Medigap

Q

QuickSilver

SF VIP
Location
Midwest
So.. What is Medigap... Is it just another name for a Medicare supplement or are they two different things?
 

I'm not positive QS but maybe it is what is happening to my wife and I. When a procedure is done, Medicare has a rate that they will only pay for.
Ex:: ultrasound of the heart. Hospital charges 600.00
Medicare has a set rate and pays 400.00
$200.00 balance
My United Healthcare pays 20%, which leaves a balance of $160.00 of which I am responsible for.

They are Nickel and diming us to death with these "extra" overages.
Im not real positive if this is what you are referring to. If not, I got it off of my chest.:sentimental:
 
I know that I already have part A..... I need to enroll in Part B.. But I also need a supplement. I have heard the word supplement and I have heard the word Medigap.. I don't know if they are the same thing...
 

As a newbie here, I was looking for a discussion regarding seniors who opted for a Medicare Advantage plan as compared to a basic Medicare plan coupled with a medigap plan. As a 73 year old, I've been enrolled in a Medicare Advantage plan for 8 years without major complaints. However, I'm a little concerned that the time is right for me to switch to regular Medicare along with a medigap policy.

I was recently denied services from a medical specialist due to the fact I have the Medicare Advantage plan (Part C) instead of regular Medicare/medigap coverage. I was subsequently able to find an alternate specialist who accepted my medical coverage, but was alerted to the fact that it may be time for my wife and I to switch back to regular Medicare/medigap coverage. Who knows when something serious may present itself?

As you know, regular Medicare Parts A & B cover doctor and hospital expenses up to 80%, and the medigap insurance policy with outside insurance generally picks up the remaining 20%. Drug coverage is considered Part D and pays for the majority of those expenses and requires an additional insurance policy. Medicare Advantage, which my wife and I have, is called Part C, and replaces the regular government Medicare plans A & B with a Medicare [replacement] plan purchased from an insurance company. This type of plan pays for the majority of 'some' medical costs and incorporates the coverage for drug expenses. See https://www.medicare.gov/sign-up-ch...-plans/how-medicare-advantage-plans-work.html
 
This is precisely why my husband and I are opting for traditional Medicare.. My husband was diagnosed with prostate cancer last year. Presently, it's stable, but there is no guarantee that it will remain so. If that happens we will search out the very best medical specialist available.. no matter where they are located. I don't want to be confined to using only the "preferred providers" the Advantage plans dictate.
 
Thanks for your reply. I just had coffee with an old workmate this morning, and he informed me that his asthma medication has just been placed on a 'non-covered' basis by our Medicare Advantage Rx Drug package. Evidently, a generic version is not prescribed by his doctor for his specific treatment.

I'll begin shopping today for traditional Medicare coverage this week. My first contact was with Mutual of Omaha, and although the premiums were competitive, they did not provide for Silver Sneakers https://www.silversneakers.com/ which has become an important part of our lives .... especially during the winter months. I found discount dental coverage for $169 annually for our 2 person coverage, and I found Part D (drugs) coverage for $18.00/month each. It looks like our total annual medical insurance coverages will increase approx $70.00 per month, but may give us more peace of mind over what we have now.
 
prowler said:
Thanks for your reply. I just had coffee with an old workmate this morning, and he informed me that his asthma medication has just been placed on a 'non-covered' basis by our Medicare Advantage Rx Drug package. Evidently, a generic version is not prescribed by his doctor for his specific treatment.

I'll begin shopping today for traditional Medicare coverage this week. My first contact was with Mutual of Omaha, and although the premiums were competitive, they did not provide for Silver Sneakers https://www.silversneakers.com/ which has become an important part of our lives .... especially during the winter months. I found discount dental coverage for $169 annually for our 2 person coverage, and I found Part D (drugs) coverage for $18.00/month each. It looks like our total annual medical insurance coverages will increase approx $70.00 per month, but may give us more peace of mind over what we have now.
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Welcome prowler..

You can do your search now but I believe you will have to wait until open enrollment to switch.

Do your research on a dental plan, I hear that they are not worth the $$$$$..Could save you money there!!
 
Ken N Tx said:
Welcome prowler..

You can do your search now but I believe you will have to wait until open enrollment to switch.

Do your research on a dental plan, I hear that they are not worth the $$$$$..Could save you money there!!
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I don't believe any dental plan is worth the money.. Sure they cover routine things like cleaning...but those are relatively inexpensive. However when it comes to the big stuff... they usually and $1000 total yearly benefits.. So big deal... add up your monthly premiums and you get even less bang for your buck.
 
A person may enroll in Medicare at any time. Part "D" is the plan for drugs and it can only be picked up at open enrollment time.
 
Regarding dental plans, we currently have a dental plan with our retirement health insurance that pays approx 30% for 'work' and pays 100% for biannual cleanings. There is a discount dental family plan for $169 [annually] which covers slightly more than our current coverage. PPO dental plans and group dental plans are WAY more expensive and would not be worth the trouble (IMO).

As far as the Silversneakers issue, that will have to go by the wayside. In our area code, only 5 carriers include that free benefit and the associated monthly premiums for any one of those 5 plans exceeds what a family membership to our local Sportsplex would be. Also, there may be a 6 month membership there which would work due to the fact we don't spend much time at the Sportsplex during warmer weather.
 
With regards to a supplemental plan, Plan F is exactly the same with any insurance company that offers Plan F. As long as the subscriber's charges are covered by Medicare, any Plan F will pay what's left over after the Medicare payment. IOW, if I go to a doctor that accepts Medicare and his/her charges total $150.00 and Medicare will only pay $115.00, the doctor will either accept the $115.00 as full payment or bill the supplemental the difference. There is no additional charge to the insured person.

Same thing if I have blood work or any test done. If the charges total $200.00 and Medicare pays $150.00, my supplemental will either pay the difference or nothing if the lab accepts whatever Medicare pays.

Since I have been retired, I have had a supplemental plan and I have never paid a penny out of pocket, (except for premiums), as long as I have used a Medicare approved doctor, hospital or lab. Plan D differs with companies, which is why I check each year in late November to see if my Plan D insurer is still paying for Rx's as they did previously. If not, I go through a search to find an insurer that pays the most for my Rx's. Last year I had as my Part D insurer Cigna. In November, I learned that their premium was going from $33.00 to $80.00, so I searched and found a company named Envision, which costs about $35.00 per month. I have one script in particular that costs $140.00 per month, but I only pay $35.00 dollars for it, so it pays for me to have the Part D.
 
Thanks for your reply. I liked all the information you provided.

You wrote, "With regards to a supplemental plan, Plan F is exactly the same with any insurance company that offers Plan F". All that is true, regarding medical needs, hospital, doctor, etc. However, additional free benefits are available via various plans of the same Medicare Plan assignment (F Plan, G plan, etc) to enhance the buyer to choose them. Such is the case with Silversneakers, which is a free additional benefit of only a few carriers, such as Humana, United Health Care, Aetna, Blue Cross/Blue Shield.
 
I get the Silver Sneakers with my advantage plan, and I like having it. Wouldn't pay extra for it, though, I'd just join a reasonably priced gym -- there are a number of them around here who have discounted prices for seniors.
 
Butterfly - I like Silversneakers, too. We use it approx 5 times / week during the winter months. The Medicare supplement plans that provide Silversneakers (for my zipcode) are a lot more expensive than some others I'm considering without that added benefit. For instance, our Sportsplex 6 month membership for 2 seniors is $250.00. That's worth considering IMO since the NON-silversneakers supplement plan for us is way less than a Medicare supplement plan WITH Silversneakers.

Thanks for your feedback.
 

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