Humana Medigap Plans

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jim779
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Humana Medigap Plans

Post by jim779 »

Just wondering if anyone had any experience with Humana Medigap plans?

My Dad is with Mutual of Omaha with a Medigap G plan that costs $390 a month he is caught in a closed pool and I'm looking to try other companies for him.
TellMeMore
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Re: Humana Medigap Plans

Post by TellMeMore »

I don't have personal experience with Humana Medigap plans but I worked with some folks who seemed to consistently have problems with them getting things processed, approved, and paid.

I have United American, high deductible, G plan, for $48/month that I'm happy with. The standard G cost is currently $247/month according to the medicare website, age, sex, and smoking depending.

You can check out the medicare website medigap supplemental insurance plans for some detailed information that might be helpful.

(Oh, I do have a Humana Part D plan this year that is working well).
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dodecahedron
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Re: Humana Medigap Plans

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TellMeMore wrote: Mon Jul 08, 2024 6:07 pm I don't have personal experience with Humana Medigap plans but I worked with some folks who seemed to consistently have problems with them getting things processed, approved, and paid.
Are you sure those folks have Humana Medigap plans, as opposed to Humana Medicare Advantage plans? My understanding is that Medigap carriers have no discretion to approve or disapprove claims. Rather, if original Medicare approved the claim and paid its share, the Medigap carrier is automatically obligated to pay their contractual share. Discretion to approve or disapprove only happens with MA claims.

That said, I have a Humana Medigap Plan F-HD. They certainly process claims promptly and they seem to be doing all the accounting properly but I have (fortunately) not yet come anywhere near reaching the Plan F-HD deductible/OOP max, so I can only trust that if I ever did reach the deductible, they would pay as agreed.
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cheese_breath
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Re: Humana Medigap Plans

Post by cheese_breath »

dodecahedron wrote: Mon Jul 08, 2024 6:41 pm Are you sure those folks have Humana Medigap plans, as opposed to Humana Medicare Advantage plans? My understanding is that Medigap carriers have no discretion to approve or disapprove claims. Rather, if original Medicare approved the claim and paid its share, the Medigap carrier is automatically obligated to pay their contractual share. Discretion to approve or disapprove only happens with MA claims.
AFAIK the only MA plans that have this discretion are HMO MAs. And the only time they could do that would be if the service required pre-approval, and the patient didn't get it.
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InMyDreams
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Re: Humana Medigap Plans

Post by InMyDreams »

OP, are you sure your father's state will allow him to change plans/providers without underwriting? That may be the biggest hurdle.
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dodecahedron
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Re: Humana Medigap Plans

Post by dodecahedron »

cheese_breath wrote: Mon Jul 08, 2024 7:08 pm
dodecahedron wrote: Mon Jul 08, 2024 6:41 pm Are you sure those folks have Humana Medigap plans, as opposed to Humana Medicare Advantage plans? My understanding is that Medigap carriers have no discretion to approve or disapprove claims. Rather, if original Medicare approved the claim and paid its share, the Medigap carrier is automatically obligated to pay their contractual share. Discretion to approve or disapprove only happens with MA claims.
AFAIK the only MA plans that have this discretion are HMO MAs. And the only time they could do that would be if the service required pre-approval, and the patient didn't get it.
MA PPO plans certainly do have discretion to require prior approval. I was on two different MA PPO plans (highly ranked ones) for several years before switching to original Medicare plus Medigap. Member handbooks for both my former PPOs made it quite clear that except in emergencies certain treatments (e.g.,chemotherapy, skilled nursing stays after hospitalization, surgery, MRI, etc.) would require prior authorization.

The KFF report below says that in 2021, 99% of all MA participants were in plans that require prior authorization for at least some procedures. 35 million such requests were submitted of which 2 million were denied in full or in part. Only 11% of those denials were appealed but 82% of the appeals succeeded. The report gives comparisons statistics for about a dozen large MA insurance carriers. Humana MA participants had a relatively high rate of needing to request prior authorization but also had a relatively low percentage of denials.

https://www.kff.org/medicare/issue-brie ... s-in-2021/

That said, a major regional hospital chain (Albany Med) and a very regional group practice recently announced they would no longer accept any Humana MA coverage though they will continue to accept Humana Medigap coverage. Their reasoning cited the increasingly burdensome approval process and encouraged patients to select another MA provider. Coincidentally, they specifically recommended the MA provider I used to have. (Their announcement came when it was still open enrollment for switching among MA plans.)
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cheese_breath
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Re: Humana Medigap Plans

Post by cheese_breath »

dodecahedron wrote: Mon Jul 08, 2024 11:06 pm
cheese_breath wrote: Mon Jul 08, 2024 7:08 pm
dodecahedron wrote: Mon Jul 08, 2024 6:41 pm Are you sure those folks have Humana Medigap plans, as opposed to Humana Medicare Advantage plans? My understanding is that Medigap carriers have no discretion to approve or disapprove claims. Rather, if original Medicare approved the claim and paid its share, the Medigap carrier is automatically obligated to pay their contractual share. Discretion to approve or disapprove only happens with MA claims.
AFAIK the only MA plans that have this discretion are HMO MAs. And the only time they could do that would be if the service required pre-approval, and the patient didn't get it.
MA PPO plans certainly do have discretion to require prior approval. I was on two different MA PPO plans (highly ranked ones) for several years before switching to original Medicare plus Medigap. Member handbooks for both my former PPOs made it quite clear that except in emergencies certain treatments (e.g.,chemotherapy, skilled nursing stays after hospitalization, surgery, MRI, etc.) would require prior authorization.
OK, but once it's approved and treatment received, the MA doesn't have discretion to deny the claim.
The surest way to know the future is when it becomes the past.
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dodecahedron
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Re: Humana Medigap Plans

Post by dodecahedron »

cheese_breath wrote: Mon Jul 08, 2024 11:46 pm
dodecahedron wrote: Mon Jul 08, 2024 11:06 pm
cheese_breath wrote: Mon Jul 08, 2024 7:08 pm
dodecahedron wrote: Mon Jul 08, 2024 6:41 pm Are you sure those folks have Humana Medigap plans, as opposed to Humana Medicare Advantage plans? My understanding is that Medigap carriers have no discretion to approve or disapprove claims. Rather, if original Medicare approved the claim and paid its share, the Medigap carrier is automatically obligated to pay their contractual share. Discretion to approve or disapprove only happens with MA claims.
AFAIK the only MA plans that have this discretion are HMO MAs. And the only time they could do that would be if the service required pre-approval, and the patient didn't get it.
MA PPO plans certainly do have discretion to require prior approval. I was on two different MA PPO plans (highly ranked ones) for several years before switching to original Medicare plus Medigap. Member handbooks for both my former PPOs made it quite clear that except in emergencies certain treatments (e.g.,chemotherapy, skilled nursing stays after hospitalization, surgery, MRI, etc.) would require prior authorization.
OK, but once it's approved and treatment received, the MA doesn't have discretion to deny the claim.
Agreed but it can be challenging for patients and their providers to navigate that approval process, which can be lengthy and burdensome on health care professionals. With original Medicare plus Medigap, only rarely is pre approval required and it is not by the Medigap carrier, just Medicare.
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jim779
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Re: Humana Medigap Plans

Post by jim779 »

Thanks for the replies everyone!

Yes my Dad will have to go through underwriting.

Dodecahedron

If you have been on the high deductible f for a while have the premiums increased steeply since you were first insured?

My Dad's almost doubled in 5 years with Mutual of Omaha with a Medigap G.
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dodecahedron
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Re: Humana Medigap Plans

Post by dodecahedron »

jim779 wrote: Tue Jul 09, 2024 12:10 am Thanks for the replies everyone!

Yes my Dad will have to go through underwriting.

Dodecahedron

If you have been on the high deductible f for a while have the premiums increased steeply since you were first insured?

My Dad's almost doubled in 5 years with Mutual of Omaha with a Medigap G.
No change in premiums since I started looking into the Humana F-HD policy in 2022.
TellMeMore
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Re: Humana Medigap Plans

Post by TellMeMore »

dodecahedron wrote: Mon Jul 08, 2024 6:41 pm
TellMeMore wrote: Mon Jul 08, 2024 6:07 pm I don't have personal experience with Humana Medigap plans but I worked with some folks who seemed to consistently have problems with them getting things processed, approved, and paid.
Are you sure those folks have Humana Medigap plans, as opposed to Humana Medicare Advantage plans?
dodecahedron

It's entirely possible that they were actually MA plans - that would make more sense.
InMyDreams
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Re: Humana Medigap Plans

Post by InMyDreams »

jim779 wrote: Tue Jul 09, 2024 12:10 am
Yes my Dad will have to go through underwriting.
...
My Dad's almost doubled in 5 years with Mutual of Omaha with a Medigap G.
There's a thread somewhere, probably in the last year or so, with the advice a BHer had received about being in a dead pool.

I have NOT tried this, and you would need to do your own homework (including finding the thread to verify),

but I think this person was told that since he had never exercised the one-year trial on an MA plan, he could join an MA plan for a short period, then switch back to a Medigap plan, presumably not in the dead-pooled lot.

YMMV. Please do your own homework about this. IANAL.
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cheese_breath
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Re: Humana Medigap Plans

Post by cheese_breath »

InMyDreams wrote: Tue Jul 09, 2024 12:48 pm
jim779 wrote: Tue Jul 09, 2024 12:10 am
Yes my Dad will have to go through underwriting.
...
My Dad's almost doubled in 5 years with Mutual of Omaha with a Medigap G.
There's a thread somewhere, probably in the last year or so, with the advice a BHer had received about being in a dead pool.

I have NOT tried this, and you would need to do your own homework (including finding the thread to verify),

but I think this person was told that since he had never exercised the one-year trial on an MA plan, he could join an MA plan for a short period, then switch back to a Medigap plan, presumably not in the dead-pooled lot.

YMMV. Please do your own homework about this. IANAL.
I think this might be the thread you're referring to,

viewtopic.php?t=390150

I'm in the same dead pool. I don't know if anybody has actually tried this though. I didn't. I don't want to risk being without any medigap plan if it doesn't work. Maybe the thread's OP could tell you more.
The surest way to know the future is when it becomes the past.
Topic Author
jim779
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Re: Humana Medigap Plans

Post by jim779 »

Thanks Inmydreams

I know about the switch back loophole. I think my Dad will make it through underwriting so hopefully he won't need it.

I didn't even think it was legal to keep closing and opening pools like this.

It's given me a lot of grief because I took a lot of time trying to get my Dad good insurance.
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