Is Medicare better than my private insurance?

[Snidely Whiplash]

As I've explained elsewhere, at 55 years old my wife has developed some significant health issues (neuroendocrine liver cancer, Cushing's Syndrome, diabetes, etc). She has been placed on Social Security disability and will receive Medicare near the end of this year. I had expected my medical costs to decline when she moves from private insurance to Medicare but as I investigate further it looks like our costs will skyrocket tremendously and it has me losing sleep.

Our current private insurance (which covers us both), a policy I have had for 15 years from when I was self employed, has an annual premium of $6,000. and a deductible of $10,000. and then our insurance picks up 100% of medical costs and prescriptions, so our outgo is capped at $16,000. per year.

When my wife is placed on Medicare my costs will be : private insurance will cost me $3,000. per year in premiums with a $5,000. deductible and the Medicare costs look to be Part A -0-, Part B $1800 year, Perscription plan $840 year plus co-pays, and Plan F $8,400 per year, for a total of $19,040 plus prescription copay (not an insignificant amount).

We live in Florida (a "must issue" state for medigap plans) but the costs are substantial. I see no way around such a plan as the 20% co-pays would quickly bankrupt us. I understand most providers waive the 20% but do they do so if the patient has assets? I suspect I need to protect myself with the Medigap policy.

Am I missing something? Medicare looks to be a terrible alternative to what I have now. I'm not sure why so many are happy with it. I must be overlooking something. I'm grateful for any advice or suggestions.

 

[kaneohe]

That Pt. F sounds quite expensive. Are you sure it's right? I'm more used
to $150-200/mo or about 2K/yr.

 

[MBSC]

Medigap plans can be very expensive for those under age 65 unless you live in a state with specific Medigap regulations for that age group. Most Medicare eligible people on SSDI choose a Medicare Advantage plan for this reason. MA plans cannot charge more for being under age 65. MA plans are popular in Florida but make sure the provider network and drug formulary meets her needs. You may find it helpful to talk to a SHIP Counselor or local independent insurance agent that specializes in Medicare. At age 65, everything resets and she will be eligible to purchase a Medigap plan at the "normal" rates. I wish your family the best.

Locate a SHIP Counselor: https://www.shiptacenter.org/

 

[rodi]

We went with the cheapest drug plan (part D) for DH... $17/month for humana/walmart.

Look to see if there is an F+ plan... That is a plan that has a deductible for the 20% not covered by part B - and once that deductible is met - pays everything in full. We found the F+ plan much less expensive than the F plan. But I'm not sure what's available for sub-65 year olds.

 

[audreyh1]

Sounds like the real problem is that this is not the Medicare coverage someone reaching 65 pays for, but much more expensive because your wife is under 65 and on SSD.

 

[Corporateburnout]

Part B premiums should be $134/month or $1600 per year for your DW. Plan F premium @700/month is extremely high. DW started on Medicare in March and her Medigap premium is $155 with 0 out of pocket cost. Is it because she's 55 and on SSDI? If so can she opt out of Medicare and keep your current insurance?

 

[AllDone]

She can't keep your work insurance as a secondary payer?

 

[Snidely Whiplash]

I'm very grateful for the advice and input offered so far.

I should have more fully explained. The price of the Medigap policy seems to be the biggest issue and I'm not seeing a way around the high premium. Although the policy is a "must issue" in Florida the premium is high because the company recognizes that anyone purchasing it under 65 in conjunction with Medicare is because of significant health issues. I guess I can look into Medicare Advantage plans but I'm worried that there will be some kinda catch. The SHIP counselor is a good idea I hadn't thought of.

I would love to avoid the Medicare issue completely and just keep our current policy. Unfortunately it's not ACA compliant so it is scheduled to go away at the end of 2018. The Medigap must issue requirement applies for within 6 months of when the disabled person is eligible for Medicare. After the 6 month period the company can deny Medigap (and with my wife's isssues I wouldnt blame them). So if I keep our current policy for another year I lose the must issue Medigap window and I'm really in a mess. I checked with our insurance and it will not act as a secondary to any other policy or Medicare.

I truly am grateful for the replies. I guess there's no easy answer. I was hoping I might be missing something simple.

 

[kaneohe]

Do you know what the guaranteed rates are for your current insurance plan vs Medicare?
Not the premiums but the charges for the various medical procedures. Perhaps Medicare might have more bargaining power and if the amounts Medicare pays are significantly less than what your current insurance pays, you might still end up ahead?

 

[Bestwifeever]

As I've explained elsewhere, at 55 years old my wife has developed some significant health issues (neuroendocrine liver cancer, Cushing's Syndrome, diabetes, etc). She has been placed on Social Security disability and will receive Medicare near the end of this year. I had expected my medical costs to decline when she moves from private insurance to Medicare but as I investigate further it looks like our costs will skyrocket tremendously and it has me losing sleep.

Our current private insurance (which covers us both), a policy I have had for 15 years from when I was self employed, has an annual premium of $6,000. and a deductible of $10,000. and then our insurance picks up 100% of medical costs and prescriptions, so our outgo is capped at $16,000. per year.

When my wife is placed on Medicare my costs will be : private insurance will cost me $3,000. per year in premiums with a $5,000. deductible and the Medicare costs look to be Part A -0-, Part B $1800 year, Perscription plan $840 year plus co-pays, and Plan F $8,400 per year, for a total of $19,040 plus prescription copay (not an insignificant amount).

We live in Florida (a "must issue" state for medigap plans) but the costs are substantial. I see no way around such a plan as the 20% co-pays would quickly bankrupt us. I understand most providers waive the 20% but do they do so if the patient has assets? I suspect I need to protect myself with the Medigap policy.

Am I missing something? Medicare looks to be a terrible alternative to what I have now. I'm not sure why so many are happy with it. I must be overlooking something. I'm grateful for any advice or suggestions.

Your poor wife (and you) . You probably have no choice but to use early Medicare and pay an additional $3k per year for it, plus prescriptions? Otherwise, I would worry that she might lose guaranteed coverage or be put into a high-risk high-premium pool at some point in the future.

 

[Scuba]

I am no expert on this topic but I've heard that the Medicare Advantage provider network is more limited than the Medicare network. So if keeping specific docs matters to you, make sure they take Medicare Advantage.

 

[youbet]

Your poor wife (and you) . You probably have no choice but to use early Medicare and pay an additional $3k per year for it, plus prescriptions? Otherwise, I would worry that she might lose guaranteed coverage or be put into a high-risk high-premium pool at some point in the future.

+1

In this kind of situation, I'd be prone to secure the coverage most likely to be there for you over the years ahead. Your wife's health issues coupled with potential changes to ACA or the private insurance company's desire to even participate make reaching for security a good move. You'll find a way to come up with the extra $3k/year. Buy the coverage least likely to disappear or make a dramatic, negative change.

 

[BuysToys]

We ran into the same issue when my husband went on Medicare last year due to disability. There is only one insurer who underwrites Medigap policies in our area and it was horrifically expensive. Combined with Medicare, it was more than we were paying for his ACA plan. Fortunately, there is one insurer who underwrites Medicare Advantage policies for those on disability. His PCP wasn't on the plan, but his specialist was. He's been very happy with the new PCP.

There is good news, I believe. Our agent told DH that he gets to choose a Medigap plan again when he turns 65. So if he decides that Medicare Advantage really isn't working for him, it's not a permanent problem.

 

[youbet]

I am no expert on this topic but I've heard that the Medicare Advantage provider network is more limited than the Medicare network. So if keeping specific docs matters to you, make sure they take Medicare Advantage.

Medicare Advantage policies vary one from the other depending on the insurance company and policy. My DW's Medicare Advantage policy (with United Health Care) accepts any provider that Medicare does. That is, the network = any provider that accepts Medicare assignment. Other Medicare Advantage policies have more limited networks. Picking a Medicare Advantage provider whose network works for you is the key.

 

[MBSC]

I guess I can look into Medicare Advantage plans but I'm worried that there will be some kinda catch.

In case Medicare Advantage is not a route you want to take, I plugged in a random FL zip code and Under 65 Medigap Plan G was listed for about $3600/yr + $200 Part B deductible (rounding) for a total of $3800/yr. High-Deductible F (HD-F or F+) had a premium of about $2300/yr + $2200 OOP for a total of about $4500/yr. $8400/yr for regular F was on the high end with rates starting around $5100/yr. Of course, the options/prices will vary in your zip code.

 

[Meadbh]

As I've explained elsewhere, at 55 years old my wife has developed some significant health issues (neuroendocrine liver cancer, Cushing's Syndrome, diabetes, etc).

It looks like our costs will skyrocket tremendously and it has me losing sleep.

My sympathies to your wife on facing these health challenges. It's so unfair to have to face added financial stress, just when she's down. That does not help anyone. It is a consequence of the societal choices your country has made, in that health care is not regarded as a public good. Apologies if this is considered a political statement. But I have never shied from the truth.

 

[Snidely Whiplash]

Do you know what the guaranteed rates are for your current insurance plan vs Medicare?

I have no idea. I know our current insurance is paying out well over $350k per year on costs between treatment, scans, medications, etc. That amount is well below the billed amounts.

You probably have no choice but to use early Medicare and pay an additional $3k per year for it, plus prescriptions? Otherwise, I would worry that she might lose guaranteed coverage ......

That's my thinking as well. Thanks for confirming that my thought process is correct.

I am no expert on this topic but I've heard that the Medicare Advantage provider network is more limited than the Medicare network. So if keeping specific docs matters to you, make sure they take Medicare Advantage.

I've found that to be true. My wife needs to see specialists in a couple of different facilities, and yet another out of state that we have to travel to see every three months. I know they all take original Medicare so my thought was to look in that direction. Her condition is so rare many doctors don't understand it at all so seeing specialists is a necessity.

+1

In this kind of situation, I'd be prone to secure the coverage most likely to be there for you over the years ahead. ......... You'll find a way to come up with the extra $3k/year. Buy the coverage least likely to disappear or make a dramatic, negative change.

It's more like $8k per year after prescriptions, but your point is well taken. She's currently on a medication that even with the Medicare prescription plan will cost me about $16k per year (not a typo) in co-pays. Hopefully this issue resolves soon and she can get off of that medication.

We ran into the same issue when my husband went on Medicare last year due to disability. There is only one insurer who underwrites Medigap policies in our area and it was horrifically expensive.

There is good news, I believe. Our agent told DH that he gets to choose a Medigap plan again when he turns 65.

I was not aware of this but have found similar information on the 'net after reading your post that confirms this. If my wife can make it to 65 our costs will drop considerably. Before my wife got ill I never knew being put on Medicare prior to 65 was an option. I figured I would have our current insurance and have a max out-of-pocket of $16k per year which we can afford if either of us were stricken with a serious illness. Like anyone, the possibility of an extra $8k + significant medication co-pays + any non-FDA approved treatments which may be necessary but wouldn't be covered by Medicare (last one stopped her cancer in its tracks but at a cost of $45k which was paid for by our current insurance) has me worried that our additional unanticipated costs could vary from $8k per year to $70k per year. That's usually the point I sit up in bed in the middle of the night sick with worry.

My DW's Medicare Advantage policy (with United Health Care) accepts any provider that Medicare does. That is, the network = any provider that accepts Medicare assignment.

That sounds like the same Medigap plan I'm looking at, and the same reasons for that choice. Oddly enough, my current private insurance is through UnitedHealthcare. They won't be quick to discount the Medigap rate if they look at what they've paid out for my wife over the last couple of years.

In case Medicare Advantage is not a route you want to take, I plugged in a random FL zip code and Under 65 Medigap Plan G was listed for about $3600/yr + $200 Part B deductible (rounding) for a total of $3800/yr. High-Deductible F (HD-F or F+) had a premium of about $2300/yr + $2200 OOP for a total of about $4500/yr. $8400/yr for regular F was on the high end with rates starting around $5100/yr. Of course, the options/prices will vary in your zip code.

I am in zip code 32043 (Clay County). Was the information on the Medicare site for the Plan G? The standard Medicare site only prices 65+ rates that aren't applicable to my situation. I'd love to be proven wrong. I need to talk with a SHIP counselor or insurance agent.

It is a consequence of the societal choices your country has made, in that health care is not regarded as a public good. Apologies if this is considered a political statement. But I have never shied from the truth.

Right now the politest response I can muster is that I have paid many many years for an insurance policy that suited my needs and now that I need to use it the government has decided it is "substandard" and is forcing my wife into a far more expensive and very much inferior government run program. I reject your version of the truth and would appreciate it if you'd keep your posts, which so far have offered only inflammatory opinion and no genuine help, out of the thread I created in an attempt to get guidance and advice which so many others have very graciously provided.

 

[Meadbh]

Right now the politest response I can muster is that I have paid many many years for an insurance policy that suited my needs and now that I need to use it the government has decided it is "substandard" and is forcing my wife into a far more expensive and very much inferior government run program. I reject your version of the truth and would appreciate it if you'd keep your posts, which so far have offered only inflammatory opinion and no genuine help, out of the thread I created in an attempt to get guidance and advice which so many others have very graciously provided.

My sympathies to your wife. My sympathies to you too. I wish her well, and hope you can find a solution.

 

[MRG]

We ran into the same issue when my husband went on Medicare last year due to disability. There is only one insurer who underwrites Medigap policies in our area and it was horrifically expensive. Combined with Medicare, it was more than we were paying for his ACA plan. Fortunately, there is one insurer who underwrites Medicare Advantage policies for those on disability. His PCP wasn't on the plan, but his specialist was. He's been very happy with the new PCP.

There is good news, I believe. Our agent told DH that he gets to choose a Medigap plan again when he turns 65. So if he decides that Medicare Advantage really isn't working for him, it's not a permanent problem.

We were told the same. My understanding is if you move out of an insurers coverage area or you turn 65 you have an opportunity to switch.

Best wishes to you and your wife.

 

[Koolau]

My suggestion would be to approach all of your wife's providers and see if they can direct you to either an advocate or a knowledgeable 3rd party ombudsman who could help you make your decisions.

Regarding the pharma costs you face, the real issue with most of them is not just the cost, but the formularies they embrace. You may find out that they will refuse to cover the particular drug that is best for your wife. Her doctors may be able to help with this issue by filling out the appropriate appeal forms, etc. They also may be able to direct your wife to an "almost as good" drug.

A quick story. Doc wants me on a blood thinner, but formulary won't support it - $12/day out of pocket!! I told him NO! He said "Well, you could just take a 325mg ASA per day - $.04/day.

I have suggested some stuff as if I know what I'm talking about - and I don't! I'm just certain there are some folks out there that can look at your needs and resources and help you make your decisions. I hope I am correct and God bless you as you struggle with your wife through this trying time. All my aloha.

 

[Snidely Whiplash]

Koolau, thanks for the insight ref: prescription issues. I plan on contacting our states SHIP counselors and maybe a private insurance agent or two. The facility where my wife receives the bulk of her treatment has been wonderful with regard to her cancer treatment and care. Everything else, not so much. I was surprised at the lack of help the social workers were. But that's another story. I guess I just need to resign myself to the fact that costs are going to increase and do what I have to do.

MRG, I guess that is at least a little light at the end of the tunnel.

 

[atmsmshr]

Last year at 54 my wife revived SS disability and was automatically enrolled in Medicaid. I am still working and have a good medical plan. Fearing losing coverage options from my employer for DW due to a gov plan - we immediately dropped the Medicaid.

We live in Florida.