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I am also considering changing from plan F to either HD-F, plan G or plan N.
USAA does not offer HD-F or plan G but does offer plan N. Am I missing some major negatives of plan N? I think I understand that plan G has basically the same benefits as plan F after the deductible payment of $183.
I am somewhat confused about being responsible for the extra percentage on top of what Medicare reimburses that might be due using plan N, plus a $20 co-pay for doctor visits.
I may have cataract surgery next year so I am trying to choose wisely or just stay with plan F.
This webpage has an extensive explanation of "excess charges", with examples:
I am somewhat confused about being responsible for the extra percentage on top of what Medicare reimbuses that might be due using plan N, plus a $20 co-pay for doctor visits.
Reed's link explains it very well. Plan N doesn't cover excess fees. Local doctors/hospitals in my area are participating Medicare providers - which means they take Medicare assignment - and cannot charge a 15% excess fee.
My cataract surgery was done at a local hospital by an opthalmologist long associated with the medical system which owns that hospital - and he and the hospital accepted the regular Medicare allowed-charge as full payment.
Per eye, that Medicare allowed-charge for the surgeon was about $1,200 - irrc. Which means, if that doc had not been a nonparticipating Medicare provider, the reimbursement would have looked as follows:
$1,200 - Participating provider Medicare allowed charge
$1,140 - Nonparticipating provider Medicare allowed charge (95% of Partic. Prov. Charge)
.....171 - 15% excess fee charged by Nonparticipating Medicare provider
$1,311 - Total due Nonparticipating Provider
....-912 - Medicare pays 80%x$1,140 ....-228 - Medigap N pays 20%x$1,140 (does not cover excess fee) $...171 - Your Responsibility
Facilities such as Mayo and some specialists are nonparticipating providers and will charge excess fees.
We have a poster on CD who has had a Medigap N for a while, underwent cancer treatment, and said Medicare and her Medigap paid for everything. It is unlikely your doctor will be a nonparticpating provider. If you ask his office if he is a participating or nonparticipating provider, chances are no one there will be able to give you an answer - based on comments from other posters here. A better question to ask is if he accepts Medicare reimbursement for this surgery - that they should understand.
Last edited by Ariadne22; 10-14-2017 at 12:49 PM..
In Wisconsin you can add a rider that covers Part B excess charges. I have an AARP/UHC co-pay Medigap policy that is basically a Plan N with the exception of the added excess charge rider which really makes it the same as a Plan G in other states with the only exception of the up to $20 co-pay for doctor(which I've yet to get) and a $50 hospital co-pay(unless you're admitted).
In Wisconsin you can add a rider that covers Part B excess charges. I have an AARP/UHC co-pay Medigap policy that is basically a Plan N with the exception of the added excess charge rider which really makes it the same as a Plan G in other states with the only exception of the up to $20 co-pay for doctor(which I've yet to get) and a $50 hospital co-pay(unless you're admitted).
That's $50 for the ER - waived if you're admitted. Regular plan N in most states includes hospital deductible - per admission of $1,316 - and foreign travel - and excludes excess. The hospital copay becomes relevant only AFTER you first pay the $1,316 hospital deductible and are hospitalized for more than 60 days.
Many people would not want the deductible exposure. In WI, you have to buy a separate rider for that.
Because of certain other mandated benefits in WI, UHC does not include the hospital deductible in its basic policy. Instead, UHC website shows two riders which combine hospital deductible, excess charges and foreign travel - one at 100% hospital deductible, the other at 50% hospital deductible. It is not possible in WI, if the UHC website is correct, to get a pure Plan N from UHC. Years back, iirc, when I called UHC they were offering foreign travel/excess separately. That has since changed.
Many people would want at least some coverage for the hospital deductible - because there is no limit to the number of times that deductible can be imposed within a one-year period. Multiple hospitalizations in a year without that coverage could get pricey, otherwise.
Granted, excess coverage isn't particularly expensive in itself - probably adding no more than $10/mo. to the premium - but, technically, adding this rider no longer makes it a Plan N.
Around here - big metro area w/excellent medical faciilities everywhere - excess isn't necessary. But if I wanted a UHC Plan N to include the hospital deductible, I must also buy excess.
Last edited by Ariadne22; 10-14-2017 at 05:56 PM..
Thanks for all this info - very helpful. I will have to calculate all my options and decide what I am comfortable with doing.
The link cleared up my confusion with excess charges. I also live in a metro area of large university hospitals and the doctors seem to accept basic Medicare reimbursement but I will double-check for sure.
I changed from F to G just last week for both my husband and I. We are with AARP United Health Care. All it took was one phone call. As stated you can change plans with them with no underwriting which is good as both of us have many health issues. Even saved about $20 a month each on the premiums.
When I chose my medi gap plan, I went with G because F, although it covers the Part B deductible, the premiums were much higher and would have ended up costing me more money than just paying my own deductible. It's worked out great for me. I save a couple hundred dollars a year by staying with my G plan.
I changed from F to G just last week for both my husband and I. We are with AARP United Health Care. All it took was one phone call. As stated you can change plans with them with no underwriting which is good as both of us have many health issues. Even saved about $20 a month each on the premiums.
We are in TX
Leaving my retired teachers supplemental group coverage w/RX coverage
They are moving all Medicare retired members to Humana Advantage w/expensive monthly costs (especially for an Advantage plan)
The agent we are using has told us since we are leaving a group supplemental we can only choose an F
I called him earlier because my retired teacher agency is not providing clear information about how to withdraw and get the needed documentation to be on new Medigap insurance come Jan 1
So our application is in stasis waiting for our documentation
Agent said at this point no one know what Congress might require in 2020 regarding plan F members' ability to a G or other plan
He also said we could move later in 2018 to plan G
And based on our health interview we would get covered-accepted
We both take meds for HBP
My husband is type II diabetic in control
What info if any is this agent misrepresenting?
I have been to Medicare.gov and it looks like I could choose several plans offered in my zip code but you have to contact the insurance companies for prices
We are in TX
Leaving my retired teachers supplemental group coverage w/RX coverage
They are moving all Medicare retired members to Humana Advantage w/expensive monthly costs (especially for an Advantage plan)
The agent we are using has told us since we are leaving a group supplemental we can only choose an F I called him earlier because my retired teacher agency is not providing clear information about how to withdraw and get the needed documentation to be on new Medigap insurance come Jan 1
So our application is in stasis waiting for our documentation
Agent said at this point no one know what Congress might require in 2020 regarding plan F members' ability to a G or other plan
He also said we could move later in 2018 to plan G
And based on our health interview we would get covered-accepted
We both take meds for HBP
My husband is type II diabetic in control
What info if any is this agent misrepresenting?
I have been to Medicare.gov and it looks like I could choose several plans offered in my zip code but you have to contact the insurance companies for prices
Why can't your agent give you prices? Find a good Medicare insurance agent who has access to multiple companies.
FYI- all Plans F provide the same basic coverage - some may add a bell or whistle like gym membership. Your agent is correct - plan G is not a guaranteed issue option at this time - see #2, here:
Some companies (not all) will allow a downgrade (F to G, for example) at a later time without health underwriting. AARP UHC is one of those.
Biggest difference among the plans is pricing - are they community-rated, issue-age rated, or attained-age rated." That difference can become very expensive as you age.
In most states (other than the few guaranteed issue states, TX is not a GI state), the only company providing a community-rated plan is AARP United Healthcare. AARP does discount for those under 77. AARP UHC community-rated may be slightly more expensive initially but will prove to be the least expensive in the longer run. UHC pricing link, here:
You mentioned CIGNA in one of your posts. CIGNA may be less expensive now, but an attained-age rated policy can become very pricey as one ages - like over $400/mo if you choose the wrong company. Even if your agent provides today's price for an 80 y/o. v. UHC, the comparison is of limited value as that risk pool is not yours. Once your book of business/risk pool closes - usually within 4-8 years - the risk pool will determine your price.
Community-rating avoids that exposure.
Last edited by Ariadne22; 11-22-2017 at 04:02 PM..
Thank you--
I knew about the community based vs attainted-age
This agent kind of discounted that because his experience is that when companies are required to offer the same benefits per plan--like all Fs offer the same level of coverage--there is always price differences between companies...
He has worked with friend for ours for 4-5 yrs since AA pushed all their retired employees out of health coverage---and this year he called her and told her she would be better off moving to the Cigna plan F--had been with different company--not AARPs--and she could save some $ w/o getting bad customer service...so she did...
I am going to talk to my husband about this--
Maybe later we will try to move to AARP
I understand the benefit of community underwriting long term
I didn't see a G plan listed on that link--why all the others and no G?
Paying your deductable doesn't seem to be much of an issue when most of the other option are fewer benefits (even if lower cost) but there is the F--the most complete coverage...
I mean it is like they just arbitrarily decided not to allow that choice when coming off a group supplemental plan...
How does that make sense???
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