Welcome to the wonderful world of Medicare - long rant

[Teacher Terry]

I just chose my Medicare plans which totaled 330/month however I get a 195 subsidy from my employer so it’s very reasonable. I spent quite a bit of time comparing and then called a professional to discuss. Definitely no advantage plan for me.

 

[2retireearly]

And everyone who makes a fairly high income (single 88000plus, joint 176000plus) at retirement (due to, for ex: roth conversion, taking money out of ira, etc) needs to face a Huge premium for Medicare Part B,D. They look at your MAGI income from 2 years prior.
I might have this issue in 2022....for my first year of Medicare. Considering I get pre 65 retiree Health Insurance now, at $200 a month, this is a terrible problem. I won't go into the reasons my income bumped way up in 2020...I can say it was a roth conversion, for simplicity, but, it doesn't reflect on my well mechanized, and planned, lower 'income' I've had for years, as a Early retiree...Its a bummer..or will be.

 

[msanniee]

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.

After running the numbers, I choose your second option. I did get a medigap with an age issued rate to help stave off rate increases as I grow older. I did find service on the policies to be lacking and I wasn’t provided correct information. Thank goodness I always do my homework.

 

[Dragomira]

I too was shocked that we had to pay for medicare, but even so, it was cheaper with lower deductibles than I paid when I was working! (I could have stayed on my husband's work policy, but it would have cost us more!). I simply throw my deductible in a bank account and go a my merry way.

 

[JJpop]

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.

In Calif our Advantage plan is simple and priced very well.
I had bills of about 330,000 last year and we paid about 3500 out of pocket.
To see a specialist is 20. PT is 20. We are also able to see the doctors at Stanford.
No complaints here.
Cost is 140 something for the Medicare and 99 for the Advantage plan.

 

[CardsFan]

And everyone who makes a fairly high income (single 88000plus, joint 176000plus) at retirement (due to, for ex: roth conversion, taking money out of ira, etc) needs to face a Huge premium for Medicare Part B,D. They look at your MAGI income from 2 years prior.
I might have this issue in 2022....for my first year of Medicare. Considering I get pre 65 retiree Health Insurance now, at $200 a month, this is a terrible problem. I won't go into the reasons my income bumped way up in 2020...I can say it was a roth conversion, for simplicity, but, it doesn't reflect on my well mechanized, and planned, lower 'income' I've had for years, as a Early retiree...Its a bummer..or will be.

See bold above. Is it REALLY a "terrible problem"? Or just a pain to pay more?

FWIW, I will be in the same boat sometime in the future. I won't like it, but it won't be a terrible problem.

 

[JJpop]

What an awesome summary of the whole program. I’m going to copy it and give it to relatives and friends who are just starting that research. I know I spent dozens of hours coming to the same conclusions.

But once I figured it all out, we are very happy with the way it works. We supplement with plan n at $80 a month and our part D drug plan only adds $14 a month. I just switched my mom from a $95 AARP plan to a $14 Clear Springs plan that pays a lot better for way less monthly. So one must shop annually for this. Plan N is cheaper monthly, but you get to pay your own deductibles. But with the annual savings you should be able to pay your own deductibles in years you incur them. “Excess charges” is possible, but when you do the math on them they are very rare, and usually tiny if they occur. Mom prefers a higher supplement premium that pays deductibles for her but is built into her cost. To each his own.

I eliminated “advantage” plans from my thinking because the real reason we have these plans are to protect us from a worst case scenario. And “advantage” plans don’t work for that.

Thanks for a great summary of how things work. We are grateful to have such good coverage for such affordable premiums. Sure beats what I had working. I have had major surgery with it, and my wife had open heart surgery with it in our first couple of years. Aside from the expected reasonable deductibles, they paid everything,

Why does an Advantage plan not cover the worst case scenario?

 

[CardsFan]

Why does an Advantage plan not cover the worst case scenario?

The simple answer is, it depends.

With a Medigap plan ( N,F.G, whatever) they are all the same from every supplier, the only difference is price.

Advantage plans have no definition except what that supplier says at the time. They range from no cost to high cost. Some have restrictive providers, some don't. You MUST do you due diligence with each and every one of these plans. There is NO uniformity.

Advantage plans are not bad, per se, but every one is unique.

 

[Rosedala]

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.

Medicare Advantage offers more than the Original Medicare. Just choose one with a reasonable premium (or no premium if you're reasonably healthy).

 

[themillerman]

Welcome to old age...

 

[littleb]

We have been on the ACA for years paying outrageous premiums which included 3,000 -5,000 annual deductibles that we only met one year.

After retiring the past few years we received an ACA subsidy which was a relief. However the deductible was still 5,000.

I went on Medicare last year and pay less than 300.00 for Medicare, supplemental and a prescription drug plan. Included is an extremely low 200 deductible.

Every specialist and every Dr I contacted accepted Medicare which was an unexpected surprise after being in PPOs with limited network Drs and hospitals.

I am ecstatic that I am finally on Medicare. [emoji16]

 

[ivinsfan]

Medicare Advantage offers more than the Original Medicare. Just choose one with a reasonable premium (or no premium if you're reasonably healthy).

This is not one size fits all advice...and how do you define more. It sure doesn't offer access to more doctors.

In fact with MA the premium is the last thing you think about IMO..

 

[DektolMan]

Original Medicare, Part D Prescription and Plan G Supplemental HD


The problem with some Advantage Plans is that they are not accepted by some Cancer centers in the country where they do accept original medicare. I want to have the option to seek the best care, anywhere in the country if I need it.

 

[CRLLS]

The simple answer is, it depends.

With a Medigap plan ( N,F.G, whatever) they are all the same from every supplier, the only difference is price.

Advantage plans have no definition except what that supplier says at the time. They range from no cost to high cost. Some have restrictive providers, some don't. You MUST do you due diligence with each and every one of these plans. There is NO uniformity.

Advantage plans are not bad, per se, but every one is unique.

The highlighted above is often quoted. As it is written, it is incomplete. All suppliers must meet the same Medicare requirements for medical benefits based on whatever Plan Letter is chosen. That is true. Some suppliers include access to Gym use and other additional benefits. These additional benefits are above and beyond the government dictated minimum requirements. For example, AARP/UHC plans include Gym Membership (Renew Active™ ) Vision, Dental and Hearing discounts. The value of these benefits may or may not be greater than other options. That is for the individual to decide. Not all suppliers offer any benefits beyond the minimum requirements. Just saying....

 

[meleana]

Here in NH, hubby has Part A and Part B, Plan G and part D. Totals over $300 per month.

My ACA silver plan was $39 per month last year and is $50 per month this year until I go on Medicare in June when I turn 65. ACA has no deductibles, tiny- if any- copays. Decent EPO network for the area.

I dread going on Medicare because we’ll be paying over $600 per month for the both of us.

 

[ivinsfan]

Here in NH, hubby has Part A and Part B, Plan G and part D. Totals over $300 per month.

My ACA silver plan was $39 per month last year and is $50 per month this year until I go on Medicare in June when I turn 65. ACA has no deductibles, tiny- if any- copays. Decent EPO network for the area.

I dread going on Medicare because we’ll be paying over $600 per month for the both of us.

Just out of curiosity what would be a non-dread price point for your coverage? You certainly can't think that 39 dollars a month was the actual cost of your current HI. At 64 I'm willing to bet the rack rate on your insurance is well over the 300 a month you will pay on Medicare..

Hey, It's fine say that you are sorry that you will pay more for your health coverage, but dread, a little excessive complaining IMO.

 

[Teacher Terry]

My sister in Chicago pays 600/month for her Medicare and supplements.

 

[CardsFan]

The highlighted above is often quoted. As it is written, it is incomplete. All suppliers must meet the same Medicare requirements for medical benefits based on whatever Plan Letter is chosen. That is true. Some suppliers include access to Gym use and other additional benefits. These additional benefits are above and beyond the government dictated minimum requirements. For example, AARP/UHC plans include Gym Membership (Renew Active™ ) Vision, Dental and Hearing discounts. The value of these benefits may or may not be greater than other options. That is for the individual to decide. Not all suppliers offer any benefits beyond the minimum requirements. Just saying....

Quite right, I should have made it clear that the base health care coverages are the same. BTW, I have the same AARP/UHC plan, with the same additional benefits, so I should have known better .

But, to be honest, these extras played no part in my decision making. But, I do need to look into the new dental discounts that started this year (at least on my plan).

 

[samm]

rest assured there is a good deal of embellishment in the post you quoted...

Reading this thread is stressful! I hope that medical cannabis will be covered by Medicare as soon as Biden legalizes it in 2021.

 

[Pellice]

One unexpected plus to my MA plan was an office at the MA company, dedicated to my particular public retiree plan, which was willing to help me with finding specialists and appointments. I had a muscle injury and was in a LOT of pain, to the point I couldn't concentrate enough to persist in phone calls. My MA rep kept me on the phone while dialing providers in my area until she found one who had an opening in a couple of days. That was so helpful!

One question I would now add to the perennial MA vs. Supplement debate is whether you get that sort of assistance with a Supplement, or instead are on your own for all arrangements. It was not a question I asked when I was researching the issue, but now I think of it as one I would recommend everyone research.

 

[pb4uski]

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.

Free, huh? You obviously don't know what you don't know.

 

[Katsmeow]

I have trouble following this thread, I, after talking to a few of my friends that I wanted a plan that covered everything.
I get a EOB, no bills. I wanted something that I didn’t have to think about when I got too old to figure it out.
Have no idea what plan it is.
Yes it costs a bit more.

Get traditional medicare with Plan G. You will have to pay a one time deductible (right now it is a little under $200), after that no bills or co payments. (NOte medicare is for medical care. Does not include routine vision or dental).

For prescriptions, pick a Part D plan based upon what medications you take.

 

[pb4uski]

Whether or not you think NY is ahead of the curve depends on what part of the curve you are on. Here's a price comparison between San Diego CA and Oneonta NY (picked because I have friends there and happen to know their zip code).

Unsubsidized monthly premium range for a 64 yr old on an ACA policy
NY -- $485.31 to $1673.02
CA -- $743.31 to $2020.12

Unsubsidized monthly premium range for a 30 yr old on an ACA policy
NY -- $485.31 to $1673.02
CA -- $304.81 to $764.28

While things in NY are looking great for the person about to go on Medicare, the 30 year old who's paying more to subsidize his elders might not feel the same way.

He's not necessarily paying to subsidize his elders... over his lifetime he's paying more now so he can pay less later.

Whole life insurance is priced similarly... level premiums for life... you overpay while you are young to be able to underpay later on... unlike term insurance where the cost increases as you age.

Most employer provided group health is the same.... same cost irrespective of age.