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Old 02-21-2016, 02:30 PM
 
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i know nothing about calipers but the whole idea of going medicare and medigap is no network .


MEDIGAP / MEDICARE SUPPLEMENT

If you have original Medicare with a private insurance supplement, you have no additional networks with which you have to be concerned. As long as your medical provider accepts Medicare, your Medicare Supplement insurance policy will be accepted.
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Old 02-21-2016, 02:44 PM
 
Location: Wisconsin
21,541 posts, read 44,039,638 times
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Quote:
Originally Posted by 2sleepy View Post
But don't your medi-gap plans have a provider network? I had a medi-gap PPO Anthem plan a few years ago and almost overnight they eliminated half the doctors and one of the two major hospitals in our area.
Quote:
Originally Posted by 2sleepy View Post
weird...I never had the option to buy a plan like that, I have to choose a plan through CalPERS and they have never offered a plan that is not PPO https://www.calpers.ca.gov/docs/form...ment-guide.pdf You can pick an advantage PPO or HMO plan, or a PPO supplement (medi-gap) plan but that's it
Because CalPERS is an employer-sponsored plan. Employers can dictate providers - even in their retiree plans.

If you purchase a Medigap outside of CalPERS, you will have NO NETWORKS.
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Old 02-21-2016, 03:46 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,938,980 times
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Quote:
Originally Posted by mathjak107 View Post
In some states, you can change plans at certain times without going through underwriting...
In Florida - where I live - you're basically SOL. Don't know about other states. Robyn
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Old 02-21-2016, 04:10 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,938,980 times
Reputation: 6716
Quote:
Originally Posted by 2sleepy View Post
But don't your medi-gap plans have a provider network? I had a medi-gap PPO Anthem plan a few years ago and almost overnight they eliminated half the doctors and one of the two major hospitals in our area. A year or two later they added them back, but at the time I had to find a new doc quickly and it was tough because most weren't accepting new patients.
Traditional Medicare (with a traditional Medigap policy) does not have networks. There is no such thing as a "Medigap" PPO - at least not where I live. You are only limited in terms of providers anywhere in the country that accept Medicare patients. If I get cancer here in Florida - I can go to any great medical institution anywhere in the US that still accepts Medicare patients.

Note that accepting Medicare patients isn't the same as "accepting Medicare". It's a billing thing. If an institution accepts Medicare patients - but not Medicare - it can charge up to about 15% more than Medicare allows for various things. This is what Mayo here in JAX does. There are Medigap policies that cover these "excess Medicare charges". My husband has plan J (now discontinued) and I have plan F (still offered). I think that even plan F will disappear soon - so I'd buy it if possible while it's still available (once you buy a particular Medigap policy - even if it's discontinued for new enrollment - you can keep it).

Although we know that a decreasing number of providers are accepting Medicare patients these days - and especially new Medicare patients - those of us on Medicare really can't do better than going on traditional Medicare with an excellent Medigap policy.

My own personal opinion - just watching what's going on where I live - is we're developing into a 2/3/4 tier medical care system. People with Medicare Advantage coverage aren't at the absolute bottom (that's for people like illegal immigrants with no coverage at all). But they're only 1 step up from the bottom - along with low income Medicaid patients. If someone can't afford traditional Medicare with a Medigap supplement unless they don't eat properly - can't pay their utility bills - etc. - fine. I can totally understand that. But when it comes to people who can afford to pay for it - but won't - I don't understand that at all. Robyn
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Old 02-21-2016, 04:25 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,938,980 times
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Quote:
Originally Posted by mathjak107 View Post
...having the freedom of of choice can be a big deal . i know if i ever get cancer i only want to be able to use sloan kettering . i don't want to be forced in to some network hospital just because i have no alternative .
Or you might want to go to MD Anderson in Texas or Mayo in Minnesota - or even Mayo in JAX. Or someplace else. It all depends on what you have - and what you might need/want. For example - one of my GYNs (who I met when he was a young resident - he is now retired) moved here from Miami about the same time we moved from Miami to work at Mayo. He developed a surgical procedure that could reconstruct a woman's bladder when the original had to be removed as a result of extensive female pelvic/reproductive organ cancer. For a long time - he was the only person in the world who could do this. Here in JAX (hardly a major metro area).

The point is you have options with traditional Medcare and a Medigap policy - many more than you have when it comes to MA plans. You might not need those options - but it's nice knowing you have them. Robyn
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Old 02-21-2016, 04:37 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,938,980 times
Reputation: 6716
Quote:
Originally Posted by Ariadne22 View Post
Because CalPERS is an employer-sponsored plan. Employers can dictate providers - even in their retiree plans.

If you purchase a Medigap outside of CalPERS, you will have NO NETWORKS.
Does it make sense for someone in a program like CalPERS to do that these days (if you or anyone else knows)?

My late FIL and his late wife were covered under a (large) employer health plan. Which they thought was adequate when they went on Medicare. Turns out it sucked - big time - if you didn't have a Medigap policy. Luckily - we read all the plan stuff and got them to buy Medigap policies before they wound up paying big bucks out of pocket.

Reckon all of these employer policies vary - a lot. And you have to go over them with a fine tooth comb. Robyn
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Old 02-21-2016, 04:41 PM
 
Location: Living rent free in your head
31,100 posts, read 13,614,329 times
Reputation: 22152
Quote:
Originally Posted by Robyn55 View Post
Traditional Medicare (with a traditional Medigap policy) does not have networks. There is no such thing as a "Medigap" PPO - at least not where I live. You are only limited in terms of providers anywhere in the country that accept Medicare patients. If I get cancer here in Florida - I can go to any great medical institution anywhere in the US that still accepts Medicare patients.

Note that accepting Medicare patients isn't the same as "accepting Medicare". It's a billing thing. If an institution accepts Medicare patients - but not Medicare - it can charge up to about 15% more than Medicare allows for various things. This is what Mayo here in JAX does. There are Medigap policies that cover these "excess Medicare charges". My husband has plan J (now discontinued) and I have plan F (still offered). I think that even plan F will disappear soon - so I'd buy it if possible while it's still available (once you buy a particular Medigap policy - even if it's discontinued for new enrollment - you can keep it).

Although we know that a decreasing number of providers are accepting Medicare patients these days - and especially new Medicare patients - those of us on Medicare really can't do better than going on traditional Medicare with an excellent Medigap policy.

My own personal opinion - just watching what's going on where I live - is we're developing into a 2/3/4 tier medical care system. People with Medicare Advantage coverage aren't at the absolute bottom (that's for people like illegal immigrants with no coverage at all). But they're only 1 step up from the bottom - along with low income Medicaid patients. If someone can't afford traditional Medicare with a Medigap supplement unless they don't eat properly - can't pay their utility bills - etc. - fine. I can totally understand that. But when it comes to people who can afford to pay for it - but won't - I don't understand that at all. Robyn
I'm not stupid, I know that hospitals that do not accept medicare assignment can charge 15% more, but there isn't one hospital in my area that doesn't accept medicare assignment, so it's irrelevant. And I'm not low income or 1 step from the bottom but if saying such a thing makes you feel better, then so be it. I've never had a problem with my PPO medicare supplement, or Kaiser HMO. My husband has not had any problems with 2 out of the 3 medicare advantage plans he has had. So we don't feel any compelling need to spend 5K a year for the benefits that we are doing fine without.

And honestly, if you get cancer the outcome will probably be the same with your local oncologist as with some place like CTCA.

Special Report: Behind a cancer-treatment firm's rosy survival claims | Reuters
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Old 02-21-2016, 04:45 PM
 
Location: Living rent free in your head
31,100 posts, read 13,614,329 times
Reputation: 22152
Quote:
Originally Posted by Robyn55 View Post
Does it make sense for someone in a program like CalPERS to do that these days (if you or anyone else knows)?

My late FIL and his late wife were covered under a (large) employer health plan. Which they thought was adequate when they went on Medicare. Turns out it sucked - big time - if you didn't have a Medigap policy. Luckily - we read all the plan stuff and got them to buy Medigap policies before they wound up paying big bucks out of pocket.

Reckon all of these employer policies vary - a lot. And you have to go over them with a fine tooth comb. Robyn
It makes sense for me, the premium for my Kaiser HMO plan is $299 a month, my employer pays $300 a month toward what ever CalPERS plan I choose so my out of pocket is limited to my part B premium. There are very few co-pays and no deductibles, Kaiser gets very good ratings, both by medicare and in other studies

California agency ranks Kaiser as best HMO, Anthem and Cigna as best PPOs - LA Times

Kaiser health plans receive top ratings
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Old 02-21-2016, 04:59 PM
 
Location: louisville
4,754 posts, read 2,014,098 times
Reputation: 1713
Why are people putting gap policies and part d, as well as ma plans... They are all elective. And there are a heck of a lot more gap plans.

Good to see you sleepy... I'm not going to weigh in on this thread. I'm healthcare' out (jk).
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Old 02-21-2016, 05:36 PM
 
Location: New Hampshire
242 posts, read 181,135 times
Reputation: 313
The new deal....
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