What is BBPGC?
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The broker shouldnât charge you anything, so thereâs no downside to letting an expert guide you through this.[/quote}
Not really. The broker may well lead you to the coverage for which he/she gets a higher commission.
You are only subject to a penalty if you donât submit the proof of credible coverage and apply for part b during the special enrollment period. Do it right and there is no penalty.
How far in advance should we start looking into everything? My husband turns 65 next March.
The window to apply for the first time is 3 mos before the month of his birthday through 3 mos after (its a 7 mo window). So you have some time, but if there are presentations you can attend, Iâd go if I were you.
@jym626 thanks.
@coolweather BBPGC is an acronym I made up - Big Bad Price Gouging Company. Itâs a company that has taken over the doctor and hospital network in Northern California. They set their contracted negotiated prices to be 4 times higher than other providers. And their insurance contractallows for their full charged rates. No discounts.
They are the reason our medical costs are so much higher than just about anywhere else.
There is a qualifying window of 8 months after the person retires and no longer is getting insurance from employer that also applies (even if the policy remains in effect for him and family as a retiree). H is older and I was and continue to be covered by the family plan of his now former employer. No one had to get Medicare B until he was retired. At that point, he gas 8 months to get part B.
He got Part A shortly after turning 65 by just signing up.
Waiting until he retired at 70 saved him 5 years of premiums for part B. I am still too young to get Medicare or I would also have had to sign up within 8 months after he retired. I will sign up for A & B within 3 months of turning 65.
As to which is primary and which is secondary, you have to read the policy. For Hâs, when he was employed, his insurance was primary. Once he retired, Medicare was primary. For him, with his insurance + Medicare B, we rarely pay out of pocket except small copay for Rx plus dental and vision.
While there is an 8 mo window after retirement, it was strongly advised to take care of it just prior to retirement.
Yes, it is best to handle so that it starts when you retire. We mailed in Hâs paperwork before he retired but didnât walk into SS/Medicare to check on it until 7 months later, only to learn that for reasons we never understood to this day, one worker decided to reject it and just hand onto the paperwork.
Fortunately, we were able to get him to give us back the paperwork and walked it back in the next day to get it approved. It was the EXACT same paperwork. If we had tried to resolve it any later, we would have been penalized for the rest of Hâs life for signing up late, never mind that it wasnât our fault!
When itâs my turn to sign up for Medicare, I think I will make an appt and walk in so we donât have the issues we had with Hâs.
Even if you walk in, check and double check. I had to go in person to sign up because Iâm a green card holder so not eligible to sign up online. I was only signing up for Medicare because I am still working and earn too much to get early social security. Then I get a letter saying Iâd elected to get early social security, earn too much to get it, but my future social security is permanently reduced because Iâm getting it a year early. Even though Iâm not getting it. Had to treck back to the nearest SS office an hour away to sort it out.
Then Medicare insisted they would be deducting my premiums from my social security - even though I told them Iâm not getting SS.
Hopefully once itâs all set up it goes more smoothly but I kind of donât trust them.
@dietz199 - I assume you mean Sutter â I do use Sutter via Blue Shield and I can assure you that the insurance rate is discounted in my area:
So for example â I with my current high deductible market HSA plan (NOT Medicare yet) I have claims that look like this:
$504.00 (Amount billed by Provider) - $201.60 (Network Savings) = $302.40 (Patient responsibility)
$192.00 (Amount billed by Provider - $113.66 (Network savings) = $78.34 (Paid by Blue Shield - Preventive)
I agree that Sutter charges higher than other area facilities â though I donât know how much higher. And I have no idea how things will work when I go to Medicare next year â but they definitely do take some Medical Advantage HMOâs. For me the choice is Sutter vs. Kaiser and either way Iâll be paying less out of pocket than I was a number of years ago before ACA came in. Sutter is pricey but I also am very satisfied with the level of care I get âthough a little concerned about shift from PPO to HMO if I go with an MA plan.
https://medicare.kaiserpermanente.org/wps/portal/medicare/plans/learn suggests that they do, if you want a less expensive option than Sutter Health or plans that are expensive because they have Sutter Health in-network.
Agree that you have to check and double-check that things are done correctly with Medicare and SS.
For H they insisted he could NOT have his premiums withheld from his fed pension and had to pay quarterly from his personal checking acct (this from the same employee who refused to process his application because the paperwork was somehow âwrongâ).
Lo and behold the next day when H went to resubmit the same âwrongâ paperwork, it was accepted and payments are monthly deductions from Hâs fed pension.
I just got an ad for a kaiser medicare plan. Itâs IIRC, a Medicare Advantage plan.
@ucbalumnus Yes, Kaiser takes Medicare - on a county by county basis. In my county, Kaiser is not yet Medicare certified. From my discussions with them on this matter, becoming Medicare certified (not sure if thatâs the correct term) takes volumes of paperwork and can take a couple of years to finalize.
@calmom. Yes. Itâs Sutter. We have a PPO plan with a 4K deductible. Prior to our small doctors group becoming Sutter an office visit would run about $100. They would charge $200 and then we would pay the reduced negotiated rate. Now, an office visit is $220 - and there is no reduced negotiated rate. Thatâs just the basic - you can sit on the wax paper - level visit. After discussing a couple of items, Hâs office visit bill was $425 - out of pocket. It was coded as âcomplex problemâ. He talked about things like joint pain and weight.
A breast ultra sound thru a non Sutter provider runs me $350 - the rate after the negotiated discount. With Sutter - the billed rate of $675 IS the negotiated rate. Believe me, I wish this wasnât so but Iâve been tracking it for years.
As for Sutterâs lab fees - they are much higher than Quest. I took the CPT codes from Hâs last blood panel and called Sutter for their pricing. Again, the negotiated rates are the billed rates. His panel would have cost us over $400 at the âconvenient - itâs in our office nowâ Sutter lab vs $119 from Quest. Of course, the Sutter docs were reluctant to send the lab orders to an âoutside companyâ. Luckily, they can not legally refuse the request.
So, if someone has a low deductible/ no deductible plan they wonât notice or care about the difference.
Or, if one has a condition where one reaches the deductible quickly and one projects that they will also meet the OOP max, then Sutter would be a viable option.
Others, who cover all their own costs, are reasonably healthy and only have a few issues a year, are well served to look elsewhere.
As for Sutter and MedicareâŠSutter is not taking new Medicare patients in my area. You have to be an established patient (as defined by certain criteria) and then they have to accept you. There are no Advantage plans in our area - at least not this year. I have absolutely no complaints or concerns about the quality of doctors and level of care provided by Sutter. H will go with a gap plan and continue to see his Sutter doctor when on Medicare. At that point cost is no longer an issue since H will pay the same whether itâs a Sutter doc or not.
I posted earlier that my folks in Oakland had Kaiser for years under Medicare. Yes, it was a Medicare Advantage plan.
But of course, that is only a good option if you have a Kaiser hospital within a decent driving distance.
^^^ Yes, my parents have/had Kaiser Medicare. It has been wonderful and easy to manage. But again, the Medicare option is on a county by county basis. Kaiser just established a presence in Santa Cruz county a little over a year ago. Kaiser in Santa Cruz does not take Medicare.
@dietz199 â it sounds like the insurance & billing rate issues are local to you. The example I posted above ($504 charge; $302.40 charge after insurance reduction) â actually happened to include a breast ultrasound (the example you gave), at the local Sutter facility. So obviously there are differences from one county to another. I know that around here the negotiations between Blue Shield & Sutter donât get resolved until the last possible minute â that is, every other year the Sutter patients get a notice that the contract has not yet been renewedâ but then it does get renewed.
The direct rates for office visits arenât reduced so much â only about $20 off the doctorâs charge. But there is an adjustment.
I agree with you about Sutter lab fees vs. Quest, but I have always used Quest and never an objection from my Sutter provider. For awhile they werenât linked electronically so the lab request needed to be faxed â but that was resolved a couple of years ago and now when my doctor orders the labs and I arrive at Quest, itâs already in their system.
Anyway, I realize that things are frustrating in your area, but it isnât the same in all counties, and I think itâs just an example of capitalism at work â Sutter apparently can get away with charging more in your area because of lack of meaningful competition.
You do raise an interesting issue about Medicare â that I should just not rely on the website info for determining which MA plan will cover services, but also verify that it will also apply to me next year as a newcomer to Medicare.
Lack of meaningful competition is hinted by both the lack of Kaiser for Medicare and that even the Sutter practices are limiting new patients (at least for Medicare patients), suggesting a general shortage of providers/practices in the area. A market that is dominated by one practice (i.e. close to being a monopoly) where there is also a shortage of providers is one which can be expected to be unfavorable for patients.