Medicare with Medigap Supplement - Deductible??

[MarkF48]

I changed for this year to Medigap Supplement coverage for my Medicare. I thought I had a good understanding of how the Part B deductible works ($183 for 2018), but after getting my first 'Medicare Summary Notice' it left me not so sure. I had had one doctors office visit for this year in March of which $56.12 went towards the $183 deductible which Medicare says I have now met in full. I couldn't figure out where the $126.88 of the $183 got paid, until I found the pdf document linked below which shows a 'pro rata' amount which matches exactly the dollar amounts I had in question. Nothing on my Medicare Summary had hinted anything at the pro rata amount that kicked into the deductible.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R111GI.pdf
Information about this is sparse and wasn't easy to find what I did.

Am I correct in thinking Medicare pro rates the deductible because I pay a monthly premium for the Medigap Supplement and this is counted as an out of pocket expense towards the deductible?

 

[fishheadbob]

Wow. I used to have to decipher that crap for a living, but a layperson trying to understand a technical manual like you copied is a recipe for disaster. Call your Medigap provider and ask them what's going on, most of them are actually helpful and will try to put it into English unless you come across as an as**ole with a chip on his shoulder.
Next October when there is a Part B open season - you'll know from the barrage of TV ads and junk mail you see - read up on Medicare advantage plans and get your fanny into the right one for you. They really work a lot better, premiums are lower or NOTHING, and your out of pocket expenses are pretty low compared to some of the national plans sold by celebrities, AARP, and so on.

 

[MarkF48]

Wow. I used to have to decipher that crap for a living, but a layperson trying to understand a technical manual like you copied is a recipe for disaster. Call your Medigap provider and ask them what's going on, most of them are actually helpful and will try to put it into English unless you come across as an as**ole with a chip on his shoulder.
Next October when there is a Part B open season - you'll know from the barrage of TV ads and junk mail you see - read up on Medicare advantage plans and get your fanny into the right one for you. They really work a lot better, premiums are lower or NOTHING, and your out of pocket expenses are pretty low compared to some of the national plans sold by celebrities, AARP, and so on.

I have coverage through my company that I retired from and pay only a small fraction of the monthly premium for both my wife and I. I can chose either an Advantage plan or a Medigap supplement plan with nation wide coverage (prescript plan included), same cost to me for either. I was enrolled in an Advantage plan, but I wasn't using most of the 'extras' (eye, dental, etc) and copays were heading up, as well as prescript costs. I did a lot of looking at the numbers and I think the Medigap supplement with the prescript program may save some money. I had figured in the $183 deductible when I looked at the whole picture, but that pro rata thing I couldn't figure out. It worked to an advantage to me this year with the doc's visit 3 months into the year, but my wife who just started on Medicare and the Medigap coverage had a doc's appointment in the first month did get hit with the $183 deductible for the several visits she had.

Almost afraid to call the Medigap provider or Medicare if for some reason they figure out they made an error

 

[k0ua]

Almost afraid to call the Medigap provider or Medicare if for some reason they figure out they made an error

I have thought about this and I can't figure it out either. I assume you have a G or N or C plan not an F plan correct?

 

[k0ua]

Hello Mark, This is k0ua's spouse. I have been working in the senior market for quite some time. To answer your original question, does medicare pro rate the Part B deductible because you have a Medigap plan. NO they do not. I looked at your thumbnail and it does not give me enough information to provide any advise. You should have received an explanation of benefits (EOB) from your Medigap provider showing what was paid, by them if anything. and what you owe on the deductible. That is your first line of defense. Or, as James suggested, call your Medigap provider, their customer service number will be on the back of your card, and ask them to explain it. The service centers for most providers are very helpful and can walk you through it. As to changing to an advantage plan. Go with caution. If you now have or expect to have medical issues in the future I recommend sticking with your Medigap plan. Advantage plans are OK and they do have their place but over the past several years I have seen the out of pocket rise on most plans dramatically. Further, if you change to an advantage plan you will have one year to test drive it. You can change back to your Medigap plan anytime during that year but as soon as you go one minute past that one year, unless you are well enough to clear underwriting, you will be on the advantage plan forever. ALWAYS look at your potential out of pocket cost, ALWAYS. Let us know if we can assist further. Linda

 

[MarkF48]

I have thought about this and I can't figure it out either. I assume you have a G or N or C plan not an F plan correct?

I'm in Massachusetts which is a little different that they have a different system, but similar in having different levels in the plans they offer. I have a BCBS MEDEX 2 plan that the company I worked for tweaked a few things in the riders which makes it sort of non-standard from plans offered the general public.

 

[MarkF48]

Hello Mark, This is k0ua's spouse. I have been working in the senior market for quite some time. To answer your original question, does medicare pro rate the Part B deductible because you have a Medigap plan. NO they do not. I looked at your thumbnail and it does not give me enough information to provide any advise. You should have received an explanation of benefits (EOB) from your Medigap provider showing what was paid, by them if anything. and what you owe on the deductible. That is your first line of defense. Or, as James suggested, call your Medigap provider, their customer service number will be on the back of your card, and ask them to explain it. The service centers for most providers are very helpful and can walk you through it. As to changing to an advantage plan. Go with caution. If you now have or expect to have medical issues in the future I recommend sticking with your Medigap plan. Advantage plans are OK and they do have their place but over the past several years I have seen the out of pocket rise on most plans dramatically. Further, if you change to an advantage plan you will have one year to test drive it. You can change back to your Medigap plan anytime during that year but as soon as you go one minute past that one year, unless you are well enough to clear underwriting, you will be on the advantage plan forever. ALWAYS look at your potential out of pocket cost, ALWAYS. Let us know if we can assist further. Linda

Good to meet you Mrs. K0UA and thanks for popping in ,

The Medigap EOB (BCBS MEDEX 2) does not itemize any of the deductibles Medicare. However the deductible of $56.12 was added to the coinsurance part that was 20% of what Medicare allowed, just not shown in any way it was part of the deductible. The statement I received from Medicare had no hint of where or how the $126.88 came from, but did say I was paid up with the $56.12 which totals up to the $183 Medicare deductible. The MEDEX 2 plan I have does not cover diagnostic office visits unless within 100 days of a hospital discharge, but the amount I'm anticipating at 20% Medicare allowed, should be in most cases be substantially less than the copay I would have had under the Advantage plan I previously had.

If you're primarily doing policies in the private sector, I wonder if corporate plans are done a bit different?

 

[rekees4300]

Nothing on my Medicare Summary had hinted anything at the pro rata amount that kicked into the deductible.

Trying to comprehend the incomprehensible (aka all Fed documents) will drive you bonkers. :confused2: Wife & I had Supplemental until we realized what a bad deal it is. We got poorer as the health insurance execs got richer. Think about it, Medicare pays 80% and Supplemental pays 20%. Assuming an annual supplemental premium of $4,000 for you and spouse, to break even you would need $4000/20% = $20,000 in medical expenses per year!

 

[k0ua]

I'm in Massachusetts which is a little different that they have a different system, but similar in having different levels in the plans they offer. I have a BCBS MEDEX 2 plan that the company I worked for tweaked a few things in the riders which makes it sort of non-standard from plans offered the general public.

That could have some bearing on the situation.. We deal only with the public plans. A plan F for instance would pay for the $183 up front, but the next step down a G would not.

 

[k0ua]

Trying to comprehend the incomprehensible (aka all Fed documents) will drive you bonkers. :confused2: Wife & I had Supplemental until we realized what a bad deal it is. We got poorer as the health insurance execs got richer. Think about it, Medicare pays 80% and Supplemental pays 20%. Assuming an annual supplemental premium of $4,000 for you and spouse, to break even you would need $4000/20% = $20,000 in medical expenses per year!

There are always different ways to look at things. For many people $10,000 per anum per person would not even begin to pay for their medical expenses.

Here is the bottom line, We sell both Advantage plans and Medsups. If you are going to stay healthy for the rest of your life, and you want a safety net, the Advantage plan is the way to go. If you are going to become ill before you die, then the Medsup is the way to go without a doubt. Easy choice right? I have just bottom lined it for every one. Just choose. Oh... by the way.. same for life insurance. If you knew when you were going to die, you would take it out at the appropriate time. Otherwise it is just a big "waste of money". Eazy Peazy.