Medicare Costs?

[GenXguy]

If you don't qualify for Medicare you can stay on an ACA policy and probably still receive a subsidy. However, in my state you would only have a choice of narrow network HMOs on the ACA. Paying for Medicare might be a better option.

Ummmm..... you are confusing "qualifying for Medicare" with "qualifying for premium free Medicare Part A." You do NOT have to work 30+ quarters to qualify for Medicare, but if you have worked less than 30 quarters, you still have to pay over $500/mo JUST for Part A.

Also, someone who doesn't qualify for Premium free Medicare Part A due to work history likely wasn't on an ACA marketplace plan, but was on ACA Medicaid Expansion, and they would NOT be eligible for sign up for an ACA marketplace plan due to age nor meet the income requirements to.

And of course, they would not meet Senior Medicaid requirements in most states due to very low income and asset limits. This has come up in several of these threads. Those seniors are getting a very raw deal compared to those through age 64 with the same resources, who get a free ride on ACA Medicaid expansion.

 

[GenXguy]

GenX
The Part G in the post refers to a Medigap Plan called Plan G. The federal government has approved several variations of Medigap plans, and each variation has a letter: G, N are most common. It doesn't matter which carrier you buy the plan from, the plans with the same letters all offer the exact same benefit.

HTH,
- Rita

You must have missed some posts. I specifically stated that I thought Part G and Medigap were the same thing. But the previous poster listed them as two separate items. I assume that was in error, and one of those was supposed to be "Part B", which wasn't listed in their total premiums calculation, so please drop it.

 

[Dtail]

No, I'm suggesting a senior citizen shouldn't have to pay so much for Medicare while people through age 64 with much much more resources can get a free ride on ACA Medicaid Expansion, that 65+ are not eligible for. So, it's not fair, definitely NOT as it should be.

Hey it happens. They should change the rules then. I am one of those persons using the ACA rules to my advantage and feel zero guilt.
Most folks who complain about the ACA subsidy rules are the ones who can't pull it off themselves.

 

[ShokWaveRider]

No, I'm suggesting a senior citizen shouldn't have to pay so much for Medicare while people through age 64 with much much more resources can get a free ride on ACA Medicaid Expansion, that 65+ are not eligible for. So, it's not fair, definitely NOT as it should be.

I thought they were, sort of anyway, they can get Medicare Advantage for ~$0 and have money added back to their SS along with Gym memberships and free groceries. Or at least that is what we are pitched.

Anyhow, it is a choice. I prefer the better "Countrywide" coverage of Medicare and a Supplement, regardless of cost to what we ever had under the ACA. Yes, it costs more, but good things inevitably do, and one gets what one pays for. It is America after all, if one can afford it, one will be OK, if not, well you take what you can get.

The ACA was good for us, and yes, we did like it at the time, when we were in one place and our doctors were "in plan". They did have to change occasionally, but we were not married to our doctors and were fortunate enough to live in a location with great healthcare and did not get really sick. It was adequate. We did fight for coverage on numerous occasions with telephone clerks to get doctors paid, I am so happy that is all over with.

Medicare for us is a godsend, we know what it costs, and the costs are predictable. We pay our bill and basically get the best healthcare available in the USA with no underwriting or 3rd party decision making. We book appointments directly with whoever we want as long as they take Medicare, and that is OK with us.

The Drug plans are a different story, looks like they were designed to make the most profit for the provider vs providing a good service to recipients. Why it is not part of regular Medicare I will never understand. and why there is a deductible is another dumb rule. All that does is give the service providers more paperwork and expense. Why it is not included in the Medicare premium I will never comprehend.

 

[mountainsoft]

Is anyone here on the "high deductible" G plan or the N plan? What has your experience with those plans been?

N seems to cover close to G, but all it would take is a couple doctor visit copays per month to blow the tiny cost difference.

 

[REWahoo]

Is anyone here on the "high deductible" G plan or the N plan? What has your experience with those plans been?

N seems to cover close to G, but all it would take is a couple doctor visit copays per month to blow the tiny cost difference.

DW and I are both on N and the premium cost is approximately $25 per month less than for G, saving each of us $300 per year. N has been a good choice for us. We've been on N for 7 years and paid very little in copays each of those years, only topping $200 this year when DW had dual TKR surgeries.

That said, depending on the premium differential between G and N, N may not be the most cost effective choice for someone who averages more than one doctor visit per month.

 

[FiveDriver]

DW and I are both on N and the premium cost is approximately $25 per month less than for G, saving each of us $300 per year. N has been a good choice for us. We've been on N for 7 years and paid very little in copays each of those years, only topping $200 this year when DW had dual TKR surgeries.

That said, depending on the premium differential between G and N, N may not be the most cost effective choice for someone who averages more than one doctor visit per month.

We are looking into Plan N or Plan G-High Deductible. We're both relatively healthy, so generally just 2 Doctor Visits per year. We also both see a Dermatologist each year to make sure the Southern Sun isn't doing any nasty things to our skin. And of course DW visits her Lady Specialist twice a year.

Question -- For Plan G-High Deductible, do Doctors typically accept the Medicare payment for these kinds of Office Visits ? Or is there a charge above the Medicare level that falls under the High Deductible ??

What is the Max Out Of Pocket on these plans ?

 

[athena53]

No. Medicare part A alone is $506 PER MONTH if you worked less than 30 quarters. <snip>

Yes, the system sucks. Seniors shouldn't have to pay so much for health care while so many people under 65 can get a free ride on the Medicaid expansion.

$506/month is a bargain. My employers and I paid in over $300,000 during my 38-year career. If I could have that back (and that's before any investment income I would have made on it) I'd be happy to pay $506/month for Part B.

Seniors are darned expensive to insure. Look around you- scooters, walkers, obesity- and that's just the visible stuff. I'm on only one prescription but require twice-yearly breast cancer screenings due to family history and an annual echocardiogram for my leaky heart valves. I consider myself lucky.

And there IS some sort of Medicaid/Medicare hybrid for low-income seniors as well as some Advantage plans with low or no premiums.

 

[Scuba]

Even though my medigap plan, etc takes a large amount of my income I figured it’s worth it to get the treatment I may need in the future. MA can require you to use step therapy if you need an expensive treatment and you could be dead or too late for the treatment to work by the time you get to the step you need. In many states you can’t go back to regular Medicare without passing underwriting. Definitely not worth the risk.

I agree 100%. Well said. DH was healthy until he wasn’t. Health can change literally overnight when something unexpected happens.

 

[Montecfo]

No. Medicare part A alone is $506 PER MONTH if you worked less than 30 quarters. Then Part B, Part D, and medigap/supplemental on top of that, which most people would say are really necessary, so you could be looking at $1000/mo or so, and even more when adding in the out of pocket costs, if you don't quality for Premium free part A.

If you worked 40 quarters or more, Medicare Part A is premium free. But the other necessary parts drive up the actual cost.

Yes, the system sucks. Seniors shouldn't have to pay so much for health care while so many people under 65 can get a free ride on the Medicaid expansion.

Well that is why we save and build NW throughout working years.

 

[athena53]

Well that is why we save and build NW throughout working years.

I agree- I retired at 61 and was stuck with "Affordable" Care Act coverage for 4 years. Fortunately DH was 76 and Medicare-eligible. Believe me, I'm grateful for Medicare AND for the fact that I never came near hitting the $6K deductible on ACA coverage during those years. I see posts on FB complaining about how dental care and hearing aids should be "free" under Medicare but I shudder to think about how many vultures would over-sell these services to seniors if Medicare were to pick up 100% of the tab for, say, dental implants or high-end hearing aids. I have dental implants and love them but they're not for everyone (being a smoker makes you a poor candidate) and need cleaning 4X/year.

On my earlier post- too late to edit but I meant to refer to Part A, not Part B.

 

[2retireearly]

My Medicare + F supplement + Part D costs me about $450/month (excluding IRMAA). It’s a bargain. I’ve yet to encounter a doc or facility that didn’t accept my coverage and I never get a bill. No deductibles or co-pays. I’ve been on Medicare for 11 years and, so far, the only thing I’ve found to bitch about is IRMAA (which I try to keep to myself! ).

Right but many of us never got part F and the poster won't get part F, so it might be an easier discussion to only talk about part G.
Part D can be very cheap,much less than $20, if you don't take expensive drugs, it's a great plan I pay $6.60 for part D.
I'm lucky, my employee pays for part G.. but that isn't the case for the poster.
Be aware of possible IRMA though.,depending on your situation..

 

[GenXguy]

Hey it happens. They should change the rules then. I am one of those persons using the ACA rules to my advantage and feel zero guilt.
Most folks who complain about the ACA subsidy rules are the ones who can't pull it off themselves.

OK, but my post had nothing to do with ACA marketplace plans or subsidies. I don't blame people for taking advantage of that.

 

[GenXguy]

$506/month is a bargain. My employers and I paid in over $300,000 during my 38-year career. If I could have that back (and that's before any investment income I would have made on it) I'd be happy to pay $506/month for Part B.

$506/mo is ONLY for part A (when having less than 30 quarters working credits), Part B is on top of that. Add on medgap, and you're up to over $1000/mo plus quite a bit out of pocket costs.

I don't think $1000/mo is a bargain for these people that won't even have any SS income! Think about that.

I'm fortunate like most of this forum to have premium free Part A.

But as I keep saying, people 64 and under with the same resources can get a free ride on the ACA Medicaid Expansion which is costing over $12,000 in premiums along with other out of pocket costs for those 65+ with the same low resources and limited work history. Not seeing the "bargain" for the 65+ person vs. the 64 year and old and under.

And there IS some sort of Medicaid/Medicare hybrid for low-income seniors as well as some Advantage plans with low or no premiums.

You must have missed it. They have very low asset and income limitations in most states that do NOT apply to the ACA Medicaid Expansion for people 64 and under, which is a key point I keep making. I know people who were hit hard by this when turning 65. They went from a free ride at age 64 to $15,000+ expenses for health care coverage at age 65. Yes, the system should be changed so they aren't hit with that type of cost increase just for turning 65.

Those Advantage plans are NOT low or no-premium for people that don't qualify for premium free Medicare Part A. So, add another $6000+ to what you thought the premium would have been.

 

[KarenF]

Medicare Plans are by zip code. If you do contact any of these companies, get a burner phone number from Google Voice and set up a special email address just for that. Otherwise they will blast your regular phone number and email non-stop. I am planning to use Boomer Benefits as my insurance broker - they issue a book yearly and have a good YouTube channel and Facebook group. They will help you straighten out claims if you are having trouble. I am planning on Medigap G - HD unless something changes in the next three years. I pay over $900 a month for a very crappy HMO ACA Plan so I am looking forward to Medicare.

 

[athena53]

I'm fortunate like most of this forum to have premium free Part A.

But as I keep saying, people 64 and under with the same resources can get a free ride on the ACA Medicaid Expansion which is costing over $12,000 in premiums along with other out of pocket costs for those 65+ with the same low resources and limited work history. Not seeing the "bargain" for the 65+ person vs. the 64 year and old and under.

OK, I was thinking of Medicare "Extra Help", which I now see applies only to Part D prescription coverage.

And how do you reach age 65 without 30 quarters of working credits? A stay-at-home spouse could qualify based on the employed spouse's record. I suppose some work under the table and some might have been full-time caregivers to a special-needs child (but had a spouse with income?) or took care of an elderly parent (but their entire adult life?). Heck, my mother's cousin, who was a nun, was sent out to work in the public schools as a lay person for 30 quarters. I kinda thought it was cheating, but that's how they got the nuns to qualify.

How do you fall through the cracks when this has been the rule since forever?

 

[mountainsoft]

I am planning to use Boomer Benefits as my insurance broker

I was just going to ask who folks used to sign up for Medicare plans. Are brokers always required, or are there online options for a more DIY approach to Medicare (similar to the ACA web site)?

I'm still a long way out from Medicare, just trying to educate myself.

 

[fosterscik]

I didn't use a broker - I saw no need. It's very easy to sign up as an individual. In my case I am delaying social security so I pay the premiums quarterly for my part B, my plan G supplement and part D (using a credit card - so I get a CC rebate!). DW claimed social security and signed up as an individual, also without a broker. SS deducts her premiums from her monthly check.
If you know what you want (as we did) I see no need for a broker's services.

 

[audreyh1]

I was just going to ask who folks used to sign up for Medicare plans. Are brokers always required, or are there online options for a more DIY approach to Medicare (similar to the ACA web site)?

I'm still a long way out from Medicare, just trying to educate myself.

No, Medicare is totally DIY if desired. DH signed up for part A and B online with Medicare, and he just used Boomer Benefits to set up Medigap and the initial Part D. After that DH did Part D himself and switched companies.

 

[isisdave]

We have the AARP Plan N. When we signed up, we were living in California, and the monthly cost difference was something like $95 for N and $150 for G. We were very healthy and might have 4 doctor visits a year, some of which had no copay as they were for "preventive" things. So we went with N.

We're now older and in Indiana, so I suspect the price difference is not so much. This plan is community-rated (preferable to age-rated) but there is a "discount" you get when you sign up at 65 that fades by a few percent every second year. Now at 72/74 we pay $282 per month total.

But the copay is not $20, it's "up to $20" and a lot of office visits are priced under $100, so the copay might be $14-18. Also, we have never seen an "excess charge" which is a 15% markup that some doctors are permitted to make, so that doesn't seem to be an issue.

So do the math. The other thing is that you are always permitted to change to a less-beneficial plan (e.g., G to N) but might need to undergo underwriting to go the other way, except in the states that permit it on request.

We have the cheapest (under $5 each) Aetna SilverScript Part D plan; 5 of our 6 meds are $5 for 3 months each. The other is a Tier 3 that is cheaper via GoodRx ($45), Amazon Pharmacy ($38), and now costplusdrugs ($18).

 

[bada bing]

No, Medicare is totally DIY if desired. DH signed up for part A and B online with Medicare, and he just used Boomer Benefits to set up Medigap and the initial Part D. After that DH did Part D himself and switched companies.

From what I've seen, you can sign up for all of the same plans/prices as an individual as a broker will quote you. But you won't save any money by DIY or spend any extra by using broker. The broker is paid by the plan sponsor and it changes nothing about your premiums. For that reason, I'd consider using a broker. Aetna and UNH (AARP) dominate the market nation wide for G plans. You can deal with either directly.

Even though my medigap plan, etc takes a large amount of my income I figured it’s worth it to get the treatment I may need in the future. MA can require you to use step therapy if you need an expensive treatment and you could be dead or too late for the treatment to work by the time you get to the step you need. In many states you can’t go back to regular Medicare without passing underwriting. Definitely not worth the risk.

I agree 100%. Well said. DH was healthy until he wasn’t. Health can change literally overnight when something unexpected happens.

One little gotcha I discovered is whether your state is underwriting required or not for changing plans after initial enrollment. Because I live in an underwriting required state, I took a plan G. I have no medical issues or meds currently, so I would have taken a HD N plan if I had guaranteed path to G in the future.

There is also a pretty big difference between premiums for different states, even for the exact same plan/sponsor. I didn't investigate whether it seemed to be partially attributable as a way to re-coup costs for having no underwriting required access to plans within a state - but maybe ?

 

[RetMD21]

...$506/mo is ONLY for part A (when having less than 30 quarters working credits), Part B is on top of that. Add on medgap, and you're up to over $1000/mo plus quite a bit out of pocket costs.....

Is it really $1000? part B is $165/month + part A would be $671 and most of us are paying much less than $329 for medigap and part D

Part A is paid through payroll taxes and part B is highly subsidized by general tax revenues so I am not sure they are really as much of a bargain as recipients might think

Perhaps the benefits should be more generous but that would take more taxation

 

[CRLLS]

I signed up for Medicare, Supplement and Part D without the use of a broker. I even changed Supplement and Part D providers along the way. It is easy.

What I didn't like about the brokers I researched, and that includes Boomer Benefits, is that they don't always offer you all of the options available to you. Of course, it would be too big a list to do so. I do have trust issues. I'll admit it. Since Supplement providers pay different commissions for clients that they sign up, I don't trust them to be working in my best interest. It is me. I know it.

 

[Midpack]

I was just going to ask who folks used to sign up for Medicare plans. Are brokers always required, or are there online options for a more DIY approach to Medicare (similar to the ACA web site)?

I'm still a long way out from Medicare, just trying to educate myself.

Brokers don’t cost you anything, and you don’t have to use them if you don’t like their recommendations. They know the industry, why not take advantage of that knowledge? Of course they want your business, so they will follow up to try to find a plan(s) you want, but ultimately you can go another direction if you want.

I did months of research to educate myself before I enrolled, and I’d decided exactly what plans to enroll in. At the last minute I called Boomer Benefits and got their recommendations. What they recommended was exactly what I would have chosen after all my self study - so I could have saved myself a lot of time. But it was reassuring to educate myself nonetheless.

https://boomerbenefits.com/

https://seniorsavingsnetwork.org/about-us/ comes highly recommended here too

https://www.seniorhealthcaredirect.com/ another option?

Of course you can just use a local insurance broker face to face as well, but they often don’t specialize like the ones above, so they may be less knowledgeable on Medicare and associated options.

 

[Koolau]

I've posted this before, but for DW (when she was alive) and I we paid about $8 K combined for Medicare, Plan F, and Part D drug plans. She was on a dozen meds and two were outrageous in cost. Her drugs cost us about $4 K OOP at that time. So our annual cost was ~$12 K.

Nevertheless, Medicare, a good Medigap policy, and a good drug plan is worth every penny of it.

Yeah, when you see the "explanation of benefits" and some procedure "lists" for $2000 and Medicare forces them to accept $250 and your MG covers 140 and leaves you with a bill of $110, that's when you know how good you've got it.

Sure, it all adds up. I think we spend around $8000/year on average for health care. Still, what would you pay for your health/life? Well worth it.