Medicare - No Supplements?

[travelover]

Quote:

Originally Posted by 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).

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]

Quote:

Originally Posted by 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.

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]

Quote:

Originally Posted by aja8888 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]

Quote:

Originally Posted by 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.

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-You...s+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-You...s+for+medicare

[John Galt III]

Quote:

Originally Posted by Telly 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-You...s+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-You...s+for+medicare

I'm starting to think I ought to find an insurance agent who can just tell me what plans are best for me, once I tell him or her my situation. I'll read the books too, but it's really too much and too complicated, to understand and to *remember*, for me. Sigh.... And I'll have to hope I find an agent who really knows the system. Another sigh....

[ivinsfan]

It's worth mentioning again that if you are in the VA system or might qualify for the VA system that many Vets over 65 do not buy supplemental insurance for Medicare.

[Calico]

Quote:

Originally Posted by John Galt III I'm starting to think I ought to find an insurance agent who can just tell me what plans are best for me, once I tell him or her my situation. I'll read the books too, but it's really too much and too complicated, to understand and to *remember*, for me. Sigh.... And I'll have to hope I find an agent who really knows the system. Another sigh....

Every state has a SHIP (state health insurance program). The name may vary a little (my state calls it State Health Insurance Information Program). They provide free assistance and counseling in navigating the maze of information about medicare. They are not insurance agents. If you are eligible for medicare you are eligible for their services.

My employer recently provided an onsite retirement seminar for employees 55+, and the local SHIP group was one of the organizations that participated. Our local library also schedules multiple free SHIP presentations throughout the year.

Here is the link to their national website - it provides links to all the state programs.

SHIP

Good luck! I will be navigating the medicare maze in 3 years, and I plan to contact SHIP at that time.

[Silver]

I have a high deductible plan F for $49 a month. A three day hospitalization last year would have cost me about $7,200 (20% of $36k) but only cost $700. Because I signed up for the Plan F in October, and was hospitalized in November, the deductible amount was pro-rated for the year, and it became quite the bargain. I was very grateful for it.