Medicare $ Estimate

[Samz]

I've taken a look at the Medicare 2015 Costs at a glance ...gov website.

And, I'm wanting to make sure I'm understanding the Medicare expected total premiums, deductible and out of pocket costs. Both my DW and I are planning to move to it when we are 65 (we are 58.5 right now)

Here is my understanding:

Medicare Premiums $ as of 2015 (x 2) Part B & D premium $2,520/yr & $432/yr ~$3,000 max / yr

Medicare Deductibles $ as of 2015 Part A & B (x 2) $2,520 & $300 = $2,820 max / yr

Assuming we both have relatively short hospital stays in the same year, and will not need any exotic Rx's...per the above...the most we would shell out would be ~$5,820 per year (in today's $s etc). Am I missing anything?

Compared to our Platinum ACA plan we picked this year (knowing my DW needed hip replacement surgery) the Medicare total $ per yr is fantastically low.

I realize I can't expect Medicare $ to only rise at ~3% along with regular inflation but having a today's $ is a start point.

 

[Brett_Cameron]

Medicare Part B pays 80% after deductible with NO max out of pocket.

 

[Samz]

Medicare Part B pays 80% after deductible with NO max out of pocket.

BC Thanks - I missed that detail.

So assuming we have lots of Dr. visits...say 4 per mo between the two of us, and they cost $100 per visit that adds up to $4,800 x 20% or $960 more per year.

With all of the above + $960 more, we are up to $6,780 per year. Still a bargain compared to what our Platinum ACA premiums, deductible & max out of pocket can add up to.

If we had serious health issues I realize 4 Dr visits each month at $100 might be too low but over ~30 years average, I'm hoping this on the high side.

My DM and DD ( 84 & 85 yrs) seem like they go a few times a week some weeks since my DM had a few minor strokes and had a pacemaker put in. They are extra careful to get things checked out.

 

[meierlde]

It should be noted that nearly everyone who stays with traditional medicare gets a medigap policy that pays 80% of the 20% depending on the policy. Soon you will no longer be able to get policies that pay the $147 per year deductible for part B Medigap policies have standardized benefits, and when you turn 65 can be bought without health questions. (Also pays the part A deductable of $1160 or so)

Further the Part premiums do depend on income: If your married and about 170k you pay additional (single is 85k) and that MAGI which includes tax exempt interest

Also part D premiums depend on income as well.

 

[Bamaman]

Our doctors will not even accept a Medicare patient if he doesn't have a supplementary policy.

They of course refuse under any circumstance to treat anyone with Medicaid.

So just about every responsible patient will have a Medicare Supplement--and that includes medicines. If we didn't have Supplements, we'd have to go back to work--with my wife on many expensive medicines.

 

[MBSC]

When making cost comparisons to an ACA plan, remember you have been paying into Medicare for years. Medicare does not cover the first 3 pints of blood, hearing aids, routine dental, routine vision, and foreign travel.

The $1,260 Part A benefit period deductible is per hospital admission when an admission is greater than 60 days from the previous discharge (the start of a new benefit period). In theory, one could have 5 benefit periods per year.

There are additional costs for hospital stays over 60 days and for Skilled Nursing Facility (SNF) stays between 21-100 days.

There is a $147 Part B deductible per person. Part B then covers 80% of most other services meaning you are responsible for 20% with no cap. This means not only 20% of your 4 doctor visits per month (plus lab work and x-rays) but also 20% of hospital professional services (doctors, anesthesia, lab work, x-rays, etc) and 20% of covered DME.

A physician who does not accept Medicare assignment can balance bill an additional 15% on top of the 20%. These are called Part B excess fees. Physical Therapy payments may be capped at $1940 in certain cases so you (or your Medigap plan) would be responsible for additional PT.

I respectfully suggest you research the high deductible version of Medigap Plan F to limit your annual Part A & B out of pocket costs to $2180 per person at a monthly premium of less than $90. Although you may be healthy now, you never know when an auto accident or cancer diagnosis could change your calculations forever.

 

[Samz]

merelde, Bamaman & SCGamecock

Thanks for the additional comments. Since we are a few years away from being able to move over to Medicare, I'm just trying to get an estimate on what might be expected based on today's $s.

I've been self employed and have been paying both the employer and employee parts of the Medi / SS for 20+ years so I know a comparison to ACA HI cost is not really apples to apples. Looking forward to not having this expense once I RE!

And after my last post I did get to thinking about the Dr / anesthesiologist, X-ray, and MRI type charges and know they could add up quick.

Bottom Line- If I add in an extra $100 / mo for Medigap Ins, using all the above estimates, I'm coming up with a grand total of $7,980 per year for HI and deductibles, co-pays etc.

For estimating purposes, and not plugging in any yearly % increases, is ~$8,000 per year for a couple in the ball park? I'm leaving dental, vision and such out of the mix right now.

TKS!
Samz

 

[ivinsfan]

My DH is on medicare right now and we pay only for part B and have the Senior Gold with BC.no extra prescription coverage, He regular meds are generic and we get a BC copay that costs maybe 5 -10 dollars a month total for both of them. He is in the VA system so if he needs more expensive meds we can get a 30 day supply, at a max of 10 dollars.

He has a couple well maintained health issues that need maintenance doctor visits and in 18 months we have not payed one penny out of pocket for anything. We don't even get any bills.

 

[MichaelB]

Bottom Line- If I add in an extra $100 / mo for Medigap Ins, using all the above estimates, I'm coming up with a grand total of $7,980 per year for HI and deductibles, co-pays etc.

Medicare coverage will probably cost a bit more than that. You need Medicare D and Medigap. You can find Prescription drug plans in your area for a quote here https://www.medicare.gov/find-a-plan/questions/home.aspx and get a quote for a Medigap plan in your area here Find a Medigap Policy in Your Area
Medigap F offers the most coverage / lowest deductible, so it is a good option if you are looking for an idea of what the costs look like.

 

[pb4uski]

Mom's on Medicare, her costs are:

Part A................0
Part B.............105
Part D...............53
Medigap..........197

Total...............355 or $4,260/year

And with that, virtually everything is covered.

 

[rbmrtn]

Mom's on Medicare, her costs are:

Part A................0
Part B.............105
Part D...............53
Medigap..........197

Total...............355 or $4,260/year

And with that, virtually everything is covered.

That sounds like my mine except she has a retiree plan so the medigap is $0. I am sure her medical bills have far exceeded what she earned in her working lifetime.

 

[explanade]

There needs to be a chart or some kind of calculator for this.

 

[REWahoo]

There needs to be a chart or some kind of calculator for this.

Too many variables.

 

[Katsmeow]

DH is on medicare. His medigap policy (Plan F through the UHC/AARP policy) is currently about $177 a month. He is 67 and it goes up some every year on his birthday.

So far, almost everything he has wanted to do since he got on Medicare has been covered except for some medication co-pays. He had major shoulder surgery last year and had 6 months of PT with medicare and his supplement paying all of it.

As mentioned, it doesn't pay for glasses or hearing aids (which he hasn't needed, but if he ever does those are expensive). Note that it Medicare also doesn't cover dental. Implants, in particular, can be really expensive (he hasn't needed any though).

Medicare does have some limits as to how often it will cover certain things. Also, it doesn't cover a routine physical examination. It will cover some screening tests on a specified schedule.

And, of course, not everyone accepts Medicare. That said, he has never tried to use a provider who didn't accept and didn't accept Medicare assignment. But, in some areas that may be more of an issue than it is where we are.