Is Medigap insurance really needed?

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills.
betterdays
Posts: 34
Joined: Sun May 11, 2014 9:08 am

Re: Is Medigap insurance really needed?

Post by betterdays »

My former employer dropped retiree coverage for those on Medicare. I will need to pick out a medigap plan very soon.

Does anyone know if Medigap Plan 'F' will fully cover ALL my medical expenses? I know I will also need Medicare part D also, but I'm researching the medical plans first.

Thanks in advance.
Longdog
Posts: 2180
Joined: Sun Feb 09, 2014 5:56 pm
Location: Philadelphia

Re: Is Medigap insurance really needed?

Post by Longdog »

One way to think of it is that it is prepaying the inevitable. Most of us aren't fortunate enough to live a life without any health complications until we simply die in our sleep at a ripe old age, after spending our last day doing something we love with our closest friends and family.
Steve
User avatar
cheese_breath
Posts: 11786
Joined: Wed Sep 14, 2011 7:08 pm

Re: Is Medigap insurance really needed?

Post by cheese_breath »

betterdays wrote:...Does anyone know if Medigap Plan 'F' will fully cover ALL my medical expenses?...
No Medigap plan will cover ALL your medical expenses, only the ones covered by Medicare. If Medicare doesn't cover it Medigap won't either, except some Medigap plans may cover a limited amount incurred outside the USA.
The surest way to know the future is when it becomes the past.
betterdays
Posts: 34
Joined: Sun May 11, 2014 9:08 am

Re: Is Medigap insurance really needed?

Post by betterdays »

Let me clarify my question.

Will Medigap plan F cover ALL the medical expense(s) left over after medicare pays their part for covered expense(s)?

Thanks
User avatar
Kevin M
Posts: 15787
Joined: Mon Jun 29, 2009 3:24 pm
Contact:

Re: Is Medigap insurance really needed?

Post by Kevin M »

nisiprius wrote:That in itself is interesting, though, because you apparently believe in the "annual physical."
Actually, the main reason I went is that I know my doc won't refill certain prescriptions unless I see him now and then. Another reason is that it is free, so why not?

Also, I'm lucky in that there's a health clinic associated with my ex-employer that I can go to get checked out and have minor procedures done for $5 per visit. I actually went there not too long after my physical last year to discuss the things my primary doc would've charged me to discuss, and to have a minor procedure done that he would have charged me for. So sharing more of the cost definitely is altering my behavior.

Kevin
If I make a calculation error, #Cruncher probably will let me know.
dbr
Posts: 46181
Joined: Sun Mar 04, 2007 8:50 am

Re: Is Medigap insurance really needed?

Post by dbr »

betterdays wrote:Let me clarify my question.

Will Medigap plan F cover ALL the medical expense(s) left over after medicare pays their part for covered expense(s)?

Thanks
There is still a deductible isn't there?
User avatar
cheese_breath
Posts: 11786
Joined: Wed Sep 14, 2011 7:08 pm

Re: Is Medigap insurance really needed?

Post by cheese_breath »

betterdays wrote:Let me clarify my question.

Will Medigap plan F cover ALL the medical expense(s) left over after medicare pays their part for covered expense(s)?

Thanks
Yes unless you choose the high deducible plan F. Then you have to pay the deductible first. Here's a chart comparing all the Medigap plan coverages side by side. Scroll down a page to get to the chart.

http://www.medicare.gov/supplement-othe ... digap.html
The surest way to know the future is when it becomes the past.
ddunca1944
Posts: 941
Joined: Fri Apr 01, 2011 1:49 pm

Re: Is Medigap insurance really needed?

Post by ddunca1944 »

betterdays wrote:Let me clarify my question.

Will Medigap plan F cover ALL the medical expense(s) left over after medicare pays their part for covered expense(s)?

Thanks
No - it won't cover dental or vision expenses.
User avatar
cheese_breath
Posts: 11786
Joined: Wed Sep 14, 2011 7:08 pm

Re: Is Medigap insurance really needed?

Post by cheese_breath »

ddunca1944 wrote:
betterdays wrote:Let me clarify my question.

Will Medigap plan F cover ALL the medical expense(s) left over after medicare pays their part for covered expense(s)?

Thanks
No - it won't cover dental or vision expenses.
Neither will Medicare cover normal medical and dental. They're not covered expenses. (*) But some surgical related expenses are covered. For example my cataract surgery and first pair of eyeglasses after were covered. And what the 20% Medicare didn't pay, my Medigap plan did.
Last edited by cheese_breath on Sun Aug 03, 2014 6:48 pm, edited 1 time in total.
The surest way to know the future is when it becomes the past.
mur44
Posts: 718
Joined: Tue Feb 27, 2007 8:30 am

Re: Is Medigap insurance really needed?

Post by mur44 »

betterdays,

If your retiree health insurance is terminated by your
employer, you have a 'guarantee issue' situation,
you can purchase a medigap plan. Plan 'F' is
one of the two popular plans.

You may want to visit your local State
Health Insurance assistance Program (SHIP)
counselor for free, unbiased consultation:

https://shipnpr.shiptalk.org/findcounselor.aspx


Disclosure: I am a Certified Volunteer Medicare (SHIP) Counselor from NJ
kaneohe
Posts: 6786
Joined: Mon Sep 22, 2008 12:38 pm

Re: Is Medigap insurance really needed?

Post by kaneohe »

cheese_breath wrote:
betterdays wrote:Let me clarify my question.

Will Medigap plan F cover ALL the medical expense(s) left over after medicare pays their part for covered expense(s)?

Thanks
Yes unless you choose the high deducible plan F. Then you have to pay the deductible first. Here's a chart comparing all the Medigap plan coverages side by side. Scroll down a page to get to the chart.

http://www.medicare.gov/supplement-othe ... digap.html
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up........this is from that chart which suggests that in the unlikely event of a very
long hospital stay, there is a cap and possibly costs that the medigap policy does not cover?
User avatar
nisiprius
Advisory Board
Posts: 52212
Joined: Thu Jul 26, 2007 9:33 am
Location: The terrestrial, globular, planetary hunk of matter, flattened at the poles, is my abode.--O. Henry

Re: Is Medigap insurance really needed?

Post by nisiprius »

mur44, if you have only traditional Medicare--parts A, B, and let's say D, but no supplemental (Medigap) or Medicare Advantage--is there ANY upper limit to the amount you might have to pay in part B co-pays?
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.
User avatar
Watty
Posts: 28859
Joined: Wed Oct 10, 2007 3:55 pm

Re: Is Medigap insurance really needed?

Post by Watty »

If you decide to not get the Medigap insurance then just remember that Medicare, with a few quirky exceptions, usually will not cover any of your expenses when you are out of the US.

The international coverage with the Medigap insurance depends on the plan and even that has many limitations so additional travel insurance may still be needed.
User avatar
cheese_breath
Posts: 11786
Joined: Wed Sep 14, 2011 7:08 pm

Re: Is Medigap insurance really needed?

Post by cheese_breath »

kaneohe wrote:
cheese_breath wrote:
betterdays wrote:Let me clarify my question.

Will Medigap plan F cover ALL the medical expense(s) left over after medicare pays their part for covered expense(s)?

Thanks
Yes unless you choose the high deducible plan F. Then you have to pay the deductible first. Here's a chart comparing all the Medigap plan coverages side by side. Scroll down a page to get to the chart.

http://www.medicare.gov/supplement-othe ... digap.html
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up........this is from that chart which suggests that in the unlikely event of a very
long hospital stay, there is a cap and possibly costs that the medigap policy does not cover?
Not sure I understand your question, but if you're asking what happens after Medicare core benefits and part A are used up, my guess would be Medigap benefits would be used up too. But that's just a guess.
The surest way to know the future is when it becomes the past.
S&L1940
Posts: 1658
Joined: Fri Nov 02, 2007 11:19 pm
Location: South Florida

Re: Is Medigap insurance really needed?

Post by S&L1940 »

cheese_breath wrote: Not sure I understand your question, but if you're asking what happens after Medicare core benefits and part A are used up, my guess would be Medigap benefits would be used up too. But that's just a guess.
Might be off track here but if there is no Medicare claim or benefits are used up, Medigap will not pay any additional bills.
I once used a doc that was not part of the Medicare program and Medigap would not pay any portion of his fees.

Finally, since we became Medicare eligible, the wife and I have not paid anything out of pocket other than drug co-pays and the odd procedure that was not Medicare approved. For this status, we pay something like $9,000 a year for A & B & D plus Medigap. And it is worth every penny.
I hope that helps and does not confuse things. Rich
Don't it always seem to go * That you don't know what you've got * Till it's gone
betterdays
Posts: 34
Joined: Sun May 11, 2014 9:08 am

Re: Is Medigap insurance really needed?

Post by betterdays »

1530jesup wrote: Finally, since we became Medicare eligible, the wife and I have not paid anything out of pocket other than drug co-pays and the odd procedure that was not Medicare approved. For this status, we pay something like $9,000 a year for A & B & D plus Medigap. And it is worth every penny.
I hope that helps and does not confuse things. Rich
1530jesup (aka Rich),

Which Medigap plan do you have?
And is the $9000.00 the Total cost for parts A,B,D and Medigap for both you and your spouse?
User avatar
cheese_breath
Posts: 11786
Joined: Wed Sep 14, 2011 7:08 pm

Re: Is Medigap insurance really needed?

Post by cheese_breath »

betterdays wrote:
1530jesup wrote: Finally, since we became Medicare eligible, the wife and I have not paid anything out of pocket other than drug co-pays and the odd procedure that was not Medicare approved. For this status, we pay something like $9,000 a year for A & B & D plus Medigap. And it is worth every penny.
I hope that helps and does not confuse things. Rich
1530jesup (aka Rich),

Which Medigap plan do you have?
And is the $9000.00 the Total cost for parts A,B,D and Medigap for both you and your spouse?
Part B, D, and Medigap are $6167 for my wife and I. Part A is free because I have enough credits. Do you have to buy into Part A, or do you just pay more for the other parts?
The surest way to know the future is when it becomes the past.
betterdays
Posts: 34
Joined: Sun May 11, 2014 9:08 am

Re: Is Medigap insurance really needed?

Post by betterdays »

cheese_breath wrote:
Part B, D, and Medigap are $6167 for my wife and I. Part A is free because I have enough credits. Do you have to buy into Part A, or do you just pay more for the other parts?
Wife isn't on medicare yet.

My Part A is no cost. Part B is 104.90/mo. I need to select a Part D plan and medigap plan starting in October 2014. Trying to decide the best plans for me without breaking the bank.
User avatar
cheese_breath
Posts: 11786
Joined: Wed Sep 14, 2011 7:08 pm

Re: Is Medigap insurance really needed?

Post by cheese_breath »

betterdays wrote:
cheese_breath wrote:
Part B, D, and Medigap are $6167 for my wife and I. Part A is free because I have enough credits. Do you have to buy into Part A, or do you just pay more for the other parts?
Wife isn't on medicare yet.

My Part A is no cost. Part B is 104.90/mo. I need to select a Part D plan and medigap plan starting in October 2014. Trying to decide the best plans for me without breaking the bank.
I intended my question for 1530jesup, not betterdays. Sorry, my bad.
The surest way to know the future is when it becomes the past.
dbr
Posts: 46181
Joined: Sun Mar 04, 2007 8:50 am

Re: Is Medigap insurance really needed?

Post by dbr »

$9000 per year for two people for Medicare A, B, and D and a cadillac Medigap plan is probably about right. You could price out the range of Medigap plans from all providers in your state. Note there are also a few states that don't offer standard A-F type Medigap plans but have alternatives where the price and coverage are not exactly the same. None of this is to be confused with Medicare Advantage plans, of course.
betterdays
Posts: 34
Joined: Sun May 11, 2014 9:08 am

Re: Is Medigap insurance really needed?

Post by betterdays »

cheese_breath wrote:
betterdays wrote:
cheese_breath wrote:
Part B, D, and Medigap are $6167 for my wife and I. Part A is free because I have enough credits. Do you have to buy into Part A, or do you just pay more for the other parts?
Would you break down your cost per plan?
TheGreyingDuke
Posts: 2219
Joined: Fri Sep 02, 2011 10:34 am

Re: Is Medigap insurance really needed?

Post by TheGreyingDuke »

nisiprius wrote:mur44, if you have only traditional Medicare--parts A, B, and let's say D, but no supplemental (Medigap) or Medicare Advantage--is there ANY upper limit to the amount you might have to pay in part B co-pays?
I don't have the definitive answer but I am taking care of the medical bills for a friend with cancer. He has Medicare A and B as well as a retiree plan that covers everything after the first $500. He has had enormous balances left after Medicare pays, that if it weren't for his retiree plan he would be on the hook for. One example was a bill for $81,000 for an outpatient radiation treatment (!) from University of California, SF. Medicare paid its share and then sent the balance to Aetna.

This gets a little bizarre as Aetna's agreement with UCSF has them paying $149,000 for the same procedure and they base their payment on that cost. Of the $81,000, Medicare paid $6100 and left a balance of $2000. That got sent to Aetna who applied their $149,000 reimbursement rate and they paid $8200.

Without the retiree plan my friend would have been responsible for the $2000 and that is just one of dozens of co-pays he would face this year No telling if there is an out of pocket limit as he is only out of pocket the modest deductible that Aetna imposes. Looking back at the Medicare reckoning of things, there is a total, so far this year, of about $7000 in co-pays that he would be responsible for, absent the retiree plan.
"Every time I see an adult on a bicycle, I no longer despair for the future of the human race." H.G. Wells
User avatar
cheese_breath
Posts: 11786
Joined: Wed Sep 14, 2011 7:08 pm

Re: Is Medigap insurance really needed?

Post by cheese_breath »

betterdays wrote:
cheese_breath wrote:
betterdays wrote:
cheese_breath wrote:
Part B, D, and Medigap are $6167 for my wife and I. Part A is free because I have enough credits. Do you have to buy into Part A, or do you just pay more for the other parts?
Would you break down your cost per plan?
Part B... $104.90 each
Part D (me) ... $16.10
Part D (wife) ... $54,60
Medigap... $121.22 each

These are the monthly premiums. Medigap is Michigan BCBS legacy plan C.
The surest way to know the future is when it becomes the past.
madbrain
Posts: 6806
Joined: Thu Jun 09, 2011 5:06 pm
Location: San Jose, California

Re: Is Medigap insurance really needed?

Post by madbrain »

cheese_breath wrote: It could be a LOT more costly. If you're discovered to have a serious medical condition or illness you might not be able to find a Medigap insurer who will accept you.
Are you saying that Medigap insurers can still screen for pre-existing conditions ?
I thought the ACA did away with all that.
TheGreyingDuke
Posts: 2219
Joined: Fri Sep 02, 2011 10:34 am

Re: Is Medigap insurance really needed?

Post by TheGreyingDuke »

madbrain wrote:
cheese_breath wrote: It could be a LOT more costly. If you're discovered to have a serious medical condition or illness you might not be able to find a Medigap insurer who will accept you.
Are you saying that Medigap insurers can still screen for pre-existing conditions ?
I thought the ACA did away with all that.
Not during the first six months that you are eligible for Medicare or if your carrier leaves the market (or if you move to an area where your carrier does not offer policies). There may be other qualifying events but otherwise the carriers are free to medically underwrite you, ACA did not change that :(
"Every time I see an adult on a bicycle, I no longer despair for the future of the human race." H.G. Wells
madbrain
Posts: 6806
Joined: Thu Jun 09, 2011 5:06 pm
Location: San Jose, California

Re: Is Medigap insurance really needed?

Post by madbrain »

TheGreyingDuke wrote:
madbrain wrote:
cheese_breath wrote: It could be a LOT more costly. If you're discovered to have a serious medical condition or illness you might not be able to find a Medigap insurer who will accept you.
Are you saying that Medigap insurers can still screen for pre-existing conditions ?
I thought the ACA did away with all that.
Not during the first six months that you are eligible for Medicare or if your carrier leaves the market (or if you move to an area where your carrier does not offer policies). There may be other qualifying events but otherwise the carriers are free to medically underwrite you, ACA did not change that :(
I see. I guess I still have 27 years to worry about it, hopefully this mess will be fixed by then.
It seems to me that for someone with chronic conditions, getting Medigap within the initial enrollment period would be a no-brainer, but I haven't done the math as it's too early.
mur44
Posts: 718
Joined: Tue Feb 27, 2007 8:30 am

Re: Is Medigap insurance really needed?

Post by mur44 »

nisiprius,

If one have Medicare Parts A, B and D (no medigap),
there is NO OOP (Out Of Pocket) limit. This
Medicare insurance (A, B and D) setup is for
'healthy' (yours and your family) individuals.

But, there are several 'tricks' one can use to
minimize OOP expenses.
TheGreyingDuke
Posts: 2219
Joined: Fri Sep 02, 2011 10:34 am

Re: Is Medigap insurance really needed?

Post by TheGreyingDuke »

mur44 wrote:nisiprius,

If one have Medicare Parts A, B and D (no medigap),
there is NO OOP (Out Of Pocket) limit. This
Medicare insurance (A, B and D) setup is for
'healthy' (yours and your family) individuals.

But, there are several 'tricks' one can use to
minimize OOP expenses.
:?: :?: :?:
"Every time I see an adult on a bicycle, I no longer despair for the future of the human race." H.G. Wells
User avatar
cheese_breath
Posts: 11786
Joined: Wed Sep 14, 2011 7:08 pm

Re: Is Medigap insurance really needed?

Post by cheese_breath »

madbrain wrote:
cheese_breath wrote: It could be a LOT more costly. If you're discovered to have a serious medical condition or illness you might not be able to find a Medigap insurer who will accept you.
Are you saying that Medigap insurers can still screen for pre-existing conditions ?
I thought the ACA did away with all that.
ACA and Medicare are different programs. ACA does not affect Medigap rules.
The surest way to know the future is when it becomes the past.
S&L1940
Posts: 1658
Joined: Fri Nov 02, 2007 11:19 pm
Location: South Florida

Re: Is Medigap insurance really needed?

Post by S&L1940 »

betterdays wrote:
1530jesup wrote: Finally, since we became Medicare eligible, the wife and I have not paid anything out of pocket other than drug co-pays and the odd procedure that was not Medicare approved. For this status, we pay something like $9,000 a year for A & B & D plus Medigap. And it is worth every penny.
I hope that helps and does not confuse things. Rich
1530jesup (aka Rich),
Which Medigap plan do you have?
And is the $9000.00 the Total cost for parts A,B,D and Medigap for both you and your spouse?
YES, the wife and I each have $104 per month ($208 combined) deducted from SS; our Medigap plan F - she with United World Mutual of Omaha, me with AARP/United Health - costs about $500 per month combined; part D with United Health $92 combined, per month.
rough math that is around $9600 a year for the both of us.

I do not believe that initial sign up for Medigap can deny for per-existing condition. If you delay, I know costs go up and they may be able to deny because I do not think Medigap is part of the Affordable Care program
Don't it always seem to go * That you don't know what you've got * Till it's gone
goaties
Posts: 542
Joined: Fri Jan 29, 2010 3:15 pm

Re: Is Medigap insurance really needed?

Post by goaties »

TheGreyingDuke wrote: ... One example was a bill for $81,000 for an outpatient radiation treatment (!) from University of California, SF. Medicare paid its share and then sent the balance to Aetna.

This gets a little bizarre as Aetna's agreement with UCSF has them paying $149,000 for the same procedure and they base their payment on that cost. Of the $81,000, Medicare paid $6100 and left a balance of $2000. That got sent to Aetna who applied their $149,000 reimbursement rate and they paid $8200.

Without the retiree plan my friend would have been responsible for the $2000.....
Um, are there some dropped zeroes in here? Did you mean to say Medicare paid $61,000 and left a balance of $20,000? Or was $8,100 Medicare's *allowed amount* for the $81,000 in services UCSF billed?

In other words, without Medigap maybe your friend would have been responsible for 20% of Medicare's *allowed amount*.....not 20% of whatever fictional number the radiation facility charges.
dolphinsaremammals
Posts: 2094
Joined: Tue Jul 22, 2014 4:18 pm

Re: Is Medigap insurance really needed?

Post by dolphinsaremammals »

dbr wrote:$9000 per year for two people for Medicare A, B, and D and a cadillac Medigap plan is probably about right. You could price out the range of Medigap plans from all providers in your state. Note there are also a few states that don't offer standard A-F type Medigap plans but have alternatives where the price and coverage are not exactly the same. None of this is to be confused with Medicare Advantage plans, of course.
These are my annual premiums for this year:

Plan A "free", paid for by previous working life paycheck deductions.
Plan B $1258.80
AARP Plan D $487.20
AARP Medigap $2132.50 (Plan F)

Total annual: $3878.50
rixer
Posts: 758
Joined: Tue Sep 11, 2012 4:18 pm

Re: Is Medigap insurance really needed?

Post by rixer »

Here's what I'm paying.

Medicare Plan A.... Free
Medicare Plan B.... $1258
Medicare Plan D.... $312
Medigap Plan F Hi-D $450
.................................
Total............... $2,020.

This keeps the cost down if I don't need much health care but if things are serious, the Plan F Hi D pays everything just like regular plan F after the deductible. For me, I have more good years than bad so I feel it's the best option for me. The nice thing about it is even if you have not met your deductible, 20% of what is left over after Medicare Part B pays 80%, is just 20% of the contracted price that medicare dictates and is usually pretty nominal. Don't let it scare you.
TheGreyingDuke
Posts: 2219
Joined: Fri Sep 02, 2011 10:34 am

Re: Is Medigap insurance really needed?

Post by TheGreyingDuke »

goaties wrote:
TheGreyingDuke wrote: ... One example was a bill for $81,000 for an outpatient radiation treatment (!) from University of California, SF. Medicare paid its share and then sent the balance to Aetna.

This gets a little bizarre as Aetna's agreement with UCSF has them paying $149,000 for the same procedure and they base their payment on that cost. Of the $81,000, Medicare paid $6100 and left a balance of $2000. That got sent to Aetna who applied their $149,000 reimbursement rate and they paid $8200.

Without the retiree plan my friend would have been responsible for the $2000.....
Um, are there some dropped zeroes in here? Did you mean to say Medicare paid $61,000 and left a balance of $20,000? Or was $8,100 Medicare's *allowed amount* for the $81,000 in services UCSF billed?

In other words, without Medigap maybe your friend would have been responsible for 20% of Medicare's *allowed amount*.....not 20% of whatever fictional number the radiation facility charges.
No error, just the fanciful and inscrutable world of medical billing. The billed amount and "allowed" amount were both $81000. The paid amount was $8100 and the balance sent to Aetna was $2000. You are correct that without the wrap around plan the total due would have been only the $2000, that's what the document indicates

You can see the whole grim picture here:https://docs.google.com/document/d/1-3s ... sp=sharing
"Every time I see an adult on a bicycle, I no longer despair for the future of the human race." H.G. Wells
Post Reply