So why is it then
that someone gets a bill in the mail if they have a Medigap plan G?
So here's the way this works.
Welcome to Medicare School Daily, where we help you understand Medicare,
save money,
avoid making Medicare mistakes, and above all else,
get the most out of your Medicare benefits.
Now, today's topic is Medigap plan G and unexpected medical bills.
Now, before I get into the details of this, let's just do a quick review.
When someone goes on Medicare, they have two different options
or two different ways they can use their Medicare benefits.
You cannot be in both of these systems at the same time.
It's one or the other.
One way to use your Medicare is to stay in original Medicare.
A and B, and people who do that
typically get a Supplemental plan to fill in the gaps in original Medicare
A and B, then their options to get an Advantage plans.
Those are called replacement plans or Part C plans.
And so those are your two options. You got to be on one or the other.
So obviously in this video we're talking about those who have chosen
to stay in their original Medicare A and B system and buy a Supplemental plan.
Now, when we stay in original Medicare A and B, A and B does pay pretty well,
but it doesn't pay for anything, 100% except preventive services.
So when someone is getting something that's non preventive service,
a diagnostic evaluation or some type of a health care service,
non preventive, then they're going to have some kind of a financial liability,
something they'll be responsible for financially.
We call that a gap in coverage and basically there are three gaps
on the A of Medicare, the inpatient side,
and three gaps on the B of Medicare, which is the outpatient and doctor
related service.
So we have these six gaps when someone buys a Medigap plan G,
that plan
G by that through that private health insurance
company is going to cover five of the six gaps.
It's almost full coverage, but not but not quite.
And so we have a G plan and everything is covered except the Medicare B deductible,
and that is once a year and the B deductible.
This year.
2022 is when I'm shooting this video that B deductibles $233.
Now if you're watching this in 2023 or 24 it certainly is going to probably be
a little bit higher that they raised up a little bit.
But the point is if I have a Medigap plan G five of the six gaps are covered
by my supplemental plan. I'm responsible for one of those.
All right and so the question is
if I have that Medigap plan G, why would I be getting a bill?
And so there's actually three questions we have to ask ourselves
when we get a bill on a Plan G, the first question is,
have you met your Medicare Part B deductible yet?
Because remember, every year we got to meet,
whatever the Part B deductible
is that something established by Medicare, approved by Congress this year?
It's $233.
So I'm not shocked if we get a bill for $233
because we're responsible to meet the B deductible.
So the first $233 of bills that are coming to the B of Medicare,
all outpatient services and all doctor related services,
we would expect we're going to get a bill up to $233 now
depending on what your claims are going to look like.
I don't know where that $233 are going to be billed from,
but it could be a couple doctor visits with labs.
Let's say your first claim is cataract surgery.
Well, you'll pay the first $233 and you're done for the year.
Let's see if an MRI or a CAT scan, very expensive test
you'll pay the first $233 and then again we're done for the year.
So the reason we get bills initially is I have to pay my B deductible.
So the first $233 I'll be billed for that is coming to my mailbox.
I'm going to have to pay that.
Then after that I have 100% coverage as long as Medicare pays
that plan pays everything but the B deductible.
So that's first question, have you met it yet? You're going to have to do so.
Number two, if you're getting a bill and let's say you have met your B deductible,
why are you getting a bill?
Well, it could be because that bill was not coded correctly.
You went to the hospital or you went the doctor or something happened.
And when that medical file
was claimed with Medicare, what happened was they didn't bill it correctly.
They didn't coded correctly.
Everything today is tied to the codes.
We have a new coding system started few years ago.
There's about 80,000 codes.
So occasionally things are mis-coded.
So that provider, hospital doctor, whoever it was filed that that claim
with Medicare and Medicare didn't like the coding that was used.
And so what happened is they denied the claim
and they sent it back to the provider.
Now you're getting a bill maybe for the full amount.
And so how do we correct that well, we called the provider and say
this should have been a Medicare coverage service,
it looks like to me could have been coded wrongly.
And so can you check the coding and if it was a wrong code, no big deal.
That claim can be refiled with Medicare and help that goes right.
Medicare is going to pay that claim.
So again, we'll see people getting bills because of coding errors
and those are easily corrected.
One phone call and they just simply refile the claim.
Or it could be last option.
You have to ask this question was a service
that is being billed by Medicare and now they're billing me
for the full amount it was that even covered by Medicare.
Now, folks, Medicare covers
almost all services, but there are some services they aren't going to cover.
Let me just give you just an easy example.
If you go to a chiropractor, Medicare only covers
at the Chiropractor's office, acupuncture 12 treatments a year,
as well as the adjustments to the spine nothing else.
So if you went to a chiropractor and that chiropractor did x-rays
or maybe some other kind of therapy beyond the adjustment,
then you're going to be 100% responsible for that.
So you may be getting a bill for something that
Medicare says we're simply not going to cover.
Medicare, covers things very, very well.
But if it's something that they're not going to cover
then you will get a bill for that full amount
because that's supplemental
pllan does not have to pay anything that Medicare
did not pay first, because that's the way supplemental plans work.
Medicare pays and they have to follow
filling in the gaps based upon the letter that you purchase.
So sometimes people get bills because they had something done
that Medicare did not cover and then you would be responsible for it.
So all the Medicare supplemental plans really pay well.
G is the most popular today.
And so occasionally you will get a bill.
So those are the questions that we're going to ask
number one, have you met your deductible?
Number two, is this something that Medicare
Should have covered and just didn't?
Or is this something that may have just been mis-coded?
And again, that's a very easy thing to correct.
Hey, thanks so much for watching the video,
and I do hope that it was helpful.
Now if you feel like
you need to learn more about Medicare
to make sure you're making the right Medicare decision,
really the best way and the easiest way to do
that is to go to MedicareSchool.com.
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