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Medicare: What Are The Options?
- Thread starter Huntn
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I have been talking to insurance brokers. What kind of experts would you recommend?
Primarily I've been talking to one guy who prefers Medicare advantage (PPO) that offers both health care and RX coverage for $37 a month (not counting Part B which is deducted about $134 a month from you social security payment. If you go into the hospital it's $395 for 4 days before insurance kicks in. This would be me going as an individual with United Health Care. My understanding is that pools of people are State by State.
The other guy is a Trust that covers retired airline employees. He prefers the Medicare Supplemental (HMO I think), but his plan is $220 a month and with a hospital stay it's $95 x5 ($475) days before insurance kicks in, but in this case I'm paying $2640 a year for coverage, versus $444 a year, before I ever see a doctor.
Complicating the decision the Supplemental guy seems sure that the price of the other plan is the equivalent of an intro price and it's sure to go up, although the first guy denies that. Secondly my understanding is that the Advantage plans are harder to find Doctors who will participate in that plan. Although both say there is no penalty for going out of network, it will be harder to find doctors who participate. Thirdly the Supplemental Guy says that because as a non-profit trust, they represent about 25000 people, that their pricing will be more stable, and that as an individual in a program, prices to increase substantially.
Thoughts anyone? I plan on signing up for something this coming week.
@Huntn, be aware Medicare Part D and Advantage have the donut hole for prescription coverage. Depending on the plan determines where that donut hole appears. Generally you pay about $300 and then part D kicks in, then somewhere around $3000 coverage stops until you reach your out of pocket max around $5000 in which place you’re covered again.
If you have expensive, (especially brand name drugs) that you take regularly that will push you into the donut hole, a supppemental plan may be worth it.
If you have expensive, (especially brand name drugs) that you take regularly that will push you into the donut hole, a supppemental plan may be worth it.
P.S. If you need any help calculating drug costs please let me know. I have access to that sort of information.
Thank you. I take 2 maintenance drugs and my wife takes six, but she won’t be on Medicare for another 5 years.
This is all very confusing. My wife is older than I am and she retired 4 years ago. She is pretty healthy. We signed her up with Healthnet which is now Allwell. It’s an Advantage plan. We pay $23 a month. All her visits are covered. All preventative stuff is covered. Mammograms, etc. Covered. She’s referred to a specialist, covered. She takes one med which costs about $50 a month. Other than that she has no out of pocket costs. All the facilities are nice, the doctors are recommended, no issues. She even signed up for program a called Silver and Fit. Gives her access to LA Fitness health club for free.
I am not sure what a hospital stay would cost, but so far all her healthcare is costing me is $23 a month. What am I missing?
I am not sure what a hospital stay would cost, but so far all her healthcare is costing me is $23 a month. What am I missing?
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This is what I am wondering. For myself the quoted Advantage plan is $37 a month. I assume her dental is not included in that price which really has no bearing on the monthly Health premium issue. Both options I’m looking at, Dental runs about $60 a month. I also need to verify if that is tied to the other coverage or if it is a stand alone product. So far my biggest concern is verifying that my doctor will accept the Advantage plan. Will be verifying that this week.
The insurance brokers are salespeople for insurance policies and they are a good resource to use.
I also believe that you should talk to a financial services retirement specialist for a comprehensive view of everything. Your healthcare is related to your finances and taxes.
When I signed up a couple of years ago I found that the only Advantage plans offered in my area were HMOs and since I wanted to keep my current doctor, I didn't spend much time investigating Advantage plans.
The question I'd have about them is; what's the coverage you'd get under the Advantage plan during a long hospital stay when you're really really sick? Yes the comparable costs of the first 4 days are an issue to be concerned about, but what you really need to find out is what happens to the benefits and coverage over time.
Supplemental plans are valuable for what you get as your Medicare benefits start to go down and ultimately phase out......which they do if you're sick and in the hospital for a long time. Supplemental plans are designed to kick in and extend those Medicare benefits.
What do the Advantage plans do? I dunno, but that's what I think you need to find out.
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After two months of agonizing over my Medicare choices, 
I have decided to go with an Advantage Plan as offered by a Trust managed by a group created by and for the benefit of retirees from my company.
It boiled down to two options, a United Health Care Advantage plan (individual coverage) that cost $37 a month for Health and RX coverage (max $6700 annual out of pocket, each hospital stay $395 a day for 4 days), versus a Retiree Trust (group) Supplemental plan at $220 per month (max $1500 annual out of pocket, hospital stay "0"), and a Blue Cross Blue Shield Advantage plan at $164 a month ($5000 max out of pocket, $95 a day for 5 days) for the same type of coverage.
For cost savings, I was favoring the UHC plan because it is substantially less expensive per month for premiums. However I recognized under the UHC plan that each hospital stay would be substantially more expensive ($1580 for 4 days VS $475 for 5 days per visit), even though I am healthy, you never know.
Ultimately when I took into account was the Silver Sneaker coverage that the Company Retiree Trust plan (about $60 a month YMCA membership of which I am a member), that lowered the difference between the BCBS Advantage plan down to a $62 a month difference ($164- $65= $99 vs $37 for UHC plan), I decided the difference was not significant enough, and that the Trust plan had both a lower per hospital visit cost, a lower total out of pocket cost (although I don't think this will be a factor), in addition to offering a better Dental Plan for about the same cost as what I could get through UHC, pushed my decision towards the Trust. I acknowledge if sickly, the $220 per month supplemental with 0 hospital charges would be the absolute best and includes a low $1500 oop. Eventually when my wife get's off her more expensive plan and transitions to a less expensive plan, I will probably switch to the Supplemental plan mentioned.
Note: All of the above is in addition to the $134 Part B (out patient doctor care) that is taken from your Social Security Payment.
I have decided to go with an Advantage Plan as offered by a Trust managed by a group created by and for the benefit of retirees from my company.It boiled down to two options, a United Health Care Advantage plan (individual coverage) that cost $37 a month for Health and RX coverage (max $6700 annual out of pocket, each hospital stay $395 a day for 4 days), versus a Retiree Trust (group) Supplemental plan at $220 per month (max $1500 annual out of pocket, hospital stay "0"), and a Blue Cross Blue Shield Advantage plan at $164 a month ($5000 max out of pocket, $95 a day for 5 days) for the same type of coverage.
For cost savings, I was favoring the UHC plan because it is substantially less expensive per month for premiums. However I recognized under the UHC plan that each hospital stay would be substantially more expensive ($1580 for 4 days VS $475 for 5 days per visit), even though I am healthy, you never know.
Ultimately when I took into account was the Silver Sneaker coverage that the Company Retiree Trust plan (about $60 a month YMCA membership of which I am a member), that lowered the difference between the BCBS Advantage plan down to a $62 a month difference ($164- $65= $99 vs $37 for UHC plan), I decided the difference was not significant enough, and that the Trust plan had both a lower per hospital visit cost, a lower total out of pocket cost (although I don't think this will be a factor), in addition to offering a better Dental Plan for about the same cost as what I could get through UHC, pushed my decision towards the Trust. I acknowledge if sickly, the $220 per month supplemental with 0 hospital charges would be the absolute best and includes a low $1500 oop. Eventually when my wife get's off her more expensive plan and transitions to a less expensive plan, I will probably switch to the Supplemental plan mentioned.
Note: All of the above is in addition to the $134 Part B (out patient doctor care) that is taken from your Social Security Payment.
My monthly Medicare Plan costs for 2019:
Medicare Part A Hospital stays: 0 premium
Medicare Part B $134 per month (Doctor's visits)
Group Plan to supplement Medicare $129
Prescription Drug Plan $97
MetLife Dental PDP $59
Vision Plan $7
Total $426
This is actually more than I was paying as an active employee (subsidized by the employer) for medical coverage per person, $600 per year for 2 of us.
So I'm paying $5000 per year for just me on medical coverage. I'm wondering how much my annual medical expenses would actually be if I paid for my Doctor's visits, if it would amount to $3156 annual costs, I am currently paying for Part B + Supplemental coverage? If I get sick, yes it might. The year I was diagnosed with a Right Bundle Branch blockage (heart) the tests that were performed by the altruistic doctors were over somewhere between $5000 and $8000 and I got a your good to go at the end of it.
Medicare Part A Hospital stays: 0 premium
Medicare Part B $134 per month (Doctor's visits)
Group Plan to supplement Medicare $129
Prescription Drug Plan $97
MetLife Dental PDP $59
Vision Plan $7
Total $426
This is actually more than I was paying as an active employee (subsidized by the employer) for medical coverage per person, $600 per year for 2 of us.
So I'm paying $5000 per year for just me on medical coverage. I'm wondering how much my annual medical expenses would actually be if I paid for my Doctor's visits, if it would amount to $3156 annual costs, I am currently paying for Part B + Supplemental coverage? If I get sick, yes it might. The year I was diagnosed with a Right Bundle Branch blockage (heart) the tests that were performed by the altruistic doctors
were over somewhere between $5000 and $8000 and I got a your good to go at the end of it.
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My monthly Medicare Plan costs for 2019:
Medicare Part A Hospital stays: 0 premium
Medicare Part B $134 per month (Doctor's visits)
Group Plan to supplement Medicare $129
Prescription Drug Plan $97
MetLife Dental PDP $59
Vision Plan $7
Total $426
This is actually more than I was paying as an active employee (subsidized by the employer) for medical coverage per person, $600 per year for 2 of us.
So I'm paying $5000 per year for just me on medical coverage. I'm wondering how much my annual medical expenses would actually be if I paid for my Doctor's visits, if it would amount to $3156 annual costs, I am currently paying for Part B + Supplemental coverage? If I get sick, yes it might. The year I was diagnosed with a Right Bundle Branch blockage (heart) the tests that were performed by the altruistic doctors
If you just saw your PCP a couple times a year it would be well below $3156
. Unless you're on very expensive prescription medications you'd still be well under that amount. Assuming you're on generics and not seeing specialists you could probably spend under $1000 out of pocket / w/o insurance.I'm curious what your copays are.
But as horrible as the cost of insurance is, it's really good to have when you're sick.
If he reduced his part B, wouldn't that knock off stuff like ambulatory services? The prescription plan is something I'm curious about. OoP cost vs. that monthly waiver fee. I'm going to make an assumption that you're on some BP and or proton pump medication? Maybe cholesterol?
You can speak with your doctor about these things. Most are willing to sit down with their patients and help them pick a plan out or change things to accommodate them best.
You can speak with your doctor about these things. Most are willing to sit down with their patients and help them pick a plan out or change things to accommodate them best.
That is the thing, how much do you want to gamble? You are trying to protect yourself from a bankrupting illness.If you just saw your PCP a couple times a year it would be well below $3156
I'm curious what your copays are.
But as horrible as the cost of insurance is, it's really good to have when you're sick.
Some stuff is covered by supplemental, but sometimes 20%. I’d have to look it up.