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LindaH

Medicare Supplements

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I think the bottom line is that each of us have our own medical needs and financial risk tolerances to consider, and there is no "one size fits all" plan. In your wife's situation, obviously the plan she has paid off for her in both respects. If our needs should change in the future obviously we would re-evaluate our options. At this point our MA plan has worked well for us both medically and financially, and we've found that many of the preconceived notions about MA plans are either wrong or don't apply to our specific plan. As neither a medical or financial professional, I would not recommend any particular plan to anyone else. I would only recommend they seek professional guidance in sorting through the various options.

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8 hours ago, Kirk W said:

We have recently moved and are in process of finding new doctors. Just last week we were told by a doctor's group that they do take a limited number of Medicare patients, but that they do not accept Medicare Advantage. Finding doctors who accept any form of Medicare is difficult in the Dallas, TX area. 

Why did you move, Kirk?  The previous seemed like a nice community for you.

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4 hours ago, 2gypsies said:

Why did you move, Kirk? 

Several reasons. Closer to the sons, and an opportunity to sell for cash. We are now in one of the "age in place" communities with all sorts of senior services. We are in independent living but when needed or desired, meals are available if desired, as is assisted living, rehab facilities, gym & pool, and many other services. Pam has been doing pretty well but she has a degenerative health issue so we felt the time had come. 

 

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3 hours ago, Kirk W said:

Several reasons. Closer to the sons, and an opportunity to sell for cash. We are now in one of the "age in place" communities with all sorts of senior services. We are in independent living but when needed or desired, meals are available if desired, as is assisted living, rehab facilities, gym & pool, and many other services. Pam has been doing pretty well but she has a degenerative health issue so we felt the time had come. 

 

Enjoy your new digs.  Good reasons to move.  It sounds ideal!

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I've been with United of Omaha since 2010, plan "F". And to date the only out of pocket expense I've had was with some uncovered lab test that Doctor ordered and neither will cover.  I received a letter from United that the plan "F" will no longer be offered to new policy holders, but since I'm already covered, I'm still covered under plan "F".

United of Omaha is not the cheapest policy out there, but it's honored just about everywhere I go.

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55 minutes ago, Captain Happy said:

I received a letter from United that the plan "F" will no longer be offered to new policy holders, but since I'm already covered, I'm still covered under plan "F".

New enrollees simply have to sign up for Plan G which has the same benefits as Plan F EXCEPT for the fact that Plan G doesn't pay for the annual Part B deductible.   As a result the premiums for Plan G are less than for Plan F. Nothing else has changed.

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1 hour ago, Captain Happy said:

 

United of Omaha is not the cheapest policy out there, but it's honored just about everywhere I go.

It's a Medicare medigap plan.  If Medicare is accepted, your Medigap is accepted, there's no "honored" to it.

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I don't know if it has changed but 10 to 12 years ago the Mayo Clinic would fill out the claim for a medigap policy but put the patient to receive the payment.  It was up to the patient to make the necessary payments to the clinic and chase down whatever the insurance paid.  I sure wish they would have honored the medigap policy.  We certainly learned how difficult and screwed up medical billing is.  Even after we obtained some training it was difficult or nearly impossible to keep up with things.  More than once we just paid the bill and hoped the insurance paid us back.  For a time both of us were receiving care.  During a time of stress you just do what you can.  The insurance must have covered most of it as we had enough to cover what we needed. After seeing and studying all of those bills we were sure thankful  for insurance!  We have since changed to a MA plan have have not had those problems.

 

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Well, maybe I just misunderstood what I read.  I thought that the provider billed Medicare, then Medicare paid it's portion and forwarded the claims to the Medigap, which then paid it's portion.  I didn't think the provider had to bill the Medigap directly at all.  In other words, the Mayo Clinic shouldn't have any contact at all with the Medigap insurance company in the claims process.

Medicare Approval and Billing

Before a doctor will schedule surgery for you, or even an MRI, CAT scan or any similar expensive tests, his/her office will first get confirmation from Medicare that it will cover the bill. That communication is done electronically and very efficiently. Most of the time, you’re not even aware of the approval process taking place. After you’ve had your procedure, surgery, or tests, your doctors and hospital electronically bill Medicare. Then, Medicare will pay a portion of those pre-approved bills directly to your doctors and hospital.

Medigap Fills in the Gaps

After that, Medicare uses a system called “crossover” to electronically notify your Medigap insurance company that they have to pay the part of the remainder (the gaps) that your Medigap policy covers. All you have to remember is this: always show your Medigap policy identification card, along with your Medicare card, to your medical providers. The rest is done automatically for you. It’s a nice system.

https://www.healthcare.com/blog/medicare-medigap-pay-medical-bills/

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38 minutes ago, chirakawa said:

Well, maybe I just misunderstood what I read.  I thought that the provider billed Medicare, then Medicare paid it's portion and forwarded the claims to the Medigap, which then paid it's portion.  I didn't think the provider had to bill the Medigap directly at all.  In other words, the Mayo Clinic shouldn't have any contact at all with the Medigap insurance company in the claims process.

Medicare Approval and Billing

Before a doctor will schedule surgery for you, or even an MRI, CAT scan or any similar expensive tests, his/her office will first get confirmation from Medicare that it will cover the bill. That communication is done electronically and very efficiently. Most of the time, you’re not even aware of the approval process taking place. After you’ve had your procedure, surgery, or tests, your doctors and hospital electronically bill Medicare. Then, Medicare will pay a portion of those pre-approved bills directly to your doctors and hospital.

Medigap Fills in the Gaps

After that, Medicare uses a system called “crossover” to electronically notify your Medigap insurance company that they have to pay the part of the remainder (the gaps) that your Medigap policy covers. All you have to remember is this: always show your Medigap policy identification card, along with your Medicare card, to your medical providers. The rest is done automatically for you. It’s a nice system.

https://www.healthcare.com/blog/medicare-medigap-pay-medical-bills/

It didn't work that way at the Mayo Clinic 10 years ago.  They would bill Medicare and send in the paperwork for the medigap policy to pay us.  I have statements showing thousands of dollars transferring between the Medigap UHC policy and thousands of dollars sent to the Mayo Clinic.  They obviously were aware of the UHC policy as they sent in the original paper work.  We were responsible for paying the bill.  We stayed around Scottsdale, Phoenix for over a year for treatment.  During Christmas of that year we stayed in the Mayo parking lot for 2 weeks so we were close in case of an emergency.  Staying in their parking lot required special doctors orders as that is normally forbidden. We also learned that there were assigned and unassigned Medicare Bill's.  The difference is Medicare pays all of the charges in some cases, such as hospital room charges.  We were informed as soon as we registered that that is the way the billing worked there and good luck figuring it out.  None of the other places we visited had this type of crazy billing.  However, the Mayo Clinic was able to do things we could not get locally and it saved lives.

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This is from the Mayo Clinic web site

Clinic and physician services
Although Mayo Clinic doesn't participate with Medicare Part B in Arizona and Florida, Medicare will help pay for services provided at all Mayo Clinic sites regardless of whether they participate with Medicare Part B. Claims will be filed to Medicare Part B and supplemental or secondary insurance companies on your behalf. In some cases, Medicare Part B and supplemental or secondary insurance payments may be sent directly to you. When this happens, patients will be responsible for reimbursing Mayo Clinic for any payments they receive and any balances not covered by their insurance.
 
Medicare assignment
Mayo Clinic is required to accept assignment for Medicare Part B for certain services designated by government regulations (for example, clinical laboratory, drugs and biologicals).
 
Medicare supplemental or Medigap insurance crossover
If you expected your claims to cross over from Medicare to your supplemental or Medigap insurance and this did not occur, please contact your Medicare supplemental or Medigap insurance organization to inquire.
 
Medicare Advance Beneficiary Notice
Before certain items or services are provided, Medicare patients may be asked to read and sign an Advance Beneficiary Notice (ABN) that explains Medicare payment restrictions and estimate of charges. By signing the ABN, you assume financial responsibility in the event Medicare denies payment.
 
Noncovered services, such as eye refractions, foot care, hearing aids, screening exams, preventive medicine services and elective procedures, do not require prior notification and are not subject to the ABN requirement. Patients are financially responsible for all noncovered services.
 
Any questions regarding a noncovered item or service should be directed to Medicare at 800-633-4227 (toll-free).
 
Medicare Advantage plans
Medicare Advantage plans are plans offered by private companies that contract with Medicare to provide all of your Medicare Part A and Part B benefits. In most cases, Medicare Advantage plans also offer Medicare prescription drug coverage. There are various types of Medicare Advantage plans, including HMO, PPO, cost-based, HCPP, Medicare Medical Savings Account and private fee-for-service plans. If your plan is considered out of network, your out-of-pocket expenses will be higher. As a general rule, Medicare Advantage plans should process the same as Medicare.
 
The following Mayo Clinic campuses limit access to some of the Medicare Advantage plans:
 
Mayo Clinic's campus in Arizona. Patients covered by any types of Medicare Advantage Plans (exception Cost share/HCPP) that are not contracted may not be seen. Patients cannot be seen on a self-pay basis.
Mayo Clinic's campus in Florida. Patients covered by Medicare Advantage HMO plans without authorization may not be seen. Patients cannot be seen on a self-pay basis.
Mayo Clinic's campus in Rochester, Minnesota. Patients covered by Medicare Advantage HMO plans without authorization may not be seen. Patients cannot be seen on a self-pay basis.
Medicare Advantage HMO plans require authorization prior to scheduling appointments at the Mayo Clinic site that is contracted or that has accepted your plan; without authorization, the patient will be financially responsible.
 
Mayo Clinic's campuses in Arizona and Florida do not agree to the terms and conditions of noncontracted Medicare Advantage plans, due to administrative and financial challenges. Please refer to your Medicare Advantage plan for a list of in-network providers.

 

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The Mayo Clinic also charges 15% more for doctors than most Medicare conforming providers.  This is Medicare approved but not Medicare covered.  Many insurance policies also do not cover this.  We were fortunate that it was covered.

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2 hours ago, Randyretired said:

The Mayo Clinic also charges 15% more for doctors than most Medicare conforming providers.  This is Medicare approved but not Medicare covered.  Many insurance policies also do not cover this.  We were fortunate that it was covered.

I believe that Medigap plans F and G pay this 15% "excess fee".  Other plans may also pay it.

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I have a part "D" plan with Humana since 2012.  I have changed plans a time or two with them due to reduced costs, etc.  But now I'm leaving Humana completely.  They obviously are exiting the portion of the business that I participate in since they are doubling my monthly premium for 2020 and increasing the deductible also.  Since I won't spend even the deductible amount during the year I am switching to the cheapest plan for my area and by by to Humana.  The premium amount they are going up to makes no sense for me.  I am fortunate that I only take cheap drugs, at least so far anyway. 

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1 hour ago, edatlanta said:

But now I'm leaving Humana completely.  They obviously are exiting the portion of the business that I participate in since they are doubling my monthly premium for 2020 and increasing the deductible also.

Quote

With all due respect, I think the only deductible associated with a Plan D would be the Medicare Part B 

Ed your experience with drug coverage is exactly the same as my own. I take 2 tier one prescription drugs as maintenance and neither one are expensive or uncommon. My premium for the Humana/Walmart part D has bee $20.70 for 2019 and recently got notice that it would be $56 for 2020. I have already signed up with a new part D from Well Care that has a premium of $13.30.

All plans then cover drugs based on a schedule of rates for each drug tier. Some have no deductible at all for tier 1, while with Humana I was charged $3 for each of the drugs I take. As the tier level goes up (from 1 to 5 I believe) the amount paid by the patient to the pharmacy each time it is renewed increases. 

Most companies do have a deductible that is based on the tire level a drug falls into and the amount charged for each tier is not the same from one insurance company to the next. It is the tier level pricing that makes it so difficult to determine what drug coverage (part D) you will get the lowest out of pocket from. In my wife's case, it takes a great deal of math to determine because she takes a total of 9 different prescription drugs and some are tier 1, some tier 2 and one of them is tier 3. Because tire 3 usually has a high out of pocket charge from any plan that has a low monthly premium, you need to balance the total out of pocket, including premiums and prescription costs for the entire year between the drug plans that you consider. My former employer provides us with that service but there are companies available to assist you in doing this. 

Edited by Kirk W

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docj. My part D has a yearly deductible of $460 plus co-pays for drugs with differing tier percentages. This is in addition to raising monthly premiums. There are 'prefered providers' that have the lowest costs, $2,  for generics.

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On 11/1/2019 at 5:08 PM, Barbaraok said:

They get your PartB premium. PLUS extra amount to cover you.  Originally the said they could do it just for the premium, got lots of people signed up and then went back to say they needed more and got it.  So all taxpayers pay for it.

"The Medicare funding sources are the same whether you are enrolled in Original Medicare or a Medicare Advantage plan." quoted from https://medicare.com/medicare-advantage/how-is-medicare-advantage-plan-funded/

Yes there is a pot funded by congress. But both plans get money from it. The Advantage plans do not get any more than medicare. They save money by managing your care with Network Providers.

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30 minutes ago, Sehc said:

docj. My part D has a yearly deductible of $460 plus co-pays for drugs with differing tier percentages. This is in addition to raising monthly premiums. There are 'prefered providers' that have the lowest costs, $2,  for generics.

As for Part D plans, we have found that it is extremely helpful to use an online "calculator" to determine which plan is best for each of us when we consider the specific medications we use.  Selecting a plan that has the lowest premium isn't always the lowest cost option.   We use a calculator provided through our benefits "broker" Via Benefits, but there's a similar one provided by Medicare which you can find here:  https://www.medicare.gov/plan-compare/#/?lang=en  You enter the drugs you take and it calculates the total annual cost including premiums and co-pays.  The annual costs for different Part D plans can often vary by several thousand dollars when you consider the specific medications being prescribed..

Edited by docj

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The system sucks.

You a find a provider you like, you talk to and understand what they say, has an accounting dept that don't demand more payments or they  will drop service, in the end refund your demanded over payment back. Then before you know it, your going to dealing the horrible WELLCARE. That is part of Part D problems

Part B has its own set problems. Remember Medicare setup the system for providers. I start having problem with my CPAP machine. I notified my provider which said there a back log but I didn't have immediate need, just have the machine after I see the doctor the following month. The CPAP failed big time before the month. I tried to buy a machine. no way. it took three days to gather all the 7 + years of records before I received a machine. Then provider couldn't be paid for the machine, finally 8 months later the EOB's come showing they are being paid monthly as a rental. OVERHEAD, OVERHEAD, OVERHEAD and not small business friendly.

For paper work Part D doesn't care what name is and likes something that matches your ID. Part B supplies must have the name exactly as Red, White & Blue Medicare card. But Medicare has a short character count for your name. My wife uses her previous surname and present surname with only her first initial. Petty problem but the people standing in line at pharmacy doesn't like it.

Doctor's order blood test off a menu but I haven't had this explained to me but three different doctors order lab test but none get any of the three items that supposedly landed a person in the hospital. So another trip to ER and hospital stay. Medicare cost saving. No

I will stop here as it is boring to you so can have time to look for Part D providers. I use Humana for Parts A&B Plan G

Clay     Why can't we back up about 60 years and clean out some overhead

 

 

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I have a plan with united health care, when I first heard this crap about eye care and free glasses, dental care, I called them and they said no one does that, 

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Related to excess charges this is from the Mayo Clinic web site.  I also looked at the Medicare web site and excess charges are mentioned as more likely in specialty clinics.   I believe I have heard MD Anderson is not accepting some insurance anymore.  So if you want to go to a specialist pay attention to excess charges I guess is the take away.

Does Mayo Clinic accept Medicare patients?

For out-of-state-residents:

Mayo Clinic is a participating Medicare facility in Rochester, Minnesota and all Mayo Clinic Health System locations.

For out-of-state-residents in Arizona and Florida:

Mayo Clinic has chosen to be a nonparticipating facility in Arizona and Florida, and thus does not accept assignment from Medicare Part B for out-of-state residents at its campuses in Arizona or Florida. Nonparticipating means that Mayo Clinic does not accept the Medicare approved amount as payment in full.

For in-state residents in Arizona and Florida:

  • Like other health care organizations that do not accept Medicare Part B assignment, Mayo Clinic can bill up to 15 percent above the Medicare allowable amount, for which the patient is financially responsible.
  • Mayo does not add a straight 15 percent to the bills; rather, Medicare determines how much above the approved amount Mayo can bill. These charges are referred to as Part B excess charges by Medicare. Accordingly, Mayo bills the patient for the full amount of the charges and expects full reimbursement from the patient.
  • In addition, Medicare will pay the patient directly for services rendered, and the patient will need to reimburse Mayo Clinic.

Does my insurance cover preventive services?

  • Each insurance policy is different. Please contact your insurance company for benefit-specific information.
  • With regard to Medicare coverage, please note that in general Medicare does not cover routine or preventive services. Please refer to your Medicare booklet for more information.

 

 

 

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I believe that the Arizona one may be changing in that they are now part of a medical school that gets federal funding, plus they need to have a certain number of patient population in order to keep accreditation.  

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20 hours ago, docj said:

As for Part D plans, we have found that it is extremely helpful to use an online "calculator" to determine which plan is best for each of us when we consider the specific medications we use.  Selecting a plan that has the lowest premium isn't always the lowest cost option.   We use a calculator provided through our benefits "broker" Via Benefits, but there's a similar one provided by Medicare which you can find here:  https://www.medicare.gov/plan-compare/#/?lang=en  You enter the drugs you take and it calculates the total annual cost including premiums and co-pays.  The annual costs for different Part D plans can often vary by several thousand dollars when you consider the specific medications being prescribed..

I agree.  I use the calculator on the medicare.gov site and set it for the lowest annual cost.  I don't care about the monthly premium amount, I want to know the lowest total annual cost.

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