Do I need more than Original Medicare?

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kay8bee
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Do I need more than Original Medicare?

Post by kay8bee » Sun Nov 04, 2018 6:19 pm

I am turning 65 in December 2018. Im have signed up for Medicare and I got my card. I am on the fence about signing up for a Medicare Supplement or a Medicare Advantage plan immediately. I can afford, and do not mind paying, Part A and Part B deductibles. I do not need Part D because my drugs costs are minimal. What I like about original Medicare is that I can go to any doctor or convenient care center that accepts Medicare in the US. I plan to go with Original Medicare for a year, and then reassess. What do you think?

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BL
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Re: Do I need more than Original Medicare?

Post by BL » Sun Nov 04, 2018 6:26 pm

You never know ahead of time when you might require lots of very costly medications.

bob60014
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Re: Do I need more than Original Medicare?

Post by bob60014 » Sun Nov 04, 2018 6:38 pm

The question is, if you do not sign up for a supplement, can you comfortably pay for the things that basic does not cover when a unexpected illness occurs?

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Flobes
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Re: Do I need more than Original Medicare?

Post by Flobes » Sun Nov 04, 2018 6:46 pm

kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
I plan to go with Original Medicare for a year, and then reassess.
Different states have different rules. You may be subject to medical underwriting to get Medicare supplement outside of this initial enrollment window. So when something happens and you need the additional coverage, you may not be able to buy into the plan.
kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
I do not need Part D because my drugs costs are minimal?
Are you aware of penalty for not signing up for Medicare Part D now? Medicare D has open enrollment each year, but you'll pay for the delay for the rest of your life.
Medicare Part D Late Enrollment Penalty
kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
What do you think?
It's a gamble.

jebmke
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Re: Do I need more than Original Medicare?

Post by jebmke » Sun Nov 04, 2018 6:48 pm

I'd suggest looking at the coinsurance information before deciding to skip supplemental

https://www.medicare.gov/your-medicare- ... t-a-glance

The deductible is peanuts. The coinsurance is not.
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Fletch
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Re: Do I need more than Original Medicare?

Post by Fletch » Sun Nov 04, 2018 6:52 pm

Medigap and Plan D insurance is just that - insurance. I also have fire insurance on my home and vehicle insurance on my vehicles - and hope that I never file a claim. It is very difficult to predict what the future will bring. :confused
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nisiprius
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Re: Do I need more than Original Medicare?

Post by nisiprius » Sun Nov 04, 2018 7:04 pm

My wife and I think we do.

I decided that I preferred to use Traditional Medicare rather than Medicare Advantage. (Medicare Advantage is a complicated system of private HMO plans--the only thing "Medicare" about them is that the premiums are partly paid for by Medicare). Given that decision...

I felt that I needed, or at least really wanted, to add a "Medicare Supplemental" insurance plan (also called "Medigap" or "Medex,") because Medicare only pays 80% of the cost of services that fall under Medicare Part B, and a bill for 20% of Part B services could potentially be many thousands of dollars; I'm not sure what the credible upper limit is. I didn't want to take that risk. The cost of the Medicare Supplemental insurance is significant.

I felt strongly that I needed Medicare Part D (prescription drugs), because of the possibility of needing very expensive prescription drugs; once your annual out-of-pocket expenses hit about $5,000, if, God forbid, you have prescription costs above that, then the "catastrophic" coverage of part D kicks in. For the prescriptions my wife and I need, the prescriptions themselves are affordable, but Medicare Part D is affordable, too, and it cuts the price of those drugs enough that our total annual costs--premiums plus out-of-pocket--are actually lower than without it. That is to say, if you're taking maintenance-type drugs like statins, it doesn't take much for Part D to pay for itself.
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Peter Foley
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Re: Do I need more than Original Medicare?

Post by Peter Foley » Sun Nov 04, 2018 7:38 pm

Yes.

There are Medicare advantage plans that are very low cost with relatively high deductibles. Why would you take a chance? While your health may be fine you cannot predict when an accident might happen.

As pointed out, Medicare D is a must because of the penalty provisions.

Personal note - I use a medi-gap plan not an advantage plan so I'm not promoting any type of plan, just mentioning the economics/costs.

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dodecahedron
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Re: Do I need more than Original Medicare?

Post by dodecahedron » Sun Nov 04, 2018 7:44 pm

kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
I am turning 65 in December 2018. Im have signed up for Medicare and I got my card. I am on the fence about signing up for a Medicare Supplement or a Medicare Advantage plan immediately. I can afford, and do not mind paying, Part A and Part B deductibles.
The deductibles are not the biggest issue. Coinsurance requirements kick in after deductibles are met. There is no out of pocket max on traditional Medicare. Your liability for medical costs is theoretically unlimited.

adamshousecat
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Re: Do I need more than Original Medicare?

Post by adamshousecat » Sun Nov 04, 2018 7:48 pm

kay8bee wrote: ↑Sun Nov 04, 2018 6:19 pm
... There is no out of pocket max on traditional Medicare. Your liability for medical costs is theoretically unlimited.

This.

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GerryL
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Re: Do I need more than Original Medicare?

Post by GerryL » Sun Nov 04, 2018 8:02 pm

If you are currently in good health you can keep your monthly costs low and protect yourself from possible catastrophic medical costs with
1) an F high-deductible Medigap plan (Your max out-of-pocket h/c cost -- after premiums -- would be the deductible, which is in the neighborhood of $2500 this year)
and
2) the lowest premium Part D drug plan available in your state (You can shop around each year at open enrollment in case your needs change)


You may enjoy good health now, but that can change in an instant. Spending the minimum now to stay covered could save you big bucks in the future.

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dodecahedron
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Re: Do I need more than Original Medicare?

Post by dodecahedron » Sun Nov 04, 2018 8:08 pm

kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
What I like about original Medicare is that I can go to any doctor or convenient care center that accepts Medicare in the US. I plan to go with Original Medicare for a year, and then reassess. What do you think?
Other options ALSO let you go to any doctor or convenient care center that accepts Medicare in the US but also limit your exposure.

Option 1) Add a Medigap plan to your traditional Medicare. All the benefits of traditional Medicare PLUS the Medigap pays some or all of your coinsurance and deductibles. Your OOP max can be held quite low--for an additional monthly premium cost.

Option 2) Substitute a PPO Medicare Advantage (not an HMO!) plan. A PPO Medicare Advantage plan also allows you to go to any doctor anywhere in the country that accepts Medicare, but again limits your OOP max. I have a plan like this. Zero dollar monthly premiums. Slightly higher copays if I go out of network, but quite manageable. The OOP max is lower than what I managed to get used to with my previous ACA plan. And it covers stuff that traditional Medicare and Medigap do not (e.g., hearing aid benefits, vision care, a $240 allowance for preventive dental care I can use at the dentist of my choice, free Silver Sneakers membership allowing me to use gyms all over the place. Free online video visits with doctors. Part D benefits are also included which keeps my life simple. Like the OP, I do not take any prescriptions now so the minimalistic Part D is fine for now.)

That said, I live in a state (NY) which guarantees me the option to switch back and forth among Medicare Advantage and Medigap plans in future years without needing to worry about preexisting conditions, etc.

If I lived in most other states, I would have agonized harder over this choice.

123
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Re: Do I need more than Original Medicare?

Post by 123 » Sun Nov 04, 2018 8:55 pm

It's time to study your options. In some states/areas Medicare Advantage plans are FREE in other areas they have a monthly premium. If you have used private insurance in the past check to see if they have a Medicare Advantage program and how it works. However, there are some rules that limit your ability to switch to other coverage if you have been enrolled in Medicare Advantage, later on if you want to switch you may have to go through medical underwriting/evaluation.
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dm200
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Re: Do I need more than Original Medicare?

Post by dm200 » Sun Nov 04, 2018 8:57 pm

Yes - because of (as best I understand) the unlimited nature of what you may have to pay with Original Medicare - that (to me) means either a Medigap supplement with Original medicare OR a Medicare Advantage (or similar) plan.

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Watty
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Re: Do I need more than Original Medicare?

Post by Watty » Sun Nov 04, 2018 9:18 pm

jebmke wrote:
Sun Nov 04, 2018 6:48 pm
I'd suggest looking at the coinsurance information before deciding to skip supplemental

https://www.medicare.gov/your-medicare- ... t-a-glance

The deductible is peanuts. The coinsurance is not.
And without a supplement Medicare part A will only pay a limited number of days in a hospital.

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dm200
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Re: Do I need more than Original Medicare?

Post by dm200 » Sun Nov 04, 2018 9:22 pm

Most (but not all) Medicare Advantage plans include prescription drug coverage.

sawhorse
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Re: Do I need more than Original Medicare?

Post by sawhorse » Sun Nov 04, 2018 9:24 pm

You only have to look at the recent thread on prescription prices to know that Part D is a must.

Even if your medications don't change, the prices might. By a lot.

https://nyti.ms/1VwDjCL

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dm200
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Re: Do I need more than Original Medicare?

Post by dm200 » Sun Nov 04, 2018 9:27 pm

sawhorse wrote:
Sun Nov 04, 2018 9:24 pm
You only have to look at the recent thread on prescription prices to know that Part D is a must.

Even if your medications don't change, the prices might. By a lot.

https://nyti.ms/1VwDjCL
True - but I believe the bigger risk is from unlimited costs for the part A and Part B conditions.

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Re: Do I need more than Original Medicare?

Post by LadyGeek » Sun Nov 04, 2018 9:32 pm

This thread is now in the Personal Finance (Not Investing) forum (Medicare).
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InMyDreams
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Re: Do I need more than Original Medicare?

Post by InMyDreams » Sun Nov 04, 2018 10:39 pm

kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
Do I need more than Original Medicare?
Yes.

Need more detail?
There is a lifetime penalty (10% per year on the premium) imposed for not enrolling in Part B when first eligible
...
Part B coverage begins once a patient meets his or her deductible ($183 for 2017), then typically Medicare covers 80% of the RUC-set rate for approved services, while the remaining 20% is the responsibility of the patient
https://en.wikipedia.org/wiki/Medicare_ ... _insurance

Here's an example.
You choose to get Medicare Parts A & B, but no medigap. In January of the year with this coverage, you are diagnosed with a type of cancer that is very treatable, but requires infusions of a medication(s) on an outpatient basis for a year or more. This medication is five figures per dose, and even after Medicare knocks it down to the what they'll pay to the poor clinic that provides the service, you still need to pay the remaining 20%. And you do this infusion - once every two weeks? Once a month? And you still have an 80-20 split on all the lab tests, doctor visits and more.

Why take the risk? Isn't risk what insurance is for?

UpperNwGuy
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Re: Do I need more than Original Medicare?

Post by UpperNwGuy » Sun Nov 04, 2018 11:28 pm

I am only a year older than you, and I am in excellent health, but I signed up for everything. Yes, it does seem like a waste of money when you’re healthy and your medication expenses are trivial, but all that can change quickly once you’re over 65. My late mother was not much older than you when she discovered she had Parkinsons. She had been in excellent health up until then. The bills were enormous, but my parents had wisely supplemented original Medicare, so most of the costs were covered. I recommend you get the supplement and Part D from the beginning.

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Ged
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Re: Do I need more than Original Medicare?

Post by Ged » Sun Nov 04, 2018 11:37 pm

Part D lets you switch plans on a yearly basis. So you can sign up for an inexpensive plan that gives some protection to start, and if your needs change choose a new plan that fits your needs better the next year.

There are online tools at MyMedicare.gov that help you choose the best plan for you given the medications you currently use.

khh
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Re: Do I need more than Original Medicare?

Post by khh » Mon Nov 05, 2018 12:03 am

Better to have it and not need it than vice versa.

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Re: Do I need more than Original Medicare?

Post by kaneohe » Mon Nov 05, 2018 7:07 am

Fletch wrote:
Sun Nov 04, 2018 6:52 pm
Medigap and Plan D insurance is just that - insurance. I also have fire insurance on my home and vehicle insurance on my vehicles - and hope that I never file a claim. It is very difficult to predict what the future will bring. :confused
This summarizes it perfectly.................you hope that your insurance(medical or otherwise) will be a "waste" of
money and that you never have to use it..........but just in case......to avoid 20% of a very large number , you need to
add these policies (or their equivalent) to limit your expenses if the worst happens.

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nisiprius
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Re: Do I need more than Original Medicare?

Post by nisiprius » Mon Nov 05, 2018 8:36 am

User mur44, who's a "Certified Volunteer Medicare Counselor from NJ," has argued that it might not be totally insane to have parts A, B, and D, but no supplemental (Medigap) policy. I really don't want to speak for him and I probably wouldn't agree even if I remembered all the details of his argument correctly.

I don't know what the chances are of being personally bankrupted by bills not covered by parts A and B that would be covered by Medigap. According to the plan literature, my Medigap insurance has a benefit-to-premium ratio of 83%. I personally am willing to pay about $2,400 a year to an insurance company that will statistically pay about $1,992 of my bills--that is, my "statistical cost" is $408/year--in order to avoid the extreme nuisance of the risk showing up, and having to pay a $10,000 medical bill myself. (I've noticed from forum postings that people who opt for high deductible health plans get surprisingly upset when the risk shows up and they actually need to pay that $10,000 deductible they signed up for). (There's also what might be called "red tape risk," the risk of needing to spend hours on the phone to get a bill negotiated down to the level insurers and Medicare would pay instead of the three-or-four-times-higher "chargemaster" rate on the bill).
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cheese_breath
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Re: Do I need more than Original Medicare?

Post by cheese_breath » Mon Nov 05, 2018 8:44 am

kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
...I can afford, and do not mind paying, Part A and Part B deductibles....
If you can afford Part A and B deductibles, then you can afford Medigap and Part D premiums or Medicare Advantage premiums. Don't be foolish over a few extra dollars.
The surest way to know the future is when it becomes the past.

palaheel
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Re: Do I need more than Original Medicare?

Post by palaheel » Mon Nov 05, 2018 8:55 am

My megacorp booklet for retirees and Medicare has a useful decision tool for what type of Medicare plan to use:

How many doctors or specialists do you see regularly?
More than 6: 3 points
4 to 6: 2 points
3 or fewer: 1 point

How many times per year do you see your doctors?
More than 10 times: 3 points
6 to 10: 2 points
Fewer than 6: 1 point

Do you have a chronic condition such as diabetes or an upcoming major treatment such as a surgery?
Yes: 2 points
No: 1 point

Do you travel often or spend much of the year in a part of the country other than your home?
Yes: 2 points
No: 1 point

Are you willing to pay deductibles or co-payments to have a lower premium?
Yes: 1 point
No: 2 points

If your total is 8 points or higher, a Medigap plan may be best.
If your total is 5 points, a Medicare Advantage plan may be best.
In between, it's unclear.
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quantAndHold
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Re: Do I need more than Original Medicare?

Post by quantAndHold » Mon Nov 05, 2018 9:07 am

Insurance is not an investment. It is, however, one of the pillars of financial planning. The point of having insurance, any kind of insurance, is to keep you from being wiped out if a catastrophe happens. Medicare A/B won’t do that. The probability of a health catastrophe, which is never zero even when we’re young, increases as we get older. By a lot.

I’m perpetually surprised by the number of otherwise financially sophisticated people who are willing to risk their entire financial future in order to save a few dollars on an insurance premium.

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Re: Do I need more than Original Medicare?

Post by jebmke » Mon Nov 05, 2018 9:08 am

palaheel wrote:
Mon Nov 05, 2018 8:55 am
If your total is 8 points or higher, a Medigap plan may be best.
If your total is 5 points, a Medicare Advantage plan may be best.
In between, it's unclear.
In my case, the first question I asked was "Are there any Advantage plans in my area?" Many rural areas have no Advantage plans available. Mine happens to be one of them, despite the fact that I am within 1.5 hours of major metro areas like DC and Baltimore and 30 minutes from a fairly major medical center in Annapolis. That allowed me to eliminate the entire "GAP vs. Advantage" analysis and move on to other parameters to make my choice.
When you discover that you are riding a dead horse, the best strategy is to dismount.

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Re: Do I need more than Original Medicare?

Post by jebmke » Mon Nov 05, 2018 9:12 am

quantAndHold wrote:
Mon Nov 05, 2018 9:07 am
I’m perpetually surprised by the number of otherwise financially sophisticated people who are willing to risk their entire financial future in order to save a few dollars on an insurance premium.
I think one of the reasons is that insurance is sort of a perverse bet with the insurance company. Take life insurance. You are betting the insurance company that you will die young but you are hoping they win the bet. So, generally, the best personal outcome when you buy insurance is that it turns out to be a bad deal financially. You don't die, you don't get sick and your house doesn't burn down.
When you discover that you are riding a dead horse, the best strategy is to dismount.

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BolderBoy
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Re: Do I need more than Original Medicare?

Post by BolderBoy » Mon Nov 05, 2018 10:27 am

cheese_breath wrote:
Mon Nov 05, 2018 8:44 am
kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
...I can afford, and do not mind paying, Part A and Part B deductibles....
If you can afford Part A and B deductibles, then you can afford Medigap and Part D premiums or Medicare Advantage premiums. Don't be foolish over a few extra dollars.
Agree with this. OP, you cannot presently fathom just how enormous Medicare bills (and therefore the copays) can unexpectedly get. Your present health status may not foretell the future.
"Never underestimate one's capacity to overestimate one's abilities" - The Dunning-Kruger Effect

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HueyLD
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Re: Do I need more than Original Medicare?

Post by HueyLD » Mon Nov 05, 2018 10:37 am

I agree with the suggestions that the OP should obtain more than just the original Medicare coverage.

But I do have a question though. If the OP doesn't mind burning thru his lifetime savings on out of pocket medical expenses, he will eventually qualify for Medicaid, right? So, it may work out for him using Medicaid as the ultimate insurance.

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Re: Do I need more than Original Medicare?

Post by Dottie57 » Mon Nov 05, 2018 10:37 am

kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
I am turning 65 in December 2018. Im have signed up for Medicare and I got my card. I am on the fence about signing up for a Medicare Supplement or a Medicare Advantage plan immediately. I can afford, and do not mind paying, Part A and Part B deductibles. I do not need Part D because my drugs costs are minimal. What I like about original Medicare is that I can go to any doctor or convenient care center that accepts Medicare in the US. I plan to go with Original Medicare for a year, and then reassess. What do you think?
High probability of needing coverage as you age. Cars break down as they age. So do people. Insurance is a very good thing.

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dm200
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Re: Do I need more than Original Medicare?

Post by dm200 » Mon Nov 05, 2018 1:58 pm

jebmke wrote:
Mon Nov 05, 2018 9:08 am
palaheel wrote:
Mon Nov 05, 2018 8:55 am
If your total is 8 points or higher, a Medigap plan may be best.
If your total is 5 points, a Medicare Advantage plan may be best.
In between, it's unclear.
In my case, the first question I asked was "Are there any Advantage plans in my area?" Many rural areas have no Advantage plans available. Mine happens to be one of them, despite the fact that I am within 1.5 hours of major metro areas like DC and Baltimore and 30 minutes from a fairly major medical center in Annapolis. That allowed me to eliminate the entire "GAP vs. Advantage" analysis and move on to other parameters to make my choice.
I read that 99% of the country has access to an advantage plan or more.

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Artful Dodger
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Re: Do I need more than Original Medicare?

Post by Artful Dodger » Mon Nov 05, 2018 2:45 pm

You might consider getting a High Deductible Plan F. Last time I looked, rates were about 60% below the regular Plan F. This way you have all the benefits of plan F, but are subject to a $2240 deductible. As noted previously, there are significant daily copays for hospital and SNF care after 60 days, and potential first dollar costs due to the 20% Part B coinsurance.

You could also purchase the lowest cost Part D plan in your area, so as not to have the late enrollment penalty and avail yourself of plan discounts. I've need some as low as $15/month.

bltn
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Re: Do I need more than Original Medicare?

Post by bltn » Mon Nov 05, 2018 10:45 pm

Dottie57 wrote:
Mon Nov 05, 2018 10:37 am
kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
I am turning 65 in December 2018. Im have signed up for Medicare and I got my card. I am on the fence about signing up for a Medicare Supplement or a Medicare Advantage plan immediately. I can afford, and do not mind paying, Part A and Part B deductibles. I do not need Part D because my drugs costs are minimal. What I like about original Medicare is that I can go to any doctor or convenient care center that accepts Medicare in the US. I plan to go with Original Medicare for a year, and then reassess. What do you think?
High probability of needing coverage as you age. Cars break down as they age. So do people. Insurance is a very good thing.
Absolutely right. Get yourself completely covered. The chances are, your covered medical expenses as you get older will will be 10x the premiums you pay, or more. Where else will you get that kind of return?

HIinvestor
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Re: Do I need more than Original Medicare?

Post by HIinvestor » Mon Nov 05, 2018 11:04 pm

Keep in mind that there is NO cap on out of pocket expenses with Medicare A or B. I personally like having a cap I can plan for so I can save for it and not have extra worries when I or a loved one is having s health crisis.

Also, for some coverages, If you don’t get them when you first qualify (eg at age 65), you may need medical underwriting to get coverage IF you can get coverage. With medical costs as they are in the US, medical coverage is something I think is very important to have well covered. Failing to can be VERY costly.

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cheese_breath
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Re: Do I need more than Original Medicare?

Post by cheese_breath » Mon Nov 05, 2018 11:16 pm

OP... My DW had a stroke 1 1/2 years ago at age 71. That's only 6 years older than you. So far her Medigap plan has paid over $100K in expenses. The prescription copays on her Part D plan are running about $500 per month. I can't imagine what my cost would be if I had to pay full price. If you want to risk something like that without supplemental insurance in order to save a few hundred dollars now, be my guest.
The surest way to know the future is when it becomes the past.

2015
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Re: Do I need more than Original Medicare?

Post by 2015 » Tue Nov 06, 2018 12:00 am

123 wrote:
Sun Nov 04, 2018 8:55 pm
It's time to study your options. In some states/areas Medicare Advantage plans are FREE in other areas they have a monthly premium. If you have used private insurance in the past check to see if they have a Medicare Advantage program and how it works. However, there are some rules that limit your ability to switch to other coverage if you have been enrolled in Medicare Advantage, later on if you want to switch you may have to go through medical underwriting/evaluation.
While overseeing elder care, their MA plan was as close to free as you can get. And they had treatment for a number of issues. I was amused when this years plan actually increased the copay for generics from 0 to $5 per script. The MA plan was outstanding such that when I called customer service stating I wanted to complain about something (wrong word choice), they actually opened a case and conducted an investigation. Upon being informed an investigation was being initiated, I apologized as I felt the issue was entirely too minor to be called a complaint. Apparently, this plan took customer service quite seriously.

The idea that MA plans are complicated is utter nonsense. If you had an HMO plan at work they work basically the same. I have relatives with Kaiser and non-Kaiser MA plans and all report ease of use. I'm on my second HMO plan under the ACA and if you can chew gum and walk you can figure out how to use them.

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Re: Do I need more than Original Medicare?

Post by celia » Tue Nov 06, 2018 12:05 am

kay8bee wrote:
Sun Nov 04, 2018 6:19 pm
I plan to go with Original Medicare for a year, and then reassess. What do you think?
It's a gamble. If you should end up in the hospital some day, are you willing to pay the part not covered by Medicare? If you end up with a serious condition (or even one not so serious, but it is a chronic condition), you will have to wait until Open Enrollment to get into a Medicare Advantage [HMO] plan and will probably not be able to get a Medigap plan because you can't pass medical underwriting. [You can sign up for anything you want when you are turning 65, even if you have a serious pre-existing condition.]

When you decide to get a drug plan to go with that condition, your drug premiums will be VERY expensive since you previously did not participate in a drug plan.

I fear you are looking at insurance as something you can get after you need it. This is like shopping for fire insurance after your house is on fire or liability insurance after you've been sued. Who would be willing to insure you after the fact?

If you want to manage the cost of future, unknown health risks, now is the time to sign up for a plan that works with Medicare.

fourwheelcycle
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Re: Do I need more than Original Medicare?

Post by fourwheelcycle » Tue Nov 06, 2018 9:08 am

Flobes wrote:
Sun Nov 04, 2018 6:46 pm

Are you aware of penalty for not signing up for Medicare Part D now? Medicare D has open enrollment each year, but you'll pay for the delay for the rest of your life.
Medicare Part D Late Enrollment Penalty

Interesting to note that many people are upset by the tax penalty if uninsured eligibles do not sign up for ACA coverage, yet we all understand the Medicare Part B and D lifetime premium penalties, which are designed to assure a broad risk base for those community-rated programs.

michaeljc70
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Re: Do I need more than Original Medicare?

Post by michaeljc70 » Tue Nov 06, 2018 9:43 am

It would be useful to see examples of the out of pocket costs with only parts A&B. For example, if you had a heart attack, diabetes, etc. I did a quick search and didn't find anything. I think the numbers would startle you if you think you don't need any other coverage. My Grandfather had a torn aorta and it was almost $500k in bills.

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HueyLD
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Re: Do I need more than Original Medicare?

Post by HueyLD » Tue Nov 06, 2018 9:46 am

fourwheelcycle wrote:
Tue Nov 06, 2018 9:08 am
Flobes wrote:
Sun Nov 04, 2018 6:46 pm

Are you aware of penalty for not signing up for Medicare Part D now? Medicare D has open enrollment each year, but you'll pay for the delay for the rest of your life.
Medicare Part D Late Enrollment Penalty

Interesting to note that many people are upset by the tax penalty if uninsured eligibles do not sign up for ACA coverage, yet we all understand the Medicare Part B and D lifetime premium penalties, which are designed to assure a broad risk base for those community-rated programs.
Well, I think Medicare beneficiaries are older and wiser :) and the vast majority of them are aware of their pre-existing conditions and mortality.

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gasdoc
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Re: Do I need more than Original Medicare?

Post by gasdoc » Tue Nov 06, 2018 9:51 am

I am big on self-insuring, but at a minimum I would have catastrophic coverage- that is the ultimate need for a risk sharing pool. Therefore, going with only the original Medicare is not a reasonable option.

gasdoc

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BL
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Re: Do I need more than Original Medicare?

Post by BL » Tue Nov 06, 2018 12:53 pm

Check out M. Advantage. Check out high-deductible Medigap. Consider length of time covered by Medicare and Medigap.

A family member used the max Medigap for a post-surgery failure at well-known medical center.

Check costs of cancer and other expensive medications.

downshiftme
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Re: Do I need more than Original Medicare?

Post by downshiftme » Tue Nov 06, 2018 6:17 pm

I am not yet Medicare age but am concerned about what kind of plan I may soon sign up for. My experience with regular health insurance makes me very concerned that Medicare Advantage plans may have exclusions or in-network vs out-of-network issues similar to the issues I had with regular employer provided health insurance. No matter how careful I was, there could still be a surprise out-of-network provider and a bill 10x the expected cost. Is this as much of a problem with Medicare Advantage plans as it is with regular employer provided health insurance?

mur44
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Re: Do I need more than Original Medicare?

Post by mur44 » Wed Nov 07, 2018 8:50 am

Medicare with Medigap supplemental insurance is the gold standard.
However, if your health is good and expect it to be good for the rest
of your life, then Medicare Parts A and B are adequate. Ask
yourself how you will know what future health care needs would be.

Even if you are not taking any medications, we recommend you enroll
into the cheapest Part D plan. If you wish to enroll into Part D later
on, penalty premium is applied.

Please note that if you are rich and your health is good (expect your
future health care needs would be minimal), it is OK to self-insure.
If you are Medicaid eligible, then you will not need Medigap.

This response is also for nisiprius, whose posts I always read.

Disclosure: I am a Certified Volunteer Medicare Counselor from New Jersey

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dm200
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Re: Do I need more than Original Medicare?

Post by dm200 » Wed Nov 07, 2018 9:07 am

downshiftme wrote:
Tue Nov 06, 2018 6:17 pm
I am not yet Medicare age but am concerned about what kind of plan I may soon sign up for. My experience with regular health insurance makes me very concerned that Medicare Advantage plans may have exclusions or in-network vs out-of-network issues similar to the issues I had with regular employer provided health insurance. No matter how careful I was, there could still be a surprise out-of-network provider and a bill 10x the expected cost. Is this as much of a problem with Medicare Advantage plans as it is with regular employer provided health insurance?
Yes - those are valid concerns. There are some differences, though, with "regular" health insurance.

1. All MA (and the similar Medicare Cost) plans must cover the same (as a minimum) conditions of Original Medicare.
2. Whether there can be "surprises" depends on the particular plan. In my case, it is nearly impossible for such a "surprise" because Kaiser is BOTH the insurer and the provider. I am no expert on the Humana MA plans, but I know several folks who are on a Humana MA plan and they are all very happy and have never mentioned any such "surprises".

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jeffyscott
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Re: Do I need more than Original Medicare?

Post by jeffyscott » Wed Nov 07, 2018 10:21 am

nisiprius wrote:
Mon Nov 05, 2018 8:36 am
User mur44, who's a "Certified Volunteer Medicare Counselor from NJ," has argued that it might not be totally insane to have parts A, B, and D, but no supplemental (Medigap) policy. I really don't want to speak for him and I probably wouldn't agree even if I remembered all the details of his argument correctly.

I don't know what the chances are of being personally bankrupted by bills not covered by parts A and B that would be covered by Medigap. According to the plan literature, my Medigap insurance has a benefit-to-premium ratio of 83%. I personally am willing to pay about $2,400 a year to an insurance company that will statistically pay about $1,992 of my bills--that is, my "statistical cost" is $408/year--in order to avoid the extreme nuisance of the risk showing up, and having to pay a $10,000 medical bill myself. (I've noticed from forum postings that people who opt for high deductible health plans get surprisingly upset when the risk shows up and they actually need to pay that $10,000 deductible they signed up for). (There's also what might be called "red tape risk," the risk of needing to spend hours on the phone to get a bill negotiated down to the level insurers and Medicare would pay instead of the three-or-four-times-higher "chargemaster" rate on the bill).
If you have high deductible insurance, you pay the insurance negotiated rate not the bogus list prices. Not on Medicare, but do have high deductible ($3000). We have gone beyond our $3000 deductible twice, but if we had no insurance that $3000 would've been much more that that.

Usually it's something like a 30-50% discount, but sometimes it can be insane. I had one statement for some tests with the total non-discounted amount billed at $7298, the amount allowed was $726, which all applied to my deductible, insurance paid nothing that was all just the discount.

Also with no insurance, we would not get free preventive care, the most significant factor with that would be paying for colonoscopies.

I do agree that it seems foolish to leave Medicare open ended by not buying a supplement or going with an Advantage plan. I believe in many areas you can get Medicare Advantage including prescription coverage for free. You might have a max out of pocket of something like $5000 with a free Medicare Advantage plan and that seems a lot more sensible than original Medicare with no out of pocket limit and no prescription coverage, due to having no supplement or part D.
press on, regardless - John C. Bogle

Leesbro63
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Re: Do I need more than Original Medicare?

Post by Leesbro63 » Wed Nov 07, 2018 10:27 am

michaeljc70 wrote:
Tue Nov 06, 2018 9:43 am
It would be useful to see examples of the out of pocket costs with only parts A&B. For example, if you had a heart attack, diabetes, etc. I did a quick search and didn't find anything. I think the numbers would startle you if you think you don't need any other coverage. My Grandfather had a torn aorta and it was almost $500k in bills.
I agree most need a Medicare supplement to reduce risk. That being said, how much did Medicare actually pay of your grandfather’s $500,000 aorta repair? And how much was covered at 100% under Part A, and what was the “exposed” patient portion under Part B?

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