I've just done this in July. I started with an agent (Boomer Benefits). I made sure that they linked me with someone licensed in more than my home state. We started with the understanding that I could be looking for care in multiple states, and might have to move for family issues.
So I wanted a policy that I could move. Because of the Advantage structure in my state, they were all eliminated quickly. Many of the Advantage plans are so limited that you'd be always out of network.
I wanted something I could afford, but would cover me. This brought us back to Medigap plans. Each of those can be different, but they must, in the same plan type, cover the same minimum list of items. I found a good price and geographical coverage in a Plan G. Plan G leaves you paying the $183 (?) deductible, but covers the rest of Medicare approved expenses, plus a few "extras". Because I occasionally enjoy a cigar, I found a plan that did not rate against smokers. All that considered, the Plan F was always more expensive, more that the $183 over the year. So Plan G it is.
BTW - Plan F will go away in the next few years, so you need to get the company policy for how they will do a transition in writing. Most will promise, few will "write". Just go with the G.
And the Rx Plan D required another specialist who took a list of all the recent and potential meds, and ran the coverage / numbers. There are tools for that, and she spent days getting answers for me.
I started this process in February, then in April was assigned a Medicare number so we could start the process. Even up to the start date in July I still had incomplete to-do lists with the Medigap company. Got it all worked out, but the agents & I spent many hours chasing details.
What was broken?
- Medigap company got all of my payment account info, but it was an account that has my Mom's name so that she can write a check on it. They required a signed form from my "wife" (ain't got one) to use that account. I killed the chaos by using a different account, but only after the agent figured out the company couldn't understand my Mother being on the account.
- Medicare issued my a card with the old style number, but set my account up with the new style number. No card for that one, and docs all have software that wants the physical card. I'm still carrying around copies of a letter from Social Security to prove the number.
- Medigap company required a copy of the card, and couldn't understand that I could know the new number without one. Getting Medicare and Medigap hooked together was a challenge, but the agents did that for me.
- Medical facilities you work with constantly will find a way to continue to bill the old insurance, no matter how hard you try. You may suffer a few weeks of getting that all sorted out.
- Even when everything is hooked up, it takes 4-6 weeks to see a claim in Medicare's system, then another 3-4 to transit the pipe to the Medigap company. In that transit period, there is no way to see what is going on. You are blind. Medicare will tell you that is was sent, but the Medigap company may be as well. Nothing gets posted with progress notes. The first time you see it, it is all done. This is most perplexing to those of us who've lived for years with companies that have claims posted the day they arrive with updates as to handling progress.
- Check with each provider you expect to use, and be sure they "accept assignment". This means they accept what Medicare and your Medigap will pay as the total. One of my docs processes through, and accepts money from Medicare / Medigap, but then wants me to agree to pay the difference. That won't happen. That same group will not accept a new patient with Medicare, but I am grandfathered in IF I stay.
- I saw ED meds mentioned. No Plan D will pay for them without a fight. Been there. I have not won that one.
- Not all Plan Ds do mailorder or larger than 30 day quantities. Be very careful to look that up. Also, there is turmoil in the acquisitions area for pharmacies. If you have a critical one, be sure it will be expected to stay in the plan next year.
Did I say to look up Boomer Benefits? They have a 6 day email "school" that explains a lot of the basics.
And remember that the agent gets paid by the company. You don't pay them. But be sure you get an agent that really works with a lot of companies, not just one or a few.
NOTE _ MY EMAIL HAS CHANGED!
Moderator - Prostate Cancer(Not a medical professional)
IGRT journey (2010) - www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 9/12-3/13, 6/14 to present
Prolia 6-mo inj 12/12 to present
Casodex started 12/14, end 3/15 after psa 30% rise
Zytiga 04-07/15 Xtandi 04/16-8/17
Post Edited (142) : 8/22/2018 12:30:18 AM (GMT-6)