By law, all Medigap policies MUST pay any provider that accepts Medicare. Period.
The gotchas are in the Plan level of Medigap you choose – deductibles, extras, etc. I chose the gold standard – Plan G – that is the most expensive but covers everything after a small deductible. Read the details. All Plan Gs must be identical (by law) but their costs differ. I changed to a different insurance company this year because they gave a discount of $30 per month for “household” (me & DH) coverage.
Then you are not very familiar with how these plans work. When there is a major, life-changing event. New job?–then you are not on Medicare. Moving, etc—the ability to change plans is recognized and permitted. Insurance companies know this fact. If you move outside the area of your current insurance, then you get a different insurer, who does cover the area where you are moving. Would you move there if the new area did NOT offer appropriate health care? We have already seen this play out elsewhere. Young people choosing to NOT move to a state that did not permit abortion because the young adults want to have to ability to make their choice–and not have someone else’s choice (the state’s) forced on them.
Your existing coverage probably offers some coverage while traveling. You DID research and buy appropriate travel insurance, right? Or not??
Being raised by a doctor who was on alert endlessly to emergencies, he did not train or teach me to think all will simply end well. Or be simply well in my case. I do not avoid possibilities healthwise. If something is more dangerous healthwise I take appropriate action. Many people in society do not. Burying their heads in the sand as it were.
Medicare Advantage plans can cost you a lot of money out of pocket. Meaning we are hearing of the things that are covered but if on vacation something happens in an emergency situation you wont necessarily find specialists in network. The no surprise law wont save you.
If you buy insurance you look at what it does not cover. You are not necessarily buying a good policy. Retirees want to travel.
Also aged seniors have a hard time finding doctors. Medicare offers more doctors than the advantage plans. You can find yourself with a doctor who never should have become a doctor and little choice.
@jaroman please read the book I referred to earlier. The deductibles may be the same but the doctors may not accept MA and/or they may add charges which the MA insurance company may not approve. A Medigap Part G will cover this but not MA. Google this as well as reading the book.
NPR has a feature today on how Medicare Advantage plans dodged auditors and cheated taxpayers if anybody is interested. We have traditional Medicare plus gap already, but it might be a good read for some of us.
I doubt it’s going to be of interest to anyone who already has or is seriously contemplating an Advantage plan. If they see none of the potential risks already, one more iteration of the questionable tactics of their insurance carrier won’t make a jot of difference.
For years I have been using standard Medicare and the “high deductible” F+ supplement. More or less, the deductible was about $2,400 and the annual difference in price between this policy and the regular type F was about $2,200 - so I was betting a maximum of $200 in incremental cost against not reaching the deductible. We have never gotten close and, relatively risk-free (with the maximum potential loss being $200), we have saved over $2,000 a year for the pair of us.
This year, I found out that, using the high deductible type G+ gives us (through the magic of small print) exactly the same coverage as what we have been using at a lower price. In fact, the price benefit of the plan quoted to us (the plans and carriers are different for each state, but we are using Emblem Health) compared to the cheapest option deductible amount was greater than the deductible. This no-brainer makes the option - by far - the best (regardless of how healthy you are) as long as you have the means to pay the maximum yearly expense at one time (instead of spread as premiums over the course of a year) as well as the probability of substantially lower costs. Unfortunately, I suspect few actually do the math.
Using standard Medicare, we have never been turned down by any doctor and do not have to see a “gatekeeper” in order to visit a specialist. We do not get glasses coverage or dental coverage, but get to choose who/what we use for those services. We do, in fact, pay separately for “concierge” service with our GP/internist which gives us same-day appointments (kept on-time) as well as unlimited telephone/email access for “real-time” questions - at a substantial price.
I do spend the time to reevaluate insurance carriers and coverage each October and frequently change annually.
I have standard medicare with medigap plan N. I still have to cover the Part B deductible annually and have $20 specialist office charge & a $50 emergency room charge if I am not admitted. Those out of pocket costs are negligible in my case.
OH I also have the cheapest Part D plan as I take no prescribed medication.
I’ve run into 2 blips in the past 7 years. I needed cataract operations which was covered but I paid for prescriptions lenses to be implanted-$600 bucks an eye. Well worth the cost as I no longer need eyeglasses except for cheapy reading glasses.
And I needed a root canal & crown that cost me $2 grand. Heck my car costs more to maintain than me. LOL
The problem comes with the Medicare supplemental (“Medigap”) plan because that is a private insurance policy, not government. The insurance companies underwrite the Medigap plans – that is, they carefully select patients who will not cost them a lot.
At age 65 the enrollee has “open enrollment.” By law, the Medigap company must sell the enrollee whatever policy they choose, regardless of health. If you choose the top-of-the-line policy (Plan G) you can go downwards in coverage later but may not be accepted to go upwards to more complete coverage.
A Medicare Advantage enrollee may select to switch to standard Medicare – that’s covered by the government. But standard Medicare only covers 80%. If the enrollee has a pre-existing condition (e.g. a chronic illness, cancer, etc.) they may be rejected by the insurance company for Medigap insurance. That could leave them on the hook for 20% of medical charges, including doctor’s charges that are above the Medicare standard fee reimbursement. That could be astronomical.
This is why it’s so important to research Medicare before enrolling.
I think that’s because every state has different regulations / plan offerings. When Jeff (and others) talk about Plans that are after the letter “D”, then I have no clue as MA only offers plans up to Part “D”. Here’s what’s offered in MA:
Hold your finger on the word you want. Options will arise. Then you can expand to other words by choosing “select all”. Or by moving the sort of bracket that appears for fewer words. More options to copy and paste pop up. When you get where you want to paste hold your finger there and “paste” will pop up.
That’s for Androids. Something similar should be true for iPhones.
Providence Oregon Medicare Advantage Plan + RX100
$92 a month premium
New robo knee (titanium on top bone, teflon on bottom bone): $42,000; my copay $350
Mental health visits don’t require a referral. Copay is $30. Out of network–30%
So, my health advisor is moving out of network, 30 minutes will be $100, I will pay $60. I can live with that once a month.