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justMongo Offline

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Post: #21
RE: Medicare Health Plans
(10-22-2014 03:29 PM)GeoffD Wrote:  I'm 56. As costs soar and all the boomers become Medicare-eligible, I suspect that Medicare will change quite a bit to control costs but it's time to become an expert on this. Is there somewhere that has detailed options about all the options and costs? I've lived my entire life with gold-plated corporate health insurance where I really didn't need to concern myself with any of this.

Getting the information is one of the big challenges to Medicare. Just before you become Medicare eligible, you will receive a guide to Medicare. It's a start.

Medicare come with two parts. A and B. You pay a monthly premium for Part B that can be deducted from your social security.

Basically A is for hospitalization and B is for doctor visits and medical supplies like for CPAP. There is a 20% copay under Part B. (Plus an annual deductible that is "means tested" based on your last year's income tax filing.)

Recently, Part D was added. That's prescription drugs. You have to sign up with a plan. The biggest problem with Part D is the doughnut hole. You hit a certain limit and there is little or no coverage in the gap. When you hit the gap is not dependent upon your out-of-pocket expenses -- it's based on the "alleged" cost of medications. The insurer isn't actually paying that much for the meds; but they get to use the "retail" cost in figuring when you hit the gap.

Two ways people go:

1) A Medicare Advantage Plan. You see them advertise on TV this time of year. You get everything rolled up into a single plan. The disadvantage is that it is an HMO. You have to use their network of doctors. (Which means they could not get a job as a real doctor.) You need a referral to a specialist...
The fundamental flaw in these plans is: They get paid a set amount by Medicare whether they deliver service or not. Driven by profit, they try to deliver minimum service. It breaks the old Fee for Service model.

2) One can stay with traditional Medicare and see any doctor who accepts Medicare -- they do not have to. With that one typically buys a Medigap Supplement that pays the 20% Part B leaves to the patient.
Medicare has standardized these plans by letter A, B, C... One also buys a Part D Rx plan. There are premiums and drug copays.

A trend I am presently noticing is a lowering of premiums but higher drug costs. Generics have gotten quite expensive. These plans use a tiered copay system to drive patients away from certain drugs. They are moving lower tier drugs to higher tiers.

Some employers provide good retiree medical benefits that exceed medicare. Most employers have been mandating retirees 65+ use medicare; but the employer offers a selection of plans plus a stipend based on salary and years of service. As the OP stated, his company has dumped retiree coverage. They can do that for most salaried employees as their "promise" had a stipulation that they could end their deal at their discretion. Union hourly workers -- have fairly solid deals.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(This post was last modified: 10-22-2014 04:35 PM by justMongo.)
10-22-2014 04:26 PM
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GeoffD Offline

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Post: #22
RE: Medicare Health Plans
(10-22-2014 04:26 PM)justMongo Wrote:  Two ways people go:

1) A Medicare Advantage Plan. You see them advertise on TV this time of year. You get everything rolled up into a single plan. The disadvantage is that it is an HMO. You have to use their network of doctors. (Which means they could not get a job as a real doctor.) You need a referral to a specialist...
The fundamental flaw in these plans is: They get paid a set amount by Medicare whether they deliver service or not. Driven by profit, they try to deliver minimum service. It breaks the old Fee for Service model.

2) One can stay with traditional Medicare and see any doctor who accepts Medicare -- they do not have to. With that one typically buys a Medigap Supplement that pays the 20% Part B leaves to the patient.
Medicare has standardized these plans by letter A, B, C... One also buys a Part D Rx plan. There are premiums and drug copays.

What do the premiums look like? Retired, I'm certainly not going to be showing anything close to a 6-figure income unless it's a capital gains hit from selling something. I have no interest in an HMO-style thing so it sounds like Medigap is what I'd be using. I'd rather pay insurance than risk co-pays that could wipe me out if something really expensive went wrong with me. I can't predict my Rx drug use then but a big deductible wouldn't kill me as long as it covers some wildly expensive Rx if something horrible went wrong.

You'd think there would be somewhere that covers all this in detail. I'm an information junkie. I've Googled a few times and never found anything that was better than simplistic high level stuff.
10-22-2014 05:06 PM
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justMongo Offline

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Post: #23
RE: Medicare Health Plans
(10-22-2014 05:06 PM)GeoffD Wrote:  ...as long as it covers some wildly expensive Rx if something horrible went wrong.

That's the rub.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-22-2014 05:18 PM
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retired_guy Offline

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Post: #24
RE: Medicare Health Plans
(10-22-2014 05:18 PM)justMongo Wrote:  
(10-22-2014 05:06 PM)GeoffD Wrote:  ...as long as it covers some wildly expensive Rx if something horrible went wrong.

That's the rub.

What kind of rub? How expensive? Where do you get it? Where do you put it?
10-22-2014 06:55 PM
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justMongo Offline

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Post: #25
RE: Medicare Health Plans
(10-22-2014 06:55 PM)retired_guy Wrote:  
(10-22-2014 05:18 PM)justMongo Wrote:  
(10-22-2014 05:06 PM)GeoffD Wrote:  ...as long as it covers some wildly expensive Rx if something horrible went wrong.

That's the rub.

What kind of rub? How expensive? Where do you get it? Where do you put it?

Well, I'll get specific. Suppose a person needed chemo drugs. They are considered specialty drugs -- they are very expensive and there is little or no coverage.

If that were to happen to me... I'd put my assets in Cayman Islands.... Sell the Nuclear Launch Codes... then show up at the VA as an indigent veteran.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-22-2014 07:26 PM
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retired_guy Offline

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Post: #26
RE: Medicare Health Plans
Yes, the prescription policy under Medicare is not that great. I believe it's next year they eliminate the "doughnut hole," but even then the "tiered" approach to establishing co-pays is really difficult for many people.

That was one of my greatest joys in converting to the VA plan. No matter what they dream up that I should take, it's $8 a copy. I can live with that!
10-22-2014 07:30 PM
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surferdude2 Offline

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Post: #27
RE: Medicare Health Plans
I use Plan F - high deductible for my Medicare supplemental coverage. The premium costs me 83$/mo. I pay the first $2110 as the deductible. After the deductible is met, plan F pays 100% of all charges that I incur after Medicare pays their part..

I could avoid the deductible by getting plan F standard version but the premium is $254/mo. That would cost me $3048/yr whether I used it or not. It pays 100% of all costs from the get go.

I figure I don't need insurance unless I get some terrible disease and even then I'll only be out the $2110 deductible plus 12 X $83 for the premium = $996. The total cost for a year could never exceed $2110 + $996 = $3106. That would be the worse case. If I am reasonably healthy, I'll pay the usual Medicare annual deductible of $147 and the plan F-high deductible premium of $996 for a total of $1143 for the year. That's a good saving over the standard plan F cost of $3048.

I consider what I have as catastrophic coverage and I'll gladly pay for the small stuff and hope it is ever so.

edit: I consider the Prescription plan D as nearly worthless but I keep it anyway.
(This post was last modified: 10-22-2014 08:11 PM by surferdude2.)
10-22-2014 08:06 PM
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justMongo Offline

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Post: #28
RE: Medicare Health Plans
(10-22-2014 08:06 PM)surferdude2 Wrote:  edit: I consider the Prescription plan D as nearly worthless but I keep it anyway.

+1 on that. It might even be responsible for an increase in Rx drug prices. Congress at its finest!

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-22-2014 08:40 PM
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me50 Offline

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Post: #29
RE: Medicare Health Plans
(10-22-2014 02:37 PM)justMongo Wrote:  
(09-16-2014 05:13 AM)JimZZZ Wrote:  I'm 14 years retired from a major corporation and was just notified that the company group health insurance plan will be cancelled for all salaried retirees at the end of 2014. After several hours of reading about various plans from private insurance companies, I am rightfully confused about the best choice.

I would really appreciate any advice from anyone who has been down this road. My questions are:

Which do you prefer (or hate):
Original Medicare
Original Medicare with Medigap
Medicare Advantage?

Which is better, HMO or PPO?

Which insurance company (or type of company) do you prefer (or hate)? I'm not sure the forum rules allow this question. If not, advise me and I will edit it out.

I also wonder if this question could be posted in the main forum. Maybe a poll?

I'm going to resurrect this necrothread to add some important info.

Choose your Medigap wisely (as the old knight said to Indiana Jones.)
As you are dumped from your company plan, you are guaranteed acceptance in the plan you choose. Should you be unhapppy with that plan and elect to change during an open enrollment period, then you become subject to medical underwriting... the new plan does not have to issue and may charge in accord with your health conditions.

B) If you do decide to make a change, never drop the first plan before you have the new plan in hand.

I am not sure that is the case if the person is eligible for LIS. Just something to check into.
10-22-2014 09:03 PM
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me50 Offline

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Post: #30
RE: Medicare Health Plans
I have to say this much, it people that weren't eligible for social security and medicare didn't receive it, we wouldn't have as much of a problem. Look at those that were told never to come back to the US but they were allowed to keep their social security that they weren't eligible for to begin with from what I understand
10-22-2014 09:05 PM
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