What does Medicare REALLY Cost Wealthy Seniors

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Goodman60
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What does Medicare REALLY Cost Wealthy Seniors

Post by Goodman60 » Tue Aug 29, 2017 8:35 am

I am curious about this. What does a full health coverage package REALLY cost wealthy seniors? I am taking about someone in the top Medicare bracket, who also wants "the best" supplement and drug coverage? What's the TOTAL cost? I get it that there is variation with regard to deductibles and copays. I have a friend who can stay on his wife's employer's plan for about $700 per month...for top "Blues" coverage with a zero deductible. That's $700/month JUST FOR HIM. I am guessing that a full Medicare package (he's high income/high net worth) will be about that much also, but am not sure.

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FrugalInvestor
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by FrugalInvestor » Tue Aug 29, 2017 8:41 am

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jebmke
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by jebmke » Tue Aug 29, 2017 8:43 am

The top bracket for Medicare B is $429 per month. Supplemental costs vary but ~$150-200 seems to be roughly where they are when I looked at it last. Add on something for a drug policy and you are probably looking at $650 +/-.

I am not in the top bracket but when I rolled up my estimate for 2018 it wasn't far off what I am paying for retiree insurance - although I have a high delectable plan with an HSA so it isn't apples to apples. I am not expecting Medicare to significantly decrease my HC costs next year. When I built my ER plan back in 2007 my assumption for the long haul was no significant drop in HC cost at 65 so things seem to be working out about where I planned.
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Allan
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by Allan » Tue Aug 29, 2017 8:45 am

I am 66 and still working, in top bracket. My Medicare, Drug plan, and high deductible supplement cost my wife and I about $665 a month each.

Allan

pshonore
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by pshonore » Tue Aug 29, 2017 8:46 am

Goodman60 wrote:
Tue Aug 29, 2017 8:35 am
I am curious about this. What does a full health coverage package REALLY cost wealthy seniors? I am taking about someone in the top Medicare bracket, who also wants "the best" supplement and drug coverage? What's the TOTAL cost? I get it that there is variation with regard to deductibles and copays. I have a friend who can stay on his wife's employer's plan for about $700 per month...for top "Blues" coverage with a zero deductible. That's $700/month JUST FOR HIM. I am guessing that a full Medicare package (he's high income/high net worth) will be about that much also, but am not sure.
If their MFJ AGI exceeds 428K, he will pay $428/month for Part B. Throw in Part D and a good Medigap supplement and he'll probably be close to the $700 figure (for him)

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Artsdoctor
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by Artsdoctor » Tue Aug 29, 2017 8:49 am

^ That's about right. If the married couple is in the highest income bracket, their MAGI will push their Medicare premiums up to the maximum, plus supplement, plus prescription plan. There will be co-pays as well.

If the wife's getting the insurance coverage through her employer, the premiums may be being paid in PRE-tax dollars. Medicare premiums will be paid in POST-tax dollars. So when you're taking comparisons into consideration, make sure you realize which side of the tax payment you're on.

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dm200
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by dm200 » Tue Aug 29, 2017 8:53 am

Goodman60 wrote:
Tue Aug 29, 2017 8:35 am
I am curious about this. What does a full health coverage package REALLY cost wealthy seniors? I am taking about someone in the top Medicare bracket, who also wants "the best" supplement and drug coverage? What's the TOTAL cost? I get it that there is variation with regard to deductibles and copays. I have a friend who can stay on his wife's employer's plan for about $700 per month...for top "Blues" coverage with a zero deductible. That's $700/month JUST FOR HIM. I am guessing that a full Medicare package (he's high income/high net worth) will be about that much also, but am not sure.
The other factor to be considered is availability of Physicians taking Medicare vs. other insurance. In this area, a great many primary care physicians do not take new Medicare patients, but will continue to serve (and take Medicare) for existing patients.

pshonore
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by pshonore » Tue Aug 29, 2017 8:54 am

Artsdoctor wrote:
Tue Aug 29, 2017 8:49 am
^ That's about right. If the married couple is in the highest income bracket, their MAGI will push their Medicare premiums up to the maximum, plus supplement, plus prescription plan. There will be co-pays as well.

If the wife's getting the insurance coverage through her employer, the premiums may be being paid in PRE-tax dollars. Medicare premiums will be paid in POST-tax dollars. So when you're taking comparisons into consideration, make sure you realize which side of the tax payment you're on.
Just a quick note that Part B and Part D premiums can be paid with tax free HSA dollars if you have them available

JW-Retired
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by JW-Retired » Tue Aug 29, 2017 9:13 am

Cost tables showing the break points are shown here:
https://www.medicare.gov/your-medicare- ... costs.html
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Goodman60
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by Goodman60 » Tue Aug 29, 2017 9:31 am

dm200 wrote:
Tue Aug 29, 2017 8:53 am
Goodman60 wrote:
Tue Aug 29, 2017 8:35 am
I am curious about this. What does a full health coverage package REALLY cost wealthy seniors? I am taking about someone in the top Medicare bracket, who also wants "the best" supplement and drug coverage? What's the TOTAL cost? I get it that there is variation with regard to deductibles and copays. I have a friend who can stay on his wife's employer's plan for about $700 per month...for top "Blues" coverage with a zero deductible. That's $700/month JUST FOR HIM. I am guessing that a full Medicare package (he's high income/high net worth) will be about that much also, but am not sure.
The other factor to be considered is availability of Physicians taking Medicare vs. other insurance. In this area, a great many primary care physicians do not take new Medicare patients, but will continue to serve (and take Medicare) for existing patients.
And around here (Pittsburgh), we have two dominant health care systems and you pretty much have to pick one vs the other. If you have the insurance offered by the one system, you can't use the other system (with some exceptions) and vice versa. Whereas Medicare patients can go anywhere. Traditional Medicare (not Medicare Advantage, offered by the warring health care systems) is the choice for the best accessibility. Pittsburgh has one of the the oldest population demographics in the nation, mostly middle and lower middle class. Providers can't survive if they don't accept Medicare (unlike Florida, where a wealthier population of seniors can allow providers to refuse lower paying Medicare patients)
Last edited by Goodman60 on Tue Aug 29, 2017 9:42 am, edited 3 times in total.

The Wizard
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by The Wizard » Tue Aug 29, 2017 9:38 am

I pay $530 per month for Medicare plus my Advantage plan, all deducted from my SS payment.
I'm in tier 3 now, going up to new tier 4 next year, I think.
Sadly, my chances of achieving IRMAA tier 5 look slim without additional income from significant part-time work...
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dm200
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by dm200 » Tue Aug 29, 2017 9:41 am

Whereas Medicare patients can go anywhere. Medicare is the choice for the best accessability.
This varies a lot by locality, and there may be significant differences between primary care and specialists.

Goodman60
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by Goodman60 » Tue Aug 29, 2017 9:43 am

dm200 wrote:
Tue Aug 29, 2017 9:41 am
Whereas Medicare patients can go anywhere. Medicare is the choice for the best accessability.
This varies a lot by locality, and there may be significant differences between primary care and specialists.
See my edited post, three above. Providers here can't survive if they refuse Medicare patients.

NotWhoYouThink
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by NotWhoYouThink » Tue Aug 29, 2017 9:52 am

pshonore wrote:
Tue Aug 29, 2017 8:54 am
Artsdoctor wrote:
Tue Aug 29, 2017 8:49 am
^ That's about right. If the married couple is in the highest income bracket, their MAGI will push their Medicare premiums up to the maximum, plus supplement, plus prescription plan. There will be co-pays as well.

If the wife's getting the insurance coverage through her employer, the premiums may be being paid in PRE-tax dollars. Medicare premiums will be paid in POST-tax dollars. So when you're taking comparisons into consideration, make sure you realize which side of the tax payment you're on.
Just a quick note that Part B and Part D premiums can be paid with tax free HSA dollars if you have them available
OK, the light finally went on. I kept trying to figure out why everyone keeps talking about over-funding the HSA. So I can put money in now and use it later to pay Medicare premiums? Cool.

Lynette
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by Lynette » Tue Aug 29, 2017 10:12 am

The Wizard wrote:
Tue Aug 29, 2017 9:38 am
I pay $530 per month for Medicare plus my Advantage plan, all deducted from my SS payment.
I'm in tier 3 now, going up to new tier 4 next year, I think.
Sadly, my chances of achieving IRMAA tier 5 look slim without additional income from significant part-time work...
Do they deduct your Advantage Plan from your SS payment? I pay for mine from an HRA allowance funded by a former employer. I got something in the mail from Medicare while I was out of town. At this stage I'm totally fed up with the bureaucratic mess I've faced as I did not take Medicare at the usual age. I'll look at it in a few days. I don't know if Medicare knows that I have a AARP United Health Care Medigap F plan. I'm certainly not wealthy but have to pay the IRMAA premium as I have pensions and SS. I pay about $500 a month. I don't know how much else I will have to pay as I foolishly actually went to the doctor for the "Welcome to Medicare". I'm trying to stay away from doctors as its so complicated!!

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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by CurlyDave » Tue Aug 29, 2017 10:23 am

dm200 wrote:
Tue Aug 29, 2017 8:53 am

...The other factor to be considered is availability of Physicians taking Medicare vs. other insurance. In this area, a great many primary care physicians do not take new Medicare patients, but will continue to serve (and take Medicare) for existing patients.
This was a very large consideration in our decision to decide on a retirement location away from the HCOL area where we worked and to move there and establish medical care providers while we still had coverage from work. Sure it was less than completely convenient, but we had no trouble becoming patients at group practices where we would not have been accepted as medicare patients.

Levett
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by Levett » Tue Aug 29, 2017 10:36 am

On the issue of physicians who accept assignment to Medicare, see the following survey:

http://www.kff.org/medicare/issue-brief ... -snapshot/

Lev

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HueyLD
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by HueyLD » Tue Aug 29, 2017 10:38 am

dm200 wrote:
Tue Aug 29, 2017 8:53 am
The other factor to be considered is availability of Physicians taking Medicare vs. other insurance. In this area, a great many primary care physicians do not take new Medicare patients, but will continue to serve (and take Medicare) for existing patients.
It is highly location dependent.

You must be in an area with a lot of pre-Medicare working folks. If you live in an area with lots of retirees (wealthy, middle class or poor), you will have no trouble finding a doctor who accepts Medicare patients.

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dm200
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by dm200 » Tue Aug 29, 2017 10:49 am

HueyLD wrote:
Tue Aug 29, 2017 10:38 am
dm200 wrote:
Tue Aug 29, 2017 8:53 am
The other factor to be considered is availability of Physicians taking Medicare vs. other insurance. In this area, a great many primary care physicians do not take new Medicare patients, but will continue to serve (and take Medicare) for existing patients.
It is highly location dependent.
You must be in an area with a lot of pre-Medicare working folks. If you live in an area with lots of retirees (wealthy, middle class or poor), you will have no trouble finding a doctor who accepts Medicare patients.
Yes, probably the case. One strategy several pre-Medicare folks adopt is to become a patient with a Primary Care Physician in a group - then if their physician leaves/retires, they can consinute with another Physician in that group. It also depends, I believe, on how "fussy" you are about your Primary care physician. There are many who take new Medicare patients, but it is not the majority and (for various reasons) the folks I know prefer others.

A totally different topic, but my opinion/conclusion (over many decades and with 20/20 hindsight as well) is that patient opinions about the competence/quality of Primary care physicians is often wrong. Sometimes (perhaps often) physicians are "popular" because they tell patients what they want to hear (such as don't worry about being 40 pounds overweight) and other are "unpopular" because they tell patients the truth (such as high risk of diabetes being so heavy).

The Wizard
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by The Wizard » Tue Aug 29, 2017 12:51 pm

Lynette wrote:
Tue Aug 29, 2017 10:12 am
The Wizard wrote:
Tue Aug 29, 2017 9:38 am
I pay $530 per month for Medicare plus my Advantage plan, all deducted from my SS payment.
I'm in tier 3 now, going up to new tier 4 next year, I think.
Sadly, my chances of achieving IRMAA tier 5 look slim without additional income from significant part-time work...
Do they deduct your Advantage Plan from your SS payment?
They do.
It's a Harvard Pilgrim Medicare Advantage plan which covers prescription drugs along with other stuff. Bundling payment with Medicare may have been optional but I'm ok with that...
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Artsdoctor
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by Artsdoctor » Tue Aug 29, 2017 1:14 pm

^ Correct me if I am wrong, but the Medicare premium is deducted from your total social security amount. Your total social security amount is subject to personal income tax and it's that amount that is entered on your 1040.

You can definitely pay Medicare premiums from your HSA but you can't pay for the supplemental plan from your HSA. You'd also want to be cautious about taking distributions from your HSA AND deducting medical expenses on your Schedule A. You cannot double-dip.

Finding physicians that do not accept Medicare patients is locale-dependent. However, the trend that seems to be emerging is that private practice physicians are working for hospital programs in higher numbers; it would be pretty unusual for a hospital-owned practice to not accept Medicare patients. There may be a wait but again, that's locale-dependent.

There are going to be good and bad points about both plans. Your wife seems to have a pretty attractive plan through the employer so I wouldn't dismiss it too quickly, but most Medicare recipients that I work with like being on Medicare.

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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by dennisbyron » Wed Aug 30, 2017 6:17 am

Someone wrote on Aug 29, 2017 12:51 pm
Lynette wrote: ↑
Tue Aug 29, 2017 10:12 am

The Wizard wrote: ↑
Tue Aug 29, 2017 9:38 am
I pay $530 per month for Medicare plus my Advantage plan, all deducted from my SS payment... Do they deduct your Advantage Plan from your SS payment?

They do.
It's a Harvard Pilgrim Medicare Advantage plan which covers prescription drugs along with other stuff. Bundling payment with Medicare may have been optional but I'm ok with that...
This is off the main topic but I see a similar comment a few places on this thread.

It is not necessary to have a public Medicare Part C or Part D premium deducted from your Social Security deposit and it is a bad idea to pay it that way. Pay it direct or set up a bank withdrawal with the Part C or Part D plan's sponsor. The reason not to use Social Security is because if you change Part C or Part D plans -- which you can do and should at least considering doing at least once a year (and you can do it much more often under some circumstances) -- it takes two or three or more months to get SS to stop deducting. So you are double paying. You will eventually get it back but why loan the government money at zero interest.

(You have no choice with Part B of course if you are on Social Security.)

Mitchell777
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by Mitchell777 » Wed Aug 30, 2017 6:43 am

Hope I'm wrong but I'm guessing the tiers are not indexed for inflation. If they are not, one can be bumped up a tier or two depending on future inflation.

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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by cas » Wed Aug 30, 2017 7:18 am

Mitchell777 wrote:
Wed Aug 30, 2017 6:43 am
Hope I'm wrong but I'm guessing the tiers are not indexed for inflation. If they are not, one can be bumped up a tier or two depending on future inflation.
The tiers aren't inflation adjusted right now, but (under current law) they are scheduled to start being adjusted by inflation (again) in 2020.*

Also, there is some tier adjustment occurring for 2018 where the two highest IRMAA brackets will be adjusted downwards and apply at lower income thresholds than they currently do. (Sorry, this is shown in a graphic in the Kaiser Family Foundation data note (see source below), so I can't easily cut and paste it into this post. See Figure 3 in the KFF data note for more info.)

Source for both the above statements: "Medicare’s Income-Related Premiums: A Data Note" (June 2015) from Kaiser Family Foundation. http://www.kff.org/medicare/issue-brief ... data-note/

*From the KFF data note:
For the first few years that the Medicare Part B income-related premium was in effect (between 2007 and 2010), the income thresholds that determined who paid the higher amounts were set to increase annually with the rate of inflation so that about 5 percent of Part B enrollees would pay the income-related premium. Since 2011, however, the income thresholds that determine who pays the higher Part B premiums have been fixed at their current levels through 2019 (a provision of the ACA); this provision also applies to Part D. . . . In 2020 and subsequent years, the income thresholds will once again be indexed to inflation, based on their levels in 2019 (a provision in MACRA).

The Wizard
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Re: What does Medicare REALLY Cost Wealthy Seniors

Post by The Wizard » Wed Aug 30, 2017 7:30 am

cas wrote:
Wed Aug 30, 2017 7:18 am

...Also, there is some tier adjustment occurring for 2018 where the two highest IRMAA brackets will be adjusted downwards and apply at lower income thresholds than they currently do. (Sorry, this is shown in a graphic in the Kaiser Family Foundation data note (see source below), so I can't easily cut and paste it into this post. See Figure 3 in the KFF data note for more info.)
Right.
So for some of us in those middle tiers, we get an increase in our Medicare premium with no change in income...
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