Welcome to the wonderful world of Medicare - long rant

[NameRedacted]

Well it's finally time to sign my gf up for Medicare. I've been looking forward to this. I'm told it's much simpler and way better than regular health insurance. She can see any doctor, 24 hours a day, no restrictions. Everything's more or less free and she'll be set for the rest of her life. I just need to research it...


3 days, 27 cups of coffee and two 6 packs later...


Ok, Let's see.

• It's not free, there's a $148/month charge.
• There's a $1400 deductible every time you go into hospital and if you stay too long they charge you more.
• $200 deductible for healthcare coverage.
• 20% coinsurance
• Part B extortianate excess charges.
• No annual limit on out of pocket, but at least once you've exhausted your life savings and are too sick to work you can get help paying the costs.

That's OK though you can buy another insurance plan that covers all the deficiencies of Medicare and then you'll be completely covered! There are lots of plans to choose from - Plan A, Plan B, Plan C discontinued, Plan D, something, something, discontinued, Plan G both expensive and cheapskate versions, Plan 9 from outer space Plan K, Plan L, Plan M, Plan N. All with multiple providers charging different amounts for the exact same coverage. Also, the provider can increase the cost of the plan every year but if you choose the wrong plan - tough - because outside of the 6 month window you can't switch because we don’t want people like you on our plan of medical underwriting.

But at least everything's covered. EXCEPT PRESCRIPTION DRUGS!!! Oh and you still have to pay a $200 deductible.



Don't worry though you can buy a 3rd insurance plan to make up for the deficiencies of the two insurance plans you already have.

This will completely cover all your prescriptions. There are lots of plans to choose from and they all cover different drugs and charge different amounts for each one. That's great there are 17 plans to choose from in my area and let's see - only one of them covers both of her insulin prescriptions and it just happens to be the most expensive one. Also the prescription costs increase after 6 months because of - donut hole (??).


Well at least after spending $5-6,000/yr she'll be completely covered except for.

• $200 deductible
• Potentially unlimited drug costs
• No Vision
• No Dental

Fortunately, you can choose a Medicare Advantage plan instead. That must be better right because it has the word "advantage" right there in the name and that's a good thing, right? Well...

• Can't choose any doctor
• $50 to see a specialist
• $375 a day for hospital visits
• $30 for lab tests
• $50 X-rays
• $90 emergency visit
• $30 urgent care
• $250 ambulance ride
• $40 physical therapy
• $6,700 out of pocket - excluding drug charges
• Once you check into Medicare Advantage you can never leave because medical underwriting

But at least you have minimal vision and dental coverage and of the 27 plans available - 3 of them cover her insulin - also donut hole!!





OK seriously though guys, why would anyone think Medicare is good value! Right now she has an ACA plan that has a $0/month premium and a $200 annual out of pocket cost. $6,000/yr seems like a lot to pay to be able to choose your own doctor.


Also, I feel that I have fairly good math and comprehension skills but I'm having a hard time deciding on what the best option for her is. How does the average person understand any of this and make informed choices, especially at the time of life when their mental faculties are starting to decline? It seems like the whole thing is deliberately designed with lots of gotchas. We know people that signed up for regular Medicare only, because the deductibles, copays and coinsurances seemed reasonable, and then got hit with quite large costs because of multiple hospital visits. Fortunately they were wealthy enough for it to not affect them too badly but for the average person living on Social Security it would be devastating.





Note: I did exaggerate a bit here. New York, where we live, does not allow Plan B Excess Charges, nor does it allow medical underwriting and is community rated - so at least she can switch back and forth between Medigap plans and Medicare Advantage if necessary.

 

[REWahoo]

For some reason this old joke comes to mind: "Other than that, how did you enjoy the play Mrs. Lincoln?"

 

[Chuckanut]

My Medicare issues were not that complicated.

Enroll in Medicare. $148 for Part B.
Enroll in Premera Medicare gap insurance (not an Advantage plan) - $125/montth
Select a Plan D. I think it took about 8 hours to evaluate the various plans. It is and was confusing. But, I think I got right. $32/month.
Decide what to do with the $300 a month I was saving in medical insurance premiums. This was the most time consuming part.

OK, upon reconsideration, part of the $300 a month will go to my yearly vision exam, maybe new glasses, and a few odds and ends. Perhaps these may add up to $600 max.

 

[pacergal]

OP--We will be enrolling this year also and I feel some of your pain and confusion! It will be more expensive than what we currently pay for retiree insurance from work.
I plan to reach out to our states HealthSherpa counselors for some help.

 

[Amethyst]

What is a Medicare "doughnut hole"?

 

[NameRedacted]

What is a Medicare "doughnut hole"?

If you eat too many doughnuts they dramatically increase the cost of your prescription drugs part way through the year - or something like that/s






Actually, it's once the total costs of your drugs (the bit you pay and the part the plan pays added together) so far, goes over a certain amount, the percentage you have to pay goes up a lot until you are almost bankrupt and then they give you a break.

 

[NameRedacted]

My Medicare issues were not that complicated.

Enroll in Medicare. $148 for Part B.
Enroll in Premera Medicare gap insurance (not an Advantage plan) - $125/montth
Select a Plan D. I think it took about 8 hours to evaluate the various plans. It is and was confusing. But, I think I got right. $32/month.
Decide what to do with the $300 a month I was saving in medical insurance premiums. This was the most time consuming part.

The problem I'm having is deciding which of these three is the best option:


Original Medicare, Part D Prescription and Plan G Supplemental
Original Medicare, Part D Prescription and Plan G Supplemental HD
Medicare Advantage - 3 different plans to consider


They all work out better in different circumstances but I have no way to predict what kind of coverage will actually be needed.


I'm thinking of going with the first option which has the highest base cost but the lowest possible maximum cost.

 

[harllee]

Now that we have the Affordable Care Act turning 65 and going on Medicare is not that much of a benefit. But pre-ACA going on Medicare was a huge benefit. I remember years ago my mother could not find any insurance anywhere at age 64 because of preexisting conditions (my parents owned their own small grocery store so no group insurance). Once mother turned age 65 and got Medicare she was SO HAPPY! Of course back then there was no Medicare prescription coverage but at least she was covered for doctor and hospital .

 

[Chuckanut]

The problem I'm having is deciding which of these three is the best option:


Original Medicare, Part D Prescription and Plan G Supplemental
Original Medicare, Part D Prescription and Plan G Supplemental HD
Medicare Advantage - 3 different plans to consider


They all work out better in different circumstances but I have no way to predict what kind of coverage will actually be needed.


I'm thinking of going with the first option which has the highest base cost but the lowest possible maximum cost.

Yes, I hear you loud and clear about that.

FWIW, I decided to go with Regular Medicare and Plan F (replaced by plan G these days). I decided to not use the Advantage plans since going back to regular Medicare might be an issue if one has health issues. You can always go to Advantage, but you may not be allowed back into Medicare later.

After a few years in regular medicare and one expensive surgery, I decided that regular was best for me. YMMV.

While my experiences are different, I will defend your right to rant to the end. Rant on!

 

[CRLLS]

You left out that Original Medicare has no maximum out of pocket.

We switched from Plan F-HD to Plan G last year. I'm glad we did. I had 2 major issues this year that would have filled the HD Plan deductible easily. Unlike our MC plan, and ACA plan(s), Medicare doesn't issue family coverage. Each person has their own plans. Although it doesn't apply to your GF's situation, unless your GF is also married , a few Medicare Supplement providers offer "his and hers" discounts. AARP/UHC is one of them.

 

[Souschef]

If you eat too many doughnuts they dramatically increase the cost of your prescription drugs part way through the year - or something like that/s


Actually, it's once the total costs of your drugs (the bit you pay and the part the plan pays added together) so far, goes over a certain amount, the percentage you have to pay goes up a lot until you are almost bankrupt and then they give you a break.

I just found out that the doughnut hole was closed in 2020

 

[UpQuark]

Wow, very good description, I am trying to figure out Medicare too, because I turn 65 in a few months. My state gives a webinar about Medicare plans but I missed half the zoom call so I have signed up again for the next one in February. But, a new confusion is at work they said that I don't have to initiate signing up for Medicare at 65 because of my coverage at work. The employer's plan is expensive but it also covers my kid who is in school. I have no idea if it would be cheaper to switch to Medicare and then pay for her to have ACA coverage except I think the subsidies in ACA only are for employed people?

 

[NameRedacted]

I just found out that the doughnut hole was closed in 2020

I think it's still open but not as gaping as it was. In the hole you pay 25% of the costs of the drug which can be quite significant. After you exit the hole you pay just 5%.

 

[NameRedacted]

You left out that Original Medicare has no maximum out of pocket.

.... unless your GF is also married , ...

Don't give her ideas.

 

[Peter]

Now that we have the Affordable Care Act turning 65 and going on Medicare is not that much of a benefit. .

That assumes you have the ACA subsidy. Not everyone does.

 

[Midpack]

We’ve never been on ACA but my Medicare with a Plan G supplement, Plan D and dental is far less than any corporate plan (actual cost) - about 1/3rd. Too many Americans don’t realize how much their Corp benefits are subsidized. Some of my employees actually thought their premium and out of pocket was outrageous - had no idea they were only paying 15-20% of actual total cost.

And my wife was on COBRA for 18 months, well over 2X what I pay for Medicare. She’s on a short term UHC plan to bridge her to Medicare eligibility this Sept, and it’s not much more than Medicare. I’ve been pleased with Medicare premiums.

Health care is very expensive in the USA...

 

[jpeter1093]

Enroll in Premera Medicare gap insurance (not an Advantage plan) - $125/montth

What plan did you go for?

 

[anethum]

OK seriously though guys, why would anyone think Medicare is good value! Right now she has an ACA plan that has a $0/month premium and a $200 annual out of pocket cost. $6,000/yr seems like a lot to pay to be able to choose your own doctor.

Most of us, however, live in states without community pricing. For me, Medicare is a far better deal than the ACA was, though I'm very thankful the ACA existed when I wanted to retire. The last full year I was on the ACA, 2018, the full retail cost of my bronze PPO plan through the ACA was $1,386/month. I got a subsidy of nearly 50% of that amount. IIRC, there was a $6,550 annual deductible. So complain all you want about Medicare, but for me and for a lot of people, it's a much better deal. My combined Medicare premiums, Plan G premiums, & Part D premiums are a fraction of what I was paying on the ACA. My only out-of-pocket expenses since I started Medicare have been the small annual plan G deductible.

 

[jldavid47]

The problem I'm having is deciding which of these three is the best option:


Original Medicare, Part D Prescription and Plan G Supplemental
Original Medicare, Part D Prescription and Plan G Supplemental HD
Medicare Advantage - 3 different plans to consider


They all work out better in different circumstances but I have no way to predict what kind of coverage will actually be needed.


I'm thinking of going with the first option which has the highest base cost but the lowest possible maximum cost.

I went with the first option. My Part B + Part D + Part G supplement comes to about $261 per month. I'm not sure where OP got the impression that Medicare was free. Only part A is has no cost to the user and it's been that way for decades.

 

[EastWest Gal]

That assumes you have the ACA subsidy. Not everyone does.

+1. Without the subsidy we'll pay over $20K/year just on premiums. Glad I can manage the subsidy in 2021 and 2023. I'll be relieved when we get on Medicare, even though it's a PITA figuring out plans.

 

[ivinsfan]

OP just out of curiosity, was there any world where you thought Medicare would cost you zero a month with a yearly OOP of 200 bucks..?

I think you are the classic case of not wanting to pay for something that you had been getting for free.

BTW ACA is regular health insurance with some or a large part of it paid for by the government....I think that's pretty simple to understand. Part A of Medicare is free but no one ever said that being completely covered by Medicare was free..

 

[ejman]

After the "pleasure" of acquiring an incurable disease at age 69 I'm immensely grateful for having the wisdom (nah sheer luck) of sticking with regular Medicare and a plan G. Just my infusions add up to about $125,000 a year (not to count CT scans, and many, many other tests and multiple specialist visits). Just for the fun of it I checked some advantage plans in my area. It turns out they wouldn't cover my infusions at all. Yes, I would have saved the cost of my plan G - about $470 a quarter. Buyer beware.

 

[ivinsfan]

Wow, very good description, I am trying to figure out Medicare too, because I turn 65 in a few months. My state gives a webinar about Medicare plans but I missed half the zoom call so I have signed up again for the next one in February. But, a new confusion is at work they said that I don't have to initiate signing up for Medicare at 65 because of my coverage at work. The employer's plan is expensive but it also covers my kid who is in school. I have no idea if it would be cheaper to switch to Medicare and then pay for her to have ACA coverage except I think the subsidies in ACA only are for employed people?

Check with HR and get a few more details...don't do anything while you are confused.

 

[CardsFan]

OK. Here is MY Rant:

Frankly, I am tired of fairly well off folks whining about the cost of Medicare and supplements. The fact that you may have been getting close to a free ride on ACA has no bearing on the cost of Medicare or any other HI plan. Consider yourself lucky you were able to play the ACA card, but don't b*tch about about having to pay the going rate when you get Medicare.

I consider the less than $350/month each that we pay to be a bargain.

 

[NameRedacted]

OK. Here is MY Rant:

Frankly, I am tired of fairly well off folks whining about the cost of Medicare and supplements. The fact that you may have been getting close to a free ride on ACA has no bearing on the cost of Medicare or any other HI plan. Consider yourself lucky you were able to play the ACA card, but don't b*tch about about having to pay the going rate when you get Medicare.

I consider the less than $350/month each that we pay to be a bargain.

In most other Western countries the cost of healthcare is essentially free. The rest of the world is laughing at us. You may be tired of people whining about the cost but I'm equally tired of privileged people not giving a damn about how unaffordable it is for the average person as long as they can afford it.