Do I need more than Original Medicare?

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michaeljc70
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Re: Do I need more than Original Medicare?

Post by michaeljc70 » Wed Nov 07, 2018 11:10 am

Leesbro63 wrote:
Wed Nov 07, 2018 10:27 am
michaeljc70 wrote:
Tue Nov 06, 2018 9:43 am
It would be useful to see examples of the out of pocket costs with only parts A&B. For example, if you had a heart attack, diabetes, etc. I did a quick search and didn't find anything. I think the numbers would startle you if you think you don't need any other coverage. My Grandfather had a torn aorta and it was almost $500k in bills.
I agree most need a Medicare supplement to reduce risk. That being said, how much did Medicare actually pay of your grandfather’s $500,000 aorta repair? And how much was covered at 100% under Part A, and what was the “exposed” patient portion under Part B?
He had an excellent supplement paid by his former employer (GM) and so that covered almost everything. He passed last year so I have no idea if he didn't have the supplement what his out of pocket would have been. Doing a rough calculation since Part A pay 80%, he could have been on the hook for $100k without supplemental coverage.

carolynb2
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Re: Do I need more than Original Medicare?

Post by carolynb2 » Thu Nov 08, 2018 11:36 am

If you fail to enroll when you first have the opportunity to do so you will suffer some life long consequences if you change your mind later:

1) permanently higher premiums for D, and I think (I may be wrong) for B
2) medical underwriting (in nearly every state) for medigap and you may be denied it or can only get it if you pay much higher premiums
3) If you choose the cheapest medigap policy now and later decide you want to get better coverage then in most states you are subjected to #2.
4)In some states even changing companies but keeping the same policy (eg have G keep G) outside of your enrollment period can subject you to underwriting.
5) There are other pricing rules (see community rated, age attained and age signed up for the differences) that may or may not affect you depending on what you pick or where you live.

As a result there are several issues you need to consider, the biggest of which is that you can not predict the future and may end up being denied coverage for any of the medigap policies.

The cost of the cheapest D is around $20/mo in most states. You can switch companies and policies with no penalty each year during the enrollment period.

The combined cost of B and a gap policy is around $300/mo, or less depending on which policy you pick (see warning #3)

As others have said, it is insurance that you buy "just in case". I am a profit center for my car insurance and renters insurance company. II still pay those premiums just in case. I am a loss center for my health insurance company. I used to be a profit center for them too until a couple of years ago. None of that could have been predicted with certainty. If you are a zillionaire likely the entire issue is irrelevant because even if your expenses run into the millions you'd still have enough to live. I'm not so it matters.

If you are looking at protecting your future wealth then buying for what you might need in the future, not what you need now (due to the penalties and possibility of being denied) makes sense.

As a side note - gap F and gap C will not be sold after 2020. You can keep it if you are in it, but it will be closed to new purchasers. The problem with buying that will be the effects of no younger people in the risk pool. Eventually the premiums will skyrocket more so than G because G will still have incoming younger people.

Leesbro63
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Re: Do I need more than Original Medicare?

Post by Leesbro63 » Thu Nov 08, 2018 11:50 am

michaeljc70 wrote:
Wed Nov 07, 2018 11:10 am
Leesbro63 wrote:
Wed Nov 07, 2018 10:27 am
michaeljc70 wrote:
Tue Nov 06, 2018 9:43 am
It would be useful to see examples of the out of pocket costs with only parts A&B. For example, if you had a heart attack, diabetes, etc. I did a quick search and didn't find anything. I think the numbers would startle you if you think you don't need any other coverage. My Grandfather had a torn aorta and it was almost $500k in bills.
I agree most need a Medicare supplement to reduce risk. That being said, how much did Medicare actually pay of your grandfather’s $500,000 aorta repair? And how much was covered at 100% under Part A, and what was the “exposed” patient portion under Part B?
He had an excellent supplement paid by his former employer (GM) and so that covered almost everything. He passed last year so I have no idea if he didn't have the supplement what his out of pocket would have been. Doing a rough calculation since Part A pay 80%, he could have been on the hook for $100k without supplemental coverage.
Is that right? Does Part A (for the hospital) pay only 80%? Maybe someone can clarify, using this situation as a good example, which parts of Medicare pay what, what's left to a privately purchased supplement and what's out of pocket with or without a supplement. For those who have "Original/Traditional Medicare".

mouses
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Re: Do I need more than Original Medicare?

Post by mouses » Thu Nov 08, 2018 11:53 am

kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
I am turning 65 in December 2018. Im have signed up for Medicare and I got my card. I am on the fence about signing up for a Medicare Supplement or a Medicare Advantage plan immediately. I can afford, and do not mind paying, Part A and Part B deductibles. I do not need Part D because my drugs costs are minimal. What I like about original Medicare is that I can go to any doctor or convenient care center that accepts Medicare in the US. I plan to go with Original Medicare for a year, and then reassess. What do you think?
I have AARP Medigap. I can go to any doctor.

I would not risk having only Medicare and no Medigap. Bills can be enormous.

mouses
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Re: Do I need more than Original Medicare?

Post by mouses » Thu Nov 08, 2018 12:07 pm

downshiftme wrote:
Tue Nov 06, 2018 6:17 pm
I am not yet Medicare age but am concerned about what kind of plan I may soon sign up for. My experience with regular health insurance makes me very concerned that Medicare Advantage plans may have exclusions or in-network vs out-of-network issues similar to the issues I had with regular employer provided health insurance. No matter how careful I was, there could still be a surprise out-of-network provider and a bill 10x the expected cost. Is this as much of a problem with Medicare Advantage plans as it is with regular employer provided health insurance?
This is one of the reasons I have Medigap and not Medicare Advantage, I had enough of the insurance companies running the game when I was on Megacorp's insurance. Medigap is night and day different, because the insurance company providing it has no say in what is covered. If Medicare covers it, Medigap covers it.

kay8bee
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Re: Do I need more than Original Medicare?

Post by kay8bee » Sat Nov 10, 2018 2:48 pm

I am the OP and want to let you know that the excellent advice all the posters provided compelled me to purchase a Medigap plan and a drug plan. I am so glad I asked this forum! Thank you, thank you, thank you!

Shallowpockets
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Re: Do I need more than Original Medicare?

Post by Shallowpockets » Sun Nov 11, 2018 2:31 am

You don't know what you don't know.
And that could hurt you down the line. Either with coverage or penalties (additional
payments for life) for not signing up for certain things since the beginning.
Once again I stress buying Medicare for Dummies. Those that don't can suffer any consequences of their failure to know when they could have.

MathIsMyWayr
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Re: Do I need more than Original Medicare?

Post by MathIsMyWayr » Sun Nov 11, 2018 5:24 am

mouses wrote:
Thu Nov 08, 2018 12:07 pm
downshiftme wrote:
Tue Nov 06, 2018 6:17 pm
I am not yet Medicare age but am concerned about what kind of plan I may soon sign up for. My experience with regular health insurance makes me very concerned that Medicare Advantage plans may have exclusions or in-network vs out-of-network issues similar to the issues I had with regular employer provided health insurance. No matter how careful I was, there could still be a surprise out-of-network provider and a bill 10x the expected cost. Is this as much of a problem with Medicare Advantage plans as it is with regular employer provided health insurance?
This is one of the reasons I have Medigap and not Medicare Advantage, I had enough of the insurance companies running the game when I was on Megacorp's insurance. Medigap is night and day different, because the insurance company providing it has no say in what is covered. If Medicare covers it, Medigap covers it.
Can you switch between Medigap and Medicare Advantage? If so, are there any restrictions such as underwriting?
  • Who sets the premiums of Medigap, Medicare or individual insurance companies?
    Is Medigap subject to IRMAA?

kaneohe
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Re: Do I need more than Original Medicare?

Post by kaneohe » Sun Nov 11, 2018 8:02 am

MathIsMyWayr wrote:
Sun Nov 11, 2018 5:24 am
..........................................
Can you switch between Medigap and Medicare Advantage? If so, are there any restrictions such as underwriting?
  • Who sets the premiums of Medigap, Medicare or individual insurance companies?
    Is Medigap subject to IRMAA?
https://www.google.com/search?q=can+i+s ... e&ie=UTF-8

Switching is more easily done from Medigap to Advantage; harder going the other way which may require underwriting. I assume the Medigap premiums are set by the individual companies. If you are subject to IRMAA, it will get you one way or another but not via Medigap premiums. If you are getting SS, IRMAA will be applied to your Medicare premiums and reduce your SS received. If you are not getting SS, I would guess that your Medicare premiums that you pay directly would be increased.

If you are not sure about Medigap vs Advantage, it might be better to get a higher level Medigap to begin with since it is usually easier to move downstream (to lower level Medigap or Advantage) than to go the other way.

FBN2014
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Re: Do I need more than Original Medicare?

Post by FBN2014 » Sun Nov 11, 2018 8:24 am

You have one chance during initial enrollment to buy a supplement plan and Part D without going through medical underwriting. If you don't take advantage of this and you get sick in the future then you will either be denied coverage or the premiums will be exorbitant. In addition there are significant penalties for not enrolling now. You are being penny wise and pound foolish. Good luck with your gamble.
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Leesbro63
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Re: Do I need more than Original Medicare?

Post by Leesbro63 » Sun Nov 11, 2018 9:21 am

kaneohe wrote:
Sun Nov 11, 2018 8:02 am
MathIsMyWayr wrote:
Sun Nov 11, 2018 5:24 am
..........................................
Can you switch between Medigap and Medicare Advantage? If so, are there any restrictions such as underwriting?
  • Who sets the premiums of Medigap, Medicare or individual insurance companies?
    Is Medigap subject to IRMAA?
https://www.google.com/search?q=can+i+s ... e&ie=UTF-8

Switching is more easily done from Medigap to Advantage; harder going the other way which may require underwriting. I assume the Medigap premiums are set by the individual companies. If you are subject to IRMAA, it will get you one way or another but not via Medigap premiums. If you are getting SS, IRMAA will be applied to your Medicare premiums and reduce your SS received. If you are not getting SS, I would guess that your Medicare premiums that you pay directly would be increased.

If you are not sure about Medigap vs Advantage, it might be better to get a higher level Medigap to begin with since it is usually easier to move downstream (to lower level Medigap or Advantage) than to go the other way.
+1. This. A good friend of mine, age 70 with significant health issues, had his Medicare Advantage network limited for 2019. He smugly boasted that he’ll just switch back to Original Meducare and buy a Plan F supplement. He got a rude awakening in that no supplement insurer will write him. So he’s basically stuck trying to get another Medicare Advantage program that works better for him. But he will still limited in freedom of choice.

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dm200
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Re: Do I need more than Original Medicare?

Post by dm200 » Sun Nov 11, 2018 1:16 pm

This. A good friend of mine, age 70 with significant health issues, had his Medicare Advantage network limited for 2019. He smugly boasted that he’ll just switch back to Original Meducare and buy a Plan F supplement. He got a rude awakening in that no supplement insurer will write him. So he’s basically stuck trying to get another Medicare Advantage program that works better for him. But he will still limited in freedom of choice.
True - but I suspect that in most areas there are very adequate provider networks.

Oddly, to, in this area a great many Primary Care Physicians will not accept new Medicare patients, but are part of a Medicare Advantage plan and accept new MA patients. So, in this area, Original Medicare folks have a limited number of Primary Care Physicians they can see.

MathIsMyWayr
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Re: Do I need more than Original Medicare?

Post by MathIsMyWayr » Sun Nov 11, 2018 2:41 pm

If you develop a serious health problem, can you see specialists out of your Medicare Advantage plan?

Leesbro63
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Re: Do I need more than Original Medicare?

Post by Leesbro63 » Sun Nov 11, 2018 2:54 pm

MathIsMyWayr wrote:
Sun Nov 11, 2018 2:41 pm
If you develop a serious health problem, can you see specialists out of your Medicare Advantage plan?
That’s the issue for my friend. Afraid of losing the ability to go to a Cleveland Clinic or Mayo or Sloan-Kettering etc.

Austintatious
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Re: Do I need more than Original Medicare?

Post by Austintatious » Sun Nov 11, 2018 3:04 pm

It looks like coverage through a prior employer's health plan is not an issue for you but, if it is or might later be, be sure to check on whether or not signing up for Part B coverage is required by the employer's plan. Some require it. And, as discussed earlier in the thread, make sure that you'll have the ability to pass on coverage now and sign up for what you want later.

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HueyLD
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Re: Do I need more than Original Medicare?

Post by HueyLD » Sun Nov 11, 2018 3:06 pm

When I am old enough to join the Medicare club, I will go with traditional plus supplement.

No way that I want to go with MA because MA providers in my area really suck. Recently, a major MA provider could not come up with an agreement with the largest hospital in town and that caused tremendous hardship for a lot of people. Let me guess, the vast majority of Medicare age people do not want to change their healthcare providers, especially when they are sick.

MathIsMyWayr
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Re: Do I need more than Original Medicare?

Post by MathIsMyWayr » Sun Nov 11, 2018 3:10 pm

dm200 wrote:
Sun Nov 11, 2018 1:16 pm
This. A good friend of mine, age 70 with significant health issues, had his Medicare Advantage network limited for 2019. He smugly boasted that he’ll just switch back to Original Meducare and buy a Plan F supplement. He got a rude awakening in that no supplement insurer will write him. So he’s basically stuck trying to get another Medicare Advantage program that works better for him. But he will still limited in freedom of choice.
True - but I suspect that in most areas there are very adequate provider networks.

Oddly, to, in this area a great many Primary Care Physicians will not accept new Medicare patients, but are part of a Medicare Advantage plan and accept new MA patients. So, in this area, Original Medicare folks have a limited number of Primary Care Physicians they can see.
Leesbro63 wrote:
Sun Nov 11, 2018 2:54 pm
MathIsMyWayr wrote:
Sun Nov 11, 2018 2:41 pm
If you develop a serious health problem, can you see specialists out of your Medicare Advantage plan?
That’s the issue for my friend. Afraid of losing the ability to go to a Cleveland Clinic or Mayo or Sloan-Kettering etc.
If I have to weigh between "Medigap: a limited number of Primary Care Physicians they can see" and "Medicare Advantage: losing the ability to go to a Cleveland Clinic or Mayo or Sloan-Kettering etc", I am inclined to choose the flexibility of seeing specialist. If I am proactive, I may do ok with an average pcp, but I want to choose the best specialists because my life may be at stake.

Gretchen
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Re: Do I need more than Original Medicare?

Post by Gretchen » Sun Nov 11, 2018 3:17 pm

We have Medicare and Anthem MedBlue, thank goodness. DH was diagnosed with colon cancer last year, and the combination of surgery plus chemotherapy totaled about $300K. Our share was less than $5K.

His checkups so far have been fine, so he's back to spending money on camera equipment. He was actually less expensive when he wasn't well!

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dm200
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Re: Do I need more than Original Medicare?

Post by dm200 » Sun Nov 11, 2018 3:51 pm

HueyLD wrote:
Sun Nov 11, 2018 3:06 pm
Let me guess, the vast majority of Medicare age people do not want to change their healthcare providers, especially when they are sick.
In my case, I do not mind changing physicians (either primary or specialty) as long as it does not happen frequently. I had to do that eight years ago, and, on balance, now believe the newer ones were better. Some changes in physicians over that eight years - not because of network changes - but the Physicians retired.

StarsandStripes
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Re: Do I need more than Original Medicare?

Post by StarsandStripes » Sun Nov 11, 2018 4:34 pm

When picking part D make sure all of your drugs are covered and your pharmacy is a preferred provider for the plan. Call heck days supply covered. Last find out if you have to use mail order with a 90 day supply. This last item is important as not all doctors will allow 90 day supplies.

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dm200
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Re: Do I need more than Original Medicare?

Post by dm200 » Sun Nov 11, 2018 4:55 pm

StarsandStripes wrote:
Sun Nov 11, 2018 4:34 pm
When picking part D make sure all of your drugs are covered and your pharmacy is a preferred provider for the plan. Call heck days supply covered. Last find out if you have to use mail order with a 90 day supply. This last item is important as not all doctors will allow 90 day supplies.
Most (but not all) Medicare Advantage plans include drug coverage. Check out such drug coverage to see how it fits your situation.

dollarsaver
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Re: Do I need more than Original Medicare?

Post by dollarsaver » Sun Nov 11, 2018 5:20 pm

dodecahedron wrote:
Sun Nov 04, 2018 8:08 pm
kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
What I like about original Medicare is that I can go to any doctor or convenient care center that accepts Medicare in the US. I plan to go with Original Medicare for a year, and then reassess. What do you think?
Other options ALSO let you go to any doctor or convenient care center that accepts Medicare in the US but also limit your exposure.

Option 1) Add a Medigap plan to your traditional Medicare. All the benefits of traditional Medicare PLUS the Medigap pays some or all of your coinsurance and deductibles. Your OOP max can be held quite low--for an additional monthly premium cost.

Option 2) Substitute a PPO Medicare Advantage (not an HMO!) plan. A PPO Medicare Advantage plan also allows you to go to any doctor anywhere in the country that accepts Medicare, but again limits your OOP max. I have a plan like this. Zero dollar monthly premiums. Slightly higher copays if I go out of network, but quite manageable. The OOP max is lower than what I managed to get used to with my previous ACA plan. And it covers stuff that traditional Medicare and Medigap do not (e.g., hearing aid benefits, vision care, a $240 allowance for preventive dental care I can use at the dentist of my choice, free Silver Sneakers membership allowing me to use gyms all over the place. Free online video visits with doctors. Part D benefits are also included which keeps my life simple. Like the OP, I do not take any prescriptions now so the minimalistic Part D is fine for now.)

That said, I live in a state (NY) which guarantees me the option to switch back and forth among Medicare Advantage and Medigap plans in future years without needing to worry about preexisting conditions, etc.

If I lived in most other states, I would have agonized harder over this choice.
Hi. Where can I find the list of states which guarantee to be able to switch each year between Medigap plans and Medicare Advantage Plans without underwriting like NY?

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dm200
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Re: Do I need more than Original Medicare?

Post by dm200 » Sun Nov 11, 2018 5:37 pm

Although not common, Medicare Cost (MC) plans allow use of Original medicare from any provider that accept Original medicare. However, due to regulations, etc. many MC plans are being terminated.

Although we do not plan to use this feature, our plan is an MC plan.

URSnshn
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Re: Do I need more than Original Medicare?

Post by URSnshn » Sun Nov 11, 2018 5:44 pm

As a side note - gap F and gap C will not be sold after 2020. You can keep it if you are in it, but it will be closed to new purchasers. The problem with buying that will be the effects of no younger people in the risk pool. Eventually the premiums will skyrocket more so than G because G will still have incoming younger people.
carolynb2 - Your statement (above) made me a do a double take. I've been helping some relatives out with Medicare and we attended a SHIP Medicare class. I think Plan F is open to new purchasers who were/will be Medicare eligible prior to 1/1/2010 on an ongoing basis - am I correct or did I misunderstand?


THAT SAID, your take on increasing premiums is interesting and was not discussed in the class - thank you for sharing this!

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cheese_breath
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Re: Do I need more than Original Medicare?

Post by cheese_breath » Sun Nov 11, 2018 7:59 pm

URSnshn wrote:
Sun Nov 11, 2018 5:44 pm
As a side note - gap F and gap C will not be sold after 2020. You can keep it if you are in it, but it will be closed to new purchasers. The problem with buying that will be the effects of no younger people in the risk pool. Eventually the premiums will skyrocket more so than G because G will still have incoming younger people.
carolynb2 - Your statement (above) made me a do a double take. I've been helping some relatives out with Medicare and we attended a SHIP Medicare class. I think Plan F is open to new purchasers who were/will be Medicare eligible prior to 1/1/2010 on an ongoing basis - am I correct or did I misunderstand?


THAT SAID, your take on increasing premiums is interesting and was not discussed in the class - thank you for sharing this!
DW and I both left Plan C because of premiums possibly skyrocking as the pool grows older. If you search the forum you'll find others who left C or F for the same reason. I went to Plan G. DW went to N. She can't pass underwriting to go to a different company, but her current company allowed current C subscribers to move to N if they wanted.
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Kevin M
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Re: Do I need more than Original Medicare?

Post by Kevin M » Sun Nov 11, 2018 9:00 pm

The Medicare Advantage PPO plan I have through my employer-retiree program covers everything the same for out of network and in network providers. Why would a Medicare supplement plan be better?

My employer-retiree program does not offer a supplement plan.

Interestingly, the provider they use, UHC, seems to offer only Medicare Advantage HMO plans on the open market in my area. Of course they also offer supplement plans.

Kevin
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Leesbro63
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Re: Do I need more than Original Medicare?

Post by Leesbro63 » Mon Nov 12, 2018 6:48 am

Kevin M wrote:
Sun Nov 11, 2018 9:00 pm
The Medicare Advantage PPO plan I have through my employer-retiree program covers everything the same for out of network and in network providers. Why would a Medicare supplement plan be better?

My employer-retiree program does not offer a supplement plan.

Interestingly, the provider they use, UHC, seems to offer only Medicare Advantage HMO plans on the open market in my area. Of course they also offer supplement plans.

Kevin

Could you go to Mayo Clinic? MD Anderson? Sloan-Kettering? Cleveland Clinic? If not, you’re giving up something, perhaps something huge, that Original Medicare (with supplement) recipients have.

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dm200
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Re: Do I need more than Original Medicare?

Post by dm200 » Mon Nov 12, 2018 12:24 pm

Kevin M wrote:
Sun Nov 11, 2018 9:00 pm
The Medicare Advantage PPO plan I have through my employer-retiree program covers everything the same for out of network and in network providers. Why would a Medicare supplement plan be better?
My employer-retiree program does not offer a supplement plan.
Interestingly, the provider they use, UHC, seems to offer only Medicare Advantage HMO plans on the open market in my area. Of course they also offer supplement plans.
Kevin
I know several folks who have a MA plan as part of their County or School retirement. Unlike most MA plans, these folks' plans have no out of pocket maximums -- so all is paid from the beginning.

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Kevin M
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Re: Do I need more than Original Medicare?

Post by Kevin M » Mon Nov 12, 2018 12:35 pm

Leesbro63 wrote:
Mon Nov 12, 2018 6:48 am
Kevin M wrote:
Sun Nov 11, 2018 9:00 pm
The Medicare Advantage PPO plan I have through my employer-retiree program covers everything the same for out of network and in network providers. Why would a Medicare supplement plan be better?

My employer-retiree program does not offer a supplement plan.

Interestingly, the provider they use, UHC, seems to offer only Medicare Advantage HMO plans on the open market in my area. Of course they also offer supplement plans.

Kevin
Could you go to Mayo Clinic? MD Anderson? Sloan-Kettering? Cleveland Clinic? If not, you’re giving up something, perhaps something huge, that Original Medicare (with supplement) recipients have.
As far as I know, yes. My interpretation of "out of network" is that there is no restriction on the provider you use for a service (other than it's in the US). The copays, coinsurance, deductibles, etc., are exactly the same for out of network and in network providers.

Kevin
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HueyLD
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Re: Do I need more than Original Medicare?

Post by HueyLD » Mon Nov 12, 2018 12:55 pm

I am confused Kevin.

If all payments are the same, why did they bother with any network?

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Kevin M
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Re: Do I need more than Original Medicare?

Post by Kevin M » Mon Nov 12, 2018 1:04 pm

HueyLD wrote:
Mon Nov 12, 2018 12:55 pm
I am confused Kevin.

If all payments are the same, why did they bother with any network?
Good question. I have no idea, and found that pretty surprising myself. I guess their network is relevant to their HMO plans, and although the same network is used for this PPO plan, for whatever reason there seems to be no penalty for using out of network providers.

Kevin
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Re: Do I need more than Original Medicare?

Post by dodecahedron » Mon Nov 12, 2018 1:16 pm

Kevin M wrote:
Mon Nov 12, 2018 12:35 pm
Leesbro63 wrote:
Mon Nov 12, 2018 6:48 am
Kevin M wrote:
Sun Nov 11, 2018 9:00 pm
The Medicare Advantage PPO plan I have through my employer-retiree program covers everything the same for out of network and in network providers. Why would a Medicare supplement plan be better?

My employer-retiree program does not offer a supplement plan.

Interestingly, the provider they use, UHC, seems to offer only Medicare Advantage HMO plans on the open market in my area. Of course they also offer supplement plans.

Kevin
Could you go to Mayo Clinic? MD Anderson? Sloan-Kettering? Cleveland Clinic? If not, you’re giving up something, perhaps something huge, that Original Medicare (with supplement) recipients have.
As far as I know, yes. My interpretation of "out of network" is that there is no restriction on the provider you use for a service (other than it's in the US). The copays, coinsurance, deductibles, etc., are exactly the same for out of network and in network providers.

Kevin
I also have a Medicare Advantage PPO (similar to Kevin´s) and it seems to be a good deal to me for now (given that I am in relatively good health.) But there is one important caveat. Yes, a Medicare Advantage PPO will generally pay for you to go to any doctor (in or out of network) but if your doctor (whether in network or out of network) recommends an expensive procedure, your PPO is much more likely to require ¨prior authorization¨ of that procedure than traditional Medicare is. That can add delay and stress and possibly require multiple time-consuming appeals from you and/or your doc before you get the particular procedure (if at all.) Medicare, by contrast, seems to pretty much rubber stamp any procedure the doctor recommends to you (as long as it is not experimental/exotic.) E.g., if your doctor feels you need a hysterectomy for some condition, traditional Medicare and Medigap are not going to second-guess your doctor´s recommendation. By contrast, your MA PPO may want to review a detailed justification for the procedure before giving the go-ahead.

The MA PPO I have chosen seems to have a reasonably good reputation for granting prior authorizations without excessive delay or redtape, but that could certainly change down the road. If it does, I am glad that I live in a state (NY) where I have the annual right to change from my MA plan back to traditional Medicare and Medigap without underwriting in the future.

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dodecahedron
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Re: Do I need more than Original Medicare?

Post by dodecahedron » Mon Nov 12, 2018 1:22 pm

Kevin M wrote:
Mon Nov 12, 2018 1:04 pm
HueyLD wrote:
Mon Nov 12, 2018 12:55 pm
I am confused Kevin.

If all payments are the same, why did they bother with any network?
Good question. I have no idea, and found that pretty surprising myself. I guess their network is relevant to their HMO plans, and although the same network is used for this PPO plan, for whatever reason there seems to be no penalty for using out of network providers.

Kevin
See my previous post. It is conceivable that network providers are more familiar with how to fill out the paperwork to maximize the likelihood that prior authorization will be promptly granted for any procedures that require them. Out-of-network providers may not even want to take you on as a patient if your MA PPO has given them a hard time on their recommended procedures in the past. Just because your MA PPO says they will cover your expenses at out-of-network providers does not guarantee those out-of-network providers want to deal with your insurance plan.

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Re: Do I need more than Original Medicare?

Post by dm200 » Mon Nov 12, 2018 1:26 pm

dodecahedron wrote:
Mon Nov 12, 2018 1:16 pm
Kevin M wrote:
Mon Nov 12, 2018 12:35 pm
Leesbro63 wrote:
Mon Nov 12, 2018 6:48 am
Kevin M wrote:
Sun Nov 11, 2018 9:00 pm
The Medicare Advantage PPO plan I have through my employer-retiree program covers everything the same for out of network and in network providers. Why would a Medicare supplement plan be better?
My employer-retiree program does not offer a supplement plan.
Interestingly, the provider they use, UHC, seems to offer only Medicare Advantage HMO plans on the open market in my area. Of course they also offer supplement plans.
Kevin
Could you go to Mayo Clinic? MD Anderson? Sloan-Kettering? Cleveland Clinic? If not, you’re giving up something, perhaps something huge, that Original Medicare (with supplement) recipients have.
As far as I know, yes. My interpretation of "out of network" is that there is no restriction on the provider you use for a service (other than it's in the US). The copays, coinsurance, deductibles, etc., are exactly the same for out of network and in network providers.
Kevin
I also have a Medicare Advantage PPO (similar to Kevin´s) and it seems to be a good deal to me for now (given that I am in relatively good health.) But there is one important caveat. Yes, a Medicare Advantage PPO will generally pay for you to go to any doctor (in or out of network) but if your doctor (whether in network or out of network) recommends an expensive procedure, your PPO is much more likely to require ¨prior authorization¨ of that procedure than traditional Medicare is. That can add delay and stress and possibly require multiple time-consuming appeals from you and/or your doc before you get the particular procedure (if at all.) Medicare, by contrast, seems to pretty much rubber stamp any procedure the doctor recommends to you (as long as it is not experimental/exotic.) E.g., if your doctor feels you need a hysterectomy for some condition, traditional Medicare and Medigap are not going to second-guess your doctor´s recommendation. By contrast, your MA PPO may want to review a detailed justification for the procedure before giving the go-ahead.
The MA PPO I have chosen seems to have a reasonably good reputation for granting prior authorizations without excessive delay or redtape, but that could certainly change down the road. If it does, I am glad that I live in a state (NY) where I have the annual right to change from my MA plan back to traditional Medicare and Medigap without underwriting in the future.
There are different degrees of such "prior authorization" requirements - especially regarding seeing a specialist. Some actually require your PCP to authorize almost all such visits, while others only require the initial visit. My Medicare plan is very flexible and only requires the initial referral/authorization - and almost always is near immediate.

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Re: Do I need more than Original Medicare?

Post by dodecahedron » Mon Nov 12, 2018 1:30 pm

dm200 wrote:
Mon Nov 12, 2018 1:26 pm
dodecahedron wrote:
Mon Nov 12, 2018 1:16 pm
Kevin M wrote:
Mon Nov 12, 2018 12:35 pm
As far as I know, yes. My interpretation of "out of network" is that there is no restriction on the provider you use for a service (other than it's in the US). The copays, coinsurance, deductibles, etc., are exactly the same for out of network and in network providers.
Kevin
Yes, a Medicare Advantage PPO will generally pay for you to go to any doctor (in or out of network) but if your doctor (whether in network or out of network) recommends an expensive procedure, your PPO is much more likely to require ¨prior authorization¨ of that procedure than traditional Medicare is. That can add delay and stress and possibly require multiple time-consuming appeals from you and/or your doc before you get the particular procedure (if at all.) Medicare, by contrast, seems to pretty much rubber stamp any procedure the doctor recommends to you (as long as it is not experimental/exotic.) E.g., if your doctor feels you need a hysterectomy for some condition, traditional Medicare and Medigap are not going to second-guess your doctor´s recommendation. By contrast, your MA PPO may want to review a detailed justification for the procedure before giving the go-ahead.
The MA PPO I have chosen seems to have a reasonably good reputation for granting prior authorizations without excessive delay or redtape, but that could certainly change down the road. If it does, I am glad that I live in a state (NY) where I have the annual right to change from my MA plan back to traditional Medicare and Medigap without underwriting in the future.
There are different degrees of such "prior authorization" requirements - especially regarding seeing a specialist. Some actually require your PCP to authorize almost all such visits, while others only require the initial visit. My Medicare plan is very flexible and only requires the initial referral/authorization - and almost always is near immediate.
DM, I agree that different MA plans have stricter or more lenient prior authorization requirements. The link to the study I posted above indicates that too. My MA plan also has a reputation being very flexible--for now. But there is no guarantee that your plan or my plan will be so easygoing in the future. (For that matter, there is no guarantee that traditional Medicare will so easygoing in the future.) I am happy that my state gives me the right to switch plans without underwriting in the future.
Last edited by dodecahedron on Mon Nov 12, 2018 1:32 pm, edited 2 times in total.

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Re: Do I need more than Original Medicare?

Post by Leesbro63 » Mon Nov 12, 2018 1:30 pm

The whole prospect of a PPO reimbursing “full sticker”, out-of-network fees, with so cap or fee-schedule, does not pass the smell test.

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Re: Do I need more than Original Medicare?

Post by dodecahedron » Mon Nov 12, 2018 1:35 pm

Leesbro63 wrote:
Mon Nov 12, 2018 1:30 pm
The whole prospect of a PPO reimbursing “full sticker”, out-of-network fees, with so cap or fee-schedule, does not pass the smell test.
My MA PPO is not going to reimburse ¨full sticker." My PPO will allow me to go to any doc (in or out of network) as long as the doctor accepts Medicare. If my provider is out-of-network, the provider will get the Medicare approved fee, not their sticker price.

Edited to add: my PPO is not as generous as Kevin´s in that it does have somewhat higher copays and OOP max for out-of-network providers, so I do have some incentive to stay in network. (Then again, I am paying $0 premiums and I am guessing Kevin´s previous employer is paying a substantial sum to his MA PPO.) My PPO´s regional network is quite large and comprehensive so I am not really concerned about routine stuff. If I get something really problematic, I would probably start with a regional provider (in network) anyway. If that doesn´t look like it is working by the time annual changes are available, time to consider switching.
Last edited by dodecahedron on Mon Nov 12, 2018 1:45 pm, edited 1 time in total.

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Re: Do I need more than Original Medicare?

Post by dm200 » Mon Nov 12, 2018 1:38 pm

DM, I agree that different MA plans have stricter or more lenient prior authorization requirements. My MA plan also has a reputation being very flexible--for now. But there is no guarantee that your plan or my plan will be so easygoing in the future. (For that matter, there is no guarantee that traditional Medicare will so easygoing in the future.) I am happy that my state gives me the right to switch plans without underwriting in the future.
Over the decades, we have had "regular" insurance (no referrals needed), HMOs (several types) and PPOs (several types). While the paperwork and bureaucracy differed, we never felt or believed that we ever were prohibited from seeing the appropriate specialist for our conditions.

Also, with so much being done by email and electronic communication, as well as sharing of medical records - such referrals and prior authorization can now be done very quickly. Recently, for example, my wife was referred to a general surgeon for a situation by here PCP at a 10 am appointment -- and saw the General Surgeon at 12 noon - at another nearby facility.

In your case, I wonder if that right to switch is at any risk of change?

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Re: Do I need more than Original Medicare?

Post by dodecahedron » Mon Nov 12, 2018 1:53 pm

dm200 wrote:
Mon Nov 12, 2018 1:38 pm
DM, I agree that different MA plans have stricter or more lenient prior authorization requirements. My MA plan also has a reputation being very flexible--for now. But there is no guarantee that your plan or my plan will be so easygoing in the future. (For that matter, there is no guarantee that traditional Medicare will so easygoing in the future.) I am happy that my state gives me the right to switch plans without underwriting in the future.
Over the decades, we have had "regular" insurance (no referrals needed), HMOs (several types) and PPOs (several types). While the paperwork and bureaucracy differed, we never felt or believed that we ever were prohibited from seeing the appropriate specialist for our conditions.

Also, with so much being done by email and electronic communication, as well as sharing of medical records - such referrals and prior authorization can now be done very quickly. Recently, for example, my wife was referred to a general surgeon for a situation by here PCP at a 10 am appointment -- and saw the General Surgeon at 12 noon - at another nearby facility.

In your case, I wonder if that right to switch is at any risk of change?
Everything, of course, is subject to risk of change. It is a matter of what it takes to make change happen. NYS law guarantees my right to change by prohibiting Medigap insurers in my state from requiring underwriting from people who switch. Losing that right would require legislative change (which can´t be discussed here.) But any change in that law would be highly visible and presumably I would be able to switch before it took effect.

By contrast, as far as I know, no law constrains a MA insurer from deciding to be tougher in granting prior authorization for expensive procedures. An MA insurer can change their prior authorization standards more or less on a whim in the future. And such internal policy review changes might not be visible or widely publicized.

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Re: Do I need more than Original Medicare?

Post by Leesbro63 » Mon Nov 12, 2018 1:55 pm

dodecahedron wrote:
Mon Nov 12, 2018 1:35 pm
Leesbro63 wrote:
Mon Nov 12, 2018 1:30 pm
The whole prospect of a PPO reimbursing “full sticker”, out-of-network fees, with so cap or fee-schedule, does not pass the smell test.
My MA PPO is not going to reimburse ¨full sticker." My PPO will allow me to go to any doc (in or out of network) as long as the doctor accepts Medicare. If my provider is out-of-network, the provider will get the Medicare approved fee, not their sticker price.

Edited to add: my PPO is not as generous as Kevin´s in that it does have somewhat higher copays and OOP max for out-of-network providers, so I do have some incentive to stay in network. (Then again, I am paying $0 premiums and I am guessing Kevin´s previous employer is paying a substantial sum to his MA PPO.) My PPO´s regional network is quite large and comprehensive so I am not really concerned about routine stuff. If I get something really problematic, I would probably start with a regional provider (in network) anyway. If that doesn´t look like it is working by the time annual changes are available, time to consider switching.
But just because the provider “accepts Medicare” doesn’t mean he/she has to accept that from you, the out of Original Medicare patient. Can’t the provider bill you “full sticker”, as a cash patient? And whatever you get from your MA PPO is between you and them?

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Re: Do I need more than Original Medicare?

Post by Broken Man 1999 » Mon Nov 12, 2018 1:57 pm

Kevin M wrote:
Mon Nov 12, 2018 1:04 pm
HueyLD wrote:
Mon Nov 12, 2018 12:55 pm
I am confused Kevin.

If all payments are the same, why did they bother with any network?
Good question. I have no idea, and found that pretty surprising myself. I guess their network is relevant to their HMO plans, and although the same network is used for this PPO plan, for whatever reason there seems to be no penalty for using out of network providers.

Kevin
I am perplexed as well, Kevin, about my employer retiree insurance offerings for 2019. I'm pleased, but puzzled.

We have a PPO via retiree insurance. This year, we pay $53.50/month for both of us. This year our retiree insurance also offered an HMO for $0/month for both of us. Made sense that the HMO insurance would be less, as you had to stay in-network. Both are Humana plans.

However, retiree insurance for 2019 costs $0/month for both of us for either the HMO or the PPO. The PPO has max OOP/member of $3000. The HMO has max OOP/member of $2500. A few other copays are slightly higher for PPO than the HMO.

Though I have been on the PPO for several years, I have never needed out-of-network services. I was considering going to the HMO for next year to shave the $630/year. Looks like my employer eliminated the difference.

I believe over time only one flavor will be offered. Hard to see why they would maintain two plans so similar.

I had an expensive 2017, but even with all my issues I only had OOP of $1,441.11. For 2018 my OOP thus far is $780.61. Wife is new to my plan, and has an OOP of $942.91. She has had eye surgery, and is currently getting PT for bad knees. She has been on the plan since June of this year.

I don't think the difference of $500 OOP for the HMO or the PPO will matter, as I haven't come close to $3000 OOP or even $2500 OOP in all the years I've had the PPO. One nice thing about both plans is having zero deductibles for medical or pharmacy.

Much like auto and homeowners insurance, I have no idea how the healthcare sausage is made. I am grateful MegaCorp is still providing excellent health insurance for retirees.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

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Re: Do I need more than Original Medicare?

Post by Kevin M » Mon Nov 12, 2018 2:06 pm

Kevin M wrote:
Mon Nov 12, 2018 1:04 pm
HueyLD wrote:
Mon Nov 12, 2018 12:55 pm
I am confused Kevin.

If all payments are the same, why did they bother with any network?
Good question. I have no idea, and found that pretty surprising myself. I guess their network is relevant to their HMO plans, and although the same network is used for this PPO plan, for whatever reason there seems to be no penalty for using out of network providers.

Kevin
Other than the possible issues already mentioned (e.g., prior authorization hassles), in reading the exact plan language, the other catch is that the provider must "accept the plan" (of course they also must not have opted out of or been excluded from Medicare, but that would apply to all the options we're discussing).

So, if any of the institutions mentioned, or any other providers, don't accept UHC Group Medicare Advantage (PPO), then I wouldn't be covered under my insurance.

Other than this, it's clearly stated that I can see any provider, network or out-of-network, "at the same cost share".

Kevin
Wiki ||.......|| Suggested format for Asking Portfolio Questions (edit original post)

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Re: Do I need more than Original Medicare?

Post by dodecahedron » Mon Nov 12, 2018 2:14 pm

Leesbro63 wrote:
Mon Nov 12, 2018 1:55 pm
dodecahedron wrote:
Mon Nov 12, 2018 1:35 pm
Leesbro63 wrote:
Mon Nov 12, 2018 1:30 pm
The whole prospect of a PPO reimbursing “full sticker”, out-of-network fees, with so cap or fee-schedule, does not pass the smell test.
My MA PPO is not going to reimburse ¨full sticker." My PPO will allow me to go to any doc (in or out of network) as long as the doctor accepts Medicare. If my provider is out-of-network, the provider will get the Medicare approved fee, not their sticker price.

Edited to add: my PPO is not as generous as Kevin´s in that it does have somewhat higher copays and OOP max for out-of-network providers, so I do have some incentive to stay in network. (Then again, I am paying $0 premiums and I am guessing Kevin´s previous employer is paying a substantial sum to his MA PPO.) My PPO´s regional network is quite large and comprehensive so I am not really concerned about routine stuff. If I get something really problematic, I would probably start with a regional provider (in network) anyway. If that doesn´t look like it is working by the time annual changes are available, time to consider switching.
But just because the provider “accepts Medicare” doesn’t mean he/she has to accept that from you, the out of Original Medicare patient. Can’t the provider bill you “full sticker”, as a cash patient? And whatever you get from your MA PPO is between you and them?
No, my PPO is quite explicit in its contract. If I go to an in-network specialist, my out-of-pocket cost will be limited to my $50 in-network copay. If I go to an out-of-network specialist, as long as s/he accepts Medicare, my out-of-pocket cost is limited to my $60 out-of-network copay. (For primary care, the corresponding copays are $0 and $50, by the way. And no referrals are needed for any specialist I choose, in or out of network, as long as the latter accept Medicare.) I assume the doc is not allowed to charge my MA PPO more than the Medicare approved fee, but that is their problem not mine, according to the terms of my contract. (Similar very explicit contractual specifications of what my OOP cost will be for in and out of network hospital care. I also have annual OOP max caps on my total in-network and out-of-network providers.)

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Re: Do I need more than Original Medicare?

Post by Leesbro63 » Mon Nov 12, 2018 2:17 pm

dodecahedron wrote:
Mon Nov 12, 2018 2:14 pm
Leesbro63 wrote:
Mon Nov 12, 2018 1:55 pm
dodecahedron wrote:
Mon Nov 12, 2018 1:35 pm
Leesbro63 wrote:
Mon Nov 12, 2018 1:30 pm
The whole prospect of a PPO reimbursing “full sticker”, out-of-network fees, with so cap or fee-schedule, does not pass the smell test.
My MA PPO is not going to reimburse ¨full sticker." My PPO will allow me to go to any doc (in or out of network) as long as the doctor accepts Medicare. If my provider is out-of-network, the provider will get the Medicare approved fee, not their sticker price.

Edited to add: my PPO is not as generous as Kevin´s in that it does have somewhat higher copays and OOP max for out-of-network providers, so I do have some incentive to stay in network. (Then again, I am paying $0 premiums and I am guessing Kevin´s previous employer is paying a substantial sum to his MA PPO.) My PPO´s regional network is quite large and comprehensive so I am not really concerned about routine stuff. If I get something really problematic, I would probably start with a regional provider (in network) anyway. If that doesn´t look like it is working by the time annual changes are available, time to consider switching.
But just because the provider “accepts Medicare” doesn’t mean he/she has to accept that from you, the out of Original Medicare patient. Can’t the provider bill you “full sticker”, as a cash patient? And whatever you get from your MA PPO is between you and them?
No, my PPO is quite explicit in its contract. If I go to an in-network specialist, my out-of-pocket cost will be limited to my $50 in-network copay. If I go to an out-of-network specialist, as long as s/he accepts Medicare, my out-of-pocket cost is limited to my $60 out-of-network copay. (For primary care, the corresponding copays are $0 and $50, by the way. And no referrals are needed for any specialist I choose, in or out of network, as long as the latter accept Medicare.) I assume the doc is not allowed to charge my MA PPO more than the Medicare approved fee, but that is their problem not mine, according to the terms of my contract. (I also have annual OOP max caps on my total in-network and out-of-network providers.)
Then I admit your plan sounds like the best of all worlds. There must be something, either Federal or state law...or maybe your network thing...where a doc who accepts Medicare has to accept that from members like you who see them as an out-of-network patient.

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Re: Do I need more than Original Medicare?

Post by Leesbro63 » Mon Nov 12, 2018 2:20 pm

Not directly related but worth discussion: The one big, glaring "loophole" from the old healthcare system, that still exists today, is the ability of providers to charge anything they want and for cash patients to be legally obligated to pay that. A $100,000 hospital bill can cost a cash patient $100,000...or force bankruptcy...but the hospital might only be able to legallt collect $20,000 from the combination of the insured patient and his insurance company.

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Re: Do I need more than Original Medicare?

Post by dm200 » Mon Nov 12, 2018 2:21 pm

I am grateful MegaCorp is still providing excellent health insurance for retirees.
Be careful and cautious when reaching Medicare eligibility. Most private companies are dropping any such retiree coverage for those eligible for Medicare.

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Re: Do I need more than Original Medicare?

Post by dodecahedron » Mon Nov 12, 2018 2:25 pm

Leesbro63 wrote:
Mon Nov 12, 2018 2:17 pm
dodecahedron wrote:
Mon Nov 12, 2018 2:14 pm
No, my PPO is quite explicit in its contract. If I go to an in-network specialist, my out-of-pocket cost will be limited to my $50 in-network copay. If I go to an out-of-network specialist, as long as s/he accepts Medicare, my out-of-pocket cost is limited to my $60 out-of-network copay. (For primary care, the corresponding copays are $0 and $50, by the way. And no referrals are needed for any specialist I choose, in or out of network, as long as the latter accept Medicare.) I assume the doc is not allowed to charge my MA PPO more than the Medicare approved fee, but that is their problem not mine, according to the terms of my contract. (I also have annual OOP max caps on my total in-network and out-of-network providers.)
Then I admit your plan sounds like the best of all worlds. There must be something, either Federal or state law...or maybe your network thing...where a doc who accepts Medicare has to accept that from members like you who see them as an out-of-network patient.
I am pretty sure it is due to a provision in federal law, which has heavily tilted towards Medicare Advantage plans in recent years. Then again, it needs to be kept in mind that many docs are not accepting new Medicare patients at all, regardless of whether they are traditional Medicare, HMO, PPO.

So the fact that my insurance company (of any type MA or traditional with Medigap) would cover my care at a given physician if s/he will accept me as a patient is no guarantee that I can actually see him or her. But under the law, I believe that if s/he agrees to accept me as a patient, and if I have any form of Medicare coverage (Advantage or traditional), they can´t charge more than Medicare allows.

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Re: Do I need more than Original Medicare?

Post by dm200 » Mon Nov 12, 2018 2:28 pm

dodecahedron wrote:
Mon Nov 12, 2018 2:25 pm
Leesbro63 wrote:
Mon Nov 12, 2018 2:17 pm
dodecahedron wrote:
Mon Nov 12, 2018 2:14 pm
No, my PPO is quite explicit in its contract. If I go to an in-network specialist, my out-of-pocket cost will be limited to my $50 in-network copay. If I go to an out-of-network specialist, as long as s/he accepts Medicare, my out-of-pocket cost is limited to my $60 out-of-network copay. (For primary care, the corresponding copays are $0 and $50, by the way. And no referrals are needed for any specialist I choose, in or out of network, as long as the latter accept Medicare.) I assume the doc is not allowed to charge my MA PPO more than the Medicare approved fee, but that is their problem not mine, according to the terms of my contract. (I also have annual OOP max caps on my total in-network and out-of-network providers.)
Then I admit your plan sounds like the best of all worlds. There must be something, either Federal or state law...or maybe your network thing...where a doc who accepts Medicare has to accept that from members like you who see them as an out-of-network patient.
I am pretty sure it is due to a provision in federal law, which has heavily tilted towards Medicare Advantage plans in recent years. Then again, it needs to be kept in mind that many docs are not accepting new Medicare patients at all, regardless of whether they are traditional Medicare, HMO, PPO.
So the fact that my insurance company (of any type MA or traditional with Medigap) would cover my care at a given physician if s/he will accept me as a patient is no guarantee that I can actually see him or her. But under the law, I believe that if s/he agrees to accept me as a patient, and if I have any form of Medicare coverage (Advantage or traditional), they can´t charge more than Medicare allows.
Yes - in this area, a lot of PCPs will not accept new Original Medicare patients.

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Re: Do I need more than Original Medicare?

Post by HueyLD » Mon Nov 12, 2018 2:32 pm

Medicare.gov says:

"Non-participating providers haven't signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services. These providers are called "non-participating."

Here's what happens if your doctor, provider, or supplier doesn't accept assignment:

You might have to pay the entire charge at the time of service. Your doctor, provider, or supplier is supposed to submit a claim to Medicare for any Medicare-covered services they provide to you.

They can't charge you for submitting a claim. If they don't submit the Medicare claim once you ask them to, call 1‑800‑MEDICARE.

In some cases, you might have to submit your own claim to Medicare using Form CMS-1490S to get paid back.

They can charge you more than the Medicare-approved amount, but there's a limit called "the limiting charge ". The provider can only charge you up to 15% over the amount that non-participating providers are paid. Non-participating providers are paid 95% of the fee schedule amount.

The limiting charge applies only to certain Medicare-covered services and doesn't apply to some supplies and durable medical equipment."

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Re: Do I need more than Original Medicare?

Post by dodecahedron » Mon Nov 12, 2018 2:35 pm

dm200 wrote:
Mon Nov 12, 2018 2:21 pm
I am grateful MegaCorp is still providing excellent health insurance for retirees.
Be careful and cautious when reaching Medicare eligibility. Most private companies are dropping any such retiree coverage for those eligible for Medicare.
Indeed, that has happened at a number of employers around here. Most prominently, General Electric dropped their retiree health plans a few years ago. GE employees were shocked, particularly the unionized ones. Two separate class action lawsuits were filed, one by salaried employees, one by union members. Appeals in both class action suits have now been dismissed. Employees are on their own to buy insurance plans in the open market, though GE does give them a fixed amount of cash (I believe it is $1,000 for employee) to help pay for the coverage they select. Compared to what they had before, this is bad enough for those of Medicare age but even worse for many of those who are not yet 65 and need to buy an individual policy from the ACA exchange.

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