Is Original Medicare really so awful?

[aja8888]

This isn't always true, it's vary wildly be area. Someone area might have great coverage, what is true is you will have limited choices and might not be comfortable traveling outside of your area.

How true, but you don't know what's in store for you until after you sign on. Why gamble with unknown consequences (unless of course, you like to gamble). Switching out of a MA plan to Medicare/Supp can be difficult after the fact.

 

[John Galt III]

JG, can you afford the monthly premiums no one actually wants to pay them but in this case it would be 115 a month well spend IMO...I'd go with the plan N.

I think you've hit on something here, ivinsfan. I can afford it, but don't want to pay it. I'm going from being spoiled on the ACA, getting great insurance for free.

I'm in denial that the good old days are gone forever.....

 

[trumpeting_angel]

Medicare has more possible penalties and issues then you want to think about. But be sure and do some research before you hit 65. And disclaimer I am not a professional so Google what I say before you take it to the bank....

For sure, sign up for Part A when you turn 65, and don’t let employer-sponsored insurance lapse without signing up for Part B. COBRA doesn’t count. The penalties are severe, and for life.

I’ve been on HMO and cheaper PPO health plans when I was younger. I tend to need more health care now and I certainly want to choose my own doctor and hospital. I’ve worked in healthcare too long to leave that choice to a MA plan if I get sick with something serious. They might have the right doc for the job, or a hospital with low infection rates, but you can’t count on it.

I live in Vermont but the nearest specialty center is Dartmouth Hitchcock, which is in New Hampshire. I paid a few extra dollars for out of state coverage. Our local hospital is going into Chapter 11, closed their childbirth center, and laid off a lot of people. You bet I’ll go to DHMC if I need a specialist, not locally.

I plan to be healthy, too. I plan not to start any new, expensive meds. I eat right, raise organic vegetables, exercise, etc. But we ain’t always that lucky!

 

[H2ODude]

If you take a Medicare Advantage doesn't that subject you to the "network" trap? As in even if you don't travel and you have some emergency acute need (hospitalization) in your hometown hospital roaming physicians can look in on you and bill for whatever they want and if not in your proper network the bill is on you?

 

[audreyh1]

If you take a Medicare Advantage doesn't that subject you to the "network" trap? As in even if you don't travel and you have some emergency acute need (hospitalization) in your hometown hospital roaming physicians can look in on you and bill for whatever they want and if not in your proper network the bill is on you?

Yes, exactly, even local network is the problem with MA. Usually quite limited.

Some plans have a lot of choice, but that seems to be the exception.

 

[CardsFan]

I think you've hit on something here, ivinsfan. I can afford it, but don't want to pay it. I'm going from being spoiled on the ACA, getting great insurance for free.

I'm in denial that the good old days are gone forever.....

Well, buck up buttercup. Insurance is not FREE. Some one is paying, and that would be the rest of us.

I'm glad you got a good deal with ACA, and if you want to take the risks, have at it. But from here on forward you will be expected to pay your share, with or without insurance.

Do you feel lucky? well do you?

 

[John Galt III]

Well, buck up buttercup. Insurance is not FREE. Some one is paying, and that would be the rest of us.

I'm glad you got a good deal with ACA, and if you want to take the risks, have at it. But from here on forward you will be expected to pay your share, with or without insurance.

Do you feel lucky? well do you?

lol.....

 

[ohsusana]

I've been on Medicare with an Advantage plan since February. Drug plans is included. After paying $699 per year for $7900 deductible for YEARS, this has been wonderful!
The plan I'm on has a "passport" program that one can use for travel within the USA (say, for snow-birds). And ER care through-out the USA is always covered for all plans.
I'd suggest to anyone nearing Medicare age to contact their state insurance agency (In Ohio it is called OSSHIP). They have a program every month to inform people of their choices. I thought long and hard before I made my choice.

 

[Jerry1]

My initial plan is to go with original Medicare and a supplemental plan. Personally, I think the risk of a major unplanned event is more scary than a known, large, monthly payment. Plus, as others have said, I’m not excited about a limited network. I’ve never been in one and I hope I don’t ever end up in one.

 

[trumpeting_angel]

I’ve been in limited networks and had good luck. But I was younger and healthy. I’m retiring from working in a hospital, and have worked in other healthcare settings, and I don’t want to be at the mercy of the choices of my insurance company. There are great physicians and mediocre physicians, and if something goes very badly I want a great one.

 

[Telly]

.........If you don't want to read all the examples below, my main question is whether it really is better to have a Medicare Advantage plan than plain Medicare and why. I understand there is no cap on the Plan B 20% . Maybe that's the whole thing right there. lol.

I've been looking at the copays and coinsurances for Medicare Advantage plans, and realized they are about the same as original medicare would be.
I am not considering Medicare Supplements now since they have monthly premiums I want to avoid. I was hooked on plan N for a while which would be $97 per month plus $17 for Plan D, which is pretty cheap, but still........

Since you don't want monthly premiums (other than the Part B premium that you must pay, no matter what, if you want Medicare anything), that leaves you with a zero-premium MA plan as the only choice.

I suggest you use the Medicare.gov tool to look at MA plans available at your zipcode, filtering for Zero-Premium. Last year, I looked just to see. I live in an area with many hospital choices. The zero plan listed ONE hospital in my county in their plan... a hospital I never heard of. It may be an old RV parked behind a building. I think an HMO would be even drearier if your mandated PCP is a Gris-gris man. It was abysmal.

When people talk about having a "MA Plan", I really don't think they mean a "Zero-Premium MA Plan", at least not around here.

As to your question "is Original Medicare that bad?" (meaning having Medicare Part A & B, but no Medigap Plan, and no Part D)... well, it's better than what elderly people had before 1965, which was, nothing. Something was a lot lot better than nothing, but having to cover the 20% with the sky's the limit did start to perturb some, as did drug costs that skyrocketed over the years. The optional coverage enhancements have to cost somebody something.

 

[Katsmeow]

I would never have original Medicare without a supplement (and at least a cheap prescription drug plan) for that matter. I would never risk having to pay 20% unlimited. Some health problems are really, really expensive even at Medicare reimbursement rates.

If I had a choice of Medicare with no supplement or a zero premium Medicare Advantage plan I would take the zero premium Medicare Advantage plan. And, I don't like Medicare Advantage plans at all! I especially wouldn't want a zero premium Medicare Advantage plans. Those tend to be the less desirable plans. The better plans still have a premium.

But I would pick Medicare + supplement. I want to be able to choose my physician and hospital.

Oh - as for cost of supplement. When my mom died at the age of 94 with Plan G, her monthly premium was $391. It gets higher -- a lot higher -- with older age. This is one reason DH and I chose to go with AARP United Healthcare supplement.

 

[John Galt III]

Since you don't want monthly premiums (other than the Part B premium that you must pay, no matter what, if you want Medicare anything), that leaves you with a zero-premium MA plan as the only choice.

I suggest you use the Medicare.gov tool to look at MA plans available at your zipcode, filtering for Zero-Premium. Last year, I looked just to see. I live in an area with many hospital choices. The zero plan listed ONE hospital in my county in their plan... a hospital I never heard of. It may be an old RV parked behind a building. I think an HMO would be even drearier if your mandated PCP is a Gris-gris man. It was abysmal.

When people talk about having a "MA Plan", I really don't think they mean a "Zero-Premium MA Plan", at least not around here.

As to your question "is Original Medicare that bad?" (meaning having Medicare Part A & B, but no Medigap Plan, and no Part D)... well, it's better than what elderly people had before 1965, which was, nothing. Something was a lot lot better than nothing, but having to cover the 20% with the sky's the limit did start to perturb some, as did drug costs that skyrocketed over the years. The optional coverage enhancements have to cost somebody something.

Was the 20% rule there from the very beginning? 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.

 

[Dtail]

DGF has the MA plan with no premiums, although typical 20-30 co pay with extensive doctor choices in our area. So far so good.

 

[mpeirce]

MA plans sure get beat up around here. DW has an Anthem PPO based MA plan here in Ohio and is very happy with it. It's very similar to the Anthem PPO that she had before (and I'm still on). Similar coverage and the same network. We chose the anthem PPO when we moved here because it's a solid plan that works for us.

 

[John Galt III]

I would never have original Medicare without a supplement (and at least a cheap prescription drug plan) for that matter. I would never risk having to pay 20% unlimited. Some health problems are really, really expensive even at Medicare reimbursement rates.

If I had a choice of Medicare with no supplement or a zero premium Medicare Advantage plan I would take the zero premium Medicare Advantage plan. And, I don't like Medicare Advantage plans at all! I especially wouldn't want a zero premium Medicare Advantage plans. Those tend to be the less desirable plans. The better plans still have a premium.

But I would pick Medicare + supplement. I want to be able to choose my physician and hospital.

Oh - as for cost of supplement. When my mom died at the age of 94 with Plan G, her monthly premium was $391. It gets higher -- a lot higher -- with older age. This is one reason DH and I chose to go with AARP United Healthcare 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.)

 

[REWahoo]

MA plans sure get beat up around here.

There is a reason for that. Good MA plans seem to be the exception rather than the rule, plus choosing to go the MA route is something you may not be able to easily change.

Let the beatings continue.

 

[ivinsfan]

There is a reason for that. Good MA plans seem to be the exception rather than the rule, plus choosing to go the MA route is something you may not be able to easily change.

Let the beatings continue.

Agree and you can start with a good MA and the insurance company can change things about your coverage. Not the case with standard Medicare supplements. Now you might live in area with lots of MA plans and competition with good prices and coverage. I'm not in MA but I THINK it's pretty easy to switch in and out of MA plans.

 

[MBSC]

Getting back to orig medicare 20% thing:

For example, inpatient hospital stay is $300 per day for the first 5 days in many MA plans. In orig medicare it is whatever the medicare allowed amount is (my guess is $250 per day?) up to cap of $1,364 for the first 60 days. Looks cheaper with orig medicare. Actually, I think there is no 20% here since it is Part A.

Lab services: 20% $5 to $30 for MA plans.

The inpatient stay will consist of two components. The facility fees (room and board) will be billed to Part A and subject to the $1364 Part A benefit period dedectible. The professional charges related to the inpatient stay (surgeon, anesthesiologist, radiologist, etc.) are billed to Part B subject to the 20% coinsurance.

Services paid from the diagnostic Lab Fee Schedule are exempt from the Part B deductible and 20% coinsurance.

Diagnostic laboratory tests

Your costs in Original Medicare

You usually pay nothing for Medicare-covered clinical diagnostic laboratory tests.

Source: https://www.medicare.gov/coverage/diagnostic-laboratory-tests

If you take a Medicare Advantage doesn't that subject you to the "network" trap? As in even if you don't travel and you have some emergency acute need (hospitalization) in your hometown hospital roaming physicians can look in on you and bill for whatever they want and if not in your proper network the bill is on you?

These are known as "surprise medical bills" and are not permitted in the Medicare Advantage world. If the hospital is in-network, the MA enrollee is only responsible for the plan's hospital copay.

Medicare Managed Care Manual
Chapter 4 - Benefits and Beneficiary Protections
Section 110.1.3 – Services for Which MA Plans Must Pay Non-contracted
Providers and Suppliers

When an enrollee visits an in-network provider, even though that in-network provider may work with an out of network provider, the enrollee is only responsible for in-network cost-sharing.

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?

In most states, UHC/AARP reduces the community-rated premium by 36% for 65 year olds. The reduction decreases by 3% per year for 12 years until they start paying the community-rated premium at age 77. This is to compete with attained-age plans which have lower premiums in the early years. This results in the 3% increase you are referring to. There is a separate annual premium adjustment for changes in medical costs. At age 77, the 3% annual increases stop but the annual inflation changes continue.

 

[ivinsfan]

Nice post MBCS in this state MN they were ordered by the government to stop selling a plan that was kind of a hybrid MA plan except for if you were traveling away from home and needed HC you could go anywhere that accepted Medicare and you would be billed only the Medicare approved rates and make you co pay on that amount. Tremendously popular in a snow bird state.

Several hundred thousand were on it when it cancelled at the end of 2018.

 

[FIRE'd@51]

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?

Just to clarify. The 3% per year is just for the first 10 years and only applies to the discount. To be competitive with non-community rated plans, AARP discounts their base rate by 30% the first year. That discount goes away over 10 years at a rate of 3% per year (so the second year the discount is 27%, third year 24%, etc. of the then base rate). When you reach 75, the discount is 0% and you pay the same base rate as all plan participants for the rest of your life. But that base rate can still increase with healthcare inflation and likely will be more than 3% per year.

IOW, if the base rate were to remain constant (0% healthcare inflation), your premium would increase 3% per year until you reach 75 then flatten off at the constant base rate. In actuality, in the first 10 years the premium will increase by 3% plus the increase in base rate.

 

[steelyman]

There is a reason for that. Good MA plans seem to be the exception rather than the rule, plus choosing to go the MA route is something you may not be able to easily change.



Let the beatings continue.

This is what I’ve been thinking about. I’m still a few years away from Medicare eligibility and am covered by retiree group insurance administered by Aetna. It’s a nationwide PPO and so far, so good but I expect to incur above average expenses upcoming so that will show how it really is.

Once Medicare kicks in, the benefit moves to an Advantage plan, also group (currently UHC) that includes part D. Also nationwide PPO.

But the big “but” is restrictions on switching from the MA plan to supplement/Medigap once the initial enrollment period passes.

So it’s wait and see how/if things change and keep learning from these posts.

 

[John Galt III]

Some anecdotal info. A nice 80 year old woman I know used to have an MA plan at age 65, but later developed expensive health problems, and switched to (even with pre-existing conditions, obviously) a supplement plan (AARP UHC, I think). She says she pays 'a lot' per month for it, but she doesn't remember the amount. She is happy with the supplement plan, since it covers everything with no hassles, she says.

 

[ivinsfan]

Some anecdotal info. A nice 80 year old woman I know used to have an MA plan at age 65, but later developed expensive health problems, and switched to (even with pre-existing conditions, obviously) a supplement plan (AARP UHC, I think). She says she pays 'a lot' per month for it, but she doesn't remember the amount. She is happy with the supplement plan, since it covers everything with no hassles, she says.

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

 

[REWahoo]

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

+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".