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Hmmm... Ariadne, I wonder what the differences are in the Wisconsin Medigap standards than those in the other states - do the changes work in your favor? I've no idea what the differences are.
modhatter, the scenario you describe is what I was thinking would probably happen. The almost $500/yr premium difference based on location would be eaten up by the underwriting.
Geez, they really have us over a barrel, don't they? (what else is new)
Hmmm... Ariadne, I wonder what the differences are in the Wisconsin Medigap standards than those in the other states - do the changes work in your favor? I've no idea what the differences are.
Basic requirements on underwriting/waiting periods/terminations/moves to other states should be the same throughout US.
Differences are state mandated benefits, essentially. WI requires additional mental health days, and chiropractic benefits NOT approved by Medicare. MN has a limitation on mental health therapy benefits which, per one poster here, wouldn't be affected if she is on an Advantage plan. I doubt that will turn out to be true, however. When I had a UHC MA plan here, chiropractic was mandated - BUT UHC MA imposed such a high copay on the benefit, essentially they never paid for it. MA plans can be very tricky, imo, have more latitude in getting around state mandated and even Medicare benefits.
Last edited by Ariadne22; 05-19-2014 at 05:30 PM..
Reason: changed deductible to "copay"
Basic requirements on underwriting/waiting periods/terminations/moves to other states should be the same throughout US.
Differences are state mandated benefits, essentially. WI requires additional mental health days, chiropractic benefits NOT approved by Medicare. MN has a limitation on mental health therapy benefits which, per one poster here, wouldn't be affected if she is on an Advantage plan. I doubt that will turn out to be true, however. When I had a UHC MA plan here, chiropractic was mandated - BUT UHC MA imposed such a high deductible on the benefit, essentially they never paid for it. MA plans can be very tricky, imo, have more latitude in getting around state mandated and even Medicare benefits.
That would be me. And they had better not mess with me for the MH benefit on the MA plan I am starting in two weeks, because it is spelled out right in their policy documents that I will have a $15 co-pay which will not be subject to deductibles. Heck, that is one of the main reasons I signed up for this plan!! Because my existing provider was in network with this plan. If things don't work out, I read the rules at Medicare.gov and in other places, and I can switch to a supplement or a different MA plan within 12 months of starting without premium increases or filling out health forms. (I am on disability and in MN).
Actually, I misspoke. What UHC did was raise the copay (not the deductible).
When I signed up for the UHC MA in 2011, chiro was my only real regular medical service - probably 2 visits a month - so I was pleased they included chiro. In 2011, UHC paid whatever remained after Medicare reimbursement and my 20% copay. Amounted to maybe $6 or $7 per visit. Guess $6/$7 per visit was more than UHC's bottom line could bear, so in 2012 UHC raised the copay for chiropractic to $50 per visit, which exceeded cost of the visit. You'll probably be OK with Medica this year. But watch the annual changes. That said, UHC is one of the worst.
Last edited by Ariadne22; 05-19-2014 at 05:28 PM..
That really sucks about Chiropractic and that policy, Ariadne22. Especially since you are pretty healthy otherwise. Hope your current policy covers it.
Yes, I am really going to be watching how this Medica Medicare Advantage Plan operates, LOL. I have had such great coverage for so many years, I'm afraid I have really high expectations. I have found that 99 percent of the time when I have had problems, it was the provider that was causing the billing problem and not the insurance company (BCBS of MN). They will be my first choice if this plan doesn't work out. That said, if their rates are too high next fall if I decide to hang it up with Medica, I will be going with another highly regarded Advantage Plan in MN--UCare. All of these plans in the Twin Cities have really large networks and almost all the same (medical-not mental health) providers participate in-network.
I do have a question, though. For the plans available here, the BCBS Supplement says "cost" not community rated. Is there a difference?
That really sucks about Chiropractic and that policy, Ariadne22. Especially since you are pretty healthy otherwise. Hope your current policy covers it.
Not really, until I meet the $2,140 deductible- which I'm very unlikely to do anytime, soon. Chiro charges me $26/visit, now - the Medicare-allowed charge, down from the $38 when I had UHC. I really can't complain.
Quote:
Originally Posted by jzeig104
I do have a question, though. For the plans available here, the BCBS Supplement says "cost" not community rated. Is there a difference?
Hmmm...sounds like it would be the same - i.e., "cost" of medical care overall in your region. Otherwise, no idea. I'm really not an expert on ratings other than what I've gleaned from the Medicare site and other posts on this board, from Robyn, in particular, who discussed this a couple of years ago on the Medigap she purchased in FL - an issue-age-rated plan.
An acquaintance of mine who has an Advantage plan issued by Humana told me over the weekend that one of the changes they recently made to their policy is that they now require a preauthorization for certain aspects of chemotherapy treatments that did not require it before. They call it the "Oncology Quality Management Program". She is really upset because now her MA plan is refusing to cover the anti-nausea med (Aloxi) that she has been getting and that has been working really well; it's administered at the same time as the chemo, so does not fall under Part D. They are telling her doctor that one of the OTC pill-form anti-nausea meds is "adequate" and that Aloxi is "not medically necessary".
Someone should make that MA pencil-pusher throw up for hours on end for days and then ask him/her how "medically necessary" Aloxi is. There's a reason why it costs $400/dose: It works better than anything else.
I'm sure Humana's "expansion" of their pre-auth/pre-cert list is likely to become a trend for a lot of the MA plans.
Behavior cited in story is typical of what I experienced the couple of times I had to deal w/UHC. Denials, endless loop w/CS w/no resolution. The bigger they are, they worse they get. It's all about their bottom line. They hope you and/or your doctor will give up. Darn shame the docs have to fight w/insurance companies for authorizations of medically necessary protocols - and payment. Stress on patients is just plain immoral.
Okay, so I'm busily researching all facets of Medicare prior to signing up in a few months, and I have a REALLY silly question, lol
I understand that when I go to a doctor, for example, that Medicare pays 80% of the "approved amount" and I pay 20% of that amount. (assuming it's a doctor who accepts assignment for the purposes of this example, and that I do not have a Medigap policy). So let's say the approved amount is $200 for ease in computing; Medicare pays $160 and I am responsible for $40. But when and how do I pay that amount? Does Medicare send me a bill for $40 once the paperwork for the visit goes through the system, or does the doctor's office send me the bill for $40 after they get paid from Medicare? Or would I have to pay the $40 up front at the time of service?
Would you believe that NOWHERE in any of the online or print resources, including the Medicare and You publication, does it say when that "20% of" amount comes due, or who asks for it? LOL
Medicare has set fee schedule established for every procedure billable to it.
Medicare covers 80% based on that fee schedule. Office may bill at whatever usual and customary they want to, Medicare covers only based off their fee schedule.
Also, you will be responsible for $167 yearly deductible. Was $140, they raised it last year.
Office that saw you should submit for billing and bill you based on EOB. To my knowledge, you can not be billed, until EOB is received by provider, unless you signed ABN and waved billing Medicare. EOB comes in, clearly stating your co-insurance payment, after deductible was met, and provider sends you a bill.
It is different story with private insurances, as THEN you start getting into contractual agreement fee schedules, that may vary widely.
But with Medicare, it is quite straightforward, as every half way brained office billing person knows allowables for particular procedure and can tell you quite well, what your coinsurance will be down the road.
From my experience in my field, for high end items, it is wise to have a 2ry insurance. But you have to qualify. Should you do, my patients have very good success with AARP Supplement plan. Not too expensive and saves them a ton. As in - thousands and thousands. Well worth $120 or so a month.
.....good success with AARP Supplement plan. Not too expensive and saves them a ton. As in - thousands and thousands. Well worth $120 or so a month.
Your parents must live in the south somewhere to have a Medigap F premium at $120, unless they have one of the plans which are cost-sharing and don't cover excess charges.
Did you read earlier post - in her area StressedOutNYer says Medigap premiums are:
Quote:
Originally Posted by StressedOutNYer
These are the rates that the site displayed for the various AARP/UHC Medigaps in my zipcode:
Plan A $156.50 -
Plan B $222.50 -
Plan C $260.00 -
Plan F $261.00 -
Plan K $91.75 -
Plan L $152.25 -
Plan N $178.75 -
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Otherwise, no idea. I'm really not an expert on ratings other than what I've gleaned from the Medicare site and other posts on this board, from Robyn, in particular, who discussed this a couple of years ago on the Medigap she purchased in FL - an issue-age-rated plan.
