Another medicare thread

[Tybee]

Thanks in advance for anyone who can chime in here with more info about choosing a Medicare plan.

Our basic dilemma is still whether we should stay on my husband's employer health plan, and take Medicare A as a secondary. That is what the employer rep told him made sense, so he went on A this month, even though he was 65 earlier in the year. He declined B.

In March I will be 65, so we signed up for open enrollment for employer benefit again, since I need health insurance until March. At first I thought I'd just take only A and stay on employer benefit, but am a little worried about pre-existing conditions, and kind of want to go ahead and sign up for A, B, a Supplement plan from AARP, and D Drug Coverage in March.

It's probably cheaper to stay on work plan, but there is something good about getting on the whole shebang so I don't have to worry about changing if something happens to his employment or to him.

I've whittled it down to buying a G plan, since F is no longer available.

Do any of you have the High Deductible G plan, or the High Deductible F plan? It is so much cheaper!

On the other hand, one brush with an ER and you'd be at the deductible right away, so in effect, you are insuring yourself by coming up with the money a bit at a time rather than having to tap into savings for the deductible.

Anyway, anyone on F or G and/or High Deductible F or G?

I discovered that when we move, I will pay almost double for the supplement in Maine. This is a complete annoying bummer.

[iris lilies]

I almost hate to answer this because I don’t have details. I suppose I could go look them up. Right away, I will tell you that yes, I have a G plan. Is it high deductible? I don’t know. Monthly cost is $149.36. provider is Aetna.

I am vague about why we chose this other than our Medicare advisor, from what I can remember, suggested this is the most comprehensive plan for moving back-and-forth between geographic areas like Hermann and St. louis.

[Tybee]

I'ts probably not high deductible with that price. Here in Michigan I think it's 129, and 219 in Maine.
High deductible was 37 dollars.

[iris lilies]

DH reminded me that one aspect if Plan G was that we could sign up for it when we became Medicare eligible, but getting onto the plan later would require health evaluations.

our Medicare advisor calked it the “ Cadillac” plan.

[dado potato]

In March I will be 65, so we signed up for open enrollment for employer benefit again, since I need health insurance until March. At first I thought I'd just take only A and stay on employer benefit, but am a little worried about pre-existing conditions, and kind of want to go ahead and sign up for A, B, a Supplement plan from AARP, and D Drug Coverage in March.

It's probably cheaper to stay on work plan, but there is something good about getting on the whole shebang so I don't have to worry about changing if something happens to his employment or to him.

My wife and are covered by Original Medicare A & B with AARP Supplement (United Health) and D (Instamed). The cost of the Supplement increases regularly as the insured person grows older (every 6 months). In comparing with the employer health plan costs, it may be possible to project each coverage into future years, with a little help from Human Resources at husband's employer, and the call center at United Health.

As to pre-existing conditions, the web page of AARP (linked below) offers an answer. If that does not tell you all that you want to know, then I would suggest contacting a human being. There also is a "Medicare Resource Center" with basic information that may be helpful, such as "Original Medicare vs Medicare Advantage".

Lechyd da! ... as they say in Wales.

http://www.aarp.org/health/medicare-qa-tool/medicare-preexisting-medical-conditions/

[Teacher Terry]

We have to stay on my health plan for 3 1/2 years until he is 65. We will not go with a advantage plan because if you get a serious illness they can require you to go through step therapy before receiving the treatment you need. Plus you need to pass a medical exam to go back. I doubt we could pass it with our preexisting conditions. I am looking forward to getting off our employer insurance. The hmo went up to 1k/month 3 years ago so we switched to the ppo at 500. My husband broke his ankle and it has cost us 5k so far. They get you one way or another. Hoping that both of us on Medicare will be either cheaper monthly or cheaper deductible and co pay wise.

[Tybee]

Thank you, this is really helpful. Like Terry, I want off the employer one.

[pinkytoe]

We are in the middle of these decisions right now for DH's renewal. Insurance of any kind is the sticker in my side as it is all unnecessarily complicated and can result in hours of gnashing teeth. My supplemental Medicare coverage (and Rx) is covered through my employer at no cost to me which makes mine very simple. I can add DH to mine at around $325 a month but deductibles are pretty high so might as well find something cheaper. Right now, he has the cheapest Medigap plan (K) with United Health Care (around $40 a mo) and a low premium Rx plan through Wellcare (He calls it Hellcare since their admin process to sign up was pure torture.)We found it helpful last year when we first signed up to speak with the state eldercare office to get our questions answered. We were told then that if we planned on moving out of state in the near future to start with Medigap acoverage.

[Tammy]

My parents went on Medicare A and B as soon as they were eligible, and they carried no other plans. They self insure for the rest. Pay for meds out of pocket.

I will buy a D plan when the time comes. I’m too risk averse for skipping part D. But I doubt I will ever but a secondary policy. People on Medicare seem to love it, and people on the private plans seem to have extremely high deductibles.

[iris lilies]

My parents went on Medicare A and B as soon as they were eligible, and they carried no other plans. They self insure for the rest. Pay for meds out of pocket.

I will buy a D plan when the time comes. I’m too risk averse for skipping part D. But I doubt I will ever but a secondary policy. People on Medicare seem to love it, and people on the private plans seem to have extremely high deductibles.
If you are risk averse, I am surprised you do not plan to get a supplemental policy.

I have a Plan D for drugs but sometimes I just pay out-of-pocket directly to my doctor because it’s just easier.. Now that I have stability in prescriptions I will probably sit down and figure out where it is cheaper to get these drugs, from my physician or going through insurance at a pharmacy. They haven’t been very expensive which is why I’m not terribly concerned about it.


But the other stuff covered ny supplemental plans can add up to a lot of money

[Tammy]

I’ve read that without the supplemental plan, Medicare has to stick to the contract limits for charges. So the rest of the bill goes to no one, as it’s not legal to hill the patient beyond the contracted Medicare rates. With the supplemental plan, it gives them one more place to bill. Supplemental plans benefit hospitals, but not patients.

That’s the theory at least ...

[catherine]

I’ve read that without the supplemental plan, Medicare has to stick to the contract limits for charges. So the rest of the bill goes to no one, as it’s not legal to hill the patient beyond the contracted Medicare rates. With the supplemental plan, it gives them one more place to bill. Supplemental plans benefit hospitals, but not patients.

That’s the theory at least ...

Really.. I wasn't aware of that. The value of the supplemental plan is they cover the cost-sharing. Here's a rather sobering example:

I have to say I was astounded, and not in a good way, yesterday when I was looking for a specific Medicare claim from a routine procedure my DH has every 6 months. It involves an endoscopy and a biopsy. It's an outpatient procedure and he's usually there for maybe 4 hours. I don't know why I wasn't aware of the cost before--I think it's because under our commercial plan the bills dribbled in from different places and I never really added it all up. But the Medicare claim consolidated everything and the cost of that biopsy is $59k!!!! I am absolutely horrified. I could see if this were some lifesaving treatment, but it's an elective biopsy!! And do you know what we paid for it?

Zero.

[Tammy]

Of course - don’t act on what I said. I’m just repeating my father’s experience ...

[iris lilies]

I’ve read that without the supplemental plan, Medicare has to stick to the contract limits for charges. So the rest of the bill goes to no one, as it’s not legal to hill the patient beyond the contracted Medicare rates. With the supplemental plan, it gives them one more place to bill. Supplemental plans benefit hospitals, but not patients.

That’s the theory at least ...
Yet Medicare and Medicaid payments don’t cover hospital costs. So I guess they’re just supposed to eat that as well?

[Tammy]

Yes. About 2/3 of our business at the hospital I worked at since 2010 was Medicare and Medicaid. It pays a much lower percentage of the bill than private insurance. That was one of our unique challenges as a public hospital.

Interestingly, the biggest bills went to those with no insurance, who were self pay,

People are not charged the same amount for identical services.

[catherine]

Yes. About 2/3 of our business at the hospital I worked at since 2010 was Medicare and Medicaid. It pays a much lower percentage of the bill than private insurance. That was one of our unique challenges as a public hospital.

Interestingly, the biggest bills went to those with no insurance, who were self pay,

People are not charged the same amount for identical services.

All part of the wacky system. Did you ever read Steven Brill's analysis of hospital charges? It's really eye-opening.

https://time.com/198/bitter-pill-why-medical-bills-are-killing-us/

[iris lilies]

Yes. About 2/3 of our business at the hospital I worked at since 2010 was Medicare and Medicaid. It pays a much lower percentage of the bill than private insurance. That was one of our unique challenges as a public hospital.

Interestingly, the biggest bills went to those with no insurance, who were self pay,

People are not charged the same amount for identical services.

But the hospital will settle at a much lower amount from those with no insurance. My friend regularly negotiates her large hospital bills down I can’t remember if she said she knocks off 1/3 or 2/3 but she gets them settled.She is a unique outlier who has Money and refuses to get insurance. Now she’s Medicare age though she did sign up for that because there is a penalty if you don’t.


I don’t understand how your hospital continues to operate if it’s not meeting costs but whatever. I know rural hospitals here close up their doors. My rural hospital, about half a mile from where I live, is in the weekly newspaper regularly about finances. It’s the hospital for the entire county and it’s of importance and concern for residents of the county.

[Tammy]

Public hospitals get state money (property tax), federal money (grants and extra dollars for those on Medicare/Medicaid), hospital foundation support. Plus we don’t need to make a profit - just break even.

And if we don’t meet quality measures we get less federal reimbursement. That’s always hanging over our head ...

[Tammy]

And also - all those bigger dollars from the private plans make up some difference from the Medicaid Medicare losses.

Charges are not the same as reimbursements are not the same as actual costs.

[iris lilies]

And also - all those bigger dollars from the private plans make up some difference from the Medicaid Medicare losses.

Charges are not the same as reimbursements are not the same as actual costs.

Yes all those bigger dollars from the private plans make up some difference for those of us who are on the public dole. It seems to me to be kind of a “ do your fair share” to have a supplemental plan unless you are destitute.

But the bottom line for me is: I won’t go without a supplemental plan because I don’t believe that they won’t come after me for any costs. I don’t really know how that plays out so I’m not gonna test it.

The small stuff like the cost of the supplemental plan is not what keeps me up at night. It’s a big cost that worries me. To that end I was just talking to our insurance guy yesterday to bump up our umbrella policy another million.

[Tybee]

I guess my inclination is to go ahead and take both A and B and go on the regular G plan and a D plan, not worry about high deductible, as I could see my deferred healthcare needs having me meeting the deductible on the first visit.

Wish Maine weren't twice as expensive as Michigan, though.

That story about the twice a year biopsy at 59,000 scares me to death, since without a plan you are on the hook for 20% of that, if it is outpatient, I think. My last two hour er visit cost over 3000.

[Tammy]

My parents had a situation where my mom needed a monthly IV medication at $10,000 each month, for about a year. This was 20 years ago. I can’t imagine the cost now.

When the doc found out they were going to pay out of pocket, he found an injectable alternative, once a week, given at home. It was $500 a month. They paid out of pocket and she recovered as expected. (Autoimmune - They were ready to sell farmland if necessary.)

First lesson - I will never choose to not get Medicare D. Too scary.

Second lesson - how many cheaper options are there if the doc has to consider cost for the patient?

[Tybee]

Tammy, such good advice about the part D. And how great that the doctor could figure out a workaround.