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US Medicare Medigap Question
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justMongo Offline

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Post: #1
US Medicare Medigap Question
I was under the impression that if a provider accepted payment from Medicare, they could not charge more than Medicare assignment. To do so would be an illegal "up-charge."

I guess I was wrong. I'm comparing a plan C medigap to a plan F medigap. The F plan pays excess charges. It would seem a provider can accept medicare + the 20% paid by my medigap plus ask for up to 15% in excess fees.

Am I reading the fine print correctly?

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
11-13-2015 02:44 PM
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Mosquitobait Online

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Post: #2
RE: US Medicare Medigap Question
Nope. If the DME accepts Medicare, and you have traditional Medicare, they accept assignment. You are responsible for 20%. If your medigap plan is covering the 20%, then you owe nothing. There is no 15%. They are scamming you.

I know nothing of Medicare Advantage Care plans. After my godmother got screwed by an Advantage plan, I chose to stick with traditional Medicare (The plan closed up mid-year while she was getting treatment - she was left with NO coverage at all until the next open period).
(This post was last modified: 11-14-2015 11:37 AM by Mosquitobait.)
11-14-2015 11:30 AM
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justMongo Offline

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Post: #3
RE: US Medicare Medigap Question
I stay with traditional Medicare and have an HRA account that my former employer puts money into for me to buy coverage. So, I buy a Medigap plan and Part D. Advantage plans are HMOs; an I'd have to use their doctors. I'll keep the one's I have.

As for you GM's situation, I thought loss of coverage due to the dissolution of a plan meant one could enroll in another plan out of the annual enrollment period.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
11-14-2015 12:25 PM
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Mosquitobait Online

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Post: #4
RE: US Medicare Medigap Question
(11-14-2015 12:25 PM)justMongo Wrote:  I stay with traditional Medicare and have an HRA account that my former employer puts money into for me to buy coverage. So, I buy a Medigap plan and Part D. Advantage plans are HMOs; an I'd have to use their doctors. I'll keep the one's I have.

As for you GM's situation, I thought loss of coverage due to the dissolution of a plan meant one could enroll in another plan out of the annual enrollment period.

Yes, but there was a gap of about 2 months between when she was notified of no coverage and coverage under a traditional Medicare plan.

I also went with traditional Medicare only because I kept getting sent to specialists and some were in-network, some not. Pretty much everybody is in-network for the BCBS senior plan.
11-14-2015 01:04 PM
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JudgeMental Offline

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Post: #5
RE: US Medicare Medigap Question
Yep. As Skeeterbait said...Traditional Medicare will pay 80% of the "allowable" amount, if the "provider" has agreed to accept Medicare. You or your Medigap will be assessed the 20% remainder. There should not be any additional 15% of anything. The provider can submit a charge of any amount that they want but is required to accept the Medicare or Medicare Plan Allowance.

Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
11-14-2015 01:04 PM
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eplantz Offline

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Post: #6
RE: US Medicare Medigap Question
I have a PLAN F Medigap policy and it covers everything. Never had any additional charges.
11-14-2015 02:49 PM
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