Trying to help acquaintence - medicare costs

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dm200
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Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 9:21 am

An acquaintance is financially challenged. In trying to help her understand (and do something about) her challenges, I am trying to understand her Medicare costs. She is a retired teacher and is on Original Medicare (as best I can see). She thinks that she is getting some kind of added retirement healthcare benefit from the teachers retirement. She pays the normal $134 for Part B, but she also has $322 per month deducted from her retirement pay. This sounds like the cost for a Medicare supplement. She is 70 years old. She keeps talking about GETTING a Medicare benefit as a retiree, BUT when I look at her retirement statement for a month - they TAKE $322 every month. She does have a lot of health issues, costs, etc. and she says she normally does not have to pay anything beyond what Medicare and the other coverage (I assume supplement) pays.

Does her paying $322 per month sound like a lot - if (as she thinks) she is really getting a retiree benefit?

neilpilot
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Re: Trying to help acquaintence - medicare costs

Post by neilpilot » Thu Jan 11, 2018 9:31 am

Paying $456 sound like a lot. But unless you post what that $322 is buying her, any further discussion here will likely border on idle speculation.

sport
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Re: Trying to help acquaintence - medicare costs

Post by sport » Thu Jan 11, 2018 9:45 am

Perhaps she has a Medicare Advantage Plan through the state teachers retirement system. She would still have to pay the Part B premium, and the pension deduction would pay for the advantage plan.

neilpilot
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Re: Trying to help acquaintence - medicare costs

Post by neilpilot » Thu Jan 11, 2018 9:51 am

post deleted (information incorrect)
Last edited by neilpilot on Thu Jan 11, 2018 4:40 pm, edited 1 time in total.

ralph124cf
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Re: Trying to help acquaintence - medicare costs

Post by ralph124cf » Thu Jan 11, 2018 10:02 am

My employers after Medicare supplemental policy (which includes drugs) costs me $550/mo. for two people. I also have to pay Medicare normal rates, but no Part D charges. If this is a supplemental policy that includes drugs, then it does not seem out of line.

Ralph

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 10:04 am

neilpilot wrote:
Thu Jan 11, 2018 9:51 am
sport wrote:
Thu Jan 11, 2018 9:45 am
Perhaps she has a Medicare Advantage Plan through the state teachers retirement system. She would still have to pay the Part B premium, and the pension deduction would pay for the advantage plan.
Incorrect. A Part C plan, aka Medicare Advantage Plan, REPLACES Medicare Parts A & B, and sometimes also Part D and/or dental.
This is the idle speculation I was referring to in my post above. :happy
Yes. I asked her to find and show me the details of what exactly she is getting for the $322 per month - and what the retirement system is paying above that (as she thinks). She does not have an advantage plan. Until I did the math on her statement, she thought she was getting the $322 per month instead of her PAYING $322.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 10:07 am

ralph124cf wrote:
Thu Jan 11, 2018 10:02 am
My employers after Medicare supplemental policy (which includes drugs) costs me $550/mo. for two people. I also have to pay Medicare normal rates, but no Part D charges. If this is a supplemental policy that includes drugs, then it does not seem out of line.
Ralph
Thanks for the feedback. Yes, your $550 for two is in line with $322 for one.

Here then is the question for you. If you did not have the employer plan for which you pay $522, what would you pay entirely on your own? In other words, how much is the employer paying or how much do you save be having the employer plan?

donall
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Re: Trying to help acquaintence - medicare costs

Post by donall » Thu Jan 11, 2018 10:12 am

I would be very careful with someone’s Medicare supplemental insurance. In most cases it is not possible to change insurance carriers without a medical review or pre-existing clauses that can increase the premium.

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Re: Trying to help acquaintence - medicare costs

Post by neilpilot » Thu Jan 11, 2018 10:19 am

dm200 wrote:
Thu Jan 11, 2018 10:07 am
ralph124cf wrote:
Thu Jan 11, 2018 10:02 am
My employers after Medicare supplemental policy (which includes drugs) costs me $550/mo. for two people. I also have to pay Medicare normal rates, but no Part D charges. If this is a supplemental policy that includes drugs, then it does not seem out of line.
Ralph
Thanks for the feedback. Yes, your $550 for two is in line with $322 for one.

Here then is the question for you. If you did not have the employer plan for which you pay $522, what would you pay entirely on your own? In other words, how much is the employer paying or how much do you save be having the employer plan?
My wife and I are both 68, and we each pay $104 for a Plan G supplement and $17 for Part D. Since we each pay $121/mo total, with no subsidy, that $322 as a benefit does seem high to me.

sport
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Re: Trying to help acquaintence - medicare costs

Post by sport » Thu Jan 11, 2018 10:49 am

neilpilot wrote:
Thu Jan 11, 2018 9:51 am
sport wrote:
Thu Jan 11, 2018 9:45 am
Perhaps she has a Medicare Advantage Plan through the state teachers retirement system. She would still have to pay the Part B premium, and the pension deduction would pay for the advantage plan.
Incorrect. A Part C plan, aka Medicare Advantage Plan, REPLACES Medicare Parts A & B, and sometimes also Part D and/or dental.

This is the idle speculation I was referring to in my post above. :happy
I am presently on a Medicare Advantage plan, and it does REPLACE parts A & B. However, I still have the Part B premium deducted from my social security check. So, maybe my speculation is not so idle. :idea:

neilpilot
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Re: Trying to help acquaintence - medicare costs

Post by neilpilot » Thu Jan 11, 2018 10:55 am

sport wrote:
Thu Jan 11, 2018 10:49 am
neilpilot wrote:
Thu Jan 11, 2018 9:51 am
sport wrote:
Thu Jan 11, 2018 9:45 am
Perhaps she has a Medicare Advantage Plan through the state teachers retirement system. She would still have to pay the Part B premium, and the pension deduction would pay for the advantage plan.
Incorrect. A Part C plan, aka Medicare Advantage Plan, REPLACES Medicare Parts A & B, and sometimes also Part D and/or dental.

This is the idle speculation I was referring to in my post above. :happy
I am presently on a Medicare Advantage plan, and it does REPLACE parts A & B. However, I still have the Part B premium deducted from my social security check. So, maybe my speculation is not so idle. :idea:
Maybe you are incorrectly paying for Part B coverage?

sport
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Re: Trying to help acquaintence - medicare costs

Post by sport » Thu Jan 11, 2018 11:01 am

neilpilot wrote:
Thu Jan 11, 2018 10:55 am
sport wrote:
Thu Jan 11, 2018 10:49 am
neilpilot wrote:
Thu Jan 11, 2018 9:51 am
sport wrote:
Thu Jan 11, 2018 9:45 am
Perhaps she has a Medicare Advantage Plan through the state teachers retirement system. She would still have to pay the Part B premium, and the pension deduction would pay for the advantage plan.
Incorrect. A Part C plan, aka Medicare Advantage Plan, REPLACES Medicare Parts A & B, and sometimes also Part D and/or dental.

This is the idle speculation I was referring to in my post above. :happy
I am presently on a Medicare Advantage plan, and it does REPLACE parts A & B. However, I still have the Part B premium deducted from my social security check. So, maybe my speculation is not so idle. :idea:
Maybe you are incorrectly paying for Part B coverage?
I wish.
From https://www.medicare.gov/what-medicare- ... vices.html
"In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan."

pshonore
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Re: Trying to help acquaintence - medicare costs

Post by pshonore » Thu Jan 11, 2018 11:08 am

neilpilot wrote:
Thu Jan 11, 2018 10:55 am
sport wrote:
Thu Jan 11, 2018 10:49 am
neilpilot wrote:
Thu Jan 11, 2018 9:51 am
sport wrote:
Thu Jan 11, 2018 9:45 am
Perhaps she has a Medicare Advantage Plan through the state teachers retirement system. She would still have to pay the Part B premium, and the pension deduction would pay for the advantage plan.
Incorrect. A Part C plan, aka Medicare Advantage Plan, REPLACES Medicare Parts A & B, and sometimes also Part D and/or dental.

This is the idle speculation I was referring to in my post above. :happy
I am presently on a Medicare Advantage plan, and it does REPLACE parts A & B. However, I still have the Part B premium deducted from my social security check. So, maybe my speculation is not so idle. :idea:
Maybe you are incorrectly paying for Part B coverage?
I think it depends on the Advantage provider:

From Medicare.gov:

What you pay in a Medicare Advantage Plan
Your out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:

Whether the plan charges a monthly premium.
Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.
Whether the plan has a yearly deductible or any additional deductibles.
How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
The type of health care services you need and how often you get them.
Whether you go to a doctor or supplier who accepts assignment (if you're in a PPO, PFFS, or MSA plan and you go out-of-network).
Whether you follow the plan's rules, like using network providers.
Whether you need extra benefits and if the plan charges for it.
The plan's yearly limit on your out-of-pocket costs for all medical services.

ralph124cf
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Re: Trying to help acquaintence - medicare costs

Post by ralph124cf » Thu Jan 11, 2018 11:18 am

dm200 wrote:
Thu Jan 11, 2018 10:07 am
ralph124cf wrote:
Thu Jan 11, 2018 10:02 am
My employers after Medicare supplemental policy (which includes drugs) costs me $550/mo. for two people. I also have to pay Medicare normal rates, but no Part D charges. If this is a supplemental policy that includes drugs, then it does not seem out of line.
Ralph
Thanks for the feedback. Yes, your $550 for two is in line with $322 for one.

Here then is the question for you. If you did not have the employer plan for which you pay $522, what would you pay entirely on your own? In other words, how much is the employer paying or how much do you save be having the employer plan?
If I did not have the employers plan, my drug costs would go WAY up. We would have to pay the part D plan charge, plus $75/mo. each in IRMAA part D charges, plus about $6,000 in out of pocket charges for drugs, versus about $2,000 out of pocket for drugs now.

The medigap portion does not help much the first part of the year, but it does have a hard out-of-pocket cap of $3,000, and this usually kicks in around June, although last year it was reached in March. On an average year we get somewhat more in reimbursements than we pay in insurance charges, but the real point is that it is insurance, and Medicare does not have an out of pocket cap.

Ralph

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 11:22 am

donall wrote:
Thu Jan 11, 2018 10:12 am
I would be very careful with someone’s Medicare supplemental insurance. In most cases it is not possible to change insurance carriers without a medical review or pre-existing clauses that can increase the premium.
Yes - very good point.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 11:24 am

neilpilot wrote:
Thu Jan 11, 2018 10:19 am
dm200 wrote:
Thu Jan 11, 2018 10:07 am
ralph124cf wrote:
Thu Jan 11, 2018 10:02 am
My employers after Medicare supplemental policy (which includes drugs) costs me $550/mo. for two people. I also have to pay Medicare normal rates, but no Part D charges. If this is a supplemental policy that includes drugs, then it does not seem out of line.
Ralph
Thanks for the feedback. Yes, your $550 for two is in line with $322 for one.
Here then is the question for you. If you did not have the employer plan for which you pay $522, what would you pay entirely on your own? In other words, how much is the employer paying or how much do you save be having the employer plan?
My wife and I are both 68, and we each pay $104 for a Plan G supplement and $17 for Part D. Since we each pay $121/mo total, with no subsidy, that $322 as a benefit does seem high to me.
Thanks. Not only does the $322 seem high, but she claims that the employer pays something more? That's why we need to look at the other detailed information and choice(s) she might have. Maybe (we will see) the costs relate to drug coverage?

Katietsu
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Re: Trying to help acquaintence - medicare costs

Post by Katietsu » Thu Jan 11, 2018 11:39 am

The plan offered to retirees may not have a comparable plan available to the general public. The best teachers retiree plan here is about $250 a month to the retiree. The price of this same plan to a member of a smaller trade union is $600 a month. However, the plan’s benefits far exceed anything I have seen on the open market. The price of a B plus D plan from the same insurer with much higher copays, deductibles, out of pocket maxes, etc is over $200 a month. Their best plan to the general public is $350 a month and still not close to the coverage of the union plan. Usually these plans include extras like hearing aids that would otherwise run $5000+.

Maybe this retiree plan is not the best option. But I have found that a great number of people do not realize the potential medical costs, be it for insurance or care, still possible after reaching Medicare age. So, everything the friend believes may well be try. For someone who does not use much healthcare or have covered drug costs then they may not see the benefit of this better plan. But with even just regular preventative care and maintenance medications, one can break even pretty quickly.

If you want to look into it get the benefit guide and call the organization (union, state or whatever) providing the benefit.
Last edited by Katietsu on Thu Jan 11, 2018 11:50 am, edited 1 time in total.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 11:49 am

Katietsu wrote:
Thu Jan 11, 2018 11:39 am
The plan offered to retirees may not have a comparable plan available to the general public. The best teachers retiree plan here is about $250 a month to the retiree. The price of this same plan to a member of a smaller trade union is $600 a month. However, the plan’s benefits far exceed anything I have seen on the open market. The price of a B plus D plan from the same insurer with much higher copays, deductibles, out of pocket maxes, etc is over $200 a month. Their best plan to the general public is $350 a month and still not close to the coverage of the union plan.
Maybe this retiree plan is not the best option. But I have found that a great number of people do not realize the potential medical costs, be it for insurance or care, still possible after reaching Medicare age.
Yes - she might be fine - especially since she has many, some serious, conditions. In my opinion, she should know what she is getting, what she pays herself and the alternatives (both cost to her and benefits/risks).

She has been assuming the employer is and has been paying a lot for her coverage - maybe true and maybe not.

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Re: Trying to help acquaintence - medicare costs

Post by pshonore » Thu Jan 11, 2018 11:59 am

dm200 wrote:
Thu Jan 11, 2018 11:49 am
Katietsu wrote:
Thu Jan 11, 2018 11:39 am
The plan offered to retirees may not have a comparable plan available to the general public. The best teachers retiree plan here is about $250 a month to the retiree. The price of this same plan to a member of a smaller trade union is $600 a month. However, the plan’s benefits far exceed anything I have seen on the open market. The price of a B plus D plan from the same insurer with much higher copays, deductibles, out of pocket maxes, etc is over $200 a month. Their best plan to the general public is $350 a month and still not close to the coverage of the union plan.
Maybe this retiree plan is not the best option. But I have found that a great number of people do not realize the potential medical costs, be it for insurance or care, still possible after reaching Medicare age.
Yes - she might be fine - especially since she has many, some serious, conditions. In my opinion, she should know what she is getting, what she pays herself and the alternatives (both cost to her and benefits/risks).

She has been assuming the employer is and has been paying a lot for her coverage - maybe true and maybe not.
In CT, the standard retirement medical insurance is run by the Teachers Retirement board. All get Medicare A and pay the Part B Premium. The supplement (similar to a "G" plan) as well as Dental, drugs, vision and hearing costs about $400/month per person. The State pays 1/3, the retired teacher pays 1/3 and active teachers contribute 1/3 of the cost as part of their retirement plan contributions.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 12:03 pm

In CT, the standard retirement medical insurance is run by the Teachers Retirement board. All get Medicare A and pay the Part B Premium. The supplement (similar to a "G" plan) as well as Dental, drugs, vision and hearing costs about $400/month per person. The State pays 1/3, the retired teacher pays 1/3 and active teachers contribute 1/3 of the cost as part of their retirement plan contributions.
So, the retiree pays about $133?

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Re: Trying to help acquaintence - medicare costs

Post by investordoc » Thu Jan 11, 2018 12:16 pm

OP
Would it be possible for you to go over to your friends house and have her call the number on the statement where they take the $322 every month and listen in on another line or have her give them permission to discuss with you what the money that is being withdrawn from her account is actually for?
It is what it is until it isn't anymore

pshonore
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Re: Trying to help acquaintence - medicare costs

Post by pshonore » Thu Jan 11, 2018 12:37 pm

dm200 wrote:
Thu Jan 11, 2018 12:03 pm
In CT, the standard retirement medical insurance is run by the Teachers Retirement board. All get Medicare A and pay the Part B Premium. The supplement (similar to a "G" plan) as well as Dental, drugs, vision and hearing costs about $400/month per person. The State pays 1/3, the retired teacher pays 1/3 and active teachers contribute 1/3 of the cost as part of their retirement plan contributions.
So, the retiree pays about $133?
Yes (plus Part B premium)

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 12:53 pm

investordoc wrote:
Thu Jan 11, 2018 12:16 pm
OP
Would it be possible for you to go over to your friends house and have her call the number on the statement where they take the $322 every month and listen in on another line or have her give them permission to discuss with you what the money that is being withdrawn from her account is actually for?
We will start first looking at the detailed choices and documents she has received, but either did not fully understand. The answers may be there.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 12:55 pm

pshonore wrote:
Thu Jan 11, 2018 12:37 pm
dm200 wrote:
Thu Jan 11, 2018 12:03 pm
In CT, the standard retirement medical insurance is run by the Teachers Retirement board. All get Medicare A and pay the Part B Premium. The supplement (similar to a "G" plan) as well as Dental, drugs, vision and hearing costs about $400/month per person. The State pays 1/3, the retired teacher pays 1/3 and active teachers contribute 1/3 of the cost as part of their retirement plan contributions.
So, the retiree pays about $133?
Yes (plus Part B premium)
OK - these numbers make sense - based on all the benefits received beyond Original Medicare.

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Artful Dodger
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Re: Trying to help acquaintence - medicare costs

Post by Artful Dodger » Thu Jan 11, 2018 2:09 pm

sport wrote:
Thu Jan 11, 2018 11:01 am
neilpilot wrote:
Thu Jan 11, 2018 10:55 am
sport wrote:
Thu Jan 11, 2018 10:49 am
neilpilot wrote:
Thu Jan 11, 2018 9:51 am
sport wrote:
Thu Jan 11, 2018 9:45 am
Perhaps she has a Medicare Advantage Plan through the state teachers retirement system. She would still have to pay the Part B premium, and the pension deduction would pay for the advantage plan.
Incorrect. A Part C plan, aka Medicare Advantage Plan, REPLACES Medicare Parts A & B, and sometimes also Part D and/or dental.

This is the idle speculation I was referring to in my post above. :happy
I am presently on a Medicare Advantage plan, and it does REPLACE parts A & B. However, I still have the Part B premium deducted from my social security check. So, maybe my speculation is not so idle. :idea:
Maybe you are incorrectly paying for Part B coverage?
I wish.
From https://www.medicare.gov/what-medicare- ... vices.html
"In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan."
Yes.

The Medicare Advantage plan replaces the benefit administration component of Medicare; ie, it covers both the Medicare benefit as well as the beneficiary cost traditionally covered via a supplemental plan. The Part B premium is required for all except those with a low income subsidy or dual eligibles (Medicare / Medicaid). There is actually a Part A premium as well if you don't have enough quarters of paid Medicare tax. Part D coverage is often included in the MA plan as well, but not required.

To the OP, there are differences between retiree plans that cover Medicare eligibles (her current arrangement) and Medicare Advantage, Medicare supplement, and Part D plans. A retiree plan that is part of an employer group plan is likely to have less restrictive benefits vs Medicare Advantage plans and possibly even traditional Medicare. Most group retiree plans that cover prescriptions will have a more liberal formulary (ie., more drugs are covered) than Medicare Advantage or Part D plans. There are a number of specialty medications that are covered by very few or no MA plans. In addition, group retiree plans usually have the same out of pocket protection for their retirees as their under 65 members. Medicare Advantage and Part D still must contend with a zero benefit during the coverage gap (donut hole) and still pay some coinsurance once you have entered the catastrophic coverage level. These out of pocket costs can add up.

I would encourage her or you to gather her RX info and go to https://www.medicare.gov/find-a-plan/qu ... /home.aspx. Here you can input her prescriptions, and see which MA plans and/or Part D plans cover them and at what level. If all her prescriptions are covered, you can use the MA plan pricing to compare to her $322 coverage. If she wants a little more flexibility, go to one of the carriers that offer traditional supplements and get their comparable pricing. Remember, you'll have to purchase a separate Part D plan to cover RX with a supplement.
Last edited by Artful Dodger on Thu Jan 11, 2018 2:50 pm, edited 1 time in total.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 2:45 pm

The Medicare Advantage plan replaces the benefit administration component of Medicare; ie, it covers both the Medicare benefit as well as the beneficiary cost traditionally covered via a supplemental plan. The Part B premium is required for all except those with a low income subsidy or dual eligibles (Medicare / Medicaid). There is actually a Part A premium as well if you don't have enough quarters of paid Medicare tax.
From what I understand, with Medicare Advantage (MA) and the similar Medicare Cost (MC) plans, you MUST sign up for parts A and B. You normally would pay the normal (for you) part B premium to Medicare. While very few MA plans still do this, I think there are still a few that have such low charges to participants that they reimburse the particpants for some of the part B charges. In my own (and my wife's) MC plan, we only pay Kaiser $30 per month for our Medicare plan (that includes prescription drug coverage). We are subject to copays for most in person services and some degree of charges for X-Rays, scans, etc., surgery, hospitalizations, etc. You do not (and, in fact cannot) have Supplement. The tradeoff is that, in our case with the plan we selected, we might have to pay up to $6,000 per year out of pocket if we incur a lot of medical services.

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Re: Trying to help acquaintence - medicare costs

Post by Good Listener » Thu Jan 11, 2018 4:30 pm

neilpilot wrote:
Thu Jan 11, 2018 10:55 am
sport wrote:
Thu Jan 11, 2018 10:49 am
neilpilot wrote:
Thu Jan 11, 2018 9:51 am
sport wrote:
Thu Jan 11, 2018 9:45 am
Perhaps she has a Medicare Advantage Plan through the state teachers retirement system. She would still have to pay the Part B premium, and the pension deduction would pay for the advantage plan.
Incorrect. A Part C plan, aka Medicare Advantage Plan, REPLACES Medicare Parts A & B, and sometimes also Part D and/or dental.

This is the idle speculation I was referring to in my post above. :happy
I am presently on a Medicare Advantage plan, and it does REPLACE parts A & B. However, I still have the Part B premium deducted from my social security check. So, maybe my speculation is not so idle. :idea:
Maybe you are incorrectly paying for Part B coverage?
Neilpilot,
For the sake of this board and people who come across this thread in a search...... As nicely as I can say this, you are incorrect. Not correct. Wrong. You must pay for part B to get into a Medicare advantage plan. Please read up on this .

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 11, 2018 8:10 pm

Neilpilot,
For the sake of this board and people who come across this thread in a search...... As nicely as I can say this, you are incorrect. Not correct. Wrong. You must pay for part B to get into a Medicare advantage plan. Please read up on this .
YES, you are correct that you must be enrolled in both Part A and Part B to enroll in a Medicare Advantage plan.

However, I think (could be wrong) that there are some MA plans that will refund you some part of the Part B premium. I know there are some with zero added premiums.

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Pajamas
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Re: Trying to help acquaintence - medicare costs

Post by Pajamas » Thu Jan 11, 2018 8:15 pm

dm200 wrote:
Thu Jan 11, 2018 8:10 pm
Neilpilot,
For the sake of this board and people who come across this thread in a search...... As nicely as I can say this, you are incorrect. Not correct. Wrong. You must pay for part B to get into a Medicare advantage plan. Please read up on this .
YES, you are correct that you must be enrolled in both Part A and Part B to enroll in a Medicare Advantage plan.

However, I think (could be wrong) that there are some MA plans that will refund you some part of the Part B premium. I know there are some with zero added premiums.
Some Medicare Advantage plans pay part of the Part B premium directly, which increases the amount of monthly Social Security payments.

Similarly, some Medicaid programs will pay the premium for other types of insurance such as COBRA and then cover copays and similar if it is cheaper for them to do so than to provide Medicaid coverage directly and in full.

Some Medicare Advantage programs provide additional benefits such as an allowance for over-the-counter medications, transportation, etc.

If someone is looking to save money and is on Medicare, they should at least look at Medicare Advantage programs available to them as a first step.

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Re: Trying to help acquaintence - medicare costs

Post by sport » Thu Jan 11, 2018 9:00 pm

Artful Dodger wrote:
Thu Jan 11, 2018 2:09 pm
Medicare Advantage and Part D still must contend with a zero benefit during the coverage gap (donut hole) and still pay some coinsurance once you have entered the catastrophic coverage level.
There are so many plans, I guess it is hard to make general descriptions and always be correct. The MA plan I am in provides coverage during the donut hole. Although I have not experienced it and therefore do not know for sure, but I believe it has no copays in the catastrophic coverage level. I hope not to find out.

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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Fri Jan 12, 2018 9:04 am

sport wrote:
Thu Jan 11, 2018 9:00 pm
Artful Dodger wrote:
Thu Jan 11, 2018 2:09 pm
Medicare Advantage and Part D still must contend with a zero benefit during the coverage gap (donut hole) and still pay some coinsurance once you have entered the catastrophic coverage level.
There are so many plans, I guess it is hard to make general descriptions and always be correct. The MA plan I am in provides coverage during the donut hole. Although I have not experienced it and therefore do not know for sure, but I believe it has no copays in the catastrophic coverage level. I hope not to find out.
Although I have been fortunate, my Medicare plan does have the donut hole, but it is not zero - but a smaller benefit than on either side.

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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Fri Jan 12, 2018 9:04 am

If someone is looking to save money and is on Medicare, they should at least look at Medicare Advantage programs available to them as a first step.
Yes, agree.

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Re: Trying to help acquaintence - medicare costs

Post by dbr » Fri Jan 12, 2018 9:40 am

Where is all her mail? Especially at this time of year there should be communications from the plan that might have new medical ID cards, new plan descriptions, lists of participating facilities, confirmations of premiums paid, etc., etc. What exists for present documentation of SS, drivers license, Medicare, etc. cards and where are they?

One sign I have experienced with those in the beginning stages of dementia of different kinds is people stop processing their mail, pile it up, throw it away, file it opened or unopened in completely illogical places, etc. It sounds like this goes well beyond just not being financially adept. Not knowing what your health care benefits are is a major problem. (I have one acquaintance who proudly showed me all the payments on his water, phone, and gas and electric bills -- checks carefully written, stapled to each bill, and filed BUT NOT MAILED. His phone and internet had been cut off and the water company was coming the next day to turn off water service. He had a pile of unopened disconnect notices piled up in a drawer. His compliant that got me involved was that his computer didn't work any more.)

Also, as suggested, an obvious starting point is to call whatever phone numbers can be found on her pension statement.

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Re: Trying to help acquaintence - medicare costs

Post by Shallowpockets » Fri Jan 12, 2018 9:58 am

Get Medicare for Dummies.
People misunderstand all sorts of things about Medicare because they do not understand the terminology.
First. you need to get your Part A, B, etc correct. Then there are Plans. Plans are not Parts. Lots of confused talk usually is cross thinking on these points, thinking we are talking the same thing, but not so.

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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Fri Jan 12, 2018 10:04 am

Shallowpockets wrote:
Fri Jan 12, 2018 9:58 am
Get Medicare for Dummies.
People misunderstand all sorts of things about Medicare because they do not understand the terminology.
First. you need to get your Part A, B, etc correct. Then there are Plans. Plans are not Parts. Lots of confused talk usually is cross thinking on these points, thinking we are talking the same thing, but not so.
Right. There may be, for example, many Medicare Advantage (or Medicare Cost) plans if you choose medicare part C. Even the same provider (such as Kaiser or Humana) may offer more than one plan.

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Re: Trying to help acquaintence - medicare costs

Post by retiredjg » Fri Jan 12, 2018 10:36 am

I didn't read every comment fully, so maybe I'm on the wrong track.

There is a lot of discussion here about Medicare Advantage plans. I don't think that is what she has. I think a Medicare Advantage plan is something she would buy directly from a private insurance company and she would pay the full premium, not just part.

I think she has been allowed to continue her insurance plan with her former governmental employer as part of her retirement benefits package. She pays part and they pay part. She also pays for Medicare Part B. She may not have chosen to enroll in Part D because Rx coverage is likely included in the employer plan.

Since she is no longer working, Medicare should be her primary coverage and the former employer plan is her secondary coverage. Between the two of them, she may be paying no medical bills at all. She might have co-pays on her prescriptions though.

This is not unusual - it is the type of set up I have as a former federal employee. I pay a monthly premium (comes out of my pension check), the govt pays a monthly premium, and I pay for Medicare Part B as well. My employer plan happens to be BCBS, but it could be any one of a number of plans and I have the option to change each year if I want. I pay no medical bills (so far). I do have co-pays on Rx. See if this sounds like what she is doing.

To my knowledge, what I'm doing is NOT a Medicare Advantage program. It is simply my chosen supplement to Medicare Part A (free) and Part B (I pay for).

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Re: Trying to help acquaintence - medicare costs

Post by dbr » Fri Jan 12, 2018 10:41 am

retiredjg wrote:
Fri Jan 12, 2018 10:36 am
I didn't read every comment fully, so maybe I'm on the wrong track.

There is a lot of discussion here about Medicare Advantage plans. I don't think that is what she has. I think a Medicare Advantage plan is something she would buy directly from a private insurance company and she would pay the full premium, not just part.

I think she has been allowed to continue her insurance plan with her former governmental employer as part of her retirement benefits package. She pays part and they pay part. She also pays for Medicare Part B. She may not have chosen to enroll in Part D because Rx coverage is likely included in the employer plan.

Since she is no longer working, Medicare should be her primary coverage and the former employer plan is her secondary coverage. Between the two of them, she may be paying no medical bills at all. She might have co-pays on her prescriptions though.

This is not unusual - it is the type of set up I have as a former federal employee. I pay a monthly premium (comes out of my pension check), the govt pays a monthly premium, and I pay for Medicare Part B as well. My employer plan happens to be BCBS, but it could be any one of a number of plans and I have the option to change each year if I want. I pay no medical bills (so far). I do have co-pays on Rx. See if this sounds like what she is doing.

To my knowledge, what I'm doing is NOT a Medicare Advantage program. It is simply my chosen supplement to Medicare Part A (free) and Part B (I pay for).
Almost certainly this is correct and is a common arrangement. The problem is that she does not understand what she has, why there is a payment deducted from her monthly pension check, where her ID card for the secondary coverage is, and whether or not she is getting her secondary coverage benefits claimed with providers. All of this can be resolved by checking with her benefits department and paying attention to anything and everything she is receiving in the mail. If there have been any actual claims on this coverage there would be a statement of benefits mailed to her for each claim.

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Re: Trying to help acquaintence - medicare costs

Post by retiredjg » Fri Jan 12, 2018 5:31 pm

dbr wrote:
Fri Jan 12, 2018 10:41 am
Almost certainly this is correct and is a common arrangement. The problem is that she does not understand what she has, why there is a payment deducted from her monthly pension check, where her ID card for the secondary coverage is, and whether or not she is getting her secondary coverage benefits claimed with providers.
Well this almost sounds like she has the secondary coverage but since she has no card, she may not have provided that information to her medical providers. If she had, there should be EOB's (explanation of benefits) for every medical visit or procedure she has had.

On the other hand, you state...."She does have a lot of health issues, costs, etc. and she says she normally does not have to pay anything beyond what Medicare and the other coverage (I assume supplement) pays.".....so it appears that she actually is getting the benefits she is paying for.

If she were not getting the secondary coverage, she would have stacks and stacks of medical bills or know that she had paid numerous bills in the past.

If she were to go to a new doctor and be asked to present her insurance cards, what would she present? If she has seen a new provider recently, maybe she will remember.

Is it possible she has chosen electronic service only and "turned off" getting the EOB's in the mail? Has she moved and not updated her current address with her supplemental insurance provider? Is it possible this is some quirk about the former employer's insurance - everything is done electronically?


Maybe I got lost in all the discussion. Is your only question just whether the $322 a month sounds like a lot? I can tell you it is more than I pay, but there could be significant differences between different governmental retirement benefits so I don't have an opinion on whether it is "a lot" or not.

Even if it is "a lot", could she be getting something cheaper in "the marketplace"?

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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Sat Jan 13, 2018 10:53 am

Maybe I got lost in all the discussion. Is your only question just whether the $322 a month sounds like a lot? I can tell you it is more than I pay, but there could be significant differences between different governmental retirement benefits so I don't have an opinion on whether it is "a lot" or not.
Even if it is "a lot", could she be getting something cheaper in "the marketplace"?
Yes.. and whether she has better choices. She thinks she is getting some big healthcare benefits as a retiree. When I showed her that they were taking $322 every month from her retirement benefit, she was surprised.

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Re: Trying to help acquaintence - medicare costs

Post by dbr » Sat Jan 13, 2018 11:50 am

dm200 wrote:
Sat Jan 13, 2018 10:53 am
Maybe I got lost in all the discussion. Is your only question just whether the $322 a month sounds like a lot? I can tell you it is more than I pay, but there could be significant differences between different governmental retirement benefits so I don't have an opinion on whether it is "a lot" or not.
Even if it is "a lot", could she be getting something cheaper in "the marketplace"?
Yes.. and whether she has better choices. She thinks she is getting some big healthcare benefits as a retiree. When I showed her that they were taking $322 every month from her retirement benefit, she was surprised.
A really good and high priced Medigap/Supplemental insurance plan could come in at $200-$250, and there are plenty of perfectly adequate plans for much less. I can tell you one example I am aware of for Federal Employees Health Benefits for a particular Federal retiree I know is $229.64/month for 2018. I don't know what my former employer would be charging now for retiree supplemental insurance because they terminated the plan a couple of years ago. One can go to the Medigap market for one's state and get pricing.

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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Sat Jan 13, 2018 11:55 am

dbr wrote:
Sat Jan 13, 2018 11:50 am
dm200 wrote:
Sat Jan 13, 2018 10:53 am
Maybe I got lost in all the discussion. Is your only question just whether the $322 a month sounds like a lot? I can tell you it is more than I pay, but there could be significant differences between different governmental retirement benefits so I don't have an opinion on whether it is "a lot" or not.
Even if it is "a lot", could she be getting something cheaper in "the marketplace"?
Yes.. and whether she has better choices. She thinks she is getting some big healthcare benefits as a retiree. When I showed her that they were taking $322 every month from her retirement benefit, she was surprised.
A really good and high priced Medigap/Supplemental insurance plan could come in at $200-$250, and there are plenty of perfectly adequate plans for much less. I can tell you one example I am aware of for Federal Employees Health Benefits for a particular Federal retiree I know is $229.64/month for 2018. I don't know what my former employer would be charging now for retiree supplemental insurance because they terminated the plan a couple of years ago. One can go to the Medigap market for one's state and get pricing.
OK - then why would this public school retiree be paying $322 AND (allegedly) be receiving some added benefits from the state teachers retirement system? Somehow, I think there is more to this story ...

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Re: Trying to help acquaintence - medicare costs

Post by BL » Sat Jan 13, 2018 11:58 am

It is good to get the information to know exactly what she has.
I would be extremely cautious in encouraging change, as it could end up costing her lots of money, or just upsetting co-pays, etc.

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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Sat Jan 13, 2018 12:00 pm

BL wrote:
Sat Jan 13, 2018 11:58 am
It is good to get the information to know exactly what she has.
I would be extremely cautious in encouraging change, as it could end up costing her lots of money, or just upsetting co-pays, etc.
Yes - I agree 100%

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Re: Trying to help acquaintence - medicare costs

Post by dbr » Sat Jan 13, 2018 12:04 pm

dm200 wrote:
Sat Jan 13, 2018 11:55 am


OK - then why would this public school retiree be paying $322 AND (allegedly) be receiving some added benefits from the state teachers retirement system? Somehow, I think there is more to this story ...
Sure, the story is they don't know what they have and she doesn't understand what is involved in retiree benefits in general or how Government health care benefits work. The first step is to find out from the teachers retirement plan what that deduction is for and after that to consider possible alternatives. The actual benefits schedule for the teacher plan has to be examined. Someone already mentioned the plan could include drug coverage so that Plan D is not needed. Plan D could be worth another $50/mo, give or take a factor of 2.

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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Sat Jan 13, 2018 12:28 pm

dbr wrote:
Sat Jan 13, 2018 12:04 pm
dm200 wrote:
Sat Jan 13, 2018 11:55 am
OK - then why would this public school retiree be paying $322 AND (allegedly) be receiving some added benefits from the state teachers retirement system? Somehow, I think there is more to this story ...
Sure, the story is they don't know what they have and she doesn't understand what is involved in retiree benefits in general or how Government health care benefits work. The first step is to find out from the teachers retirement plan what that deduction is for and after that to consider possible alternatives. The actual benefits schedule for the teacher plan has to be examined. Someone already mentioned the plan could include drug coverage so that Plan D is not needed. Plan D could be worth another $50/mo, give or take a factor of 2.
Dealing with her is like peeling an onion. BUT - one layer at a time..

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Re: Trying to help acquaintence - medicare costs

Post by retiredjg » Sat Jan 13, 2018 3:48 pm

dbr wrote:
Sat Jan 13, 2018 11:50 am
A really good and high priced Medigap/Supplemental insurance plan could come in at $200-$250, and there are plenty of perfectly adequate plans for much less.
Where does a person find plans like that? I know that is a dumb question, but I've never had anything except employer provided insurance so I don't know where to shop. You mentioned the state Medigap market which I assume I can find on the internet. Are there other sources?

Would such plans cover the entire deductible and all copays (other than Rx) as well? Or would the person have the deductible and co-pays as the result of paying a lower premium? A person with significant medical bills might prefer the higher premium.
I can tell you one example I am aware of for Federal Employees Health Benefits for a particular Federal retiree I know is $229.64/month for 2018.
I don't think that is a good comparison. Federal benefits are better than some. This person is probably not eligible so I don't think it should be considered as a comparison. Her current possibly high premium should only be compared to what is available to her that provides the same coverage.

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Re: Trying to help acquaintence - medicare costs

Post by retiredjg » Sat Jan 13, 2018 3:51 pm

dm200 wrote:
Sat Jan 13, 2018 12:28 pm
Dealing with her is like peeling an onion. BUT - one layer at a time..
I think you must be one fine friend to have taken this on. :happy

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Re: Trying to help acquaintence - medicare costs

Post by dbr » Sat Jan 13, 2018 3:58 pm

retiredjg wrote:
Sat Jan 13, 2018 3:48 pm
dbr wrote:
Sat Jan 13, 2018 11:50 am
A really good and high priced Medigap/Supplemental insurance plan could come in at $200-$250, and there are plenty of perfectly adequate plans for much less.
Where does a person find plans like that? I know that is a dumb question, but I've never had anything except employer provided insurance so I don't know where to shop. You mentioned the state Medigap market which I assume I can find on the internet. Are there other sources?

Would such plans cover the entire deductible and all copays (other than Rx) as well? Or would the person have the deductible and co-pays as the result of paying a lower premium? A person with significant medical bills might prefer the higher premium.
I can tell you one example I am aware of for Federal Employees Health Benefits for a particular Federal retiree I know is $229.64/month for 2018.
I don't think that is a good comparison. Federal benefits are better than some. This person is probably not eligible so I don't think it should be considered as a comparison. Her current possibly high premium should only be compared to what is available to her that provides the same coverage.
A good starting place is here: https://www.medicare.gov/supplement-oth ... digap.html Note there are also Medicare Advantage Plans, which are a different thing entirely.

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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Sat Jan 13, 2018 3:59 pm

retiredjg wrote:
Sat Jan 13, 2018 3:51 pm
dm200 wrote:
Sat Jan 13, 2018 12:28 pm
Dealing with her is like peeling an onion. BUT - one layer at a time..
I think you must be one fine friend to have taken this on. :happy
We shall see.. One pattern that is emerging is that she does not seem to understand the relatively large amount of mortgage debt she has taken on. This is her condo as well as a house he and her late father bought in another state.

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Re: Trying to help acquaintence - medicare costs

Post by retiredjg » Sat Jan 13, 2018 4:45 pm

dbr wrote:
Sat Jan 13, 2018 3:58 pm
A good starting place is here: https://www.medicare.gov/supplement-oth ... digap.html Note there are also Medicare Advantage Plans, which are a different thing entirely.
What a wealth of information! And not difficult to understand either. Thanks for the link.

I found some interesting things. Medigap (medicare supplemental insurance) plans are standardize so there is some hope of being able to comparison shop (unlike mattresses :D ).

The higher cost plans can run up to $283 a month in my state. These plans cover a lot more than the cheaper plans. My guess is that the friend's current plan would have to be compared with the higher cost plans just based on the fact that she apparently is not paying any sort of bills (other than maybe Rx which I don't think has been discussed).

One thing that did catch my eye was this:
  • Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

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