My 2015 Medicare Costs/benefit changes

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dm200
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My 2015 Medicare Costs/benefit changes

Post by dm200 »

There have been many views and opinions expressed about the future changes in Medicare Advantage Costs and benefits.

I just looked at the 2015 changes to my Kaiser Medicare Cost (much like Medicare Advantage) plan in the Washington DC area. I have the "basic" option, and a quick look indicates that the monthly cost (beyond what Medicare deducts from my Social security) is increasing to $25 per month from $15 in 2014 and zero in previous years. Copays for primary care and specialists remain the same ($20 and $30 respectively), and prescription drugs go up just a few dollars. Bottom line is that, from what I see so far - I am pleased that this seems to be a very small cost increase.
montanagirl
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Re: My 2015 Medicare Costs/benefit changes

Post by montanagirl »

My MA "Value Plan" went from 30 to 50.50..

I really want to jump ship to a Plan F next year but I will miss the free gym membership.
kaneohe
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Re: My 2015 Medicare Costs/benefit changes

Post by kaneohe »

ymmv, but if you can manage to make the jump from MA to medigap, some plans have the Silver Sneakers program w/ free gym membership.....so ask.
AARP/UHC in CA has this, at least in my area.
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dm200
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Re: My 2015 Medicare Costs/benefit changes

Post by dm200 »

Another factor significantly affecting my "bottom line" health/medical care cost (that is not readily apparent in just reading the costs/charges and coverage documents) is that so many things can be don't at no charge, such as email consultations with physicians, phone appointments and virtual "housecalls" (they advertise this but I have not investigated it). It also is the case that for some kinds of issues my primary care physician will consult with a specialist (such as a cardiologist) - and reach a conclusion/response/recommendation without the need for me to actually see the specialist (and take the time and make the copayment). it also occurred to me that my previous physician has an office in a hospital medical office building and I had to pay $4 for parking every time would see her (or some of the other specialists in those offices).
Alan S.
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Re: My 2015 Medicare Costs/benefit changes

Post by Alan S. »

Watch for increased referral requirements for many covered services, and for declining numbers of specialists in networks. The latter is often not clearly disclosed.
Ron
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Re: My 2015 Medicare Costs/benefit changes

Post by Ron »

dm200 wrote:<snip...>I just looked at the 2015 changes to my Kaiser Medicare Cost (much like Medicare Advantage) plan in the Washington DC area. I have the "basic" option, and a quick look indicates that the monthly cost (beyond what Medicare deducts from my Social security) is increasing to $25 per month from $15 in 2014 and zero in previous years.
A 66% increase in one year and you don't see a possible future problem - as the premiums get to "big numbers" ?

It's probably part of the push to bring Advantage plans to be more in line with gap policies over time.

- Ron
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dm200
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Re: My 2015 Medicare Costs/benefit changes

Post by dm200 »

Ron wrote:
dm200 wrote:<snip...>I just looked at the 2015 changes to my Kaiser Medicare Cost (much like Medicare Advantage) plan in the Washington DC area. I have the "basic" option, and a quick look indicates that the monthly cost (beyond what Medicare deducts from my Social security) is increasing to $25 per month from $15 in 2014 and zero in previous years.
A 66% increase in one year and you don't see a possible future problem - as the premiums get to "big numbers" ?

It's probably part of the push to bring Advantage plans to be more in line with gap policies over time.

- Ron
By your math of this being a 66% increase - then when it went from zero to $15 - I suppose that was an infinite increase [$15 divided by zero!]. A $10 per month increase in premiums - with very small increases (in what I can determine now) is not much. I believe the correct measure of the percentage change is the expected or average total cost (including the monthly premium increase of $10 per month, small increase in some prescription drugs and zero increase in copays). So, just as an example if in 2014, I paid $180 in premiums, $120 for 6 visits to my primary care Dr, $180 for 6 specialist visits, and prescriptions costing $300 = $780. Then, in 2015 the same usage would be $300 in premiums, $120 primary care visits, $180 specialist visits, and $330 prescriptions = $930. $930/780 = 19% increase. Important also is the fact that the maximum cap on spending is still $3,400 - no change from 2014.

I believe an important measure of whether this increase I face causes my total costs (or projected/likely costs) to be increasing faster than what someone on Traditional Medicare and a typical supplement and the Prescription drug plan is seeing. I would like to hear back from folks with that combination and see what their percentage increase is.
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Sheepdog
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Re: My 2015 Medicare Costs/benefit changes

Post by Sheepdog »

My Humana Choice Regional PPO Advantage Plan have these increases for 2015. (I am in my 1st year with this plan.)
These are just select items with increases.
Monthly premium from $66 to $86....+30%
Doctor's office visits primary care ....No change
Specialists visits copay from $40 to $45......+12%
Outpatient diagnostic, xray, therapeutic services, etc. copay from $40 to $45%.....+12%
Advanced imaging (MRI, CTScan, etc. $200 copay to $270 Copay.....+35%
In-patient hospital stays copay.....+6.5%
Part D prescription drug coverage deductible from $0 to $225 !!

I just don't know whether to go back to Medicare + Medigap + Part D within a 1 year trial. They were increasing dramatically as well which is a reason I converted.
Unless you try to do something beyond what you have already mastered you will never grow. (Ralph Waldo Emerson)
Ron
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Re: My 2015 Medicare Costs/benefit changes

Post by Ron »

Just to put some numbers up for a traditional medigap plan thus far:

2014: Medigap Plan F (no deductible/co-pay) currently at 126.72 each (wife/me).
2015: Medigap Plan F - new rate not yet received.

2014: Part D (wife) - Humana Rx (through Wally-world): $12.60
2015: Part D (wife) - Humana Rx (through Wally-world): $15.70 - a 24.6% increase (she uses plan very little)

2014: Part D (me) - Cigna Rx: $33.20
2015: Part D (me) - Cigna RX: $32.90 - a 0.9% decrease (which is a surprise since I use the plan quite extensively and am currently in the catastrophic phase - past the doughnut hole).

We are required to get our coverage via a Medicare Exchange (Towers Watson) since my/our HRA (Health Reimbursement Account) contribution comes as a retirement benefit from my former employer. The plans selected meet our requirements for no co-pays or deductible (standard Medicare deductible paid by plan), along with coverage for our international travel - which we do every year and the plans offered are matched against usage history to ensure the best (based upon desire as well as cost) plan is available for selection. For example, for 2015 there will be a selection of 13 Medigap, 20 Part D (Drug), and 24 Advantage plans; however not all plans have updated 2015 costs at this time. We'll review our current plans against what's available when all costs are posted.

You have the option to go cheap a pay along the way or go for a bit more cost but don't have to worry about the incidentals during the year. If our medical was not well funded as it is, we probably would be looking at less expensive solutions.

FWIW,

- Ron
Last edited by Ron on Sat Oct 04, 2014 11:01 am, edited 1 time in total.
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plannerman
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Re: My 2015 Medicare Costs/benefit changes

Post by plannerman »

My group Medicare Advantage Plan (PPO) went up from $43 to $52--i'm happy.

Where we live, many of the specialist's practices have been bought up by the local hospitals (because they can charge Medicare more).
The upside for consumers is that because these hospitals are all in network so are these specialists.

plannerman
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dm200
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Re: My 2015 Medicare Costs/benefit changes

Post by dm200 »

plannerman wrote:My group Medicare Advantage Plan (PPO) went up from $43 to $52--i'm happy.

Where we live, many of the specialist's practices have been bought up by the local hospitals (because they can charge Medicare more).
The upside for consumers is that because these hospitals are all in network so are these specialists.

plannerman
Could you explain/elaborate how, apparantly, the same medical service is paid more by Medicare, if the practice iw owned by the hospital?
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jeffyscott
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Re: My 2015 Medicare Costs/benefit changes

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dm200 wrote:Important also is the fact that the maximum cap on spending is still $3,400 - no change from 2014.
I'm a long way from Medicare, but this would be the most important factor to me...what is the worst case for total max OOP + monthly premiums. Secondary consideration would be the expected total cost per year.

Sounds like you went from $0 + $3400 to $15x12+$3400 and then to $25x12+$3400. So the worst case scenario had a 5.3% increase followed by a 3.4% increase.
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dm200
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Re: My 2015 Medicare Costs/benefit changes

Post by dm200 »

jeffyscott wrote:
dm200 wrote:Important also is the fact that the maximum cap on spending is still $3,400 - no change from 2014.
I'm a long way from Medicare, but this would be the most important factor to me...what is the worst case for total max OOP + monthly premiums. Secondary consideration would be the expected total cost per year.

Sounds like you went from $0 + $3400 to $15x12+$3400 and then to $25x12+$3400. So the worst case scenario had a 5.3% increase followed by a 3.4% increase.
yes - that is certainly one way (of many) to look at it. There is also the Medicare Part B premium to consider if/when that deduction changes from the current 104.90.

I received the detailed book from Kaiser about the entire schedule of fees, charges, etc. As I originally posted, the Dr visit copays for my plan stay the same ($20 primary care and $30 specialist). Some other charges have gone up a little and some stay the same. This plan includes the prescription drug benefit and some drug categories have gone up slightly and some stay the same. The "donut hole" threshold has gone up a little as well (I am not up to the donut hole yet!)

The other "moving part" in this Kaiser Medicare Cost plan tending to keep my actual cost lower is that there are a few more things (and things I am learning how to use) that are no charge. On occasion, I have had a telephone appointment with my primary care doctor (No charge) and I make extensive use of email with several of my physicians (mostly my Primary care doctor) - No Charge. I have not used it yet, but Kaiser (in this area) is offering (and advertising) "virtual" house calls if you can connect with a video feed for after hours urgent type issues. This is also NO Charge. I am investigating this as well.

I certainly cannot "quantify" this - but in conversations with several folks who also have Kaiser (both Medicare and 'regular'), many of them are not taking advantage of these "no charge" features that Kaiser offers. Not only is there no charge, using such features can be much, much more convenient and save a lot of time - without (in my opinion) any loss of quality of care.

The other (IMO very significant) recently added/enhanced Kaiser feature in this area is "Urgent Care" facilities at a center that also has a "Clinical Decision Unit (CDU)". There are two of these within about a 15-20 minute trip for us. These facilities, in my opinion and experience, can handle almost all of what many consider "emergencies" in addition to "urgent" issues - 24 hours a day, 7 days a week. The copay is low ($30 in my case) and there is access to all kinds of equipment. If needed, patients can be kept there in the CDU for up to 24 hours. Last year, I spent about 18 hours (late afternoon until late morning the next day) there - and it is just like a hospital inside. There were some very sick folks there as well (from my observing them going in and out). My visit of 18 hours was a false alarm (my Doctor feared I might be having a heart attack - although I was of the opinion that such a possibility was near zero). My total cost was only $60 - for everything [$30 copay checking in and $30 copay to cardiologist]. My visit included chest X-ray, 3-4 blood tests, being hooked up with portable heart monitor, treadmill stress test, etc. Even with Traditional Medicare, I would guess that the equivalent time and services of an emergency room visit and staying in the hospital for the same 18 hours (overnight) would have been a bill of many hundreds of dollars.
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plannerman
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Re: My 2015 Medicare Costs/benefit changes

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dm200 wrote: Could you explain/elaborate how, apparantly, the same medical service is paid more by Medicare, if the practice iw owned by the hospital?
For one thing, they charge for both the doctor and the facility--just like if you wert to the ER--even though it's in the same doctors office you have always visited.

plannerman
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