Deductables

[RonandLaine]

Question, My wife and I are on Medicare and TFL, she visits her doctor and within a few weeks she gets a bill for deductible because Medicare or TFL does not cover it., is this correct?

[Jaydrvr]

1 hour ago, RonandLaine said:

Question, My wife and I are on Medicare and TFL, she visits her doctor and within a few weeks she gets a bill for deductible because Medicare or TFL does not cover it., is this correct?

 

Edited November 21, 2019 by Jaydrvr

[Twotoes]

Is the bill for her Medicare deductible or did Medicare deny the claim. Medicare has a deductible of $185 and pays 80% of the remaining bill. If you have a Supplement, it will pay the remaining 20%, after you pay the $185 annual deductible. If you have an Advantage Plan it is different. I have a Supplement and know nothing about Advantage Plans. 

[docj]

5 minutes ago, Twotoes said:

If you have a Supplement, it will pay the remaining 20%, after you pay the $185 annual deductible.

To clarify, if you have a Plan F Supplement it will cover your Medicare Part B deductible.

[lenp]

I also am on Medicare and TFL.  After every office or hospital visit I receive a medicare statement showing what they paid and what I may be billed.  Soon after Tricare For Life statement comes telling me they have paid the "what I may be billed" amount.  These statements are not always timely - received one yesterday that dated back to March of this year.

I am certainly no expert but I understand that as long as your provider is under contract with (accepts) Medicare AND you have Medicare Part B AND the procedure(s) are covered by Medicare AND your covered by TFL you should NEVER see a bill for doctor or hospital.  At least I don't and have not for nearly ten years not (I am 74).  You will have a copay on medications though.  Hospitals and doctors have billed Medicare well over $100K on me this year and I do not expect to pay a dime!  Of course Medicare only allows a much smaller portion of what they are billed and you cannot be billed for anything over what Medicare allows.

FYI for others - TFL is Tricare for Life that covers military retirees over 65 and is essentially a Medicare supplement.

Lenp

[Sehc]

I change to "Plan F" after a year on "plan something else" I got tired of doctor bills that often came months after my visit. Now I don't see a bill. It is sometimes up to six months before I see the Medicare and then Supplement report on what was paid. It maybe different with TFL, but I wouldn't think so. If you are seen by someone that doesn't accept medicare, you could get a surprise. Be careful of what you sign, as you should be informed if no medicare assignment.

[Rover]

With Medicare and TFL, I usually don’t have to pay any deductible. TFL has covered the Medicare deductible each year. I think one year I had to pay a few dollars toward a Tricare deductible but don’t remember why. 
 

Vicki

 

[Second Chance]

2 hours ago, Rover said:

With Medicare and TFL, I usually don’t have to pay any deductible. TFL has covered the Medicare deductible each year. I think one year I had to pay a few dollars toward a Tricare deductible but don’t remember why. 
 

Vicki

 

I've never had to pay a TFL deductible of any kind. As a secondary payer, TFL has picked up anything Medicare didn't.

Rob

[Twotoes]

13 hours ago, docj said:

To clarify, if you have a Plan F Supplement it will cover your Medicare Part B deductible.

No docj. I have Plan G and it pays the 20%. You don’t have to have Plan F. 

[chirakawa]

1 hour ago, Twotoes said:

No docj. I have Plan G and it pays the 20%. You don’t have to have Plan F. 

That's not what he said.  Plan G does not pay the deductible.

[docj]

3 hours ago, Twotoes said:

No docj. I have Plan G and it pays the 20%. You don’t have to have Plan F. 

The 20% isn't a deductible, it's a copay.  To my knowledge only Plan F covers the deductible.

[Captain Happy]

There are well over 1000 supplemental plans out there, and it you want cheap, that's what your going to wind up with. Now if you want a plan that'll  pay any left over co-pay that Medicare does not pay for your going to have to up the amount you willing to pay. If you don't have a lot medical expenses your probably OK with a Advantage Plan.

Like others have stated if you want the whole amount paid get yourself an Mutual of Omaha Plan "F".

And if your like me and have heart failure, a pace-maker and all kinds of Cardio doctors that you have to deal with, you going to need a Plan "F" to cover the co-pays not covered by Medicare. Now if your on a lot of meds your also need a drug plan like Silver Script, and their other out there.

[Ray,IN]

58 minutes ago, Captain Happy said:

There are well over 1000 supplemental plans out there, and it you want cheap, that's what your going to wind up with. Now if you want a plan that'll  pay any left over co-pay that Medicare does not pay for your going to have to up the amount you willing to pay. If you don't have a lot medical expenses your probably OK with a Advantage Plan.

Like others have stated if you want the whole amount paid get yourself an Mutual of Omaha Plan "F".

And if your like me and have heart failure, a pace-maker and all kinds of Cardio doctors that you have to deal with, you going to need a Plan "F" to cover the co-pays not covered by Medicare. Now if your on a lot of meds your also need a drug plan like Silver Script, and their other out there.

Since ronandlaine  are retired military, there is nothing better for less money on the commercial market than the Medicare/TRICARE combination. There are 2 things that combination does not cover, corrective vision and dental-which are extra- payment is in the form of a monthly deduction from your retirement pay.

TRICARE contracts Express-Scripts for prescription drug administration. There is no need to purchase a 2nd prescription drug insurance. No-one will ever find a comparable plan for less money. 

Edited November 23, 2019 by Ray,IN

[hamrs_62]

I do not think everyone qualifies for the plan G or F, if you smoke or have a preexisting condition, they might reject you 

[chirakawa]

55 minutes ago, hamrs_62 said:

I do not think everyone qualifies for the plan G or F, if you smoke or have a preexisting condition, they might reject you 

The same is true of all the Part B supplemental plans.  They don't have to accept your business.

[docj]

2 hours ago, chirakawa said:

The same is true of all the Part B supplemental plans.  They don't have to accept your business.

During the initial 6 months following a person's Medicare eligibility date this isn't true.  You can sign up for Medigap Supplemental plans (they cover more than Part B gaps) with no restrictions during that period.  Once you get past that 6 months or if you want to transfer from one carrier to another you might have to pay a higher premium or you could be rejected due to pre-existing conditions.

[docj]

13 hours ago, Captain Happy said:

if you want the whole amount paid get yourself an Mutual of Omaha Plan "F".

To clarify, all Plan F policies are exactly the same with respect to the primary coverage.  Some may include extra benefits, such as Silver Sneakers, but the Medicare-prescribed coverage is exactly the same for all of them regardless of which carrier you buy it from.

[chirakawa]

20 minutes ago, docj said:

During the initial 6 months following a person's Medicare eligibility date this isn't true.  You can sign up for Medigap Supplemental plans (they cover more than Part B gaps) with no restrictions during that period.  Once you get past that 6 months or if you want to transfer from one carrier to another you might have to pay a higher premium or you could be rejected due to pre-existing conditions.

That's what I meant.

[Captain Happy]

Update:  forgot I received a notice from Mutual of Omaha a few months ago, I think it stated that there no longer writing Plan F plans for new customers, but are going to honor all who already have the plan in force.

In my previous I used the name Mutual of Omaha as the plan carrier I'm using. What I should have stated is that all Plan F's are the same no matter who writes them. Sorry

[j2catfish]

22 hours ago, Ray,IN said:

Since ronandlaine  are retired military, there is nothing better for less money on the commercial market than the Medicare/TRICARE combination. There are 2 things that combination does not cover, corrective vision and dental-which are extra- payment is in the form of a monthly deduction from your retirement pay.

TRICARE contracts Express-Scripts for prescription drug administration. There is no need to purchase a 2nd prescription drug insurance. No-one will ever find a comparable plan for less money. 

X2: The combination above is without a doubt the best medical coverage for old military folk over 65.  Really, only cost 20 years (or more) in service to our country. Thanks to the actions of a retired Col from the U S Air Force (Bud Day - MOA)  who pushed Congress to enact the TFL program after the recruiters made promises that were not authorized that said we would get medical care  for life if we stayed for 20 years. All retired military owe Col Day a big thank you. 

Semper Fi,

Catfish