Medicap plan limits ALL your covered cost by whichever plan design you choose.

 

If you choose Plan F, there is actually NO medical out of pocket cost for the beneficiary.  You can go to any doctor that accepts Medicare assignment even without a referral.  As long as the medical procedure is medically necessary and is covered by Medicare, then Medicare will pay their 80% of the Medicare negotiated rate and Plan F will cover the other 20%.  NO, OOP for the beneficiary.

 

If you choose Plan G - the only coverage difference between Plan G and Plan F is that you have to pick up the Part B deductible (for 2020 - that is $ 198) - that's it.  However, there may be some substantial premium savings between Plan F and Plan G, insurer to insurer specific..

 

There is also a Plan F HIGH DEDUCTIBLE PLAN - it is on the list - look it up from the previous link provided.  It will continue to be offered.  It gives good value to the covered Medicare services and your out of pocket is limited to a specific amount.  Premiums should reflect differences in coverage.

 

Any insurer that offers a Medigap plan in your state has to cover the defined GAP benefits as indicated in the various plans.  The plans are set by FED stature, the premiums can change from insurer to insurer even for the same plan.. 

 

Premiums are set in (3) different ways -  the way premiums are rated by insurers can make a difference down the road because they might consider age (or not) as well as medical inflation when setting premiums.  The rating method can affect you - now or later.

Medicare.gov - Cost of Medigap Policies 

 

 

2) Why do you suggest Plan G? Seems to be the same as F except that it does not cover the Part B deductible.

https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies 

"Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans."

 

Down the road, Plan F premiums may begin to rise because of the health of the people still in the plan - they will be older and getting older with no younger and healthier beneficiaries coming in to balance out the healthcare cost of everybody in the plan.  That is conjecture on my part - but it happened to my Mom when her (another letter) plan was discontinued years ago.

 

Helpful hints:

  • Read the Medicare.gov site on Medigap and Medicare Advantage plans.  They are different - but the same - A MA plans has to cover everything that Medicare covers but in a different way.  A MA plan can offer additional benefits on an annual contract basis that Medicare can't offer.  Like vision, dental and perhaps dental, other ones that may be more helpful to some beneficiaries at a specific time or health condition than others.  MA insurers can add or subtract from these extra benefits on an annual basis - it takes a change in law/rule at the Fed level to add, subtract or change benefits in Original Medicare.
  • Deal with a local INDEPENDENT Medicare insurance agent that writes for multiple insurers - not just one.
  • You might also see if your state's Dept of Insurance has a good state reference on Medigap insurance - some states do an excellent job in providing this information and keeping it up to date.  The reason being that although Medicare (Fed. gov) sets the plans and the coverage, it is your state that regulates insurers and thus they make other special rules dealing with eligibility and pricing guidelines for Medigap plans.

MA is network oriented; Medicare is "accepts assignment" oriented.  MA is therefore more locally oriented.   Medicare is nationwide, for (complete) coverage the provider just has to accept assignment - they can be located anywhere.

 

I am no expert - just a senior that has helped others with the decision by giving them some details.

I try to stay up on the ins and outs of Medicare.  The decision is ultimately up to you as is the case of picking any insurance.

 

There are others here that hopefully will give you some other general incite because they work in the field.

 

If you come up with a graphic comparison of Medicare +/- Medigap + PDP vs MA with ot without an included PDP - let me know.

 

Medicare isn't just an insurance coverage plan; It is a Science.

 

 

 

 

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Message 23 of 26

@billdz access to health care is generally more important than just dollars and sense.

 

I can't recall anyone facing a life changing condition asking for the cheapest doctor who can treat me. It certainly doesn't work that way in the movies . . . . or in real life.

 

Advantage plans have a lower premium, often $0, but they come with a price.

 

Deductibles, copay's, networks, high OOP limits ($6700 for many plans), and those caps only apply to IN NETORK APPROVED health care charges. Rx is on top of your health care $$$

 

This message brought to you by the letters HMO and PPO.

 

And yes, you generally will not be able to qualify for a Medigap plan once your health goes south. It's like jumping out of an airplane and then discovering your parachute doesn't work.

 

Most folks love their Advantage plans until they use them.

 

If you can't afford a Medigap plan you can't afford to get sick when you have an Advantage plan.

 

Choose wisely.


Bark less. Wag more.
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Message 24 of 26

Gail,

 

Thanks much for the reply. Couple of follow up questions:

 

1) Why might Medigap be a better option in the future "when you might be using more health care dollars"? 

2) Why do you suggest Plan G? Seems to be the same as F except that it does not cover the Part B deductible.

 

I am aware that if I do not go with Medigap now I might not be able to get it later, which is certainly a factor.

 

Some folks are saying that Medigap is better because, in the event of a serious disease, it gets me into the Mayo Clinic, M.D. Anderson, and other "famous" institutions while MA would not. If so, that would be a factor, although I'm not sure it is worth it to pay $315 a month just in case I might want to go to a famous place sometime in the future. 

 

I've seen dozens of comparison pages where you can select and compare various MA plans, but I've never seen one that allows comparison of MA vs. Medigap + drug.

 

Thanks again,

Bill

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Message 25 of 26

@billdz 

 

You aren't really missing anything EXCEPT maybe being able to look into the future and seeing what your health might look like then - when you might be using more health care dollars.

 

Wonder why your broker recommended Plan F Medigap (personallt I don't think Plan F is a good choice now - it is no longer available to new enrollees after 01/01/2020; so only the older/sicker might continue with the plan in the future.  Check out Plan G or some of the other ones.

Medicare.gov - Medigap Plan comparison 

 

Things people have to consider when enrolling in Medicare and making their choice - there are pluses and minuses on both sides - you, your pocketbook, your health, possibly the state where you live Medigap rules - as long as you continue to live there - all of these things and more influence your decision.

 

  • their financial situation (now and into the planned future) to pay MA out of pocket cost OR to pay the monthly Medigap premium
  • their health and how much they they will use the (whichever) choice - (now and into the planned future)
  • based on federal and your state rules, you may not be able to get a Medigap down the road or it could be a whole lot more expensive.   IMO, this may be the biggest.
  • there is NO top limit to your out of pocket cost in original Medicare - not annual, not lifetime.
  • With a MA plan, you can switch every year as need or desire warrants.

If you sign up for original Medicare + Medigap + drug plan, you can always switch to a MA plan - it is the switch back to Original Medicare that has the gotcha' because of the Medigap rules of when you have guaranteed issue rights.

Medicare.gov - Guaranteed Issue Rights (also called Medigap Protection) 

 

Would you pick Original Medicare WITHOUT a Medigap? 

Some people have to do it - There may be NO MA plan available in their area.

 

 

 

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Medigap Plan F vs. Medicare Advantage

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Message 26 of 26

Hello,

 

I'm enrolling in Medicare for 2020, and I'm generally familiar with the differences between original Medicare + Medigap + drug plan and Medicare Advantage. My insurance broker and others are strongly recommending original with Medigap Plan F.

 

Maybe it's just because I'm frugal but I'm having a hard time understanding why this route is better. Plan F plus a drug plan would cost me $315 a month, with no dental or vision benfits. There are MA plans that cost $0 and include drugs, dental, and vision. I understand that MA plans are less flexible and you have to stay in network, but I have no particular "must have" doctors.

 

So it seems that I would get a lot more and pay a lot less with MA. What am I missing?

 

Thanks,

Bill 

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