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Medicare Advantage vs. Medigap policies aka Medicare Supplement plans

John Cummings

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>>N is not the same as F because it does not cover excess charges. <<

momeason,

>>Basically the same as F if your doctor accepts assignment<<

Isn't it true that if a doctor accepts assignment, he can't make excess charges?

Hardly anyone does a "what-if" analysis on these. If your doc charges 15% extra on three office visits a year, it's not a big deal, and you'll come out ahead with the cheaper plan. If your heart surgeon marks up your valve replacement 15%, it's another matter.

But, as with most insurance, without your crystal ball it's hard to tell what to buy!

I believe you are referring to "balance billing" which is not allowed if the doctor agrees to take the assignment. This happened to me a few years ago. I contacted my insurance company and they informed the doctor that it was not allowed.
 

WinniWoman

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Mary Ann,

I went to the AARP UHC Medicare Supplement page and used their pricing tool with zip 12566, and plan F was $209 and Plan N $143 using ages of 66 and 76. They don't offer plan G in New York.

But looking at Mutual of Omaha, F is $352 (68% more); G is $283; they don't offer N. So you see the price varies a lot from one company to another for the very same product.

It looks like ALL companies in New York have community-rated pricing (same for all ages). Can you tell us what company/companies you were looking at?

Unless you have frequent doctor visits, plan N is a good deal. Basically the same as F if your doctor accepts assignment, except they don't pay the annual deductible of $166, and there's a $20 copay for SOME doctor visits.

Get an independent agent to help you navigate this. The AARP plan is community-rated, meaning everyone pays the same regardless of age. Other (age-rated) plans will cost more as you get older. BUT THEY ALL HAVE THE SAME COVERAGE -- that is, Plan F has the same benefits regardless of what company sells it to you.

There is a good table for comparing all the plans here.

Good luck.

Thank you so much, Dave! I went on the Medicare.gov page and I must be doing something wrong or I am just not reading it the right way. I will have to look at the AARP page- I am not a member. When I have more time I will go on the sites and try again.
 
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WinniWoman

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Are you over 65?
If you are under 65, the rates are much higher.

Send me your zip codes, county and state and your ages and let me check for you.
I am not licensed in your state but I certainly know how to check rates.


LOL! Not yet. My husband is 62 and I am 59 but I am gathering information so that I understand everything for when my husband is ready. I am also trying to help an elderly friend.

I just must be doing something wrong when I go on the page (from the link). I thought I saw rates like $5000 per year! LOL! I will look at it again.
 

isisdave

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This is probably what is happening. When you go there, put in dates that make you at least 65.
 

momeason

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PS I heard the G plan is just as good as the F plan, but less expensive?

And- can't people just enroll on-line for these plans? Why would they need an agent at all?

There are a vast number of insurance carriers with large differences in price and financial stability and the different plan levels are confusing. I am licensed in 3 states. For example, in one state, Mutual of Omaha is a great deal, in the other two states not so much. A good independent agent can help you enroll in the plan that best meets your needs and budget. It does not cost you to get advice and shop. One of my new clients enrolled online at Medicare Mall 3 years ago. She is eligible for Extra Help, no one told her. She also was not told about needing a prescription plan. She has not had one for 3 years. Luckily since I discovered and helped her start the process for help, she will get a prescription plan and not pay the penalty. She also will get her part B premium and her Part D premium paid and low cost drugs. Visiting me, an individual agent, saved her over $200/mo.

There are bad agents but some of us offer much needed expertise. Not usually the online sales people though.
 
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momeason

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I believe you are referring to "balance billing" which is not allowed if the doctor agrees to take the assignment. This happened to me a few years ago. I contacted my insurance company and they informed the doctor that it was not allowed.

I am referring to allowed excess charges which are not rare at all and are becoming more common every day.
 

momeason

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Look, if you can't afford a supplement, just take basic Medicare after age 65. $104 pp a month, withdrawn from your SS. If you are reasonably healthy and don't take a lot of meds, you can save a lot of money. And no one forces you to live in a jurisdiction with expensive schools and high property taxes. Move to 'tax haven' New Hampshire.

High Deductible F is very reasonable and protects you from unlimited out of pocket expenses. I would never go without any out of pocket limits with just original Medicare.
 

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Medigap and RX

I have an AARP United Health Medigap F plan and an AARP UH RX plan. The RX plan is not going to cover four of my expensive drugs in 2016. I've spent hours on medicare.gov trying to compare drug plans but the site does not seem to recognize my Medigap plan. Am I to compare as if I have just Original Medicare and a drug plan? I've tried each method...just my zip or my personal information...both having my drugs listed. Each comes back with very different results. Yes, I've waited till the last minute. :)
 
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This is my article on Medicare. Technically, I am still a licensed Health Insurance agent, but since I am not appointed (changed career), I can only advise, not sell. The numbers between this article and current numbers may change. And yes, I can find you a local agent if you need.

Medicare

TS
 

Glynda

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Thread

This is my article on Medicare. Technically, I am still a licensed Health Insurance agent, but since I am not appointed (changed career), I can only advise, not sell. The numbers between this article and current numbers may change. And yes, I can find you a local agent if you need.

Medicare

TS

Good thread! Thanks. I'm going to get on the phone with Medicare again today. They sent me to AARP yesterday but that really wasn't what I needed either. I think I can word my questions better today. The search results are confusing me as I'm not sure each of the two methods is taking the same facts into consideration.
 
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AARP Medicare is United Healthcare, but an independent agent would be a better person to talk to. If you call them (AARP Medicare), you're talking to licensed insurance agents appointed ONLY with UHC.

In terms of Medicare Supplements, I used to be appointed with United American, their High-Deductible F (HDF) plan was HALF the cost of United Healthcare. With the HDF, you pay around $65/month (in addition to Part-B premium), pay the Part-B deductible then pay 20%, and/or Part-A copays. Once your out-of-pocket reaches the HDF's deductible, you pay $0. Would the AARP agent have that info? Yes and no, they have access to Medicare, but being a Captive Agent, they can not discuss it.

TS
 

Glynda

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Solved one problem!

AARP Medicare is United Healthcare, but an independent agent would be a better person to talk to. If you call them (AARP Medicare), you're talking to licensed insurance agents appointed ONLY with UHC.

In terms of Medicare Supplements, I used to be appointed with United American, their High-Deductible F (HDF) plan was HALF the cost of United Healthcare. With the HDF, you pay around $65/month (in addition to Part-B premium), pay the Part-B deductible then pay 20%, and/or Part-A copays. Once your out-of-pocket reaches the HDF's deductible, you pay $0. Would the AARP agent have that info? Yes and no, they have access to Medicare, but being a Captive Agent, they can not discuss it.

TS

I do understand that. My problem on comparing drug coverage on the medicare.gov site turned out to be glitch that I finally recognized. Two calls to them and one to AARP were of little help. While I had updated my drug list and imported the new ID number and date into my search and the site was showing my current drug list, it was actually estimating my drug costs based on an old ID number and date drug list. I knew the figure was wrong. The Medicare agent just kept saying "I'm sorry." and wanted to proceed to point out another policy based on false results. Later I saw the old ID number was being used even though a list of current drugs was showing. Got that fixed and moved on to a new drug plan. Spent the better part of a day and a half over that!

Thanks for the information!
 

WinniWoman

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Can you imagine the very elderly having to deal with all of this nonsense?
 

Glynda

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No!

Can you imagine the very elderly having to deal with all of this nonsense?


I FELT very elderly there for a bit! I knew it couldn't be right as I got different results from when I hand typed in the current drug list from when I imported that same drug list back in to use again but no one could tell me why or what to do about it. I was about to give up when I spied that the site was pulling up the right drugs in the list but the wrong ID number and realized that the low estimate had to be based upon the fewer, and less expensive, drugs listed in the earlier list. ARGH! It is not easy even when it's working! A lot of reading and studying is necessary or someone you trust to guide you. Obviously, the people I got on the phone didn't know.
 

WinniWoman

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I FELT very elderly there for a bit! I knew it couldn't be right as I got different results from when I hand typed in the current drug list from when I imported that same drug list back in to use again but no one could tell me why or what to do about it. I was about to give up when I spied that the site was pulling up the right drugs in the list but the wrong ID number and realized that the low estimate had to be based upon the fewer, and less expensive, drugs listed in the earlier list. ARGH! It is not easy even when it's working! A lot of reading and studying is necessary or someone you trust to guide you. Obviously, the people I got on the phone didn't know.

This is what goes on. As complicated as it is for us to understand the people that work there know even less than we do!

I find this to be the case on many areas of life! Ugh!
 

momeason

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On Medicare.gov to search for a plan to cover all your drugs, You need to check Original Medicare as your coverage. (Your Medigap policy does not cover prescriptions.) Check that you want to look at prescription plans only. Then just list the prescriptions you take and what pharmacy you wish to use. Call me if you have problems 910-750-2605. I can do it for you.

You can always do a general search without name if you are having trouble with your list.

Tomorrow, 12/7 is the deadline for changes to your prescription plan for 2016
 
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Glynda

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Thanks!

On Medicare.gov to search for a plan to cover all your drugs, You need to check Original Medicare as your coverage. (Your Medigap policy does not cover prescriptions.) Check that you want to look at prescription plans only. Then just list the prescriptions you take and what pharmacy you wish to use. Call me if you have problems 910-750-2605. I can do it for you.

You can always do a general search without name if you are having trouble with your list.

Tomorrow, 12/7 is the deadline for changes to your prescription plan for 2016


Thanks. Went through both processes numerous times. Both the "General Search" and "Personalized Search" options. Tried both hand typing in drugs and importing same list by its ID number and date. I checked "Drug plans with Original Medicare." And chose pharmacies.

My problem was a glitch with the site apparently as it kept using an older ID number to estimate drug costs though I could see new drugs listed. Once I figured that out myself, I was able to get it fixed and compare plans and enroll in a new one. It was just frustrating that I had to spend most of a day and a half and long hold phone calls only to find the problem myself in the end as they did not catch it.

I appreciate your willingness to share and help!
 

momeason

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AARP Medicare is United Healthcare, but an independent agent would be a better person to talk to. If you call them (AARP Medicare), you're talking to licensed insurance agents appointed ONLY with UHC.

In terms of Medicare Supplements, I used to be appointed with United American, their High-Deductible F (HDF) plan was HALF the cost of United Healthcare. With the HDF, you pay around $65/month (in addition to Part-B premium), pay the Part-B deductible then pay 20%, and/or Part-A copays. Once your out-of-pocket reaches the HDF's deductible, you pay $0. Would the AARP agent have that info? Yes and no, they have access to Medicare, but being a Captive Agent, they can not discuss it.

TS

Absolutely right. I am a very independent agent, licensed and appointed in NC, SC and VA with many carriers.
Medicare is not supposed to recommend anything. When you call any particular company, they will try to sell you only what they sell and what earns the highest commission. I do not favor any one company but give you the low down on each, pros and cons.
This is one of my business numbers. It is already public. 910-750-2605..call or text if you have questions. I am a consumer advocate. I fix problems and offer free assistance all the time. You can find my site with lots of free tips on Facebook. Call or text me if you want free expert help. I help lots of people who already have coverage..kind of like TUG except for health plans...lol
 
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