How exactly does Medicare handle high medical costs?

[Refresher]

Not familiar with Medicare except knowing people make co pays and prescriptions cost something.

If a major ongoing illness occurred which required surgeries, treatments, drugs etc and costs totaled
hundreds of thousands, how is it handled?

Does Medicare pay so much and the patient gets a big bill?
What happens if they can't pay it? Bankruptcy?
Does treatment stop?

Hopefully nobody experiences this but how is the system set up for those who do?

 

[gozer]

WebMD link seems to give some answers.

I don't have first hand experience with medicare yet.

 

[REWahoo]

Not familiar with Medicare except knowing people make co pays and prescriptions cost something.

If a major ongoing illness occurred which required surgeries, treatments, drugs etc and costs totaled
hundreds of thousands, how is it handled?

Does Medicare pay so much and the patient gets a big bill?
What happens if they can't pay it? Bankruptcy?
Does treatment stop?

Hopefully nobody experiences this but how is the system set up for those who do?

The hospital carries you out into the parking lot and dumps you.

 

[easysurfer]

Get a good Medicare supplement plan that covers what Medicare doesn't cover. Otherwise, 20% of a ct scan or two can be pretty much

 

[Refresher]

Get a good Medicare supplement plan that covers what Medicare doesn't cover. Otherwise, 20% of a cat scan or two can be pretty much

Do those supplements cover everything above and beyond.
Is there a max out of pocket?

 

[braumeister]

Do those supplements cover everything above and beyond.
Is there a max out of pocket?

Different supplement plans, different coverages and limits.

Hey, you're dealing with the gummint; why should it be simple?

 

[aja8888]

Do those supplements cover everything above and beyond.
Is there a max out of pocket?

Depends on the plan you chose (A - F). F is one of the best, and costs the most. Go to medicare.gov and read up.

 

[aja8888]

Different supplement plans, different coverages and limits.

Hey, you're dealing with the gummint; why should it be simple?

It sure was easier than signing up for Obamacare!

 

[easysurfer]

Do those supplements cover everything above and beyond.
Is there a max out of pocket?

I don't qualify for medicare until years away. But here's more info on the F plan from eheatlh:

Medicare Supplement Plan F is the most comprehensive plan out of the 10 available Medigap policies. The expansive coverage makes this a popular plan, though it is also the most expensive. Plan F leaves a beneficiary with no out-of-pocket expenses because it covers all remaining hospital and doctor costs after Original Medicare (Part A and/or Part B) has paid its portion.

http://www.ehealthinsurance.com/medicare/supplement-plan-f

 

[MichaelB]

Do those supplements cover everything above and beyond.
Is there a max out of pocket?

Here's an short overview of Medicare supplemental insurance you may find helpful http://www.medicare.gov/Pubs/pdf/11575.pdf

The hospital carries you out into the parking lot and dumps you.

They don't carry you anyplace. More like kick you out the side door, but not until they've performed one surgical procedure .. a walletectomy.

 

[REWahoo]

They don't carry you anyplace. More like kick you out the side door, but not until they've performed one surgical procedure .. a walletectomy.

Hey, I thought sure my supplement F coverage (I mean that in the nicest way possible) included "carrying charges."

 

[audreyh1]

Well, I do know that Medicare does not allow balance billing.

But back in the early 2000s, I don't think there was such a thing as a max OOP, so someone without supplemental insurance could really end up with a huge tab if they had a 20% copay. A few things changed in the later 2000s. But I still don't know about the max OOP.

 

[Katsmeow]

There are some things that Medicare doesn't pay or it limits. For example, there is a limit on how you can be hospitalized (well, how long they will pay for). You can get that extended by a supplemental policy but that isn't unlimited either. After that time is up, you either have to be released for a period of time or you have to self-pay.

When my father was dying (in retrospect - at the time there was still some hope of recovery or at least hope that he would released from the hospital) he was hospitalized for several months. There was talk of him coming home for Christmas day, but his doctor said that Medicare was being more difficult on that and that if he left for the hospital premises for the day they might take the position he didn't need hospitalization and would not allowed him to be re-admitted (at the time he was unable to eat and was being fed totally through IV). So we celebrated Christmas at the hospital.

I have also read about Medicare at times putting strict limits on how many days they will pay for someone to be in the hospital for specific things and that, even if the doctors disagree, they get released at the end of that time.

For other things, if Medicare won't pay then the individual has to pay. For example, if you wanted a screening test more often than Medicare will pay.

 

[MichaelB]

Hey, I thought sure my supplement F coverage (I mean that in the nicest way possible) included "carrying charges."

Only if you live in Virginia

 

[MRG]

Is F medicare still available in all states? Another family member thinks it's not. I can't find it offered in my state. Medicare F might make DW options better.

Not trying to dispute, seeking knowledge.
Thanks in advance,
MRG

Sent from my SAMSUNG-SGH-I337 using Early Retirement Forum mobile app

 

[REWahoo]

Is F medicare still available in all states? Another family member thinks it's not. I can't find it offered in my state.

Apparently not all Medicare supplemental policies are available in all states. Not sure why.

Sent from my two Campbell's Soup cans linked by a string

 

[dessert]

 

[aja8888]

Plan F has two options (where I am), the good deal (everything covered + +) and the "high deductible" option (which I declined).

*Sent from my Dick Tracy wrist watch with the high frequency stealth option.

 

[Buckeye]

Do those supplements cover everything above and beyond.
Is there a max out of pocket?

My mom recently spent 5 days in the hospital after two visits to the ER. She came home with an oxygen concentrator (which she quit using after 2 weeks) and had a home visit from a respiratory therapist.

Between her Medicare and her AARP United Healthcare "F" supplemental policy, her total cost has been $0. She pays about $240 per month for her "F" supplemental policy. I'm guessing her portion of the bill would have been $4-$5,000 without a supplemental policy. The "F" policy is very comprehensive but it ain't cheap!

She also has a Part D drug policy from Humana that costs about $37 per month. Her monthly meds are about $75. Her asthma inhalers are expensive.

 

[aja8888]

I have full Plan F (not high deductible). I had a total hip replacement done by a top surgeon using the anterior procedure and my total cost out of pocket was $0.

That included the pre-op physical, stay in hospital (which was brief - 2 1/2 days), follow up visits, meds (a few), a regiment of anti-blood clotting injections (administered by my DW ), and a week of home based physical therapy (which I cut short after three days). Stiches out after 10 days and then just long walks to strengthen leg.

My premium for plan F is approximately $220/month. It's a good deal and coupled with the Medicare premium, and a good Plan D drug plan, it's considered the Holy Grail of insurance for a person on Medicare.

 

[Buckeye]

I have full Plan F (not high deductible). I had a total hip replacement done by a top surgeon using the anterior procedure and my total cost out of pocket was $0.

That included the pre-op physical, stay in hospital (which was brief - 2 1/2 days), follow up visits, meds (a few), a regiment of anti-blood clotting injections (administered by my DW ), and a week of home based physical therapy (which I cut short after three days). Stiches out after 10 days and then just long walks to strengthen leg.

My premium for plan F is approximately $220/month. It's a good deal and coupled with the Medicare premium, and a good Plan D drug plan, it's considered the Holy Grail of insurance for a person on Medicare.

Am I correct that (theoretically) someone with a Medicare Advantage plan (Part B, Part B Supplement, & Part D rolled into one plan) would have paid $0 also (assuming the doc, hospital, etc. were in network)?

 

[Free bird]

I don't know Jack about Medicare but I can't resist. Sent from my Maxwell Smart shoe phone.

 

[aja8888]

Am I correct that (theoretically) someone with a Medicare Advantage plan (Part B, Part B Supplement, & Part D rolled into one plan) would have paid $0 also (assuming the doc, hospital, etc. were in network)?

Medicare Advantage (MA) is a different animal than separate Medicare, Supplemental & Part D. MA programs vary by state and are not as comprehensive (in general) as the separate plans. Here in Texas, we have Texas Choice, which I originally signed up for and very quickly changed my mind after finding out about the deductibles, limited doctor choices, limitations on coverage, etc. (and this (Houston) is a great area for medical services). I personally did not want to be kept out of a major hospital like M.D. Anderson (cancer treatment) because (or if) the doctors there would not accept MA. So I bought the best available here (geographically) for a guy over 65.

I understand that some areas, like the east coast, have a fine MA provider (Kaiser) and it's much better that what I had to choose from. My BIL in Northern Wisconsin has access to a good MA provider.

Whether or not you can have it all and pay $0 with all "network" coverage in an MA plan is something I don't know and I would bet it is plan-specific. Sorry I can't be more helpful.

 

[AllDone]

Am I correct that (theoretically) someone with a Medicare Advantage plan (Part B, Part B Supplement, & Part D rolled into one plan) would have paid $0 also (assuming the doc, hospital, etc. were in network)?

MA plans (technically Medicare Part C) can be either HMO or PPO. The PPO version is quite a bit more expensive. Otherwise they work like any PPO or HMO with co-pays, etc. The HMO plans that I'm familiar with don't have a deductible for medical care and may or may not have a small deductible for drugs. You do need referrals and have to use in-network doctors. There is an additional premium for most plans.

Currently the MA plans cost the government about 12% more than comparable care through Medicare. These extra payments are being phased out over time as part of the ACA and may affect future availability. Additionally, if you get sick, it may be hard to get a supplemental policy, if you want to switch back to Medicare (ask my mom!)

 

[Bestwifeever]

I don't know Jack about Medicare but I can't resist. Sent from my Maxwell Smart shoe phone.

Me neither (in my new signature ).