What I spent in 6 months on medicare

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

What I spent in 6 months on medicare

Post by dm200 » Thu Jul 05, 2018 5:47 pm

I am in my early 70's - and I just reviewed what I spent on Medical costs under Medicare. While this is anecdotal - it is an example of my low costs (so far at least).

Medicare Part B - $134/month - 6 months = $804
Medicare (Kaiser) plan premiums $30/month - 6 months = $180
My approximate prescription drug costs - 6 months = about $140 total
My medical out of pocket - 6 months $880 - includes office visit copays, one outpatient surgery, one CT scan and a few other scans, xrays, etc.

My wife has incurred similar expenditures.

I expect the next six months to be a bit lower than the $880 out of pocket - BUT we shall see,

JoinToday
Posts: 849
Joined: Sat Mar 10, 2007 9:59 pm

Re: What I spent in 6 months on medicare

Post by JoinToday » Thu Jul 05, 2018 6:13 pm

$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:

That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
I wish I had learned about index funds 25 years ago

yosh99
Posts: 129
Joined: Thu Apr 19, 2012 8:44 pm

Re: What I spent in 6 months on medicare

Post by yosh99 » Thu Jul 05, 2018 6:16 pm

JoinToday wrote:
Thu Jul 05, 2018 6:13 pm
$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:

That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
And Medicare does not cover dental or vision expenses.

User avatar
Hayden
Posts: 1266
Joined: Tue Apr 16, 2013 5:13 pm

Re: What I spent in 6 months on medicare

Post by Hayden » Thu Jul 05, 2018 6:21 pm

JoinToday wrote:
Thu Jul 05, 2018 6:13 pm
$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:

That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
I had the opposite reaction. I wish I could buy into Medicare. I recently saw the 2019 figures for my ACA plan. My premiums will go up almost 40% next year.

User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Thu Jul 05, 2018 6:58 pm

yosh99 wrote:
Thu Jul 05, 2018 6:16 pm
JoinToday wrote:
Thu Jul 05, 2018 6:13 pm
$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:
That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
And Medicare does not cover dental or vision expenses.
These amounts are very low compared to the actual costs and what those not on Medicare would pay.

My Medicare plan does cover vision (exam by Optometrist for $20 copay) and discounted dental.

User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Thu Jul 05, 2018 7:18 pm

One point I was trying to make is that my "out of pocket" amount of $880 + $180 premiums (or about $177 per month) is less than many or most Medigap plans with Original Medicare.

mhalley
Posts: 7782
Joined: Tue Nov 20, 2007 6:02 am

Re: What I spent in 6 months on medicare

Post by mhalley » Thu Jul 05, 2018 7:47 pm

I am 63 and paying 24k a year for HSA bronze plan, plus my wife spent 3 days in the hospital that cost Me 6k. Can't wait for Medicare. Plus about $300 for rx.

JoinToday
Posts: 849
Joined: Sat Mar 10, 2007 9:59 pm

Re: What I spent in 6 months on medicare

Post by JoinToday » Thu Jul 05, 2018 7:50 pm

Hayden wrote:
Thu Jul 05, 2018 6:21 pm
JoinToday wrote:
Thu Jul 05, 2018 6:13 pm
$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:

That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
I had the opposite reaction. I wish I could buy into Medicare. I recently saw the 2019 figures for my ACA plan. My premiums will go up almost 40% next year.
40% of what amount? I am trying to get some perspective. And how much was your healthcare before ACA (if you can recall)

Did you reap the (promised) benefits of your ACA plan when you joined?:
1. Saved $2500
2. If you liked your doctor, you could keep your doctor
3. If you liked your health plan, you could keep your health plan
(or to quote a recent thread, are you calling that Bravo Sierra? :wink: )

I think my employer paid more than $8K for my family's health insurance, but it isn't like it is a factor of 2 cheaper.
I wish I had learned about index funds 25 years ago

JoinToday
Posts: 849
Joined: Sat Mar 10, 2007 9:59 pm

Re: What I spent in 6 months on medicare

Post by JoinToday » Thu Jul 05, 2018 7:51 pm

mhalley wrote:
Thu Jul 05, 2018 7:47 pm
I am 63 and paying 24k a year for HSA bronze plan, plus my wife spent 3 days in the hospital that cost Me 6k. Can't wait for Medicare. Plus about $300 for rx.
I need to join the real world. I am stunned by these prices.
I wish I had learned about index funds 25 years ago

User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Thu Jul 05, 2018 7:57 pm

JoinToday wrote:
Thu Jul 05, 2018 7:51 pm
mhalley wrote:
Thu Jul 05, 2018 7:47 pm
I am 63 and paying 24k a year for HSA bronze plan, plus my wife spent 3 days in the hospital that cost Me 6k. Can't wait for Medicare. Plus about $300 for rx.
I need to join the real world. I am stunned by these prices.
(sort of) stunned as well. Being in the age group just before medicare (under ACA in most states) has premiums 3x that of young folks. It was more like 4-6x before the ACA.

reimann
Posts: 54
Joined: Thu Mar 30, 2017 9:31 pm

Re: What I spent in 6 months on medicare

Post by reimann » Thu Jul 05, 2018 8:00 pm

I am 59 and BCBS health care insurance with $500 deductible for my family of 5 is $33k/year. (self employed) No health problems. No meds.

bhsince87
Posts: 2642
Joined: Thu Oct 03, 2013 1:08 pm

Re: What I spent in 6 months on medicare

Post by bhsince87 » Thu Jul 05, 2018 8:02 pm

Interesting. I was actually thinking about making a post asking what folks on Medicare actually pay per year.

I have no idea what to budget for that phase of my life!
"If ye love wealth better than liberty, the tranquility of servitude better than the animating contest of freedom, go home from us in peace." Samuel Adams

PartIrish
Posts: 65
Joined: Mon Feb 23, 2015 10:39 pm

Re: What I spent in 6 months on medicare

Post by PartIrish » Thu Jul 05, 2018 8:21 pm

dm200,

Except for the out-of-pocket costs, your total seems quite reasonable to me. I am 61 and buy insurance through my state retirement plan (retired educator). My 2018 total cost of premiums is $9540, and that is with a small subsidy on premiums that all state retirees receive in my state. Other than one skin check-up, I have yet to use any of the insurance. This single budget item is the only variable for which I cannot accurately plan, and which keeps me working in the private sector, post-retirement, although I am an independent contractor/consultant so I cover that costs myself.

One questions: Were your out of pocket costs because you do not have a supplemental plan to cover them? My spouse has such a plan which I believe covers nearly everything else.

cutterinnj
Posts: 311
Joined: Wed Jun 01, 2011 10:08 pm

Re: What I spent in 6 months on medicare

Post by cutterinnj » Thu Jul 05, 2018 8:25 pm

JoinToday wrote:
Thu Jul 05, 2018 6:13 pm
$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:

That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
I spend about 5 times this for my healthy family of 4 (2 small kids, 2 adults) with high deductible.

Jack FFR1846
Posts: 10819
Joined: Tue Dec 31, 2013 7:05 am
Location: 26 miles, 385 yards west of Copley Square

Re: What I spent in 6 months on medicare

Post by Jack FFR1846 » Thu Jul 05, 2018 8:37 pm

That's way cheaper than I'm paying even with megacorp insurance coverage.
Bogle: Smart Beta is stupid

marcopolo
Posts: 2787
Joined: Sat Dec 03, 2016 10:22 am

Re: What I spent in 6 months on medicare

Post by marcopolo » Thu Jul 05, 2018 8:53 pm

JoinToday wrote:
Thu Jul 05, 2018 7:51 pm
mhalley wrote:
Thu Jul 05, 2018 7:47 pm
I am 63 and paying 24k a year for HSA bronze plan, plus my wife spent 3 days in the hospital that cost Me 6k. Can't wait for Medicare. Plus about $300 for rx.
I need to join the real world. I am stunned by these prices.
It is easy to get a pretty accurate quote for your specific location/situation from healthcare,gov
Once in a while you get shown the light, in the strangest of places if you look at it right.

schachtw
Posts: 151
Joined: Mon Jul 06, 2015 6:15 pm

Re: What I spent in 6 months on medicare

Post by schachtw » Thu Jul 05, 2018 8:58 pm

6 month Medicare costs, for wife and myself:

Medicare part B: $1608 ($134/month for each)
BCBSIL Plan G: $1812 ($151/month for each)
Part D Basic: $290 (24.10/month for each)
Total monthly fixed costs: $620

Drugs YTD: 1,000
Dental YTD: 4,000

We budget 12-15K/year for medical costs.

User avatar
FrugalInvestor
Posts: 5318
Joined: Fri Nov 07, 2008 12:20 am

Re: What I spent in 6 months on medicare

Post by FrugalInvestor » Thu Jul 05, 2018 9:10 pm

Hayden wrote:
Thu Jul 05, 2018 6:21 pm
JoinToday wrote:
Thu Jul 05, 2018 6:13 pm
$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:

That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
I had the opposite reaction. I wish I could buy into Medicare. I recently saw the 2019 figures for my ACA plan. My premiums will go up almost 40% next year.
I am on Medicare and recently had a significant medical issue treated under Medicare at a high profile medical facility. My total out-of-pocket costs for the last year (diagnosis through treatments) have been around $300 plus premiums of around $275/month.

My wife is still on an ACA plan. She can hardly wait to be on Medicare.

Edit: I neglected to account for my Part B deductible of $183. It needs to be added to the above. I have a 'G' supplement so I pay that out-of-pocket. Total out-of-pocket would be about $450 ($300 was a high estimate).
Last edited by FrugalInvestor on Fri Jul 06, 2018 7:39 am, edited 1 time in total.
IGNORE the noise! | Our life is frittered away by detail... simplify, simplify. - Henry David Thoreau

drawpoker
Posts: 2809
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: What I spent in 6 months on medicare

Post by drawpoker » Fri Jul 06, 2018 12:13 am

PartIrish wrote:
Thu Jul 05, 2018 8:21 pm
....Except for the out-of-pocket costs, your total seems quite reasonable....... questions: Were your out of pocket costs because you do not have a supplemental plan to cover them?.....
The clue here is the $30 a month dm200 pays - He is with a Medicare Advantage plan - not traditional Medicare with a supplement.
In return for the low price for his MA (with Kaiser) he has to pony up co-pays for a whole lot. One of the advantages of going with a MA (versus traditional Medicare) is you don't have to purchase a separate Part D plan as nearly all MA plans include wraparound Rx drug coverage. (Still co-pays, of course, just like with a Part D)

The big Disadvantage of these MA plans is that, by law, you are not allowed to purchase a separate, "supplemental plan" as you suggest, to cover your out-of-pocket (OOP) costs. You are pretty much stuck with whatever your particular MA plan's annual OOP max is (some can go over $6,000)

Depending on which state you live in, also the state of your health, and how competitive the various insurance companies in the Medigap market want to be where you live, taking traditional Medicare with either Plan F or Plan G, might be a better choice, cost-wise.

Ex: What I spent in 6 months on Medicare

Part B premium $134 x 6 mo = $ 804 (exactly same as the OP)
Medigap Plan F $223 x 6 mo = $1,338
Part D premium -0- (In Maryland, a single with below $36,700 in income, state SPDAP pays)
Rx co-pays $120 (Very close to the OP)
Out of Pocket -0-

As of this 6-month window, yes, am behind the OP by around $250. However, if his OOP goes up in the next six months by around $500 due to the unexpected, I will come out ahead. With Plan F you know exactly to the penny what your OOP will be = -0- Also, I was not tied into the "in network" requirements of a MA. Instead free to go anywhere across the country to obtain specialized care (no referrals required) from any surgeon willing to accept Medicare reimbursement. This aspect can become a real deal-breaker if you are faced with a diagnosis of one of the more deadly forms of cancer.
(So as not to confuse the matter even more - folks nearing Medicare enrollment at 65 should remember that the gumb-mint decreed that Plan F (and C) can no longer be sold starting in 2019, the window is quickly closing. Folks already on Plan F will be grandfathered, no need to panic :sharebeer )

neilpilot
Posts: 2917
Joined: Fri Dec 04, 2015 1:46 pm
Location: Memphis area

Re: What I spent in 6 months on medicare

Post by neilpilot » Fri Jul 06, 2018 7:19 am

dm200 wrote:
Thu Jul 05, 2018 5:47 pm
I am in my early 70's - and I just reviewed what I spent on Medical costs under Medicare. While this is anecdotal - it is an example of my low costs (so far at least).

Medicare Part B - $134/month - 6 months = $804
Medicare (Kaiser) plan premiums $30/month - 6 months = $180
My approximate prescription drug costs - 6 months = about $140 total
My medical out of pocket - 6 months $880 - includes office visit copays, one outpatient surgery, one CT scan and a few other scans, xrays, etc.

My wife has incurred similar expenditures.

I expect the next six months to be a bit lower than the $880 out of pocket - BUT we shall see,
68 yo male, and for the first 6 months of 2018:

Medicare Part B - $134/mo x 6 = $804
Medicare supplement G = $117/mo x 6 = $702
Med part D = $17.75 x 6 = $106.50
prescription drug costs - 6 months = $22.80
Medical out of pocket (includes 2 Dr visits & 1 dental) = $157

Keep 2 things in mind:
[1] healthcare needs are individual, so comparisons are somewhat meaningless
[2] dm200 is a fanboy of Kaiser, with many posts proclaiming that his Kaiser Medigap should be a prime consideration. This thread maybe moving in that direction.

User avatar
BolderBoy
Posts: 4539
Joined: Wed Apr 07, 2010 12:16 pm
Location: Colorado

Re: What I spent in 6 months on medicare

Post by BolderBoy » Fri Jul 06, 2018 8:47 am

dm200 wrote:
Thu Jul 05, 2018 5:47 pm
Medicare (Kaiser) plan premiums $30/month...
Interesting the difference here. I'm in the Boulder/Denver Kaiser service area and our Medicare plan dues are $48/month.
"Never underestimate one's capacity to overestimate one's abilities" - The Dunning-Kruger Effect

larsm
Posts: 74
Joined: Thu Sep 23, 2010 8:04 pm

Re: What I spent in 6 months on medicare

Post by larsm » Fri Jul 06, 2018 9:09 am

reimann wrote:
Thu Jul 05, 2018 8:00 pm
I am 59 and BCBS health care insurance with $500 deductible for my family of 5 is $33k/year. (self employed) No health problems. No meds.
$33 thousand sounds like a lot. But it works out to $550 per month per person. Sounds a lot better that way. Just saying...

User avatar
AAA
Posts: 1233
Joined: Sat Jan 12, 2008 8:56 am

Re: What I spent in 6 months on medicare

Post by AAA » Fri Jul 06, 2018 9:18 am

yosh99 wrote:
Thu Jul 05, 2018 6:16 pm
And Medicare does not cover dental or vision expenses.
My Medicare Advantage plan ($77/month) includes some coverage for these.

Lynette
Posts: 1898
Joined: Sun Jul 27, 2014 9:47 am

Re: What I spent in 6 months on medicare

Post by Lynette » Fri Jul 06, 2018 9:33 am

/////
Last edited by Lynette on Mon Jan 07, 2019 3:06 pm, edited 1 time in total.

protagonist
Posts: 6093
Joined: Sun Dec 26, 2010 12:47 pm

Re: What I spent in 6 months on medicare

Post by protagonist » Fri Jul 06, 2018 9:40 am

dm200 wrote:
Thu Jul 05, 2018 5:47 pm
I am in my early 70's - and I just reviewed what I spent on Medical costs under Medicare. While this is anecdotal - it is an example of my low costs (so far at least).

Medicare Part B - $134/month - 6 months = $804
Medicare (Kaiser) plan premiums $30/month - 6 months = $180
My approximate prescription drug costs - 6 months = about $140 total
My medical out of pocket - 6 months $880 - includes office visit copays, one outpatient surgery, one CT scan and a few other scans, xrays, etc.

My wife has incurred similar expenditures.

I expect the next six months to be a bit lower than the $880 out of pocket - BUT we shall see,
I'm 66. I have not done an accounting, but I have spent a bit less than you over my past year on Medicare (though definitely more than I was paying on "Romneycare" (Massachusetts' program similar to "Obamacare", available up to age 65, income-dependent). My monthly HMO premiums are with Tufts in MA ....$24/month. My prescription drug costs I believe have been less than yours. The Tufts coverage is quite comprehensive and even covers travel emergency care overseas- I do not have additional dental or eye care. My medical out-of pocket was a lot lower than yours. Other than routine outpatient visits I had a diagnostic colonoscopy that was negative.
Last edited by protagonist on Fri Jul 06, 2018 9:45 am, edited 2 times in total.

FeesR-BullNotBullish
Posts: 136
Joined: Sat May 28, 2016 11:22 am

Re: What I spent in 6 months on medicare

Post by FeesR-BullNotBullish » Fri Jul 06, 2018 9:41 am

I am 38 and DW is 41. We are child free. 2018 insurance premiums will run $9200. 2018 has been a healthy year thus far, but if misfortune hits we will be out another $5,500 per individual before our “insurance” starts to pay for stuff. Even then out of pocket costs will continue to rise on the inevitable things that are necessary but not covered.

We have a Kaiser Permanente HMO plan with a high deductible and a very limited network. This plan was by far the most “affordable” we could find on the marketplace for 2018. I’m afraid to look at the rates for 2019. Our health care system is suffocating me, and I very rarely participate in it.

I know my story isn't abnormal and I'm even getting off easy compared to some like mhalley and reimann. But it's absolutely criminal nonetheless to be paying these exorbitant fees to feed a medical system that has become a monster swallowing as many resources as it can.
Last edited by FeesR-BullNotBullish on Fri Jul 06, 2018 9:55 am, edited 1 time in total.

jebmke
Posts: 9999
Joined: Thu Apr 05, 2007 2:44 pm

Re: What I spent in 6 months on medicare

Post by jebmke » Fri Jul 06, 2018 9:52 am

yosh99 wrote:
Thu Jul 05, 2018 6:16 pm
JoinToday wrote:
Thu Jul 05, 2018 6:13 pm
$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:

That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
And Medicare does not cover dental or vision expenses.
I was surprised that Medicare covered part of my routine eye exam this year. I never figured out whether it was covered under Medicare or the supplemental or exactly why it was covered. It certainly won't cover glasses (fortunately I don't need them now that I had my lenses replaced) or dental work. Both of those can be expensive as can hearing aids. I am keeping my HC budget at $1K per person even as we transition to Medicare. We will probably underspend for some years but I'm confident that eventually we will get hit by something that isn't covered. Eventually I will need hearing aid(s); so far resisting for reasons other than money.

Edit: I am also expecting that eventually some preferred docs will be non-Medicare participants or not accept Medicare as full payment so out of pocket could rise for "covered" stuff.
When you discover that you are riding a dead horse, the best strategy is to dismount.

SpideyIndexer
Posts: 497
Joined: Thu Apr 02, 2015 10:13 pm

Re: What I spent in 6 months on medicare

Post by SpideyIndexer » Fri Jul 06, 2018 10:50 am

It depends. My mother in law's income was low and she was in Kaiser MA and paid under $100 per month, so I had thought Medicare was almost free.

Now I am learning about IRMAA, will go with Traditional + Supplement and will probably pay approx. $600 per month, more than my retiree plan. But it will decrease eventually....unless rates increase of course.

PartIrish
Posts: 65
Joined: Mon Feb 23, 2015 10:39 pm

Re: What I spent in 6 months on medicare

Post by PartIrish » Fri Jul 06, 2018 11:52 am

drawpoker wrote:
Fri Jul 06, 2018 12:13 am
PartIrish wrote:
Thu Jul 05, 2018 8:21 pm
....Except for the out-of-pocket costs, your total seems quite reasonable....... questions: Were your out of pocket costs because you do not have a supplemental plan to cover them?.....
The clue here is the $30 a month dm200 pays - He is with a Medicare Advantage plan - not traditional Medicare with a supplement.
In return for the low price for his MA (with Kaiser) he has to pony up co-pays for a whole lot. One of the advantages of going with a MA (versus traditional Medicare) is you don't have to purchase a separate Part D plan as nearly all MA plans include wraparound Rx drug coverage. (Still co-pays, of course, just like with a Part D)

The big Disadvantage of these MA plans is that, by law, you are not allowed to purchase a separate, "supplemental plan" as you suggest, to cover your out-of-pocket (OOP) costs. You are pretty much stuck with whatever your particular MA plan's annual OOP max is (some can go over $6,000)

Depending on which state you live in, also the state of your health, and how competitive the various insurance companies in the Medigap market want to be where you live, taking traditional Medicare with either Plan F or Plan G, might be a better choice, cost-wise.

Ex: What I spent in 6 months on Medicare

Part B premium $134 x 6 mo = $ 804 (exactly same as the OP)
Medigap Plan F $223 x 6 mo = $1,338
Part D premium -0- (In Maryland, a single with below $36,700 in income, state SPDAP pays)
Rx co-pays $120 (Very close to the OP)
Out of Pocket -0-

As of this 6-month window, yes, am behind the OP by around $250. However, if his OOP goes up in the next six months by around $500 due to the unexpected, I will come out ahead. With Plan F you know exactly to the penny what your OOP will be = -0- Also, I was not tied into the "in network" requirements of a MA. Instead free to go anywhere across the country to obtain specialized care (no referrals required) from any surgeon willing to accept Medicare reimbursement. This aspect can become a real deal-breaker if you are faced with a diagnosis of one of the more deadly forms of cancer.
(So as not to confuse the matter even more - folks nearing Medicare enrollment at 65 should remember that the gumb-mint decreed that Plan F (and C) can no longer be sold starting in 2019, the window is quickly closing. Folks already on Plan F will be grandfathered, no need to panic :sharebeer )
Thank you, drawpoker, that information is very helpful.

User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 12:31 pm

BolderBoy wrote:
Fri Jul 06, 2018 8:47 am
dm200 wrote:
Thu Jul 05, 2018 5:47 pm
Medicare (Kaiser) plan premiums $30/month...
Interesting the difference here. I'm in the Boulder/Denver Kaiser service area and our Medicare plan dues are $48/month.
Yes - we are in the Washington DC - Baltimore MD - Northern VA area of Kaiser. I looked at the various Kaiser Medicare plans around the country and there are many differences in premiums and the amounts of copays, etc. - even in the same state such as CA and CO.

User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 12:34 pm

[2] dm200 is a fanboy of Kaiser, with many posts proclaiming that his Kaiser Medigap should be a prime consideration. This thread maybe moving in that direction.
Not Kaiser Medigap - but Kaiser Medicare Advantage or Medicare Cost.

User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 12:42 pm

drawpoker wrote:
Fri Jul 06, 2018 12:13 am
PartIrish wrote:
Thu Jul 05, 2018 8:21 pm
....Except for the out-of-pocket costs, your total seems quite reasonable....... questions: Were your out of pocket costs because you do not have a supplemental plan to cover them?.....
The clue here is the $30 a month dm200 pays - He is with a Medicare Advantage plan - not traditional Medicare with a supplement.
In return for the low price for his MA (with Kaiser) he has to pony up co-pays for a whole lot. One of the advantages of going with a MA (versus traditional Medicare) is you don't have to purchase a separate Part D plan as nearly all MA plans include wraparound Rx drug coverage. (Still co-pays, of course, just like with a Part D)
The big Disadvantage of these MA plans is that, by law, you are not allowed to purchase a separate, "supplemental plan" as you suggest, to cover your out-of-pocket (OOP) costs. You are pretty much stuck with whatever your particular MA plan's annual OOP max is (some can go over $6,000)
Depending on which state you live in, also the state of your health, and how competitive the various insurance companies in the Medigap market want to be where you live, taking traditional Medicare with either Plan F or Plan G, might be a better choice, cost-wise.
Ex: What I spent in 6 months on Medicare
Part B premium $134 x 6 mo = $ 804 (exactly same as the OP)
Medigap Plan F $223 x 6 mo = $1,338
Part D premium -0- (In Maryland, a single with below $36,700 in income, state SPDAP pays)
Rx co-pays $120 (Very close to the OP)
Out of Pocket -0-
As of this 6-month window, yes, am behind the OP by around $250. However, if his OOP goes up in the next six months by around $500 due to the unexpected, I will come out ahead. With Plan F you know exactly to the penny what your OOP will be = -0- Also, I was not tied into the "in network" requirements of a MA. Instead free to go anywhere across the country to obtain specialized care (no referrals required) from any surgeon willing to accept Medicare reimbursement. This aspect can become a real deal-breaker if you are faced with a diagnosis of one of the more deadly forms of cancer.
(So as not to confuse the matter even more - folks nearing Medicare enrollment at 65 should remember that the gumb-mint decreed that Plan F (and C) can no longer be sold starting in 2019, the window is quickly closing. Folks already on Plan F will be grandfathered, no need to panic :sharebeer )
Yes - all very true. My max annual OOP is currently $6,000. I can change every year to the "high option" and pay $142 and have lower copays and OOP ($3,500). The copays are not that high for office visits (in person -$20 PCP and $45 specialist) - and often I can (no charge) handle things by email, telephone apt or virtual house call (smart phone 2 way). In addition, for some specialties - such as Cardiology and Hematology - my PCP (no charge) acts as an intermediary and sends me the results - without my actually seeing that specialist in person.

This is the first year that I have been on Medicare (since 2011) where I had a lot of office visits (both primary care and specialists), surgery (outpatient) and multiple tests.

User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 12:47 pm

SpideyIndexer wrote:
Fri Jul 06, 2018 10:50 am
It depends. My mother in law's income was low and she was in Kaiser MA and paid under $100 per month, so I had thought Medicare was almost free.
Now I am learning about IRMAA, will go with Traditional + Supplement and will probably pay approx. $600 per month, more than my retiree plan. But it will decrease eventually....unless rates increase of course.
How does IRMAA affect MA vs Original and supplement?

2015
Posts: 2906
Joined: Mon Feb 10, 2014 2:32 pm

Re: What I spent in 6 months on medicare

Post by 2015 » Fri Jul 06, 2018 12:49 pm

neilpilot wrote:
Fri Jul 06, 2018 7:19 am
dm200 wrote:
Thu Jul 05, 2018 5:47 pm

Keep 2 things in mind:
[1] healthcare needs are individual, so comparisons are somewhat meaningless
[2] dm200 is a fanboy of Kaiser, with many posts proclaiming that his Kaiser Medigap should be a prime consideration. This thread maybe moving in that direction.
I wholeheartedly agree with [1], as available plan choices are location dependent, and costs are influenced by a host of factors. OTOH, other than Part B premiums, a relative on an MA plan paid 0 plan premiums, had under $1K combined drug and services copays for the entire years, and this is after a number of hospitalizations, use of ground and air transport, all kinds of durable medical equipment, home health, etc. There was no need for "supplemental insurance" of any kind and the hospitalization care was nothing short of outstanding.

I don't see anything wrong with being a fanboy of Kaiser, either. I have relatives who have been extremely happy with everything related to their Kaiser MA plans, both pre-/post-retirement. IIRC, dm200 has an MA plan with Kaiser, not a Medigap plan.

mrsbetsy
Posts: 205
Joined: Mon Jun 26, 2017 12:16 am

Re: What I spent in 6 months on medicare

Post by mrsbetsy » Fri Jul 06, 2018 1:04 pm

Wow....dreaming of the day of Medicare for all.

We pay $14,400 a year for two of us to have a HDHC Kaiser plan. We've spent $1200 out of pocket this year for copays typical checkups, but I had a suspicious mammogram which required follow up scans. I was completely impressed that Kaiser had me scheduled for those follow ups within 24 hours and within 72 hours we had all the answers we needed that it was nothing. We cash flowed the out of pocket.

We are fully funding our HSA and investing with Lively. At 57 and 62, we are building it up for the future.

We cannot wait for that healthcare entitlement!!!

drawpoker
Posts: 2809
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: What I spent in 6 months on medicare

Post by drawpoker » Fri Jul 06, 2018 1:10 pm

dm200 wrote:
Fri Jul 06, 2018 12:47 pm

How does IRMAA affect MA vs Original and supplement?
https://q1medicare.com/q1group/Medicare ... ory_id=133

Since everyone on Medicare must pay the Part B premium - whether on Original or in a MA plan - you might say the IRMAA has no real net effect on which you choose. It is just another (higher) cost to be figured in when trying to project future health care budgeting.

Which, frankly, I think is pretty futile these days, unless you have some special crystal ball. Or tea leaves. :wink:
Last edited by drawpoker on Fri Jul 06, 2018 1:14 pm, edited 1 time in total.

User avatar
Artful Dodger
Posts: 810
Joined: Thu Oct 20, 2016 12:56 pm

Re: What I spent in 6 months on medicare

Post by Artful Dodger » Fri Jul 06, 2018 1:10 pm

dm200 wrote:
Thu Jul 05, 2018 5:47 pm
I am in my early 70's - and I just reviewed what I spent on Medical costs under Medicare. While this is anecdotal - it is an example of my low costs (so far at least).

Medicare Part B - $134/month - 6 months = $804
Medicare (Kaiser) plan premiums $30/month - 6 months = $180
My approximate prescription drug costs - 6 months = about $140 total
My medical out of pocket - 6 months $880 - includes office visit copays, one outpatient surgery, one CT scan and a few other scans, xrays, etc.

My wife has incurred similar expenditures.

I expect the next six months to be a bit lower than the $880 out of pocket - BUT we shall see,
I think you're getting a good deal. Med Advantage plans in my area are similar in price or a little more, and I seem to recall you had Kaiser, and were very happy with the service. A traditional Medicare Plan F supplement for someone in their mid 70s in our area would be around $225 per month, and lower cost Part D Rx about $30. The Supp plan would have covered the medical out of pocket in full versus the $880 you paid, but 6 months premium would have been $1530 vs the $180 you paid. I expect Rx outlay with the lower cost Part D plan would have been at least as high as yours. Bravo! :beer

User avatar
Artful Dodger
Posts: 810
Joined: Thu Oct 20, 2016 12:56 pm

Re: What I spent in 6 months on medicare

Post by Artful Dodger » Fri Jul 06, 2018 1:15 pm

dm200 wrote:
Fri Jul 06, 2018 12:47 pm
SpideyIndexer wrote:
Fri Jul 06, 2018 10:50 am
It depends. My mother in law's income was low and she was in Kaiser MA and paid under $100 per month, so I had thought Medicare was almost free.
Now I am learning about IRMAA, will go with Traditional + Supplement and will probably pay approx. $600 per month, more than my retiree plan. But it will decrease eventually....unless rates increase of course.
How does IRMAA affect MA vs Original and supplement?
You pay IRMAA additional tax regardless whether you have traditional Medicare or go with the Med Advantage plan. Pt D IRMAA as well, unless you have not enrolled in Pt D (whether separate plan or combined with Med Adv).

TravelGeek
Posts: 3189
Joined: Sat Oct 25, 2014 3:23 pm

Re: What I spent in 6 months on medicare

Post by TravelGeek » Fri Jul 06, 2018 1:21 pm

Hayden wrote:
Thu Jul 05, 2018 6:21 pm
I had the opposite reaction. I wish I could buy into Medicare. I recently saw the 2019 figures for my ACA plan. My premiums will go up almost 40% next year.
40% approved increase or 40% requested increase? I thought none had been approved yet.

https://www.kff.org/private-insurance/i ... exchanges/

SurfCityBill
Posts: 518
Joined: Tue May 01, 2012 10:15 pm

Re: What I spent in 6 months on medicare

Post by SurfCityBill » Fri Jul 06, 2018 1:23 pm

General thank you to all posters. I'm getting close enough now age-wise that education on these golden year topics, Medicare, SS benefits, etc, is becoming very important. This comparative discussion is extremely valuable to myself and I'm sure many others.

Much appreciated.

dennisbyron
Posts: 44
Joined: Wed Mar 22, 2017 5:21 am

Re: What I spent in 6 months on medicare

Post by dennisbyron » Fri Jul 06, 2018 1:27 pm

drawpoker wrote:
Fri Jul 06, 2018 12:13 am

The clue here is the $30 a month dm200 pays - He is with a Medicare Advantage plan - not traditional Medicare with a supplement. In return for the low price for his MA (with Kaiser) he has to pony up co-pays for a whole lot. One of the advantages of going with a MA (versus traditional Medicare) is you don't have to purchase a separate Part D plan as nearly all MA plans include wraparound Rx drug coverage. (Still co-pays, of course, just like with a Part D)

The big Disadvantage of these MA plans is that, by law, you are not allowed to purchase a separate, "supplemental plan" as you suggest, to cover your out-of-pocket (OOP) costs. You are pretty much stuck with whatever your particular MA plan's annual OOP max is (some can go over $6,000)
This advantages/disadvantages description of public Part C of Medicare (of which Medicare Advantage is a kind) is accurate up until the words "you are pretty much stuck..." You might get the impression from the word "stuck" that the annual OOP limit is a bad thing or that the annual OOP is a deductible. It is not; it is a maximum a person could spend on such a plan (whereas traditional Medicare has no such protection and the total you could spend is unlimited. A private Medigap supplement on top of traditional Medicare (much more expensive than Part C as the other examples in the thread illustrate) and many group retirements plans (going away but about 30% of people on Medicare still have them) effectively provide such protection. But even then, Medigap cuts off if you hit the lifetime and per-incident limits of traditional Medicare (this is unlikely but of course you buy insurance as protection against the unlikely).

So in fact, the annual out of pocket spend limit is a major advantage of Part C, not a disadvantage... The major disadvantage of public Part C of Medicare -- as the commenter implies -- is that Part C is managed and networked and traditional Medicare is roll your own/go anywhere you want. So if your favored provider accepts public Part C of Medicare, it's a great deal. If he or she doesn't, stay away from it (unless you don't mind switching providers). Further if he or she accepts it, you also have to use other providers to which he or she refers you (although there are various types of networks, some more liberal than others). In other words, it works just like 80% or so of all other health insurance in the United States

drawpoker
Posts: 2809
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: What I spent in 6 months on medicare

Post by drawpoker » Fri Jul 06, 2018 1:35 pm

dm200 wrote:
Fri Jul 06, 2018 12:42 pm

.... My max annual OOP is currently $6,000. I can change every year to the "high option" and pay $142 and have lower copays and OOP ($3,500).......This is the first year that I have been on Medicare (since 2011) where I had a lot of office visits (both primary care and specialists), surgery (outpatient) and multiple tests.
Sounds like the bloom is fading fast from the rose. That $30 a month was pretty good. When you were pretty healthy, that is.
You are now finding out what many of us also found out since joining Medicare - health seldom gets better as you get older.
It definitely starts going South. :x
I imagine you will strongly consider taking that higher option plan on your anniversary. $142 a month can look pretty good, too. Depending just how bad things can go.

drawpoker
Posts: 2809
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: What I spent in 6 months on medicare

Post by drawpoker » Fri Jul 06, 2018 2:17 pm

dennisbyron wrote:
Fri Jul 06, 2018 1:27 pm

This advantages/disadvantages description of public Part C of Medicare (of which Medicare Advantage is a kind) is accurate up until the words "you are pretty much stuck..." You might get the impression from the word "stuck" that the annual OOP limit is a bad thing or that the annual OOP is a deductible. It is not; it is a maximum a person could spend on such a plan (whereas traditional Medicare has no such protection and the total you could spend is unlimited.

Yes, if anyone is stupid enough to take traditional Medicare with no supplement. Having no supplement to take care of the 20% co-insurance on Part B services, yes, theoretically, the total you could "spend" is unlimited.





A private Medigap supplement on top of traditional Medicare (much more expensive than Part C as the other examples in the thread illustrate) and many group retirements plans (going away but about 30% of people on Medicare still have them) effectively provide such protection. But even then, Medigap cuts off if you hit the lifetime and per-incident limits of traditional Medicare (this is unlikely but of course you buy insurance as protection against the unlikely).

Whoa, whoa. Way, way misleading. Part C (MA Plans) has to follow the same rules as regular Medicare as far as lifetime caps on reserve days (Part A benefits) You must be referring to some special rules that your state, Massachusetts, follows. Because Massachusetts is one of the 3 states that do not recognize the 10 standardized Medicare supplement insurance forms, Massachusetts legislated their own forms. All 10 Medicare supplement plans have to provide 365 additional days after lifetime reserve has been exhausted.


So in fact, the annual out of pocket spend limit is a major advantage of Part C, not a disadvantage...

When people research this, think you will have a hard time convincing people that is a "fact" as you put it.


User avatar
Sheepdog
Posts: 5425
Joined: Tue Feb 27, 2007 3:05 pm
Location: Indiana, retired 1998 at age 65

Re: What I spent in 6 months on medicare

Post by Sheepdog » Fri Jul 06, 2018 2:24 pm

I am 84 and my wife is 77. You may be interested in our medical costs. These are using Medicare Advantage plans. I have used these plans since 2014 and my wife since 2016. Since going to these plans comparing our total Medicare, plus Part D and other out of pocket costs we are each saving $2000 a year with Advantage plans. (Medigap policy rates were increasing dramatically as we aged is why we changed.)

These are our (2 retirees) out of pocket costs in 2016 and 2017. First is 2016 and the second is 2017

Medical insurance premiums including Medicare which comes from our Social Security $4135.....$4691
Dentist $413.....$2209
Physicians $725.....$1048
Prescriptions $1293.....$2755
Hospital and Surgical $0.....$214
Misc (eyes, lab, hearing $1276,....$1947

TOTAL OUT OF POCKET $7,842......$12,864

NOTE: My wife is now taking some expensive medications and will continue to do so. And we are unable to do anything about our increasing dental costs. Hearing aids are being covered by our advantage plans which is a big help.
Just because it isn't your fault doesn't mean it isn't your responsibility....Josh Reid Jones

User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 2:39 pm

So in fact, the annual out of pocket spend limit is a major advantage of Part C, not a disadvantage...
In my opinion, it is BOTH. You know that the annual OOP has a cap - but that cap may be higher than you would like.

There also seem to be some who claim that MA (and MC) plans may not cover everything that Original medicare covers. That is not true - every MA (and MC) plan must cover everything Original medicare covers - and MA and MC plans can cover additional services (such as vision).

User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 2:42 pm

drawpoker wrote:
Fri Jul 06, 2018 1:35 pm
dm200 wrote:
Fri Jul 06, 2018 12:42 pm
.... My max annual OOP is currently $6,000. I can change every year to the "high option" and pay $142 and have lower copays and OOP ($3,500).......This is the first year that I have been on Medicare (since 2011) where I had a lot of office visits (both primary care and specialists), surgery (outpatient) and multiple tests.
Sounds like the bloom is fading fast from the rose. That $30 a month was pretty good. When you were pretty healthy, that is.
You are now finding out what many of us also found out since joining Medicare - health seldom gets better as you get older.
It definitely starts going South. :x
I imagine you will strongly consider taking that higher option plan on your anniversary. $142 a month can look pretty good, too. Depending just how bad things can go.
No, not yet - far from it. I believe I am still far ahead financially - as well as health and health risk. There are also zero hassles with filing claims - only the very occasional error in billing - always cleared up quickly and satisfactorily.

Also, small things add up. We never pay for parking at any facility we use. Most previous PCP and specialist offices were in a hospital adjacent office building - and that was $5 for every office visit. While technically, the annual physical is only "free" if you do not bring up new issues, I do that all the time - and have never been charged. About half of what I do with physicians can be done (no charge) by email, telephone appt or two way smart phone. There is an urgent care facility (used it several times) open 24x7 - and telephone advice nurse line 24x7.
Last edited by dm200 on Fri Jul 06, 2018 2:51 pm, edited 1 time in total.

drawpoker
Posts: 2809
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: What I spent in 6 months on medicare

Post by drawpoker » Fri Jul 06, 2018 2:49 pm

Sheepdog wrote:
Fri Jul 06, 2018 2:24 pm

.......TOTAL OUT OF POCKET $7,842......$12,864......

Yowza, yowza, yowza.

Since you lumped your Medicare Part B premiums and MA cost into one broad category, can't tell which income bracket you are in on Part B ($134 or $187.50)
Anyway, the real meaning that jumps out to me is now you have crossed the $1,000 a month threshold, and fast approaching $13,000 a year. :shock: )

That tells me this - In Indiana, in your age group, Medigap Plan G now costs more than $540 per month, per person.
Is that right? (Am assuming since you posted you gave up Plan G and switched to a MA plan to save $$)
Last edited by drawpoker on Fri Jul 06, 2018 3:03 pm, edited 1 time in total.

dennisbyron
Posts: 44
Joined: Wed Mar 22, 2017 5:21 am

Re: What I spent in 6 months on medicare

Post by dennisbyron » Fri Jul 06, 2018 2:55 pm

dm200 wrote:
Fri Jul 06, 2018 12:47 pm
SpideyIndexer wrote:
Fri Jul 06, 2018 10:50 am
It depends. My mother in law's income was low and she was in Kaiser MA and paid under $100 per month, so I had thought Medicare was almost free.
Now I am learning about IRMAA, will go with Traditional + Supplement and will probably pay approx. $600 per month, more than my retiree plan. But it will decrease eventually....unless rates increase of course.
How does IRMAA affect MA vs Original and supplement?
It affects Part B (which is required for both, if by "supplement" you mean an individually purchased private Medigap policy) equally no matter which you put on top of your A and B. It affects Part D, which you will likely want if you have a private supplement. It affects Part C premiums in some way similar to the way it affects Part D (basically it increases the Part D component of any Part C plan you choose). Not exactly sure how it works if you choose Part C

likegarden
Posts: 2938
Joined: Mon Feb 26, 2007 5:33 pm

Re: What I spent in 6 months on medicare

Post by likegarden » Fri Jul 06, 2018 2:57 pm

I did not read all comments, but in respect to some comments Medicare paid our colonoscopies and cataract eye surgeries.

User avatar
Topic Author
dm200
Posts: 22959
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 3:03 pm

dennisbyron wrote:
Fri Jul 06, 2018 2:55 pm
dm200 wrote:
Fri Jul 06, 2018 12:47 pm
SpideyIndexer wrote:
Fri Jul 06, 2018 10:50 am
It depends. My mother in law's income was low and she was in Kaiser MA and paid under $100 per month, so I had thought Medicare was almost free.
Now I am learning about IRMAA, will go with Traditional + Supplement and will probably pay approx. $600 per month, more than my retiree plan. But it will decrease eventually....unless rates increase of course.
How does IRMAA affect MA vs Original and supplement?
It affects Part B (which is required for both, if by "supplement" you mean an individually purchased private Medigap policy) equally no matter which you put on top of your A and B. It affects Part D, which you will likely want if you have a private supplement. It affects Part C premiums in some way similar to the way it affects Part D (basically it increases the Part D component of any Part C plan you choose). Not exactly sure how it works if you choose Part C
We are not affected by IRMAA, but my understanding is that the (required) Part B premium is the same - whether on Original Medicare or an MA plan. Most MA (and MC) plans include drug coverage as well - so I don't know the IRMAA impact. I don's see how IRMAA affected the choice (one wan or another) on the decision for Original Medicare or an Advantage plan.

Post Reply