Trying to help acquaintence - medicare costs

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Sat Jan 13, 2018 4:48 pm

One thing that did catch my eye was this:
•Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
Interesting.

I think she receives drug benefits with her retiree plan.

staythecourse
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Re: Trying to help acquaintence - medicare costs

Post by staythecourse » Sat Jan 13, 2018 5:05 pm

Not to sound like a smart**s, but I would just call her retirement pension folks and ask them direct. It is nice of you to intervene and this is the best way to do it. There are a MILLION things it could be, so no way to know unless you have her retirement plan documents available by paper or online.

IF I had to guess it is for the 20% secondary insurance that is being offered. As you know medicare (like any primary insurance) picks up 80% of the cost of anything and someone else picks up 20%. I would think this is the cost for the other 20% coverage which is likely the same insurance carrier the current workers use as for their primary insurance.

Good luck.
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retiredjg
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Re: Trying to help acquaintence - medicare costs

Post by retiredjg » Sat Jan 13, 2018 5:09 pm

My thinking exactly. Her plan may be more expensive than mine and others, but that does not mean she can get good coverage for a whole lot less, especially if she has to add in a Medicare Part D premium as well.

One thing that comes to mind. It is unclear if your friend is inexperienced and naive or incompetent or maybe something else entirely. But it seems to me that having all her bills paid for by simply paying Medicare Part B and the $322 every month is worth something. She might have some difficulty keeping up with the bills and copays and making sure it is all covered by both companies before she pays the bill....I'm sure you see the problem too.

dbr
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Re: Trying to help acquaintence - medicare costs

Post by dbr » Sat Jan 13, 2018 5:32 pm

In my opinion you would have to be insane to not have Medicare A,B, and D and a Medigap or Supplement plan or the equivalents in an Advantage Plan. As mentioned before there is quite a range of standardized Medigap plans, many of which are not as expensive as the plan we are discussing.

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Fletch
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Re: Trying to help acquaintence - medicare costs

Post by Fletch » Sat Jan 13, 2018 6:30 pm

Two people, Medigap Plan F and Part D insurance about $500/mo. No subsidy. Plus the Medicare insurance payment.
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Re: Trying to help acquaintence - medicare costs

Post by Grasshopper » Sat Jan 13, 2018 7:29 pm

How about MyMedicare.gov, it is all right there under all current plans and insurance

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Sun Jan 14, 2018 9:45 am

retiredjg wrote:
Sat Jan 13, 2018 5:09 pm
My thinking exactly. Her plan may be more expensive than mine and others, but that does not mean she can get good coverage for a whole lot less, especially if she has to add in a Medicare Part D premium as well.

One thing that comes to mind. It is unclear if your friend is inexperienced and naive or incompetent or maybe something else entirely. But it seems to me that having all her bills paid for by simply paying Medicare Part B and the $322 every month is worth something. She might have some difficulty keeping up with the bills and copays and making sure it is all covered by both companies before she pays the bill....I'm sure you see the problem too.
Oh yes. In fact, there may even be benefits she is not taking advantage of. Or, perhaps, there are just as good (or better) options for her that she has not chosen. Since she has multiple and expensive health/medical issues, as well as financial challenges, it is good that her insurance pays in full.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Sun Jan 14, 2018 9:48 am

dbr wrote:
Sat Jan 13, 2018 5:32 pm
In my opinion you would have to be insane to not have Medicare A,B, and D and a Medigap or Supplement plan or the equivalents in an Advantage Plan. As mentioned before there is quite a range of standardized Medigap plans, many of which are not as expensive as the plan we are discussing.
Yes - I agree for almost everyone.

While I am a big fan of advantage (and cost) plans, such plans do not pay 100% of everything. You, to a degree, take the risk of out of pocket annual expenses. Our plans (DW and I) have up to $6,000 out of pocket maximums each in 2018. Offsetting that, however, is that we only pay $30 per month (beyind the Part B premium) for the plan and drug coverage is included.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Mon Jan 15, 2018 4:10 pm

OK - peeling a few layers of the "onion"...

Her 2018 Medicare plan is an AETNA Medicare Advantage plan with drug coverage. For almost all services, she has a zero copay and a low ($200) annual out of pocket limit. It seems she has no other choices as long as she stays in (and gets benefits of) the school retirement "system". SO - maybe she is actually getting something very worthwhile for her.

She is looking up the details of what was sent to her .. and we can peel down a few more layers of that "onion".

djd1950
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Re: Trying to help acquaintence - medicare costs

Post by djd1950 » Mon Jan 15, 2018 4:33 pm

Please use this free and reliable public resource - there is a program in each state which offers counseling to people on or considering Medicare and this site will direct you to your state:

https://www.seniorsresourceguide.com/di ... onal/SHIP/

What is SHIP?
SHIP is a free health benefits counseling service for Medicare beneficiaries and their families or caregivers. SHIPs mission is to educate, advocate, counsel and empower people to make informed healthcare benefit decisions. SHIP is an independent program funded by Federal agencies and is not affiliated with the insurance industry.

SHIP Counseling is FREE of charge
State Health Insurance Assistance Programs (SHIPs) provide free help to Medicare beneficiaries who have questions or issues with their health insurance. You can call a counselor or attend a workshop/presentation in your area

retiredjg
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Re: Trying to help acquaintence - medicare costs

Post by retiredjg » Mon Jan 15, 2018 4:36 pm

Educate me here.

I thought Medicare Advantage programs took the place of Medicare Part B and D, etc. If that is correct, why is she paying for Medicare Part B? Or have I just assumed she is paying for Medicare Part B?

Does the fact it is a Medicare Advantage program explain why she does not get EOBs? Or have a card?

Agree with the SHIP counseling recommendation.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Mon Jan 15, 2018 4:41 pm

retiredjg wrote:
Mon Jan 15, 2018 4:36 pm
Educate me here.
I thought Medicare Advantage programs took the place of Medicare Part B and D, etc. If that is correct, why is she paying for Medicare Part B? Or have I just assumed she is paying for Medicare Part B?
Does the fact it is a Medicare Advantage program explain why she does not get EOBs? Or have a card?
Agree with the SHIP counseling recommendation.
Yes - Medicare Advantage plans do take the place of Parts A and B, as well as sometimes (her case yes) Part D. When you choose an MA plan, you MUST sign up for AND pay for the applicable Part B premium. It turns out she does have an AETNA card. (part of peeling this onion).

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Re: Trying to help acquaintence - medicare costs

Post by retiredjg » Mon Jan 15, 2018 4:50 pm

I guess persistence eventually does provide.😉

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Re: Trying to help acquaintence - medicare costs

Post by andypanda » Mon Jan 15, 2018 5:20 pm

I thought her premium sounded reasonable, but I read the thread anyway.

I retired from the Commonwealth of Virginia in 2012 after 38 years. I was 62, so I had to pay my health insurance until I qualified for Medicare. It was well over $600 a month for the same Anthem policy I'd had for years.

At age 65 I began paying for Part B and my Anthem plan converted to the state's Advantage 65 plan at $343/month.
As of this month, it's down to $310/month, also with some dental and vision benefits.

To remain on the state plan I must be on Medicare. If I ever drop the state plan I can never, ever, never, never, never get it back.

I'm glad I don't have to negotiate the world of picking my own supplemental plan.

Here's the link to the 2018 premiums for the Advantage 65 plan, fwiw.
www.dhrm.virginia.gov/docs/default-sour ... f?sfvrsn=0

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Tue Jan 16, 2018 9:15 am

andypanda wrote:
Mon Jan 15, 2018 5:20 pm
I thought her premium sounded reasonable, but I read the thread anyway.
I retired from the Commonwealth of Virginia in 2012 after 38 years. I was 62, so I had to pay my health insurance until I qualified for Medicare. It was well over $600 a month for the same Anthem policy I'd had for years.
At age 65 I began paying for Part B and my Anthem plan converted to the state's Advantage 65 plan at $343/month.
As of this month, it's down to $310/month, also with some dental and vision benefits.
To remain on the state plan I must be on Medicare. If I ever drop the state plan I can never, ever, never, never, never get it back.
I'm glad I don't have to negotiate the world of picking my own supplemental plan.
Here's the link to the 2018 premiums for the Advantage 65 plan, fwiw.
www.dhrm.virginia.gov/docs/default-sour ... f?sfvrsn=0
Thanks. I was able, as well, to find the school employees retirement inforomation online for her jurisdiction. It seems that, for 2018, she had to go on a medicare Advantage plan (Aetna) that seems to be some combination of HMO and PPO. From the outline I found online, unlike the Advantage plans I often see, there is only a $200 per year out of pocket max AND most services have zero copay. I think, prior to 2018, she had original medicare and a supplement. While, in some senses, expensive (compared to most MA plans) she gets zero copays and good benefits. In her case, she benefits a lot because she has many, some serious, health issues. She has just started this plan and may have to switch one or two doctors -- but there is no choice for her - UNLUSS she drops out of the retiree plan - BUT she would then face much higher costs of care and/or premiums.

Thanks for all the feedback. She is looking through her documents, but the other thing I wonder about is whether there may be benefits she could take advantage f that she does not understand.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Wed Jan 17, 2018 10:59 am

From what I see now, it appears that the retirement system has negotiated a MA plan with AETNA with BOTH high monthly premiums AND high benefits (LOW or ZERO copays AND low out of pocket limit). It is the only choice offered and is mandatory UNLESS participants leave and can never get back. It seems (compared with the general choices in MA plans and Supplements) to financially (short term at least) penalize the very healthy retirees i order to help financially those with health issues/problems and the longer term risks.

Since the plan(s) offered/required have changed over the years, I suppose this could change as well in the future -- although my guess is that there is probably some term of the contract with AETNA.

It seems to be a hybrid between HMO and PPO - so the issue could be how wide or narrow the network of available providers is and will be in the future.

The more I learn about Medicare plans and choices, the much more complex it becomes...:(

Thanks again to all - including some very informative PMs.

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Re: Trying to help acquaintence - medicare costs

Post by pshonore » Wed Jan 17, 2018 11:39 am

Yes, a $200 OOP max is almost unheard of these days. Also depends on how high the copays are. However she's paying over $400/month for that coverage. Here's a link for comparison to Connecticutcare Medicare Advantage Plans. There are available to any CT resident eligible for Medicare. Almost all plans require you part the Part B premium; some have no charge beyond that, but do have a $6K OOP max and a lot of copays. Some cover drugs, some do not. (I do not think the $6K OOP includes drugs). AFAIK, Connecticare contracts with a large number of providers.
https://medicare.myconnecticare.com/see ... nd-compare

There are several other Advantage providers in CT.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Wed Jan 17, 2018 11:46 am

pshonore wrote:
Wed Jan 17, 2018 11:39 am
Yes, a $200 OOP max is almost unheard of these days. Also depends on how high the copays are. However she's paying over $400/month for that coverage. Here's a link for comparison to Connecticutcare Medicare Advantage Plans. There are available to any CT resident eligible for Medicare. Almost all plans require you part the Part B premium; some have no charge beyond that, but do have a $6K OOP max and a lot of copays. Some cover drugs, some do not. (I do not think the $6K OOP includes drugs). AFAIK, Connecticare contracts with a large number of providers.
https://medicare.myconnecticare.com/see ... nd-compare
There are several other Advantage providers in CT.
From the online summary, she seems to have zero $ copays for most things. She is paying $322/month - as best I see. For someone like her with large health issues/risks/costs - she is getting a good deal.

Yes - MA (and the similar MC) plans almost always have much larger OOP annual limits, BUT much lower monthly premiums sometimes zero). Our own MC (like MA) plan costs us $30 per month per person and excellent care/benefits/etc. BUT potentially up to $6,000 max annual OOP. I think it would require significant hospitalization to hit the $6,000. I am having outpatient surgery in six weeks at the Kaiser outpatient surgical facility and the online estimate shows "only" $250.

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Re: Trying to help acquaintence - medicare costs

Post by retiredjg » Wed Jan 17, 2018 12:27 pm

dm200 wrote:
Wed Jan 17, 2018 11:46 am
From the online summary, she seems to have zero $ copays for most things. She is paying $322/month - as best I see. For someone like her with large health issues/risks/costs - she is getting a good deal.
Do you mean her Medicare Part B premium is included in the $322? Or is there another $134 on top of that?

Either way, I think it is likely to be a pretty good deal for her situation. Yes, some people have it better, but I think some have it much worse.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Wed Jan 17, 2018 12:34 pm

retiredjg wrote:
Wed Jan 17, 2018 12:27 pm
dm200 wrote:
Wed Jan 17, 2018 11:46 am
From the online summary, she seems to have zero $ copays for most things. She is paying $322/month - as best I see. For someone like her with large health issues/risks/costs - she is getting a good deal.
Do you mean her Medicare Part B premium is included in the $322? Or is there another $134 on top of that?
Either way, I think it is likely to be a pretty good deal for her situation. Yes, some people have it better, but I think some have it much worse.
No, she pays $134 per month part B (deducted from SS). Then an additional $322 per month from retirement for the AETNA MA plan (I think), unless that $322 changes in 2018. So, for her Medicare she pays $134 PLUS $322 - I will follow up with her to see if the $322 changes from the December deduction.

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Re: Trying to help acquaintence - medicare costs

Post by sport » Wed Jan 17, 2018 12:48 pm

Our Aetna MA plan includes Part D. Aetna has stated that if we choose any other Part D plan (we get solicitations every year) we will be kicked out of the medical insurance part of the Aetna MA plan, as well as the Part D. So, if you like the medical insurance, don't try to change the Part D.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Wed Jan 17, 2018 12:48 pm

sport wrote:
Wed Jan 17, 2018 12:48 pm
Our Aetna MA plan includes Part D. Aetna has stated that if we choose any other Part D plan (we get solicitations every year) we will be kicked out of the medical insurance part of the Aetna MA plan, as well as the Part D. So, if you like the medical insurance, don't try to change the Part D.
yes - her MA plan includes drug benefits

Usually, MA and MC plans include prescription drugs, but not always. yes, you cannot get a separate Part D plan.

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Re: Trying to help acquaintence - medicare costs

Post by pshonore » Wed Jan 17, 2018 12:55 pm

dm200 wrote:
Wed Jan 17, 2018 12:48 pm
sport wrote:
Wed Jan 17, 2018 12:48 pm
Our Aetna MA plan includes Part D. Aetna has stated that if we choose any other Part D plan (we get solicitations every year) we will be kicked out of the medical insurance part of the Aetna MA plan, as well as the Part D. So, if you like the medical insurance, don't try to change the Part D.
yes - her MA plan includes drug benefits

Usually, MA and MC plans include prescription drugs, but not always. yes, you cannot get a separate Part D plan.
Connecticare has some Advantage plans that do not include Part D coverage; I believe in that case you can buy Part D

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Wed Jan 17, 2018 1:28 pm

pshonore wrote:
Wed Jan 17, 2018 12:55 pm
dm200 wrote:
Wed Jan 17, 2018 12:48 pm
sport wrote:
Wed Jan 17, 2018 12:48 pm
Our Aetna MA plan includes Part D. Aetna has stated that if we choose any other Part D plan (we get solicitations every year) we will be kicked out of the medical insurance part of the Aetna MA plan, as well as the Part D. So, if you like the medical insurance, don't try to change the Part D.
yes - her MA plan includes drug benefits
Usually, MA and MC plans include prescription drugs, but not always. yes, you cannot get a separate Part D plan.
Connecticare has some Advantage plans that do not include Part D coverage; I believe in that case you can buy Part D
Our MC plan (much like MA plans) choices allow the plan without drug coverage. BUT the cost difference is trivial. A few years ago, what we now pay $30 for was zero - even with the drug plan.

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BL
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Re: Trying to help acquaintence - medicare costs

Post by BL » Thu Jan 18, 2018 12:13 am

Glad you got it somewhat sorted out. You may as well check to see what is included for eyes, ears, and teeth. I know regular Medicare covers audiologist test (but not hearing aids), medical checks for cataracts and other medical problems (but not glasses or their prescriptions), and probably dental surgery (but not dental work). I have heard that some Advantage plans cover more than this.

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dm200
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Re: Trying to help acquaintence - medicare costs

Post by dm200 » Thu Jan 18, 2018 9:54 am

BL wrote:
Thu Jan 18, 2018 12:13 am
Glad you got it somewhat sorted out. You may as well check to see what is included for eyes, ears, and teeth. I know regular Medicare covers audiologist test (but not hearing aids), medical checks for cataracts and other medical problems (but not glasses or their prescriptions), and probably dental surgery (but not dental work). I have heard that some Advantage plans cover more than this.
Yes. Friends of ours have a Humana MA plan, and they get (or are offered) regular home visits by a nurse to monitor/advise them on health issues. I have heard of some that include gym memberships. Our plan includes Optometrist visits for refractions for a $20 copay.

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