Am I missing something about Medicare costs?

[LARS]

In the process of signing up DW for Medicare.

And we've decided to go with Plan G and separate Drug Coverage.

Costs in our state for Part B plus Medigap Plan G and Drug Coverage come to approximately $360 per month (including the $183 one time deductible).

With G, after deductible, there are no additional out of pocket expenses.

So the only unknown for future additional health expenses (apart from premium increases) is basically Drug Expense. (Not considering long term care issues of course.)

Am I missing something? Seems like a great coverage, which allows one to get a reasonable handle on Health Care expenses minus future unknown drug expenses (which could be substantial).

 

[athena53]

For the most part... yes. DH, who was 15 years older, was on Medicare (with supplement and prescription drug plan) from age 75 when I retired to age 78 when he died. He had multiple health issues and died of acute myeloid leukemia with hospice support and our only out-of-pocket expenses were the premiums and copays for prescriptions.

I thought I was home free when I hit 65 after a succession of high-deductible plans with skimpy networks but have found I'm at the mercy of whoever codes claims at my doctor's office. If Medicare doesn't think it's "medically necessary" they won't pay and neither will the supplement. I once had $800 in bloodwork kicked back as "not medically necessary" even though it included a lipids panel (my total cholesterol is over 200) and an a1C (my fasting glucose runs around 110). I got off the hook only because I hadn't signed an Advanced Beneficiary Notice. Most recently she did a breast exam and a Pap smear and they were coded as a single procedure ("breast exam and Pap smear") and the whole charge was rejected because annual Pap smears are no longer considered necessary at my age. I appealed the coding and wanted them to code the two procedures separately- so far no luck. I paid the $110 bill to make it go away.

I love my doctor but I may have to replace her because of her inept staff.

 

[LARS]

For the most part... yes. DH, who was 15 years older, was on Medicare (with supplement and prescription drug plan) from age 75 when I retired to age 78 when he died. He had multiple health issues and died of acute myeloid leukemia with hospice support and our only out-of-pocket expenses were the premiums and copays for prescriptions.

I thought I was home free when I hit 65 after a succession of high-deductible plans with skimpy networks but have found I'm at the mercy of whoever codes claims at my doctor's office. If Medicare doesn't think it's "medically necessary" they won't pay and neither will the supplement. I once had $800 in bloodwork kicked back as "not medically necessary" even though it included a lipids panel (my total cholesterol is over 200) and an a1C (my fasting glucose runs around 110). I got off the hook only because I hadn't signed an Advanced Beneficiary Notice. Most recently she did a breast exam and a Pap smear and they were coded as a single procedure ("breast exam and Pap smear") and the whole charge was rejected because annual Pap smears are no longer considered necessary at my age. I appealed the coding and wanted them to code the two procedures separately- so far no luck. I paid the $110 bill to make it go away.

I love my doctor but I may have to replace her because of her inept staff.

Interesting.

Certainly with traditional health insurance you are still subject to "medically necessary"hurdle. I know I've had that conversation from time to time with my GP (though he has generally found a way to satisfy insurance company).

Are you suggesting your experience with "medically necessary" has been worse on Medicare than pre-65 health insurance?

 

[athena53]

Interesting.

Certainly with traditional health insurance you are still subject to "medically necessary"hurdle. I know I've had that conversation from time to time with my GP (though he has generally found a way to satisfy insurance company).

Are you suggesting your experience with "medically necessary" has been worse on Medicare than pre-65 health insurance?

Interesting question- yes, I think it has been. I had the same blood tests under ACA, same doctor, no problem getting reimbursed. The problem with the Pap smear may be new because I've shifted into the age bracket where they're no longer recommended annually- in fact, my sister, an OB/Gyn, says they're not necessary at all. I'm 66.

 

[Teacher Terry]

The recommendations are to have your last Pap smear at 65.

 

[braumeister]

I love my doctor but I may have to replace her because of her inept staff.

That might be the answer, unfortunately.

I've been on Medicare for a lot longer, and nothing has ever been rejected as not medically necessary (even when I suspected it should have been).

Went through an interesting exercise recently where a test my doc felt strongly about was nearly impossible to get approved. His staff spent hours (literally) going through phone conversations and computer code breakdowns until they finally found the right combination of codes to submit, and it was approved.

That seems to be the key point: the folks in the doc's office who submit the codes for approval.

I have no idea how to check that out in advance.

 

[REWahoo]

I love my doctor but I may have to replace her because of her inept staff.

I think you've found the source of the problem.

DW and I have been on Medicare for 6+ years, have seen numerous doctors and have never had an issue with something not approved or coded incorrectly.

 

[aja8888]

In 10 years of Medicare, between DW and I, we have had only one submittal that was coded wrong. And that was taken care of with a simple resubmittal by the Doc.

Our experience over that time includes a hip replacement, a heart ablation procedure, a heart valve replacement, repairing fractured vertebrae, many tests for all kinds of stuff, COPD issues, and yearly physicals.

DW alone has 5 docs for her conditions...COPD, Endo, GP, Cardio, Bone Guy. I have one (GP).


Athena53, I would consider finding a practice that is experienced in dealing with Medicare.

 

[SheitlQueen]

I recently used Boomer Benefits to purchase my Medicare Part G and Part D coverage. My understanding is that if there are coding problems or other issues with Medicare and/or Part G not paying, call them and they will do all the work to deal with the issue. Hate to sound like I am giving them a plug, but I like the idea of someone else dealing with any problems that arise.
While Medicare is going to cost me more per month than my ACA plan, I don't mind because the coverage is so much better.

 

[Telly]

.......Costs in our state for Part B plus Medigap Plan G and Drug Coverage come to approximately $360 per month (including the $183 one time deductible).

I'm curious how you worked the $183 deductible into the $360 per month. Did you take $183/12=~$15 and add it to the Part B, Plan G, and Part D monthly premiums to get $360?

I'm in my first year, at $268 for same, not accounting for the Part B deductible.

So far, after cataract surgery with follow-ups, etc., no problems with Medicare nor my Plan G insco. Did have a problem with my Part D provider, Aetna, now Wellcare I think. They did not seem to understand that a person usually has TWO EYES! Between the two surgeries I spent many hours in a pharmacy while the personnel there called and recalled Aetna. The Aetna Part D phone answerers refused to cover the eye drops for the second eye, said I had enough drops in the first set. Wrong. I needed both types of eyedrops from the first set, to continue to treat the first eye! They kept giving a date in the future when I could be approved for more, that was two weeks AFTER the upcoming scheduled second surgery, which was occurring two days hence! And they also hung up on the pharmacy folks multiple times. I finally went home, and hours later the pharm folks finally got through a thick head at Aetna that a person may indeed have TWO eyes!

I wondered whether Aetna had pulled their people they wanted to keep in Aetna into their other business unit, and dumped all the people they wanted to get rid of into the Part D unit that they were selling off.

 

[LARS]

Telly. Yes, simply divided by 12.

Great. We're choosing Aetna for Part D. They have the best drug formulary for my wife.

Good Aetna relented. By same token your surgeon could have extended time between eye surgeries. Still, who needs the hassle Aetna put you thru.

Your Part G must be pretty low cost to get $268. Something like $115 per month. We're $191 with BCBS for G. AARP (United Healthcare) was $220 per month in our state.

 

[Throwdownmyaceinthehole]

Don't forget the shocking price of dental work! And there doesn't seem to be any insurance coverage available for dental implants and crowns. I thought my teeth were in pretty good shape until I cracked a crown, its going to cost $5k to replace

 

[LARS]

Don't forget the shocking price of dental work! And there doesn't seem to be any insurance coverage available for dental implants and crowns. I thought my teeth were in pretty good shape until I cracked a crown, its going to cost $5k to replace

You are absolutely correct. The two Ds: drugs and dental.

Guess I think I of dental as separate category as we've been paying for that out of pocket (no insurance) for decades!

 

[athena53]

Don't forget the shocking price of dental work! And there doesn't seem to be any insurance coverage available for dental implants and crowns. I thought my teeth were in pretty good shape until I cracked a crown, it's going to cost $5k to replace

I agree. There are many previous discussions on the subject of dental insurance and you can look them up, but most of us self-insure. I just had my 5th implant last year!

I also wanted to add on your OT: I've mentioned my tangles over the bloodwork and the Pap smear, but have gotten qualified for increased screening for breast cancer due to family history and have also had a bone scan (because I'm post-menopausal and have low BMI) and haven't paid a dime out of pocket. So, overall Medicare is working as I'd hoped.

 

[misty57]

I recently used Boomer Benefits to purchase my Medicare Part G and Part D coverage. My understanding is that if there are coding problems or other issues with Medicare and/or Part G not paying, call them and they will do all the work to deal with the issue. Hate to sound like I am giving them a plug, but I like the idea of someone else dealing with any problems that arise.
While Medicare is going to cost me more per month than my ACA plan, I don't mind because the coverage is so much better.

I have heard Boomer Benefits mentioned/recommended more than once on retiree forums so I decided to check out the reviews on them. It seems people love them (real reviews or not?) or hate them (obviously real reviews). Please let us know good or bad any future experiences that you have with them.

 

[SheitlQueen]

I have heard Boomer Benefits mentioned/recommended more than once on retiree forums so I decided to check out the reviews on them. It seems people love them (real reviews or not?) or hate them (obviously real reviews). Please let us know good or bad any future experiences that you have with them.

Will do. So far my experience with them has been excellent. They helped determine which policy fit me best, and when they found a less expensive Part D they called me back and recommended changing my application. I tend to take negative reviews with a grain of salt because dissatisfied people will tell everyone in the world about the experience and those who are happy generally keep silent. But a repeated history of poor reviews would concern me. But I like the fact that if there are problems in the future, they will take care of them at no cost to me. Relieves me of having to deal with the medical offices and insurance companies.

 

[John Galt III]

Will do. So far my experience with them has been excellent. They helped determine which policy fit me best, and when they found a less expensive Part D they called me back and recommended changing my application. I tend to take negative reviews with a grain of salt because dissatisfied people will tell everyone in the world about the experience and those who are happy generally keep silent. But a repeated history of poor reviews would concern me. But I like the fact that if there are problems in the future, they will take care of them at no cost to me. Relieves me of having to deal with the medical offices and insurance companies.

I wonder if Boomer Benefits would go to bat for me if I got them to broker me into a Medicare Advantage plan. Everyone seems to be using them for supplements, not MA plans.

 

[Telly]

I wonder if Boomer Benefits would go to bat for me if I got them to broker me into a Medicare Advantage plan. Everyone seems to be using them for supplements, not MA plans.

Since you seem to be set on going the MA route, you may want to deal with those who sell them.

Chris Westfall at https://seniorsavingsnetwork.org/ in SC now sells them. He didn't sell MA plans before. Besides the listed business, he also has an agent-training business, and the increasing popularity of MA plans may have shifted him to broaden up his offerings to get some of that business too. CW also has many many worthwhile videos on youtube. Some here at ER-Org use him, though they may have been Medigap plans, not MA plans that they were interested in. I think he said in one of his videos that independent agents make a much larger commission on selling a MA plan than a Medigap plan. That's not surprising at all...

 

[REWahoo]

... independent agents make a much larger commission on selling a MA plan than a Medigap plan.

Yep.

Am I an outlier in my belief that regardless of the product being sold, the higher the commission for the sales rep the lower the true benefit to the purchaser?

 

[SheitlQueen]

I wonder if Boomer Benefits would go to bat for me if I got them to broker me into a Medicare Advantage plan. Everyone seems to be using them for supplements, not MA plans.

I would assume so, but not sure. Obviously MA plans work differently than Original plus a supplement.

 

[SheitlQueen]

So far I'm happy. I was previously with Providence, but with Medicare I can continue to go Providence clinics and see all the doctors I saw before even though I am no longer with Providence. They will bill Medicare and my supplemental plan. Only thing I need to make sure of is that there won't be any issues with which ever labs they use.

 

[Telly]

Telly. Yes, simply divided by 12.

Great. We're choosing Aetna for Part D. They have the best drug formulary for my wife.

Good Aetna relented. By same token your surgeon could have extended time between eye surgeries. Still, who needs the hassle Aetna put you thru.

Your Part G must be pretty low cost to get $268. Something like $115 per month. We're $191 with BCBS for G. AARP (United Healthcare) was $220 per month in our state.

I was signed up for Aetna Part D when the announcement was made that CVS buying Aetna required that Aetna divest it's Part D business So I thought I'll just see, and change to somebody else in late 2019 if it's a problem.

My Ophth is also the surgeon, and his standard delay between cataract surgeries is a month! I pushed him to two weeks, he agreed to do that if the first one went well and was still OK after 1 1/2 weeks, it was. Two reasons I wanted two weeks, not a month - I did not want to cross the year-end medicare deductible reset. And my opto-shop person, who has many many years of dealing with older people, pointed out that with my existing lens power required, and astigmatism, I would have a very hard time with one eye operated on, and the other, not! So glad I pushed for the two weeks. She was SOooo right!

My Plan G is $117, so your estimate is right there! I used CSGActuarial.com for a month to look at rates so I wouldn't be such a newby. BCBS here was $146, and had a much steeper slope up with age than anyone else I looked at. AARP/UHC was $139. Aetna was $136. In general, lower initial also meant lower rates by ages 70, 75, 80. I didn't look beyond 80. Separately, I heard that the most-picked Medigap plan in Dallas county is Western United Life, it was $116 here, but they had an AM Best rating of B+, which was below my decided rating cutoff. United World, the MoO company for TX, was $132, but with their unusual (at least to me) discount which I met, brought it down to $117. Of course, the future is not guaranteed in anything for anything

 

[ivinsfan]

Yep.

Am I an outlier in my belief that regardless of the product being sold, the higher the commission for the sales rep the lower the true benefit to the purchaser?

No you are not an outlier and as a result agents definitely push an MA plan if you are unsure of what you want, it's an easy sell for the agent because it's usually cheaper. As to JG, he seems set on the free MA in spite of earlier threads he started on this subject. I do hope it works out for him, but he doesn't seem to understand there won't be any billing issues because he will go where the MA tells him to go and do what the MA plan is willing to pay for. There is no "go to bat for a claim", you don't even get to step up to the plate on MA.

 

[Telly]

Am I an outlier in my belief that regardless of the product being sold, the higher the commission for the sales rep the lower the true benefit to the purchaser?

You'll have to scoot over, REW, there's a bunch of us that will be sharing your (statistical) tail area

 

[OldConch]

I wonder if Boomer Benefits would go to bat for me if I got them to broker me into a Medicare Advantage plan. Everyone seems to be using them for supplements, not MA plans.

Called Boomer Benefits last week and although they were very helpful we ended up with an F HD plan through a local broker. The rep told me that the only supplemental plans they offer are F and G.