Am I missing something about Medicare costs?

[John Galt III]

Don't forget the shocking price of dental work! And there doesn't seem to be any insurance coverage available for dental implants and crowns. I thought my teeth were in pretty good shape until I cracked a crown, its going to cost $5k to replace

I'm currently considering a Medicare Advantage plan with CapitalBlue (for $0 per month) that seems to have pretty good dental coverage. At no extra cost. Still $0 per month. $10 copay for office visit includes cleaning and 2 free bitewing xrays, and free cleaning. Max benefit of $2,000 per year. It pays 50% of the 'covered amount' for fillings, crowns, inlays, and onlays (but not implants) and endodontics, and the dentist is not allowed to charge you any more than that. My own dentist, whom I like, does not accept any medicare insurance. There are lots of dentists in my area who do accept medicare insurance, and I am researching them, hoping to find a competent one.

 

[John Galt III]

No you are not an outlier and as a result agents definitely push an MA plan if you are unsure of what you want, it's an easy sell for the agent because it's usually cheaper. As to JG, he seems set on the free MA in spite of earlier threads he started on this subject. I do hope it works out for him, but he doesn't seem to understand there won't be any billing issues because he will go where the MA tells him to go and do what the MA plan is willing to pay for. There is no "go to bat for a claim", you don't even get to step up to the plate on MA.

Ivinsfan. You seem to be advocating FOR a MA plan, in that there will be no decisions needed on my part, since the MA plan will tell me what I need to do. That has unfortunately not been my experience with the insurance companies I have used. My complaint with the typical ins co is that the customer needs to be ever-vigilant and ask the ins co what is in network, what is covered, what is covered but subject to deductible (which means in effect it is NOT covered). etc, etc. If having an xray somewhere, is the company running the xray machine in network or not? Will a specialist send a tissue sample to an in network or out of network lab? It's the fact that the ins co never tells you anything unless you ask, that bugs me, and also, once you ask your question, you get different answers from different cs reps, even supervisors. It's the incompetence of the cs reps that bugs me. My rationale for (once ) going with a supplement plan instead of an MA plan, was that with a supplement plan I could I could just lie back and say 'Hey man, I'm broken, so fix me. Have a nice day' and not owe a dime and not have to spend hours precertifying everything. OMG, now I'm talking myself back towards getting a supplement plan, lol... sigh....

 

[ivinsfan]

Ivinsfan. You seem to be advocating FOR a MA plan, in that there will be no decisions needed on my part, since the MA plan will tell me what I need to do. That has unfortunately not been my experience with the insurance companies I have used. My complaint with the typical ins co is that the customer needs to be ever-vigilant and ask the ins co what is in network, what is covered, what is covered but subject to deductible (which means in effect it is NOT covered). etc, etc. If having an xray somewhere, is the company running the xray machine in network or not? Will a specialist send a tissue sample to an in network or out of network lab? It's the fact that the ins co never tells you anything unless you ask, that bugs me, and also, once you ask your question, you get different answers from different cs reps, even supervisors. It's the incompetence of the cs reps that bugs me. My rationale for (once ) going with a supplement plan instead of an MA plan, was that with a supplement plan I could I could just lie back and say 'Hey man, I'm broken, so fix me. Have a nice day' and not owe a dime and not have to spend hours precertifying everything. OMG, now I'm talking myself back towards getting a supplement plan, lol... sigh....

I think you will find a Medicare supplement eliminates a lot of that back and forth. The in and out of network stuff won't be a problem if the provider accepts Medicare. I do have to say that I never had a problem with either straight insurance or a Medicare supplement and my DH had an open heart procedure with both kinds of coverage. I never had to make one single phone call, so I consider myself lucky there. An advantage plan is one stop shopping but if you are happy with where you have to shop, go for it. If you might like to pick and choose or shop somewhere besides where you live, go for the supplement.

 

[Katsmeow]

Am I missing something? Seems like a great coverage, which allows one to get a reasonable handle on Health Care expenses minus future unknown drug expenses (which could be substantial).

No, you aren't missing anything. My mom who died at 94 and had had a lot of health problems had traditional Medicare plus Plan G and it was a great choice for her. Particularly as she got older and it was harder for her to navigate stuff.

Yes, the coding issue can be a real one. But, it seems relatively rare. My mom never really had any problems with it.

There are some differences in what Medicare will pay for. For example, you might be used to going in and having an annual physical with blood work. With Medicare it doesn't work they way. There are certain preventative tests they will do but it is laid out pretty specifically what they will do and not do. With that exception they don't pay for annual blood work if you don't have a reason to have the blood work.

That said - it hasn't really been an issue for DH. His doctors have always been able to get any blood work done that they felt needed to be done. The key is "needed" to be done. I went to the doctor the other day for the first time since going on Medicare. He ran a limited blood test to test specifically for things related to a prescription I was taking. He also generally asked me how I was doing and I am sure if anything had raised concerns he would have run any necessary tests.

Medicare does have rules for how many days of hospitalization or rehab they will cover. But for most people you won't exceed them unless you need long term care which isn't covered anyway.

We're $191 with BCBS for G. AARP (United Healthcare) was $220 per month in our state.

AARP UHC is higher because it is community rated and not age rated. You do get a discount for the first 12 years as I recall but, after that, your premium will not increase with age.

My rationale for (once ) going with a supplement plan instead of an MA plan, was that with a supplement plan I could I could just lie back and say 'Hey man, I'm broken, so fix me. Have a nice day' and not owe a dime and not have to spend hours precertifying everything. OMG, now I'm talking myself back towards getting a supplement plan, lol... sigh....

Yes, that is in fact a big reason people go with traditional Medicare and a supplement. I guess I could fight with a network and getting everything approved with an MA plan. But, I keep thinking of how hard that would have been for my mom after she got to be, say, 80 or o.der. I don't think she could have managed it. Just too exhausting and complex. As you get older, there is a lot to be said for keeping things simpler.

 

[athena53]

There are some differences in what Medicare will pay for. For example, you might be used to going in and having an annual physical with blood work. With Medicare it doesn't work they way. There are certain preventative tests they will do but it is laid out pretty specifically what they will do and not do. With that exception they don't pay for annual blood work if you don't have a reason to have the blood work.

That said - it hasn't really been an issue for DH. His doctors have always been able to get any blood work done that they felt needed to be done. The key is "needed" to be done.

Yeah, that's what caught me by surprise. My late DH had health issues that required monthly blood testing and we never paid a dime out of pocket. Totally different when I got my first bloodwork done, but now I use requestatest.com and just pay for it myself. I see that Quest Labs now has their own portal called QuestDirect. Both sites let you have access to whatever bloodwork you want without a doctor's visit. I paid $177 for all of the stuff my doc used to order, plus a urinalysis.

To be fair- I got kicked into a higher-risk group for breast cancer because of family history and have had increased screening because of it- Medicare has paid it all.

 

[Another Reader]

Yep.

Am I an outlier in my belief that regardless of the product being sold, the higher the commission for the sales rep the lower the true benefit to the purchaser?

No.

 

[kaneohe]

Don't forget the shocking price of dental work! And there doesn't seem to be any insurance coverage available for dental implants and crowns. I thought my teeth were in pretty good shape until I cracked a crown, its going to cost $5k to replace

don't know about other insurance, but AARP has dental insurance that covers
implants?/crowns after 1 yr waiting period. They cover cavities immediately so
if you have cavities and a crystal ball (or can wait) about implants/crowns. it might be ok for a short period.

 

[ShokWaveRider]

Is it not true that one can start a Medigap during the initial open enrollment then if you do not like it, even after a few years, one can switch to a MA without Underwriting, or did I read it incorrectly?

 

[SumDay]

Am I an outlier in my belief that regardless of the product being sold, the higher the commission for the sales rep the lower the true benefit to the purchaser?

Our broker told us he got a much larger commission for signing someone up for an Advantage plan than he would for a traditional Supplement. And yet, he pushed us to the Supplement, which is what we ending up with.

To the OP, I have been amazed at how much easier DH's life (and mine) is now that he's on Medicare. When he was on my Megacorp United Health Care, it was a constant battle. He'd need blood drawn and would have it done at the doctor's office, when the only way that's covered is if he went to a certain lab. UHC requires pre-approval for virtually everything. We haven't had one issue with Medicare along these lines. Sometimes we'll get a big bill, and discover that the provider didn't have our Supplement info. Giving them the info has taken care of it 100% of the time. Medicare is the greatest thing since sliced bread.

 

[ivinsfan]

Is it not true that one can start a Medigap during the initial open enrollment then if you do not like it, even after a few years, one can switch to a MA without Underwriting, or did I read it incorrectly?

That's my understanding too and you would do it during the annual open enrollment period. But once you make that switch you would be subject to underwriting to go back to a supplement.

 

[ivinsfan]

Our broker told us he got a much larger commission for signing someone up for an Advantage plan than he would for a traditional Supplement. And yet, he pushed us to the Supplement, which is what we ending up with.

To the OP, I have been amazed at how much easier DH's life (and mine) is now that he's on Medicare. When he was on my Megacorp United Health Care, it was a constant battle. He'd need blood drawn and would have it done at the doctor's office, when the only way that's covered is if he went to a certain lab. UHC requires pre-approval for virtually everything. We haven't had one issue with Medicare along these lines. Sometimes we'll get a big bill, and discover that the provider didn't have our Supplement info. Giving them the info has taken care of it 100% of the time. Medicare is the greatest thing since sliced bread.

And do you know why the commission is bigger? My agent was very forthcoming in telling me the government pays your MA company a certain amount of money each and every month. In our state it's around 700 bucks, the MA company takes that money and then they start squeezing the consumer because they want to keep as much money as possible. What a conflict of interest IMO...in effect the government pays a bunch of your monthly premium and you are back to the old model and not really on Medicare in its pure form.

 

[isisdave]

Take a look at https://boomerbenefits.com/medigap-plan-f-vs-plan-g-vs-plan-n/ and consider Plan N, which I have. I live in southern California. For someone just turning 65, N would be $131, G $162, and F $172. There might be 12-month discounts on some of these if you sign up at 65.

SOME doctor visits have a copay up to $20. I haven't figured this out exactly. I think they're office visits that aren't preventive. If the office visit price is less than $100 (I see a lot in the $85 range), the copay will be less than $20 (but the supplemental policy pays nothing).

Supposedly N doesn't cover "Part B excess charges." Some states don't allow these, and I've never seen one even though California is not one of those.

Anyway, for most of us, the monthly difference easily covers the deductible and half a dozen copays.

 

[Maidensong]

We used Boomer Benefits to help decide which plan the DH should choose when he qualifies for Medicare later this year. The big difference I see between Medigaps & MA is that you're rolling the dice with a Medicare Advantage plan. The premiums might be $0 to start, but the out of pocket can really shoot up if you actually get sick. Then if you want to switch to a supplement later, you may face underwriting and medical questions. Another thing Boomer Benefits does is give you an idea of average increases for policies over time. Some are greatly discounted at first, but skyrocket later. Check your state laws. Some allow you to change companies to shop for the best deal each year. Others require underwriting. I think MO, CA & OR are the only ones that allow consumers to switch companies without medical questions.

Our experience with BB was excellent.