Old Fashioned Medicare verses Medicare Advantage Plans?

I see a number of you guys are claiming to be almost as old as Trapper, so a question.

Have you thought about your Health Care choices after age 65?

With Medicare Part C, Medicare Advantage Plans, there is the option of having coverage for more items, such as Dental, Hearing and Glasses, with the drawback that you are in a PPO of HMO and have the same private insurance companies which routinely deny coverage that your employers enroll you in now.

Medicare Parts A & B provide coverage for fewer areas, however it is back to the 1960's, where you walk in, get the service and Medicare pays the bill, no questions asked.

Which way will you go?

FWIW we went traditional, and we love it. No hassle about in network or out of network and no hassle about having the providers get paid.

Jake from State Farm wrote:I've looked at both and decided to keep working for a while due to the insurance my employer provides. My out of pocket costs to the wife and I would top out at least to $16,000. Me for prescriptions and her for pain treatments. I could probably cut way back on my prescriptions and stay fairly healthy but the wife is in pain every day and needs the treatments, unless she wants to turn into an addict.

Are you sure?

Asking because Medicare Parts A & B cost $164.90 per person per month & Medicare Part D (Drugs) while more expensive for some plans, and you cost chose the plan the provides the best coverage for the drugs you need, are nowhere near that expensive.  My plan cost $3.30 per month, though it is a "placeholder" for me, as we don't have any regular drug usage.

All three plans have deductible caps on the order of from 3k to 4k, plus there are the Medicare Supplement Plans, some of which will cover the 20% you pay before the cap limits for around $100 per person per month.

Using my numbers as an example, we pay just under $10k for this year for insurance for me and my SO, and the insurance covers 98% of our costs.

Adding all these numbers up it looks like you should be able to cover you and your SO for less than the $16k on old fashioned Medicare, as it seems unlikely you would be looking at $3k a year per person for a Part D Plan.

Jake from State Farm wrote:

Trapper Gus wrote:

Are you sure?

Asking because Medicare Parts A & B cost $164.90 per person per month & Medicare Part D (Drugs) while more expensive for some plans, and you cost chose the plan the provides the best coverage for the drugs you need, are nowhere near that expensive. My plan cost $3.30 per month, though it is a "placeholder" for me, as we don't have any regular drug usage.

All three plans have deductible caps on the order of from 3k to 4k, plus there are the Medicare Supplement Plans, some of which will cover the 20% you pay before the cap limits for around $100 per person per month.

Using my numbers as an example, we pay just under $10k for this year for insurance for me and my SO, and the insurance covers 98% of our costs.

Adding all these numbers up it looks like you should be able to cover you and

They base the cost of prescriptions on their actual cost, once that hits a certain amount you start paying out of pocket. One of the medications I take costs me $10/month. The actual cost is $1,000, but that's what they're going to use to get to the dollar amount for when they don't have to pay until it reaches the catastrophic level. Then coverage kicks in again and I "only" have to pay 25% or in this case it would be $250/month.
IOW if my maximum out of pocket is $6,000 I'm going to use up $5,000 of it in the first five months on just one prescription and then they pay more of the costs until the total amount reaches the catastrophic level. At least that's the way I understand it.

I found the world of choosing health coverage without a company limiting my choices to be sort of intimidating when I went through it, and it took about a month of reading the "Medicare & You" book from Medicare and research to begin to understand the options and costs.

That said, Medicare has an on-line "tool" which will find all the possible drug plans (Part D) or Medicare Advantage Plans (Part C), or Supplemental Plans, A, B, C, D, E, G, & H (explained in Medicare & You.

Here is the link: https://www.medicare.gov/plan-compare/#/?year=2023&lang=en

You can look at all the competing drug plans to see what the choices and costs are.

FWIW the "donut hole" was eliminated via the ACA. -

The Affordable Care Act eliminated the Coverage Gap (“the donut hole”) in the original Part D benefit, reducing patient cost-sharing responsibility for covered medications from 100% to 25%”.

but you should use the Medicare site tools to find what your costs would be.

Jake from State Farm wrote:If you go to the websites of the providers of gap coverage or whatever it is they usually have a place where you can enter in all your prescriptions and they will come back with a monthly cost. Mine ranged from $500 to $1000 monthly depending upon when in the year certain provisions kicked in and out due to out of pocket costs and other factors.

The Medicare on-line tool I posted the link to allows the user to enter all the drugs they normally buy and then gives a list of possible drug plans for the user's location and the yearly cost to the user for each one.  Somewhat easier than going to each site.

Jake from State Farm wrote:

Trapper Gus wrote:

The Medicare on-line tool I posted the link to allows the user to enter all the drugs they normally buy and then gives a list of possible drug plans for the user's location and the year cost to the user for each one.  Somewhat easier than going to each site.

I'll have to check it out. I really don't want to keep working forever just to pay for medications.

I don't know if it is typical, and I readily admit that I am talking about the few times in the last years when I have had dental surgery and been prescribed common antibiotics or Tylenol 5, but the costs have been way lower than the words in my Part D providers documentation suggested that they would be.  Antidotal, forsure, and the Medicare tool is where I would go if I were you, not reading about some guy who "thankfully so far" has no regular drugs.

Jake from State Farm wrote:

Trapper Gus wrote:

I don't know if it is typical, and I readily admit that I am talking about the few times in the last years when I have had dental surgery and been prescribed common antibiotics or Tylenol 5, but the costs have been way lower than the words in my Part D providers documentation suggested that they would be. Antidotal, forsure, and the Medicare tool is where I would go if I were you, not reading about so guy who "thankfully so far" has no regular drugs.

It looks like the Medigap plans don't cover prescriptions?

That is correct. Medicare Part D is what covers prescriptions.

Or if you want, a Medicare Part C (Medicare Advantage) Plan, which is buying a private insurance plan, partly or totally funded by the government Medicare program but set up like a PPO or HMO, depending on which one you chose.

Medigap plans, (and for those who might be reading this but have no idea what is being discussed, Medigap plans are from private insurers, but the coverage is exactly defined by the government via Medicare) cover the copays & deductibles and out of the country health care that Parts A & B don't cover. Depending on which one you chose, A, B, C, D, F, G, K, L, M & N there are different amounts covered for different copays and deductibles in Medicare Parts A & B. If you're up for this sort of thing, F & G provide high-deductible plans in some states which lower the month cost but have a deductible amount, yearly of $2,370 (2021). You have to be an old guy, like me, to qualify for G so probably your option here is F.

GRR Spartan wrote:Medicare advantage plans are throwing a bone to the health insurance companies and your premiums that pay their admin costs plus other costs.

And this is where things turn political, sort of...

I'm not fond of Part C, because there is a profit being made for no reason that I can see, other than what GRR said, however, due to Congress, Part C plans can provide more coverage than Parts A & B plus Medigap, and they are required to provide as much coverage as Part A & B, however, the downside is that it is like dealing with some of the more restrictive employer plans, which, if you happen to have a really good, "gold plated" employer plan, aka UAW or other union negotiated plan, you will not know what you are getting into.

https://www.cnbc.com/2023/02/01/why-it-pays-to-wait-to-claim-social-security-retirement-benefits.html

I.B. Fine wrote:

Trapper Gus wrote:https://www.cnbc.com/2023/02/01/why-it-pays-to-wait-to-claim-social-security-retirement-benefits.html

This is an ongoing debate with retirement advisors. Sure, you're monthly goes up 8% a year up to 70, but the gamble is are you going to have the health to enjoy it?
Break even is 81 and most people aren't traveling and spending as much money in their 80's, if they live that long.

Agreed, this totally depends on the person and their life expectations.

If they are in poor health and may peg out at any moment at age 62 then take Social Security Old Age Insurance then, though if they are in really poor health then Social Security Disability might be an option and it might be better financially, and I think Medicare might be included.

If they are still running 10k's at age 65 and all their biological parents and grandparents lived to be 100 then wait, if they can financially.

What is important to know is that since Social Security payments are adjusted for inflation every year the greater amount at age 70 means more income after that has an inflation adjustment built in.

There is also the question of a spouse who may be long lived, and who may be dependent on their spouses Social Security.

For people who are below a certain retirement income Medicaid also will pay part of health care costs. The income amounts are by state.

https://www.medicaid.gov/medicaid/eligibility/seniors-medicare-and-medicaid-enrollees/index.html

Kilberandy wrote:I'm new to the forum and am trying to wrap my head around the different types of Medicare options. I think I'm leaning towards traditional Medicare Parts A & B as it seems simpler and I don't want to deal with the hassle of in-network/out-of-network stuff.

That would be the better choice if that is your main concern. You should also consider a Medicare supplemental policy to cover some of the costs which Part A & Part B do not pay for and you should have a Part D policy to pay for drugs.

If vision & dental coverage is important to you then maybe you should consider a Part C policy as some of those provide that coverage, with the hassles you mention.

benefitowys wrote: also like the idea of getting services and having Medicare pay the bill, no questions asked.  I'm trying to do a little research on the cost of traditional Medicare. Can anyone point me in the right direction?

Sure, but what do you mean by "the cost of traditional Medicare"?

The cost to the person covered or the cost to the government.

The cost to the person covered for the average person are pretty simple.

Medicare Part A - for hospitalizations is free to the people using it, with a deductible and a deductible cap.

Medicare Part B - for doctors' visits has a subsidized monthly premium, adjusted each year.  For 2023 it is $168.90 per month.  There are programs, most related to Medicaid, for people with low incomes.  It has a deductible and a deductible cap.

Medicare Part C - Private Insurance replacement for Medicare Parts A & B and typically Part D also.  Prices and coverage are all over the map, but it must, by law, cover what Medicare Parts A & B cover.  This will probably limit the health care providers who are in network, etc.  Also varies by location as to policies available.

Medicare Part D - Private Insurance for prescription drugs.  Prices & drug coverage are all over the map, though there is a certain level of coverage that has to be there to qualify as a Medicare Part D program.  Also varies by location as to policies available.

Medicare Supplemental Polices - Private Insurance policies which cover some to almost all of the deductibles in Medicare Parts A & B.  There are 10 levels of coverage available, which are defined by Medicare.  Prices vary by company and location.

Medicare has a Web Page to help you sort this all out.

https://www.medicare.gov/

https://www.dailykos.com/stories/2023/8/4/2185318/-Vermont-Retirees-Block-Effort-to-put-them-in-Medicare-Advantage-NY-City-Retirees-win-a-round

This popped up on my liberal go to news site.  While I'm partly aware that the federal government is, in a money gift to private insurance, allowing private insurers to administrate traditional Medicare Parts A & B, this is the first I had heard of anyone forcing the Medicare eligible crowd to sign up for only MediCare Part C, the restrictive Medicare managed, IMO, for huge profit and shitty service by private insurance companies.

Is anyone aware of other cases of this?

Jake from State Farm wrote:I still haven't signed up for this because I'm working at home and no need to yet, but this is interesting:
The Medicare Advantage Ripoff that Every American Should Know About

It sounds to me like we're better off just going with the standard medicare and purchasing medigap instead of the medicare advantage (scam?).

Not sure what your intent was, but the link goes to a political news page.

Thanks, I didn't realize what a scam Medicare Part C is.

Somehow, I thought it worked like a standard self-insured system, where the insurance companies managed it but Medicare paid the bills.

I didn't realize it was a contracted amount per person regardless of if the people have bills or not.  This is a license to steal.

I am rethinking my advice that these programs might be right for some people.  That still may be the case, but I strongly believe that they need to be redone to reduce the costs for the rest of us.  Due to that I no longer recommend that anyone look at joining them.

GRR Spartan wrote:

Floyd Robertson wrote:From last week.

Hospitals are dropping Medicare Advantage left and right

On the west side of MI we have Priority Health that works closely with CoreWell former Spectrum which is the healthcare mafia in GR.  

If you, your siblings or parent(s) are or are going to be eligible for Medicare in 2024 time to sharpen up your call blocking skills because Oct 15 thru Dec 7.  It's open enrollment and everyone selling additional Medicare (like Joe Namath:roll:) along with those just wanting your money will start calling.  Medicare mailings will be filling your mail boxes too.

It's simple.  If 65 this year sign up for Medicare parts A & B, about $170 a month, and the drug plan, Part D, that fits your needs, mine is about $5 per month.  Then get the suplimental BCBS, in Michigan this is the only sane option, which depending on which plan will be between $80 to $160  per month.  A couple of them, F & G have high deductible  option that knock the price down.

Oh and if you have low income MI medicaid will pick up part of or all of the premiums.

https://www.axios.com/2023/11/22/hospitals-medicare-advantage-coverage-denial

Fucking private health insurance companies. May they all rot in hell.

The sooner we get private business out of front-line health care the better.

Zurn wrote:

Trapper Gus wrote:https://www.axios.com/2023/11/22/hospitals-medicare-advantage-coverage-denial

Fucking private health insurance companies.  May they all rot in hell.

The sooner we get private business out of front-line health care the better.

Be careful what you wish for.

https://www.dailymail.co.uk/news/article-12593821/Newborn-baby-just-seven-days-old-died-parents-slam-NHS-trust-centre-baby-death-scandal-coroner-orders-inquest.html

Rule number one about life & the internet.

People die and someone is always going to exploit their deaths to argue the opposite of reality.

There will always be errors in health care, regardless of anything else, and people will die. The article has nothing at all to do with the argument of private insurers denying treatment.