Is Original Medicare really so awful?

[ivinsfan]

+1

DW and I recently switched our Medigap plans (from an HD Plan F to a Plan N) with a different insurer. We both had to go through underwriting and had to answer a LOT of questions about our medical history. Fortunately we had only minor pre-existing conditions and were approved. I doubt that would have been the case had we been that 80 year old with "expensive health problems".

So for people reading this, if you don't pass underwriting you just continue with the policy that you have in force correct, IOW you need to be currently insured paying your premiums when you are trying to switch supplement plans, no gaps in coverage?

 

[REWahoo]

Correct.

 

[FIRE'd@51]

Don't count on doing this as it isn't the normal course of events.

Sounds like even with her pre-existing conditions, she was still able to "pass" underwriting for a higher premium. That is, her pre-existing conditions were not bad enough to cause an outright rejection, but still prevented her from getting the same base rate as other plan participants.

 

[FIRE'd@51]

you either pass underwriting or you don't, there are no higher rates based on health

This is not true except during your initial open enrollment period when its guaranteed-issue. I inquired about switching from Plan F to Plan G and told the UHC agent about a heart issue I had and was told that, although the issue wouldn't disqualify me from switching, the Plan G premium I would pay would actually be higher than the Plan F premium I was currently paying.

 

[Telly]

Sounds like even with her pre-existing conditions, she was still able to "pass" underwriting for a higher premium. That is, her pre-existing conditions were not bad enough to cause an outright rejection, but still prevented her from getting the same base rate as other plan participants.

Yes, in effect. AARP/UHC has multiple rate structures for the same zipcode range, with different medical conditions when applying.

I saved off info from last year for Plan Effective Dates July 2018 - June 2019... subject to change. I rounded to the nearest dollar for my zipcode for the following PLAN G examples:

"Standard Rates with Enrollment Discount for individuals ages 65-76 whose acceptance is guaranteed or who do not have any of the medical conditions listed on the application"
Age 65 $139, age 66 $146 etc... age 76 $211. Age 77 and up, $217. All these premium figures do not include the inevitable medical cost inflation over the coming years.

Then, germaine to the issue of an 80 year old with problems being allowed in, there is:

"Level 2 Rates for individuals ages 65 and older whose acceptance is not guaranteed and who have one or more of the medical conditions on the application".
Age 65+ is $369.

There are higher rates if the person comes in as a tobacco user, the $369 would be $403.
This is just a quick look at the rates, there are many schedules and requirement conditions.

This was born out last year when I used the CSGActuarial website, there was the lower AARP/UHC rate, and then some really high AARP/UHC rates!

I have heard, maybe it was here @ E-R.org, maybe elsewhere, that AARP/UHC is a bit friendlier on taking on other people who are not guaranteed. But they are no dummies, those folks will have to pay for the increased medical costs they bring along.

 

[ivinsfan]

This is not true except during your initial open enrollment period when its guaranteed-issue. I inquired about switching from Plan F to Plan G and told the UHC agent about a heart issue I had and was told that, although the issue wouldn't disqualify me from switching, the Plan G premium I would pay would actually be higher than the Plan F premium I was currently paying.

Really that's interesting to know ..wow that really confuses things and thank you for correcting my comment. I'm going to delete that since it was in error.

And I want to thank Telly as well for adding more detail. of all the things I've read here about Medicare supplements I did not realize underwriting was not a black and white situation. I thought it was pass or fail...I guess they give C's..instead of underwriting and better term could be underrating.

And I can why the subject isn't discussed more often the increases in rates are pretty substantial and most people would just continue on their current plan.

 

[ShokWaveRider]

To answer the OP's question, No it is not that awful and better than no coverage at all. I personally know 3 seniors that cannot afford a supplement and cannot get a MA plan as they are over 75. They had a plan till they could no longer afford it. $2500 - $3500 a year for a plan is a lot of money for some seniors, especially if they do not own their own homes and rent.

 

[W2R]

This is all so complicated. It's enough to make one's head swim. And understanding ACA is insanely difficult for me too. I am just glad that I don't have to deal with any of it for myself, due to my federal employee/retiree BCBS insurance supplementing Medicare.

I used to worry more about F's insurance situation, but finally accepted that he's a smart guy and will figure out the best way forward. He certainly understands more about this stuff than I ever could. So do all participating in this discussion.

In an ideal world, it would all be simpler. Life would be full of rainbows and ponies with no insurance or taxes to worry about.

 

[ShokWaveRider]

Anything to do with insurance companies is overly complicated by design, so that average folks, let alone old average folks cannot completely understand it. They need to be completely removed from the HealthCare equation in order to simplify it. End of story.

 

[mpeirce]

Anything to do with insurance companies is overly complicated by design, so that average folks, let alone old average folks cannot completely understand it. They need to be completely removed from the HealthCare equation in order to simplify it. End of story.

And the alternative is?

My personal experience with insurance companies has been fine. Certainly there are good one and there are bad ones.

 

[Dtail]

Wow there is a lot of stuff for Medicare.
Well got the ACA stuff pretty much down pat, as have a brother who is my dependent and a non married partner who is already on a MA plan. Lots of conversations about getting the taxes right and managing MAGI for the brother and me.
59 y.o., so tackling SS will be next then unto Medicare. lol

 

[homestead]

I'll post my Medicare Advantage plan. I'ts Regence BC of Oregon.

What is good/bad about this plan?

It does cover preventive dental and vision.

 

[FreeBear]

I dont' get it. I've always considered "traditional medicare" as the gold standard after Megacorp Cadillac plans.

Friends do report good experiences with ACA, but we're stuck with HMO costwise. Even the ACA PPO's in this area are not full network. Not like Megacorp Cadillac, where I could see anyone.

Our friends report excellent results with traditional Medicare; all carry a supplement. Some couples had bills of around half a mil and only had to pay a few thousand out of pocket. Sounds great to me.

I'm frugal, but I don't want to be too cheap on stuff like this. Like my friends, I want to limit total worse case liablity, as long as I can afford the monthlies. Too much worrying is too much like w*rk!

 

[ivinsfan]

I dont' get it. I've always considered "traditional medicare" as the gold standard after Megacorp Cadillac plans.

Friends do report good experiences with ACA, but we're stuck with HMO costwise. Even the ACA PPO's in this area are not full network. Not like Megacorp Cadillac, where I could see anyone.

Our friends report excellent results with traditional Medicare; all carry a supplement. Some couples had bills of around half a mil and only had to pay a few thousand out of pocket. Sounds great to me.

I'm frugal, but I don't want to be too cheap on stuff like this. Like my friends, I want to limit total worse case liablity, as long as I can afford the monthlies. Too much worrying is too much like w*rk!

I agree my DH had a total of probably 300K in rack rate medical issues from a national ranked heart center. total cost after paying premium for supplement ..ZERO….

 

[aja8888]

Our friends report excellent results with traditional Medicare; all carry a supplement. Some couples had bills of around half a mil and only had to pay a few thousand out of pocket. Sounds great to me.

Between my hip replacement, DW's heart valve replacement, her back surgeries for 5 fractured vertebrae, and my recent SVT heart monitoring and ablation, we probably have racked up well over $1 million in medical charges with those procedures alone. OOP costs were $368 (2 years Part G deductible for me, and $0 for DW as she has full Plan F)

Yeah, this (Medicare + Supplement) is the Holy Grail of medical insurance.

 

[ShokWaveRider]

And the alternative is?

The fact that one has to ask, is the problem, Take the blinkers off, look who does it better, covers more people for less cost to subscribers and follow their lead. No need to expand on this, it has been beaten to death many times. The US just puts their blinkers on and continues to ignore the facts, and predictably ONLY points out the shortcomings. The lobbyists make sure of it.

 

[razztazz]

And the alternative is?

My personal experience with insurance companies has been fine. Certainly there are good one and there are bad ones.

I can say the exact same thing. I have had no problems with insurance of any kind let alone medical insurance. However, I have been using government provided medical insurance all these years as a retired military. But that's not the issue. It's not a "your" problem thing. It's a system-wide problem.

Wanna knock communism? Hey, there were some people living quite well in the Soviet Union. That didn't make it good overall. Love that capitalism and "private" industry? Detroit. Child Labor. Company towns. We all know of the long list of market failures and inefficiencies. Should we all go "Commie?" That won't fix it either. To say "I got mine" or "mine works, I don't know what your problem is" misses the larger pernt.

 

[FreeBear]

I agree my DH had a total of probably 300K in rack rate medical issues from a national ranked heart center. total cost after paying premium for supplement ..ZERO….

Between my hip replacement, DW's heart valve replacement, her back surgeries for 5 fractured vertebrae, and my recent SVT heart monitoring and ablation, we probably have racked up well over $1 million in medical charges with those procedures alone. OOP costs were $368 (2 years Part G deductible for me, and $0 for DW as she has full Plan F)

Yeah, this (Medicare + Supplement) is the Holy Grail of medical insurance.

Wow! You guys have been through a lot. Glad Medicare + supplement has w*rk out for you as well as my friends. My friends feel very blessed just to be alive and, better yet, doing well overall. They certainly feel they got their money's worth. It was nice that Medicare pretty much took the money worries away and they could focus on getting healthy, the real challenge.

 

[FIRE'd@51]

I've always considered "traditional medicare" as the gold standard after Megacorp Cadillac plans.

I think it, is since you can go to any doctor or hospital that takes Medicare (no networks or referrals from a PCP are required). You just have to research the plans carefully since they are only guaranteed-issue with no health questions required during your initial open enrollment period (usually when you turn 65) Changing plans later can present problems if you develop pre-existing conditions.

My advice is to remember you are purchasing insurance - not prepaid healthcare. Don't get carried away with the idea that you are healthy now and don't need more comprehensive coverage. As we all know, serious health problems can occur "out of the blue", so it's nice to have the best coverage you can get while it's guaranteed-issue.

 

[RetMD21]

I think MA plans are fine for most but I will be looking for a supplement for regular medicare when the time comes. Travel and the small possibility of developing an unusual condition that would justify some sort of specialized treatment.

 

[trumpeting_angel]

There are decent insurance companies, not-so-decent ones, and nightmarish ones. There are ones that are great until you cost them some real money, then they become not so great, or nightmarish.

I’m cynical from working in healthcare for decades. Congress passed a parity bill mandating that mental health be reimbursed the same way as physical health, in 2008 IIRC. Now Congress is working on a bill to enforce the parity bill. A major insurer was just successfully sued for not doing so. Since 2008. All kinds of tricks to avoid paying for necessary treatment.

Sorry. I don’t trust them. And I have tradition Medicare and a Part G supplemental plan. And Part D. I’m not entrusting my choices to a MA plan.

 

[John Galt III]

To answer the OP's question, No it is not that awful and better than no coverage at all. I personally know 3 seniors that cannot afford a supplement and cannot get a MA plan as they are over 75. They had a plan till they could no longer afford it. $2500 - $3500 a year for a plan is a lot of money for some seniors, especially if they do not own their own homes and rent.

So the folks got their supplement premium raised year after year, probably even if they were loyal premium payers. And then no MA plan would take them? This is news to me. I thought anyone could get into a MA plan at any age, with no underwriting. I've been assuming I could switch around from MA company to MA company every year and still find a zero premium plan. Wrong? I've been immersing myself in this boring stuff for months and I still don't know this? Are premiums for MA plans age rated?

 

[RetMD21]

I thought that MA eligibility was non-restritive from Boomer Benefits:

Medicare Part C Eligibility
Who is eligible for Medicare Part C? Any Medicare beneficiary, regardless of age, can purchase a plan if they meet these criteria:

You must be enrolled in both Medicare Part A and B.Many people mistakenly think they can drop Part B if they enroll in a Medicare Part C plan. This is NOT the case. If you drop Part B, you will immediately be kicked out of your Part C plan.
You need to live in the plan’s service area. This Medicare Part C eligibility will be based on the address that you have on file with Social Security. You must choose a plan that operates in that same county. Some plans will be specific to only one or two counties, while others might span the whole state.
Finally, you must not have End-Stage Renal Disease. This is only medical questions on a Part C application.

https://boomerbenefits.com/new-to-medicare/parts-of-medicare/medicare-part-c/

 

[John Galt III]

I thought that MA eligibility was non-restritive from Boomer Benefits:

Medicare Part C Eligibility
Who is eligible for Medicare Part C? Any Medicare beneficiary, regardless of age, can purchase a plan if they meet these criteria:

You must be enrolled in both Medicare Part A and B.Many people mistakenly think they can drop Part B if they enroll in a Medicare Part C plan. This is NOT the case. If you drop Part B, you will immediately be kicked out of your Part C plan.
You need to live in the plan’s service area. This Medicare Part C eligibility will be based on the address that you have on file with Social Security. You must choose a plan that operates in that same county. Some plans will be specific to only one or two counties, while others might span the whole state.
Finally, you must not have End-Stage Renal Disease. This is only medical questions on a Part C application.

https://boomerbenefits.com/new-to-medicare/parts-of-medicare/medicare-part-c/

Thanks! And from what I've seen, the MA plans don't charge you a higher premium even if you are getting up in years. This is an overlooked advantage of MA plans, IMO: the premiums don't go up every year like Med Supplement plans do. At least the zero-premium plans premiums don't go up. Yes, of course the benefits could become less generous.

 

[Katsmeow]

The good news is it's 20% of the allowed amount, which is almost always less than half of the billed amount. And sometimes only 10 % to 25% of the billed amount. And I noticed that even if you have an MA plan to cover the 20%, the MA plans do NOT cover the 20% for chemo drugs, even if the MA plan has drug coverage.

It is true that often the amount is discounted. However, I remember when my mom was in rehab during his final months. Those amounts added up fast. There was the facility charge, there was a doctor charge (every day), their was physical therapy, there was even a psychologist who stopped by a couple of times (that was quite expensive for what was a 10 minute visit). It didn't matter really because she had a supplement. That would have been a huge bill for 20% of it had she not had a supplement.

Thank you. Your mom was paying $135 per mo for Plan B, plus the $391 per mo for the supplement, total $526 per mo? I assume your mom was in an age-driven premium scheme. AARP United Health Care supplement is community-based premium pricing, I believe, yes? That's where I got the 3% increase per year number, that I mentioned earlier. Community-based premium increases for a good supplement plan. Is it too good to be true? only 3% annual increase for a supplement, even into your 90's? That would be something to consider paying $114 per month for ( a Plan N AARP UHC supplement for me would be $97 and then $17 for a Part D plan, plus $135 Part B.)

What MBSC said on how the AARP UHC works. But, personally, when I turned 65 this year I got the AARP UHC supplement which I think works out better for most in the long term. But, as MBSC says you don't quite have it right on how the premium increases work.