Going on Medicare next month - I already miss my old health insurance

[RetiredHappy]

What is this basic Medicare coverage ? , do they have a deluxe version ?

Perhaps you mean original Medicare, or just Medicare as anything else is not Medicare, it's something else.

I think cosmetic surgery for looks is denied, but my limited experience from knowing a few really really old folks all in their 90's , is Medicare has covered everything medically necessary.

I think the post meant Traditional Medicare. Many types of experimental drugs are not covered. Our friend had lung cancer and went on experimental drugs under UCLA care for about 2 years before he passed away. Medicare did not cover and they paid out of pocket. Many types of Biologics also cost an arm and a leg like Skyrizi and Humira and out of pocket costs under Medicare is very significant.

 

[sengsational]

Interesting - I find the plans for DWs "TV drug" vary greatly - anywhere from $1700/yr to over $8k/yr. As you say, a lot depends on the tier and if you see it advertised on TV, you don't want to be on it

Certainly don't do the one that needs to be advertised! When I said the plans were the same, I should have said the premiums can be wildly different for pretty much the same formulary.

I neglected to say that when I was comparing Part-D plans, it was through the lens of needing an expensive drug. I figured we don't need to do any hand wringing if it's a drug that won't hit the deductible. So I didn't get into price because, if your drug is expensive, all plans will cost the same amount, by law...the max out of pocket. The difference between plans becomes how hard you have to fight to get them to pay. Or how hard you have to fight to get them to accept a substitute if the one on the formulary has proven not to work for you.

 

[AudiDudi]

Certainly don't do the one that needs to be advertised! When I said the plans were the same, I should have said the premiums can be wildly different for pretty much the same formulary.

I neglected to say that when I was comparing Part-D plans, it was through the lens of needing an expensive drug. I figured we don't need to do any hand wringing if it's a drug that won't hit the deductible. So I didn't get into price because, if your drug is expensive, all plans will cost the same amount, by law...the max out of pocket. The difference between plans becomes how hard you have to fight to get them to pay. Or how hard you have to fight to get them to accept a substitute if the one on the formulary has proven not to work for you.

In8 years, I have never had them deny anything so no fighting needed .

 

[sengsational]

In8 years, I have never had them deny anything so no fighting needed .

And that's probably the most common case. They're happy to supply many prescriptions because many of those actually are a net positive, a profit, on their books. But there are drugs that hit the max out of pocket in a week. Those are the ones they are more likely to assemble obstacles to access, thus trying to wriggle out of paying.

 

[2retireearly]

I pay nothing for my new pard D wellcare plan. it is wonderful..has covered what little drugs I currently take. totally.

 

[Flieger]

I pay nothing for my new pard D wellcare plan. it is wonderful..has covered what little drugs I currently take. totally.

Wow! I have so much investigation to do over the next 2 years!

Flieger

 

[AudiDudi]

Wow! I have so much investigation to do over the next 2 years!

Flieger

And every year after that.

 

[gauss]

If you look at one of you employer W2 forms, you should see an entry in box 12 with code DD. This is the true cost of the health insurance provided by your employer (ie the sum of employer contributions AND employee contributions)

If I am not mistaken, the cost of any dental and/or vision coverage would not be included in the DD figure.

-gauss

I just finished signing up for my Part D and Part G plans and all my ducks are in a row to start Medicare in a few weeks. It's not all that expensive, but premiums are five times what I paid on my employer sponsored retiree medical plan from age 55 until now and some of the medications that used to be covered now are not. I know, start playing the world's smallest violin for me, but I didn't realize how good a deal I had until it's gone.

 

[AudiDudi]

DW's Part G just jumped from $227 to $280 (Aetna). My Part G is up 50% in 2 years @ $220. Getting old (73,74) is getting expensive

 

[youbet]

DW's Part G just jumped from $227 to $280 (Aetna). My Part G is up 50% in 2 years @ $220. Getting old (73,74) is getting expensive

Yep, escalating age related health care costs need to be accounted for, for sure.

My G supplement from BCBS of Illinois is now $267. I'll turn 78 shortly.

DW's employer sponsored retiree MA plan works very well for her. (She knows because, unfortunately, she's used it a lot.) And traditional Medicare with Part D and a G supplement works for me. We feel fortunate. It's not cheap at almost a combined $20k/yr with IRMAA, OOP's, deductibles, etc. But we've planned for that level of cost and are thankful the coverage is available.

 

[aja8888]

DW's Part G just jumped from $227 to $280 (Aetna). My Part G is up 50% in 2 years @ $220. Getting old (73,74) is getting expensive

Wait until you hit 80, then you will see a good size increase in G.

 

[AudiDudi]

Wait until you hit 80, then you will see a good size increase in G.

I'm just hoping to make it to 80 (and a ways beyond)

 

[marko]

I'm quite happy with Medicare pricing!

Never had employer insurance once I left the company. Getting us both on Medicare saved us over $26,000 per year which we paid 10 years for me and 16 for DW. ($13k each)

They just picked up a $250,000 tab for my cancer treatment without even a whimper.

 

[youbet]

I'm quite happy with Medicare pricing!

Never had employer insurance once I left the company. Getting us both on Medicare saved us over $26,000 per year which we paid 10 years for me and 16 for DW. ($13k each)

They just picked up a $250,000 tab for my cancer treatment without even a whimper.

I'm curious Marko because I've been trying to understand Medicare's "allowed amounts."

Was your total rack-rate bill $250k and Medicare paid (guessing) $60k or so? Or was your total rack-rate bill more like $900k of which Medicare paid $250k?

Whenever I get EOB's from Medicare, I'm always amazed at what a low percentage of the billed amount they actually pay due to max allowed amounts.

 

[YellowSubmarine]

What is this basic Medicare coverage ? , do they have a deluxe version ?

Perhaps you mean original Medicare, or just Medicare as anything else is not Medicare, it's something else.

I think cosmetic surgery for looks is denied, but my limited experience from knowing a few really really old folks all in their 90's , is Medicare has covered everything medically necessary.

Of course cosmetic surgery is denied; otherwise there would be a line longer than the Disney attractions and SS office in NYC combined.

 

[YellowSubmarine]

I'm quite happy with Medicare pricing!

Never had employer insurance once I left the company. Getting us both on Medicare saved us over $26,000 per year which we paid 10 years for me and 16 for DW. ($13k each)

They just picked up a $250,000 tab for my cancer treatment without even a whimper.

Same here!

 

[marko]

I'm curious Marko because I've been trying to understand Medicare's "allowed amounts."

Was your total rack-rate bill $250k and Medicare paid (guessing) $60k or so? Or was your total rack-rate bill more like $900k of which Medicare paid $250k?

Whenever I get EOB's from Medicare, I'm always amazed at what a low percentage of the billed amount they actually pay due to max allowed amounts.

It's confusing as anything. From what I can tell, the bill was for the full amount. Medicare picked up about 90% and my supplement covered the rest. I'd guess that the hospital knows exactly what and who to charge in order to get fully paid and not a penny less.

 

[MichaelB]

Whenever I get EOB's from Medicare, I'm always amazed at what a low percentage of the billed amount they actually pay due to max allowed amounts.

What amazes me is how health care providers bill prices 5-10 times more than the contractually agreed price and then send those invoices to the patients, all with full knowledge the prices are incorrect.

 

[audreyh1]

What amazes me is how health care providers bill prices 5-10 times more than the contractually agreed price and then send those invoices to the patients, all with full knowledge the prices are incorrect.

I know, it’s outrageous!

 

[davidfin]

I just finished signing up for my Part D and Part G plans and all my ducks are in a row to start Medicare in a few weeks. It's not all that expensive, but premiums are five times what I paid on my employer sponsored retiree medical plan from age 55 until now and some of the medications that used to be covered now are not. I know, start playing the world's smallest violin for me, but I didn't realize how good a deal I had until it's gone.

The difference is you paid a premium that was highly subsidized while working. Employers typically contribute 50% or more to the cost of insurance and write it off. The working population is far younger than the Medicare cohort and expects fewer claims. Medicare can’t be structured that way and cover 10s of millions of elderly subscribers.