Nightmare Applying for Husband's Medigap Policy

[clifffaith]

This time next year I'll be in my first month of Medicare. We sat with an Aetna broker last month when Cliff was tossing out Healthnet in favor of Aetna. The broker was quite knowledgeable and I commented that I liked the generous hearing aid allowance, dental, eye and quarterly "free stuff" from CVS, and that if Cliff was happy this year I'd just take the same plan. He immediately said to me "No, you have pre existing issues (spinal stenosis and a bulging disc), you'll want a supplement plan so you can go to your choice of doctor, and you need to sign up for that immediately because after 3 months (I think that was the time period) they'll send you through underwriting where they can reject you and/or charge you more (I think). I have a better idea of what "supplement" means, and at last a direction to head in when my time comes to choose something.

 

[Rolltydr]

But notice that all the problems are with private companies. As we have aged we have had to deal with health care much more. It is always a nightmare and I cannot wait for medicare next year.

I just signed up for original Medicare and my wife did in January of this year. We had no problems at all. She is a retired federal employee and our private health insurance is through her retiree plan. We were able to reduce the private plan which will save us ~$200 a month but it is still a BC/BS plan and we didn’t have to try and navigate through the tangled web of Medicare Advantage, Medigap and Part D plans. With the BC/BS Basic plan and original Medicare, my wife has had no out of pocket expenses this year. She is pretty healthy so only had her routine visits plus maybe one illness, and she is on 3 or 4 prescription drugs. Medicare and BC/BS coordinate payment and she hasn’t received a bill all year. Hopefully, my experience now will be the same. Being able to use original Medicare greatly simplifies the process. I understand different people have different needs and I guess Medicare Advantage plans can be less expensive but they sure do add a lot of confusion and many times, as we get older, it is difficult to comprehend the information and know what is really best for us. I spent a 38 year career with an insurance company. They profit from this confusion and in most cases they are only going to tell you what benefits them.

My mother lived to be 92 so I also have several years of experience dealing with her medical bills. We only had 1 problem that I can recall. She had heart problems and once an ambulance had to transport her to the hospital. They wanted to take her to her local and rural emergency room near her home. She insisted on being transported to the hospital where her cardiologist practiced. Medicare initially refused to pay. I contacted them and explained the situation. I was told to have the cardiologist send a letter stating that transporting her to his hospital was medically necessary. He did so and Medicare paid the bill. I may be wrong but I doubt that a private insurance company would have been so helpful.






Sent from my iPad using Tapatalk

 

[geekette]

Remember- I worked as an account executive for a health insurance company and designed plans for large and small groups so I am not stupid when it comes to this stuff.

You have a massive advantage over most everyone! Insurance is intentionally complex. I know much more than I used to (after 2 different stints involved in medical billing) but still able to get flummoxed well before I wish it would set in.

I'm so glad you found The Right Person. Makes a difference!!! Congrats!!!

 

[clifffaith]

Just opened a $999 bill from pathologist that looked at Cliff's squamous samples during his August hand surgery. I was immediately suspicious of the $999 number because with his new Aetna plan that is the maximum out of pocket, so at first blush this seems like a way for the pathologist to get money outside his old plan. We already paid $200 for the surgery, performed by the surgeon they sent us to, so not about to pay the pathologist without kicking and screaming about it. Cliff says he'll call Healthnet to see what gives, but I'm pretty good about letting doctor's bills just sit on my desk and if there is no follow up I don't pay or call (had a $300 Labcorp bill that sat for 9 months with nary a follow up, so I assume my insurance eventually paid them).

 

[dougp26364]

Seems to me the problem described here was not the US government Medicare program (original Medicare) but a private insurance company that offers Medicare Advantage/Medigap programs. The problem is that we’re trying to have it both ways in this country and it is unnecessarily confusing and expensive. Many (most?) advanced countries in the rest of the world provide their citizens with some type of government sponsored healthcare at a much lower cost than we pay for our convoluted system. The VA is another issue and I completely agree that it needs to be fixed or even reinvented. Of course, if we truly did have “Medicare for all”, there wouldn’t need to be a separate VA system, would there?


Sent from my iPad using Tapatalk

But notice that all the problems are with private companies. As we have aged we have had to deal with health care much more. It is always a nightmare and I cannot wait for medicare next year.

I don’t want to get into politics, so this will be my last post.
The US government rarely does its own work. It sells it to the lowest bidder. That’s how they do things for the most part and it’s how, IMHO, they are most likely to do Medicare for all. No significant changes. Lots of gaps in coverage filled by independent providers.

Or, it will be like the VA. My wife works for the VA. I was contract labor for the VA up until a year ago. I don’t want to go down that road. It would take to much time and violate plenty of TUG rules for posting.

 

[Patri]

This company- VIA Benefits- has so many complaints and bad reviews on the BBB it is amazing they are allowed to operate.
And FYI- not all brokers "sell" all the plans available. They choose which ones to sell based on commission.

I guess you didn't check the reviews on the company before you enlisted them. I use a gal who is an independent. She truly chooses the companies best for her clients, not for the money she makes. For some plans, it is pretty much nothing, but she knows it fits the people's situation. And she tries to save the clients money, but some dig in their heels not wanting to change policies, even though she can show them on paper how much they will come out ahead. One retired guy, apparently, was sticking with his old company health insurance plan, though he was paying COBRA rates. He still had that loyalty to his employer.....
My gal helped out when I ran into bureaucracy with the Medicare company on POA, prescriptions, etc. Can't remember all the details but the whole thing was bizarre.

 

[WinniWoman]

I guess you didn't check the reviews on the company before you enlisted them. I use a gal who is an independent. She truly chooses the companies best for her clients, not for the money she makes. For some plans, it is pretty much nothing, but she knows it fits the people's situation. And she tries to save the clients money, but some dig in their heels not wanting to change policies, even though she can show them on paper how much they will come out ahead. One retired guy, apparently, was sticking with his old company health insurance plan, though he was paying COBRA rates. He still had that loyalty to his employer.....
My gal helped out when I ran into bureaucracy with the Medicare company on POA, prescriptions, etc. Can't remember all the details but the whole thing was bizarre.

Had no reason to check. Hubby's employer steered us to use them so he could get the employer HRA contribution. Have to use them to get it. Even when I turn 65 if I go through them I too, would get an employer contribution from HIS employer. His employer is a fortune 500 company btw. We just figured since they were handling his employers retirees we would be treated very well.

Not!

 

[WinniWoman]

Something else I found interesting is VIA Benefits had the Empire Plan F premium at $230. But when I called Empire to inquire about purchasing directly through them, they said the premium was $243. Medigap plans bought either directly through the carrier or through a broker should always be the same premium! Another issue!

 

[VacationForever]

This time next year I'll be in my first month of Medicare. We sat with an Aetna broker last month when Cliff was tossing out Healthnet in favor of Aetna. The broker was quite knowledgeable and I commented that I liked the generous hearing aid allowance, dental, eye and quarterly "free stuff" from CVS, and that if Cliff was happy this year I'd just take the same plan. He immediately said to me "No, you have pre existing issues (spinal stenosis and a bulging disc), you'll want a supplement plan so you can go to your choice of doctor, and you need to sign up for that immediately because after 3 months (I think that was the time period) they'll send you through underwriting where they can reject you and/or charge you more (I think). I have a better idea of what "supplement" means, and at last a direction to head in when my time comes to choose something.

You have up to 2 years after 65 to change to any supplement plan. At 67 you will be subject to underwriting for supplement plans.

 

[pianodinosaur]

@WinniWoman:

I am now officially retired. My first post as a retiree is as follows:

I don’t think VIA Benefits cares one iota about you or your husband. To hell with them!!

 

[isisdave]

I refer to those people as “The Oblivion’s” and they live in their own world of oblivion.

My Mom, way before the Internet made things REALLY difficult, used to say "What do the stupid people do?"

 

[Talent312]

My Mom, way before the Internet made things REALLY difficult, used to say "What do the stupid people do?"

This is what "we" did/do...
B4 the net, we talked to people. People told us what was what.
Nowadays, we use Facebook, becuz nothing happens unless it's on FB.
.

 

[WinniWoman]

My Mom, way before the Internet made things REALLY difficult, used to say "What do the stupid people do?"

I actually say that all the time!

 

[rapmarks]

A few years ago, our state retiree plan decided that instead of a Medicare supplement plan, we were going on a Medicare advantage plan with no restrictions in or out of network. If we left the plan, we could not get back in. A surprisingly large number of people told me to leave the plan. When I read these posts, I am so thankful we stayed with the plan.

 

[DancingWaters]

rapmarks,
Do you have STRS of Ohio medical plan?

 

[rapmarks]

rapmarks,
Do you have STRS of Ohio medical plan?

No on an Illinois plan TRAIL

 

[AnnaS]

Not looking forward to any of this when I reach 65. Hoping it's simple.

I do remember I had switched my mom from Medicare to Empire Medicare Advantage Plan. It was okay but it was so much easier with straight Medicare. It did cost a few dollars more out of her pocket but there was a lot less b.s. She was not on it long before she passed

Hubby is all taken care of. I guess when I reach 65, I will be on Medicare. Not sure if his (work/private) insurance becomes my secondary like it is for him now. I have a lot of years before I need to look into it.

You have your work cut out for you Mary Ann.