Remind me why we have Medicare supplement

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montanagirl
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Remind me why we have Medicare supplement

Post by montanagirl » Mon May 06, 2019 11:43 am

A friend periodically calls me with this question, why get a supplement or Advantage plan if the cost is more than you would actually pay in most situations? This time her SO had back surgery and the hospital bill came out to exactly what it would have been as an Advantage co-pay. We do not have a lot of MA options in our state BTW. So she is flirting with going without any secondary insurance at all.

So I told her it's because you own a house outright and he doesn't. So do I. I want the upside protection on liability in the event of something catastrophic, like the long cancer treatments I have witnesses all around me, and don't want to get stuck in some long hassle with medical billers even if I can legally protect my house and IRAs in bankruptcy. I mean I don't even want to hear, "can't you cash out your Roth" or anything like that.

Am I right?

kaudrey
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Re: Remind me why we have Medicare supplement

Post by kaudrey » Mon May 06, 2019 11:50 am

Yes, Medigap (or medicare supplement) policies will be very helpful if you have a long, drawn out hospital stay. For example, Medicare Part A pays up to 60 days hospitalization (after a deductible). If you are in the hospital longer than 60 days, you begin paying an expensive daily copay for your hospital care. If you are in the hospital 150 days, your hospital coverage runs out altogether. Under Part B, after the deductible, you pay 20% of approved services, forever....their is no cap.

So, for a one-time surgery, there may not be a difference. But, as you rightly note, a long-term illness is an entirely different scenario, and the one for which you want to be protected.

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Stinky
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Re: Remind me why we have Medicare supplement

Post by Stinky » Mon May 06, 2019 11:54 am

It’s the same reason that you buy any type of insurance -
to pay current premiums in exchange for future benefits from the insurer.

Medicare definitely doesn’t cover all medical expenses, and uncovered medical expenses in retirement could be hazardous to your financial health. Med Supp / MA plans give you protection against catastrophic losses.

Yes, on average your Med Supp plan will cost you more than you receive back in benefits, just like any insurance does. The insurer needs to pay expenses and make a profit. But that’s not a reason not to buy insurance, especially in a competitive marketplace like Med Supp where many companies are competing for your business, which keeps premiums reasonable.
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GerryL
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Re: Remind me why we have Medicare supplement

Post by GerryL » Mon May 06, 2019 12:03 pm

It's insurance. You buy it and hope you never need it, instead of passing it up and wishing you had bought it.

If it's available in your state, maybe suggest she look into and F high-deductible Medigap plan.

btenny
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Re: Remind me why we have Medicare supplement

Post by btenny » Mon May 06, 2019 12:10 pm

Medicare pays most medical bills except for the 20% co-pay. I buy Anthem Medigap Plan F-High Deductible to pay that 20% co-pay if they get too big for this exact reason. I want protection in case of major big $$$ illness. My plan has a annual deductible of $2300. It costs $49 per month. It saves me about $1200 per year in premiums versus the higher cost plan regular Plan F or Plan G. But I spend $700 average per year to pay various medical costs deductibles. So I save about $500 net. I also have to track and pay the various bills as they happen which is sort of a PIA.

So unless I have a major illness the plan pays nothing in a given year. I am 72 and have done this for seven years. It paid maybe $50 one year but I have never been major league sick. So far it has worked great.

Good Luck.

JGoneRiding
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Re: Remind me why we have Medicare supplement

Post by JGoneRiding » Mon May 06, 2019 12:21 pm

If there was some sort of cap on the co pay I wouldn't rec it so much. But 20% can be huge even for a normal surgery

drawpoker
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Re: Remind me why we have Medicare supplement

Post by drawpoker » Mon May 06, 2019 12:41 pm

Yes, your friend is flirting with danger.

Maybe this will sink in. Surgery can be minor or major stuff, but even the simple stuff, if it involves a hospital admission, Friend with no supplement (or in MA plan) will be hit with the Part A (hospital) deductible, presently $1,364

Be sure and remind her that, unlike Part B deductible, that is not an annual deductible but rather a per period deductible. The period being 61 days.

So, under present CMS rules, that unfortunate person could have three, separate hospital stays within a year, no matter how brief, as long as they are at least 61 days apart, and be liable for $4K - along with the 20% co-insurance amounts all those doctors within the hospital will be charging.

Maybe your friend is thinking she is super-healthy, unlikely to contract any diseases, and is banking that any accidental injury will be due to a car wreck, so that insurance will pay her medical.

I guess there are some sr. citizens who might think like that. But I wouldn't, would you?

For those who are fretting about a "cap" on the 20% charges, yes, there is a cap. It's called buying Plan F or Plan G.
The cap then becomes whatever your annual premium is to your insurer. :)

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montanagirl
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Re: Remind me why we have Medicare supplement

Post by montanagirl » Mon May 06, 2019 12:47 pm

drawpoker wrote:
Mon May 06, 2019 12:41 pm
Yes, your friend is flirting with danger.

Maybe this will sink in. Surgery can be minor or major stuff, but even the simple stuff, if it involves a hospital admission, Friend with no supplement (or in MA plan) will be hit with the Part A (hospital) deductible, presently $1,364

Be sure and remind her that, unlike Part B deductible, that is not an annual deductible but rather a per period deductible. The period being 61 days.

So, under present CMS rules, that unfortunate person could have three, separate hospital stays within a year, no matter how brief, as long as they are at least 61 days apart, and be liable for $4K - along with the 20% co-insurance amounts all those doctors within the hospital will be charging.

Maybe your friend is thinking she is super-healthy, unlikely to contract any diseases, and is banking that any accidental injury will be due to a car wreck, so that insurance will pay her medical.

I guess there are some sr. citizens who might think like that. But I wouldn't, would you?

No. To me insurance is like renting someone else's assets. It seems worth it.

My friend's SO has no assets, but I'd think the hit to his credit for a (hypothetical) default could cause him trouble down the road.

drawpoker
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Re: Remind me why we have Medicare supplement

Post by drawpoker » Mon May 06, 2019 1:11 pm

montanagirl wrote:
Mon May 06, 2019 12:47 pm

My friend's SO has no assets, .........
Yikes. In addition to counseling her on Medicare coverage, maybe a heart-to-heart about dumping this B.F. might be in order? :oops:

BarbBrooklyn
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Re: Remind me why we have Medicare supplement

Post by BarbBrooklyn » Mon May 06, 2019 1:24 pm

Medicare will pay for up to 20 days of rehab at full payment. Days 21-100 have a copay of ?160. per day.

The supplement is so worth it.
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."

MathIsMyWayr
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Re: Remind me why we have Medicare supplement

Post by MathIsMyWayr » Mon May 06, 2019 10:39 pm

A friend of mine had a heart surgery a few years ago. The total bill came out over $1.3 MM (million). Calculation:
  • 20% of $1.3 MM = $260K.

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Sandtrap
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Re: Remind me why we have Medicare supplement

Post by Sandtrap » Mon May 06, 2019 10:48 pm

GerryL wrote:
Mon May 06, 2019 12:03 pm
It's insurance. You buy it and hope you never need it, instead of passing it up and wishing you had bought it.

If it's available in your state, maybe suggest she look into and F high-deductible Medigap plan.
I have "part F Medigap" and it's "no deductible". Maybe it depends on the state?
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Spirit Rider
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Re: Remind me why we have Medicare supplement

Post by Spirit Rider » Tue May 07, 2019 12:25 am

Sandtrap wrote:
Mon May 06, 2019 10:48 pm
I have "part F Medigap" and it's "no deductible". Maybe it depends on the state?
It is Plan F, not Part F. There are Medicare Parts A, B, C, and/or D. Medigap plans available to new eligible Medicare enrollees are A, B, C, D, F, F-HD, G, K, L, M and N. Plans C, F, and F-HD will no longer be offered to Medicare enrollees newly eligible on or after 1/1/2020. There will be a new Plan G-HD (high deductible)

Plan F covers both Part A and Part B deductibles and most other charges. However, as noted above there is separate Plan F-HD (high deductible), that does not pay until a deductible (2019 = $2300) is met.

The above are the standard plans available in all states except for MA, MN and WI.

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Sandtrap
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Re: Remind me why we have Medicare supplement

Post by Sandtrap » Tue May 07, 2019 1:24 am

Spirit Rider wrote:
Tue May 07, 2019 12:25 am
Sandtrap wrote:
Mon May 06, 2019 10:48 pm
I have "part F Medigap" and it's "no deductible". Maybe it depends on the state?
It is Plan F, not Part F. There are Medicare Parts A, B, C, and/or D. Medigap plans available to new eligible Medicare enrollees are A, B, C, D, F, F-HD, G, K, L, M and N. Plans C, F, and F-HD will no longer be offered to Medicare enrollees newly eligible on or after 1/1/2020. There will be a new Plan G-HD (high deductible)

Plan F covers both Part A and Part B deductibles and most other charges. However, as noted above there is separate Plan F-HD (high deductible), that does not pay until a deductible (2019 = $2300) is met.

The above are the standard plans available in all states except for MA, MN and WI.
Thanks. I've been finding all that confusing.
I did indeed get Plan F then.
aloha
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strafe
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Re: Remind me why we have Medicare supplement

Post by strafe » Tue May 07, 2019 5:31 am

MathIsMyWayr wrote:
Mon May 06, 2019 10:39 pm
A friend of mine had a heart surgery a few years ago. The total bill came out over $1.3 MM (million). Calculation:
  • 20% of $1.3 MM = $260K.
It’s 20% of the Medicare allowable, not 20% of inflated charges.
Still, a lot of money.

Shallowpockets
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Re: Remind me why we have Medicare supplement

Post by Shallowpockets » Tue May 07, 2019 6:19 am

montanagirl wrote:
Mon May 06, 2019 11:43 am
A friend periodically calls me with this question, why get a supplement or Advantage plan if the cost is more than you would actually pay in most situations? This time her SO had back surgery and the hospital bill came out to exactly what it would have been as an Advantage co-pay. We do not have a lot of MA options in our state BTW. So she is flirting with going without any secondary insurance at all.


Am I right?
This is confusing. A surgery that cost the same as a co pay would have been, without coverage on Part B? I have an MA plan and I had a hip replaced for my copay of $295. If someone has non MA plan the usual monthly extra premium is maybe $50-200. So put that at 200 x 12 = $2400. You are saying that your friend only paid $2400 out of pocket for a surgery with no coverage for Part B Medicare? More or less.
Tell your friend that forgoing Part B coverage now will hit her with a lifetime excess charge oenalty should she opt for a plan that covers it later. Same with Part D drug coverage.
This recent medical cost for your friend may have worked out this year, but I would not go forward thinking that every year would be like that.
Penny wise, pound foolish.

drawpoker
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Re: Remind me why we have Medicare supplement

Post by drawpoker » Tue May 07, 2019 1:44 pm

Shallowpockets wrote:
Tue May 07, 2019 6:19 am

......Tell your friend that forgoing Part B coverage now will hit her with a lifetime excess charge oenalty...... Same with Part D drug coverage.
I don't believe the OP's friend was considering not signing up for Parts A and B Medicare when eligible; I took it to mean the friend was balking at paying for either a Medicare supplement, or joining a MA plan.

If that is wrong, the OP can correct it.

In terms of the friend's SO (The B.F.) and his reported experiences - since the B.F. is apparently able to boast he has no assets, it is entirely possible his income is also low enough that the state is not only paying his Part B monthly premiums but also picking up his co-insurance amounts. "Extra Help" from the feds (aka the Purple Letter) for Rx costs. Essentially, a person fitting this picture would not be buying a Medicare supplement, as they would automatically be put into one of Montana's MCO's for dual-eligibles.

There are four diff. Medicare Savings programs (QMB, SLMB, et al) in which no asset, low income folks can get their state Medicaid program to pick up the tab on a whole lot.

I hope the OP's friend was not getting the impression that she could do as well...... :?:

cashmoney
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Re: Remind me why we have Medicare supplement

Post by cashmoney » Tue May 07, 2019 2:22 pm

montanagirl wrote:
Mon May 06, 2019 11:43 am
A friend periodically calls me with this question, why get a supplement or Advantage plan if the cost is more than you would actually pay in most situations? This time her SO had back surgery and the hospital bill came out to exactly what it would have been as an Advantage co-pay. We do not have a lot of MA options in our state BTW. So she is flirting with going without any secondary insurance at all.

So I told her it's because you own a house outright and he doesn't. So do I. I want the upside protection on liability in the event of something catastrophic, like the long cancer treatments I have witnesses all around me, and don't want to get stuck in some long hassle with medical billers even if I can legally protect my house and IRAs in bankruptcy. I mean I don't even want to hear, "can't you cash out your Roth" or anything like that.

Am I right?



Some providers may not want to schedule her for consultations ,procedures etc. if they they think they may not be paid so it may limit her choice of providers and care received .

jebmke
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Re: Remind me why we have Medicare supplement

Post by jebmke » Tue May 07, 2019 2:24 pm

drawpoker wrote:
Mon May 06, 2019 12:41 pm
I guess there are some sr. citizens who might think like that. But I wouldn't, would you?
I do taxes for low income seniors in the area. Quite often I get taxpayers who have Part B and no supplemental. Every once in a while I even get people who have no Part B and only Part A (they are very low income). They will resort to Medicaid if things get dicey. They really have no other choice.
When you discover that you are riding a dead horse, the best strategy is to dismount.

drawpoker
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Re: Remind me why we have Medicare supplement

Post by drawpoker » Wed May 08, 2019 9:28 pm

jebmke wrote:
Tue May 07, 2019 2:24 pm

.....do taxes for low income seniors.......... Every once in a while I even get people who have no Part B and only Part A (they are very low income). They will resort to Medicaid if things get dicey. They really have no other choice.
Are these folks sure they aren't already qualified for Medicaid (dual-eligible) ?

The asset/resource limits for the over-65 folks who are low-income can vary by state. Because it is each state's responsibility under its own Medicaid program to fund these various services for people on Medicare, the means-testing is not federally mandate (unlike Medicaid LTSS for folks on Medicare)

ncbill
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Re: Remind me why we have Medicare supplement

Post by ncbill » Thu May 09, 2019 9:01 am

I helped a relative (early 70s) sign up for both Part B & Plan G spring of 2018 after they started having terrible back pain.

Because of financial constraints (their only income was SS taken at age 62) they hadn't signed up for Part B.

So their Part B (& Plan G plus drug plan) coverage became effective July 1, they went to specialists, and were soon scheduled for surgery to shore up their many fractured vertebrae.

That surgery was stopped literally after they were sedated & on the table...they then were sent up to oncology, where they eventually received their diagnosis of terminal cancer.

The above alone entailed several weeks in hospital...20% of that would have been way more than the $120/month Plan G (& drug plan) combined premiums.

After discharge they elected Hospice so nearly all of the subsequent costs were covered under Part A.

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munemaker
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Re: Remind me why we have Medicare supplement

Post by munemaker » Thu May 09, 2019 9:14 am

Here's why:

I have been healthy with just a small medial claim here and there. Then late last year, I developed some symptoms. My PCP had a hard time diagnosing and sent me to specialists: an internist, urologist and ultimately a surgeon. They ordered a bunch of diagnostics: two ultrasounds, two CT scans (with and without contrast), a MRI, EKG, multiple blood and urine analysis, cystoscopy, and more. Turns out it was gall stones/gall bladder which was successfully removed. The tab was $38,000. I have Medicare Advantage and paid $520. And really, this was a fairly minor problem. Think of what it would cost if it was something serious.

In addition, I had all the preventive stuff at no charge...shingles shots, pneumonia shot, flu shot, wellness exam, etc. Advantage covers my basic dental, vision and gym membership.

Going without a supplement or advantave plan would be very foolish.

There are some reasonably good Advantage plans in our area that are free ($0 premium). I pay $40/month for mine.

celentano
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Re: Remind me why we have Medicare supplement

Post by celentano » Tue May 21, 2019 9:02 pm

It is incredible that you only paid $520. I am getting ready to sign up for something (advantage or supplement). I am lost and confused... In my area all advantage plans have 20% co-pays for MRI or EKG kind of stuff and minimum $4200 out of pocket maximum. If my bills totaled $32,000 I don't think I could have gotten away with $520. In which in state and with which company do you have your advantage plan for $40? Thanks.

cashmoney
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Re: Remind me why we have Medicare supplement

Post by cashmoney » Tue May 21, 2019 9:13 pm

celentano wrote:
Tue May 21, 2019 9:02 pm
It is incredible that you only paid $520. I am getting ready to sign up for something (advantage or supplement). I am lost and confused... In my area all advantage plans have 20% co-pays for MRI or EKG kind of stuff and minimum $4200 out of pocket maximum. If my bills totaled $32,000 I don't think I could have gotten away with $520. In which in state and with which company do you have your advantage plan for $40? Thanks.


Not really typically an MRI at a free standing imaging center is about 60.00 and an EKG is about 15.00 when you pay the 20% co insurances with just original medicare.With a medicare advantage plans the 20% co insurance are often a little lower than original medicare at in network providers.

Leroy Jones
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Re: Remind me why we have Medicare supplement

Post by Leroy Jones » Wed May 22, 2019 7:36 am

Recently had some heart surgery. Total bill was $100,000. Insurance, Medicare Advantage, paid $27000. My out of pocket cost was $450. Can't imagine what the cost would have been without Medicare Advantage Supplemental. Also the MA Plan has no monthly premium other than Part B payment.
Leroy Jones :sharebeer

gtg970g
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Re: Remind me why we have Medicare supplement

Post by gtg970g » Wed May 22, 2019 10:29 am

strafe wrote:
Tue May 07, 2019 5:31 am
MathIsMyWayr wrote:
Mon May 06, 2019 10:39 pm
A friend of mine had a heart surgery a few years ago. The total bill came out over $1.3 MM (million). Calculation:
  • 20% of $1.3 MM = $260K.
It’s 20% of the Medicare allowable, not 20% of inflated charges.
Still, a lot of money.
Also the 20% copay is only on the doctor's portion of the bill. Hospital billing is covered by part A and has a separate schedule of copays.

InMyDreams
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Re: Remind me why we have Medicare supplement

Post by InMyDreams » Wed May 22, 2019 10:42 am

I've seen someone who had no MA nor supplement. She didn't think her condition could happen to her, because she was devoted to a healthy lifestyle. Indeed, except for her one (major) medical problem, she was quite healthy.

So, she worked out some sort of deal for her 20% of very expensive series of treatments until she hit open enrollment (several months of treatment). Then she enrolled in a MedAdvantage program, and on January 1, had to jump thru the MA's hoops - going thru another referral, work up, change of clinics, etc.

I have no idea what she paid out of pocket. I'm sure it was more than the premiums she would have been paying had she enrolled either in a supplement or in an Advantage.

Medicare alone does not have a Max Out of Pocket (MOOP). That's why you have insurance - protect yourself from enormous costs.

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