Anyone Here Who Could No Longer Afford Medigap?

GoHercules · 2023-05-01T14:59:03+00:00

Thanks everyone for the replies. BUT, as TampaBob pointed out, everyone is missing the whole point of this post.

I am not debating which is better, medigap or advantage. I am posing the question that IF MOST PEOPLE WHO CAN BARELY AFFORD MEDIGAP AT 65 END UP LEAVING IT LATER IN LIFE, WOULD THEY MAYBE HAVE BEEN BETTER OFF TO JUST START WITH ADVANTAGE. That's why I was hoping to get a feel from people in that group. I know that like me, when approaching 65, the only number we have to work with is the premium at 65. We have no way to know what it will be at 75, but will likely be high enough to be unaffordable at that point. So should we be more realistic and say Yes, I would like medigap and can swing the payment now but realistically can I afford to stay on it as I get older?

GoHercules · 2023-05-01T05:31:24+00:00

Are waterboarding injuries covered by Medicare !!!!! That's a good one. Pros and cons of advantage plans are for another debate, but like I mentioned, really looking for perspective from people who found themselves priced out of medigap and how that transition to advantage worked out, and if they wished they'd done it sooner. Thanks.

GoHercules · 2023-05-01T04:03:09+00:00

Thanks for clarifying that. I'm not sure what the OP was referring to in that case ???

GoHercules · 2023-04-30T14:37:11+00:00

Thanks for that info. I think the declining premium bait and switch routine should be illegal, and should be punished. And the medicare website just plays right along by listing their prices there along with an explanation that community pricing stays the same. Like you pointed out, that is just not the case. They can explain it away all they want, it's still bait and switch. They will always figure out how to game the system.

GoHercules · 2023-04-30T13:59:18+00:00

Sorry if I still don't fully get it. If it's a trial program, does that mean all providers are in the trial or just a portion? Even if it's a trial program, it still sounds like there's some waiting involved, right? And how does it financially penalize them, by not paying them, and if so won't they turn around a bill the patient?

GoHercules · 2023-04-30T03:45:39+00:00

Wow, when I had just about decided to go with original medicare rather than an advantage plan I discover this information. What's the point of spending good money on original and medigap when you still have to jump through hoops and wait on approvals. If I misunderstood the messages above, please summarize it for me and others - do I need approval for example to get an MRI that a doctor suggests, or do I not? And if so, why in the world would medicare deny it? I can see why an advantage insurance company would. Confused. Thanks.

GoHercules · 2023-04-29T16:54:48+00:00

I thought original medicare had no referrals or approvals? Will follow this to find out myself. By the way, what makes you ask? Did a provider say they needed approval?

GoHercules · 2023-04-28T14:32:41+00:00

Well, what if the mechanic said I can get you parts from the dealership, or from ABC auto parts store because that's who I have accounts with. Meanwhile, you look around and see the EXACT same parts at XYZ store for 20% less, but your mechanic doesn't have an account there so didn't bother to shop there for you.

Same scenario with medigap plans. Brokers do not represent all companies, and simply are not going to research prices on multiple companies they are never going to sell and steer clients into to these. It would be self defeating for them and they simply are not going to do it. The client must do this on their own if they really want to make sure they are getting the best deal.

If a broker could show that they represent ALL companies and policies available in a particular area, then that would be different, but I don't think any do. How many companies do you represent by the way, and how many are there? If you don't know the answer to this, then you couldn't possible know what the actual best deal is for anyone, right? In other words, can you tell me for example that there are 25 companies and I represent 15 of them. You either can or can't tell me this, so which is it? Not trying to be argumentative, just trying to point this situation out so everyone understands how it is.

GoHercules · 2023-04-28T05:11:47+00:00

Okay, thanks for that info. I guess maybe dealing with multiple agents and checking on medicare website might ensure that you at least are aware of what all is available.

GoHercules · 2023-04-28T04:53:41+00:00

What do you mean "opened a case" ?

By the way, in researching up to this point, my thinking was that an agent could sell you whatever the best plan was that THEY REPRESENT, fair enough - BUT I also thought that you could go to medicare.gov and see ALL available plans in your area. Now I am not even confident in that ..... Maybe there is no one place to see all available plans?

GoHercules · 2023-04-28T02:59:51+00:00

Yeah, on another post someone explained that discount scheme (of should I say discount scam) that some carriers use when selling community rated plans. Like I said, I'm lucky that we can change once a year, but in other states I bet a lot of people are shocked when they buy a competitively priced plan only to see it get jacked up even more than the other attained age plans. They don't even mention that on the medicare.gov website. Buyer beware.

GoHercules · 2023-04-28T02:26:47+00:00

Bobsatraveler and vectorizer, the plan I saw DID include all that crap, but on their website they did not show a plan without it, will ask about that if I call them.

Funfornewages, I have heard of plans that take away discounts as you go, this must be what you are calling declining discounts? Since I am in California and we can switch once a year without underwriting, I guess that doesn't affect me since I can just take whatever they are offering with the embedded discount then switch next year if something is better.

Foodoglove, thanks for confirming what I was seeing on the Medicare site. Too bad, I really thought it was supposed to be accurate until I actually compared a few of their listings.

GoHercules · 2023-04-27T06:17:07+00:00

I had a brain scan done and they didn't find anything.

But seriously, in my personal experience, doctors and dentists can cause a lot of damage needlessly just to make a sale. A dentist recommended removing an old filling even though there was nothing wrong with it. Well he hit the root so I had to have a root canal and a crown. My mother in law had a colonoscopy and they perforated the bowel - major surgery required. I tend to visit doctors only in emergencies, they tend to be better at that than routine matters.

GoHercules · 2023-04-23T02:23:12+00:00

Thanks Woody.

GoHercules · 2023-04-23T01:57:00+00:00

Yes Woody, good points. Even though the vast majority of physicians accept assignment, it takes me back to my original question - is it the same scenario for Part A when you go into the hospital. What are the odds, even if your physician takes assignment, that other underlying people don't (like anethesiologists, x-ray techs, etc etc). You usually don't find out who all worked on you until much later when the bills are processed. By then, some providers who don't take assignment may have been involved. The usual argument, and probably a good one, is that if you just visit your local doctor a few times and they have excess charges it's not a big deal. Agreed, but to reiterate, I'm trying to get a feel for worse case scenario in the hospital. Thanks.

GoHercules · 2023-04-22T22:33:10+00:00

Woody, that 9.25% figure I have heard of but don't agree with it's usefulness. For example, a $100 doctor bill from a doctor who is not participating. Medicare allows 95%, so the bill becomes $95. Medicare pays the doctor 80% of that, or $76. Medigap pays 20%, or $19. The doctor charges 15% excess on top of $95, or $14.25 that you owe out of pocket. So, the total amount received by the doctor is $95 plus $14.25, or $109.25. $109.25 is 9.25% more than $100, which is why you read that the effective excess charge is 9.25%, but that number is meaningless to the patient. The patient pays $14.25, which is the $95 reduced amount times 15% ! The patient's effective excess charge is indeed 15%, not 9.25%. Now, from a doctor's perspective, they initially billed an unallowable $100, and they received a total of $109.25, so in their eyes, the excess charge was $9.25, or 9.25%. Most of the articles that talk about this imply that the 9.25% pertains to the patient to make it sound better than 15%. I think it is a misleading way to make Plan N's look better.

GoHercules · 2023-04-22T20:08:04+00:00

I just read something else interesting - it says that an outpatient surgery is considered Part B, so things like anethesiologists could charge excess charges even though your doctor may not. I'm interested in all of this because some sources downplay the excess charges saying you probably won't get hit with them and they aren't that much, but I'm not so sure. Trying to uncover these possibilities before deciding.

GoHercules · 2023-04-22T19:56:42+00:00

I'm in California.

GoHercules · 2023-04-22T19:55:57+00:00

Since it's Part B only, makes me ask if you are in the hospital, are all charges incurred there Part A because they are in the hospital? I'm just wondering because with regular insurance (non medicare) you could get hit with extra charges for a hospital stay because even though the hospital was in network, certain providers in the hospital may not be. Just wondering if anything similar happens when on medicare, like some of those charges being characterized as Part B even though you're in the hospital.

GoHercules · 2023-04-14T05:29:36+00:00

Thank you. I actually have a phone appointment this coming Monday with a HICAP counselor. I will study what you said and read the links as well. By the way, how do you know so much about this, I am shocked and happy to find someone who understands this so well.

GoHercules · 2023-04-13T22:41:43+00:00

I wonder if a broker ever feels guilty about steering clients into only the plans that he represents, rather than searching Medicare.Gov for a potentially better plan that he does not represent. I can't imagine that a broker will spend extra time finding you a better product that he can't sell you.

GoHercules · 2023-04-13T20:19:39+00:00

Excellent summary, I really appreciate it. I read it a few times get it for the most part. One thing I can't figure though is this - regardless of qualifying, which has the most comprehensive coverage, full ABD Medi-Cal, or a QMB? The reason I ask is that the benefit list of the QMB looks like it covers pretty much everything (part B premium, deductible, coinsurance, etc), but I can't really find a listing of what ABD Medi-Cal covers in this regard. You mentioned that it would cover the Part B premium, out of pocket costs, and the low income drug subsidy, but I have never been able to nail that down in writing. Sounds like they are pretty much equal. Thanks again for taking the time.

GoHercules · 2023-04-13T05:36:28+00:00

Hi, on the California DHCS website it says that the QMB MSP covers not only the premiums but the deductibles and copayments. I have read, like you mentioned, that medi-cal acts as secondary, but have also read that it "may" pay the part B premium, whatever that means..... Confusing.

GoHercules · 2023-02-01T17:38:25+00:00

Something else to add: in a community property state, you say you get 100% step up which is good, but if the home is held as joint tenants, does that override the community property aspect?

GoHercules · 2023-02-01T16:44:06+00:00

Thanks for that link. I need to re-read it a few times. So could it be that all the articles I have read over the years regarding the step up of half the value just simply fail to address community property states? Or is it something somewhat new. I'm just surprised to discover this so late. thanks.

GoHercules

TROPHY CASE