(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.