Medicare - No Supplements?

[SumDay]

DH turns 65 next year, so I'm wading into the Medicare alphabet soup. I searched Medicare on this board and learned lots, but I also stumbled on this article, written by a doctor, questioning whether or not supplements are worth it.

Anyone 'self-insure" with their Medicare?

P.S. I apologize for using any inaccurate Medicare terminology - this is giving me a headache.

 

[meierlde]

DH turns 65 next year, so I'm wading into the Medicare alphabet soup. I searched Medicare on this board and learned lots, but I also stumbled on this article, written by a doctor, questioning whether or not supplements are worth it.

Anyone 'self-insure" with their Medicare?

P.S. I apologize for using any inaccurate Medicare terminology - this is giving me a headache.

Note that there exist high deductible medigap policies which cost a lot less with a 2800 or so deductible plus the part B deductible. That self insures for the little stuff, but protect from the big bills.

 

[kaneohe]

Think very carefully before you forego the Supplement. If 2K in premiums is going to bother you, think how much more you will be bothered if DH gets afflicted w/ some disease where each round of treatment costs that much and there might be 6-8 rounds in a cycle and perhaps several cycles a year. Plus associated doctor and lab costs.......total of 30-40K/yr. (That's your 20% share). Hopefully odds are not that great that DH gets that affliction but that's what insurance is for........in case you're the unlucky one. A side benefit is that you don't care about the insurance bills........generally medicare or the supplement will be paying so you don't care much about whether the bill is right or not so a lot of the worry and scrutiny will vanish.

 

[MichaelB]

The nice things about MediGap insurance is the policies are regulated and the coverage itself is clearly spelled out, making it easy to compare policy options. Here's a PDF https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf

That linked article didn't cover things like skilled nursing facilities and rehab centers. That's a major component of the more comprehensive MediGap policies. One reason why average hospital stays are shorter is patients are moved from hospitals to rehab facilities. Cost sharing from one extended stay there is enough to pay multiple years premiums.

In addition to the high deductible F plan already mentioned, keep in mind that MediGap policies are guaranteed issue only once, when you are first eligible. After that, insurers are free to underwrite and deny new policies.

In response to the question asked in the OP, I don't know anyone who self insurers. I have a few extended family that have no supplemental coverage, but that is "can't afford", not self insure.

 

[bmcgonig]

One surgery could be 40k (That's what my appendectomy cost.. approved cost). Then you're out 20% of that.

 

[SumDay]

Note that there exist high deductible medigap policies which cost a lot less with a 2800 or so deductible plus the part B deductible. That self insures for the little stuff, but protect from the big bills.

That's the one that's going away (Plan F?) in 2020, but if you get in before that, it's supposed remain available?

 

[MichaelB]

That's the one that's going away (Plan F?) in 2020, but if you get in before that, it's supposed remain available?

Regular plan F, with no deductible, is going away, replaced with Hi-Deductible F,

 

[aja8888]

I can't wait to see what DW's recent heart surgery cost (the billed amounts) and she has Plan F. If it's not $100 K I'll be surprised. My BIL's heart transplant two years ago had to be $1 MM ++.

Going naked with Medicare is not a good idea.

 

[Sunset]

One surgery could be 40k (That's what my appendectomy cost.. approved cost). Then you're out 20% of that.

Easily, a few years ago, I had 1 surgery and the cost was $125,000 in total, including the 3 days in hospital. It was a planned operation, not an emergency type thing.

I was soooo glad we had insurance.

 

[travelover]

The linked article talks about averages but I insure against the extremes. F High Deductible plan here.

 

[Katsmeow]

I would never go without a supplement. Since traditional Medicare doesn't have any out of pocket max, 20% copay can add up fast. That is not a risk I want to take. The only way I wouldn't have a supplement would be if I did Medicare Advantage and had an out of pocket max (but I prefer traditional Medicare).

 

[MBSC]

That's the one that's going away (Plan F?) in 2020, but if you get in before that, it's supposed remain available?

Regular plan F, with no deductible, is going away, replaced with Hi-Deductible F,

Plans F and HD-F do not 'go away' in 2020. Persons with a Medicare effective date of 1/1/2020 or later will not be able to choose them but will be able to use G and HD-G as substitutes.

More info: www.naic.org/documents/committees_b_senior_issues_170201_medigap_faq.pdf

 

[marko]

In response to the question asked in the OP, I don't know anyone who self insurers. I have a few extended family that have no supplemental coverage, but that is "can't afford", not self insure.

You do now!
I just started Medicare in June and don't have a supplement. My initial thought was that I'm in pretty good health (so far) and can handle any typical non-covered issues.
But, now this thread has me wondering......not having rehab coverage might be a good thing to have at some point.
Am I correct in thinking that I can get supplemental coverage in a few years if I saw something coming. (yes, I know you don't see things coming sometimes)

 

[REWahoo]

Am I correct in thinking that I can get supplemental coverage in a few years if I saw something coming. (yes, I know you don't see things coming sometimes)

There are consequences for delaying.

After the initial 6 month window of enrolling in Medicare you may not find an insurer willing to sell you supplemental coverage.

If you do find an insurer willing to sell you Medigap coverage, pre-existing conditions will apply and your "something coming" may not be covered until a 6 month or longer waiting period.

Your premiums will be higher than if purchased during the initial enrollment period.

 

[marko]

There are consequences for delaying.

After the initial 6 month window of enrolling in Medicare you may not find an insurer willing to sell you supplemental coverage.

If you do find an insurer willing to sell you Medigap coverage, pre-existing conditions will apply and your "something coming" may not be covered until a 6 month or longer waiting period.

Your premiums will be higher than if purchased during the initial enrollment period.

Ah! Thank you. I'm on it.

 

[John Galt III]

God help me. I'm 63 now and trying to learn the Medicare scene. I've read and read so much but still can't remember how everything connects. I guess my computer programming skills are fading! Is there a website that lays it all out in pictorial form, with a few words added here and there? Maybe Venn diagrams? Or some sort of flow chart? Thanks.

 

[ivinsfan]

God help me. I'm 63 now and trying to learn the Medicare scene. I've read and read so much but still can't remember how everything connects. I guess my computer programming skills are fading! Is there a website that lays it all out in pictorial form, with a few words added here and there? Maybe Venn diagrams? Or some sort of flow chart? Thanks.

I hear you, I'm a year out and having analysis paralysis....my DH turned 65 6 months after a mitral valve repair/afib/ and defibrillator implant. I was so shell shocked by everything I just went to my insurance agent and listened while she enrolled him in Senior Gold..I'm still not sure how that penciled out...he has ongoing maintence with cardio, had a hernia fixed..at some point will need a new defibrillator so I'm just sticking with the Senior Gold, but I don't have a clue what to do for myself.

 

[kaneohe]

God help me. I'm 63 now and trying to learn the Medicare scene. I've read and read so much but still can't remember how everything connects. I guess my computer programming skills are fading! Is there a website that lays it all out in pictorial form, with a few words added here and there? Maybe Venn diagrams? Or some sort of flow chart? Thanks.

https://www.amazon.com/s/ref=nb_sb_...ies+2017&rh=i:aps,k:medicare+for+dummies+2017

might be at your local library

 

[aja8888]

A word to the wise, seeing many of us members have Medicare in their sights:

Get the best supplement offered since you will get sick later. My DW literally fell apart (medically) at 71 and what we went through over the last year would cost many thousands if she didn't have Plan F (full).

I'll list a few things she has been dealing with since 11/16:

COPD (now on O2 full time)
Severe osteoporosis (over $1 k per month OPP for bone drugs alone)
5 compression fractures of vertebrae requiring Kayroplasty surgeries
Mitral heart valve replacement

I haven't calculated what her 11 or 12 ongoing prescriptions cost us but I do know we hit the Donut Hole in May or so.

And I went from Full F to G last year as I am very healthy and wanted to reduce the rate of increase of the supplemental plan. To do that, I had to qualify for the change and that included having a physical, blood checked, answering a many page questionnaire of medical history, being phone interviewed for an hour by a medical rep from the insurance company, etc.

What a royal PIA all that was and if I had it to do over, I would have just left well enough alone.

 

[Crewer]

aja8888 is right - eventually nearly everyone gets something.

But my thought is self-insurance has the problem that you (the insurer) are in a lousy negotiating position. Insurance companies negotiate lower rates for everything and the self-pay person pays the highest amount for everything. Even a no cost Medicare Advantage plan gives you the advantage of lower negotiated rates. (If they still have no cost plans like that - we get the extra insurance over medicare as my retiree medical plan).

 

[travelover]

aja8888 is right - eventually nearly everyone gets something.

But my thought is self-insurance has the problem that you (the insurer) are in a lousy negotiating position. Insurance companies negotiate lower rates for everything and the self-pay person pays the highest amount for everything. Even a no cost Medicare Advantage plan gives you the advantage of lower negotiated rates. (If they still have no cost plans like that - we get the extra insurance over medicare as my retiree medical plan).

But in the case of the OP, Medicare is the insurer and negotiates the rates. You are on the hook for 20% of the negotiated rate.

 

[Ian S]

OK, a few things to clarify. First, Part A has a deductible of ~ $1300 per benefit period. How a benefit period is calculated depends on whether or not you stay out of the hospital for at least 60 days after being discharged after the initial stay but it's quite possible to wind up having more than one benefit period in a year and therefore having more than one deductible payment. Now you are unlikely to have to pay co-insurance under Part A since you'd have to be in the hospital more than 60 days in a benefit period after which you'd pay $329/day. After 90 days it essentially doubles but that's probably very low risk. Medigap policies will cover these costs up to a year after Part A benefits lapse.

But Part B costs are where you could really rack up some coinsurance costs and that's because Part A only covers in-hospital costs. And with the number of common problems (including surgery) that are now treated on an out-patient basis the 20% coinsurance for Part B could really run up quickly.

I also think the use of a $200/month supplement premium is a little on the high side. If you want to self-insure, do it smart and pick a G or N supplement which in my area start at half what the doctor suggested.

 

[aja8888]

OK, a few things to clarify. First, Part A has a deductible of ~ $1300 per benefit period. How a benefit period is calculated depends on whether or not you stay out of the hospital for at least 60 days after being discharged after the initial stay but it's quite possible to wind up having more than one benefit period in a year and therefore having more than one deductible payment. Now you are unlikely to have to pay co-insurance under Part A since you'd have to be in the hospital more than 60 days in a benefit period after which you'd pay $329/day. After 90 days it essentially doubles but that's probably very low risk. Medigap policies will cover these costs up to a year after Part A benefits lapse.

But Part B costs are where you could really rack up some coinsurance costs and that's because Part A only covers in-hospital costs. And with the number of common problems (including surgery) that are now treated on an out-patient basis the 20% coinsurance for Part B could really run up quickly.

I also think the use of a $200/month supplement premium is a little on the high side. If you want to self-insure, do it smart and pick a G or N supplement which in my area start at half what the doctor suggested.

Good post above.

My recent meniscus repair in my right knee was outpatient in a surgery center. According to the Medicare statement, the doctor billed over $9 K and his assistant over $3 K. Then there were other charges for anesthesia, etc. Now Medicare and my supplement covered it all except for my annual Plan G deductible of $184.

We haven't seen DW"s statements for her Mitral valve replacement yet, but I'll bet those will be 20 times what my knee job was.

When I switched to G vs. F this year, I saved about $95 per month in premium as Plan F was escalating higher each year (I'm 73 and was paying about $240/month for F). Folks, it goes up every year! My new Plan G was $155/month and the only difference between the two plans is that Plan F cover all deductibles and Plan G doesn't cover the annual deductible of $184 but covers all the other deductibles.

 

[Ian S]

Good post above.

My recent meniscus repair in my right knee was outpatient in a surgery center. According to the Medicare statement, the doctor billed over $9 K and his assistant over $3 K. Then there were other charges for anesthesia, etc. Now Medicare and my supplement covered it all except for my annual Plan G deductible of $184.

We haven't seen DW"s statements for her Mitral valve replacement yet, but I'll bet those will be 20 times what my knee job was.

When I switched to G vs. F this year, I saved about $95 per month in premium as Plan F was escalating higher each year (I'm 73 and was paying about $240/month for F). Folks, it goes up every year! My new Plan G was $155/month and the only difference between the two plans is that Plan F cover all deductibles and Plan G doesn't cover the annual deductible of $184 but covers all the other deductibles.

I just switched from F to G now that AARP/UHC offers a G plan. Minor bonus is my annual deductible was already used up so no deductibles for the rest of the year even though I'm now on Plan G. Also the savings on Plan G more than pay for the annual deductible.

 

[Telly]

God help me. I'm 63 now and trying to learn the Medicare scene. I've read and read so much but still can't remember how everything connects. I guess my computer programming skills are fading! Is there a website that lays it all out in pictorial form, with a few words added here and there? Maybe Venn diagrams? Or some sort of flow chart? Thanks.

I had the same problem. I bought this book on Amazon, it is an interesting read, and easy to locate sections/topics when I have forgotten:
https://www.amazon.com/Get-Whats-Yo...sr=8-1&keywords=get+what's+yours+for+medicare

At the same time, I also ordered up this revised edition on SS, as the previous edition I had went obsolete with the flurry of SS changes a couple years ago:
https://www.amazon.com/Get-Whats-Yo...sr=8-2&keywords=get+what's+yours+for+medicare