Medigap

[Lancaster]

This is a theoretical question.

I am almost 69 and going to retire at the end of this year and planning to get a Medigap plan when I start Part B Medicare.

If I were currently paying 20% for rental for my asv machine to a DME now under my current employer health insurance,would Medigap take over the 20% immediately after I retire?

The aarp booklet says under Exclusions "Stays beginning, or care or services received, before your plan's effective date" are excluded."

This seems like they would not pay it. When I asked the DME she said that Medicare would rent it for me for 13 months no matter how long I already had rented for under my employer health insurance. But no information on what the Medigap plan would do.

[chunkyfrog]

Call Medicare--
Different plans will cover varying amounts.
You may benefit from a meeting with a SHIIP representative (or your state's equivalent)
It is free, and since you are just starting, you do not have to wait for the open enrollment
to evaluate part B supplements.
Note: we consult with them for part D every year, because every plan changes---every year.

[Janknitz]

Your first concern is Medicare Part B, before you worry about Medi-gap insurance. People mistakenly believe that Medi-gap will pick up anything Medicare does not pay, but that's not true. Medicare pays minus co-pays and deductibles, then (and only then) will a Medi-gap plan pay part or all of the co-pay or deductible, depending on the plan. They don't pay if Medicare doesn't pay first. When looking for Medi-gap insurance, you need to understand how the particular plan covers your out of pocket costs, what providers they will cover, etc.

I think you're going to have to get documentation to Medicare about your need for the bipap--sleep study and documentation of why you are not able to use regular CPAP before Medicare will approve paying for it. Then they are going to start a brand new capped rental for 13 months. They will pay 80% of the Medicare approved rate, your medi-gap will cover whatever they cover, then you pay whatever deductible (two of them since this extends beyond a year) and co-pays you are responsible for under your Medi-gap plan.

I think that if they are going to start the capped rental all over again you should get a brand new machine from Medicare--same cost to Medicare, same cost to you out of pocket. But your DME may try to simply make you re-purchase the same machine you have already been using for some time on your employer health group plan.

I agree, contact your state's SHIP program for valuable help in choosing a Medi-gap plan and trustworthy info about DME on Medicare.

[Lancaster]

I had two sleep studies. One showed 36 ahi. 25 from csa and 11 osa. I think it showed I stopped breathing like 13 minutes an hour.

The 2nd study was with the ASV machine which showed awesome improvement. So I never was tested on regular cpap or failed regular cpap.

I did have the required follow up to document improvement in my symptoms.
Then I had an ablation of RVOT tachycardia (50k pvcs hour) afterwards so I am not having the arrhythmia now. So CSA is probably also improved from that ablation.

[greatunclebill]

Your first concern is Medicare Part B, before you worry about Medi-gap insurance. People mistakenly believe that Medi-gap will pick up anything Medicare does not pay, but that's not true.

Medicare pays 80%. Tricare for life, pays 20% and all medicare deductibles. I have no co-pays. In 4 yrs on medicare/tricare for life i have paid zero dollars out of pocket. All I pay is medicare part B. Tricare for life has no cost. If you did not know about this, you may not know about others.

[chunkyfrog]

I have a Medicare part B--plan F
Right now it pays the part B deductible and the 20% copay.
But it is not cheap.
Choosing this type of plan requires math and much thought.
See SHIIP before somebody screws you--you are in the cross-hairs . . .

[zoocrewphoto]

What is your current plan paying? If you were not changing coverage, would the rental be a capped rental? When would that end, if you were not retiring?

I'm wondering if there might be a way to finish that off before changing coverage.

If you do have to start over, see if you can get a new machine since they are paying for a new one, and then offer the DME a deal to complete the purchase on the older one as a backup.

[Janknitz]

Your first concern is Medicare Part B, before you worry about Medi-gap insurance. People mistakenly believe that Medi-gap will pick up anything Medicare does not pay, but that's not true.

Medicare pays 80%. Tricare for life, pays 20% and all medicare deductibles. I have no co-pays. In 4 yrs on medicare/tricare for life i have paid zero dollars out of pocket. All I pay is medicare part B. Tricare for life has no cost. If you did not know about this, you may not know about others.

You are missing my point.

Suppose your doctor recommended hyperbaric oxygen treatment for a certain type of cancer, but Medicare denies coverage of hyperbaric oxygen for that particular type of cancer because the FDA has not approved hyperbaric oxygen treatment for that type of cancer. If Medicare will not pay for this treatment, NEITHER WILL TRICARE or any other Medi-Gap policy. Medi-gaps only pay part or all of the out of pocket costs AFTER Medicare has approved and paid its portion for the treatment.

Medi-gap policies all have different levels for the coverage for the deductibles and co-pays, depending on which plan you choose--so no, I don't know about ALL the various plans. You are thanked for your service to this nation (Thank you!) with wonderful coverage from Tri-Care, but some people have Medi-Gap plans that only cover a portion of the deductibles and co-payments for Medicare covered treatment and DME. And NOBODY has a Medi-gap policy that covers what Medicare does not (exception for policies that add in vision and/or dental coverage).

This is often a rude awakening when people are in nursing homes and Medicare says they no longer qualify for "skilled nursing services"--they expect their Medi-Gap plan to pick up the costs and are very surprised to find out that's not how Medi-gap insurance works. If Medicare doesn't cover it, Medi-Gaps don't pay for it either.

[greatunclebill]

you are mostly right except if tricare for life covers something and medicare doesn't, tricare for life becomes first payer and deductibles come into play. it's rare that it would happen that way. it's written in the plan because it could happen.

it also works the other way around. medicare covers things that tricare for life doesn't. in that scenario tricare for life doesn't cover the 20% and deductibles are back in play.

for the largest majority, both pay and i don't. not sure if link will work.

https://www.tricare4u.com/wps/portal/td ... BIS9nQSEh/

[JimW159]

Like chunkyfrog, I, too have a supplement (AKA Medigap) Plan F. I have yet, in the ten years I've had it, had to pay a single penny for any procedures or devices prescribed. As she stated, it is not cheap, but when compared to the co-pays for surgery, it has not only been an economic win, but it offers a comfortable shelter when medical bombs drop. I have heard that the full Plan F (there is a high deductible version that is somewhat cheaper, but I don't know what the deductible is) will be phased out in a few years. I have also heard that if one is already enrolled, continuation is insured. I got mine through AARP - they can provide full information about every aspect.

[calusa]

I have heard that the full Plan F (there is a high deductible version that is somewhat cheaper, but I don't know what the deductible is) will be phased out in a few years.

My high-deductible Plan F has a $2,200 annual deductible. That sounds really high, but to date I've never come even CLOSE to paying my medical providers the extra cost of a standard Plan F (which for me would be about $1,800 a year in extra premiums).

I don't understand paying $1,800 extra every year to maybe save $2,200 in one year....

While it's great that some people didn't pay a dime of out-of-pocket costs due to a Medigap policy, it's only great if your Medigap policy doesn't cost you 2 or 3 times what you didn't have to pay directly to medical providers.

(The high-deductible Plan F has TOTAL coverage above $2,200, so it takes care of those really bad years that any of us may have just as well as any other Medigap policies.)

I'm not in the insurance business or the medical business -- but I'm glad I paid attention in math class, because the insurance business has as many sharks as the DME business...

[JimW159]

I have heard that the full Plan F (there is a high deductible version that is somewhat cheaper, but I don't know what the deductible is) will be phased out in a few years.

My high-deductible Plan F has a $2,200 annual deductible. That sounds really high, but to date I've never come even CLOSE to paying my medical providers the extra cost of a standard Plan F (which for me would be about $1,800 a year in extra premiums).

I don't understand paying $1,800 extra every year to maybe save $2,200 in one year....

While it's great that some people didn't pay a dime of out-of-pocket costs due to a Medigap policy, it's only great if your Medigap policy doesn't cost you 2 or 3 times what you didn't have to pay directly to medical providers.

(The high-deductible Plan F has TOTAL coverage above $2,200, so it takes care of those really bad years that any of us may have just as well as any other Medigap policies.)

I'm not in the insurance business or the medical business -- but I'm glad I paid attention in math class, because the insurance business has as many sharks as the DME business...

I understand and totally agree with you, it doesn't make sense if one feels the difference is between maybe and perhaps. However, in my case I knew there was a surgery that I had to decide on within a year that would have presented me with a definite minimum co-pay of at least $10,000. Thus I felt not obligated, but certainly incentivised to minimise that expense if possible. If one has never been presented with the bills that come out of surgery, one has perhaps no concept of how many sattelite service providers and doctors are involved. As an aside: while the surgeon was measuring and marking up the incision site he was commenting about the economics of "...a $45 pen to mark up an area of just a few square inches and thrown away."

[LSAT]

Your first concern is Medicare Part B, before you worry about Medi-gap insurance. People mistakenly believe that Medi-gap will pick up anything Medicare does not pay, but that's not true.

Medicare pays 80%. Tricare for life, pays 20% and all medicare deductibles. I have no co-pays. In 4 yrs on medicare/tricare for life i have paid zero dollars out of pocket. All I pay is medicare part B. Tricare for life has no cost. If you did not know about this, you may not know about others.

military retirees only

[calusa]

in my case I knew there was a surgery that I had to decide on within a year that would have presented me with a definite minimum co-pay of at least $10,000.

Can you explain a little more?

I'm assuming you have Medicare Part B, and the discussion is about supplementing that coverage with a Medigap policy to cover what Medicare will not pay.

Are you saying that if you proceed with this surgery, you will face at least a $10,000 co-pay despite what Medicare Part B covers? And that your regular Plan F will cover all or most of that co-pay -- thus a high-deductible Medigap policy with a $2,200 deductible would make you pay the full $2,200 before it covered the rest of your $10,000 co-pay?

[Lancaster]

This is an interesting topic as I have to decide whether I want Kaiser or Medigap Supplement and if so which Medigap plan .

If your surgery is in hospital, does the $2200 include the $1360 Part A deductible?