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ot medi-gap insurance - long

updated fri 28 may 04


clifton wood on thu 27 may 04

hi, everyone.

i have medicare & medigap insurance.

i've experience something similar to leslie, but for a different reason.

in the past, each state defined a standard set of medigap insurance
plans, each with varying coverage.
next, suppliers would offer their own form of these plans, with their
own costs. the costs were usually "close". in new york, they didn't
vary much more that 20%. these plans were offered by local companies,
the blues, aarp, and fortune 50 companies.

all i had to do was pick the medigap plan i wanted... then, using a
state web site, i could compare prices among offering companies.

my medigap coverage from the blues(without rx), ran $90 a month.

this year, the feds & the state defined more "managed care" plans...
many of them NOT called hmo's.

so... this year, i could get what looked like the same coverage from the
blues for $30 a year.

great deal, yes?

maybe not.

in both plans, specialists have to be pre approved.

in the old plan, even if a specialist was denied, the bill would first
be supmitted to medicare, which would often pay something or a lot...
then go on to the blues who would pay nothing.

in the new plan, the bills go straight to the blues. and if it's been
denied, you get nothing.

i needed specialized testing this year. my internist & other doctors
couldn't talk the blues into it, even though it had HUGE impact on my meds.

the testing was way over $1000.

if i had chosen the "new but almost the same" blue coverage, i would
have received $0.

but, because i chose to keep the old version, the bill went to medicare,
who paid almost 90%.

and... once i leave the old medigap plan, i can never return, because
it's being phased out.

so... the moral is... ask gobs of questions. take your prior bills to a
plan you're considering and ask what they would pay under the new plan.

sorry this was so long.

clifton, norwich & sabra