Is Original Medicare really so awful?

[ivinsfan]

Quote:

Originally Posted by John Galt III You guys! Paying almost $400 a month for Medicare (which I had looked forward to as being free, then had the reality check of the $135 per month premium) is mindblowing for me. I've been conditioned to paying my enormous property taxes each year without flinching, but I can't bring myself to fork out $400 a month, even for stress-free cadillac insurance. W2R, may I ask you to divulge the name of the MA insurance company in La that is so popular? Here in Pa I'm looking at Humana, United Health Care, and CapBlue Cross HMO's. The HMO vs PPO thing does not seem to be a big deal. I still have my doctors in the network, and I do not think I need referrals.

JGI these prices vary wildly be state. And the big decision is supplement or MA you get one six month bite at that apple. I believe if you choose MA at your ORIGINAL signup period you have a small windrow to drop it and go to a supplement. As far as the MA company you are not locked into a certain company you can switch at the open enrollment every year.

I too lived in fairytale land thinking it would be free and later thinking it would cost around 135 a month but as in many things, the devil is in the details...

[OldConch]

JGIII,

Have you considered an F HD plan? Same as a plan G but with a $2300 deductible.

I plugged an Allentown zip into this website and found an F HD plan for less than $50/month and a Part D plan for less than $20.

https://www.ehealthmedicareplans.com/

BTW, this website gives instant quotes based on age and location but doesn't include all available companies.

[Chuckanut]

Quote:

Originally Posted by John Galt III You guys! Paying almost $400 a month for Medicare (which I had looked forward to as being free, then had the reality check of the $135 per month premium) is mindblowing for me. I've been conditioned to paying my enormous property taxes each year without flinching, but I can't bring myself to fork out $400 a month, even for stress-free cadillac insurance.

The real issue is the cost of medical care. Insurance mostly reflects that cost. $400 a month is a lot of money to most people. So is $10,000 for an emergency room visit and some out patient treatment.

A friend of mine broke an arm in a European Country (France?). IIRC, his cost of the x-ray and setting the bone in a cast was well under $2000 even though he was not covered under the country's medical plan and had to pay the rack rate.

Our politicians need to look into why we pay so much more than the rest of the 1st world.

[travelover]

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Originally Posted by Chuckanut ........Our politicians need to look into why we pay so much more than the rest of the 1st world.

Heh. And the fox really needs to investigate where all of those chickens have disappeared to.

[Global Wizzo]

If you travel outside the US, Medicare does not cover you. Take a look at what the managed plans cover. I picked up a Geo Blue policy for about $700 a year for travel coverage. Supplemented that with a MedJet Assist membership.

Only point here is to make sure your coverages matches your lifestyle.

[Maidensong]

Choosing the right company for your supplemental is pretty important. Some start with lower premiums and have a track record of jacking up the prices in later years. And if you want to change companies, you may face underwriting with medical questions unless you live in MO, OR or CA. I understand those 3 states allow retirees to shop for the best price each year without underwriting during the renewal period.

[travelover]

Quote:

Originally Posted by Global Wizzo If you travel outside the US, Medicare does not cover you. ..........

But some of the supplements do, to a point.

Quote:

Some Medigap plans cover emergency medical services you receive outside the United States. Medigap Plans C, D, F, G, M, and N pay 80% of your costs for certain emergency care in a foreign country if your situation meets all of the following conditions: The care you receive is medically necessary. The care begins during the first 60 days of your travel. Medicare doesn’t otherwise cover this care. You’ve met your Medigap deductible for the year.

https://www.ehealthmedicare.com/faq/...a-emergencies/

[Katsmeow]

Quote:

Originally Posted by John Galt III You guys! Paying almost $400 a month for Medicare (which I had looked forward to as being free, then had the reality check of the $135 per month premium) is mindblowing for me. I've been conditioned to paying my enormous property taxes each year without flinching, but I can't bring myself to fork out $400 a month, even for stress-free cadillac insurance. W2R, may I ask you to divulge the name of the MA insurance company in La that is so popular? Here in Pa I'm looking at Humana, United Health Care, and CapBlue Cross HMO's. The HMO vs PPO thing does not seem to be a big deal. I still have my doctors in the network, and I do not think I need referrals.

You thought Medicare was free?

As for $400 a month being expensive. In March, I paid the monthly premium for my pre-Medicare health insurance coverage. It was for a very good policy with a PPO network and did cover out of network stuff at a lower rate and higher deductible. My in network deductible was $1500 and I think $3000 for out of network.

The premium was $1118 a month! (I was reimbursed for part of this by DH's former employer). That did include prescription coverage.

Now compare that to now. My Medicare premium is $135.50. The prescription plan is $28. My supplement (plan G) is about $128 a month. Right now that total is a little under $300 a month. My deductible on Medicare is $185. Plan G covers everything else (except prescription drugs). The one prescription that I take has a $0 co payment.

I am SO much better off financially now as I am spending more than $800 a month less than I was before and I have a much lower deductible and no co pays!


Oh -- on the HMO v. PPO v. Traditional Medicare thing not being a big deal. It isn't a big deal until it is. For routine care, it isn't a big deal. When you break your hip and have to go to rehab and your network has only a narrow choice of facilities then it is a bigger deal. When you get cancer and you want to go to M.D. Anderson and you can't because you have a network, then it is a very big deal. The problem with HMOs usually isn't the ordinary, routine care. It is when you want the best specialist and you have a narrow choice that this becomes an issue. Of course, I recognize some people really can't afford a supplement so I respect that. In that case, then of course the HMO plan is better than not having a plan. And I am sure many people get lucky and are perfectly content with every provider in the plan.

[msanniee]

Quote:

Originally Posted by audreyh1 Most people I know are on original aka traditional Medicare plus Supplement and are very happy with it. We plan to go that route ourselves. Mainly due to largest nationwide network and portability. I don’t want to be stuck in some restricted local network when battling a major disease. No way would I go without the Medicare supplement. Medicare has no max OOP, and 20% of expensive cancer drugs can run to 10s of thousands a year. Traditional Medicare reported spending $300K to treat a relative’s late stage cancer over 2 years. Would you want to be personally responsible for the remaining $75K?

I wholly agree. I will be eligible for Medicare this year and will take the traditional plan with a supplement. I want to be able to vote with my feet and that can’t be done with an Advantage plan.

[gooddog]

Threads like this is what makes this the most valuable website for my family. The posters have something to do with it too.

[Chuckanut]

Quote:

Originally Posted by travelover But some of the supplements do, to a point. https://www.ehealthmedicare.com/faq/...a-emergencies/

+1

My supplement has $20,000 for out of country expenses. I also will consider medical only coverage travel insurance in the future.

[aja8888]

Quote:

Originally Posted by Katsmeow Oh -- on the HMO v. PPO v. Traditional Medicare thing not being a big deal. It isn't a big deal until it is. For routine care, it isn't a big deal. When you break your hip and have to go to rehab and your network has only a narrow choice of facilities then it is a bigger deal. When you get cancer and you want to go to M.D. Anderson and you can't because you have a network, then it is a very big deal. The problem with HMOs usually isn't the ordinary, routine care. It is when you want the best specialist and you have a narrow choice that this becomes an issue. Of course, I recognize some people really can't afford a supplement so I respect that. In that case, then of course the HMO plan is better than not having a plan. And I am sure many people get lucky and are perfectly content with every provider in the plan.

Great points and mentioned here before. Let me add that if it wasn't for DW's Full Plan F, and the ability to pick specialists, she would probably not be sitting here with me today.

[rk911]

we both chose medicare with a supplement (BCBS Plan F) + a BCBS Part D plan over the MA plan for a simple reason. we have been covered by BCBS thru our jobs forever. the coverage is good, premiums, in our opinion, are reasonable and, except for Part D which i think is farmed out, their telephone customer is exceptionally good.

so we wanted to stay with BCBS but their MA, which functioned like an HMO...primary care doc, referrals needed to see specialists, etc. that plan would revert to more like a PPO when we were out of our home area. we’re typically out of our home area 4-6 mos a year. BCBS told us that we could be transfered to a new “home” area with 2-weeks notice. we travel by motor home and sometimes don’t know where we will hang our hats tomorrow much less in 2-weeks. my wife could have received $0 premium managed coverage (HMO) from her retirement system with even stricter out-of-home-area restrictions.

we’re very happy with our choice.

[GlitterGirl]

I am a Registered Nurse and worked many years in the hospital doing case management so I have a different view on the question. By FAR, the easiest patient to secure medical services for was the one with traditional Medicare. I'd cringe when folks came in with some of the Medicare Advantage plans that had almost no home health coverage or limited or no rehab benefit. I'd have to beg some home care agencies to accept these patients and make sure that they got the referral for the next traditional Medicare patient to make up for it. I recall clearly a big man in his eighties who had a complicated hip replacement surgery and really needed a few days in a rehab. But the low cost Medicare Advantage plan he thought was so great had ZERO rehab benefits. Zero. He ended up going home with his petite wife terrified that she'd be unable to even assist him to the commode. I could tell many stories like this of people who are admitted to the hospital and think they have a great insurance plan but who have such limited access to doctors and services that it is frightening and sad. The insurance companies that sell the Medicare Advantage plans have to make their money somewhere and they do it by limiting or denying services that are covered untder traditional Medicare.

[Hermit]

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Originally Posted by aja8888 This is well worth the price of admission. Ask my wife about her heart valve replacement WITHOUT having to crack her sternum and chest wide open. It's all about doctor selection.

A friend had his chest cracked open for heart valve replacement a month ago. If they hadn't, he would be dead because of an undected aneurism. Other than that, he is very healthy. Some times ya get lucky.

[ARW44]

I have Medicare plus Supp from United Health Care through AARP. As I am 74 this year, I pay $130 per month. The plan I am on apparently is not available to start now. I have no copays, no limits on payout, can go to any provider, anywhere, ambulance is included. I had outstanding health history until I turned 70, then a big deal flu, cancer of the ureter with chemo and costly followup monitoring, ruptured appendix (12 days in hospital), solo unexplained bicycle crash resulting in two hospital days with multiple MRIs and studies (none of which I remember).

Total medical, hospital, and
ambulance bills (which I call "retail.": $858,078
Total paid buy Medicare: $154,751
Total paid by AARP Med Supp: $ ??
Grand total paid by me: $0.00

Except for premiums, I have paid NOTHING for medical care since I turned 65. Do not scrimp on coverage because you have been healthy so far. Things can change drastically.

[Calico]

OP: I will be retiring in 18 months, and I will sign up for traditional Medicare and a supplement.

I was healthy all my life until last year - when I got cancer. I finished treatment last October, and I recently checked my BCBS record to see what the insurance had paid (I knew what I had paid in total - $10,000) and the insurance paid over $200,000 for the year. The insurance is a "cadillac" employer plan. The $200,000 included surgery, 4 chemo treatments, a couple of hospital stays, and countless tests and clinic visits over the year. Some people I met were on much longer chemo regimens than I was - some for months or years.

I will not go 5 minutes between leaving my employer plan and being enrolled in Medicare and the supplement. I am cancer free now, and god willing will remain so for the rest of my life, but the thing is - you just never know. And I am more than willing to pay for traditional Medicare and a good supplement, because I can't put a price on peace of mind.

I live 15 minutes from an NCI cancer center, and I got world class care every step of the way - because I was blessed to have the best insurance available, with no limitations on whom I could see. I intend to replicate that insurance as closely as possible when I retire.

I am frugal (some say cheap) in most areas of my life, but health insurance is not one of them. It isn't worth the risk.

[LARS]

Quote:

Originally Posted by Maidensong Choosing the right company for your supplemental is pretty important. Some start with lower premiums and have a track record of jacking up the prices in later years. And if you want to change companies, you may face underwriting with medical questions unless you live in MO, OR or CA. I understand those 3 states allow retirees to shop for the best price each year without underwriting during the renewal period.

Don’t know about other states but CT allows changing plans/Insurers each year during enrollment without underwriting.

[NoMoreJob]

Quote:

Originally Posted by audreyh1 We plan to go that route ourselves. Mainly due to largest nationwide network and portability. I don’t want to be stuck in some restricted local network when battling a major disease.

This was one of the biggest considerations for me especially after having come from ACA plans with increasingly limited networks. As it turns out I was diagnosed with cancer almost immediately after going on traditional Medicare with a G supplement. I was accepted for treatment at Mayo Clinic AZ. Traditional Medicare got me in (in AZ Mayo does not accept Medicare Advantage) and Plan G covered the 'excess charges' (Mayo does not accept Medicare assignment so can charge 10-15% over the standard Medicare approved amounts for certain things).

Had I not been on traditional Medicare my options for and quality of treatment would have been much different and without a supplement my out-of-pocket expense would have been very large. As it was I received some of the best treatment available and paid very little out of pocket. Most importantly I am now back to 95% and my prognosis for a long and enjoyable life is excellent which would have been unlikely had I made a different choice.

All I can say is be careful about skimping on health insurance coverage especially during the time of life that you're most at risk for serious illness and resulting large expenses. Prior to this experience I had never even been a patient in a hospital.

[Calico]

Quote:

Originally Posted by NoMoreJob This was one of the biggest considerations for me especially after having come from ACA plans with increasingly limited networks. As it turns out I was diagnosed with cancer almost immediately after going on traditional Medicare with a G supplement. I was accepted for treatment at Mayo Clinic AZ. Traditional Medicare got me in (in AZ Mayo does not accept Medicare Advantage) and Plan G covered the 'excess charges' (Mayo does not accept Medicare assignment so can charge 10-15% over the standard Medicare approved amounts for certain things). Had I not been on traditional Medicare my options for and quality of treatment would have been much different and without a supplement my out-of-pocket expense would have been very large. As it was I received some of the best treatment available and paid very little out of pocket. Most importantly I am now back to 95% and my prognosis for a long and enjoyable life is excellent which would have been unlikely had I made a different choice. All I can say is be careful about skimping on health insurance coverage especially during the time of life that you're most at risk for serious illness and resulting large expenses. Prior to this experience I had never even been a patient in a hospital.

Excellent outcome!