Medicare Costs?

[Dash man]

I ran across this video on YouTube which does a good comparison between Medicare plans.

We still have a few years before we have to decide, but right now I'm kind of leaning towards the advantage plans. We've already had Kaiser for the last 35+ years, so we're already familiar with that system. My mom has the PacificSource advantage plan and it works well too with a few additional perks over Kaiser.



Lots to research...

I would advise you to avoid the Advantage plans. It’s not really Medicare. The government pays the insurance company a certain amount each month to care for you. The insurance company manages your care, not your doctors. Denials are common, requiring appeals. More and more hospitals are refusing Advantage plans. You’re restricted by networks, and they change frequently. You are restricted to their prescription plan.
With a Medicare Supplement you can go to any hospital or doctor that accepts Medicare. If Medicare pays, the supplement pays automatically. You don’t have to worry about health plan changes every year like you do with Advantage plans at annual enrollment, with the exception of Part D prescription plans.
My FIL has what is considered a Cadillac Advantage plan through his union, and it’s still a pain to deal with trying to get pre approval for procedures. Getting an ambulance service paid for by them out of his network took months to resolve.
A Medicare Supplement Plan N or Plan G will make your life much easier, especially in your older years.

 

[aja8888]

I would advise you to avoid the Advantage plans. It’s not really Medicare. The government pays the insurance company a certain amount each month to care for you. The insurance company manages your care, not your doctors. Denials are common, requiring appeals. More and more hospitals are refusing Advantage plans. You’re restricted by networks, and they change frequently. You are restricted to their prescription plan.
With a Medicare Supplement you can go to any hospital or doctor that accepts Medicare. If Medicare pays, the supplement pays automatically. You don’t have to worry about health plan changes every year like you do with Advantage plans at annual enrollment, with the exception of Part D prescription plans.
My FIL has what is considered a Cadillac Advantage plan through his union, and it’s still a pain to deal with trying to get pre approval for procedures. Getting an ambulance service paid for by them out of his network took months to resolve.
A Medicare Supplement Plan N or Plan G will make your life much easier, especially in your older years.

Agree 100%. There is nothing like picking your own doctors. Try getting a heart transplant authorized with a MA Plan!

I guess, if one thinks they won't ever get REALLY sick, Joe Namath can't be wrong.

 

[Teacher Terry]

Even though my medigap plan, etc takes a large amount of my income I figured it’s worth it to get the treatment I may need in the future. MA can require you to use step therapy if you need an expensive treatment and you could be dead or too late for the treatment to work by the time you get to the step you need. In many states you can’t go back to regular Medicare without passing underwriting. Definitely not worth the risk.

 

[RetireBy90]

We have the Medicare Advantage with Kaiser. Medicare costs us $361/Month each or $8,664/Yr, plus another $37/Mo for the Kaiser or $9,552/Yr. Add in a few out of pocket expenses each year and $10K per year. Not what I expected when planning for retirement.

 

[DallasGuy]

Yeah, the monthly/yearly premiums seem high, but as we age and we have more and more health issues, the combination of medicare, supplemental and drug plan is one of the best deals around and you can pick your own doctors. If you get sick, you pay very little out of pocket. I can sympathize with older people that don't have much saved and struggle to pay the supplemental premium costs and I can understand why they pick an Advantage plan. But for people in this group with plenty of assets, it should be a no-brainer to try to buy the best you can afford.

And don't give me that "well, I'm very healthy, always have been", because when you least expect it and especially as we get older, the chances of a major illness increase by alot.

 

[RetMD21]

.... But for people in this group with plenty of assets, it should be a no-brainer to try to buy the best you can afford.

And don't give me that "well, I'm very healthy, always have been", because when you least expect it and especially as we get older, the chances of a major illness increase by alot.

Yeah, I hope to never need a heart transplant but I'd like to pick the facility and surgeon if it came to it.

Denial of services is an issue with Advantage plans. There is a OIG report https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000299.asp

They give an example of a beneficiary who was denied authorization for a timely follow up MRI for a possibly malignant adrenal lesion. The Advantage plan claimed that one year should elapse between scans but that was something they just made up. They did reverse on appeal.

OTOH my MIL has had a work sponsored Advantage plan for 25 years with no problems. One hospital system dominates her city and accepts her insurance. Now she's too old to even think about traveling for a second opinion.

 

[ShokWaveRider]

Our Medicare costs (Part B, G & D combined) are higher than our previous ACA plans. But knowing exactly what one's annual healthcare costs will be (Drugs for some notwithstanding, but ours are known), the piece of mind that there are no clerks and a database deciding on our healthcare fate, Zero provider Copays and no real out of pocket costs are priceless.

 

[Livefree]

My wife just turned 65 and signed up for a 'G' Plan that costs $180 per month and another 8 dollars for prescription coverage (1 Generic Prescription) through Boomer Benefits. I can't recommend them enough...they did all the heavy lifting.


I have a Blue Cross PPO Medicare Advantage plan that costs zero per month...going on 4 years now. I've only needed annual physicals.



We live in Mass so there's no underwriting if I want to switch out at some point in the future.

 

[pacergal]

We have Kaiser Advantage.
I tried them for a couple of years via work insurance just to see if I liked their system.
Never had a problem with them.
We pay $164.90 for Medicare Part B, $0 premium for Advantage and $44 extra for added vision/dental/hearing benefits. $208.90 each, $417.80/mo total for both of us.

Never have had a problem getting any care requested. All referrals I have asked for for self and DH have been given without question. Between DH and myself, we have had MRIs, CAT scans, Physical therapy, specialty referrals, podiatry, sleep studies, specialty dental, etc.
Maybe it helps being an RN, but I go into appts with symptoms, labs, history and request such and such as next steps.
So far, have been pleased with knowledge/skills of all of the Drs we have seen.
And so far, our health care spending has been less than when I was on Blue Cross or MODA while working.

 

[ShokWaveRider]

Today we signed DW up for her Medicare Part G supplement. Used AARP United Healthcare. Took 10 minutes and we get a discount for us both being on it.

 

[DallasGuy]

Today we signed DW up for her Medicare Part G supplement. Used AARP United Healthcare. Took 10 minutes and we get a discount for us both being on it.

I have had an AARP United Healthcare supplemental plan for 2 years and like it. It includes a free health club membership which I take advantage of, so that might be worth looking into.

 

[ncbill]

We still have a few years before we have to decide, but right now I'm kind of leaning towards the advantage plans. We've already had Kaiser for the last 35+ years, so we're already familiar with that system. My mom has the PacificSource advantage plan and it works well too with a few additional perks over Kaiser.

Lots to research...

Most Advantage plans (maybe not Kaiser) will rook you on things like physical therapy...e.g. post-surgery they might pay for two PT sessions, not ten.

Sure, you can appeal...but IIRC there's no 3rd party review until it's passed two levels of review internal to the MA plan itself.

The worst possibility, though, is if you develop some uncommon condition that requires $$$ treatment...over on bogleheads a poster needs $100k worth of infusions annually.

MA plans can simply decide that's too expensive & force you onto a cheaper treatment WITHOUT a review by a specialist in the same field.

Sure, you can appeal...see the above.

 

[MissMolly]

Most Advantage plans (maybe not Kaiser) will rook you on things like physical therapy...e.g. post-surgery they might pay for two PT sessions, not ten.

Sure, you can appeal...but IIRC there's no 3rd party review until it's passed two levels of review internal to the MA plan itself.

The worst possibility, though, is if you develop some uncommon condition that requires $$$ treatment...over on bogleheads a poster needs $100k worth of infusions annually.

MA plans can simply decide that's too expensive & force you onto a cheaper treatment WITHOUT a review by a specialist in the same field.

Sure, you can appeal...see the above.

I have had no issues with anything you state on my retiree Advantage plan. I’ve had dozens of PT sessions in a single year. I’m on a medication that costs $14,000/month. Part of the year I pay $55/month and part of the year I pay $110/month. I have never had any problems at all with seeing specialists, getting tests, MRIs, CT scans, surgeries - nothing. Nothing ever had to appealed. Nothing was challenged.

 

[badatmath]

I rarely see it mentioned and I understand brokers do not push it but some say the high deductible G plan is worth signing up for.

 

[jollystomper]

I would advise you to avoid the Advantage plans. It’s not really Medicare. The government pays the insurance company a certain amount each month to care for you. The insurance company manages your care, not your doctors. Denials are common, requiring appeals. More and more hospitals are refusing Advantage plans. You’re restricted by networks, and they change frequently. You are restricted to their prescription plan.

There is a difference between Medicare Advantage plans:
- HMO plans. Yes, very restrictive, agree to avoid, I would not want to be one.
- PPO plans. Flexible, you choose any doctors that accept medicare, want within the network, no pre-approvables for specialists necessary.
- Company sponsored PPO plans. Probably the best, as they are for a limited audience and may have additional benefits for that audience.

These distinctions I never see made in the "evils of Medicare Advantage" videos .

We are fortunate to be on the latter. We have better coverage under this plan than our pre-retiree health insurance, with lower premiums and deductibles.

I understand that most people may not have this option. But if one does, it might be good to look into it. I am glad I researched and compared these types of Medicare Advantage plans, as we would be paying a lot more with Medicare + Supplements.

 

[Dash man]

There is a difference between Medicare Advantage plans:
- HMO plans. Yes, very restrictive, agree to avoid, I would not want to be one.
- PPO plans. Flexible, you choose any doctors that accept medicare, want within the network, no pre-approvables for specialists necessary.
- Company sponsored PPO plans. Probably the best, as they are for a limited audience and may have additional benefits for that audience.

These distinctions I never see made in the "evils of Medicare Advantage" videos .

We are fortunate to be on the latter. We have better coverage under this plan than our pre-retiree health insurance, with lower premiums and deductibles.

I understand that most people may not have this option. But if one does, it might be good to look into it. I am glad I researched and compared these types of Medicare Advantage plans, as we would be paying a lot more with Medicare + Supplements.

My FIL has a union MA plan and never pays a dime. But a couple of years ago we still had a lot of hassles with his insurance company to get approval for tests and procedures when he had urothelial cancer. At 88 years old at the time, if he didn’t have my wife, he would have just given up out of frustration. So he doesn’t pay anything, but the insurance company still can deny or delay tests and procedures.

 

[Midpack]

I assume the OP was talking about his/her cost estimates for one person.

For others like us who paid COBRA and then a private HC policy (UHC) until DW turned 65 - Medicare is a screaming bargain. And we have been very happy with our coverage, we rarely pay anything out of pocket, we've been on Medicare for 4 and 2 years respectively.

We currently pay:

|Me|DW|Tot/Mo Both|Tot/Yr
Medicare Part B|$164.90|$164.90|$329.80|$3957.60
Medigap Plan G|$153.93|$96.72|$250.65|$3007.80
Medicare Part D|$11.10|$4.20|$15.30|$183.60
Tot/Mo Indiv|$329.93|$265.82| $595.75 |
Tot/Yr|$3959.16|$3189.84|| $7149.00

We are actually paying IRMAA penalties over and above for Part B & D above but that's temporary. We also have a dental policy that pays for itself in benefits (I don't understand how that's possible but it is).

 

[Teacher Terry]

My friend paid nothing in premiums for his advantage plan but when he needed surgery 3 years in a row he paid 7k each year which was the maximum out of pocket for his plan.

 

[RetiredHappy]

On the other hand, since I pay full freight for an off exchange individual plan, costing me about $20K a year in premiums, drugs and co-pay, I cannot wait to get old so that I can get on relatively cheapo Medicare + supplement plan.

 

[orchid55]

Yes, Medicare is a screaming bargain for us as well. We were paying full freight for ACA plans. The last year that we were both on ACA was $18,000 in premiums and a $7500 per person deductible. We did not consider it health insurance, but rather bankruptcy insurance.

The other marvelous thing about Medicare with a supplement is the nationwide coverage. In our state all of the ACA policies were narrow network HMOs.

 

[Venturer]

We both have Medicare + supplement + part D it works a lot better for us than what we had during our working year. My biggest thing is I have COPD and have a Treligy inhaler which is very expensive. But for now at least after I spend $650.00 I can send in a form to the company that makes it and they help me out when I send in a prescription to them they then send me a 90 day supply for free the rest of the year. I'll be getting another 90 day supply next month which will last until Jan.2024 at which time I'll have to start over for the new year. With out that I would be paying around $750. per month just for the treligy + what ever other meds cost.

 

[GenXguy]

I assume the OP was talking about his/her cost estimates for one person.

For others like us who paid COBRA and then a private HC policy (UHC) until DW turned 65 - Medicare is a screaming bargain. And we have been very happy with our coverage, we rarely pay anything out of pocket, we've been on Medicare for 4 and 2 years respectively.

It's not as much of a bargain if you haven't worked 40 quarters. And if you have worked less than 30 quarters, Medicare Part A alone is over $500/mo!

Anyway, it all seems ridiculously expensive for me. Seniors have to pay all these premiums and out of pocket while so many under 65 are getting a free ride on the Medicaid expansion.

 

[Rianne]

I was able to go to the Mayo Clinic and see a specialist who verified I was misdiagnosed at our local healthcare conglomerate. The local specialist diagnosed a nasty disease that had me dead, on dialysis, or a kidney transplant within 5 years. I do not have that disease verified by a simple genetics test done at the Mayo Clinic. And I will continue my relationship with Mayo.

Medigap - $164.90 + Part G - $94 + Part D - $8 = $266.90/month.

I would not have been approved to go to the Mayo Clinic if I had Medicare Advantage.
The Mayo Clinic specialist charged a similar office fee as the local Nephrologist. The difference was minimal, not that I paid it but was able to see it on my medical summary.

 

[MissMolly]

I was able to go to the Mayo Clinic and see a specialist who verified I was misdiagnosed at our local healthcare conglomerate. The local specialist diagnosed a nasty disease that had me dead, on dialysis, or a kidney transplant within 5 years. I do not have that disease verified by a simple genetics test done at the Mayo Clinic. And I will continue my relationship with Mayo.

Medigap - $164.90 + Part G - $94 + Part D - $8 = $266.90/month.

I would not have been approved to go to the Mayo Clinic if I had Medicare Advantage.
The Mayo Clinic specialist charged a similar office fee as the local Nephrologist. The difference was minimal, not that I paid it but was able to see it on my medical summary.

It depends what Medicare Advantage plan you have. Mayo Clinic in Rochester accepts both United Heathcare Advantage and Humana Medicare Advantage - the two largest Medicare Advantage programs in the country.

 

[GenXguy]

Medigap - $164.90 + Part G - $94 + Part D - $8 = $266.90/month.

I thought Part G and Medigap were the same thing. You have them listed separately with different prices.

Also, you didn't list your Part B. Or maybe the Medigap was really Part B?