Medigap Insurance Advice

[WhitewaterWoman]

4So, I've gone on Medicare (instead of having a spouse's insurance through work). It has come to my attention that Medicare does not cover some expenses or only 80% of some expenses and that a GAP coverage is recommended that one has to purchase separately.

I have been slowly working through a post-divorce budget (still no signed order) and it is coming out better than I expected, but I am loathe to pay more for more health insurance. OTOH, I am 71 and not getting younger or healthier. Right now I don't expect to have weeks or months in hospital, etc, but you never know. (Which is how the insurance companies get you.)

My choices seem to be $189/month that would cover most of the gap.

$140/month that would cover most as above, but with some copays and a deductible. $257 deductible, $20 for office visits and $50 for ER. This does not seem onerous.

High deductible option. $2800 deductible and then appears to cover everything over. Cost is $65/month.

My current thinking is to go with the high deductible options. It saves me almost $1000 in premiums and then there is only $1800 to make up.

Apparently I need to get this in right away due to Medicare limits - like tomorrow (Thursday 2/27). At first I just thought not to have Medigap supplemental insurance at all. Now it seems to be important if I were to get seriously ill or hurt.

Any advice or input would be appreciated.

Thank you.

 

[TBRS1]

I'm not especially good at stuff like this, but - if I was sure I would the $2800 always available, I'd feel comfortable going with the high deductible option.

I'd choose this for the reasons you've stated, plus the fact that the risk is easily manageable when there is safe money in the bank.

 

[Aspychata]

Good luck, sorry , l am completely clueless, but l like your reasoning.

 

[Judge]

I have just one question for you. You've confined this exclusively to Medigap Coverage.

Do you have something against the countless Medicare Advantage plans out there?

This is a subject best handled by professionals trained to inform consumers of their options free of charge (Florida): Medicare

https://health.usnews.com/medicare/articles/medigap-vs-medicare-advantage

This is something IMO way too complicated to look for answers from well-intended amateurs. Best done through a professional who can help you weigh all your options.

 

[WhitewaterWoman]

Judge, the other Medicare options have been decided. Medicare Advantage limits the providers one can use. It is like an HMO. I have complex health care needs better managed by providers I can choose.

I have been talking to advisors about my financial situation. A lot. Plus I have some experience with Medicare programs from my previous work. I actually am more familiar with Medicare Advantage (Part C) than I am with straight Medicare. Where I am lacking in direct knowledge is in Medigap. My clients always had Medicaid as a back up. It didn’t really occur to me I might need a back up for Medicare.

I’m asking here just to see if anyone has any experience or pointers that might be useful.

TBRS1, for example, has a good point. (Thank you TBRS1.) I actually knew this from previous work but had forgotten it.

I have found there is benefit in “bouncing” ideas over others’ experiences. It opens my mind which can get closed due to anxiety.

I am so grateful for this community.

 

[Judge]

Judge, the other Medicare options have been decided. Medicare Advantage limits the providers one can use. It is like an HMO. I have complex health care needs better managed by providers I can choose.

Point taken. I can choose where to report to, but have no control over the provider they assign to me. With no specific medical needs that could influence what provider I should be seeing.

Yeah, you're in a different situation for sure. Hope you find one that suits your needs at what you can afford. But there are a lot of counselors out there to assist you.

To me discussing the complexities of Medicare is much like discussing income taxes.

 

[Mary Terry]

I'd stay away from any Medicare Advantage plan, especially the one offered by United Healthcare. Can you consult with an independent insurance agent to help you find an affordable plan?

 

[Gerald Wilgus]

I'd stay away from any Medicare Advantage plan, especially the one offered by United Healthcare. Can you consult with an independent insurance agent to help you find an affordable plan?

Wise advice. Advantage plans are not Medicare and insurers will require pre-approvals and still deny claims that are covered by Medicare. HHS will not advocate for you if you try to elevate any denials since you signed on with a private, for-profit insurer. Advantage plans are the single greatest source of fraud in Medicare expenditures and need to be eliminated.

 

[Gerald Wilgus]

After looking at all the options, I went with a Medigap, Plan G because of coverage during travel and reasonable deductible. Over two years ago I was in the hospital for what should have been a simple procedure but a complication led to 10 hours of severe, unremitting pain and I was stressed out and had chest pain radiating to my neck. That got cardiology involved and while a stress test did not show any infarct, the cath-lab found partial blockage in the left anterior descending artery (the widow-maker because it is usually silent until it kills you). So, I had a week in the hospital on heparin waiting for my blood thinner to clear from my system, then open heart surgery followed by another week of recovery in ICU where I measured my progress by the wires and tubes being pulled out of my chest. My cost for all of this was $0.00.

 

[WhitewaterWoman]

Thank you Mary Terry and Gerald Wilgus. This is the kind of information I want. I saw this happen with my clients with special needs.

I do have an agent who is providing me with information, but sometimes she is wrong. I check with Medicare. I'd like to find another agent for advice, but haven't come up with any.

I found out from Medicare that I have until May 2025 to make a choice. But here is the real kicker:

Once you have made a choice, you are stuck with that forever. Any changes would go through underwriting and be more expensive and they could deny you.

I'm really struggling to work on my finances and can only do one or two hours a day of research before my head stops input. So far I've found lower prices for auto insurance, cell phone, homeowners (maybe) and more. I may be able to get out of this without going bankrupt.

 

[Mary Terry]

Thank you Mary Terry and Gerald Wilgus. This is the kind of information I want. I saw this happen with my clients with special needs.

I do have an agent who is providing me with information, but sometimes she is wrong. I check with Medicare. I'd like to find another agent for advice, but haven't come up with any.

I found out from Medicare that I have until May 2025 to make a choice. But here is the real kicker:

Once you have made a choice, you are stuck with that forever. Any changes would go through underwriting and be more expensive and they could deny you.

I'm really struggling to work on my finances and can only do one or two hours a day of research before my head stops input. So far I've found lower prices for auto insurance, cell phone, homeowners (maybe) and more. I may be able to get out of this without going bankrupt.

I didn't realize that you're stuck with your gap coverage choice forever. Thanks for posting that!

 

[WhitewaterWoman]

I didn't realize that you're stuck with your gap coverage choice forever. Thanks for posting that!

We all learn together. One of the wonderful things about the forum is sharing knowledge and support.

Meanwhile, I have signed up for a Medigap plan N, which has small copays but otherwise covers everything Medicare doesn't cover. It is cheaper than the all out cover everything, without much risk. It will cover me at 80% for emergencies out of the country and will start tomorrow so it will cover me when I travel in Europe.

I have until May of this year to change my mind and go with the more expensive plan (ie, the open enrollment period based on the effective date of Part B).

So I will still be listening to any advice or sharing of experiences to see how things go.

Thank you, everyone.

 

[Mary Terry]

We all learn together. One of the wonderful things about the forum is sharing knowledge and support.

Meanwhile, I have signed up for a Medigap plan N, which has small copays but otherwise covers everything Medicare doesn't cover. It is cheaper than the all out cover everything, without much risk. It will cover me at 80% for emergencies out of the country and will start tomorrow so it will cover me when I travel in Europe.

I have until May of this year to change my mind and go with the more expensive plan (ie, the open enrollment period based on the effective date of Part B).

So I will still be listening to any advice or sharing of experiences to see how things go.

Thank you, everyone.

Please share what you learn !

 

[Gerald Wilgus]

Thank you Mary Terry and Gerald Wilgus. This is the kind of information I want. I saw this happen with my clients with special needs.

I do have an agent who is providing me with information, but sometimes she is wrong. I check with Medicare. I'd like to find another agent for advice, but haven't come up with any.

I found out from Medicare that I have until May 2025 to make a choice. But here is the real kicker:

Once you have made a choice, you are stuck with that forever. Any changes would go through underwriting and be more expensive and they could deny you.

I'm really struggling to work on my finances and can only do one or two hours a day of research before my head stops input. So far I've found lower prices for auto insurance, cell phone, homeowners (maybe) and more. I may be able to get out of this without going bankrupt.

When I was searching for a plan, I started out on the Medicare site. There are tools for comparison and you can drill down for specifics. At least the site is not yet taken down by DOGE.

Find a Medicare plan

My supplement plan paid for my original ASD diagnosis (yes, I was that old when I finally was diagnosed) as well as the Cognitive Processing Therapy.

 

[WhitewaterWoman]

When I was searching for a plan, I started out on the Medicare site. There are tools for comparison and you can drill down for specifics. At least the site is not yet taken down by DOGE.

Find a Medicare plan

My supplement plan paid for my original ASD diagnosis (yes, I was that old when I finally was diagnosed) as well as the Cognitive Processing Therapy.

That is really interesting that your plan paid for an assessment and some therapy. I should see if my plan covers any of my therapy.

It is likely due to my neurology, but I can rarely learn from one source. It takes a long time for stuff to sink into my brain. The Medicare site is quite good and if I weren’t naturally suspicious of the fine print, it would be fine. It is also user friendly.

I also called Medicare twice, called two different brokers, asked here in the forum, asked my brother (who hasn’t weighed in as he is on a winter expedition in Yellowstone) and read a lot of stuff on the web.