^^In addition to no new enrollees in Plan F after 2020, the same it true for Plan C. Thus, perhaps your local BC plan is starting the transition early and, by jacking up the rates on this year’s Plan C, discouraging folks from taking it.
@annamom, Blue Cross doesn’t offer Plan C in my area, but I did see that the UH (AARP) has plan C priced almost the same as F (F: $144.48; C: $144; G: $123.84). But C is almost the same as F, except that C doesn’t charge “Part B Excess Charges” – but it does cover the Part B deductible.
From an actuarial perspective, probably 95% percent or more of insured are going to incur the Part B deductible – so that’s one of those things that they have to factor in as a cost for almost everyone who buys F or C. (But no worries, UH is charging their customers around an extra $250/year to pay that $183).
So if C/F are priced relatively the same, my guess is because the insurance company doesn’t have to worry about the excess charges thing in your area.
Here’s the deal on that:
From: https://65medicare.org/medicare-part-b-excess-charges/
But guess what? Some states prohibit excess charges (from the link above, Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.)
So that one bit of coverage might not make a lot of difference in many areas.
From the doctor’s perspectives, the ability to charge 15% over and above medicare’s rate might not be worth the administrative costs entailed in doing so. Maybe for high-demand specialist…but for most it probably just creates extra work, between the steps entailed in billing the patient for the excess & the level of confusion it creates. The question isn’t whether they can charge it, but whether it is something they can reasonably collect. If they just agree to accept the medicare assignment, then they have all of the administrative benefits of a single-payer system. They bill medicare; medicare pays them. No more billing to worry about.
^^thank you. I have learned so much just by reading both of your discussions. I have also thought I would buy the advantage plan. Now I am going to get Plan G.
Thank you. I have just enrolled in Plan G. Now I am looking for the prescription Plan. From the government website, after entering the medication I am currently taking, Silverscript is cheapest for me. However, I have never heard of it. I used to have Blue Cross Blue Shield, but it is difficult to justify over $60/month premium. Does anyone have any negative experience with silverscript?
no direct experience, annamom, but my neighbor just changed out of silver script. If I recall she said that the network required that she use the Walmart pharmacy first and, while she had no philosophical issues with Walmart, she said that our local one always had lines at the Rx counter. And she just got tired of waiting to fill her scripts. Of course, that just could be an issue with our local store.
I went to a seminar on Medicare put on by a local non-profit agency last week. Checking it out for DH. OMG. We all walked out of the room like we were shell shocked!
So if you get an Advantage plan and need care out of state, you’re screwed? It sounds like emergency care would be covered, but nothing more. If we wanted to eventually stay in Texas for a couple of months in the spring (I like winter in Maine but can’t stand the “spring” here), that would be a problem, wouldn’t it??
Medicare Advantage plans are like an HMO or EPO, so yes, its a limited network, by definition. So yes, for snowbirds, they may not be optimal. OTOH, I believe if one chooses say, the Kaiser Advantage plan, you can go to any Kaiser facility (assuming that Kaiser is offered in both your winter and summer residence location.)
MaineL, did you look into the Advantage plans offered by the Blues? Do they also restrict out of area coverage to emergency only? (Asking bcos I haven’t gotten that far in my research.)
I don’t like Silverscripts because they don’t just function in the background; they want to participate in my life. However, it’s not a big commitment to choose a Part D plan. If you don’t like it you can change to something different during open enrollment. So go with the cheapest on that suits your needs.
As I understand it, Medicare Advantage = health insurance. Limited networks, deductibles, copays, the need for pre-authorizations, claims processing, and everything else we’ve all come to know and love about dealing with health insurance over the years. But with a much lower premium. (At age 64, my ACA bronze PPO policy would be $1200 monthly for the coming year for full payers. ) The MA premiums are much, much lower.
The MA plans in my area are HMO’s. My friends who have always been with Kaiser are happy with their Kaiser MA plans, which makes sense. Pretty seamless transition for them.
Medigap is a totally different system. Closer to single payer. Everything gets billed directly to Medicare. The insurer is providing gap coverage, paying for whatever Medicare approves but doesn’t pay because of coverage limitations. So the bill gets sent straight to Medicare, and then I think Medicare pays what it pays and sends the invoice for whatever remains onto the Medigap insurer. So ideally, patients with an F plan would never see a bill, ever…other than the premiums.
But there are two premiums, one for Medicare Part B and one for the Medigap policy.
Whereas Medicare Advantage replaces the Part B (outpatient care) so only one premium, which generally is significantly less overall than the combination of Part B and Medigap.
Because of the information on this thread I called AARP United Healthcare with whom I have my medigap coverage and asked if I could change from Plan F to Plan G without medical underwriting. The answer was that I can before October 1st. So I did.
^^^ What makes October 1st the cut off date for the switch?
I asked that and the woman I was talking to said something vague like, “well, they thought that would be a good date.” I don’t know if the October 1st date is an AARP thing or a Medicare thing. I’d gotten what I needed so I didn’t pursue it.
I’m leaning toward the Blue Cross Innovative F Medigap plan. I keep trying to figure out what the catch is, but so far it looks like the best deal. Monthly premium only a couple of dollars higher than the G plan, but the vision benefit is worth it to me. (I’m a contact lens wearer and they have a $150 annual allowance toward the lenses, so right there I am making up the premium difference). The only thing I can figure with the Innovative F is that they want to get people signed up with what is essentially a teaser rate, and then gradually increase premiums over the years.
Either that or from a marketing perspective, they value the upsell opportunities – they are very happy to tack on an overpriced dental and/or drug plan along with the basic Medigap plan. But I’ll opt for a cheap $20/month Part D plan instead, since I don’t regularly take any prescription drugs.
As to the Part D — they all seem to have some sort of preferred-provider network-- so that is something to check in advance. For me it comes down to a choice between a Walgreens that is 5 min. away or an out-of-town CVS-- so I’ll opt for the plan that offers the best discounts at the most convenient store for my needs. But that’s totally a function of geography.
My Medicare Advantage Plan is a PPO plan with Anthem Blue Cross Blue Shield. It is a group plan through our state teachers retirement board. We have coverage within the Anthem BC/BS network nationwide.
We also have emergency and urgent care coverage abroad.
Not sure this is a plan available to folks other than groups.
My RX coverage is through Express Scripts.
We also have vision, hearing and dental through Cigna.
I pay my full Medicare premium plus an additional $130 a month for this.
I have SilverScripts. Supposedly, I get the most discount at CVS.
Personally, I don’t like Advantage plans. As a therapist, they pay less than regular Medicare, and charge the patient half of the payment. I only had one Advantage plan in the past year. Six months after ending a short term treatment, they asked for the $$ back.
I’m relieved when someone has a supplementary plans from AARP, BC, United American, USAA, Horizon, Continental general, GHI, etc. every MD who accepts Medicare will accept these secondaries. Oh yes, the patient has NO copayment
Nothing wrong with a teaser rate or loss leader. you can always swap out if they significantly increase the rates later.
I’ll have to scrounge around to see if they have a teaser rate for my zip code.
Agreed, given that I am in California and will be able to make whatever changes I need to in future years. For me it comes down to essentially a math problem. I’m a little skeptical that there needs to be a catch somewhere, but bottom line, with the vision benefit factored in, it’s a cost saving over the G plan, and Blue Cross has the best rates in my zip code in any case.
of course the question calmom is whether you’d get locked into Plan F-Alt, and not be able to switch to Plan G later without medical underwriting…
But that’s not a problem in California. State law allows us to always switch to an equal or lesser plan each year. So actually one more benefit to starting with an F plan… it means that in year 2 I will be able to shop other F plans as well as G.
My understanding is that Blue Cross started their F+ Plan in California, though it is now also available in other states. But definitely developed in the context of a large and competitive insurance market.
My insurance agent told me that unlike regular health insurance, sometimes medigap premiums go down rather than up in future years. I can see that because a large chunk of the target market are people on fixed incomes, and by definition it is secondary coverage only. Medicare is the primary, and Medicare also handles the initial claims screening, and also sets limits on overall charges.
So I think Blue Cross is looking for a way to build its customer base in a competitive market, by throwing in some potentially attractive extras.
^^ahh, got it. thanks.