Medicare Out of Pocket Costs

[lawman3966]

I recently got an award of SSDI benefits, and will be eligible for Medicare in late 2018. I will be on an ACA plan for most of 2017 and 2018, and will prepare to sign up for M-care once I'm eligible.

For planning purposes, I'm posting to find out what the members pay out of pocket once covered by Medicare, at various stages of their retirement. I saw a figure of $5K online, but that may include high-cost patients getting complex surgeries. I'd like to hear from moderately healthy people in their 50s and 60s regarding their out of pocket costs.

The list of costs should include premium, copays, co-insurance, and Supplemental-plan expenses (if applicable).

Thanks in advance for any input.

 

[old woman]

I have an advantage plan, seldom see doctors but when I did I spent about $100. Dental isn't covered and cost me a large fortune for dental surgery and crowns and stuff. Next month 6K for implants, then need crowns and a bridge. I spent about 22K last year and about the same this year.

 

[braumeister]

Medicare is an amazingly good deal in my experience.

Here's my experience, from my records. Nearly 100% of the "didn't pay" amounts were covered by my supplemental plan:

Year	Amount Billed	Medicare paid	Medicare didn't pay
2011	$6,169	$1,152	$291
2012	$5,961	$1,469	$657
2013	$19,797	$4,669	$1,800
2014	$4,549	$1,139	$536
2015	$7,734	$2,112	$726

 

[grasshopper]

$125 for Med"B" $167 Sup "F" $17 Sup D, with "F" I should not have out of pocket costs and so far so good. $3708 annual.

 

[aja8888]

For two (DW & I)

Medicare premiums and Plan F (full) - ~ $7K per year OOP (we are just over 70)

Plan D - me - $360 OOP total including prescriptions

DW - $4,000 OOP (she takes a lot of expensive meds)

 

[Sarah S]

Check what supplemental plans are available to people under 65 in your state. Medigap is not guaranteed available in every state and some states that do mandate availability may limit it to the less comprehensive medigap policies

 

[MBSC]

I recently got an award of SSDI benefits, and will be eligible for Medicare in late 2018.

The list of costs should include premium, copays, co-insurance, and Supplemental-plan expenses (if applicable).

Most on SSDI choose Medicare Advantage plans due to the limited availability and high premium of Medigap plans for those under age 65. Everything does reset at age 65 and you can then choose a Medigap at the reasonable premiums being posted in this thread. Medicare Advantage plans cannot charge more for being under age 65. Your best resources will be a local, experienced health insurance agent and a local SHIP counselor.

Find a SHIP Counselor: https://shipnpr.acl.gov/%28X%281%29S%283dyf0o3xasithe45p0m3m03i%29%29/Default.aspx?AspxAutoDetectCookieSupport=1

In the meantime, you can go to Medicare.gov, enter your zip code and view MA plans available in your area. You will be able to see the deductibles and out-of-pocket limits that apply to your location.

For example, notice the limited under 65 Medicare Supplement choices in Washington state: https://www.insurance.wa.gov/your-i.../cost-cover/documents/medicare-supp-plans.pdf

 

[Richard4444]

Check what supplemental plans are available to people under 65 in your state. Medigap is not guaranteed available in every state and some states that do mandate availability may limit it to the less comprehensive medigap policies

Also note that in states where you can buy a Supplemental plan (or Medigap), it is usually costlier than the same plan if you are 65. That is because the insurance companies know they are "buying a claim" since someone is disabled.

Rich

 

[MRG]

Most on SSDI choose Medicare Advantage plans due to the limited availability and high premium of Medigap plans for those under age 65. Everything does reset at age 65 and you can then choose a Medigap at the reasonable premiums being posted in this thread. Medicare Advantage plans cannot charge more for being under age 65. Your best resources will be a local, experienced health insurance agent and a local SHIP counselor.

Find a SHIP Counselor: https://shipnpr.acl.gov/(X(1)S(3dyf0o3xasithe45p0m3m03i))/Default.aspx?AspxAutoDetectCookieSupport=1

In the meantime, you can go to Medicare.gov, enter your zip code and view MA plans available in your area. You will be able to see the deductibles and out-of-pocket limits that apply to your location.

For example, notice the limited under 65 Medicare Supplement choices in Washington state: https://www.insurance.wa.gov/your-i.../cost-cover/documents/medicare-supp-plans.pdf

+1
We were eligible to upgrade to Medigap from moving out of her Advantage plans coverage area but at 59 it was pricy. Look again at 65

 

[lawman3966]

+1
We were eligible to upgrade to Medigap from moving out of her Advantage plans coverage area but at 59 it was pricy. Look again at 65

Does this mean that you passed on Medigap coverage between ages 59 and 65, or that you are recommending that I do so?

Can you provide some idea of what level of risk that going without a Medigap plan entails with regard to expenses not covered by the base Medicare coverage.

 

[MRG]

Does this mean that you passed on Medigap coverage between ages 59 and 65, or that you are recommending that I do so?

Can you provide some idea of what level of risk that going without a Medigap plan entails with regard to expenses not covered by the base Medicare coverage.

We did a Medicare Advantage plan due to the cost of Medigap.

I think the biggest issue with Advantage plans is the smaller networks. My understanding is this varies by coverage area. ln this state we can purchase a state wide network.

 

[Corporateburnout]

DW started on Medicare March 1 and her payments are $134 for part B, $155 for a BCBS Medigap supplement 1 plan with no deductibles and no out of pocket (equivalent to plan F) and $32 for part D prescription drug plan. We expect an additional $50 out of pocket for her drugs for a total of $3912 medical cost excluding dental.

We budgeted 12K annually for healthcare for the two of us.