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Old 06-01-2014, 04:21 AM
 
Location: Florida
19,774 posts, read 19,875,860 times
Reputation: 23194

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Quote:
Originally Posted by highcotton View Post
Remember, the Medigap plan you choose is just insurance against the 20% gap that Medicare doesn't pay, so your [high] deductible you may [potentially] have to pay when choosing the H-D Plan F is only for 20% gap.
.
This is the important thing to remember when choosing.
Medicare is still going to pay the bulk of any bills.
I seldom doctor but did have an accidental injury this past year, requiring, not only treatment but Physical Therapy.
The out of pocket costs, because of the high deductible Plan F still ended up being less than what three months of Plan F premiums would have been .
In most years it's less than 2 months and that's mostly because of having to pay the Part B .If it happens that I have an extremely expensive year, I figured I might end up paying about $200 more than
with Plan F.
The years that I have saved have already paid for that and if it looks to be permanent, I'll switch back to Plan F.
In NYS BC/BS has dropped HD F, I believe, but has me grandfathered in.
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Old 06-01-2014, 07:56 AM
 
Location: Glenbogle
730 posts, read 1,026,267 times
Reputation: 1046
The cost/benefit analysis (lacking the necessary crystal ball, LOL) is what can drive us all crazy. ;-)

Basically the numbers for my area run like this:
* A regular Plan F would cost me $3232 in Medigap premiums per year
* A Plan N would cost me $2148 in premiums, plus the $147 Part B deductible (= $2295) and a maximum copay of $20 for most office visits; if I had 10 of those per year (and thus $200 in copays), my out of pocket could be around $2496 but also could be higher or lower depending on the coding of the office visits or how many. I'd need to limit myself to only participating providers in order to avoid excess charges.
* A hi-D Plan F would cost me $780 in premiums, plus the potential of up to $2140 additional = maximum total $2920out of pocket per year. However, in years when I don't need to see a doctor very often, my out of pocket could conceivably be within spitting distance of only $1000 (given the Part B copay and only a few 20% coinsurances). I would guess that it might average out, over time, to something like $1500/yr out of pocket.

Of course those numbers are in addition to $1250 in Part B premiums, and keeping the cheapest available Part D plan which is $13/month ($156/yr plus the $310 deductible).

What I'd really love to find is a schedule of the Medicare-approved fees for all the CPT (procedure) codes! If I had that, I could look up the codes for all of the procedures and visits that I commonly have -- they are very consistent -- and get a good handle on what my out of pocket costs would be for both the Plan N and the hi-D plan F.

But apparantly that information must be "highly classified" because nobody I've spoken to will admit to knowing where to find such a thing.

Anyone got a "mole" in the Medicare claims department? LOL
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Old 06-01-2014, 10:15 AM
 
Location: OH>IL>CO>CT
5,226 posts, read 8,384,895 times
Reputation: 7180
Quote:
Originally Posted by StressedOutNYer View Post

What I'd really love to find is a schedule of the Medicare-approved fees for all the CPT (procedure) codes! If I had that, I could look up the codes for all of the procedures and visits that I commonly have -- they are very consistent -- and get a good handle on what my out of pocket costs would be for both the Plan N and the hi-D plan F.

But apparantly that information must be "highly classified" because nobody I've spoken to will admit to knowing where to find such a thing.

Anyone got a "mole" in the Medicare claims department? LOL
It is all here , if you have the patience to learn some of the terminology, etc that is used. When I had a Barium Swallow test done recently the CPT (aka HCPCS code) was 74220. The provider was paid exactly what the schedule said.

Physician Fee Schedule Search

Have fun......
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Old 06-01-2014, 12:43 PM
 
Location: Glenbogle
730 posts, read 1,026,267 times
Reputation: 1046
Quote:
Originally Posted by reed303 View Post
It is all here , if you have the patience to learn some of the terminology, etc that is used. When I had a Barium Swallow test done recently the CPT (aka HCPCS code) was 74220. The provider was paid exactly what the schedule said.

Physician Fee Schedule Search

Have fun......
Oh wow... thank you SO MUCH! May the gods deliver a case of chocolates (or case of 125-year-old Scotch, according to preference ;-) ) to your doorstep tomorrow! :-D

This is EXACTLY what I need in order to make an as-informed-as-possible decision. :-)

Knowledge is power. ;-)
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Old 06-01-2014, 04:29 PM
 
Location: Wisconsin
21,534 posts, read 43,962,244 times
Reputation: 15135
Quote:
Originally Posted by StressedOutNYer View Post
The cost/benefit analysis (lacking the necessary crystal ball, LOL) is what can drive us all crazy. ;-)
Since NY allows you to switch at any time, why not try the hd-F for a while and see how it goes. In the end, you'd be gambling you might be paying $500/yr more than v. Medigap N. If your health takes a serious turn for the worst, you can always switch to an N, F or G. Keep in mind, N has no caps on out-of-pockets. No idea what that could mean for you, worst case scenario - whereas hd-F is capped at $2,140 - and out-of-pockets are no concern at all in F & G.

In WI, the number of carriers offering hd-F is diminishing. BCBS dropped the hd-F in WI for 2014. Same may happen in NY - and that option in future might not be there - which was another reason I bought the hd-F for 2014. Once sold - even if discontinued later - usually the company will keep you on that plan - it just won't sell it to new customers.

Other Medigaps will always be there most likely - in one form or another. The hd-F, because of its low premium, is probably the least profitable for the insurers so they will rid themselves of that offering, first, I would expect.
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Old 06-01-2014, 06:42 PM
 
3,262 posts, read 3,001,812 times
Reputation: 1893
Quote:
Originally Posted by StressedOutNYer View Post
Oh wow... thank you SO MUCH! May the gods deliver a case of chocolates (or case of 125-year-old Scotch, according to preference ;-) ) to your doorstep tomorrow! :-D

This is EXACTLY what I need in order to make an as-informed-as-possible decision. :-)

Knowledge is power. ;-)
This is the parent directory for data from CMS in general: Medicare - Centers for Medicare & Medicaid Services

What you were linked earlier should be good if you mostly have simple physician office visits; things get more complicated fast once you start talking about inpatient care, skilled nursing, etc.

Quote:
Originally Posted by Ariadne22 View Post
Since NY allows you to switch at any time, why not try the hd-F for a while and see how it goes. In the end, you'd be gambling you might be paying $500/yr more than v. Medigap N. If your health takes a serious turn for the worst, you can always switch to an N, F or G. Keep in mind, N has no caps on out-of-pockets. No idea what that could mean for you, worst case scenario - whereas hd-F is capped at $2,140 - and out-of-pockets are no concern at all in F & G.

In WI, the number of carriers offering hd-F is diminishing. BCBS dropped the hd-F in WI for 2014. Same may happen in NY - and that option in future might not be there - which was another reason I bought the hd-F for 2014. Once sold - even if discontinued later - usually the company will keep you on that plan - it just won't sell it to new customers.

Other Medigaps will always be there most likely - in one form or another. The hd-F, because of its low premium, is probably the least profitable for the insurers so they will rid themselves of that offering, first, I would expect.
If insurers are dropping hd-F's it's because not enough people are buying them locally to justify the administrative overhead, not because the plans are inherently less profitable. The reason the price differential seems too good to be true is because of problems with traditional Medigap plan F products. The zero cost sharing and lack of managed care makes them attractive to people who expect to use a lot of medical care and want to be able to see the most expensive providers without limitation and are willing to pay for that - aka the people who are likely to have the worst claims experience. Further, the lack of cost sharing causes what is called induced utilization - people will use more services than they would otherwise because there is no copay or coinsurance or deductible.

So people with traditional F plans cost more to insure than people in traditional FFS or in Medicare Advantage and that higher cost (or more accurately 20% of it) gets passed on in the form of high premiums. The hd-F plans seem way too good to be true relative to traditional F plans, it's not because of lower insurer profits, it's because you're getting out of a really bad risk pool and into a much healthier one with less induced utilization. Of course, a traditional plan F is still better for those people who expect to use a lot of services at high cost providers - what it boils down to is buying insurance appropriate for your needs.
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Old 06-01-2014, 07:00 PM
 
1,337 posts, read 3,490,949 times
Reputation: 1384
Quote:
Originally Posted by ALackOfCreativity View Post
This is the parent directory for data from CMS in general: Medicare - Centers for Medicare & Medicaid Services

What you were linked earlier should be good if you mostly have simple physician office visits; things get more complicated fast once you start talking about inpatient care, skilled nursing, etc.



If insurers are dropping hd-F's it's because not enough people are buying them locally to justify the administrative overhead, not because the plans are inherently less profitable. The reason the price differential seems too good to be true is because of problems with traditional Medigap plan F products. The zero cost sharing and lack of managed care makes them attractive to people who expect to use a lot of medical care and want to be able to see the most expensive providers without limitation and are willing to pay for that - aka the people who are likely to have the worst claims experience. Further, the lack of cost sharing causes what is called induced utilization - people will use more services than they would otherwise because there is no copay or coinsurance or deductible.

So people with traditional F plans cost more to insure than people in traditional FFS or in Medicare Advantage and that higher cost (or more accurately 20% of it) gets passed on in the form of high premiums. The hd-F plans seem way too good to be true relative to traditional F plans, it's not because of lower insurer profits, it's because you're getting out of a really bad risk pool and into a much healthier one with less induced utilization. Of course, a traditional plan F is still better for those people who expect to use a lot of services at high cost providers - what it boils down to is buying insurance appropriate for your needs.

WOW... thanks to everyone who is participating in this thread... I very much appreciate the time and thoughtful replies! I was almost convinced to do "regular" F because I may get foot surgery later in the year...but now I'm back to thinking hi-D F is the way to go. And Ariadne ( I think it was that poster)
also made the good point that a current -hi-D client may be grandfathered in if the companies do drop the product, whereas the "full" options would likely always be there.

I gotta ask... ALackofCreativity...are you in the med insurance biz or work in a medical office? At any rate, thanks for the info!
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Old 06-01-2014, 07:48 PM
 
3,262 posts, read 3,001,812 times
Reputation: 1893
Quote:
Originally Posted by catfancier View Post
WOW... thanks to everyone who is participating in this thread... I very much appreciate the time and thoughtful replies! I was almost convinced to do "regular" F because I may get foot surgery later in the year...but now I'm back to thinking hi-D F is the way to go. And Ariadne ( I think it was that poster)
also made the good point that a current -hi-D client may be grandfathered in if the companies do drop the product, whereas the "full" options would likely always be there.

I gotta ask... ALackofCreativity...are you in the med insurance biz or work in a medical office? At any rate, thanks for the info!
If you do need foot surgery later in the year than a "regular" F will probably be better for you next year -- just speak to your insurance agent about whether it would be possible to buy one for next year and then to switch to a better value proposition hi-D F or Advantage plan the year after that (and if companies dropping plans is a significant risk or not, etc.), assuming you are relatively healthy for your age bar the whole foot issue. If that's something you can do great, if it's not that's a harder choice.

I don't really like talking about what I do here (or online in general) and everything I say is my personal opinion, not professional ...anyway, my opinion and everyone else's online is going to be 100X less knowledgeable and useful than that of your insurance agent who will understand both the local market and your personal situation a lot better than any of us will and you should make any decisions based on your own thoughts and his/her guidance, just using us to help in thinking about potential issues you may not have thought of on your own.
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Old 06-01-2014, 08:14 PM
 
Location: Wisconsin
21,534 posts, read 43,962,244 times
Reputation: 15135
@catfancier - Know that Medicare-approved rates are notoriously low. You need to check w/your surgeons on the exact Medicare-approved costs, here. Will your 20% share of those Medicare-approved charges (doctor, hospital, surgeon, etc.) exceed $2,140, less your premium?

Further, know that once you've enrolled in a Medigap, most carriers require you complete a health questionnaire - even during the annual open enrollment - before switching carriers or changing your plan. StressedOutNYer learned the State of NY allows switching of Medigaps at any time with no prohibition on preexisting conditions. That is not true in most states, where Annual Open Enrollment is the only time you are given the opportunity - without any guarantees of acceptance - to apply for different coverage. Whereas, any plan you apply for now must take you.

Last edited by Ariadne22; 06-01-2014 at 08:33 PM..
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Old 06-01-2014, 08:23 PM
 
48,516 posts, read 83,880,155 times
Reputation: 18049
I agree Advantage plans are limiting. Most never see it until its a major illness and you want top specialist or even getting approval for treatment thru them. I think the best is fee for service Medicare and as good a supplement as you can afford. that was my choice and I do not regret it by any means. if a Advantage plans is the best you can afford then its the best you can afford; plain and simple.
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