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Retirement planning for Medicare costs
Old 03-27-2018, 02:34 PM   #1
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Retirement planning for Medicare costs

What are your thoughts on an annual budget expectation for healthcare costs (including prems) while on Medicare? Is $1500 per month too high?
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Old 03-27-2018, 02:48 PM   #2
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Having just spent ~2 hours with a trusted advisor last week (DH is Medicare eligible on 6/1) I think $1500 seems high, but I guess you're probably factoring in vision and dental?


His Part F & D premiums & Medicare B will be $350 a month, and from what I can see, there will be very little out of pocket, unless he gets some unworldly expensive medication prescribed for some new malady.


If we switch to Advantage next year, that cost will be a lot less.
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Old 03-27-2018, 02:53 PM   #3
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Depending on a number of factors (overall health, life expectancy, etc.), it is estimated that for a 65 year old retired *couple*, total health care costs in retirement will run anywhere from $275K - $490K. Again, that is *per couple* aged 65.
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Old 03-27-2018, 03:08 PM   #4
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I am not against a Medicare Advantage Plan- but cost are only one aspect of healthcare.. Remember that an Advantage Plan is a limited provider option and in certain situations the limited provider option can be a major disadvantage if outcome of a health issue is a concern. Just be careful. Some of these plans are great - but they all limit choice- which may or may not be important in health outcomes. Health outcomes certainly is not always linked to the most expensive path- just be aware of what you are choosing.
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Old 03-27-2018, 03:10 PM   #5
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For us, your $1,500/mo number is substantially high but as has been stated, your actual number will depend on a number of factors, primarily your state of health.

As a couple, during our first five years on Medicare our total costs including premiums, out-of-pocket, drugs, dental and vision is averaging about $700/mo.
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Old 03-27-2018, 03:14 PM   #6
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Quote:
Originally Posted by joeprintz View Post
I am not against a Medicare Advantage Plan- but cost in only one aspect of healthcare.. Remember that an Advantage Plan is a limited provider option and in certain situations the limited provider option can be a major disadvantage if outcome of a health issue is a concern. Just be careful. Some of these plans care great - but they all limit choice- which may or may not be important in health outcomes. Health outcomes certainly is not always linked to the most expensive path- just be aware of what you are choosing.
A couple of recent experience examples:

M.D. Anderson (renowned cancer treatment center) does not accept MA plans.

The surgeon who replaced my DW's heart valve does not accept MA plans.

The list is long as I can add more real life examples, but, then again, I am sure some doctor in an MA network will cover the above if needed.
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Old 03-27-2018, 03:15 PM   #7
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Medicare B is $134 monthly, per person. Medicare D depends on your prescription lineup. IRMAA applies to both and drive that price up. Medicare supplemental high deductible F is often financially compelling option where available, and the $2240 deductible policy might cost less than that in annual premium.

The cost of dental care is the most uncertain and unpredictable component.
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Old 03-27-2018, 03:18 PM   #8
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The cost of dental care is the most uncertain and unpredictable component.
Yes, highly unpredictable, variable and potentially financially painful.
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Old 03-27-2018, 04:42 PM   #9
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If you count as "healthcare" costs a lot of items that may not be covered by Medicare it makes it hard to generalize. Some fairly expensive items can include vision correction, dental (I had a pretty expensive implant one year) and hearing aids.
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Old 03-27-2018, 05:16 PM   #10
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How much you pay for medicare is partly based on income. Check your RMD, pensions, etc. before using others numbers.
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Old 03-27-2018, 05:28 PM   #11
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As was referenced upthread, your income (including RMDs) can affect your Part B and Part D premiums via IRMAA surcharges.

Great article here:

https://www.kitces.com/blog/irmaa-me...gi-thresholds/

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Old 03-27-2018, 08:03 PM   #12
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As was referenced upthread, your income (including RMDs) can affect your Part B and Part D premiums via IRMAA surcharges.

Great article here:

https://www.kitces.com/blog/irmaa-me...gi-thresholds/

omni
Just read the article. Excellent article bookmarked for future reference.
Thanks.
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Old 03-27-2018, 08:44 PM   #13
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Originally Posted by joeprintz View Post
I am not against a Medicare Advantage Plan- but cost are only one aspect of healthcare.. Remember that an Advantage Plan is a limited provider option and in certain situations the limited provider option can be a major disadvantage if outcome of a health issue is a concern. Just be careful. Some of these plans are great - but they all limit choice- which may or may not be important in health outcomes. Health outcomes certainly is not always linked to the most expensive path- just be aware of what you are choosing.
They don't all limit choice. Our advantage plan is a PPO. No network. We can see any doctor we want. No difference in coverage. There is no in-network/out of network.
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Old 03-27-2018, 09:01 PM   #14
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My SO's medicare advantage is also a PPO . He has had heart surgery and two total knee replacements while on this plan and he paid very little out of pocket and had top doctors and great care .
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Old 03-27-2018, 09:44 PM   #15
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One thing to factor is is the "donut hole" in drug coverage.
https://blog.medicare.gov/2010/08/09...nut%C2%A0hole/

I put off filling a prescription in December to wait for January which starts the new year as far as the donut hole is concerned.
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Old 03-27-2018, 11:18 PM   #16
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By Definition:Preferred Provider Organization (PPO).. Therefore by definition the preferred providers limit (maybe by cost) availability..In smaller towns with not enough providers to form a panel- choice may not be limited because they can't get a panel-especially in sub-specialities(oncology, heart, etc... These plans are PPO by definition but not by how they are run because of necessity where they are provided as an option. The cost to the plan is expensive, but to the patient there maybe an advantage in care.
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Old 03-28-2018, 12:46 AM   #17
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A couple of recent experience examples:

M.D. Anderson (renowned cancer treatment center) does not accept MA plans.

The surgeon who replaced my DW's heart valve does not accept MA plans.

The list is long as I can add more real life examples, but, then again, I am sure some doctor in an MA network will cover the above if needed.
But do M.D. Anderson or other high-end specialists accept Medigap?

My reason for going with Advantage is I had heard from many that docs don't want to deal with Medigap and some will refuse to take it. Didn't think to check into M.D. Anderson, etc.--which is a significant consideration, just in case.
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Old 03-28-2018, 07:56 AM   #18
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But do M.D. Anderson or other high-end specialists accept Medigap?

My reason for going with Advantage is I had heard from many that docs don't want to deal with Medigap and some will refuse to take it. Didn't think to check into M.D. Anderson, etc.--which is a significant consideration, just in case.
Here's M.D. Anderson's page on Medicare/Medigap:
https://www.mdanderson.org/patients-...-medicaid.html

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Old 03-28-2018, 09:38 AM   #19
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DW has Medicare A & B + Plan G supplement + Plan D - total mo. cost including amortizing $183 plan G possible deductible over the year and adding in her mo. Rx copays = $261 per mo.

She has 7 medications but fortunately all are generic.
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Old 03-28-2018, 10:32 AM   #20
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Here's M.D. Anderson's page on Medicare/Medigap:
https://www.mdanderson.org/patients-...-medicaid.html

omni
I keep seeing statements that "so-and-so" doesn't accept this or that Medigap (aka Medicare Supplement) policy. This is what mdanderson states.

Quote:
Medicare Supplemental (MediGap) policies allow enrollees to see any provider that accepts Medicare. Some of these supplemental plans are accepted at MD Anderson. However, we do not accept any supplemental plans that require enrollees to use a provider in a restricted network that does not include MD Anderson or its physicians.
It is my understanding that if a medical provider accepts Medicare assignment, then they cannot deny you treatment based on your choice of Medigap policy/provider. You may not have Medigap coverage if your particular policy has a restricted medical provider list. But the doctor cannot refuse to see you based on the Medigap policy itself. In such cases, you will have to pay based on what Medicare deems fair an reasonable and would be your Medicare copay or Medicare deductible.

At least that's how I understand it.

DW and I have Medicare Part A ( no fee) + Medicare Part B (134/mo) + Medigap Plan FHD (~50 per mo) and Medicare Part D (~20/mo) for a total each of $204ish, or $408 for the two of us. Drug copays, Medicare deductible and copay, and Medigap deductible will vary from year to year depending on our health needs. Eye care and dental are additional.
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