Understanding Medicare Options?

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Yellowjacket1
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Understanding Medicare Options?

Post by Yellowjacket1 » Sun Aug 12, 2018 2:04 pm

I am eligible for Medicare next year. I keep seeing/hearing about Medicare Supplements, Medicare Advantage, and gap insurance. Can someone direct me to where I can get a better understanding of all these terms and their implications? Is there a site or book someone can recommend?

Thanks in advance.

jebmke
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Re: Understanding Medicare Options?

Post by jebmke » Sun Aug 12, 2018 2:17 pm

I would start with the Medicare site.

https://www.medicare.gov/

Many states have resources called SHIP (State Health Insurance Assistance Program) coordinators who can help. Quality of their knowledge seems to vary.
When you discover that you are riding a dead horse, the best strategy is to dismount.

JoeRetire
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Re: Understanding Medicare Options?

Post by JoeRetire » Sun Aug 12, 2018 2:25 pm

Get What's Yours for Medicare is a very good resource:

https://smile.amazon.com/Get-Whats-Your ... 01CO34BIC/

dcdowden
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Re: Understanding Medicare Options?

Post by dcdowden » Sun Aug 12, 2018 2:29 pm

You will shortly be inundated with phone calls and mailings from various sources that want to 'help' you with these decisions.

Of course, they are mostly selling their own solutions.

I second the use of the medicare site - it definitely has some very good resources. But I found that some of the best advice was talking to friends that had already been through the process.

Your biggest decision will be between taking conventional Medicare combined with Supplemental Insurance to cover what Medicare does not cover, or choosing some sort of Medicare Advantage plan which is a form of managed care program typically with more restrictions but also can be lower premiums. You also need to double check what sort of plan your previous employer may offer for retirees. Often those plans are some sort of Medicare Advantage plans, but your employer may be providing some sort of subsidy for their retirees.

Good Luck!

kaneohe
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Re: Understanding Medicare Options?

Post by kaneohe » Sun Aug 12, 2018 2:29 pm

probably available at public library:
https://www.amazon.com/Medicare-Dummies ... +paperback

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Watty
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Re: Understanding Medicare Options?

Post by Watty » Sun Aug 12, 2018 2:30 pm

I would highly recommend the book "Medicare for Dummies" despite the title. It was very good. Be sure you get the most current editions since there are lots of changes.

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dm200
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Re: Understanding Medicare Options?

Post by dm200 » Sun Aug 12, 2018 2:35 pm

Yellowjacket1 wrote:
Sun Aug 12, 2018 2:04 pm
I am eligible for Medicare next year. I keep seeing/hearing about Medicare Supplements, Medicare Advantage, and gap insurance. Can someone direct me to where I can get a better understanding of all these terms and their implications? Is there a site or book someone can recommend?
Thanks in advance.
Some local jurisdictions have folks/offices that can help seniors understand the options and the implications of the various choices. Some areas may have seniors groups where these things can be discussed.

If you choose or stay with Original Medicare - you almost certainly will want to add a "supplement". A Medicare supplement is also called "Medigap".

Depending on the area and other details, you may wish to evaluate Medicare Advantage - MA (or similar) programs instead of Original Medicare and supplement. With a Medicare Advantage (MA) plan - you do not (cannot) purchase a supplement. If evaluating MA plans, try to talk to folks enrolled - since the experiences may differ (in both directions) from what the plan documents seem to say.

Raabe34
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Re: Understanding Medicare Options?

Post by Raabe34 » Sun Aug 12, 2018 2:51 pm

Not that this this should matter in an individuals decision but from a volunteer position on a board of a hospital: But we get reimbursed less from MA plan than for med supp plans. And they are generally harder to work with. So if you've got any type of relationship with a doctor/system get some input there also.

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dm200
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Re: Understanding Medicare Options?

Post by dm200 » Sun Aug 12, 2018 2:57 pm

Raabe34 wrote:
Sun Aug 12, 2018 2:51 pm
Not that this this should matter in an individuals decision but from a volunteer position on a board of a hospital: But we get reimbursed less from MA plan than for med supp plans. And they are generally harder to work with. So if you've got any type of relationship with a doctor/system get some input there also.
Yes - if your current physician relationship(s) are important - check this out.

MA vs Original/supplement varies a lot.

In this area, one potential challenge with Original Medicare is that a great number of Primary care physicians do not accept new Medicare (original) patients - but will continue existing patients. There is much lower risk to you if you are in a physicians group. With MA plans, the plan should always have all the Physicians options you need in their network. Of course, those physicians may or may not be to your liking.

When my wife and I went on a Medicare plan, we had to switch all Physicians. We were (and are) very happy with all of the new ones - no big deal for us.

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dm200
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Re: Understanding Medicare Options?

Post by dm200 » Sun Aug 12, 2018 3:13 pm

Raabe34 wrote:
Sun Aug 12, 2018 2:51 pm
Not that this this should matter in an individuals decision but from a volunteer position on a board of a hospital: But we get reimbursed less from MA plan than for med supp plans. And they are generally harder to work with. So if you've got any type of relationship with a doctor/system get some input there also.
Seems to me these two issues are much more of concern to the hospital than to the patient.

pintail07
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Re: Understanding Medicare Options?

Post by pintail07 » Sun Aug 12, 2018 3:28 pm

My decision came down to networks. Wife and I both have illnesses that are being treated out of state and out of network with MA plans. We pay more each month, about 300 total, than an MA plan. If you want to not be limited to local networks, and the extra cash flow doesn't negatively impact you, I would do regular medicare with supplement.

jebmke
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Re: Understanding Medicare Options?

Post by jebmke » Sun Aug 12, 2018 3:34 pm

pintail07 wrote:
Sun Aug 12, 2018 3:28 pm
My decision came down to networks. Wife and I both have illnesses that are being treated out of state and out of network with MA plans. We pay more each month, about 300 total, than an MA plan. If you want to not be limited to local networks, and the extra cash flow doesn't negatively impact you, I would do regular medicare with supplement.
This can be very locale specific. Some areas (tend to be urban) might have excellent Advantage plans that are competitive or even lower cost than Supplemental. It can really depend on the location and one's personal situation (travel or no .......). For example, I helped my sibling evaluate MA vs. Medigap. She was already on an MA plan. The comparison turned out to be more or less a wash and she was happy with her plan and there were no network restrictions. So she decided to stay with MA for a while longer. In my area (more rural), there are virtually no MA plans so there wasn't really a choice but to go the Medigap route.

Unfortunately, there is no substitute for doing a fair bit of homework on the system and local conditions.
When you discover that you are riding a dead horse, the best strategy is to dismount.

LadyIJ
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Re: Understanding Medicare Options?

Post by LadyIJ » Sun Aug 12, 2018 3:45 pm

call your village or township and ask how to make an appointment with a SHIP (Senior Health Insurance Information Program) representative. I also agree with previous comments on "Medicare for Dummies" the Medicare website - I would read those BEFORE the appointment with the SHIP representative.

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dm200
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Re: Understanding Medicare Options?

Post by dm200 » Sun Aug 12, 2018 3:46 pm

jebmke wrote:
Sun Aug 12, 2018 3:34 pm
pintail07 wrote:
Sun Aug 12, 2018 3:28 pm
My decision came down to networks. Wife and I both have illnesses that are being treated out of state and out of network with MA plans. We pay more each month, about 300 total, than an MA plan. If you want to not be limited to local networks, and the extra cash flow doesn't negatively impact you, I would do regular medicare with supplement.
This can be very locale specific. Some areas (tend to be urban) might have excellent Advantage plans that are competitive or even lower cost than Supplemental. It can really depend on the location and one's personal situation (travel or no .......). For example, I helped my sibling evaluate MA vs. Medigap. She was already on an MA plan. The comparison turned out to be more or less a wash and she was happy with her plan and there were no network restrictions. So she decided to stay with MA for a while longer. In my area (more rural), there are virtually no MA plans so there wasn't really a choice but to go the Medigap route.
Unfortunately, there is no substitute for doing a fair bit of homework on the system and local conditions.
Yes - BUT remember that one potential risk of an MA plan is that (except for the first year) if you choose to go back to Original Medicare - you may not be able to qualify for a supplement.

Many MA plans have in network providers that are not just very local. Check the details.

While you would need to stay in-network for MA plans, it could be that needed referrals to specialists may be much quicker than Original Medicare. It all depends on the many details. In my Medicare plan, I often am referred to an appropriate specialist quickly (sometimes by my email request) and often see the specialist in one or two days. My wife once saw a surgeon only two hours after getting the referral from her PCP.

jebmke
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Re: Understanding Medicare Options?

Post by jebmke » Sun Aug 12, 2018 3:49 pm

dm200 wrote:
Sun Aug 12, 2018 3:46 pm
Yes - BUT remember that one potential risk of an MA plan is that (except for the first year) if you choose to go back to Original Medicare - you may not be able to qualify for a supplement.
Yes; almost any change in coverage might result in a need to go through underwriting. Even changing from one gap plan to another.
When you discover that you are riding a dead horse, the best strategy is to dismount.

drawpoker
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Re: Understanding Medicare Options?

Post by drawpoker » Sun Aug 12, 2018 3:54 pm

All good suggestions here, Yellowjacket1, but you can save yourself a lot of time and wasted effort by starting with your doctor's office.

You Do have a PCP you regularly see, right? Ask the billing/business office person which Medicare Advantage plans the doctor accepts. If you are told, sorry, none, that gives you a starting point - you know that if you want to try and save some :dollar by taking MA instead of Original Medicare, you will have to switch doctors.

If you say, okay, no big deal, I can change doctors, continue to Step 2. If not, you now know you can concentrate on researching Medicare Supplement plans and which insurers in your area offer which Plans.

Now, wasn't that easy...... :wink:

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dm200
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Re: Understanding Medicare Options?

Post by dm200 » Sun Aug 12, 2018 3:59 pm

drawpoker wrote:
Sun Aug 12, 2018 3:54 pm
All good suggestions here, Yellowjacket1, but you can save yourself a lot of time and wasted effort by starting with your doctor's office.
You Do have a PCP you regularly see, right? Ask the billing/business office person which Medicare Advantage plans the doctor accepts. If you are told, sorry, none, that gives you a starting point - you know that if you want to try and save some :dollar by taking MA instead of Original Medicare, you will have to switch doctors.
If you say, okay, no big deal, I can change doctors, continue to Step 2. If not, you now know you can concentrate on researching Medicare Supplement plans and which insurers in your area offer which Plans.
Now, wasn't that easy...... :wink:
While I liked my former PCP, now (with 20/20 hindsight) I have concluded changing to all new Physicians was a plus. None of the new/current Physicians are a medical step down and there is only one specialist that I actually miss.

drawpoker
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Re: Understanding Medicare Options?

Post by drawpoker » Sun Aug 12, 2018 4:04 pm

dm200 wrote:
Sun Aug 12, 2018 3:59 pm

While I liked my former PCP, now (with 20/20 hindsight) I have concluded changing to all new Physicians was a plus. None of the new/current Physicians are a medical step down and there is only one specialist that I actually miss.
Fine. But only the OP can make that decision. No one (especially on anonymous internet board) can know the OP's personal
references. What you might regard as plus for you could turn into a big fat minus for someone else. :idea:

Edited to add: I think the only thing that is safe to assume about the OP here - He/she is presently in reasonably good health for a 64 yr old. Hence, wrestling with the decision. If he/she was in poor health, one Foot in grave, there would be no debate. MA would be ruled out immediately and a Medicare Supplement must be purchased.
Last edited by drawpoker on Sun Aug 12, 2018 4:12 pm, edited 1 time in total.

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dm200
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Re: Understanding Medicare Options?

Post by dm200 » Sun Aug 12, 2018 4:10 pm

drawpoker wrote:
Sun Aug 12, 2018 4:04 pm
dm200 wrote:
Sun Aug 12, 2018 3:59 pm
While I liked my former PCP, now (with 20/20 hindsight) I have concluded changing to all new Physicians was a plus. None of the new/current Physicians are a medical step down and there is only one specialist that I actually miss.
Fine. But only the OP can make that decision. No one (especially on anonymous internet board) can know the OP's personal preferences. What you might regard as plus for you could turn into a big fat minus for someone else. :idea:
Absolutely true! I agree..

drawpoker
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Re: Understanding Medicare Options?

Post by drawpoker » Sun Aug 12, 2018 4:20 pm

Oh, boy, now I am confused.

Judging from this post in another thread, the OP is not at all in good health. Being on SSDI puts a whole another complexion on this.
Unless there are two different Yellowjacket1 (s) buzzing around here..... :?:

-------------------------------------------------------------------------------

by Yellowjacket1 » Fri Aug 03, 2018 7:47 pm

If you think you may need to apply for Social Security Disability Insurance (SSDI), PM me. I have been on SSDI for last 9 months after unexpectedly being hit with a major health issue. I would be glad to pass along some things for you to consider.





Carl53
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Re: Understanding Medicare Options?

Post by Carl53 » Sun Aug 12, 2018 4:24 pm

dcdowden wrote:
Sun Aug 12, 2018 2:29 pm
You will shortly be inundated with phone calls and mailings from various sources that want to 'help' you with these decisions.

Of course, they are mostly selling their own solutions.

I second the use of the medicare site - it definitely has some very good resources. But I found that some of the best advice was talking to friends that had already been through the process.

Your biggest decision will be between taking conventional Medicare combined with Supplemental Insurance to cover what Medicare does not cover, or choosing some sort of Medicare Advantage plan which is a form of managed care program typically with more restrictions but also can be lower premiums. You also need to double check what sort of plan your previous employer may offer for retirees. Often those plans are some sort of Medicare Advantage plans, but your employer may be providing some sort of subsidy for their retirees.

Good Luck!
Personally I only got information from AON who was being paid by my former employer to give me options and answer questions. I used their information backed up with what the medicare site had to decide.

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dm200
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Re: Understanding Medicare Options?

Post by dm200 » Sun Aug 12, 2018 4:24 pm

drawpoker wrote:
Sun Aug 12, 2018 4:20 pm
Oh, boy, now I am confused.
Judging from this post in another thread, the OP is not at all in good health. Being on SSDI puts a whole another complexion on this.
Unless there are two different Yellowjacket1 (s) buzzing around here..... :?:
-------------------------------------------------------------------------------
by Yellowjacket1 » Fri Aug 03, 2018 7:47 pm

If you think you may need to apply for Social Security Disability Insurance (SSDI), PM me. I have been on SSDI for last 9 months after unexpectedly being hit with a major health issue. I would be glad to pass along some things for you to consider.

I believe that you qualify for Medicare after being on SSDI for two years. I believe the medicare choices and evaluation of those choices would be about the same whether on SSDI or age 65.

drawpoker
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Re: Understanding Medicare Options?

Post by drawpoker » Sun Aug 12, 2018 4:32 pm

dm200 wrote:
Sun Aug 12, 2018 4:24 pm

I believe that you qualify for Medicare after being on SSDI for two years. I believe the medicare choices and evaluation of those choices would be about the same whether on SSDI or age 65.
That is really nuts.

If you are in bad health the last thing you need is to set yourself up for an automatic OOP in the $6,700 neighborhood (Medicare Advantage) per year.

When you can grab Plan F for around $3,000 less (or $4,000 depending where you are) a year in cost.

Whether the OP is 49, 59, or 64, we know anyone on SSDI cannot be described as in "good health". (He even described it as "major" in the other thread.

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dm200
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Re: Understanding Medicare Options?

Post by dm200 » Sun Aug 12, 2018 4:37 pm

drawpoker wrote:
Sun Aug 12, 2018 4:32 pm
dm200 wrote:
Sun Aug 12, 2018 4:24 pm
I believe that you qualify for Medicare after being on SSDI for two years. I believe the medicare choices and evaluation of those choices would be about the same whether on SSDI or age 65.
That is really nuts.
If you are in bad health the last thing you need is to set yourself up for an automatic OOP in the $6,700 neighborhood (Medicare Advantage) per year.
When you can grab Plan F for around $3,000 less (or $4,000 depending where you are) a year in cost.
Whether the OP is 49, 59, or 64, we know anyone on SSDI cannot be described as in "good health". (He even described it as "major" in the other thread.
Not true (universally) at all. Because of the nature (and details) of qualification for SSDI, such folks may very well not have medical bills higher than the average retiree. I personally know several folks on SSDI and Medicare as a result who are "healthier" than I am - and my health is good.

drawpoker
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Re: Understanding Medicare Options?

Post by drawpoker » Sun Aug 12, 2018 4:39 pm

Nope. It is still nuts.

Very bad advice

Yellowjacket1
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Re: Understanding Medicare Options?

Post by Yellowjacket1 » Sun Aug 12, 2018 6:25 pm

Thanks for all the great advice. Yes, I am on SSDI and am recovering from a major health issue that could reappear at any time. Will have the opportunity to go on Medicare, but I am not up to speed with all the terms, much less the nuances, health benefits vs financial benefits of various options.

So, it sounds like I need to familiarize myself with the terms, check with my doctors Re what they will and won’t accept and then navigate the available options.

And yes, there is only one Yellowjacket1. Go Jackets!

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dodecahedron
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Re: Understanding Medicare Options?

Post by dodecahedron » Sun Aug 12, 2018 6:40 pm

drawpoker wrote:
Sun Aug 12, 2018 4:32 pm
dm200 wrote:
Sun Aug 12, 2018 4:24 pm

I believe that you qualify for Medicare after being on SSDI for two years. I believe the medicare choices and evaluation of those choices would be about the same whether on SSDI or age 65.
That is really nuts.

If you are in bad health the last thing you need is to set yourself up for an automatic OOP in the $6,700 neighborhood (Medicare Advantage) per year.

When you can grab Plan F for around $3,000 less (or $4,000 depending where you are) a year in cost.

Whether the OP is 49, 59, or 64, we know anyone on SSDI cannot be described as in "good health". (He even described it as "major" in the other thread.
Note: in some states, there are no Medigap plans available to folks under 65 even if they qualify for Medicare. In other states, where such plans are offered, they may not be priced the same as the plans available to folks age 65+. See here for more information.

However, since it appears the OP is almost 65, this may be a moot point in his/her particular case or, at worst, may only be relevant for a few months. Once the OP is 65, s/he will have the same set of options as any other 65 year old in the same state.
Last edited by dodecahedron on Sun Aug 12, 2018 6:44 pm, edited 1 time in total.

MtnBiker
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Re: Understanding Medicare Options?

Post by MtnBiker » Sun Aug 12, 2018 6:43 pm

dm200 wrote:
Sun Aug 12, 2018 4:24 pm
I believe that you qualify for Medicare after being on SSDI for two years. I believe the medicare choices and evaluation of those choices would be about the same whether on SSDI or age 65.
Not necessarily. The Medicare Supplement (Medigap) choices may be very different whether on SDDI or age 65 or greater. The availability differs greatly from state to state. Medigap may not be offered prior to age 65, may not be guarantee issue, or not be cost effective compared to MA. MA plans are generally the same regardless of age. See:

https://specialneedsanswers.com/filling ... ents-15927
Individuals with disabilities under age 65 often face obstacles in purchasing Medigap insurance that older Medicare beneficiaries do not face. In many states, Medigap policies are either not available to younger beneficiaries due to their age or the premiums are too costly.
For these reasons my wife used MA while on SSDI prior to age 65 and then switched to Medigap upon reaching age 65.

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dm200
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Re: Understanding Medicare Options?

Post by dm200 » Sun Aug 12, 2018 6:49 pm

The Medicare Supplement (Medigap) choices may be very different whether on SDDI or age 65 or greater. The availability differs greatly from state to state. Medigap may not be offered prior to age 65, may not be guarantee issue, or not be cost effective compared to MA. MA plans are generally the same regardless of age.
Thanks for the information. I did not know that.

drawpoker
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Re: Understanding Medicare Options?

Post by drawpoker » Sun Aug 12, 2018 7:49 pm

Yellowjacket1 wrote:
Sun Aug 12, 2018 6:25 pm
Thanks....Yes, I am on SSDI and am recovering from a major health issue that could reappear at any time. Will have the opportunity to go on Medicare........
Okay, thanks for clearing that up.

You indeed have some real concerns here. You do not want to rush yourself and mess up with a bad choice you might be stuck with (after open enrollment with that brief window of No Underwriting, No Medical Questions )

Since you already posted that you have been on SSDI for only 9 months (not close to 24) we are going to assume the reason you are Medicare-eligible soon is you are turning 65, correct?

As others have pointed out, Medigap availability & terms is very state-specific (in some rare cases ZIP code specific)

If you don't mind posting what state you are in - please do so and we can try and steer you in the right direction.

(Recently we had a Kentucky poster in another thread ready to give up because he couldn't find any insurers offering Plan G with issue-age rating. Voila! We found him one)

Chaconne
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Re: Understanding Medicare Options?

Post by Chaconne » Sun Aug 12, 2018 8:06 pm

Yellowjacket1 wrote:
Sun Aug 12, 2018 6:25 pm
Thanks for all the great advice. Yes, I am on SSDI and am recovering from a major health issue that could reappear at any time. Will have the opportunity to go on Medicare, but I am not up to speed with all the terms, much less the nuances, health benefits vs financial benefits of various options.

So, it sounds like I need to familiarize myself with the terms, check with my doctors Re what they will and won’t accept and then navigate the available options.

And yes, there is only one Yellowjacket1. Go Jackets!
Ramblin' wrecks DO keep on ramblin'.

Yellowjacket1, I implore you to get your hands on "Medicare for Dummies." It's insane that the gov't drops this eight-headed beast on us just at the time our ability to understand complex issues is starting to diminish (for many). And these ARE complex issues indeed. That book, as well as other sources of info, could save your bacon. Best of luck!

drawpoker
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Re: Understanding Medicare Options?

Post by drawpoker » Sun Aug 12, 2018 8:55 pm

hesson11 wrote:
Sun Aug 12, 2018 8:06 pm

Ramblin' wrecks DO keep on ramblin'..........Yellowjacket1, I implore you........ complex issues.........
True, but to be charitable we really don't know just what type disability, and associated medical issues, the OP may be dealing with. (TBH, in my case, after having to go under general anesthesia twice in a 30-day period for complicated surgeries lasting hours, my cognitive functions did not return to normal for a long time afterwards. :( Really)
Of course, some of my friends claim those functions have still not returned... :P

Know What bothers me way more? The posters here whose porch lights have gone out. Or getting real dim.
They don't know it, so have no idea just how inane and illogical some of their posts are.

Aren't they the real Ramblin wrecks? :(

Yellowjacket1
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Re: Understanding Medicare Options?

Post by Yellowjacket1 » Sun Aug 12, 2018 9:19 pm

I didn’t know I needed to provide so much individual info, as I had only wanted general info, but will accept all the specific/detailed info I can.

I am on SSDI and won’t be eligible for Medicare until next year. I am a planner and want to be prepared. Also, I have the time to research this now and depending upon how things go, I may not have the free time to research it next year.

I am 62 and live in Georgia.

My wife has already ordered from our library the two books on Medicare recommended.

Thanks All!

drawpoker
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Re: Understanding Medicare Options?

Post by drawpoker » Sun Aug 12, 2018 9:38 pm

Yellowjacket1 wrote:
Sun Aug 12, 2018 9:19 pm
..didn’t know I needed to provide so much individual info....only wanted general info....am 62 and live in Georgia...
See, that's exactly the point. With Medicare there is really no "general information". As hesson11 and others have posted, this stuff is complex. Nothing for amateurs to fool with!

We thought with your user name you might be in GA (?) But could not be sure, that's why all the :?: :?: Many here use names associated with roots, yet, are actually transplants living in some other state.
See, Medicare beneficiaries in Massachusetts, Wisconsin, Minnesota, New York, Vermont, Calif and Oregon come under far different rules than folks in the other states. That is why we were trying to pin down your location. Not trying to be intrusive 8-)

Sounds like you have a plan, and are headed on the right track. :)

looking
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Re: Understanding Medicare Options?

Post by looking » Mon Aug 13, 2018 3:17 am

Yellowjacket1 wrote:
Sun Aug 12, 2018 2:04 pm
I am eligible for Medicare next year. I keep seeing/hearing about Medicare Supplements, Medicare Advantage, and gap insurance. Can someone direct me to where I can get a better understanding of all these terms and their implications? Is there a site or book someone can recommend?

Thanks in advance.
option G is a way to go,

dennisbyron
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Re: Understanding Medicare Options?

Post by dennisbyron » Mon Aug 13, 2018 7:04 am

[/quote]

That is really nuts. If you are in bad health the last thing you need is to set yourself up for an automatic OOP in the $6,700 neighborhood (Medicare Advantage) per year. When you can grab Plan F for around $3,000 less (or $4,000 depending where you are) a year in cost.

[/quote]

Some commenter is quite confused about the term "OOP" (or see Note) and Medicare in general.
1. There is no such thing as an "automatic OOP in the $6700 neighborhood (Medicare Advantage) per year." Annual out of pocket (OOP) spend limits vary from one public Part C Medicare health plan to another. There is nothing automatic about them. $6700 is the highest they can be (last time I looked). The average is about $5000 (last time I looked). I have seen them as low as $1500. As you expect with insurance, the lower the annual OOP spend limit, the higher the premium (typically if the OOP limit is $6700, the Part C premium is zero and you only have to pay your Part B premium)
2. The annual OOP limit applies to all public Part C Medicare health plans of which Medicare Advantage is just one type.
-- The OOP limit applies to medical services and professionally administered prescription drugs. It does not include self administered prescription drugs although most Part C plans cover self administered prescription drugs using the same co-pay and coverage rules as Part D.
-- Medicare Parts A and B do not have such a limit; the amount you could spend annually on Medicare Parts A and B are unlimited. Medicare Parts A and B do not cover self administered prescription drugs
3. Just in case, those words are not clear
-- the term "annual out of pocket spend limit" means that's the MOST you can spend in a given year; that does not mean that is what you have to spend. On the average, people on a public Part C health plan spend about $1000 out of pocket on medical services.
-- the term "unlimited" means that you could be on the hook for tens of thousands of dollars or more under just Medicare Parts A and B
4. Therefore whether spending multiple thousands on a private Medigap supplement such as Plan F (which puts some limits on the unlimited liability of Parts A and B) is better for you than likely spending around $1000 and knowing you cannot spend MORE THAN likely $5000, simply depends on how risk averse you are. Part C plans also often cover some medical services -- for example dental or vision -- not covered at all by Part A and B even with a private supplement. I don't find those additional services especially persuasive as a differentiator but most public Part C health plans also include an annual physical exam; Medicare Parts A and B even with a supplement does not cover such as exam but simply an annual wellness visit (which office nurses call a "non-naked"). That is potentially an additional annual saving of $500 or more
5. All the hints in this thread about what does your doctor accept, what is available in your county, and so forth should be the real determining factors in choosing a private vs. a public supplement

[NOTE: It is a common technique of unscrupulous insurance agents in the Medicare supplement market to claim an annual Part C OOP spend limit is a deductible. It is actually the opposite of a deductible.]

carolinaman
Posts: 3329
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Location: North Carolina

Re: Understanding Medicare Options?

Post by carolinaman » Mon Aug 13, 2018 7:55 am

jebmke wrote:
Sun Aug 12, 2018 2:17 pm
I would start with the Medicare site.

https://www.medicare.gov/

Many states have resources called SHIP (State Health Insurance Assistance Program) coordinators who can help. Quality of their knowledge seems to vary.
Your state SHIIP group can provide good guidance, especially for the basics. It will work best if you do some research to learn what options are available and then talk with them. The Medicare site is good and Googling medicare or specific options like advantage, supplement, etc should give you plenty of information.

cashmoney
Posts: 181
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Re: Understanding Medicare Options?

Post by cashmoney » Mon Aug 13, 2018 8:17 am

dm200 wrote:
Sun Aug 12, 2018 3:13 pm
Raabe34 wrote:
Sun Aug 12, 2018 2:51 pm
Not that this this should matter in an individuals decision but from a volunteer position on a board of a hospital: But we get reimbursed less from MA plan than for med supp plans. And they are generally harder to work with. So if you've got any type of relationship with a doctor/system get some input there also.
Seems to me these two issues are much more of concern to the hospital than to the patient.

So true.The first law of nature is self preservation.I have seen many times where a provider will hate on MA plans because either they dont accept any MA plans , because it is a little less reimbursement for them or they dont like the extra paperwork involved in referrals ,prior authorizations etc..On the other hand I have seen where a primary care physician who embrace and accept all MA plans will steer their patients to THEIR favorite MA plan for reasons such as higher reimbursement /capitation rates etc..Take what advise your provider gives you about insurance with a grain of salt

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susa
Posts: 448
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Re: Understanding Medicare Options?

Post by susa » Mon Aug 13, 2018 8:18 am

Watty wrote: I would highly recommend the book "Medicare for Dummies" despite the title.
http://media.wiley.com/assets/7359/93/9781119419457.pdf

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dm200
Posts: 18896
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Understanding Medicare Options?

Post by dm200 » Mon Aug 13, 2018 12:12 pm

cashmoney wrote:
Mon Aug 13, 2018 8:17 am
dm200 wrote:
Sun Aug 12, 2018 3:13 pm
Raabe34 wrote:
Sun Aug 12, 2018 2:51 pm
Not that this this should matter in an individuals decision but from a volunteer position on a board of a hospital: But we get reimbursed less from MA plan than for med supp plans. And they are generally harder to work with. So if you've got any type of relationship with a doctor/system get some input there also.
Seems to me these two issues are much more of concern to the hospital than to the patient.
So true.The first law of nature is self preservation.I have seen many times where a provider will hate on MA plans because either they dont accept any MA plans , because it is a little less reimbursement for them or they dont like the extra paperwork involved in referrals ,prior authorizations etc..On the other hand I have seen where a primary care physician who embrace and accept all MA plans will steer their patients to THEIR favorite MA plan for reasons such as higher reimbursement /capitation rates etc..Take what advise your provider gives you about insurance with a grain of salt
Yes - In some areas, like mine, there are many highly advertised and promoted MA plans - and all of them seem to have a large number of participating physicians. So, from that, I assume most of such Physicians see this as positive financially.

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