Where Does Medicare Fall Short?

[Rianne]

I start Medicare this year. I read articles talking about how healthcare in retirement will cost $250K +. How does that happen if you're on Medicare? I understand a specialist not accepting Medicare would be expensive.

My premiums including prescription drugs will be @ $280/month. I really don't expect to live past 95. That's $100,800 for premiums alone for 30 years. What are these extraordinary health expenses? I'm asking about OOP expenses that might be expected.

 

[REWahoo]

Long Term Care expenses are the big unknown.

 

[MichaelB]

Long Term Care expenses are the big unknown.

+1. The only thing known is, if needed, they will be costly.

Dental expenses can also be significant.

 

[mathjak107]

Dental was a biggie for us .

I have all implants , I rejected a few over the years and my wife needed extensive work .

So we dropped about 40k over the last ten years in to dental ,maybe more .


We were lucky enough to get a ny state partnership plan for long term care .

They are no longer available here .

We have 3 years of coverage and then a special version of medicaid will pay all bills .

All assets are 100% protected , with no look back ,spend down or restricted income for the stay at home spouse .

All our private homes here will take assignment if you paid for 2-3 years .

Most states have partnership plans but they are not full asset coverage .

They are called dollar for a dollar plans .so if medicaid paid 200k only 200k is protected .

Not a good deal compared to full asset

 

[Rianne]

I'm not buying a dental or vision policy. If an ophthalmologist finds something serious, that should be covered under medicare (right?). I can get a free eye exam and glasses for $500-$1000. I've had my current glasses for over 8 years.

If extraordinary dental work was needed, $40,000. So, approx. $1300/year over 30 years. I don't know what kind of payment plans dentists allow, but just saying.

LTC would be an issue but pension and SS would cover, depending on the care needed.
If I were in an LTC facility of sorts, I would not be out grocery, clothes shopping, driving, paying utilities, cable, all the rest, or vacationing. I'd probably sell the house, so no more maintenance. Ballpark, an intermediate LTC facility in our area runs $3000-$5000/month. That includes food and basic medical care. Even $8-$10,000 a month is doable according to Firecalc.

I'm trying to get a handle on our typical monthly spending as healthy seniors. And what we'd not be spending in a health care facility that we normally do.

I guess you plan and God laughs. I'm agnostic, so plans are a blueprint and nothing is guaranteed.

Is anyone willing to share about their experience and knowledge?

 

[Rianne]

I should clarify:
Medicare Plan G: $92/month
Part B: $170
Drug Plan: $11/month

When or if I switch my spending to LTC from normal day-to-day spending, it seems like a wash or am I totally and completely ignorant.

 

[mathjak107]

They get 130k a year here plus we would still have the stay at home spouse expenses.

Not even close for us

Plus many things are not covered in the nursing home as well

 

[Sunset]

I'm not buying a dental or vision policy. If an ophthalmologist finds something serious, that should be covered under medicare (right?). I can get a free eye exam and glasses for $500-$1000. I've had my current glasses for over 8 years.

If extraordinary dental work was needed, $40,000. So, approx. $1300/year over 30 years. I don't know what kind of payment plans dentists allow, but just saying.

........

How do you get free eye exams ?

Dental is about $300 for regular 2x yr cleaning visits = $9K for 30 yrs + whatever major implant/crown work would be needed probably avgs $15K per person (my guess).

 

[mathjak107]

I had undiagnosed diabetes and starting losing my teeth at a young age .

So my bottom is 6 implants that hold a full permanent implant denture ..that alone I just replaced for 15k . That did not include the implant costs

The top is a removable denture .

It works well on top but the bottom was not a do at all .

Over 10 years I rejected 3 of the implants and had to have them replaced .

3 years ago I had an implant canal infection destroy the implant and the expensive denture had to be cut up and destroyed to get to the infection .

The new one can be unscrewed

 

[pb4uski]

I start Medicare this year. I read articles talking about how healthcare in retirement will cost $250K +. How does that happen if you're on Medicare? I understand a specialist not accepting Medicare would be expensive.

My premiums including prescription drugs will be @ $280/month. I really don't expect to live past 95. That's $100,800 for premiums alone for 30 years. What are these extraordinary health expenses? I'm asking about OOP expenses that might be expected.

$250k sounds about right since that is for a couple. Our Part B, Part D and Medigap total $715/month for 2022. $715/month*12 months * 30 years (95-65) is $257,400. Then add in another $13,980 for Part B deductible ($233*2*30 years) and that is $271,380. YMMV.

 

[Gumby]

...
I guess you plan and God laughs. I'm agnostic, so plans are a blueprint and nothing is guaranteed....

In preparing for battle I have always found that plans are useless, but planning is indispensable.

Dwight D. Eisenhower

 

[geeky_grrl]

I'm not on Medicare yet, but my MIL was surprised at how big her prescription bills were compared to her previous employer health insurance. She has several thousand dollars a year in prescriptions even after part D.

 

[mathjak107]

I love Medicare .

Compared to the 800 dollar a month silver plan I had with 4500 out of pockets Medicare is a dream

 

[Rianne]

How do you get free eye exams ?

Dental is about $300 for regular 2x yr cleaning visits = $9K for 30 yrs + whatever major implant/crown work would be needed probably avgs $15K per person (my guess).

Free eye exams:
https://www.healthline.com/health/e...yeglasses-without-insurance#national-programs

At America's Best, if you buy 2 pairs of glasses you get a free eye exam.

 

[Midpack]

I love Medicare .

Compared to the 800 dollar a month silver plan I had with 4500 out of pockets Medicare is a dream

After paying COBRA for 18 months and a United Healthcare plan for 19 months between the time DW retired and her Medicare eligibility - I’d agree Medicare is a real bargain. I’ve been on for 3 years and DW is coming up on 1 year. Costs are more than reasonable IMO and claims handling has been great so far. Anyone who thinks Medicare isn’t a good value, needs to shop medical coverage on the open market…

 

[W2R]

I'm not on Medicare yet, but my MIL was surprised at how big her prescription bills were compared to her previous employer health insurance. She has several thousand dollars a year in prescriptions even after part D.

Exactly. I even have the exact same prescription drug coverage as I did before I retired, since I kept my federal BCBS to supplement Medicare (as suggested). But as you grow older, most people need more regular medications and as always, I have to pay my share. Also dental implants are expensive, and so on. Also, Medicare premiums can go up temporarily due to IRMAA.

On the other hand, I had cataract surgery in 2015 (paid for either by Medicare or BCBS, I forgot, but I didn't pay even one cent). I haven't needed glasses at all since then.

I would say just allow what you allowed before, but make sure you have plenty of "wiggle room" in your budget in case you need it. At least, that works for me. If I don't spend the extra on medical, then the next year I have a ball spending it on fun stuff.

 

[Dtail]

Medicare with the supplement would currently be more expensive than my MAGI ACA controlled medical expenses at the current age of 62.
I accept it and am thrilled for the lower medical for me between age 57 and 62 so far.

 

[Rianne]

Medicare with the supplement would currently be more expensive than my MAGI ACA controlled medical expenses at the current age of 62.
I accept it and am thrilled for the lower medical for me between age 57 and 62 so far.

The same for us, DH and me. We've been on ACA since 2014 and it's extremely affordable. We're on the Bronze plan. But Medicare will give us peace of mind traveling. I always worry about going out of network. And we can go to any hospital or specialist in the country that takes Medicare. With our ACA plan, we're limited to local Drs and care. Hopefully, we won't need to but it's comforting to know.

 

[sengsational]

With our ACA plan, we're limited to local Drs and care. Hopefully, we won't need to but it's comforting to know.

My ACA plan has a BlueCard feature that they don't hype at all. But if you get care out of state, the provider sends the claim to their local Blue Cross and it's treated as in-network. So if my insurance is for local provider Brand A, and I go across the street to Brand B, it's out of network, but if I cross the state line for service, it's in-network, LOL!

 

[ERhoosier]

Traditional Medicare (TA) has NO total out-of-pocket (OOP) maximum costs. Not only for prescription drugs (initial co-pays, 'donut hole', then 5% above that) but also for skilled nursing (even IF one initially qualifies, no coverage over 100d/yr) and inpatient care (no coverage over 90d/yr after one has used their "lifetime reserve days", lifetime max 190 mental health inpatient days). Private Medigap insurance can cover some of those gaps, but not all.
According to an Urban League study published this month, over 4 million Medicare recipients had over $5,000 in OOP medical expenses. Some 800,000 has OOP expenses over $15,000, with some much, MUCH higher than that.

Medicare Advantage (MA) with its HMO-like structure offers some OOPmax protection, but those limits are now up over $7,500k/yr ($11,300 for in- & out-of-network care if MA plan allows). And that does not include expenses not approved by MA (deemed "not medical necessary", which commonly crop up).
https://www.urban.org/research/publication/adding-out-pocket-spending-limit-traditional-medicare


DW & I are transitioning to Medicare this year and our total costs (inc premiums, IRMAA (TM supplement & Part D), deductibles/co-pays) will likely be a bit lower than when we were on ACA (no subsidy) & COBRA ... IF we have no medical catastrophe. But the lack of an OOP max with TM (or a 'true' OOPmax with MA) is (to use the OP's words) is a big feature where Medicare 'falls short'.

 

[rodi]

One of the things we discovered when DH went on Medicare was that the annual checkup wasn't $0 like it was under ACA. But the insurance and OOP expenses are so much lower than the ACA plan he was on more than make up for that.

 

[Bamaman]

I hope this clarifies things:

"Across the board, the average stay in a nursing home is 835 days, according to the National Care Planning Council." That's 2.3 years.

It's said that 50-70% of the population will need some kind of assisted living or full nursing home care. The average time in assisted living is 28 months.

We had an aunt in full nursing home care for about 4 years. I remember going into the lunchroom trying to find her one day, and it was a sea of blue hairs--every one of them in a wheelchair. There were very few men that lived there.

 

[Time2]

I should clarify:
Medicare Plan G: $92/month
Part B: $170
Drug Plan: $11/month

OK, I am confused.

Your Medicare is $92?

My Medicare is $170.10
My part B plan G is $188.30
Drug plan is $22.70.
What am I doing wrong?

 

[Midpack]

I should clarify:
Medicare Plan G: $92/month
Part B: $170
Drug Plan: $11/month

When or if I switch my spending to LTC from normal day-to-day spending, it seems like a wash or am I totally and completely ignorant.

OK, I am confused.

Your Medicare is $92?

My Medicare is $170.10
My part B plan G is $188.30
Drug plan is $22.70.
What am I doing wrong?

What’s confusing? You’re saying much the same, although your Plan G is the highest I’ve seen (1 person?). Your Part D is higher too but you probably have better Rx benefits.

 

[marko]

I love Medicare .

Compared to the 800 dollar a month silver plan I had with 4500 out of pockets Medicare is a dream

+1
For all its "shortcomings", I'm getting better care than when I was paying $13k a year with a $3000 deductible. I may well have had no insurance as I never went beyond the deductible.