Self insure vs Medigap when on "traditional" Medicare

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curmudgeon
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by curmudgeon » Tue Aug 29, 2017 8:19 pm

Artsdoctor wrote:
Tue Aug 29, 2017 6:48 pm
DM,

A few things to consider.

When you're considering your options, bear in mind that there is some state-to-state variability. What one poster will offer may not apply to you so it benefits you to do your research.

Within 6 months of beginning Medicare, you'll need to decide whether or not you want your Supplement. You can't be turned down no matter what your pre-existing history is.

However, after that 6-month period, the insurance companies offering supplemental plans can price the supplement according to your health record. There are exceptions to this rule (for example, if your previous employer was offering a supplement and they decided to stop it, you'd have your "open enrollment"; if you had an Advantage plan and then moved, etc., etc.). But you can't say that "I'm healthy at 65 so I'll just get my secondary if I get a serious illness." It doesn't work that way.

It is true that there are a lot of healthy seniors out there. But don't forget that the older you are, the more likely you are to have health problems. Some of those problems build on each other: a healthy 65-year-old with a hip fracture is going to generally have an easier and quicker hospitalization than an 85-year-old with the same fracture. These bills can be staggering. You'd be on the hook for 20% of the Medicare allowable.

I don't buy into the argument that "chances are, you'll be fine and won't get your money's worth." Sure, you may have a long healthy life with very few health consequences. Good for you! But that is a gamble I personally wouldn't take, and I know those statistics pretty well.
Interesting thought comes to mind - it is possible to get *lower* rates by signing up later with medical underwriting, presuming you are in excellent health? It doesn't seem likely, but the thought made me curious.

dennisbyron
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by dennisbyron » Wed Aug 30, 2017 4:19 am

Artsdoctor wrote:
DM,
...

When you're considering your options, bear in mind that there is some state-to-state variability. What one poster will offer may not apply to you so it benefits you to do your research.

Within 6 months of beginning Medicare, you'll need to decide whether or not you want your Supplement. You can't be turned down no matter what your pre-existing history is. However, after that 6-month period, the insurance companies offering supplemental plans can price the supplement according to your health record.
The first paragraph is the best advice. The second violates the advice. There are states where you can choose a a private Medigap policy (I believe that is what artsdoctor means by "Supplement") at any time for any reason without any penalty or underwriting or higher premium. Massachusetts is one such state but I think there are others particularly in the Northeast U.S.

Here in Massachusetts for example, Medigap enrollment is open and continuous and the rating is community based (no different between someone 65 and 85). The only thing you can't do here is sign up in the ambulance and have the car accident for which you are being transported covered. One of the favored strategies here is to sign up for the higher deductible Medigap plan (we do not use the Medigap Plan lettering system here and have only two Medigap options: expensive and very expensive) for most of the time but switch to the first dollar coverage plan (I think it's called Plan F in other states) if you need an operation and its date is elective. After the operation, you can switch back the next month.

(Of course that's also why we here in Massachusetts have the most expensive health care in the world.)

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Artsdoctor
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by Artsdoctor » Wed Aug 30, 2017 9:26 am

dennisbyron wrote:
Wed Aug 30, 2017 4:19 am
Artsdoctor wrote:
DM,
...

When you're considering your options, bear in mind that there is some state-to-state variability. What one poster will offer may not apply to you so it benefits you to do your research.

Within 6 months of beginning Medicare, you'll need to decide whether or not you want your Supplement. You can't be turned down no matter what your pre-existing history is. However, after that 6-month period, the insurance companies offering supplemental plans can price the supplement according to your health record.
The first paragraph is the best advice. The second violates the advice. There are states where you can choose a a private Medigap policy (I believe that is what artsdoctor means by "Supplement") at any time for any reason without any penalty or underwriting or higher premium. Massachusetts is one such state but I think there are others particularly in the Northeast U.S.

Here in Massachusetts for example, Medigap enrollment is open and continuous and the rating is community based (no different between someone 65 and 85). The only thing you can't do here is sign up in the ambulance and have the car accident for which you are being transported covered. One of the favored strategies here is to sign up for the higher deductible Medigap plan (we do not use the Medigap Plan lettering system here and have only two Medigap options: expensive and very expensive) for most of the time but switch to the first dollar coverage plan (I think it's called Plan F in other states) if you need an operation and its date is elective. After the operation, you can switch back the next month.

(Of course that's also why we here in Massachusetts have the most expensive health care in the world.)
Yes, indeed! Your comments are correct and you'll notice that my first sentence came first for a good reason!

Massachusetts is an exception to the rule. There are three waiver states that I'm aware of: MA, MN, and WI. The six-month Open Enrollment period doesn't apply. However, every other place is subject to that rule.

Lynette
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by Lynette » Wed Aug 30, 2017 9:51 am

Thanks for the thread - I'll read it tomorrow. I got a statement from Medicare a few days ago. I was stupid enough to go for a Welcome to Medicare and got referred for a Mammogram and Infusion to prevent osteoporosis at a hospital. I'm 73, and healthy and stopped working last year and have had all 4 months getting Medicare B card and 3 appeals as billing got screwed up. I've got AARP United Healthcare Medigap F - ($200 per month) don't know why - insurance for the future I suppose. So after complaining about the insane bureaucracy, my contribution to this thread is that two of my former employers offer an HRA as a supplement on an exchange. I get $3,000 from the one and about $2,000 from the other. I can use this for Medicare premiums or Supplemental Insurance. The bureaucracy to get the supplements is also insane.

Best wishes to all who have to navigate this maze of programs!

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Uncle Pennybags
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by Uncle Pennybags » Wed Aug 30, 2017 12:08 pm

dennisbyron wrote:
Wed Aug 30, 2017 4:19 am
The only thing you can't do here is sign up in the ambulance and have the car accident for which you are being transported covered
Auto accidents are covered by auto insurance. My daughter slammed her finger in a car door parked in a driveway. My health insurance and auto insurance went into finger pointing. They should take those fingers and put them where the moon doesn't shine.

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Re: Self insure vs Medigap when on "traditional" Medicare

Post by BHUser27 » Thu Aug 31, 2017 7:01 pm

mouses wrote:
Tue Aug 29, 2017 5:17 pm
kaneohe wrote:
Mon Aug 28, 2017 12:44 pm

Be careful what you conclude from this. The others don't have stated annual OOP limits/caps but they can be effectively 0.
E.g. with my plan F, I pay nothing..........either Medicare pays or the supplement pays (assuming it is a Medicare covered cost).
I have plan F and didn't have to pay a nickel for a hospitalization a few years ago, whew.
Actually, you probably paid quite a lot for that hospital stay if you look at the fixed premium costs for every year you owned Plan F versus when you really needed that level of coverage. It may have been a bargain, or may not. It is dangerous to think one is getting a good deal just because "everything is covered with zero OOP". A true comparison of premiums and estimated OOP costs (copay/coins/deductibles) between various plans is worthwhile IMO.

cashmoney
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by cashmoney » Thu Aug 31, 2017 8:34 pm

dm200 wrote:
Mon Aug 28, 2017 9:25 am
About a third of us have group retirement insurance through a union or former employer that acts as a Medicare supplement (although that percent is decreasing).
decreasing rapidly, in my opinion.


I agree and many retired and working medicare beneficiaries who do have coverage from their employer they are paying for can do better taking an individual plan such as medicare supplement or medicare advantage but never bother to shop it.The medicare part D coverage gap is becoming less of an issue since the coverage gap( donut hole) has been incrementally closing since 2010 and will be completely closed by 2020.

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PaFromFL
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by PaFromFL » Thu Aug 31, 2017 10:09 pm

Be very careful of Advantage Plans. They replace Original Medicare with managed care controlled by private insurance companies so as to maximize profit, sometimes at the expense of patients. They have a lot of freedom to change rules and restrict provider networks. They can offer zero premiums because of large per-patient federal subsidies. Blue states tend to have laws to protect the insured from abuses.

Medigap plans employ private insurance companies to act as billing agents restricted by rigid federal rules. You know what you are getting and you know it won't change (assuming there are no major Medicare reforms).

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FrugalInvestor
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by FrugalInvestor » Thu Aug 31, 2017 10:35 pm

BHUser27 wrote:
Thu Aug 31, 2017 7:01 pm
mouses wrote:
Tue Aug 29, 2017 5:17 pm
kaneohe wrote:
Mon Aug 28, 2017 12:44 pm

Be careful what you conclude from this. The others don't have stated annual OOP limits/caps but they can be effectively 0.
E.g. with my plan F, I pay nothing..........either Medicare pays or the supplement pays (assuming it is a Medicare covered cost).
I have plan F and didn't have to pay a nickel for a hospitalization a few years ago, whew.
Actually, you probably paid quite a lot for that hospital stay if you look at the fixed premium costs for every year you owned Plan F versus when you really needed that level of coverage. It may have been a bargain, or may not. It is dangerous to think one is getting a good deal just because "everything is covered with zero OOP". A true comparison of premiums and estimated OOP costs (copay/coins/deductibles) between various plans is worthwhile IMO.
I agree, however, what can't be quantified is the value of simplified finances as we age. It's a topic often discussed here. Having a policy that covers everything removes the complication of trying to match EOBs with provider billings and Medicare and suplement plan payments and deal with Medicare, insurance and provider beauracracies - and all of this at at a time of physical and emotional stress due to medical problems and related treatments. I decided on Plan G for exactly this reason thinking that it would prevent additional stress for both me and my wife as we age. That's worth quite a bit in my estimation.
IGNORE the noise! | Our life is frittered away by detail... simplify, simplify. - Henry David Thoreau

inbox788
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by inbox788 » Thu Aug 31, 2017 11:40 pm

FrugalInvestor wrote:
Thu Aug 31, 2017 10:35 pm
BHUser27 wrote:
Thu Aug 31, 2017 7:01 pm
mouses wrote:
Tue Aug 29, 2017 5:17 pm
kaneohe wrote:
Mon Aug 28, 2017 12:44 pm

Be careful what you conclude from this. The others don't have stated annual OOP limits/caps but they can be effectively 0.
E.g. with my plan F, I pay nothing..........either Medicare pays or the supplement pays (assuming it is a Medicare covered cost).
I have plan F and didn't have to pay a nickel for a hospitalization a few years ago, whew.
Actually, you probably paid quite a lot for that hospital stay if you look at the fixed premium costs for every year you owned Plan F versus when you really needed that level of coverage. It may have been a bargain, or may not. It is dangerous to think one is getting a good deal just because "everything is covered with zero OOP". A true comparison of premiums and estimated OOP costs (copay/coins/deductibles) between various plans is worthwhile IMO.
I agree, however, what can't be quantified is the value of simplified finances as we age. It's a topic often discussed here. Having a policy that covers everything removes the complication of trying to match EOBs with provider billings and Medicare and suplement plan payments and deal with Medicare, insurance and provider beauracracies - and all of this at at a time of physical and emotional stress due to medical problems and related treatments. I decided on Plan G for exactly this reason thinking that it would prevent additional stress for both me and my wife as we age. That's worth quite a bit in my estimation.
Yes, I don't think that's been mentioned until now, but the management of paying bills, especially as I lose my mind is one reason for getting the gap coverage. I don't know much about the plans, but I'm afraid there is possible medical underwriting later on or the rates can may increase. Or if the rates are fixed, the insurance companies simply drop the unprofitable plans forcing one into less desirable plans as one ages. Basically what is happening to better LTC insurance plans.

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Lancelot
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by Lancelot » Fri Sep 01, 2017 2:53 am

Good thread. I too have thought about self insuring beyond what Medicare will reimburse, but after seeing high deductible Plan Fs ($2,280) for as low as $40/mo, I'm probably going to go that route. I travel a lot and especially like Plan Fs international coverage, although its capped at $50k lifetime and limited to the first 60 days out of country.
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by BHUser27 » Fri Sep 01, 2017 7:26 am

FrugalInvestor wrote:
Thu Aug 31, 2017 10:35 pm
BHUser27 wrote:
Thu Aug 31, 2017 7:01 pm
A true comparison of premiums and estimated OOP costs (copay/coins/deductibles) between various plans is worthwhile IMO.
I agree, however, what can't be quantified is the value of simplified finances as we age. It's a topic often discussed here. Having a policy that covers everything removes the complication of trying to match EOBs with provider billings and Medicare and suplement plan payments and deal with Medicare, insurance and provider beauracracies - and all of this at at a time of physical and emotional stress due to medical problems and related treatments. I decided on Plan G for exactly this reason thinking that it would prevent additional stress for both me and my wife as we age. That's worth quite a bit in my estimation.
I do agree with your sentiment (highlighted above), but I don't see how you completely avoid this with any Medicare choice. Whether you choose A+B+D, or A+B+D+Medigap or C(Advantage/Cost/MSA) you should still know your coverages, know how to navigate an EOB (or Medicare statement), and know how to handle mis-coded billings. Medicare doesn't "cover everything" and neither does Plan F. I do agree that Plan F can simplify the billing of everything that Medicare does cover.

Excellent discussion all around - I greatly appreciate the different perspectives represented in this thread.

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dm200
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by dm200 » Fri Sep 01, 2017 7:52 am

PaFromFL wrote:
Thu Aug 31, 2017 10:09 pm
Be very careful of Advantage Plans. They replace Original Medicare with managed care controlled by private insurance companies so as to maximize profit, sometimes at the expense of patients. They have a lot of freedom to change rules and restrict provider networks. They can offer zero premiums because of large per-patient federal subsidies. Blue states tend to have laws to protect the insured from abuses.
Medigap plans employ private insurance companies to act as billing agents restricted by rigid federal rules. You know what you are getting and you know it won't change (assuming there are no major Medicare reforms).
I believe this varies by locality and provider. Friends who have the Humana MA plan in this are very happy, and my wife and I are very happy with our Kaiser Medicare Cost plan (both financially and healthcare quality). In our case, as well, there are very few billing errors -- and when there are - they are corrected quickly.

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Re: Self insure vs Medigap when on "traditional" Medicare

Post by Spirit Rider » Fri Sep 01, 2017 10:11 am

kaneohe wrote:
Mon Aug 28, 2017 12:44 pm
BHUser27 wrote:
Mon Aug 28, 2017 10:43 am
I am keenly interested in this thread, as DW will start medicare next year.

From my research and reading this thread, I believe the following are correct:

1) Medigap K and L are the only supplemental plans with an annual OOP limit/cap.
.........................................................
Be careful what you conclude from this. The others don't have stated annual OOP limits/caps but they can be effectively 0.
E.g. with my plan F, I pay nothing..........either Medicare pays or the supplement pays (assuming it is a Medicare covered cost).
The K/L plans look like they need to have an annual OOP limit because they only pay a fraction of many of the costs while the other plans pay 100%
To expand on what kanohe stated, these plans have the following effective OOP limits.
  • $0, Plan C and Plan F
  • $183, Plan D and Plan G (2017 Part B deductible $183)
  • $841, Plan M (2017 Part B deductible $183 + 1/2 2017 Part A deductible $1316)
  • $2200, Plan F high-deductible
For plans currently issued to new enrollees, only Plans A, B have no real OOP limit.

Plan N technically has no limit, but it is effectively limited by only being subject to $20 co-pay for some office visits and $50 co-pay for emergency room visits.

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Uncle Pennybags
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by Uncle Pennybags » Fri Sep 01, 2017 10:55 am

dm200 wrote:
Fri Sep 01, 2017 7:52 am
I believe this varies by locality and provider.
Insurance falls under state law sometimes limited to counties. Use caution.

pshonore
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by pshonore » Fri Sep 01, 2017 11:45 am

Spirit Rider wrote:
Fri Sep 01, 2017 10:11 am
kaneohe wrote:
Mon Aug 28, 2017 12:44 pm
BHUser27 wrote:
Mon Aug 28, 2017 10:43 am
I am keenly interested in this thread, as DW will start medicare next year.

From my research and reading this thread, I believe the following are correct:

1) Medigap K and L are the only supplemental plans with an annual OOP limit/cap.
.........................................................
Be careful what you conclude from this. The others don't have stated annual OOP limits/caps but they can be effectively 0.
E.g. with my plan F, I pay nothing..........either Medicare pays or the supplement pays (assuming it is a Medicare covered cost).
The K/L plans look like they need to have an annual OOP limit because they only pay a fraction of many of the costs while the other plans pay 100%
To expand on what kanohe stated, these plans have the following effective OOP limits.
  • $0, Plan C and Plan F
  • $183, Plan D and Plan G (2017 Part B deductible $183)
  • $841, Plan M (2017 Part B deductible $183 + 1/2 2017 Part A deductible $1316)
  • $2200, Plan F high-deductible
For plans currently issued to new enrollees, only Plans A, B have no real OOP limit.

Plan N technically has no limit, but it is effectively limited by only being subject to $20 co-pay for some office visits and $50 co-pay for emergency room visits.
What happens if you "run through" the Part A coverages for in hospital daily charges and SNF facility. Although it's a real long shot, what happens when you exhaust those limits? Are you on the hook for a potentially large payment? Would an Advantage plan pay those indefinitely?

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Re: Self insure vs Medigap when on "traditional" Medicare

Post by BHUser27 » Fri Sep 01, 2017 12:26 pm

pshonore wrote:
Fri Sep 01, 2017 11:45 am
What happens if you "run through" the Part A coverages for in hospital daily charges and SNF facility. Although it's a real long shot, what happens when you exhaust those limits? Are you on the hook for a potentially large payment? Would an Advantage plan pay those indefinitely?
Part C plans will vary on this, but the two Part C (Advantage PPO) plans I looked at last week "flip" the typical Part A hospital coverage around.

For Example, here is an excerpt from a "zero-premium" Advantage plan in my area...
In-network: $290 per day, days 1-5; $0 per day, days 6-90
You pay $0 per day for days 91 and beyond.
Our plan covers an unlimited number of days for an inpatient hospital stay.
Out-of-network: 45% per stay

cashmoney
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by cashmoney » Fri Sep 01, 2017 12:48 pm

dm200 wrote:
Fri Sep 01, 2017 7:52 am
PaFromFL wrote:
Thu Aug 31, 2017 10:09 pm
Be very careful of Advantage Plans. They replace Original Medicare with managed care controlled by private insurance companies so as to maximize profit, sometimes at the expense of patients. They have a lot of freedom to change rules and restrict provider networks. They can offer zero premiums because of large per-patient federal subsidies. Blue states tend to have laws to protect the insured from abuses.
Medigap plans employ private insurance companies to act as billing agents restricted by rigid federal rules. You know what you are getting and you know it won't change (assuming there are no major Medicare reforms).
I believe this varies by locality and provider. Friends who have the Humana MA plan in this are very happy, and my wife and I are very happy with our Kaiser Medicare Cost plan (both financially and healthcare quality). In our case, as well, there are very few billing errors -- and when there are - they are corrected quickly.



Most people are very happy with their Medicare Advantage Plans (HMO,PPO).These plans have to cover everything that the original medicare does, usually have part D included and often will include benefits beyond what the original medicare covers such as free gym memberships,dental,routine vision(optometry) and hearing aids all at very low or 0 monthly premium .The trend in most areas has been that part C plans have been getting better benefits each year and the original medicare has been shifting more cost share to the beneficiaries. Yes there is a network limitations with part C but chances are you can find a plan that includes your providers especially if you live in an urban area.IMO the original medicare will probably be shifting to a more coordinated care plan model too because the consensus out there seems to be that out of all the managed care plans out there that that have government involvement medicare advantage plans seems to be the one bright spot.They have already started somewhat using a network with the durable medicare equipment providers.Take what your doctor's office advise gives you about what health insurance to get with a grain of salt.The ones who prefer dealing directly with medicare instead of medicare advantage plan may have their own financial reasons for doing so which may not necessarily be in your own financial interest.With that said there is no best choice between part C vs medicare supplement it all depends on your particular needs.


-Are you reasonably healthy or do you have multiple chronic diseases?
-If your not willing to switch are your providers covered in the part C plan?
-Do you prefer the prepay model of med supp or the pay as you go model of part C ?
-Do you do much traveling? Med supp is better for travel in the USA especially for routine doctoring.Part C covers worldwide emergency for a flat 75.00 copay which is actually a much better foreign travel benefit than you get with a medicare supplement.
-Are you taking prescription drugs? Many times as an incentive to enroll in the plan the part D drug coverage integrated in a part C plan is better that what you can find in a stand alone part D plan.i.e coverage through the gap

HIinvestor
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by HIinvestor » Fri Sep 01, 2017 1:03 pm

In our family, my folks gave Medicare A & B plus coverage from former employer that dad retired from. H also has Medicare A & B plus different former employer he retired from. If he or dad didn't have coverage from former employer, I'd get them Medicare advantage or supplemental policy because otherwise there is NO cap on the 20% you'd pay out of pocket and that can run up VERY high.

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Lancelot
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by Lancelot » Fri Sep 01, 2017 6:22 pm

GerryL wrote:
Sun Aug 27, 2017 4:21 pm
Gill wrote:
Sun Aug 27, 2017 9:56 am
plannerman wrote:
Sun Aug 27, 2017 9:52 am
We have high deductible Medigap plans. So we self insure for out of pocket costs of up to $2200 each per year. These seems like a more rational solution than self insuring for unlimited medical expenses.

plannerman
Agree. We have the Plan F high deductible at a total cost for two of about $2,300. It is a form of self insurance with plenty of coverage for catastrophic losses.
Gill
Ditto. I pay less than $30 a month for an F-HD plan. I estimated that since I rarely have a lot of healthcare bills, I would come out ahead most years. 20% may not seem like a lot, but the question is "20% of what?"
Location matters :) (Low premium reference)

I'm not an actuary, but the low premium for HD Plan Fs tells me that Insurance companies have calculated that their liability to pay claims exceeding the deductible is small.

Will most of us stay longer than 60 days in a hospital?

If money was really tight and I had to make a choice, I'd probably opt for Medicare Part D, drug coverage, and roll the dice on a Medicare Supplement. Or go with a Medicare Advantage Plan with $0 premium. Part D has a nasty "Gotcha", a %1 penalty per month -for the rest of your life- if you don't sign up for coverage when first eligible.

Having said that, I'll probably opt for a HD Plan F myself; I was quoted $40/month for my area.
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dm200
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by dm200 » Sat Sep 02, 2017 7:28 am

I'm not an actuary, but the low premium for HD Plan Fs tells me that Insurance companies have calculated that their liability to pay claims exceeding the deductible is small.
Neither am I, but I suspect that the rates are strongly influenced by "adverse selection", such that thos with higher or much higher risk will tend to stay away from the high deductible plans.

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Re: Self insure vs Medigap when on "traditional" Medicare

Post by jebmke » Sat Sep 02, 2017 8:23 am

dm200 wrote:
Sat Sep 02, 2017 7:28 am
I'm not an actuary, but the low premium for HD Plan Fs tells me that Insurance companies have calculated that their liability to pay claims exceeding the deductible is small.
Neither am I, but I suspect that the rates are strongly influenced by "adverse selection", such that thos with higher or much higher risk will tend to stay away from the high deductible plans.
I suspect you are right on the adverse selection. I did a quick look at one carrier selling F and F-HD. The deductible is about 2x the premium difference for the year. Also, when I did a quick scan of the rate document for the state, it appeared that all the insurers with HD policies are using attained age pricing -- maybe this is the norm. Have not looked at it carefully so not sure how this affects one's decision.
When you discover that you are riding a dead horse, the best strategy is to dismount.

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dm200
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Re: Self insure vs Medigap when on "traditional" Medicare

Post by dm200 » Sat Sep 02, 2017 8:40 am

I suspect you are right on the adverse selection. I did a quick look at one carrier selling F and F-HD. The deductible is about 2x the premium difference for the year. Also, when I did a quick scan of the rate document for the state, it appeared that all the insurers with HD policies are using attained age pricing -- maybe this is the norm. Have not looked at it carefully so not sure how this affects one's decision.
When I went on Medicare seven years ago, I chose a Kaiser plan (Medicare Cost - much like Medicare Advantage). For the first year, I chose the "High Option" that cost about $100 per month more than the "Standard Option". When I looked at the cost vs benefit - I concluded I did not get much benefit and was a bit puzzled by the $100 per month premium difference. I concluded this must be due to "adverse selection" where the overwhelming number of folks that pick the "High Option" are those that make heavy use of the plan.

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Re: Self insure vs Medigap when on "traditional" Medicare

Post by Spirit Rider » Sat Sep 02, 2017 11:07 am

pshonore wrote:
Fri Sep 01, 2017 11:45 am
What happens if you "run through" the Part A coverages for in hospital daily charges and SNF facility. Although it's a real long shot, what happens when you exhaust those limits? Are you on the hook for a potentially large payment? Would an Advantage plan pay those indefinitely?
All Medigap plans pay Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up.

All Medigap plans except K & L pay Part A hospice care coinsurance or copayment. K & L are subject their 50% and 75% respective payment rates up to their respective OOP limits.

Medigap plans C, D, F, G, M, and N pay Skilled Nursing Facility (SNF) coinsurance. K & L are subject their 50% and 75% respective payment rates up to their respective OOP limits.

I do not know what Part C plans cover.

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