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
whr19606
Posts: 34
Joined: Sun Sep 30, 2007 6:50 am

Re: What I spent in 6 months on medicare

Post by whr19606 » Sat Jul 07, 2018 2:54 pm

Am 76, retired for 7 years, with no employer-related health coverage. DW still works and has her own health insurances, so these costs are for me only. Since location affects Medigap costs, we live in Berks Co., PA.

First 6 months of 2018:

Medicare Part B - $804
Medigap (Plan G) - $1,530
Dr. office visits this year - (11)
Physical Therapy visits - (18)
Blood & Cardiac Tests (4) - ($0)
Out of Pocket Medical Costs - $183
Drug Ins. - $76
Medicines (OOP) - $852
Dental Care (1 cleaning) - $36 (am on DW's ins.)
Eye care (1 exam) - $10 (am on DW's ins.)

Regarding the state of my health and my medical costs, I consider myself blessed.

Good Listener
Posts: 721
Joined: Wed Dec 30, 2015 5:24 pm

Re: What I spent in 6 months on medicare

Post by Good Listener » Sat Jul 07, 2018 3:56 pm

kaneohe wrote:
Sat Jul 07, 2018 7:05 am
Good Listener wrote:
Fri Jul 06, 2018 3:53 pm
dm200 wrote:
Fri Jul 06, 2018 3:08 pm
drawpoker wrote:
Fri Jul 06, 2018 3:05 pm
No, that is incorrect
IRMAA tacks on an additional charge to both Part B and Part D monthly premiums.
I agree with this. What is "incorrect"??

I believe the affects of IRMAA are identical whether on Original Medicare and a drug plan - AND Medicare Advantage plan with the drug plan. Am I correct?
Yes. You must have Part B to get Medicare Advantage and you are subject to the IRMAA for Parts B abnd D regardless. The maximum this year for Part B and both IRMAAs is $503.40. If one adds a supplement like F (most expensive) or G (2nd highest), that is about $200 per month and then a part D for anywhere from $20-75 per month.

And I will add my usual warning that I hate Medicare Advantage, having lived through it for 2 months last year when I was put into it by a company retirement plan. I changed to original Medicare plus the supplement and Part D as soon as I could. With what I now have there are no prior authorizations or any other costs except out of pocket drug copays. It was the prior authorization requirements that got to me. Even if one could get them, it was a nuisance and worry to deal with. MA may give some things like gym memberships and a few bucks to a hearing aid and save premiums but if you can afford it, I would avoid MA.
I have a supplement plan and wife has Advantage. Perhaps I missed it....but I distinctly remember looking at the last annual SS statement which details the charges for Medicare that are deducted from the SS payment. I saw the IRMAA surcharge for pt B on both of our statements , but the pt D surcharge was only on mine. Was wondering if perhaps wife's Advantage plan picked up that charge.

We both do get gym memberships from our health plans.......so possible (but not guaranteed) for both supplement and Advantage, depending on specific plan.
Your observation is correct in that some or most MA plans include Part D so your wife doesn't have a separate Part D and therefore doesn't pay a Part D premium or surcharge. Note that Part D is not required to be obtained under any circumstances and you can enroll at any new annual period albeit if you didn't have Part D or creditabale coverage (including MA with drug benefits included) you would pay a penalty for life.

Good Listener
Posts: 721
Joined: Wed Dec 30, 2015 5:24 pm

Re: What I spent in 6 months on medicare

Post by Good Listener » Sat Jul 07, 2018 4:02 pm

dm200 wrote:
Sat Jul 07, 2018 9:29 am
And I will add my usual warning that I hate Medicare Advantage, having lived through it for 2 months last year when I was put into it by a company retirement plan. I changed to original Medicare plus the supplement and Part D as soon as I could. With what I now have there are no prior authorizations or any other costs except out of pocket drug copays. It was the prior authorization requirements that got to me. Even if one could get them, it was a nuisance and worry to deal with. MA may give some things like gym memberships and a few bucks to a hearing aid and save premiums but if you can afford it, I would avoid MA.
To be fair, I believe what you "hated" was the specific MA plan that you had. A great many of us (including my wife and I) have zero problems or delays or incomveniences by "prior authorization" requirements of our plans - these all happen cery, very quickly and conveniently. You, now, have the added monthly costs for the supplement and Part D.
I had a great MA plan with full out of network benefits. Still some docs wouldn't take it even after United had a person call them and explain that they paid exactly what original Medicare would. Worse were prior authorizations. No I wasn't rejected but I didn't want to deal with it ever. I recall seeing an ENT and needing elective outpatient surgery and he would have done it right then but needed prior authorization. So I had to return. And I hope you never experience it, but one is never denied or delayed until they are.

For me saving a few hundred a month is not important. And when/if something horrible happens, like cancer, I am heading off to Sloan Kettering and not where the plan allows.

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 4:10 pm

I had a great MA plan with full out of network benefits. Still some docs wouldn't take it even after United had a person call them and explain that they paid exactly what original Medicare would. Worse were prior authorizations. No I wasn't rejected but I didn't want to deal with it ever. I recall seeing an ENT and needing elective outpatient surgery and he would have done it right then but needed prior authorization. So I had to return. And I hope you never experience it, but one is never denied or delayed until they are.
For me saving a few hundred a month is not important. And when/if something horrible happens, like cancer, I am heading off to Sloan Kettering and not where the plan allows.
Sorry you had negative experience(s). Over many situations (7 years for me and 3 years for wife), never delays or issues with "authorizations". One example - I had some symptoms (not at all urgent) and emailed my Primary care physician in the middle of an afternoon about the issue. She replied that evening that if I had an infection - make an appintment to see her, BUT if I did not have an infection she would refer me to an ENT specialist. First thing the next morning, I replied that I did not have an infection - so she (electronically) authorized the referral, sent it to the ENT and the ENT office called me at 10 am to tell me the ENT specialist would see me at noon.

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

Re: What I spent in 6 months on medicare

Post by 2015 » Sat Jul 07, 2018 5:19 pm

dm200 wrote:
Sat Jul 07, 2018 1:03 pm
2015 wrote:
Sat Jul 07, 2018 12:51 pm
dm200 wrote:
Fri Jul 06, 2018 3:27 pm
?"
I am very, very happy with my PCP for the last seven years. We get along very well - and she is cooperative with my "diligence" in following every test, every situation - in great detail. In fact, at the end of discussions at office visots, she typically asks, "What do you think about that?" In my plan, though, I am convinced there are many other Primary care physicians where I would also be very happy. I also think there are a few with whom I would not be fully satisfied. In my plan, we can switch PCPs instantly for any or no reason. Online, from time to time as well - I look at the names and profiles of available PCPs if/when I need to find a new one. I have also seen two other PCPs when mine is away on vacation.
Same with my parents. They particularly like their Kaiser MA plan's use of technology. Neither one has had any issues with their PCP, or any other aspect of their care, including a fairly serious surgery which was a success. Another friend here in Los Angeles has been happy with Kaiser for years. I accompanied her during an outpatient surgery (for support) and was impressed with the facilities as well as how organized everything was.

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 » Sat Jul 07, 2018 5:32 pm

marcopolo wrote:
Sat Jul 07, 2018 1:42 pm
engineerartist wrote:
Sat Jul 07, 2018 12:58 pm

In summary, for the 4 years, our total provider charges (not including prescriptions) was $828,465,
while the discounted amount actually paid by Medicare and Medigap combined was $72,451.
The combined Medicare/Medigap payments to providers were only 9% of the provider charges.
This is a real-life example of Medicare reducing the cost of treatment.
I am not sure how much of the reduction can be attributed to Medicare. I think you would need to compare what Medicare paid to what a sizeable insurance company, or HMO would pay for the same procedure.

As far as I can tell, the provider charges might as well be from a random number generator. Does anyone actually ever pay those amounts? There also does not seem to be any correlation between them and what is actually paid. For some charges, the insurance might pay close to 100%, and for others, the insurance might pay less than 10%.
Yes, it makes me wonder, too. There doesn't seem to be any rhyme or reason to it. Here's some figures for Maryland.

I have fairly predictable and frequent office visits and lab work with both PCP and specialist (oncology)
The PCP's "amount provider charged" for routine office visit (under 15 min.) is $98.00 and the "Medicare approved amount" is $75.89, meaning Medicare decided 77.4% was good enough. And keep in mind, Medicare is lopping off 20% of that "allowed" amount when they ante up reimbursement.
The oncologist charges $230.00 and Medicare allows $115.76, might as well say it comes out 50%.
The dermatologist, who I see only once a year, comes out worse. Office visit $190.60, only $65.46 allowed, that works out to around 35%.
With lab work, it is even more puzzling, there doesn't seem to be any established percentage amount for blood work, sometimes I think the CMS people just throw darts at a board illustrating the hundreds of various blood tests to decide just what they will pay for what. :confused

The 10% figure you mentioned, yes, I found that very common for Part B physician fees connected with a hospital. In looking over last year's MSNs I found the following: "CT scan chest with contrast $491, Medicare approved amount $64.14"
"Ultrasound of head and neck $249, approved $28.35 (These represent the fees the radiologists charged for their services, not the procedure costs, so when you factor in Medicare is only paying 80% of the "approved" amount you are really getting into the 10% and below ballpark)

User avatar
midareff
Posts: 6465
Joined: Mon Nov 29, 2010 10:43 am
Location: Biscayne Bay, South Florida

Re: What I spent in 6 months on medicare

Post by midareff » Sat Jul 07, 2018 5:43 pm

My wife and I seem to have medical issues find us... me much more than her FWIW. I'm 70, she is 55. Her medical insurance through my former employer is $570 a month and going up much faster than inflation. Besides being a bit expensive the coverage for medical is impeccable and I won't drop it until she is on Medicare. Speaking of Medicare I'm at $134 a month + $350 in round numbers for United Plan F + Rx. Add another $80 - $100 a month for meds for both. Realistically speaking that's without eye glasses, dental care and cleanings and supplemental costs for mammograms and other female such.

Realistically speaking, our medical and dental have run since 2012 from a low of $16K to $29K (dental implants year) and this year should be in the $22-24K range, already at $20K.

If I would have known I probably would have worked another year but the 8 year bull has well taken care of all that and more as I am into year 7 of retirement and my lovely wife is in year 8.

Thank you Uncle Jack for making affording all of this real.

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 » Sat Jul 07, 2018 9:21 pm

dm200 wrote:
Sat Jul 07, 2018 12:41 pm

OK - $2932/6 = $489/month for both or $244 per person per month. You each would pay at least $134 for Part B - leaving $110 for Medigap AND Part D.......
Not necessarily.
You are forgetting that although $134 is supposed to be the minimum Part B premium - that little detail of the "hold harmless" provision of SSA law has resulted in quite a few of us not coughing up the whole $134.
Because of the crappy years when there was no COLA, or the itsy-bitsy teeny ones like two-tenths of a percent :P people like me (and Sheepdog's spouse in this thread) stayed below the $134. Sheepdog posted that, for 2017, their actual Part B premiums were $110 and $108, respectively.
If the beneficiary's dollar amount of the increase isn''t enough to cover the current Part B premium the law can't get the $$ by reducing the net monthly benefit SSA is paying out.
Even this year's 2% bump-up wasn't enough to get me up to $134, I pay $123, up from $107 previous year.
The catch is: Particularly with women, their SSA check, from which Part B is deducted, may be on the low side
because it is coming as a spousal or survivors benefit, not their own old age PIA, which they may be delaying until 70.
That is why the puny increases can't catch up with the Medicare Part B increases year after year.
Also, keep in mind, lots of seniors in states with a generous SPDAP program (like Maryland) pay zero every month for a Part D plan premium. And, fortunately, there are still enough Part D insurers out there offering zero-deductible plans to choose, making the whole deal twice as sweet.
Last edited by drawpoker on Sat Jul 07, 2018 11:11 pm, edited 2 times 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 » Sat Jul 07, 2018 10:00 pm

dm200 wrote:
Sat Jul 07, 2018 9:57 am

....... For example, our Medicare plan will not use a well renowned and very large hospital facility in the area for either hospitalization or surgery or treatments. They used to, but a few years ago dropped that large facility ...........
Not that it affects me now, but others here may be curious.
Are you referring to Johns Hopkins? Or MedStar Washington Hospital Center?

randomguy
Posts: 8531
Joined: Wed Sep 17, 2014 9:00 am

Re: What I spent in 6 months on medicare

Post by randomguy » Sat Jul 07, 2018 10:11 pm

2015 wrote:
Sat Jul 07, 2018 12:51 pm
dm200 wrote:
Fri Jul 06, 2018 3:27 pm

But it all begins with "what does your favorite doctor take?"
Oh, yes - 6 months is a short time - but it is enlightening to me since my usage of my plan went up quite a bit - and I still see "reasonable" costs. This discussion has been very enlightening.

We did have to switch all of our doctors - BUT, on balance, all of the new ones are just as good better than the old ones (especially with 20/20 hindsight). Just my current opinion, but keeping favorite doctors is an overrated reason to pick a plan. In the last 7+ years on this plan, several physicians have retired. Still have my (now about 40) PCP - but turnover with all the specialists.
Couldn't agree more with your statement in bold. As one who has owned his own health care for well over 20 years, I don't and never will have a "favorite doctor". No health care provider is responsible for the quality of my healthspan and I take complete responsibility for it.

I view all health care providers as (very expensive) consultants who provide me with information on which I make decisions. Based on this model, when the elderly individual I mentioned above with a number of expensive, serious health conditions required a series of hospitalizations (and many other health care interventions), I owned the entire process. Under this MA plan, total costs were less than $1K for the entire year (excluding Part B premiums). Finally, as a result of conducting extensive research well in advance of when needed, the partnership with all providers has been exceptional resulting in optimal outcomes at each stage.

Edited to add: I am well aware that YMMV as health care, like investing, is highly individualistic.
It sort of depends on what you are using your doctor for. Imagine you have spend the last decade dealing with some chronic condition with your doctor. Do you really want to switch to a new one and explain the success and failures of every treatment that you have done for the past decade? It isn't about the new doctor being better or worse. It is all about having to bring them up to speed. The less health issues you have, the less this type of interaction matters.

And I am betting a lot of the desire to keep your doctor is simply sloth about not wanting to have to spend the time and effort to find a new practice.

pshonore
Posts: 6669
Joined: Sun Jun 28, 2009 2:21 pm

Re: What I spent in 6 months on medicare

Post by pshonore » Sun Jul 08, 2018 8:11 am

drawpoker wrote:
Sat Jul 07, 2018 9:21 pm
dm200 wrote:
Sat Jul 07, 2018 12:41 pm

OK - $2932/6 = $489/month for both or $244 per person per month. You each would pay at least $134 for Part B - leaving $110 for Medigap AND Part D.......
Not necessarily.
You are forgetting that although $134 is supposed to be the minimum Part B premium - that little detail of the "hold harmless" provision of SSA law has resulted in quite a few of us not coughing up the whole $134.
Because of the crappy years when there was no COLA, or the itsy-bitsy teeny ones like two-tenths of a percent :P people like me (and Sheepdog's spouse in this thread) stayed below the $134. Sheepdog posted that, for 2017, their actual Part B premiums were $110 and $108, respectively.
If the beneficiary's dollar amount of the increase isn''t enough to cover the current Part B premium the law can't get the $$ by reducing the net monthly benefit SSA is paying out.
Even this year's 2% bump-up wasn't enough to get me up to $134, I pay $123, up from $107 previous year.
The catch is: Particularly with women, their SSA check, from which Part B is deducted, may be on the low side
because it is coming as a spousal or survivors benefit, not their own old age PIA, which they may be delaying until 70.
That is why the puny increases can't catch up with the Medicare Part B increases year after year.
Also, keep in mind, lots of seniors in states with a generous SPDAP program (like Maryland) pay zero every month for a Part D plan premium. And, fortunately, there are still enough Part D insurers out there offering zero-deductible plans to choose, making the whole deal twice as sweet.
You might catch up this year - looks like the SS COLA could be in the neighborhood of 2.5 - 3%. We're 8 months in and the average CPI figures for the last three months show a 2.7% increase over the corresponding period from 2017. Of course we don't know what next years Part B premium will be. June CPI will be out this Thursday.

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

Re: What I spent in 6 months on medicare

Post by dennisbyron » Sun Jul 08, 2018 8:45 am

drawpoker wrote:
Sat Jul 07, 2018 5:32 pm
marcopolo wrote:
Sat Jul 07, 2018 1:42 pm
engineerartist wrote:
Sat Jul 07, 2018 12:58 pm

In summary, for the 4 years, our total provider charges (not including prescriptions) was $828,465,
while the discounted amount actually paid by Medicare and Medigap combined was $72,451.
The combined Medicare/Medigap payments to providers were only 9% of the provider charges.
This is a real-life example of Medicare reducing the cost of treatment.
I am not sure how much of the reduction can be attributed to Medicare. I think you would need to compare what Medicare paid to what a sizeable insurance company, or HMO would pay for the same procedure.

As far as I can tell, the provider charges might as well be from a random number generator. Does anyone actually ever pay those amounts? There also does not seem to be any correlation between them and what is actually paid. For some charges, the insurance might pay close to 100%, and for others, the insurance might pay less than 10%.
Yes, it makes me wonder, too. There doesn't seem to be any rhyme or reason to it. Here's some figures for Maryland.
Unfortunately as with all things government related there is actually too much rhyme and reason involved as well as multiple K Street guys. There is no percentage to start with but instead the prices for something like 10,000 different medical services are actually set by the AMA... in other words, by the providers themselves... based on some relative value methodology (e.g., giving you a flu shot is worth half of what giving you a shingles shot is worth--just making up those numbers up but that's the idea). Then it is adjusted by medical specialty and geography and probably a few more obtuse factors. The result for Part B is described here https://www.cms.gov/apps/physician-fee- ... rview.aspx There is a similar convoluted process for Part A

Although the same system does not apply to public Part C sponsors, the Part A and Part B prices set the bar and most sponsors of Part C plans simply go along with those A/B provider-set prices rather than re-invent the wheel. In fact, I think most insurance carriers administering self-insured employer plans for people not on Medicare (about 50% of the U.S. population), and even the few examples left where real insurance activity is involved covering health care (only around 10% of the U.S. population), also uses the Medicare price schedule as the starting point for negotiation.

As a result there is very little relation between the so-called Chargemaster price (the big number) and what the provider gets (the much smaller number, but a number arrived at by his own association). Looking at the differences and having a little experience in health accounting way back, I can only guess that the guy who wrote the original Chargemaster software assumed that every time someone had a CAT scan, the hospital would have to buy a new CAT scan machine. It has to be something that weird to account for the huge difference.

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Sun Jul 08, 2018 9:09 am

drawpoker wrote:
Sat Jul 07, 2018 10:00 pm
dm200 wrote:
Sat Jul 07, 2018 9:57 am
....... For example, our Medicare plan will not use a well renowned and very large hospital facility in the area for either hospitalization or surgery or treatments. They used to, but a few years ago dropped that large facility ...........
Not that it affects me now, but others here may be curious.
Are you referring to Johns Hopkins? Or MedStar Washington Hospital Center?
No - Kaiser dropped INOVA Fairfax (previously Fairfax Hospital)

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Sun Jul 08, 2018 9:17 am

It sort of depends on what you are using your doctor for. Imagine you have spend the last decade dealing with some chronic condition with your doctor. Do you really want to switch to a new one and explain the success and failures of every treatment that you have done for the past decade? It isn't about the new doctor being better or worse. It is all about having to bring them up to speed. The less health issues you have, the less this type of interaction matters.
And I am betting a lot of the desire to keep your doctor is simply sloth about not wanting to have to spend the time and effort to find a new practice
.

Yes - I see the point. On the other hand, maybe a fresh (and different) set of eyes that fully reviews the entire history could be a benefit. Some doctors are willing and able to spend the necessary time getting up to speed with these kinds of cases and others are not. I have experienced both.

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

Re: What I spent in 6 months on medicare

Post by marcopolo » Sun Jul 08, 2018 9:31 am

dennisbyron wrote:
Sun Jul 08, 2018 8:45 am
drawpoker wrote:
Sat Jul 07, 2018 5:32 pm
marcopolo wrote:
Sat Jul 07, 2018 1:42 pm
engineerartist wrote:
Sat Jul 07, 2018 12:58 pm

In summary, for the 4 years, our total provider charges (not including prescriptions) was $828,465,
while the discounted amount actually paid by Medicare and Medigap combined was $72,451.
The combined Medicare/Medigap payments to providers were only 9% of the provider charges.
This is a real-life example of Medicare reducing the cost of treatment.
I am not sure how much of the reduction can be attributed to Medicare. I think you would need to compare what Medicare paid to what a sizeable insurance company, or HMO would pay for the same procedure.

As far as I can tell, the provider charges might as well be from a random number generator. Does anyone actually ever pay those amounts? There also does not seem to be any correlation between them and what is actually paid. For some charges, the insurance might pay close to 100%, and for others, the insurance might pay less than 10%.
Yes, it makes me wonder, too. There doesn't seem to be any rhyme or reason to it. Here's some figures for Maryland.
Unfortunately as with all things government related there is actually too much rhyme and reason involved as well as multiple K Street guys. There is no percentage to start with but instead the prices for something like 10,000 different medical services are actually set by the AMA... in other words, by the providers themselves... based on some relative value methodology (e.g., giving you a flu shot is worth half of what giving you a shingles shot is worth--just making up those numbers up but that's the idea). Then it is adjusted by medical specialty and geography and probably a few more obtuse factors. The result for Part B is described here https://www.cms.gov/apps/physician-fee- ... rview.aspx There is a similar convoluted process for Part A

Although the same system does not apply to public Part C sponsors, the Part A and Part B prices set the bar and most sponsors of Part C plans simply go along with those A/B provider-set prices rather than re-invent the wheel. In fact, I think most insurance carriers administering self-insured employer plans for people not on Medicare (about 50% of the U.S. population), and even the few examples left where real insurance activity is involved covering health care (only around 10% of the U.S. population), also uses the Medicare price schedule as the starting point for negotiation.

As a result there is very little relation between the so-called Chargemaster price (the big number) and what the provider gets (the much smaller number, but a number arrived at by his own association). Looking at the differences and having a little experience in health accounting way back, I can only guess that the guy who wrote the original Chargemaster software assumed that every time someone had a CAT scan, the hospital would have to buy a new CAT scan machine. It has to be something that weird to account for the huge difference.
Yeah, it is the Chargemaster prices (usually shows up as "Amount Billed" on EoB) that i was suggesting came from a random number generator.
As you explain, what they will actually get is reasonably well known. What is the point of billing some made up number that no one actually pays?
Here is an example. I recently had MRI done on both knees. Same procedure, same facility. The charge for the left knee was 3x the charge for the right knee. The both got reduced significantly, to where the paid "allowed" was similar, but not the same. Does it cost more, or is there more "value" in imaging the left knee vs. the right? Interestingly, the facility knew exactly how much they were going to get from my insurance ahead of time, I had not hit my deductible yet, so they had me pay the full amount at my procedure. It was correct down to the penny of what the insurance was willing to pay. What is the point of the rest of the charade of billing ridiculous larger amount?
Once in a while you get shown the light, in the strangest of places if you look at it right.

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Sun Jul 08, 2018 10:13 am

Here is an example. I recently had MRI done on both knees. Same procedure, same facility. The charge for the left knee was 3x the charge for the right knee. The both got reduced significantly, to where the paid "allowed" was similar, but not the same. Does it cost more, or is there more "value" in imaging the left knee vs. the right? Interestingly, the facility knew exactly how much they were going to get from my insurance ahead of time, I had not hit my deductible yet, so they had me pay the full amount at my procedure. It was correct down to the penny of what the insurance was willing to pay. What is the point of the rest of the charade of billing ridiculous larger amount?
Maybe the two tests went to different specialists - one specialized in right knees and the other left :confused :oops:

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 » Sun Jul 08, 2018 12:58 pm

pshonore wrote:
Sun Jul 08, 2018 8:11 am

You might catch up this year - looks like the SS COLA could be in the neighborhood of 2.5 - 3%. We're 8 months in and the average CPI figures for the last three months show a 2.7% increase over the corresponding period from 2017. Of course we don't know what next years Part B premium will be. June CPI will be out this Thursday.
There is no question I will "catch up" for 2019 - am turning 70 and will start drawing my own SSA, will be getting around $700 a month more :sharebeer .

Know what really amazes me about this, pshonore ? Knowing how the gumbmint operates, you would think they would have provided for just this eventuality occurring, and devised a method for recouping these losses for Part B. Treated these cases similar to the way "overpayments" in SSA and Medicare matters are handled, take back the $$ after notifying the beneficiary.

It really represents a form of overpayment, doesn't it, looking at it objectively. (Better keep my mouth shut, don't want to give them any :idea: :idea: )

orlandoman
Posts: 493
Joined: Tue Oct 19, 2010 7:27 am

Re: What I spent in 6 months on medicare

Post by orlandoman » Sun Jul 08, 2018 1:13 pm

"All real estate is local"

"All medicare plan comparsons are local" ... trying compare a supplement/medicare advantage plan from one area to another or one person's medical expenses to another ... just begets a lengthy tread of comments.
"Don't Believe Everything You Think"

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Sun Jul 08, 2018 2:04 pm

drawpoker wrote:
Sun Jul 08, 2018 12:58 pm
pshonore wrote:
Sun Jul 08, 2018 8:11 am
You might catch up this year - looks like the SS COLA could be in the neighborhood of 2.5 - 3%. We're 8 months in and the average CPI figures for the last three months show a 2.7% increase over the corresponding period from 2017. Of course we don't know what next years Part B premium will be. June CPI will be out this Thursday.
There is no question I will "catch up" for 2019 - am turning 70 and will start drawing my own SSA, will be getting around $700 a month more :sharebeer . Know what really amazes me about this, pshonore ? Knowing how the gumbmint operates, you would think they would have provided for just this eventuality occurring, and devised a method for recouping these losses for Part B. Treated these cases similar to the way "overpayments" in SSA and Medicare matters are handled, take back the $$ after notifying the beneficiary.
It really represents a form of overpayment, doesn't it, looking at it objectively. (Better keep my mouth shut, don't want to give them any :idea: :idea: )
My wife began SS and medicare 2 or 3 years ago - a percentage based on my earnings. Even though her monthly SS benefit was much less than mine, she paid the "full" Part B and mine was less for a year or two die to "hold harmless".

I suspect this "system" was put in place when it was believed low of no SS COLAs would be very very rare and last only one year. Things change.

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 » Sun Jul 08, 2018 2:54 pm

Yes, and I had no idea how many SSA beneficiaries are impacted by the 'hold harmless" rule. It adds up to a whole lot of $$ This article is over a year old, but it is still very relevant when looking at history of Part B annual increases.

I know there are members here who were on Medicare back in 2006. So, they can look at the chart, wax nostalgic when reminded that, back then, Part B cost $78

Wonder - which poster in this thread can go back the greatest number of years on Medicare......


https://www.fool.com/retirement/2017/02 ... m-inc.aspx

(I do disagree with one comment in the Motley Fool article. I don't think Part B premium is the "biggest wild card" as they put it in health care cost planning. I definitely think the monthly premium cost of either MA or Medigap plan is a far bigger "wild card" Some would probably say the cost of prescription drugs (co-pays) is really a bigger wild card, too.

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Sun Jul 08, 2018 3:18 pm

I do disagree with one comment in the Motley Fool article. I don't think Part B premium is the "biggest wild card" as they put it in health care cost planning. I definitely think the monthly premium cost of either MA or Medigap plan is a far bigger "wild card" Some would probably say the cost of prescription drugs (co-pays) is really a bigger wild card, too.


Who knows about the future - BUT I tend to agree - with (in my opinion) the Medigap premiums the larger of the two.

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

Re: What I spent in 6 months on medicare

Post by 2015 » Sun Jul 08, 2018 7:00 pm

randomguy wrote:
Sat Jul 07, 2018 10:11 pm
2015 wrote:
Sat Jul 07, 2018 12:51 pm
dm200 wrote:
Fri Jul 06, 2018 3:27 pm

But it all begins with "what does your favorite doctor take?"
Oh, yes - 6 months is a short time - but it is enlightening to me since my usage of my plan went up quite a bit - and I still see "reasonable" costs. This discussion has been very enlightening.

We did have to switch all of our doctors - BUT, on balance, all of the new ones are just as good better than the old ones (especially with 20/20 hindsight). Just my current opinion, but keeping favorite doctors is an overrated reason to pick a plan. In the last 7+ years on this plan, several physicians have retired. Still have my (now about 40) PCP - but turnover with all the specialists.
Couldn't agree more with your statement in bold. As one who has owned his own health care for well over 20 years, I don't and never will have a "favorite doctor". No health care provider is responsible for the quality of my healthspan and I take complete responsibility for it.

I view all health care providers as (very expensive) consultants who provide me with information on which I make decisions. Based on this model, when the elderly individual I mentioned above with a number of expensive, serious health conditions required a series of hospitalizations (and many other health care interventions), I owned the entire process. Under this MA plan, total costs were less than $1K for the entire year (excluding Part B premiums). Finally, as a result of conducting extensive research well in advance of when needed, the partnership with all providers has been exceptional resulting in optimal outcomes at each stage.

Edited to add: I am well aware that YMMV as health care, like investing, is highly individualistic.
It sort of depends on what you are using your doctor for. Imagine you have spend the last decade dealing with some chronic condition with your doctor. Do you really want to switch to a new one and explain the success and failures of every treatment that you have done for the past decade? It isn't about the new doctor being better or worse. It is all about having to bring them up to speed. The less health issues you have, the less this type of interaction matters.

And I am betting a lot of the desire to keep your doctor is simply sloth about not wanting to have to spend the time and effort to find a new practice.
I have spent well over the past two decades with a managed but serious health condition. As I take total responsibility for my own health care, there is no "bringing them up to speed". I simply educate any health care provider as a situation warrants. An example of this is during elder hospice care I'm overseeing (not my own!), hospice wanted to prescribe a medication that resulted in hospitalization when prescribed previously during home health care but prior to hospice. I simply explained why the new prescription wasn't gonna happen and alternatives were found.

IMO, we place way too much responsibility for our own health in the hands of our providers. My own direct experience of achieving superior outcomes as a result of partnering with my providers has taught me it's better to take responsibility for and own one's health care.

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Sun Jul 08, 2018 7:12 pm

I have spent well over the past two decades with a managed but serious health condition. As I take total responsibility for my own health care, there is no "bringing them up to speed". I simply educate any health care provider as a situation warrants. An example of this is during elder hospice care I'm overseeing (not my own!), hospice wanted to prescribe a medication that resulted in hospitalization when prescribed previously during home health care but prior to hospice. I simply explained why the new prescription wasn't gonna happen and alternatives were found.
IMO, we place way too much responsibility for our own health in the hands of our providers. My own direct experience of achieving superior outcomes as a result of partnering with my providers has taught me it's better to take responsibility for and own one's health care.
In general, this is the way I have moved in dealing with my health as well. My physicians and I are "partners" and I often "educate" my Primary Care Physician - and she seems ok when I do.

Northern Flicker
Posts: 5070
Joined: Fri Apr 10, 2015 12:29 am

Re: What I spent in 6 months on medicare

Post by Northern Flicker » Mon Jul 09, 2018 11:29 pm

For me saving a few hundred a month is not important. And when/if something horrible happens, like cancer, I am heading off to Sloan Kettering and not where the plan allows.
Oncologists around the country are qualified to administer the protocols developed at Sloan Kettering and M.D. Anderson. Unless you have a rare type of cancer, wouldn't it be better to be in your home city with the support of friends and family and in your home with your belongings at hand?
Index fund investor since 1987.

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Tue Jul 10, 2018 10:02 am

jalbert wrote:
Mon Jul 09, 2018 11:29 pm
For me saving a few hundred a month is not important. And when/if something horrible happens, like cancer, I am heading off to Sloan Kettering and not where the plan allows.
Oncologists around the country are qualified to administer the protocols developed at Sloan Kettering and M.D. Anderson. Unless you have a rare type of cancer, wouldn't it be better to be in your home city with the support of friends and family and in your home with your belongings at hand?
Thanks for the information and insight. Makes sense to me.

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

Re: What I spent in 6 months on medicare

Post by marcopolo » Tue Jul 10, 2018 12:06 pm

dm200 wrote:
Tue Jul 10, 2018 10:02 am
jalbert wrote:
Mon Jul 09, 2018 11:29 pm
For me saving a few hundred a month is not important. And when/if something horrible happens, like cancer, I am heading off to Sloan Kettering and not where the plan allows.
Oncologists around the country are qualified to administer the protocols developed at Sloan Kettering and M.D. Anderson. Unless you have a rare type of cancer, wouldn't it be better to be in your home city with the support of friends and family and in your home with your belongings at hand?
Thanks for the information and insight. Makes sense to me.
Where this can become an issue, i think, is if you want to get into a clinical trial. They typically occur at major research hospitals. The trial will pay for a lot of the actual treatment, but you are still left with a lot of other costs like imaging, pain meds, etc. Those are usually covered by you health insurance. But, if you are in a narrow network that does not have providers near the research institution where the trial is happening, that can become a costly/inconvenient problem. Admittedly, this is a bit of a corner case, but it does happen. We encountered this with a close relative.
Once in a while you get shown the light, in the strangest of places if you look at it right.

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Tue Jul 10, 2018 12:49 pm

Where this can become an issue, i think, is if you want to get into a clinical trial. They typically occur at major research hospitals. The trial will pay for a lot of the actual treatment, but you are still left with a lot of other costs like imaging, pain meds, etc. Those are usually covered by you health insurance. But, if you are in a narrow network that does not have providers near the research institution where the trial is happening, that can become a costly/inconvenient problem. Admittedly, this is a bit of a corner case, but it does happen. We encountered this with a close relative.
I wonder as well. I often see advertisements and publicity for certain types of clinical trials as well. None ever directly applied to me - I have wondered the same thing.

User avatar
Topic Author
dm200
Posts: 22922
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 20, 2018 12:23 pm

dm200 wrote:
Sun Jul 08, 2018 7:12 pm
I have spent well over the past two decades with a managed but serious health condition. As I take total responsibility for my own health care, there is no "bringing them up to speed". I simply educate any health care provider as a situation warrants. An example of this is during elder hospice care I'm overseeing (not my own!), hospice wanted to prescribe a medication that resulted in hospitalization when prescribed previously during home health care but prior to hospice. I simply explained why the new prescription wasn't gonna happen and alternatives were found.
IMO, we place way too much responsibility for our own health in the hands of our providers. My own direct experience of achieving superior outcomes as a result of partnering with my providers has taught me it's better to take responsibility for and own one's health care.
In general, this is the way I have moved in dealing with my health as well. My physicians and I are "partners" and I often "educate" my Primary Care Physician - and she seems ok when I do.
I am hoping to spend less in the second six months of 2018. To my pleasant surprise, this has been a very informative discussion and I believe we have learned a lot about may aspects of Medicare. My opinion is that a great many Medicare recipients do not fully receive the best value and/or make choices that are not the "optimum".

DPT31
Posts: 18
Joined: Thu Jul 19, 2018 10:40 am

Re: What I spent in 6 months on medicare

Post by DPT31 » Fri Jul 20, 2018 12:39 pm

JoinToday wrote:
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.
Yes...I remember when Rubio slashed the risk corridors which is when the premiums for the ACA started exploding...
https://www.nytimes.com/2015/12/10/us/p ... e-act.html

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 20, 2018 1:29 pm

dm200 wrote:
Fri Jul 20, 2018 12:23 pm

........ My opinion is that a great many Medicare recipients do not fully receive the best value and/or make choices that are not the "optimum".
Has it occurred to you that many of us had little choice in the matter when turning 65? In my county, in 2014, know how many MA plans were offered?

None.

A couple years later, two (2) MA plans opened for business here, did extensive advertising. One, affiliated with Johns Hopkins, stayed their year, then folded up their tent. Don't know why. The other, UMMS Health Advantage, is still here, has a monthly cost similar to your Kaiser ($41) And, drum roll now, a rousing 2.5 star rating!

And, ....another drum roll.... - has a Grand Total of four (4) PCPs in their network.

One, an internist, has the online notice "not taking new patients". Another, a G.P., has managed to make such a mess of his personal life (this is well-known thru the newspaper's police blotter) that no one in their right mind would trust him as a doctor. So, that leaves two to pick. One is a female, GP, well-regarded, but also well into her mid-70's, believed to be on the brink of retirement. The 4th, an internist, lists his age as 71, is Chinese, and altho he understands English very well, patients have told me he carries a pronounced accent when speaking. Making it difficult at times to understand him.

So, that pretty much wraps up the Medicare Advantage landscape here. A far cry from Kaiser.

Point is - It's not that we are stupid, going around rejecting the "best value" as you put it. Or blindly making "non-optimum" choices. Living in a rural area gives us little choice.

The only "choices" I had when first going on Medicare was - Which Medigap plan? Am quite sure there are many other posters here who found themselves in same boat, effectively shut out from any half-way decent MA plan by geography.

User avatar
Topic Author
dm200
Posts: 22922
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 20, 2018 1:57 pm

drawpoker wrote:
Fri Jul 20, 2018 1:29 pm
dm200 wrote:
Fri Jul 20, 2018 12:23 pm
........ My opinion is that a great many Medicare recipients do not fully receive the best value and/or make choices that are not the "optimum".
Has it occurred to you that many of us had little choice in the matter when turning 65? In my county, in 2014, know how many MA plans were offered?
None.
A couple years later, two (2) MA plans opened for business here, did extensive advertising. One, affiliated with Johns Hopkins, stayed their year, then folded up their tent. Don't know why. The other, UMMS Health Advantage, is still here, has a monthly cost similar to your Kaiser ($41) And, drum roll now, a rousing 2.5 star rating!
And, ....another drum roll.... - has a Grand Total of four (4) PCPs in their network.
One, an internist, has the online notice "not taking new patients". Another, a G.P., has managed to make such a mess of his personal life (this is well-known thru the newspaper's police blotter) that no one in their right mind would trust him as a doctor. So, that leaves two to pick. One is a female, GP, well-regarded, but also well into her mid-70's, believed to be on the brink of retirement. The 4th, an internist, lists his age as 71, is Chinese, and altho he understands English very well, patients have told me he carries a pronounced accent when speaking. Making it difficult at times to understand him.
So, that pretty much wraps up the Medicare Advantage landscape here. A far cry from Kaiser.
Point is - It's not that we are stupid, going around rejecting the "best value" as you put it. Or blindly making "non-optimum" choices. Living in a rural area gives us little choice.
The only "choices" I had when first going on Medicare was - Which Medigap plan? Am quite sure there are many other posters here who found themselves in same boat, effectively shut out from any half-way decent MA plan by geography.
Oh, yes - sure has. In my opinion, no matter what the situation, there are probably ways to get better value in many cases. You, correctly, point out that MA plans vary widely from one area to another - as well as that some go belly up. i agree that aging physicians may be near retirement - and you could be stranded - whether MA or original Medicare. If I learn something about medicare that I did not know before - I am happy and do not interpret my learning something new as my being "stupid".

LiterallyIronic
Posts: 1353
Joined: Sat Dec 05, 2015 10:36 am

Re: What I spent in 6 months on medicare

Post by LiterallyIronic » Fri Jul 20, 2018 2:08 pm

JoinToday wrote:
Thu Jul 05, 2018 7:50 pm
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 know you're being facetious, but my wife is still on her grandfathered old plan. Pre-ACA, we were on a plan together, and it was $59/month to cover both of us ($11k deductible each). It increased to $89/month, still pre-ACA, so we dropped it for being too expensive ($89/month would've been about 10% of my monthly income at the time). We later got her covered again, including maternity coverage, for $79/month. Since then, it has increased to $103/month, including maternity coverage. I could probably cover her for cheaper through my work plan (that I and our baby are on), but I like knowing that we have that old grandfathered plan that we could put the baby on for $70/month if I lost my job. It's "insurance insurance", if you will.

So as far as I can tell, you could keep your old plan if you wanted.

dkb140
Posts: 70
Joined: Mon May 21, 2018 3:30 pm

Re: What I spent in 6 months on medicare

Post by dkb140 » Fri Jul 20, 2018 2:12 pm

I'm still working with a relatively "good" employer-sponsored Cigna PPO plan. My bi-weekly deductions look like:
FSA $100.00
Medical $47.90
Dental $4.83
Vision $1.52

The FSA just about covers my (above-average) out-of-pocket costs, so I'm looking at around the same $4000 this year.

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 20, 2018 2:29 pm

dm200 wrote:
Fri Jul 20, 2018 1:57 pm
Oh, yes - sure has. In my opinion, no matter what the situation, there are probably ways to get better value in many cases.
Well I don't know just what you mean by that. No matter what the situation? Ways to get better value? All I can think of as it applies to many folks - switching from F to G. Or G to N. That sort of thing.

In any event, we will just have to agree to disagree. btw, no one was suggesting you were stupid, it was the other way around, I thought you were implying people were making poor choices and foregoing "optimum" value out of ignorance.

What I really wish for - the mods would step in and post a reminder for members to keep on topic. This discussion is clearly titled for Medicare only; yet there is presently a blizzard coming from some trying to hijack the thread into ACA and non-Medicare insurance matters :!:

They can easily start a new thread for that. :)

User avatar
Topic Author
dm200
Posts: 22922
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 20, 2018 2:56 pm

drawpoker wrote:
Fri Jul 20, 2018 2:29 pm
dm200 wrote:
Fri Jul 20, 2018 1:57 pm
Oh, yes - sure has. In my opinion, no matter what the situation, there are probably ways to get better value in many cases.
Well I don't know just what you mean by that. No matter what the situation? Ways to get better value? All I can think of as it applies to many folks - switching from F to G. Or G to N. That sort of thing.
In any event, we will just have to agree to disagree. btw, no one was suggesting you were stupid, it was the other way around, I thought you were implying people were making poor choices and foregoing "optimum" value out of ignorance.
What I really wish for - the mods would step in and post a reminder for members to keep on topic. This discussion is clearly titled for Medicare only; yet there is presently a blizzard coming from some trying to hijack the thread into ACA and non-Medicare insurance matters :!:
They can easily start a new thread for that. :)
Let me just give some examples of things that I have known or have learned - showing the kinds of things I am referring to -

1. A friend (Original Medicare) has a long time Physician in an individual practice. He, on short notice, retired - and she found a great many Primary care physicians in this area would not take new medicare patients. She finally found one she was satisfied with. Most such PCPs here will continue when you go on Medicare if you are already a patient - and will continue to see you in a group practice if your physician retires, etc.

2. In my plan, I learned that I only paid one specialist copay (Ophthalmology) if I saw the Doctor and had a certain test at the same appointment - BUT paid twice if the test was done separately. Now I know.

3. A friend on the same medicare plan refuses to use email to communicate with her Physician (only in person appointment). I save many trips in person every year with email (NO CHARGE). This friend pays more for prescription refills than I o because she refuses to order refills by mail.

User avatar
LadyGeek
Site Admin
Posts: 58776
Joined: Sat Dec 20, 2008 5:34 pm
Location: Philadelphia
Contact:

Re: What I spent in 6 months on medicare

Post by LadyGeek » Fri Jul 20, 2018 3:03 pm

With regards to some earlier posts, the discussion is starting to derail on another situation.

Please stay focused on the OP's question.
Wiki To some, the glass is half full. To others, the glass is half empty. To an engineer, it's twice the size it needs to be.

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 20, 2018 3:16 pm

dm200 wrote:
Fri Jul 20, 2018 2:56 pm


....friend on the same medicare plan refuses to use email to communicate with her Physician (only in person appointment). I save many trips in person every year with email (NO CHARGE). ...........
Nothing unique or special about that.
Medicare can only be billed for face-to-face patient visits. No doc taking Medicare, the Original or MA kind, can CHARGE for emails, returning phone calls, re-filling Rx, other routine work. In fact, this very issue came up in the other thread on Concierge Medicine, one of the many unreimbursed expenses the concierge fee helps cover since the docs can't charge for the time spent.

Like your friend, I opt out of Rx by mail order. Too chancy with the crummy postal service we have here. Also, the diff. between mail re-fills and the local drugstore is just pennies (under a $1 for my scripts) Not worth taking chances with mail delays, weather interruptions.

User avatar
Topic Author
dm200
Posts: 22922
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 20, 2018 3:45 pm

drawpoker wrote:
Fri Jul 20, 2018 3:16 pm
dm200 wrote:
Fri Jul 20, 2018 2:56 pm
....friend on the same medicare plan refuses to use email to communicate with her Physician (only in person appointment). I save many trips in person every year with email (NO CHARGE). ...........
Nothing unique or special about that.
Medicare can only be billed for face-to-face patient visits. No doc taking Medicare, the Original or MA kind, can CHARGE for emails, returning phone calls, re-filling Rx, other routine work. In fact, this very issue came up in the other thread on Concierge Medicine, one of the many unreimbursed expenses the concierge fee helps cover since the docs can't charge for the time spent.
Like your friend, I opt out of Rx by mail order. Too chancy with the crummy postal service we have here. Also, the diff. between mail re-fills and the local drugstore is just pennies (under a $1 for my scripts) Not worth taking chances with mail delays, weather interruptions.
1. Agree - not "unique" that there is no charge. What is, I think, uncommon though is offering such responsiveness and encouraging it. Somehow, my Medicare plan has figured out how to make such no charge services financially viable.
2. Never had any problem with mail refills

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 20, 2018 4:22 pm

dm200 wrote:
Fri Jul 20, 2018 3:45 pm

... not "unique" that there is no charge. What is, I think, uncommon though is offering such responsiveness and encouraging it. Somehow, my Medicare plan has figured out how to make such no charge services financially viable.
No, not uncommon at all. Your MA plan is just going with the times.

Around here, nearly all of the PCPs went to the eclinicalweb patient portal around 3 years ago. This is the website where after you register, you can email your doc with questions, request appointments, re-fill Rx, see your latest lab results as soon as they are posted, etc, etc. This is a free service to all patients, Medicare or otherwise. Maybe Kaiser uses the same vendor for this product, maybe they devised their own software (?)

The benefits of this system are many for the patient. Obvious one is having immediate access to lab results, not waiting for a phone call. Also getting answers from the doc by email so a hard copy can be printed out, not having to take notes while jiggling phone in other hand.
Can't really see how it serves the doc any better, unless just cutting down on the time the staff is answering the phone, they can be doing other things (?)

User avatar
Topic Author
dm200
Posts: 22922
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 20, 2018 4:39 pm

drawpoker wrote:
Fri Jul 20, 2018 4:22 pm
dm200 wrote:
Fri Jul 20, 2018 3:45 pm

... not "unique" that there is no charge. What is, I think, uncommon though is offering such responsiveness and encouraging it. Somehow, my Medicare plan has figured out how to make such no charge services financially viable.
No, not uncommon at all. Your MA plan is just going with the times.
Around here, nearly all of the PCPs went to the eclinicalweb patient portal around 3 years ago. This is the website where after you register, you can email your doc with questions, request appointments, re-fill Rx, see your latest lab results as soon as they are posted, etc, etc. This is a free service to all patients, Medicare or otherwise. Maybe Kaiser uses the same vendor for this product, maybe they devised their own software (?)
The benefits of this system are many for the patient. Obvious one is having immediate access to lab results, not waiting for a phone call. Also getting answers from the doc by email so a hard copy can be printed out, not having to take notes while jiggling phone in other hand.
Can't really see how it serves the doc any better, unless just cutting down on the time the staff is answering the phone, they can be doing other things (?)
ok - how do these providers (for Medicare patients) get compensated for these services? No question that the patient benefits - but how does the Physician/provider?

mrgeeze
Posts: 235
Joined: Wed Nov 04, 2015 11:09 am

Re: What I spent in 6 months on medicare

Post by mrgeeze » Fri Jul 20, 2018 4:54 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.

Truth is many people are in the dark about the cost of healthcare in the US.
For a variety of reasons many receiving health insurance through their employers are not aware of the costs.

Without trying to open the wound on a very contentious issue I offer a few reasonable basic numbers

Healhtcare costs average between 17 and 20% of US GDP- about 50% higher than any country in the world.
The rate of increase is at least 10%.

US healthcare cost per capita is the highest in the planet. Over 30% higher than number 2 (France, I believe)
The rate of increase is over 10% per year

Healthcare quality ranks approximately 35th in the world and declining almost every year.

Americans are on average the first or second most overweight nation.

I used to think Medicare would bail me out of healthcare problems.
Apparently I have nothing to look forward to in that respect.

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 20, 2018 4:54 pm

dm200 wrote:
Fri Jul 20, 2018 4:39 pm

ok - how do these providers (for Medicare patients) get compensated for these services?
They don't. They had no choice in the matter. Either comply with the law, or risk losing their Medicare/Medicaid.

https://www.usfhealthonline.com/resourc ... s-mandate/

User avatar
willthrill81
Posts: 15165
Joined: Thu Jan 26, 2017 3:17 pm
Location: USA

Re: What I spent in 6 months on medicare

Post by willthrill81 » Fri Jul 20, 2018 5:04 pm

This thread makes me glad that (1) everyone in our family currently has excellent health and (2) we're maxing out our family HSA every year and paying for our very limited medical costs out of pocket while saving receipts. I estimate that we'll have $100-$150k in the HSA by my planned retirement, and I'm sure that we'll (unfortunately) encounter many opportunities to use those funds. :|
Sheepdog wrote:
Fri Jul 06, 2018 2:24 pm
And we are unable to do anything about our increasing dental costs.
A lot of folks in the Southwest have found that trips across the southern border can save them 70-90% on their dental costs. It seems that some folks are even flying down there for medical tourism, particularly for dental care. Just a thought.
“It's a dangerous business, Frodo, going out your door. You step onto the road, and if you don't keep your feet, there's no knowing where you might be swept off to.” J.R.R. Tolkien,The Lord of the Rings

User avatar
Topic Author
dm200
Posts: 22922
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 20, 2018 6:49 pm

drawpoker wrote:
Fri Jul 20, 2018 4:54 pm
dm200 wrote:
Fri Jul 20, 2018 4:39 pm
ok - how do these providers (for Medicare patients) get compensated for these services?
They don't. They had no choice in the matter. Either comply with the law, or risk losing their Medicare/Medicaid.
https://www.usfhealthonline.com/resourc ... s-mandate/
OK - then aren't such providers being financially penalized by doing some things (such as email responses and telephone appointments) that cost them money AND receive no income?

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 20, 2018 7:19 pm

R E A D
T H E
L I N K !
(Please)
Quote:

"The American Recovery and Reinvestment Act also included financial incentives for healthcare providers who prove meaningful use of electronic health records (EHR). EHR is not only a more comprehensive patient......"

Broken Man 1999
Posts: 3763
Joined: Wed Apr 08, 2015 11:31 am

Re: What I spent in 6 months on medicare

Post by Broken Man 1999 » Sat Jul 21, 2018 10:51 am

Wife and I are on a Humana Medicare Advantage PPO plan, which means no referrals are necessary. Anywhere near the larger metropolitan areas in Florida, there are plenty of Medicare services available.

We pay the Medicare Part B charge of $134/month. Then, we either pay zero for my retiree insurance (including wife) or we pay $52.50 per month. My benefits group has given me both amounts on different calls. So far I haven't been billed, but it is early in the process. Whatever figure ($0 or $52.50) is a steal for us, IMHO.

Our plan has no deductibles, maximum out of pocket of $3000.00/ea.

Total Spending Breakdown for 01/01/18 thru 06/30/18 (wife is brand new to Medicare, so no uses yet)

Total Billed: 17,283.16
Total Plan Discounts: 10,307.56
Total Plan Exclusions: 29.90
Total Plan Approved: 6,945.70
Total Claims Paid: 6311.51
Total Paid by Me: $634.19

The previous 12 month period of time was a bad time for me, beginning in May of 2017. In a freak accident, I broke both legs, left with a compound fracture, right with a simple fracture. Then, when I was in the hospital following surgery, I had a bad reaction (stopped breathing) with Fentanyl. The higher charges have carried thru this year, as I had a pressure sore develop from the splint on my left heel. It was about the size of a silver dollar, and was over 1/2 inch deep.

Almost all the charges for the period of time from 01/01/18 thru 06/30/18 were getting the hole cleaned up and getting it closed.

Like the mythical Phoenix, I have once again risen from the ashes of my own destruction..... older. much wiser, and definitely more aware of the destructive power of my wheelchair.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 21, 2018 10:57 am

Broken Man 1999 wrote:
Sat Jul 21, 2018 10:51 am
Wife and I are on a Humana Medicare Advantage PPO plan, which means no referrals are necessary. Anywhere near the larger metropolitan areas in Florida, there are plenty of Medicare services available.
We pay the Medicare Part B charge of $134/month. Then, we either pay zero for my retiree insurance (including wife) or we pay $52.50 per month. My benefits group has given me both amounts on different calls. So far I haven't been billed, but it is early in the process. Whatever figure ($0 or $52.50) is a steal for us, IMHO.Our plan has no deductibles, maximum out of pocket of $3000.00/ea.
Total Spending Breakdown for 01/01/18 thru 06/30/18 (wife is brand new to Medicare, so no uses yet)
Total Billed: 17,283.16
Total Plan Discounts: 10,307.56
Total Plan Exclusions: 29.90
Total Plan Approved: 6,945.70
Total Claims Paid: 6311.51
Total Paid by Me: $634.19
The previous 12 month period of time was a bad time for me, beginning in May of 2017. In a freak accident, I broke both legs, left with a compound fracture, right with a simple fracture. Then, when I was in the hospital following surgery, I had a bad reaction (stopped breathing) with Fentanyl. The higher charges have carried thru this year, as I had a pressure sore develop from the splint on my left heel. It was about the size of a silver dollar, and was over 1/2 inch deep.
Almost all the charges for the period of time from 01/01/18 thru 06/30/18 were getting the hole cleaned up and getting it closed.
Like the mythical Phoenix, I have once again risen from the ashes of my own destruction..... older. much wiser, and definitely more aware of the destructive power of my wheelchair.
Broken Man 1999
Glad it is working for you. Seems to me your experience is typical of many MA plans. Humana MA plans are widely available in this area as well - and are advertised and promoted as well.

Leroy Jones
Posts: 72
Joined: Thu Nov 16, 2017 8:14 pm

Re: What I spent in 6 months on medicare

Post by Leroy Jones » Sun Jul 22, 2018 8:42 am

We currently have a Medicare Advantage Plan. We live in upstate NY and the plan has no premium and includes drug coverage. We both must pay our part B premium of $134.00/month or $268.00 per month. Primary care is $20.00/visit and specialist is $50.00/visit. Been on the plan for four months and so far are very pleased. No referrals needed if in network. All our doctors are in network and it basically covers 95% of doctors and all hospitals in Western New York and North Western Pennsylvania. Been good so far, time will tell. For the first six months this year about $4700. This includes monthly cost of former employer insurance and dental. :sharebeer

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Sun Jul 22, 2018 9:29 am

Leroy Jones wrote:
Sun Jul 22, 2018 8:42 am
We currently have a Medicare Advantage Plan. We live in upstate NY and the plan has no premium and includes drug coverage. We both must pay our part B premium of $134.00/month or $268.00 per month. Primary care is $20.00/visit and specialist is $50.00/visit. Been on the plan for four months and so far are very pleased. No referrals needed if in network. All our doctors are in network and it basically covers 95% of doctors and all hospitals in Western New York and North Western Pennsylvania. Been good so far, time will tell. For the first six months this year about $4700. This includes monthly cost of former employer insurance and dental. :sharebeer
Great it works so well for you. Another example of the big differences in MA plans in different areas.

User avatar
Topic Author
dm200
Posts: 22922
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: What I spent in 6 months on medicare

Post by dm200 » Sun Aug 12, 2018 12:03 pm

likegarden wrote:
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.
Yes - although Medicare covers the "basic" cataract surgery.

I hope and expect the second 6 months of 2018 will have lower expenses than the first six months :)

We shall see ---

Post Reply