Is Original Medicare really so awful?

[CRLLS]

I wish that AARP UHC had a Plan F-HD in my area. I would have gone with them. I like the Community rating for the later years. Alas, They didn't offer F-HD. I chose my plan based on coverage first, then the Company based on other criteria, of which current price was only 1 factor.

 

[ivinsfan]

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.



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.

Kats agree with your comment, my DH's surgery went wrong resulted in a longer stay then usual for his procedure. Probably around 3 days longer, so on about the average discharge day, day 6, a parade of people started coming into his room. 3 yes 3 different physical therapists, cardiac, occupational and plain physical paraded through daily . Diet, counseling, hospitalists, it was like a revolving door. I realized A ,,they were laying a paper trail to justify his longer hospital stay and B. they were trying to increase the money they could collect from Medicare. Never bothered talking to anyone about it, because I'm sure it was SOP and to be frank that hospital saved his life and I didn't care about that aspect of it.

 

[John Galt III]

I'm still not clear one why some folks end up with $400 a month premiums for medicare supplements and some don't. My Apprise medicare counselor (volunteer) told me she knows some folks on med supps who are paying $400 a month for a med suppl even though they signed up at 65, and never changed their ins co. The premium started around $150 a month and just kept going up every year. The Apprise counselor said different ins companies have huge differences in premium prices and subsequent price increases. Even though the benefits are supposedly identical. Well, at least they're getting a wide range of doctors to use, and no copays or coinsurance, for that $400 per mo.

 

[OldConch]

+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".

Hi Wahoo. Applied/approved for medicare this week and need to choose a medigap plan. In our area the difference between HD F and N is $77/month. Mind if I ask why you switched.

 

[REWahoo]

Hi Wahoo. Applied/approved for medicare this week and need to choose a medigap plan. In our area the difference between HD F and N is $77/month. Mind if I ask why you switched.

The difference in monthly premium costs were much smaller for us and that's why we changed to Plan N. Compared to our HD-F plans, DW is paying $13/mo more and I'm paying and additional $24/mo, which I saw as relative bargains.

Our HD-F plans were with BC/BS and after seven years and what I thought were higher than the norm rate increases, I started doing some comparisons. Boomer Benefits suggested I look at United World (Mutual of Omaha) Plan N due to both their current premium rates, the 12% rate discount they offered to couples, and their favorable history of moderate rate increases.

 

[Gotadimple]

I'm still not clear one why some folks end up with $400 a month premiums for medicare supplements and some don't.

Simply put, because they don't check rates or know they have conditions stops them from being accepted by other insurers. In addition as the experience in the plan changes over time a carrier is allowed to change rates to reflect increased medical costs.

My Apprise medicare counselor (volunteer) told me she knows some ... who are paying $400 a month for a med suppl even though they signed up at 65, and never changed their ins co.

The assumption here is that you sign up early your rate will stay the same. That's never true for anything. People are conditioned to sign up for Part B on time to avoid a higher premium, same for Part D. That doesn't apply to private insurance. Again,the amount of medical claims plays a big part in the cost of supplemental insurance.

Apprise counselor said different ins companies have huge differences in premium prices and subsequent price increases.

Insurance carriers are allowed some freedom in setting premiums based on their claims experience, but, they are REQUIRED by the federal government to offer the same set of plans - that language is set. The cost of a procedure in one state will be/can be substantially different in another state (or county).

 

[CRLLS]

I'm still not clear one why some folks end up with $400 a month premiums for medicare supplements and some don't. My Apprise medicare counselor (volunteer) told me she knows some folks on med supps who are paying $400 a month for a med suppl even though they signed up at 65, and never changed their ins co. The premium started around $150 a month and just kept going up every year. The Apprise counselor said different ins companies have huge differences in premium prices and subsequent price increases. Even though the benefits are supposedly identical. Well, at least they're getting a wide range of doctors to use, and no copays or coinsurance, for that $400 per mo.

Without a "community rated" plan, not only do prices increase year on year with the rate of inflation for medical services, they also increase based on attained age. Here is one example from Illinois' website comparing available plans and prices.

https://www2.illinois.gov/aging/ship/Pages/default.aspx

It is not uncommon for a person at age 85 to be paying 1-1/2 to 2x the rate that a 65 year old pays with the same company in the same year. In this case 2019. It shows a person could be paying ~400 per month at age 75 for Plan F. It is an outlier, for sure. But it is not uncommon. Then add any late signup fees on top of that if a person doesn't sign up at age 65.

For comparison, I have added AARP UHC. AARP UHC is the only "community rated" provider in my area. you can see the discounts and a constant premium after age 75.

 

[OldConch]

The difference in monthly premium costs were much smaller for us and that's why we changed to Plan N. Compared to our HD-F plans, DW is paying $13/mo more and I'm paying and additional $24/mo, which I saw as relative bargains.

Our HD-F plans were with BC/BS and after seven years and what I thought were higher than the norm rate increases, I started doing some comparisons. Boomer Benefits suggested I look at United World (Mutual of Omaha) Plan N due to both their current premium rates, the 12% rate discount they offered to couples, and their favorable history of moderate rate increases.

Thanks for the real-world example. Leaning toward HD F for $44/month. It's my understanding that in Washington we can switch medigap plans at any time without underwriting and plans are community rated.

 

[haha]

I have original and a supplement, and I like it quite a bit. My GF has Kaiser. I tried to explain the advantages of original+supplement but she was accustomed to Kaiser from her work and elected to stay with it. But overall I would say that there are advantages and disadvantages to each approach.

Kaiser will hound you to get tests like stool occult blood on a schedule. Also, it is clear what to do when anything pops up. Yesterday GF in her car got rear-ended when stopped at a traffic light. Kaiser has good emergency services locally, so it took a while but she got helped at the organization that has all her records, and they are computerized and always available to the Docs. Also, she has had several surgeries over the years, both when covered by Kaiser at her job, and more recently by Kaiser Medicare.

What I hate is that at least in our state a surgery center does not have to publish how many of a certain procedure they perform, and for what period this figure pertains. The best indicator of a good surgical outcome is how many does a program do. More practice makes if not quite perfect, at least a lot closer to perfect than less practice.

My only surgery has been a hip replacement, due to arthritis from a crash many, many years ago. When I knew that I would be needing a joint replacement, I started attending presentations at the larger surgery centers in my city. I finally got on a waiting list of what looked best to me. The surgeon did hips all day one day a week and knees another day. Very wisely, this is all he did and does, and as might be expected, he does them well. My hip job is only a little over 5 years old, and very good so far. It's an anterior approach, and the scar is almost invisible at this point. I was walking on crutches the next day, and a cane a couple of days later.

This Doc does publish his operative totals on these procedures, so if you can wait in the queue, you are very likely to get good work. I had to wait from August until the following March.

Ha

 

[Independent]

Most people I know are on original aka traditional Medicare plus Supplement and are very happy with it.

We plan to go that route ourselves. Mainly due to largest nationwide network and portability. I don’t want to be stuck in some restricted local network when battling a major disease.

No way would I go without the Medicare supplement. Medicare has no max OOP, and 20% of expensive cancer drugs can run to 10s of thousands a year. Traditional Medicare reported spending $300K to treat a relative’s late stage cancer over 2 years. Would you want to be personally responsible for the remaining $75K?

^ This.

 

[Katsmeow]

I'm still not clear one why some folks end up with $400 a month premiums for medicare supplements and some don't. My Apprise medicare counselor (volunteer) told me she knows some folks on med supps who are paying $400 a month for a med suppl even though they signed up at 65, and never changed their ins co. The premium started around $150 a month and just kept going up every year. The Apprise counselor said different ins companies have huge differences in premium prices and subsequent price increases. Even though the benefits are supposedly identical. Well, at least they're getting a wide range of doctors to use, and no copays or coinsurance, for that $400 per mo.

There are a lot of reasons:

1. In general, any supplement plans can increase premiums due to to their costs going up. No one is paying the same thing at age 90 as they were paying at 65. Premiums inflate.

2. Most supplements are attained age policies. The premium goes up each year based upon age. This is in addition to the normal increase in premiums due to increased costs/inflation. My mother was paying $391 a month for Plan G because she was 94! She would have paid much less if she was 65.

3. Some policies are community rated. The most well known is AARP UHC. It does not increase with age. However, for the first 12 years or so you get a discount on the premium cost that decreases by 3% each year. But once the discount is used up, the premium doesn't increase with age any more. It will increase due to increased cost/inflation.

4. Also - bear in mind - that supplement plans do vary. You have compare premiums for the same plan not other plans.

5. It is hard to switch supplements since you have to have medical underwriting in most states after the initial enrollment period. One reason to carefully choose your insurer. But, a "good" company for premium history when you sign up at age 65 may be a "bad" company on premium history 20 years later.

 

[John Galt III]

There are a lot of reasons:

1. In general, any supplement plans can increase premiums due to to their costs going up. No one is paying the same thing at age 90 as they were paying at 65. Premiums inflate.

2. Most supplements are attained age policies. The premium goes up each year based upon age. This is in addition to the normal increase in premiums due to increased costs/inflation. My mother was paying $391 a month for Plan G because she was 94! She would have paid much less if she was 65.

3. Some policies are community rated. The most well known is AARP UHC. It does not increase with age. However, for the first 12 years or so you get a discount on the premium cost that decreases by 3% each year. But once the discount is used up, the premium doesn't increase with age any more. It will increase due to increased cost/inflation.

4. Also - bear in mind - that supplement plans do vary. You have compare premiums for the same plan not other plans.

5. It is hard to switch supplements since you have to have medical underwriting in most states after the initial enrollment period. One reason to carefully choose your insurer. But, a "good" company for premium history when you sign up at age 65 may be a "bad" company on premium history 20 years later.

KM, Is it not true that a 90 year old can enroll in a Medicare Advantage zero premium policy? Not a trick question. Just asking. I think they can, and do. But I could be wrong.

 

[Katsmeow]

KM, Is it not true that a 90 year old can enroll in a Medicare Advantage zero premium policy? Not a trick question. Just asking. I think they can, and do. But I could be wrong.

You can switch to Medicare Advantage during the yearly open enrollment. You just aren't guaranteed to be able to get a supplement if you switch back to original Medicare (there are some exceptions where you can, but you can't if you are just choosing to switch back).

All I can say is that it was far, far, far easier for my mom during her last few years of life (especially the last year) that she had original medicare and a supplement than if she had Medicare Advantage (whether zero premium or not). But, if she had been really tight on money she could have switch to any Medicare Advantage plan.

Just to give a comparision:

I have two mothers -- an adoptive mom and a birthmother. In early 2018 that were both gravely ill. My birthmom broke her hip and then went into a downward spiral.

After her hip surgery she went to a series of rehab facilities where she declined steadily. Ultimately she went home with home care and was in hospice and then a nursing home. The good news was that she rebounded and is fine now.

My adoptive mom had many chronic illnesses that suddenly worsened in early 2018. She spent 2 1/2 months either in the hospital or rehab before dying.

My birth mom has a Medicare Advantage plan (I don't know if it was zero premium or not). My sister mostly helped with getting her medical care. She spent endless hours on the phone trying to find the right help. A huge issue was that she a list of in network rehab facilities and couldn't do out of the network. And, she had to get approval for everything such as moving her from a facility they were unhappy with.

For my adoptive mom, she could go to any place that took Medicare. We had a huge choice of facilities. In fact, my sister told me that she had wanted to send my birthmom to the same rehab my adoptive mom was in. But, she couldn't. It was out of network for the Medicare Advantage plan.

Oh, the EOBs for my mom's last few months (2 1/2 months) showed the supplement company paid about $9700. Of course, you might say well she didn't spend that every year. And, it is true she wasn't hospitalized every year. But, she had chronic illnesses - heart failure, Type II diabetes and kidney failure - so she saw physicians quite regularly and had lots of tests, etc. She had huge prescription costs which were helped with her Part D plan.

Oh - I don't think she had been diagnosed with any of those illnesses when she turned 65. All of that basically came later.

 

[John Galt III]

Katsmeow, thanks for the reply. My parents have both had a MA plan ever since they went on Medicare. The reason is that it costs less than a supplement. They are both financially savvy (or were). They could afford the supplement but chose not to get it. They did have some years where they met the $6,700 deductible, probably. I think they just didn't want to think about it. They just paid whatever they had to pay, in copays, etc. The hospital they were using had everything in network, luckily. I think there is some policy in effect prohibiting out-of-network charges for any customer whose insurance has the hospital listed as in network. I'm possibly overthinking the whole thing, but I have the hope that I can understand it all if I just keep trying. lol. I'm leaning towards getting a Blue Cross HMO MA plan since the coverage looks 'good', and it is zero premium. One of the Apprise medicare counselors I talked to said he has the same HMO and likes it. The other counselor refused to tell me what she had, and refused to recommend any (against the Apprise policy to recommend). This HMO I'm looking at has both the big hospitals in my town in network, and my doctors also.

 

[FIRE'd@51]

They did have some years where they met the $6,700 deductible, probably.

Do you really mean deductible or did you mean OPM?

 

[ShokWaveRider]

I guess it depends on plans, MA vs MG Supplements. I have read this morning of many horror stories and some good supporting ones. I am reading it highly depends on your location and access to medics. PPO is definitely preferred over HMO. I opted for MG as it does recommend that first, then if you do not like it you can switch. Visa versa is not so easy. Although AARP says you can switch between MG plans. Not sure I believe them and one never knows till one tries.

 

[W2R]

I opted for MG as it does recommend that first, then if you do not like it you can switch. Vida versa is not so easy. Although AARP says you can switch between MG plans. Not sure I believe them and one never knows till one tries.

I will never switch. I have federal employee/retiree BCBS, which converted to a Medicare supplement when I turned 65 (but the monthly premium remains the same). So far, between Medicare and my federal BCBS I have spent $0.00 on medical costs in the past ten years of retirement (other than part of prescription drug costs and all of dental costs). So this is why I will never switch. No deductible or co-pay any more.

Between Medicare, Part B, and BCBS, I pay $378.67/month but that amount is not a hardship for me to pay.

 

[ivinsfan]

I will never switch. I have federal employee/retiree BCBS, which converted to a Medicare supplement when I turned 65 (but the monthly premium remains the same). So far, between Medicare and my federal BCBS I have spent $0.00 on medical costs in the past ten years of retirement (other than part of prescription drug costs and all of dental costs). So this is why I will never switch. No deductible or co-pay any more.

Between Medicare, Part B, and BCBS, I pay $378.67/month but that amount is not a hardship for me to pay.

This is about what I pay right now right for that kind of coverage.

 

[John Galt III]

Do you really mean deductible or did you mean OPM?

Oops! I meant OPM.

 

[H2ODude]

Been following this thread. All it has done is re-affirmed my commitment to the traditional with a supplement. Katsmeow's experience sort of captures what my impression of the choice is: very similar to HMO vs. traditional healthcare of the past. I don't even know if HMO's are still a thing, but my recollection of our experience with one in the 80's was not good. The whole idea of networks and referrals turns me off. Admittedly, saving $300 or something a month on healthcare is not a big deal for us so I'm willing to pay to avoid such restrictions. We've been blessed that the primary experience with healthcare has been paying premiums and copays. Well, when MIL lived with us we watched her gobble up a ton of expense on MC and supplement; the healthcare industry seemed to love providing her service. So, we'd prefer to have that available if necessary even if there's a price.

This is sort of tangential to the discussion, but is my one recollection of the HMO comparison. When DS was a preteen or so, knocked his head pretty good, traditional approach was I believe an X-ray and referral to ER. Then, when we switched to HMO almost identical injury resulted in primary doc saying, wake him up in middle of the night and if he's coherent he'll be fine! I have no idea what the best approach is, clearly the latter is cheaper!

 

[REWahoo]

Been following this thread. All it has done is re-affirmed my commitment to the traditional with a supplement.

Yep.

DW and I have been on Medicare for seven years and are each paying less than $100/mo for our Part D and medigap (N) plans. Barring a major financial disaster I see no way we would ever choose to go the MA route.

 

[John Galt III]

This is about what I pay right now right for that kind of coverage.

You guys! Paying almost $400 a month for Medicare (which I had looked forward to as being free, then had the reality check of the $135 per month premium) is mindblowing for me. I've been conditioned to paying my enormous property taxes each year without flinching, but I can't bring myself to fork out $400 a month, even for stress-free cadillac insurance. W2R, may I ask you to divulge the name of the MA insurance company in La that is so popular? Here in Pa I'm looking at Humana, United Health Care, and CapBlue Cross HMO's. The HMO vs PPO thing does not seem to be a big deal. I still have my doctors in the network, and I do not think I need referrals.

 

[John Galt III]

Yep.

DW and I have been on Medicare for seven years and are each paying less than $100/mo for our Part D and medigap (N) plans. Barring a major financial disaster I see no way we would ever choose to go the MA route.

Well, that is encouraging, REWahoo. I believe you went with AARP UHC?

 

[REWahoo]

JGIII, costs vary considerably based on location and what medigap plan you choose. DW and I are each paying less than $250/mo for our Medicare/medigap/drug coverage.

 

[REWahoo]

I believe you went with AARP UHC?

No, United World (Mutual of Omaha).