It's Time For Medicare (whether I want it or not)

[beowulf]

We (wife and I) had a standard plan G Medicare Supplement plan for several years. The joint premiums gradually rose to about $340 a month. We then looked at a high deductible plan because we rarely went to the doctor and when we did go it was for things that were already fully covered by Medicare (annual physicals, flu shots, periodic colonoscopies and such). So two years ago we opted for a high deductible Medicare Supplement Plan G and our joint premiums are now just under $75 a month (I'm at about $44 and wife at about $30 a month).

So, with the high deductible plan we are saving $265 a month ($3,100 a year) and we have spent (toward our deductible) about $200 a year jointly. So this has worked out for us. The deductible we are potentially responsible to pay is about $2,400 each for the calendar year (though I think there would be a $210 deductible with any plan). We understand we could get hit with some serious out of pocket costs if either or both of us really have some serious medical issues. But, even if one of us has to pay the full deductible in any given year, we are still ahead and each year we are saving money which we could put to the deductible in a bad year. If we had gone for the high deductilbe plan years ago we would be thousands ahead.

Note: this is not an Advantage Plan - for the reasons stated by others here we wanted to avoid that altogether - and wanted to keep our very good doctors who are not on any Advantage plan list.

I realize this is not one-size-fits-all as everyone's medical needs are different - and can change year to year. This just happened to suit our situation for now. It may be different in a few years.

We also have a drug plan - $7.50 per month each. My wife takes two tier one drugs. I don't take any.

 

[MAD777]

The "advantage" of straight up Medicare is that you can go to any doctor or any hodpital in the country. This can be supplemented with another policy, A-N, that covers anything left after Medicare. The supplement policy cannot deny any claim that Medicare pays.

The Advantage Plans are HMO's that dictate who you see, where you go, when you can go and whether or not they want to cover you.

I live in Northern New England, where states are so small that we cross state lines just to go grocery shopping, LOL. I get cancer treatments at Dana-Farber Research Center in Boston... That would be a no-go with any Advantage Plan!
.

 

[k0ua]

I went through this a year ago. My insurance agent was pushing the Advantage plan. I was leaning that way until I did my own research. Agents push the advantage plans because they get a lot larger sales commission from them.

I went with a Medicare Supplement plan G. I can go to any doctor & hospital of my choice anywhere in the US. Everything that is medically necessary is covered. Nothing has to be pre approved. I also have a part D prescription plan. You need to chose the prescription plan based on the meds you take.

I have been on Medicare just over one year. My total out of pocket costs for that year including the supplement plan, prescription plan, copays on prescriptions & the Medicare deductible was $1872. This includes 2 years of Medicare deductible. The only thing that would have increased my out of pocket costs would be prescription co pays. It does not include the amount Medicare withholds from my SSI check.

My brother has an Medicare Advantage plan. He had major medical issues the last 2 years. His total out of pocket costs for the 2 years as over $16,000.

Advantage plane are like private health insurance. You can only go to doctors & hospitals that are in their network. There are co pays on most services. If you go to a provider out of the network, you pay very higher co pays, that could be the total cost of the service. You have to get pre approval for services. Advantage plans do have some perks that Supplements plans do not.

Most of my pre purchase research was talking to friends, family & Youtube. I learned the most from Youtube.

This man has it figured out. And he has given you good information. I am still licensed but I sell just a few supplements a year. I don't sell advantage plans any more, even though the payoff for the agent is greater.

I could not stand the horror stories of people that really got sick. Here, I will nutshell it for you. If you are going to remain healthy, right up to the day you die, then an advantage plan will pencil out at lowest out of pocket. BUT if you become ill and most of use do, before we die, then you will be far ahead to have a Plan G supplement. I have a plan G supplement. I know I am not going to remain healthy until I die. Heck in fact, I am not healthy now. And it ain't gonna get better.

Advantage plans are great, how can you beat a zero cost premium? Heck they even include the part D drug program. Just don't get chronically ill and linger for years until death. There, free advice, worth all that you paid.

 

[LouNY]

Well I'm past when I could have started Medicare but I was covered by my wifes insurance so didn't bother. But I'm going to be dropping
her plan as they had some formulary plan changes and are not covering one of my meds now.
I'm researching it all now and with the Part "B" cost added to a supplemental and a part "D" that covers my current meds two of which are listed as tier 3 or 4 depending on the plan.
The supplemental plans are from$100 to $400 per month, then the Part D are $30 to $90 per month with the Part B at $158 per month so roughly $420 per month.
Also some of the advantage plans are PPO which function like the original medicare.
And I've still got to contact the VA and see how there coverage and prescriptions are now and see which of my current meds are on there list.

 

[dougtrr2]

I am retired military so basic medicare and Tri-Care for life is about as good as it gets. The whole process is very confusing, and it was very hard to find a clear answer as to whether I needed any supplements. (I don't, TriCare for life takes the place of supplements and prescriptions for me);

In my area there were free seminars on signing up for Medicare. Granted, they were sponsored by insurance brokers but there was a lot of good information and explanations provided about the Medicare system.

One odd fact about signing up. When we were doing our initial application I provided a specific change over date. I had given two month notice at work and new the exact date I would switch to Medicare. That day came and went. A month or so later we went to the doctor and had an issue with the billing. Turns out you had to call Medicare a second time and tell them you really dropped your other insurance. Got a love a bureaucracy.

Get the books from Medicare and start reading now. Some choices, if made wrong could penalize your for a long time.

Doug in SW IA

 

[Oaktree]

Advantage plane are like private health insurance. You can only go to doctors & hospitals that are in their network. There are co pays on most services. If you go to a provider out of the network, you pay very higher co pays, that could be the total cost of the service. You have to get pre approval for services. Advantage plans do have some perks that Supplements plans do not.

We just went with basic Medicare for a few years after we turned 65. Both my wife and I are in good health, and didn't want to pay extra for benefits we wouldn't use, we figured we could change to a more comprehensive plan if it ever came to it. We did not opt for Part D (prescriptions) because the premiums were higher than we even paid for the few we took, all of which were $10 ones at Walmart.

We switched to an Advantage plan a couple years ago, which included prescriptions (with co-pay). Doesn't cost all that much more than basic Uncle Sam Medicare and covers quite a bit more. Any doctors we use with one exception are part of the plan. We're looking around during open enrollment, but we're pretty satisfied with what we have.
We self-insured for a few years before being eligible...me because I was self-employed and the wife because her employer didn't offer it. Glad to have gotten out from the *&%^ Obamacare penalty.

The only minor drawback is that the only pharmacy that's part of the plan is a supermarket whose nearest store is an hour drive away. Not a big deal, we just plan refills around trips to the area and make a day of it. Both of our prescriptions (osteoporosis for the wife, BP for me) are 3 month supplies so not a major inconvenience.

 

[skipmarcy]

I don't know about other states but TN has SHIPP - a govt. organization you can find out all about Medicare in YOUR state. The representatives work for the state and cannot give you advice directly about what plans to go with but will explain ALL the plans to you and answer questions etc. My wife & I went 2 years ago before I turned 65 and it was the best thing I did to learn about Medicare plans. It was an appointment and one-on-one sit-down at a local senior center and totally unbiased. Each state has it's own specific plans available.

I went with a Plan G supplement with my original Medicare A & B and then a separate part D plan - the cheapest they had because I take no prescription drugs yet. Later, I can change that plan D if I have the need for drugs later in life and not pay the penalty. I avoided the Advantage plans as it limits what providers you can use and in this area you don't have much to pick from anyway. Sometimes you get what you pay for ...

 

[KennyG]

One odd fact about signing up. When we were doing our initial application I provided a specific change over date. I had given two month notice at work and new the exact date I would switch to Medicare. That day came and went. A month or so later we went to the doctor and had an issue with the billing. Turns out you had to call Medicare a second time and tell them you really dropped your other insurance. Got a love a bureaucracy.


Doug in SW IA

There seems to be no limit to how a government entity can screw up. When I signed up, they started it too early and I had to jump through hoops to get a refund for the months I didn't need Medicare.

 

[Snobdds]

From what I can see, Part G plans have a minimum $100/mo premium in addition to the Part B $150/mo premium. That's a dead stop.

The plans I'm looking at have no monthly premium and pay back a portion of the Part B premium.

It's too expensive to be cheap.

Stay away from advantage plans.
Go with medicare supplement plans.

 

[k0ua]

Your not going to get any "pay back benefit" unless you can qualify for Medicaid. And you have to be pretty poor to qualify for that. Only dual eligible's get their part B paid for by the government. And my guess is anyone that owns a tractor is not going to qualify for Medicaid. Joe Namath and George Foreman's lies aside. If the zero dollars monthly is all you can afford towards your healthcare plan, then that is cool. Just don't get chronically ill. You will have to pay a little as you go and you will likely be able to afford that, just don't get really sick.