Medicare with Medigap Supplement - Deductible??

[fishheadbob]

Long answer here, try to stay with it.
I'm in N.Y. My Medicare Advantage cost me nothing. I still pay the part B premium. The plan I chose works well for me. My first doctor visit each year has no co-pay; Medicare considers it a wellness visit which is covered in full. The second and any subsequent visits to a primary physician cost me $20, I have no part B deductible. I went to an opthalmologist so I had to pay him $50 (specialist). He sent me to a retina specialist who did some laser surgery, he billed my plan $980 which insurance knocked down to $600, I paid $50. (he can still afford his Lexus). I have blood tested twice a year. The lab bills my plan about $300 for the tests, the plan has negotiated them down to a fee of $58, I pay $10, insurance pays the other $48. I take generic lipitor and a high blood pressure generic. I fill a 90 day Rx at WalMart for a copay of zero.The plan I chose doesn't cover as well if I get ill far away as I understand it, and I get my dental expensively through BENEFEDS plans for federal retirees so I'm packing an awful lot of dental work into this year as I'll only pay for the dental for this year, it's expensive but works for me as I'm packing a lot of work into this year. (ouch). They use Delta Dental as a carrier and they knock my dentists bills down substantially.
My Medicare Advantage plan is available to anyone who lives in my geographic area; there are many similar and competing plans that are very much alike. There are also some lousy plans out there, you must do your own little cost/benefit analysis. Simply put with the advantage plans, the more you pay, the better the traveling coverage, dental, or vision might be.

My daughter works in benefits for a Fortune 500 company that offers health insurance coverage after retirement. We agree that the plans this company offers suck; they don't pay well and are confusing. You may work for a similar company.
As a very general rule of thumb... high tax states like N.Y., Mass., California etc. have a lot of hidden bureaucrats tucked away in places with names like the state insurance agency who do a pretty good job of fostering competition and setting and challenging rates the companies charge. In N.Y. they also provide something called a guide to medicare policies which name names, list premiums, and explain what is and isn't covered. Also has a 1 to 5 star rating for each plan. I'd guess there are 50 or 60 Medicare advantage plans sold in different areas of the state, as well as a lot of regular plans, many of which stink.

 

[k0ua]

Yep, bottom line is you have to decide which type of plan, and which plan of that type is best for YOU. The fact that your neighbor has this or that and is ecstatic about it, means very little. He does not have your health and budget constraints. Also some companies are much easier to deal with than others. You also need to pick a local agent you trust, no matter what you buy.

 

[TractorGuy]

Wife and I went with an advantage plan offered by the same HMO we have been insured through for most years of our employment. Cost is $35 in addition to the plan B cost and all is deducted from our SS monthly. After our wellness visit we pay $10 at the GP and $40 for a specialist. The best I could understand it our maximum out of pocket for any year would be around 6 grand. Hope not to get to that. I had a ER visit a while back and my copay for that was $100. They did a cat scan during that visit that was included. My GP ordered an ultrasound that was free and another cat scan that was $100. We also get some drug coverage but most of those reports say the insurance paid nothing. Even when they pay nothing we get a discounted rate they negotiated with the pharmacies. Most of our antibiotics have been free. I don't think I have had anything cost over $10 yet. I did get one prescription for a nausea drug that was high so we just bought 3 pills. Didn't seem to help so we didn't buy any more. So far we are pretty pleased but that could change with age and failing health.

 

[k0ua]

All advantage plans will have a stated total out of pocket for each year. This is often around $6700 or so, but can be less for some plans. You just have to compare. This is often refered to as the "safety net". This can be a big problem for some people, and no big deal for others. This is why some people who could have been paying $120 a month for a med supp that pays for every thing except the $183 annual deductible come to us crying asking if there is any way they can get out of their advantage plan and into that med sup we offered them a year or two ago. The answer is no. There is no way as they are ill now and won't clear underwriting.

This is not a very pleasant thing for them or us. Again, if you remain relatively healthy until the end of life with no "dread diseases" then without a doubt you will come out money ahead with just about any advantage plan. If you become ill with a "dread disease" then you will not be money ahead, and you will wish for the med supp you passed up with its continuous monthly payment laughing all the way to the bank.

When you are signing up at 65, you can be at deaths door and the insurance (med supp) companies HAVE to take you no matter what. When you turn that down and let your 1 year advantage plan test drive expire... too late.. Of course if you were badly ill at 65, you would be a fool to take out an advantage plan.

By the way full disclosure: We make more money selling an Advantage Plan then we do a Med Supp. So it is in my interest to talk you into an Advantage Plan. BUT it may or may not be in your interest. It just "depends".

 

[k0ua]

Some of you may be wondering where the money comes from to "pay" for the $0 monthly premium advantage plans. Short answer is the money comes from the Government in the form of the $134 monthly deduction from your SS or the quarterly payments you send in if not retired yet. The government kicks that back to the insurance companies to help fund the advantage plans. It is an "advantage" for the government not to have to deal with your medical claims.

 

[TractorGuy]

All advantage plans will have a stated total out of pocket for each year. This is often around $6700 or so, but can be less for some plans. You just have to compare. This is often refered to as the "safety net". This can be a big problem for some people, and no big deal for others. This is why some people who could have been paying $120 a month for a med supp that pays for every thing except the $183 annual deductible come to us crying asking if there is any way they can get out of their advantage plan and into that med sup we offered them a year or two ago. The answer is no. There is no way as they are ill now and won't clear underwriting.

This is not a very pleasant thing for them or us. Again, if you remain relatively healthy until the end of life with no "dread diseases" then without a doubt you will come out money ahead with just about any advantage plan. If you become ill with a "dread disease" then you will not be money ahead, and you will wish for the med supp you passed up with its continuous monthly payment laughing all the way to the bank.

When you are signing up at 65, you can be at deaths door and the insurance (med supp) companies HAVE to take you no matter what. When you turn that down and let your 1 year advantage plan test drive expire... too late.. Of course if you were badly ill at 65, you would be a fool to take out an advantage plan.

By the way full disclosure: We make more money selling an Advantage Plan then we do a Med Supp. So it is in my interest to talk you into an Advantage Plan. BUT it may or may not be in your interest. It just "depends".

Wish I would have seen this discussion 6 months ago. I am past a year into it. I read until my eyes were bleeding and NEVER saw any $120 per month option that paid everything except a $183 or I would have jumped on it.

 

[k0ua]

Wish I would have seen this discussion 6 months ago. I am past a year into it. I read until my eyes were bleeding and NEVER saw any $120 per month option that paid everything except a $183 or I would have jumped on it.

Well, that is what it would be here in Missouri, about $118.69 for female and $127.00 for Male. you prices could vary in Florida, I don't know anything about Florida prices. This would be for a Plan G. Pays everything but the $183 You can research a G plan on the internet. Those are current Missouri prices from Mutual of Omaha and assuming you live with a significant other. (household discount). YOu would still need a drug plan. Typically from about $18 up to around $35 depending on what drugs you are taking. This has nothing to do with the med supp though. Separate entity entirely.

I understand the bleeding eyes. An ordinary person cannot figure out all of this crap. To even have a glimmer of understanding of these very complex ever-changing rules you must be in the business. You have to certify on advantage plans every year to sell them, and it ain't no 2 hour seminar either. This is why you need a local insurance agent that specializes in the senior market THAT YOU TRUST to explain your options. And ordinary life and heath guy that may be a wizz on life insurance is not necessarily that guy. They must specialize in the senior market to keep up and understand all of this arcane crap. Sure he can probably sell you something , but it may or may not be right for you.

 

[k0ua]

Don't get me wrong, there is still tons of this I don't know either. When I run into a problem I can't solve I run to my wife. She knows the answers, or at least where to find them. She has loads more years of experience solving problems. While I was making the world safe for Communications Engineering, she was selling and servicing health insurance. I got into the game late in life.

 

[TractorGuy]

The research part of the transition wore me down and having an inexpensive choice that resembled what we already had and was used to (sans the total out of pocket possibility) made our decision a little easier.

 

[k0ua]

The research part of the transition wore me down and having an inexpensive choice that resembled what we already had and was used to (sans the total out of pocket possibility) made our decision a little easier.

We see that a lot. Often we come across people that have done research until they are sick of it. Sometimes they are more confused than when they started. Let alone the constant solicitation phone calls and the full mailbox.