Medicare - just A + B?

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hicabob
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Medicare - just A + B?

Post by hicabob »

The time has come when I will be applying for Medicare soon. After reading about the various advantage, medigaps, etc. plans I am curious if many folk just do A + B and self insure for the rest? I'm in decent health, have way more $$ than I need and am currently insured with Kaiser via a bronze HSA hi-deductible, zero subsidy, ACA plan.
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Re: Medicare - just A + B?

Post by nisiprius »

No, because the catastrophic coverage provision of part D seems really important to me, so, definitely, part D (prescription drugs).

We do have supplemental/"Medigap" because the statistics on our policy say 89% of the premiums get paid out as benefits, and if I multiply the premiums by 11% that is an amount I'm willing to pay for "peace of mind," the convenience of not having to do anything about part B copays, and for the fact that a really expensive year without it could be somewhere between very very inconvenient and quite difficult, even if theoretically we could afford it. I'm not sure what the absolute upper end would be, the maximum we might be responsible for if we didn't have supplemental.
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Re: Medicare - just A + B?

Post by pshonore »

I believe there's a late enrollment penalty for Part D if you don't take it when initially eligible. Of course you never know when you're going to need the coverage but some of the new drugs are quite pricey
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oldcomputerguy
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Re: Medicare - just A + B?

Post by oldcomputerguy »

I just turned 65 last July and signed up for Medicare. In my case, I decided to sign up for a Medigap supplement (specifically the AARP plan offered through UnitedHealthcare).

The thing about insurance is that it is a great thing to have when you need it, and a drain on your pocketbook when you don't. This is true of every sort of insurance, medical, dental, homeowners, auto, fire, what have you. Part B pays 80% of covered expenses, and leaves the rest for you to pay. If you don't think that 20% of any upcoming medical expenses will be too much to pay out of pocket, then yes, you could get by without a supplement. In my case, that seems more risky than I feel comfortable with, so I did the supplement. It costs me $116/month, so if one does the break-even math, it would indicate that going without a supplement would have been financially better up to around $7,000 of medical expenses in a year. Over this, the scale tips the other way. Of course, one never knows ahead of time just what health problems will come down the pike. I sleep better with the supplement in place.


As a side note, just to make sure you're aware, you will no longer be able to contribute pre-tax dollars to your HSA after you join Medicare.

Contributions to an HSA / Limit on Contributions / Enrolled in Medicare
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Re: Medicare - just A + B?

Post by Kenkat »

I am not on Medicare yet but my big concern would be that there are no upper limits / out of pocket maximums as there are with private or ACA plans. If you have a major medical incident like cancer or a major heart issue, you are responsible for 20% of the cost, with no limit. So a $1,000,000 cancer incident (which is very possible) results in you being responsible for $200,000 of that cost.
Last edited by Kenkat on Tue Apr 13, 2021 11:37 am, edited 1 time in total.
ModifiedDuration
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Re: Medicare - just A + B?

Post by ModifiedDuration »

Most people here with Traditional Medicare Parts A and B seem to favor a MediGap plan and a Part D prescription plan.

The most popular MediGap plans for new Medicare enrollees are Plan G, Plan G - high deductible, and Plan N.

These will cover the 20% that Medicare Part B does not (which can run into a big number when you have medical issues), as well as provide $50,000 in foreign emergency medical coverage and cover a myriad of other costs that Traditional Medicare does not cover.

The Plan G and Plan G- high deductible will also cover the 15% Excess Charge on Part B that you may be charged.

In addition, consider a Part D prescription plan. Even if you have no expensive prescriptions now, get at least an inexpensive plan to provide catastrophic prescription coverage.

Plan G high-deductible is particularly interesting. The “high deductible” is a misnomer, because, under this plan Medicare Parts A and B do pay their shares first and then you pay the $1,408 Medicare Part A deductible (for 2021) if you are admitted to a hospital and the 20% of Medicare-approved costs that Part B does not cover, up to a total “deductible” of $2,370 (for 2021).

If you are in good health, it can be a good value, as the monthly premiums are very low and, over time, your out-of-pocket expenses could be significantly lower than the additional cost of a regular Plan G.

In my case, the Plan G high-deductible premium is $37 a month vs. about $150 a month for the lowest cost regular Plan G, so basically any year that I am not admitted to the hospital I should come out way ahead.

(If you are going to get a MediGap plan, you may have to learn about the three different pricing methodologies (attained-age, issue-age, and community-rated pricing), depending on what is allowed and available in your state. Really, reading a book like Medicare For Dummies or Medicare Demystified would be most helpful.)
Last edited by ModifiedDuration on Tue Apr 13, 2021 11:52 am, edited 4 times in total.
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Re: Medicare - just A + B?

Post by 123 »

When my uncle signed up for Medicare A+B he switched from an expensive Kaiser HMO plan that he had under COBRA to a Kaiser Medicare Advantage Plan. Kaiser seems to have Medicare Advantage Plans in many of their service areas but the prices vary. When he signed up we found that the plan was free in parts of Southern California but there was a charge of maybe $100 monthly in Northern California areas.

Some people love Kaiser and it works well for them, my uncle has used them for many years and wouldn't consider any other option. Others have a history with their own private physicians they want to maintain and they have to make alternative arrangements.

Of course once you get enrolled in a Medicare Advantage plan it makes it more difficult to switch over to a MediGap plan later because you can't switch without medical underwriting/evaluation which may make coverage more expensive or unavailable.
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Re: Medicare - just A + B?

Post by gips »

oldcomputerguy wrote: Tue Apr 13, 2021 11:28 am I just turned 65 last July and signed up for Medicare. In my case, I decided to sign up for a Medigap supplement (specifically the AARP plan offered through UnitedHealthcare).

The thing about insurance is that it is a great thing to have when you need it, and a drain on your pocketbook when you don't. This is true of every sort of insurance, medical, dental, homeowners, auto, fire, what have you. Part B pays 80% of covered expenses, and leaves the rest for you to pay. If you don't think that 20% of any upcoming medical expenses will be too much to pay out of pocket, then yes, you could get by without a supplement. In my case, that seems more risky than I feel comfortable with, so I did the supplement. It costs me $116/month, so if one does the break-even math, it would indicate that going without a supplement would have been financially better up to around $7,000 of medical expenses in a year. Over this, the scale tips the other way. Of course, one never knows ahead of time just what health problems will come down the pike. I sleep better with the supplement in place.


As a side note, just to make sure you're aware, you will no longer be able to contribute pre-tax dollars to your HSA after you join Medicare.

Contributions to an HSA / Limit on Contributions / Enrolled in Medicare
just starting to research medicare, I'm leaning towards aarp united healthcare plan but need to perform more due diligence. I've heard some crazy costs thrown around for medical events ($600k-$1mm) so I'm not willing to entertain self-insurance...I'd like to think $116/month is basically noise for most retirees on this forum.
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Re: Medicare - just A + B?

Post by Stinky »

I would never go without additional coverage of some type.

In my case, it makes the most sense to go with an Advantage plan. My Advantage plan covers 99% of the doctors in my state and 100% of the hospitals. I get my Part D coverage and a few additional freebies at no cost to me.

Others will advocate for supplemental and drug plans, based on their choice of plans and doctors. And that’s fine.

But I would not go without additional coverage.
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Re: Medicare - just A + B?

Post by radiowave »

Just transitioning to retirement and considering both Kaiser Medicare Advantage plan (currently on Kaiser on employer plan) or Plan G + drug plan. I like Kaiser, very well integrated and organized. I am concerned if I had to go to Plan G I would have to make an effort to organize my own care, e.g. if I needed specialist for some reason. Also, with the Medicare Advantage plan, you get Silver Sneakers plus eye and hearing and dental, those would be extra costs going to a MediGap plan. I haven't made a decision yet but OP please consider all your options and penalties if you don't get extra coverage.
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Re: Medicare - just A + B?

Post by nisiprius »

Kenkat wrote: Tue Apr 13, 2021 11:31 am I am not on Medicare yet but my big concern would be that there are no upper limits / out of pocket maximums as there are with private or ACA plans. If you have a major medical incident like cancer or a major heart issue, you are responsible for 20% of the cost, with no limit. So a $1,000,000 cancer incident (which is very possible) results in you being responsible for $200,000 of that cost.
The thing that makes it confusing is that part A covers hospital expenses 100%. Part B and the 20% co-pay only apply to services billed separately by doctors' offices. And when you are in a hospital, it is not and has never been clear exactly what services are included in the hospital's bill. For example, drugs you take while in the hospital are included. Some of the doctors that see you are included, others are not. So the question is: 20% of what, and just how high can it go?

Here's a question. There have been newspaper stories about people getting snakebite, going to an emergency room, and getting billed $100,000 for antivenin. Exactly what kinds of insurance would have covered the cost of the antivenin? Medicare part A, B, D? Medigap?
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Re: Medicare - just A + B?

Post by ModifiedDuration »

nisiprius wrote: Wed Apr 14, 2021 6:25 am
Here's a question. There have been newspaper stories about people getting snakebite, going to an emergency room, and getting billed $100,000 for antivenin. Exactly what kinds of insurance would have covered the cost of the antivenin? Medicare part A, B, D? Medigap?
If the patient just goes to the Emergency Room and is not admitted to the hospital, then everything (including the antivenin) is covered under Part B. A Medigap plan would cover the 20% that Part B does not cover (to the extent that that particular Medigap plan covers Part B expenses).

If the person is admitted to the hospital, then Part A would cover everything (including the antivenin). A Medigap plan would cover the $1,484 Part A deductible (to the extent that that particular Medigap plan covers the Part A deductible).
Last edited by ModifiedDuration on Wed Apr 14, 2021 7:05 am, edited 3 times in total.
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Re: Medicare - just A + B?

Post by Chris K Jones »

I am a couple of years away from this, but I intend to get A, B, D and a Medigap policy. I remember a couple of years ago seeing an analysis of what was covered by Medigap policies (or perhaps was uncovered by the underlying plans A & B). The analysis showed how much out of pocket expenses people were left with. It was a big outlier, but there was at least one person who had out of pocket expenses of over a million dollars. I find it hard to understand how it can get that high using medicare reimbursements, but I got the message. I wouldn't fly without any of these plans. Best wishes to you whatever you do.
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Re: Medicare - just A + B?

Post by bberris »

Instead of going without, there are free or nearly free options depending on your state and circumstances.
1. Medicare advantage, with a high deductible, usually including drugs and a restricted network
2. Medicare advantage savings account. Also high deductible, no premium, cash deposit for initial expenses and full doctor availability that accepts medicare. So these programs have a donut hole where you would have to pay, but your OOP is limited. I wrote about these previously, they are not available in every state. Doesn't include drugs, but there are cheap part D plans.
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Re: Medicare - just A + B?

Post by nisiprius »

ModifiedDuration wrote: Wed Apr 14, 2021 6:39 am
nisiprius wrote: Wed Apr 14, 2021 6:25 am
Here's a question. There have been newspaper stories about people getting snakebite, going to an emergency room, and getting billed $100,000 for antivenin. Exactly what kinds of insurance would have covered the cost of the antivenin? Medicare part A, B, D? Medigap?
If the patient just goes to the Emergency Room and is not admitted to the hospital, then everything (including the antivenin) is covered under Part B. A Medigap plan would cover the 20% that Part B does not cover (to the extent that that particular Medigap plan covers Part B expenses).

If the person is admitted to the hospital, then Part A would cover everything (including the antivenin). A Medigap plan would cover the $1,484 Part A deductible (to the extent that that particular Medigap plan covers the Part A deductible).
So, in this case, Summer Bummer: A Young Camper's $142,938 Snakebite,
The helicopter flight transported Oakley 80 miles from a school parking lot just outside the forest to St. Vincent Evansville hospital in Indiana, where she received four vials of antivenin. She was then transferred to Riley Hospital for Children in Indianapolis for observation.
The antivenin was administered in the ER, and the total ER bill was $72,638 including $67,596 for antivenin. An eight-page image of an actual bill is reproduced in the story; it doesn't match up with the story details in that it apparently reflects a later bill after the insurer had agreed to pay. I am also assuming he rest of the $142,938 includes the hospital bill after the patient was transferred and admitted to another hospital.

As I understand it, you are saying that in this situation a Medicare patient with parts A and B but not Medigap supplemental, would be responsible for 20% of $72,638 = $14,257, while someone with Medigap would be fully covered?

(The story strongly implies that this is another case of for-profit hospital "chargemaster" billing with insane markups that an insurer would not actually need to pay...)

(While camping in Tucson in 2019, a camper in a campsite fifty yards from ours was bitten by a snake, rushed to a hospital, was given antivenin, and had to say two nights, so a "snakebite" scenario is in my mental map of "things that really happen!" They were international visitors from Germany, and of course I don't know how or how much they were billed or what their insurance situation was, although I have often wondered...)
Last edited by nisiprius on Thu Apr 15, 2021 1:17 pm, edited 1 time in total.
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Re: Medicare - just A + B?

Post by LongRoad »

You sound like a good candidate for a high-deductible G plan plus the cheapest part D plan you can find (you can choose a different part D plan each year if anything changes).

Or there may be a low cost medicare advantage plan with a broad network in your area. Some MA plans have no premium cost beyond your Part B premium. If you're happy with Kaiser, they offer medicare advantage plans in a number of areas:
https://medicare.kaiserpermanente.org/w ... ns/explore
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Re: Medicare - just A + B?

Post by pennywise »

I've got an example of someone who only had Medicare A and B, my mother in law. I think she had some type of supplemental healthcare coverage under her husband's retirement benefits (teacher) but he had not selected a survivor-benefit option so she lost that at his death when she was 74. She's 97 now so has been on only 'basic' Medicare for 20+ years.

In her case it's been pretty amazing because she has managed to thread the needle as far as ONLY requiring what A and B cover. She was always suspicious about doctors and though she took decent care of herself (no smoking/drinking, healthy diet, active, annual check ups) as she aged and dementia set in she had 3 hip fractures(!).

For each one Medicare covered almost all of the costs of the ER, hospital and rehab following discharge. After the 3rd, she had to go into assisted living and of course Medicare doesn't cover that. However it did cover adding hospice service a year ago to provide supplemental help with bathing, dressing etc. She has been in decline and after a recent stroke is in a vegetative state, but hospice is in place so hopefully she will remain at the ALF instead of a nursing home transfer till the end.

We finally put her on a Medicare supplement plan a couple of years ago, mostly in case of some kind of catastrophic dementia-connected event or complication. That's not costing anything extra.

Regarding the drug coverage penalty, of course she never signed up for that. When we added it as required by the supplement plan the penalty-which was the max due to her never having had coverage-was $53/month. She onyl takes a thyroid med and hypertension drug now which are both covered so the actual out of pocket cost is ~$24/month. We thought the penalty would be a lot higher, so there's one data point.

So I suppose she could be considered a successful customer of a bare bones plan but I'd say that is mostly due to a freakishly strong constitution and extreme good luck.
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Re: Medicare - just A + B?

Post by ModifiedDuration »

nisiprius wrote: Thu Apr 15, 2021 6:19 am
ModifiedDuration wrote: Wed Apr 14, 2021 6:39 am
nisiprius wrote: Wed Apr 14, 2021 6:25 am
Here's a question. There have been newspaper stories about people getting snakebite, going to an emergency room, and getting billed $100,000 for antivenin. Exactly what kinds of insurance would have covered the cost of the antivenin? Medicare part A, B, D? Medigap?
If the patient just goes to the Emergency Room and is not admitted to the hospital, then everything (including the antivenin) is covered under Part B. A Medigap plan would cover the 20% that Part B does not cover (to the extent that that particular Medigap plan covers Part B expenses).

If the person is admitted to the hospital, then Part A would cover everything (including the antivenin). A Medigap plan would cover the $1,484 Part A deductible (to the extent that that particular Medigap plan covers the Part A deductible).
So, in this case, Summer Bummer: A Young Camper's $142,938 Snakebite,
The helicopter flight transported Oakley 80 miles from a school parking lot just outside the forest to St. Vincent Evansville hospital in Indiana, where she received four vials of antivenin. She was then transferred to Riley Hospital for Children in Indianapolis for observation.
The antivenin was administered in the ER, and the total ER bill was $72,638 including $67,596 for antivenin. An eight-page image of an actual bill is reproduced in the story; it doesn't match up with the story details in that it apparently reflects a later bill after the insurer had agreed to pay. I am also assuming he rest of the $142,938 includes the hospital bill after the patient was transferred and admitted to another hospital.

As I understand it, you are saying that in this situation a Medicare patient with parts A and B but not Medigap supplemental, would be responsible for 20% of $72,638 = $14,257, while someone with Medigap would be fully covered?

(The story strongly implies that this is another case of for-profit hospital "chargemaster" billing with insane markups that an insurer would not actually need to pay...)


(While camping in Tucson in 2019, a camper in a campsite fifty yards from ours was bitten by a snake, rushed to a hospital, was given antivenin, and had to say two nights, so a "snakebite" scenario is in my mental map of "things that really happen!" They were international visitors from Germany, and of course I don't know how or how much they were billed or what their insurance situation was, although I have often wondered...)
The short answer is that the patient would be responsible for the 20% coinsurance in the scenario described in the article, but that a Medigap policy would cover it (depending on the Medigap plan purchased). However, it is a little more complicated than that.

First off, as you mentioned, the figures in the article are what was billed. The amount Medicare would pay would be a fraction of that. For simplicities sake, let’s assume that the $70,000 plus bill for the ER and for the other hospital when under observation were reduced to $25,000 each under Medicare.

Next, note that at the second hospital the person was not admitted, but was under observation. This makes a tremendous difference under Medicare. Since the person was not admitted to the hospital and was just under observation, then the second charge for hospital is also covered under Part B, not Part A (you do not want to be under observation at a hospital, you want to either be admitted or discharged).

Now, if the second hospital had admitted the patient, then everything (including the ER visit) would have been covered under Part A. Crazy, no?

So, in the scenario that was described in the article, since the person was just under observation in the second hospital, then the person would owe out-of-pocket, assuming no Medigap plan, 20% of the assumed $50,000 Medicare-approved billing for the ER and the second hospital, or $10,000 (ignoring the Part B $203 annual deductible).

If the patient has been admitted to the second hospital, then they would just owe the Part A deductible of $1,484, assuming no Medigap plan, for the whole thing.

Now, what a Medigap plan would cover depends upon which Medigap plan was purchased.

The most comprehensive plan currently available, Plan G, would cover everything not covered by Medicare (whether the person was admitted to the hospital or not), except for the $203 Part B annual deductible. So would several of the other Medigap plans currently available.

Some of the less popular Medigap plans, such as plans K and L, would have only covered either 50% or 75%, respectively, of the Part A deductible and either 50% or 75% of the Part B 20% coinsurance, with an out-of-pocket maximum of $6,220 and $3,110, respectively.

One other point: you mention the insane markups at for-profit hospitals. I would submit that the same insane markups exist at the two-thirds of the hospitals in the US that are non-profit. They all have insane markups, whether for-profit or non-profit.

Finally, Medicare actually has a pretty useful page on the differences in coverage between being admitted and not being admitted to a hospital:

https://www.medicare.gov/what-medicare- ... tal-status
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Re: Medicare - just A + B?

Post by hicabob »

Thanks for the answers all. One more medicare question .... I've heard that some docs will not take medicare patients due to the lower compensation. Has anyone found this to be true? If so I suppose that would be a huge advantage for an HMO type advantage plan.
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Re: Medicare - just A + B?

Post by nisiprius »

ModifiedDuration wrote: Thu Apr 15, 2021 9:17 am...One other point: you mention the insane markups at for-profit hospitals. I would submit that the same insane markups exist at the two-thirds of the hospitals in the US that are non-profit. They all have insane markups, whether for-profit or non-profit...
Point taken, post corrected.
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Re: Medicare - just A + B?

Post by David Jay »

nisiprius wrote: Tue Apr 13, 2021 11:24 amNo, because the catastrophic coverage provision of part D seems really important to me, so, definitely, part D (prescription drugs).
If one has no expensive prescriptions, one can get a "limited coverage" Part D for about $15 - $20 a month at age 65.

Well worth having Part D coverage - and no penalty later - if one develops health problems that call for expensive drugs. A broader coverage Part D can then be selected at any open enrollment(i.e each year). Consider it cheap insurance.
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Re: Medicare - just A + B?

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hicabob wrote: Thu Apr 15, 2021 1:14 pm Thanks for the answers all. One more medicare question .... I've heard that some docs will not take medicare patients due to the lower compensation. Has anyone found this to be true? If so I suppose that would be a huge advantage for an HMO type advantage plan.
A doctor can choose to take no Medicare patients whatsoever (i.e. this would probably work for a pediatrician...), but if they accept one Medicare patient then they must generally accept Medicare patients.
Last edited by David Jay on Thu Apr 15, 2021 1:44 pm, edited 1 time in total.
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Re: Medicare - just A + B?

Post by nisiprius »

hicabob wrote: Thu Apr 15, 2021 1:14 pm Thanks for the answers all. One more medicare question .... I've heard that some docs will not take medicare patients due to the lower compensation. Has anyone found this to be true? If so I suppose that would be a huge advantage for an HMO type advantage plan.
I don't know if this varies from market to market. Where I live I have not found it to be true. Before going onto Medicare I made a list of more than twenty doctors that included every doctor I'd actually seen, plus a few selected specialist whose names I picked from a publication that supposedly names the "top doctors" in our region. I then looked them all up on the Medicare provider directory, and they all accepted Medicare assignment.

You can and should do something similar. And then, if possible, repeat it with the Medicare Advantage plan's provider directory for whatever plan you're considering. Around here my experience has been that everybody seems to accept Medicare assignment, and that everybody also accepts "all major insurance."

I've heard that doctors hate traditional Medicare because of low reimbursements, but at the same time love it because collection is much easier than with private insurers.

So far, in nearly ten years, I have not had any doctors who did not take Medicare assignment, including a dental surgeon whose office seemed puzzled by the question. I have a notion that "the best doctors don't take Medicare" may be fearmongering or may refer to concierge medicine or things like cosmetic surgery where they may have found that Medicare is unpredictable about approvals. But maybe it is regional, maybe some cities or states are more traditional-Medicare-friendly than others.

The flip side of the coin, of course, is that traditional Medicare covers you nationally with any doctor anywhere who takes Medicare assignment, whereas Medicare Advantage "networks" are regional and have complicated provisions about out-of-network coverage.
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Re: Medicare - just A + B?

Post by ModifiedDuration »

hicabob wrote: Thu Apr 15, 2021 1:14 pm Thanks for the answers all. One more medicare question .... I've heard that some docs will not take medicare patients due to the lower compensation. Has anyone found this to be true? If so I suppose that would be a huge advantage for an HMO type advantage plan.
Per this article, 99% of non-pediatric physicians accept Medicare, with the largest specialty not accepting Medicare being psychiatrists (at 7%):

https://www.kff.org/medicare/issue-brie ... e-program/

So, you can have Traditional Medicare, which 99% of the physicians in the country accept, or an HMO, where you are restricted to the physicians in that specific HMO network.
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Re: Medicare - just A + B?

Post by BatBuckeye »

I'm always amazed at the EOB, Explanation of Benefits, from the insurance company for each medical bill.
It lists the DR/hospital/LAB bill and then lists typically a much smaller amount that the INS CO will pay. And then I have some fee to pay after all that.
Although you mention you can self pay, one benefit of insurance is they have already negotiated smaller fees.
In your case you could pay full price or you can negotiate the price for services if and when needed. That could turn into a lot of negotiating if you choose that route.
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Re: Medicare - just A + B?

Post by dpc »

Thanks for the answers all. One more medicare question .... I've heard that some docs will not take medicare patients due to the lower compensation. Has anyone found this to be true? If so I suppose that would be a huge advantage for an HMO type advantage plan.
Yes. Before we moved, our long-time doctors' clinic in Oregon would not take NEW Medicare patients. If you were an established patient prior to going on Medicare, they would continue to see you. This is definitely something to be aware of.
"Worrying is like paying interest on a debt that you might never owe" -- Will Rogers
andypanda
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Re: Medicare - just A + B?

Post by andypanda »

"I've heard some crazy costs thrown around for medical events ($600k-$1mm) "

A buddy I've known for 43 years was hospitalized for 7 weeks due to Covid19, most of it in ICU on a ventilator, etc. His bill, before the Medicare and insurance company negotiated reductions was $2,900,000 and change. So yes, things can get very expensive very quickly.

Speaking of negotiated prices, I have Medicare A & B, plus the retired state employee supplement I pay for that includes prescriptions and some dental and eye care. The last time I had a root canal and crown I discovered that instead of paying the old rate of 50% I had to pay 95%. I asked my dentist about it and he explained that I was paying 95% of the negotiated $800 and not the cash price of nearly double that amount if that 5% wasn't included in the contract. Oh well, good thing the system is looking out for me .. :beer
trueblueky
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Re: Medicare - just A + B?

Post by trueblueky »

I am a retired fed. I have Medicare A + B. My FEHB plan covers medicine at a level at least equal to Medicare D. My experience is that I pay little for anything. Because the FEHB plan is qualifying, I would be able to begin Medicare D at some later date without penalty.

https://www.opm.gov/healthcare-insuranc ... /medicare/
TravelforFun
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Re: Medicare - just A + B?

Post by TravelforFun »

Kenkat wrote: Tue Apr 13, 2021 11:31 am I am not on Medicare yet but my big concern would be that there are no upper limits / out of pocket maximums as there are with private or ACA plans. If you have a major medical incident like cancer or a major heart issue, you are responsible for 20% of the cost, with no limit. So a $1,000,000 cancer incident (which is very possible) results in you being responsible for $200,000 of that cost.
I have the Medicare Advantage Plan provided by UnitedHealthcare. My premium is $145 a month which is $0 over the basic Medicare Part A and B premium. My max. out of pocket cost for 2021 is $3,900.

TravelforFun
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Kenkat
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Re: Medicare - just A + B?

Post by Kenkat »

TravelforFun wrote: Thu Apr 15, 2021 10:10 pm
Kenkat wrote: Tue Apr 13, 2021 11:31 am I am not on Medicare yet but my big concern would be that there are no upper limits / out of pocket maximums as there are with private or ACA plans. If you have a major medical incident like cancer or a major heart issue, you are responsible for 20% of the cost, with no limit. So a $1,000,000 cancer incident (which is very possible) results in you being responsible for $200,000 of that cost.
I have the Medicare Advantage Plan provided by UnitedHealthcare. My premium is $145 a month which is $0 over the basic Medicare Part A and B premium. My max. out of pocket cost for 2021 is $3,900.

TravelforFun
The out of pocket maximum is one of the most compelling reasons to use a Medicare Advantage Plan in my opinion.
InMyDreams
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Re: Medicare - just A + B?

Post by InMyDreams »

Stinky wrote: Tue Apr 13, 2021 11:38 am I would never go without additional coverage of some type.
.
.
.

But I would not go without additional coverage.
+1000.

There's at least one other thread on this subject.

** Found it
viewtopic.php?t=263125

Remember - MCare parts A & B do not have an Out of Pocket Max. Seriously, you can create significant liability for yourself in a very short period of time, and be praying for open enrollment to come around soon so you can get into a MedAdvantage program, because you won't be eligible for guaranteed issue/rate like you are at 65 (check your state for local laws) with a MediGap policy. In addition, you may be limiting your treatment providers, as some won't want to take you on knowing that you have a significant coverage gap.

Oh, and - healthy is good, but it can literally change overnight. Been there, seen that.
tj
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Re: Medicare - just A + B?

Post by tj »

pennywise wrote: Thu Apr 15, 2021 6:50 am
We finally put her on a Medicare supplement plan a couple of years ago, mostly in case of some kind of catastrophic dementia-connected event or complication. That's not costing anything extra.

Regarding the drug coverage penalty, of course she never signed up for that. When we added it as required by the supplement plan the penalty-which was the max due to her never having had coverage-was $53/month. She onyl takes a thyroid med and hypertension drug now which are both covered so the actual out of pocket cost is ~$24/month. We thought the penalty would be a lot higher, so there's one data point.

So I suppose she could be considered a successful customer of a bare bones plan but I'd say that is mostly due to a freakishly strong constitution and extreme good luck.
What was the experience getting her through Medigap underwriting in her 90s?
pennywise
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Re: Medicare - just A + B?

Post by pennywise »

tj wrote: Sat Apr 17, 2021 9:34 am
pennywise wrote: Thu Apr 15, 2021 6:50 am
We finally put her on a Medicare supplement plan a couple of years ago, mostly in case of some kind of catastrophic dementia-connected event or complication. That's not costing anything extra.

Regarding the drug coverage penalty, of course she never signed up for that. When we added it as required by the supplement plan the penalty-which was the max due to her never having had coverage-was $53/month. She onyl takes a thyroid med and hypertension drug now which are both covered so the actual out of pocket cost is ~$24/month. We thought the penalty would be a lot higher, so there's one data point.

So I suppose she could be considered a successful customer of a bare bones plan but I'd say that is mostly due to a freakishly strong constitution and extreme good luck.
What was the experience getting her through Medigap underwriting in her 90s?
During Medicare open enrollment, there is no underwriting requirement to join a Medicare advantage plan.

Yep, surprised us too.
Soon2BXProgrammer
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Re: Medicare - just A + B?

Post by Soon2BXProgrammer »

hicabob wrote: Tue Apr 13, 2021 11:14 am The time has come when I will be applying for Medicare soon. After reading about the various advantage, medigaps, etc. plans I am curious if many folk just do A + B and self insure for the rest? I'm in decent health, have way more $$ than I need and am currently insured with Kaiser via a bronze HSA hi-deductible, zero subsidy, ACA plan.
From what i understand is the 20% co-insurance for medicare has NO limit. While i could afford it, i would assume most people once in their life (normally near the end) will have a million dollar treatment. (or even a half million), which means, you could just pay for a medigap policy the entire retirement for the cost of that episode, and not worry about it, it would make your cashflow predictable, which means you can give away more of your wealth sooner.
ModifiedDuration
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Re: Medicare - just A + B?

Post by ModifiedDuration »

pennywise wrote: Sun May 09, 2021 8:58 am
tj wrote: Sat Apr 17, 2021 9:34 am
pennywise wrote: Thu Apr 15, 2021 6:50 am
We finally put her on a Medicare supplement plan a couple of years ago, mostly in case of some kind of catastrophic dementia-connected event or complication. That's not costing anything extra.

Regarding the drug coverage penalty, of course she never signed up for that. When we added it as required by the supplement plan the penalty-which was the max due to her never having had coverage-was $53/month. She onyl takes a thyroid med and hypertension drug now which are both covered so the actual out of pocket cost is ~$24/month. We thought the penalty would be a lot higher, so there's one data point.

So I suppose she could be considered a successful customer of a bare bones plan but I'd say that is mostly due to a freakishly strong constitution and extreme good luck.
What was the experience getting her through Medigap underwriting in her 90s?
During Medicare open enrollment, there is no underwriting requirement to join a Medicare advantage plan.

Yep, surprised us too.
Seems to be a little confusion between Medicare Advantage Plans and Medicare Supplement Plans (Medigap) here.

It appears that pennywise’s mother-in-law has a Medicare Advantage Plan, not Traditional Medicare with a Medicare Supplement (Medigap) Plan.

With a Medicare Supplement Plan, you have Traditional Medicare Parts A and B (which is administered by the Federal government) and then you enroll in a Medicare Supplement Plan with an insurance company to fill in the “gaps” in Medicare Parts A and B.

If you enroll in Traditional Medicare Parts A and B at your 65th birthday there is an Open Enrollment period for the following 6 months for Medicare Supplement Plans (no medical underwriting). After that 6 months, if you decide that you want to get a Medicare Supplement Plan you would have to pass underwriting (except in a few states with special rules).

Medicare Advantage is Part C of Medicare. Medicare Advantage Plans are administered by insurance companies and are in lieu of Traditional Medicare Parts A and B. The insurance company is paid by the Federal government to provide your health care.

For Medicare Advantage Plans, there is an annual open enrollment period in the Fall when you can switch Medicare Advantage Plans or move from Traditional Medicare Parts A and B to a Medicare Advantage Plan. There would be no medical underwriting in the Medicare Advantage Open Enrollment Period.
niagara_guy
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Re: Medicare - just A + B?

Post by niagara_guy »

I just have basic Medicare with no supplement. I needed several procedures done a few months ago that I had to pay the 20% for. Since Medicare dictates to the provider what they can charge (and it's way below their list price) what I had to pay was very low.

However, at open enrollment in the fall I will review this and I may pick different coverage.
tj
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Re: Medicare - just A + B?

Post by tj »

niagara_guy wrote: Sun May 09, 2021 4:58 pm I just have basic Medicare with no supplement. I needed several procedures done a few months ago that I had to pay the 20% for. Since Medicare dictates to the provider what they can charge (and it's way below their list price) what I had to pay was very low.

However, at open enrollment in the fall I will review this and I may pick different coverage.
Will you be forced to do an Advantage plan, or do you think some Medigap insurers will accept you?
egrets
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Re: Medicare - just A + B?

Post by egrets »

hicabob wrote: Tue Apr 13, 2021 11:14 am The time has come when I will be applying for Medicare soon. After reading about the various advantage, medigaps, etc. plans I am curious if many folk just do A + B and self insure for the rest? I'm in decent health, have way more $$ than I need and am currently insured with Kaiser via a bronze HSA hi-deductible, zero subsidy, ACA plan.
I have A, B. D (prescriptions) and AARP Medigap plan F. I think you can only get Plan G now not F but I think the only difference is a smallish deductible. One medical catastrophe and there goes half a mil if not more. I would never sign up for a Medicare Advantage plan and be back in a situation where some insurance company decides whether to pay for medical care or not.
egrets
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Re: Medicare - just A + B?

Post by egrets »

hicabob wrote: Thu Apr 15, 2021 1:14 pm Thanks for the answers all. One more medicare question .... I've heard that some docs will not take medicare patients due to the lower compensation. Has anyone found this to be true? If so I suppose that would be a huge advantage for an HMO type advantage plan.
I've been on Medicare for nearly twenty years, with lots of medical stuff going on and in that time period only two specialists have said nope. They were easy to replace. I live near excellent teaching hospitals which I suspect makes a difference. There are really excellent doctors here. If you live in Mud Flats, Texas, maybe this is not the case.
egrets
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Re: Medicare - just A + B?

Post by egrets »

Kenkat wrote: Fri Apr 16, 2021 9:38 am
TravelforFun wrote: Thu Apr 15, 2021 10:10 pm
Kenkat wrote: Tue Apr 13, 2021 11:31 am I am not on Medicare yet but my big concern would be that there are no upper limits / out of pocket maximums as there are with private or ACA plans. If you have a major medical incident like cancer or a major heart issue, you are responsible for 20% of the cost, with no limit. So a $1,000,000 cancer incident (which is very possible) results in you being responsible for $200,000 of that cost.
I have the Medicare Advantage Plan provided by UnitedHealthcare. My premium is $145 a month which is $0 over the basic Medicare Part A and B premium. My max. out of pocket cost for 2021 is $3,900.

TravelforFun
The out of pocket maximum is one of the most compelling reasons to use a Medicare Advantage Plan in my opinion.
I'm on Medigap and have no out of pocket maximum.
tj
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Re: Medicare - just A + B?

Post by tj »

egrets wrote: Sun May 09, 2021 5:31 pm
Kenkat wrote: Fri Apr 16, 2021 9:38 am
TravelforFun wrote: Thu Apr 15, 2021 10:10 pm
Kenkat wrote: Tue Apr 13, 2021 11:31 am I am not on Medicare yet but my big concern would be that there are no upper limits / out of pocket maximums as there are with private or ACA plans. If you have a major medical incident like cancer or a major heart issue, you are responsible for 20% of the cost, with no limit. So a $1,000,000 cancer incident (which is very possible) results in you being responsible for $200,000 of that cost.
I have the Medicare Advantage Plan provided by UnitedHealthcare. My premium is $145 a month which is $0 over the basic Medicare Part A and B premium. My max. out of pocket cost for 2021 is $3,900.

TravelforFun
The out of pocket maximum is one of the most compelling reasons to use a Medicare Advantage Plan in my opinion.
I'm on Medigap and have no out of pocket maximum.
What Medicare-covered expenses are you liable for after Medicare and Medigap pay?
TheDDC
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Re: Medicare - just A + B?

Post by TheDDC »

tj wrote: Sun May 09, 2021 6:39 pm
What Medicare-covered expenses are you liable for after Medicare and Medigap pay?
None. Because the medigap plan covers the rest of the Medicare eligible expense. That’s literally what every Medigap insurer under the sun will tell you when you call and ask. You get a bill you ignore it.

Be careful about ambulance trips and how they are coded. While certain coded trips are covered as Medicare eligible, not all ALS/BLS trips are covered. This especially comes into play if you are in a nursing facility. But that’s okay. Just don’t get imprisoned/locked down in one and you’ll generally be okay financially.

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Kenkat
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Re: Medicare - just A + B?

Post by Kenkat »

TheDDC wrote: Sun May 09, 2021 7:05 pm
tj wrote: Sun May 09, 2021 6:39 pm
What Medicare-covered expenses are you liable for after Medicare and Medigap pay?
None. Because the medigap plan covers the rest of the Medicare eligible expense. That’s literally what every Medigap insurer under the sun will tell you when you call and ask. You get a bill you ignore it.
In effect, then, it’s an out of pocket maximum of zero because everything gets paid.
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GerryL
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Re: Medicare - just A + B?

Post by GerryL »

hicabob wrote: Tue Apr 13, 2021 11:14 am The time has come when I will be applying for Medicare soon. After reading about the various advantage, medigaps, etc. plans I am curious if many folk just do A + B and self insure for the rest? I'm in decent health, have way more $$ than I need and am currently insured with Kaiser via a bronze HSA hi-deductible, zero subsidy, ACA plan.
As someone else wrote, you seem like a good candidate for a high-deductible Medigap plan. Medicare covers all but 20% of needed care, but the question is 20% of what? $1,000? $100,000? $500,000?

I am now in my early 70s and am in generally good health, and I am not inclined to see a doc for routine aches, pains and mishaps. So, low healthcare usage. In addition to my standard Medicare premium, I pay <$50 for Medigap G-HD and <$7 for Part D. Each year I know what my max out-of-pocket expenses will be and know I can cover it. So far I have not come close to paying the max but have been saving on rock-bottom premiums. I too have "way more $$ than I need," but I have no desire to spend those $$ on 1) more coverage than I need or 2) high medical bills if I should someday require more care.
PowderDay9
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Re: Medicare - just A + B?

Post by PowderDay9 »

What's the most anyone had to pay out of pocket for Part B? Or what was the largest claim paid from your Medigap policy?

The way I've understood Medigap is the plan general only covers cost shares from already Medicare covered services. Medigap plans typically run around a 65% loss ratio and have high sales commissions. (It's pretty incredible Nisiprius found one with an 89% loss ratio!) That means the insurance company is only paying out 65% of the premiums for claims. Since the typical Medigap premium is $100-200 range, there can't be that many large claims, otherwise the premiums would be higher.

When you see news stories about million dollar claims, those are billed charges. The Medicare approved allowed charges are much less. Typically the really large claims are for Part A and the amount you have to pay is only $1,484. It's much harder to have really high part B claims. Even if you had $100k in allowed part B claims, you'd owe the $20k (10 years of Medigap premiums) for some really rare event. I've never heard of anyone having a really large part B claim but if somebody has, that would be interesting to hear about.
Last edited by PowderDay9 on Sun May 09, 2021 8:39 pm, edited 3 times in total.
TheDDC
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Re: Medicare - just A + B?

Post by TheDDC »

Kenkat wrote: Sun May 09, 2021 7:10 pm
TheDDC wrote: Sun May 09, 2021 7:05 pm
tj wrote: Sun May 09, 2021 6:39 pm
What Medicare-covered expenses are you liable for after Medicare and Medigap pay?
None. Because the medigap plan covers the rest of the Medicare eligible expense. That’s literally what every Medigap insurer under the sun will tell you when you call and ask. You get a bill you ignore it.
In effect, then, it’s an out of pocket maximum of zero because everything gets paid.
Bingo! I have to say that when I had a loved one who had many severe medical conditions arise in their later years and I had begun assisting in managing their financial matters it was really nice to just throw away medical bills. She had made a very wise choice in selecting a Medigap plan. The only problem I saw is that it was a "plan F" with a narrower insured pool which made it pretty expensive, but really no good way to have moved to a "plan G" at that late point in time. I am nowhere near having to make the choice, but I believe if I had to today I would not hesitate in selecting Medigap plan G when the time comes. I would probably spring for a higher deductible plan option, however.

-TheDDC
Rules to wealth building: 75-80% VTSAX piled high and deep, 20-25% VTIAX, 0% given away to banks, minimize amount given to medical-industrial complex
tj
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Re: Medicare - just A + B?

Post by tj »

PowderDay9 wrote: Sun May 09, 2021 7:47 pm Since the typically Medigap premium is $100-200, there can't be that many large claims, otherwise the premiums would be higher.
Might want to check Age 90 premiums in California!

I think you'd need the HD G plan to get into the $100 range.
ModifiedDuration
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Re: Medicare - just A + B?

Post by ModifiedDuration »

With a Medicare Supplement Plan F, which is no longer available to people turning 65, you would have no out-of-pocket costs for Medicare expenses.

With a Medicare Supplement Plan G, your only out-of-pocket cost would be the $203 Part B annual deductible.

I have a high-deductible Plan G that is $37 a month and for ages 80 and above the cost is currently $77 a month in my area with my insurance company (and there hasn’t been a price increase in over 10 years) and $7 a month for a Part D prescription plan.
Last edited by ModifiedDuration on Sun May 09, 2021 8:45 pm, edited 3 times in total.
PowderDay9
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Re: Medicare - just A + B?

Post by PowderDay9 »

tj wrote: Sun May 09, 2021 8:07 pm
PowderDay9 wrote: Sun May 09, 2021 7:47 pm Since the typically Medigap premium is $100-200, there can't be that many large claims, otherwise the premiums would be higher.
Might want to check Age 90 premiums in California!

I think you'd need the HD G plan to get into the $100 range.
Fair point. Most people don't make it to age 90 though. Yes the range varies but most ages and plans have monthly costs under $250 or so.

Also, some rates get really high as a result of a death spiral. Often times the insurance company will close the plan to new entrants if claims are higher than expected. Then with only existing members left, the high rate increases begin. Healthy members switch plans and the rates keep going up.
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Chip Munk
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Re: Medicare - just A + B?

Post by Chip Munk »

PowderDay9 wrote: Sun May 09, 2021 7:47 pm Typically the really large claims are for Part A and the amount you have to pay is only $1,484.
The thing that surprised me about this when I was preparing to sign up for Medicare is that the Part A deductible is per "benefit period", not per year. You could end up paying this deductible more than once in one year. Here's how Medicare describes "Benefit Period" in the "Medicare and You" handbook:

Benefit Period
The way that Original Medicare measures your use of hospital and skilled nursing facility services. A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t gotten any inpatient hospital care (or skilled care in a skilled nursing facility) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.
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