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LindaH

Medicare Supplements

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1 hour ago, docj said:

I guess I'm not sure why any full-timer would want to use a Part D plan that mails prescriptions.   This year we have Express Scripts and have not once had anything mailed to us. I think we pay a dollar or two more for SOME scripts in order to get them at Walgreens, but wind it a lot more convenient.

Because for some things the difference would be $30-$50 more at Walgreens than through ExpressScripts.   The only thing we willing pay moe for is Dave's Lantus - it is just to hard to get it delivered during the 6 months we are traveling all over and much easier on us to use Walgreens, but it is $35.00 more per box, thankfully Dave only needs 1 box every 90 days.  

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3 hours ago, docj said:

I guess I'm not sure why any full-timer would want to use a Part D plan that mails prescriptions.   This year we have Express Scripts and have not once had anything mailed to us. I think we pay a dollar or two more for SOME scripts in order to get them at Walgreens, but wind it a lot more convenient.

We are not full time but we are not home a lot.   Our part d is paid for by my DW's former employer.  Hence we use a mail order pharmacy because that is what is provided.  They also pay for our Advantage Plan, which pays at any place that accepts medicare anywhere.

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Randy, a Medicare Advantage plan is very restrictive. It does not pay everything everywhere. You must be in network (your state of residence). If you are out of network you will be responsible for a larger portion of the bill. A Medicare Supplement Plan will pay most of your bill not covered by Medicare almost anywhere. If you have a Advantage Plan you don’t need part D, it is included. If you have a Supplement you may purchase a Part D Prescription Plan and it will be good almost anywhere. So if you have a Part D paid for by your wife’s employer than you must also have a Supplement Plan not a Advantage Plan paid for by her employer. Just an FYI. I’m not implying that you are incorrect. Your wife’s employer may have something special or doesn’t know the difference. 

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I'm not sure but from what I read. My supplement (F) is accepted anywhere Medicare is accepted. The billing is automatic, the provider doesn't have to file anything other than Medicare.  My supplement is ok even at the offices where they do not except the listed Insurance provider on the card.  Advantage plans are very much more limited. Many doctors are not covered.

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34 minutes ago, Twotoes said:

Randy, a Medicare Advantage plan is very restrictive. It does not pay everything everywhere. You must be in network (your state of residence). If you are out of network you will be responsible for a larger portion of the bill. A Medicare Supplement Plan will pay most of your bill not covered by Medicare almost anywhere. If you have a Advantage Plan you don’t need part D, it is included. If you have a Supplement you may purchase a Part D Prescription Plan and it will be good almost anywhere. So if you have a Part D paid for by your wife’s employer than you must also have a Supplement Plan not a Advantage Plan paid for by her employer. Just an FYI. I’m not implying that you are incorrect. Your wife’s employer may have something special or doesn’t know the difference. 

Many Advantage plans are restricted as you mentioned but this plan is provided as a retirement benefit.  It is not restricted to in network and the benefits are great.  We have used it in multiple states without a problem.  Her former employer also offers a supplemental plan at her choice but this advantage plan works best for us.  We have a copay of $5 to $10 for doctor visits and $50 for emergency room.  ALL of the rest is 100% paid.  The plan offers some of the other benefits common to advantage plans.  Not all plans are the same and no I am not confused.  We have had this plan for a few years and unfortunately we have used it more than I imagined.

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14 hours ago, Barbaraok said:

The only thing we willing pay moe for is Dave's Lantus - it is just to hard to get it delivered during the 6 months we are traveling all over and much easier on us to use Walgreens, but it is $35.00 more per box, thankfully Dave only needs 1 box every 90 days.

FWIW you might want to check what Express Scripts plan you and Dave are on.  I've attached a screenshot showing the cost of the 5 boxes my wife uses in 90 days.  There's virtually no difference between the cost of buying it at Walgreens or having ES mail it to us. 

When I used the computer system at Via Benefits (Towers Watson) to analyze Part D plans I selected Walgreens as my preferred pharmacy and I chose our plans based on that selection.

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Joel, the cost would be the same whether it is for 5 boxes or 1 box - - it is how the Rx is written.  Because UT System self-insures, we have some things that are different than other insurances.   We have no choice in whom we use, but that's ok because they only thing we ever pay for any medical care is usually $20 or less for 90 days prescription.  

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"I don't know about any rules for going from an advantage plan to a supplement."

Linda,

There are no Federal rules about moving from an Advantage Plan to a Supplement. The process and rules are very similar to switching to a new RV insurance company.  You shop, they offer you a price if they want to, or tell you they are not interested in insuring you..

The broker, or agent (eHealth is a broker) wants to sell you a Supplement because they, and their agents, get a commission. Typically, about 20% of your policy price for several years and then about half that for the remaining years you stay on their policy.  They are intermediaries between you and the company that is actually providing the insurance (e.g. United Health Care, Aetna ...).  These underwriters set their acceptance rules.  If, in their sole opinion, you're not likely to be profitable, they will reject your application.  

If you are fortunate enough to not have any chronic health problems, you should at least consider a High Deductible Plan (F+ or G+).  Why?  Because if your actual medical expenses are less than the HD-Plan's deductible, you're likely to save money by going with the HD version.  In my particular case, I've saved more than $6K with a high deductible plan F, over a standard Plan F,  since, I became eligible for Medicare in 2014. And a critical point - my catastrophic insurance benefits were identical to a non-HD Plan F during that time.  

Consider widening your shopping net beyond eHealth.  I have no experience with them and am not trying to disparage them.  But there may be providers that would be good for you and not profitable for them.  For example, the lowest cost Plan F HD plan offered by my (prior employer subsidizsed website) was 80% higher than what I was able to find in the open market.  The provider I chose has an AM Best rating of A+.   I paid an annual fee of $590 for my Plan F-HD in 2018 and 2019.

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1 hour ago, DanZemke said:

In my particular case, I've saved more than $6K with a high deductible plan F, over a standard Plan F,  since, I became eligible for Medicare in 2014.

Like anything having to do with insurance, it's all a matter of how you prefer to handle risk.  I like my "standard Plan F".  Essentially, since I became eligible for Medicare ~7 years ago neither my wife nor I have paid ANYTHING for health care above our premiums and the cost of prescription drugs.  As we get older and our health issues increase, IMO it's nice to know we won't ever see a bill. JMO

Edited by docj

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8 minutes ago, docj said:

Like anything having to do with insurance, it's all a matter of how you prefer to handle risk.  I like my "standard Plan F".  Essentially, since I became eligible for Medicare ~7 years ago neither my wife nor I have paid ANYTHING for health care above our premiums and the cost of prescription drugs.  As we get older and our health issues increase, IMO it's nice to know we won't ever see a bill. JMO

I agree with the plan "F" that I have had since 2012.  Unfortunately that plan goes away as an option 1-1-2020 for anyone not already on that plan.  I'm glad I have it already.

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docj,

"Like anything having to do with insurance, it's all a matter of how you prefer to handle risk."

Good point. You're right.

Edited by DanZemke
clarity

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17 hours ago, DanZemke said:

Consider widening your shopping net beyond eHealth. 

I haven't been using eHealth, or any broker.  I've been getting my information directly from the medicare.gov website.

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15 hours ago, edatlanta said:

I agree with the plan "F" that I have had since 2012.  Unfortunately that plan goes away as an option 1-1-2020 for anyone not already on that plan.  I'm glad I have it already.

Not exactly.  From everything I've been reading, the only people who will not be eligible for Plan F are those who turn 65 in 2020.  Anyone else already on Medicare can sign up for Plan F even if they're not currently on it.

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On ‎10‎/‎6‎/‎2019 at 7:36 AM, Twotoes said:

...a Medicare Advantage plan is very restrictive. It does not pay everything everywhere. You must be in network (your state of residence). If you are out of network you will be responsible for a larger portion of the bill.

There are PPO Medicare Advantage plans that you can use in areas other than your home area.  But not all PPO Medicare Advantage plans have in-network providers in all states.  For example, in my calling several companies, I've found that Asuris' PPO Medicare Advantage plan doesn't have in-network providers in Arizona, although they do in Nevada.  Humana, on the other hand, has in-network providers in all states.

On ‎10‎/‎6‎/‎2019 at 7:36 AM, Twotoes said:

If you have a Advantage Plan you don’t need part D, it is included.

Not "all" Advantage Plans offer Part D -- something you have to look at VERY carefully!  (For example, Humana has two PPO Medicare Advantage Plans -- one includes Part D, the other one doesn't.)  AND -- if you sign up for a Medicare Advantage Plan that doesn't include Part D, you cannot purchase a separate Part D like you can with a Supplement Plan.  Just another "gotcha" one has to be aware of when shopping for Medicare plans.

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Linda,

I'm truly not trying to debate with you.  But I have a different impression than you seem to have.  My impression is that for most folks,  the only people who will be eligible for a Plan F plan in 2020 are those who already have a Plan F. 

"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."

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

Edited by DanZemke
clarity

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2 hours ago, DanZemke said:

If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans."

I would take that to mean that we can, but must do so before the January 1, 2020 deadline. We had plan F for several years but then found that changing to plan G, which is the same as F except it doesn't pay the Medicare deductible, saves us about $50/year each as the total of the premiums for our plan F compared to plan G were more than the amount of that deductible. 

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Linda and Kirk,

I did a bit more research and I think a Mea Culpa is due.  You have it.

The description of who will be able to buy a 2020 Plan F is ambiguous for current Medicare, on many websites.  But I found some that say anyone currently on Medicare in 2019 will be able to choose a Plan F for 2020.  So, from several sources saying you can, versus several ambiguous sources - the "you can sites" seem more probable.

It appears that I was wrong.  I apologize.

However, it's not clear to me why anyone would want to sign up for a Plan F (or Plan F HD) in 2020.  Plan G (or Plan G HD) seems to me to be a better option.

I am currently on a Plan F and am hoping to change to a Plan G  in 2020.  Why?  Because future younger folks won't be able to sign up for a Plan F.  Over time, the risk pool for plan F subscribers will be older.  Older folks, in aggregate, have higher medical expenses.  I'd rather be in an insurance pool that accepts younger folks.  That's why I would like to switch to a Plan G.  In my case, a Plan G HD seems best.

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14 hours ago, DanZemke said:

I am currently on a Plan F and am hoping to change to a Plan G  in 2020.  Why?  Because future younger folks won't be able to sign up for a Plan F.  Over time, the risk pool for plan F subscribers will be older.  Older folks, in aggregate, have higher medical expenses.  I'd rather be in an insurance pool that accepts younger folks.  That's why I would like to switch to a Plan G.  In my case, a Plan G HD seems best.

An excellent point! I suspect that our age plays into the reason it became cost effective for us to shift to plan G. It seems that ever since we passed age 75 our rates jump more each year and the differential in the two plans became greater. 

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On 10/6/2019 at 10:36 AM, Twotoes said:

Randy, a Medicare Advantage plan is very restrictive. It does not pay everything everywhere. You must be in network (your state of residence). If you are out of network you will be responsible for a larger portion of the bill. A Medicare Supplement Plan will pay most of your bill not covered by Medicare almost anywhere. If you have a Advantage Plan you don’t need part D, it is included. If you have a Supplement you may purchase a Part D Prescription Plan and it will be good almost anywhere. So if you have a Part D paid for by your wife’s employer than you must also have a Supplement Plan not a Advantage Plan paid for by her employer. Just an FYI. I’m not implying that you are incorrect. Your wife’s employer may have something special or doesn’t know the difference. 

And again, not true. My wife and I have a Medicare Advantage PPO which works nationwide, with thousands of in-network providers. Mine is from Ohio, but 95% of my medical procedures and Dr's have been in FL, or some other state. Very happy with their service.

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My wife changed from an Advantage plan to Plan G and couldn't get the cheapest, her medical mentioned COPD. She is insured with Blue Cross Blue Shield, no problem.

Part D we are insured by Aetna with no problem but they have been bought out by WELLCARE and for me that was BAD BAD bad. Two problems, I had payment problems and you couldn't talk to them. Customer service left me cussing. Anyway when I stopped using them they send me a check promptly for the months I overpaid which I knew I had to pay at their insistance to continue service.

Were looking for a new plan

Clay

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On 10/5/2019 at 7:25 PM, docj said:

I guess I'm not sure why any full-timer would want to use a Part D plan that mails prescriptions.   This year we have Express Scripts and have not once had anything mailed to us. I think we pay a dollar or two more for SOME scripts in order to get them at Walgreens, but wind it a lot more convenient.

DocJ, to pick up the meds at Walgreen triples out cost out of pocket.  So we fight the idiots at Optum RX

Ken

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20 hours ago, DanZemke said:

Linda and Kirk,

I did a bit more research and I think a Mea Culpa is due.  You have it.

The description of who will be able to buy a 2020 Plan F is ambiguous for current Medicare, on many websites.  But I found some that say anyone currently on Medicare in 2019 will be able to choose a Plan F for 2020.  So, from several sources saying you can, versus several ambiguous sources - the "you can sites" seem more probable.

It appears that I was wrong.  I apologize.

However, it's not clear to me why anyone would want to sign up for a Plan F (or Plan F HD) in 2020.  Plan G (or Plan G HD) seems to me to be a better option.

I am currently on a Plan F and am hoping to change to a Plan G  in 2020.  Why?  Because future younger folks won't be able to sign up for a Plan F.  Over time, the risk pool for plan F subscribers will be older.  Older folks, in aggregate, have higher medical expenses.  I'd rather be in an insurance pool that accepts younger folks.  That's why I would like to switch to a Plan G.  In my case, a Plan G HD seems best.

Why would someone want to stay with Plan F-HD even if the plan is closed to younger members? Because 1. Plan G will now be a guaranteed issue plan so rates will go up faster from now on. 2. From the rates I've seen so far for Plan G-HD on a senior insurance forum they are considerably more than Plan F-HD. 3. In order for Plan F-HD to be adversely impacted by any changes, the average person on the plan will have to have almost $12,000 in annual medical bills year in and year out.  The current average for all of Medicare is $800 according to my Medigap insurance broker, although I see a slightly higher average on kff.org.  4. Plan F-HD definitely saves someone money when they are healthy and even when someone is in their 80s, the Plan F-HD rate plus deductible will likely be cheaper than the other rates. 

Here's a good article on why a high deductible plan may be good for some people:

https://www.journalofaccountancy.com/newsletters/2018/mar/high-deductible-medigap-plan.html



 

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On 10/2/2019 at 7:29 PM, Twotoes said:

I have had United of Omaha for a year now. Found out on my Welcome to Medicare physical that I am diabetic. UofO has paid every claim promptly. When Medicare started it was UofO that set up the claims process for the Federal Government. When I was doing my due diligence last year I saw nothing but bad reviews about Humana. Don’t know anything about Asuris. AARP is an organization that I choose not to be a member of. United Health Care does seem to be the most popular however. 

The Federal Government has never processed Medicare claims.  Since the beginning of Medicare, the claims processing has been contracted out to private insurance companies. MoO may have been one of many private insurance companies processing claims.   Nowadays rather on a state level, the claims are processed by MACs, who handle the claims for a geographic region.

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On 10/4/2019 at 11:10 AM, Barbaraok said:

If all G plans cover exactly the same thing, why wouldn't you choose the cheapest?  

 

Because some insurance companies are notorious for closing blocks of Medigap business every few years to keep rates low for new entrants. As long as you're healthy and can pass underwriting it's not an issue, because you can change insurance companies, but at some point you will be denied and then stuck with a closed block of business and future sky high rates.

Edited by saydiver

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