What I spent in 6 months on medicare

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drawpoker
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Re: What I spent in 6 months on medicare

Post by drawpoker » Fri Jul 06, 2018 3:05 pm

No, that is incorrect
IRMAA tacks on an additional charge to both Part B and Part D monthly premiums.

https://www.kitces.com/blog/irmaa-medic ... hresholds/

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dm200
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Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 3:08 pm

drawpoker wrote:
Fri Jul 06, 2018 3:05 pm
No, that is incorrect
IRMAA tacks on an additional charge to both Part B and Part D monthly premiums.
I agree with this. What is "incorrect"??

I believe the affects of IRMAA are identical whether on Original Medicare and a drug plan - AND Medicare Advantage plan with the drug plan. Am I correct?

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Re: What I spent in 6 months on medicare

Post by dennisbyron » Fri Jul 06, 2018 3:10 pm

dm200 wrote:
Fri Jul 06, 2018 2:39 pm
So in fact, the annual out of pocket spend limit is a major advantage of Part C, not a disadvantage...
In my opinion, it is BOTH. You know that the annual OOP has a cap - but that cap may be higher than you would like.

There also seem to be some who claim that MA (and MC) plans may not cover everything that Original medicare covers. That is not true - every MA (and MC) plan must cover everything Original medicare covers - and MA and MC plans can cover additional services (such as vision).
1. Every county is different but I believe in most counties (not counting a few that have no Part C) you can buy a plan with a cap as low as about $2400 and as high as $6700. If yours is "higher than you would like," look for one with a lower cap. But again, the first thing to always check is whether a preferred provider takes it and whether you can live with his or her network

2. You are basically correct but a Part C plan on top of A and B does not have to cover the medical services that A and B alone cover in exactly the same way in terms of deductibles, co-pays, co-insurance etc. They have to be what the nerds call "actuarially equivalent." For example, I have never seen a Part C plan that did not have a substantially smaller co-pay for a one or two day admitted acute care hospitalization but after four days it begins to wash with the Part A deductible. In my opinion the most important medical service that almost all public Part C plans cover that A and B alone -- even with a private supplement added -- does not cover is an annual physical exam

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Re: What I spent in 6 months on medicare

Post by drawpoker » Fri Jul 06, 2018 3:14 pm

"We are not affected by IRMAA, but my understanding is that the (required) Part B premium is the same - whether on Original Medicare or an MA plan"...."

It's complicated, dm200.
The IRMAA does not use the same income brackets as regular Part B does. So, the (required) Part B premium amount can vary. It is misleading to state it the way you did, that's why I called for a correction/clarification

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Re: What I spent in 6 months on medicare

Post by dennisbyron » Fri Jul 06, 2018 3:20 pm

dm200 wrote:
Thu Jul 05, 2018 5:47 pm
I am in my early 70's - and I just reviewed what I spent on Medical costs under Medicare. While this is anecdotal - it is an example of my low costs (so far at least).

Medicare Part B - $134/month - 6 months = $804
Medicare (Kaiser) plan premiums $30/month - 6 months = $180
My approximate prescription drug costs - 6 months = about $140 total
My medical out of pocket - 6 months $880 - includes office visit copays, one outpatient surgery, one CT scan and a few other scans, xrays, etc.

My wife has incurred similar expenditures.

I expect the next six months to be a bit lower than the $880 out of pocket - BUT we shall see,
I joined the thread to answer the original question and went off in a few tangents. My opinion would be that looking at 6 months is too short a timeframe no matter what options you are looking at. In now almost 10 years on Medicare (with some serious health episodes), because my provider accepts public Part C (and because the Part C plan works exactly the way his plan worked before I reached Medicare), our ability to choose Part C has saved us about $25,000 or more (see Note) vs if we had had to get a private supplement and Part D and vision and/or dental and pay for annual physicals out of pocket.

But it all begins with"what does your favorite doctor take?"

NOTE: I used to track the costs of Medigap plans but no longer do so the savings may be substantially more than $25,000 depending on what has happened to Medigap prices. As one of the many examples of the unintended consequences of the Democrats voting for PPACA without reading it, my Part C plan premiums have stayed pretty much the same for 10 years (up or down a few dollars a month). That means -- as long as I stay on Part C -- I am always going to be ahead of the game because my maxium OOP per year is $3200 (I guess unless I live to 90 and reach the max every year, both of which are unlikely)

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Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 3:20 pm

2. You are basically correct but a Part C plan on top of A and B does not have to cover the medical services that A and B alone cover in exactly the same way in terms of deductibles, co-pays, co-insurance etc. They have to be what the nerds call "actuarially equivalent." For example, I have never seen a Part C plan that did not have a substantially smaller co-pay for a one or two day admitted acute care hospitalization but after four days it begins to wash with the Part A deductible. In my opinion the most important medical service that almost all public Part C plans cover that A and B alone -- even with a private supplement added -- does not cover is an annual physical exam
I agree. Part C plans, also, vary widely from one area to another (even same provider) as well as from one provider to another. Never judge "part C" by what just one plan does and does not do.

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Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 3:27 pm

I joined the thread to answer the original question and went off in a few tangents. My opinion would be that looking at 6 months is too short a timeframe no matter what options you are looking at. In now almost 10 years on Medicare (with some serious health episodes), because my provider accepts public Part C (and because the Part C plan works exactly the way his plan worked before I reached Medicare), our ability to choose Part C has saved us about $25,000 or more (see Note) vs if we had had to get a private supplement and Part D and vision and/or dental and pay for annual physicals out of pocket.

But it all begins with "what does your favorite doctor take?"
Oh, yes - 6 months is a short time - but it is enlightening to me since my usage of my plan went up quite a bit - and I still see "reasonable" costs. This discussion has been very enlightening.

We did have to switch all of our doctors - BUT, on balance, all of the new ones are just as good better than the old ones (especially with 20/20 hindsight). Just my current opinion, but keeping favorite doctors is an overrated reason to pick a plan. In the last 7+ years on this plan, several physicians have retired. Still have my (now about 40) PCP - but turnover with all the specialists.

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Re: What I spent in 6 months on medicare

Post by drawpoker » Fri Jul 06, 2018 3:35 pm

dm200 wrote:
Fri Jul 06, 2018 3:20 pm
Part C plans, also, vary widely from one area to another (even same provider) as well as from one provider to another. Never judge "part C" by what just one plan does and does not do.
Particularly when dealing with Wisconsin, Minnesota and Massachusetts (home state of dennisbryan)
These 3 states are the only ones who have rejected Original Medicare with its choice of 10 standardized plans and have legislated their own laws dealing with consumer choices for senior citizens on Medicare.
Much of what has been posted here regarding Part C plans, especially costs, in the Commonwealth does not apply to the other 47 states.

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Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 3:45 pm

Just as an example of the differences in Part C plans from the same provider - and in the same "area"

The Kaiser Medicare plan for the Washington DC - Baltimore MD - and Northern VA area - has the same monthly premium for "standard" - $30/month. However, in Virginia - it is a Medicare Cost plan. In Washington DC, it is a Medicare Advantage plan - and in Maryland, some counties it is a Cot plan and in others an Advantage plan. Some copays and OOP maximums are a little different for Cost and Advantage.

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Re: What I spent in 6 months on medicare

Post by drawpoker » Fri Jul 06, 2018 3:45 pm

dm200 wrote:
Fri Jul 06, 2018 3:27 pm
...did have to switch all of our doctors -.... Just my current opinion, but keeping favorite doctors is an overrated reason to pick a plan. .................
Does your wife feel the same?
This may get tossed for being sexist or inappropriate comment - but - my current opinion is that keeping favorite doctors is far more important to wives than it is to husbands.
At least it is very true for me (female) And comments I have heard from male friends seem to support this. .
It probably harks back to that well-known trait of men in general, i.e., they really dislike going to the doctor and try to avoid it. Until their wives nag them into going. :)

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Re: What I spent in 6 months on medicare

Post by Good Listener » Fri Jul 06, 2018 3:53 pm

dm200 wrote:
Fri Jul 06, 2018 3:08 pm
drawpoker wrote:
Fri Jul 06, 2018 3:05 pm
No, that is incorrect
IRMAA tacks on an additional charge to both Part B and Part D monthly premiums.
I agree with this. What is "incorrect"??

I believe the affects of IRMAA are identical whether on Original Medicare and a drug plan - AND Medicare Advantage plan with the drug plan. Am I correct?
Yes. You must have Part B to get Medicare Advantage and you are subject to the IRMAA for Parts B abnd D regardless. The maximum this year for Part B and both IRMAAs is $503.40. If one adds a supplement like F (most expensive) or G (2nd highest), that is about $200 per month and then a part D for anywhere from $20-75 per month.

And I will add my usual warning that I hate Medicare Advantage, having lived through it for 2 months last year when I was put into it by a company retirement plan. I changed to original Medicare plus the supplement and Part D as soon as I could. With what I now have there are no prior authorizations or any other costs except out of pocket drug copays. It was the prior authorization requirements that got to me. Even if one could get them, it was a nuisance and worry to deal with. MA may give some things like gym memberships and a few bucks to a hearing aid and save premiums but if you can afford it, I would avoid MA.
Last edited by Good Listener on Fri Jul 06, 2018 3:57 pm, edited 1 time in total.

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Re: What I spent in 6 months on medicare

Post by cas » Fri Jul 06, 2018 3:54 pm

Hayden wrote:
Thu Jul 05, 2018 6:21 pm

I had the opposite reaction. I wish I could buy into Medicare. I recently saw the 2019 figures for my ACA plan.
Several people had a comment of this sort. (I'm quoting Hayden just because his/her comment was ready at hand to use the quote tool upon.)

The premiums that dms200 mention are accurate for the majority of current Medicare recipients, but he didn't mention a lot of additional context that wasn't relevant to his post. However, that context *is* relevant to comparing Medicare premiums to ACA premiums.

Main point of a long post: if someone had to pay full price (no subsidy or cost reduction of any kind) for Medicare, the premium would be, as far as I can tell, with some simplifying assumptions: approx $13,188 per year per person ($1099 per month per person)

That premium surprised/shocked me initially, but some playing around with the healthcare.gov tools indicates that it doesn't seem to be that far off from what a 64 year old would pay for unsubsidized ACA premiums (I've forgotten whether I was looking at silver or gold premiums or both) in 2018, so I probably shouldn't be surprised. (And, yes, I'm leaving out the uncertainty about ACA premiums going forward, due to the current flux in individual health insurance policy. But that gets beyond allowed forum discussion.)

Specifically...

Full price Medicare A (inpatient hospitalization) premium: $422/month ($5064/year)
Full price Medicare B (doctors visits, outpatient care, labs, etc) premium: $536/month ($6432/year)
Full price Medicare D (prescription coverage) premium (2017 national average cost; individual cost depends on plan, not sure what 2018 cost is): $141/month ($1692/month)
Medigap or Medicare Advantage (covers (some) stuff that parts A,B,D don't cover, e.g. the unlimited 20% Medicare B copay.) Medicare Advantage requires Part B but probably replaces part D entirely. Monthly premiums vary widely depending on exact nature of plan, location of recipient, and possibly age of recipient)

If you add up the full price A,B, D premiums (and, to simplify the estimate, leave out the Medigap and Medicare Advantage possible premiums), that $13,188 per year per person estimated premium is the result.

So why have there not been great screams of agony about Medicare premium costs? Because (almost?) nobody pays the full price. (Possibly people who immigrated to the US after/near Medicare age do, but I'm vague on that.)

For example, using dms200 as a case study, dms200 does not pay these full prices because:

Medicare Part A: dms200 pays $0 because dms200 and/or his wife paid payroll taxes for at least 10 years, which qualifies him to have the Medicare Trust Fund pay 100% of the Medicare A premium.

Medicare Part B: dms200 pays $134 because he is in the lowest IRMAA (Income Related Monthly Adjustment Amount) bracket, which means that 75% of the full cost of the Medicare B premium is paid out of the general revenues of the US treasury. (The Medicare Trust Fund - all those Medicare payroll taxes employees pay - is relevant only to Medicare Part A.) Stating it the other way around - dms200 pays 25% of the full cost of the Medicare part B premium. (Projections (in 2015) were that in 2018, 92% of all Medicare recipients would be in the lowest IRMAA bracket. But, depending on income (IRMAA bracket), the required contribution to Medicare part B and D premiums ranges from 25% to 80% (2018) or 85% (starting 2019).

Medicare Medicare Part D: dms200 doesn't pay Medicare D premiums, but pays Medicare Advantage premiums instead. If dms200 did buy Medicare Part D, since he is in the lowest IRMAA bracket, he would pay around 25% of the premium, with the rest of the premium coming out of the general revenues of the US treasury. (As far as I understand, the 75% contribution from the US treasury is based on the national average of the cost of a part D plan, so exact cost to any individual person would depend on the exact Part D plan they purchased.)

Medigap: dms200 doesn't buy a Medigap Plan, but pays Medicare Advantage premiums instead.

Sources:

"Part A costs" https://www.medicare.gov/your-medicare- ... costs.html

"An Overview of Medicare" https://www.kff.org/medicare/issue-brie ... -medicare/

"Medicare's Income Related Premiums under Current Law and Proposed Changes" https://www.kff.org/medicare/issue-brie ... d-changes/

"New Medicare Premium Surcharge Tier And Other Tax Implications Of The Bipartisan Budget Act of 2018" https://www.kitces.com/blog/bipartisan- ... deduction/

"Medicare’s Income-Related Premiums: A Data Note" https://www.kff.org/medicare/issue-brie ... data-note/

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Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 4:03 pm

cas wrote:
Fri Jul 06, 2018 3:54 pm
Hayden wrote:
Thu Jul 05, 2018 6:21 pm
I had the opposite reaction. I wish I could buy into Medicare. I recently saw the 2019 figures for my ACA plan.
Several people had a comment of this sort. (I'm quoting Hayden just because his/her comment was ready at hand to use the quote tool upon.)
The premiums that dms200 mention are accurate for the majority of current Medicare recipients, but he didn't mention a lot of additional context that wasn't relevant to his post. However, that context *is* relevant to comparing Medicare premiums to ACA premiums.
Main point of a long post: if someone had to pay full price (no subsidy or cost reduction of any kind) for Medicare, the premium would be, as far as I can tell, with some simplifying assumptions: approx $13,188 per year per person ($1099 per month per person)
That premium surprised/shocked me initially, but some playing around with the healthcare.gov tools indicates that it doesn't seem to be that far off from what a 64 year old would pay for unsubsidized ACA premiums (I've forgotten whether I was looking at silver or gold premiums or both) in 2018, so I probably shouldn't be surprised. (And, yes, I'm leaving out the uncertainty about ACA premiums going forward, due to the current flux in individual health insurance policy. But that gets beyond allowed forum discussion.)
Specifically...
Full price Medicare A (inpatient hospitalization) premium: $422/month ($5064/year)
Full price Medicare B (doctors visits, outpatient care, labs, etc) premium: $536/month ($6432/year)
Full price Medicare D (prescription coverage) premium (2017 national average cost; individual cost depends on plan, not sure what 2018 cost is): $141/month ($1692/month)
Medigap or Medicare Advantage (covers (some) stuff that parts A,B,D don't cover, e.g. the unlimited 20% Medicare B copay.) Medicare Advantage requires Part B but probably replaces part D entirely. Monthly premiums vary widely depending on exact nature of plan, location of recipient, and possibly age of recipient)
If you add up the full price A,B, D premiums (and, to simplify the estimate, leave out the Medigap and Medicare Advantage possible premiums), that $13,188 per year per person estimated premium is the result.
So why have there not been great screams of agony about Medicare premium costs? Because (almost?) nobody pays the full price. (Possibly people who immigrated to the US after/near Medicare age do, but I'm vague on that.)
For example, using dms200 as a case study, dms200 does not pay these full prices because:
Medicare Part A: dms200 pays $0 because dms200 and/or his wife paid payroll taxes for at least 10 years, which qualifies him to have the Medicare Trust Fund pay 100% of the Medicare A premium.
Medicare Part B: dms200 pays $134 because he is in the lowest IRMAA (Income Related Monthly Adjustment Amount) bracket, which means that 75% of the full cost of the Medicare B premium is paid out of the general revenues of the US treasury. (The Medicare Trust Fund - all those Medicare payroll taxes employees pay - is relevant only to Medicare Part A.) Stating it the other way around - dms200 pays 25% of the full cost of the Medicare part B premium. (Projections (in 2015) were that in 2018, 92% of all Medicare recipients would be in the lowest IRMAA bracket. But, depending on income (IRMAA bracket), the required contribution to Medicare part B and D premiums ranges from 25% to 80% (2018) or 85% (starting 2019).
Medicare Medicare Part D: dms200 doesn't pay Medicare D premiums, but pays Medicare Advantage premiums instead. If dms200 did buy Medicare Part D, since he is in the lowest IRMAA bracket, he would pay around 25% of the premium, with the rest of the premium coming out of the general revenues of the US treasury. (As far as I understand, the 75% contribution from the US treasury is based on the national average of the cost of a part D plan, so exact cost to any individual person would depend on the exact Part D plan they purchased.)
Medigap: dms200 doesn't buy a Medigap Plan, but pays Medicare Advantage premiums instead.
Sources:
"Part A costs" https://www.medicare.gov/your-medicare- ... costs.html
"An Overview of Medicare" https://www.kff.org/medicare/issue-brie ... -medicare/
"Medicare's Income Related Premiums under Current Law and Proposed Changes" https://www.kff.org/medicare/issue-brie ... d-changes/
"New Medicare Premium Surcharge Tier And Other Tax Implications Of The Bipartisan Budget Act of 2018" https://www.kitces.com/blog/bipartisan- ... deduction/
"Medicare’s Income-Related Premiums: A Data Note" https://www.kff.org/medicare/issue-brie ... data-note/
Very good analysis! I believe, however, that the approx $13,188 per year per person ($1099 per month per person) is probably on the low side. My wife had an Obamacare plan at Kaiser for 2 years prior to going on Medicare (63 and 64 years old) about five years ago. That plan was far inferior to Medicare in many ways - and the unsubsidized cost was about $1,000 per month for just her.
So why have there not been great screams of agony about Medicare premium costs? Because (almost?) nobody pays the full price.
Exactly..

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Re: What I spent in 6 months on medicare

Post by cas » Fri Jul 06, 2018 4:15 pm

dm200 wrote:
Fri Jul 06, 2018 4:03 pm

Very good analysis! I believe, however, that the approx $13,188 per year per person ($1099 per month per person) is probably on the low side. My wife had an Obamacare plan at Kaiser for 2 years prior to going on Medicare (63 and 64 years old) about five years ago. That plan was far inferior to Medicare in many ways - and the unsubsidized cost was about $1,000 per month for just her.
Yeah, I left out the complications of what various permutations of Medicare cover (deductibles, networks, etc) vs various metal colors of ACA in various different locations (rural vs urban, etc), but I figured that was getting way too far off track. And beyond my knowledge level.

My main point: I get the impression that a lot people tend to compare the so-called "standard" $134 (in 2018) monthly Part B Medicare premium directly to an unsubsidized ACA premium. There are a whole bunch of complications in figuring out what the correct apples-to-apples comparison is (and quite a bit of that analysis would probably break forum rules regarding politics and future developments), but "standard" part B premium vs unsubsidized ACA premium definitely isn't the right comparison.

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Re: What I spent in 6 months on medicare

Post by drawpoker » Fri Jul 06, 2018 4:21 pm

You betcha.
apples to oranges comparisons that is. With the ACA
In the senior citizens group I mentor on Medicare topics, there often crops up the confusion over "pre=existing" conditions.
This comes up when explaining medical underwriting under Medicare past open enrollment rates.
there is always more than 1 person who cries out "But, I thought they can't do that, count pre-existing conditions anymore!
It is a hard sell to have to explain to some. :oops:

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Re: What I spent in 6 months on medicare

Post by dm200 » Fri Jul 06, 2018 4:29 pm

drawpoker wrote:
Fri Jul 06, 2018 4:21 pm
You betcha.
apples to oranges comparisons that is. With the ACA
In the senior citizens group I mentor on Medicare topics, there often crops up the confusion over "pre=existing" conditions.
This comes up when explaining medical underwriting under Medicare past open enrollment rates.
there is always more than 1 person who cries out "But, I thought they can't do that, count pre-existing conditions anymore!
It is a hard sell to have to explain to some. :oops:
Complicated indeed !!! Medicare and insurance companies seem to think they can just "solve" the complexity of understanding all of this - just by printing in large type. :confused :confused

but "standard" part B premium vs unsubsidized ACA premium definitely isn't the right comparison.
Sure is not...

Let me also add that the ACA capped (in most states) the age related premiums at 3 times the young folks covered. Before the ACA (from our experience) - these were 4-5 times the young rates.

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Re: What I spent in 6 months on medicare

Post by Northern Flicker » Sat Jul 07, 2018 2:57 am

dm200 wrote:
Thu Jul 05, 2018 7:18 pm
One point I was trying to make is that my "out of pocket" amount of $880 + $180 premiums (or about $177 per month) is less than many or most Medigap plans with Original Medicare.
The govt share of the costs is higher for medicare advantage plans than for traditional medicare, so it would be expected that your share would be lower.
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Post by Sheepdog » Sat Jul 07, 2018 5:17 am

drawpoker wrote:
Fri Jul 06, 2018 2:49 pm

Since you lumped your Medicare Part B premiums and MA cost into one broad category, can't tell which income bracket you are in on Part B ($134 or $187.50)
Anyway, the real meaning that jumps out to me is now you have crossed the $1,000 a month threshold, and fast approaching $13,000 a year. :shock: )

That tells me this - In Indiana, in your age group, Medigap Plan G now costs more than $540 per month, per person.
Is that right? (Am assuming since you posted you gave up Plan G and switched to a MA plan to save $$)
Yes, we did reach that $1000 a month medical costs. The big jump has been partially due to dental work for both of us. Our total dental went from $413 in 2016 to $2209 in 2017. This year we will, together, approach $5000, but I can't imagine that 2019 will be high....hope so, anyway. At least I can still chew a good steak or a BBQ bone as can my spouse.

In addition, my wife started taking expensive medications which last year went to $2821. This year it is already almost $2000. No complaints, as she is doing very well. We only spent together $426 out of pocket in 2015 and $279 in 2014! (By the way, we are healthy and active otherwise.)

I don't know what Indiana's Plan G rate is today because I switched to my Regional PPO Advantage plan in 2014. I can only say that I switched then because the Medigap premium was increasing fast each year especially beginning at age 75. The reason was definitely money. Our total insurance costs, which included Medigap and Part D prescription coverage, but not the Medicare insurance cost, went from $6427 in 2013 down to $1641 in 2016. We each saved well over $2000 a year out of pocket with the changes. I even can receive hearing aids every year with a years worth of batteries which prior to Advantage cost me $2000 each plus the battery cost. (I still can't figure out why my insurer, Anthem Blue Cross Blue Shield, will let me get new aids every year with no copay with comparatively lower premium. )

I don't know why your asked the question about the Medicare premium, as it is not the major medical expense for us, but in 2018, my Medicare monthly insurance is $134 and my wife's is $123. In 2017 they were $110 and $108.

Let me add, I love our PPO Advantage plans. We have had no problems with access to any medical care. I can see any physician I wish, but would pay more, of course, for an out-of-network provider.
Last edited by Sheepdog on Sat Jul 07, 2018 5:32 am, edited 2 times in total.
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Re: What I spent in 6 months on medicare

Post by dennisbyron » Sat Jul 07, 2018 5:20 am

drawpoker wrote:
Fri Jul 06, 2018 3:35 pm
dm200 wrote:
Fri Jul 06, 2018 3:20 pm
Part C plans, also, vary widely from one area to another (even same provider) as well as from one provider to another. Never judge "part C" by what just one plan does and does not do.
Wisconsin, Minnesotta and Massachusetts have rejected Original Medicare with its choice of 10 standardized plans and have legislated their own laws dealing with consumer choices for senior citizens on Medicare. Much of what has been posted here regarding Part C plans, especially costs, in the Commonwealth does not apply to the other 47 states.
This commenter's opinions about Massachusetts (and I assume Wisconsin and Minnesotta) are almost totally incorrect. No idea what the commenter is thinking about or where she gets her information. If the commenter provided a source, perhaps we could explain the situation in Massachusetts to her.

1. It is true that Massachusetts does not provide the 10 standardized private Medigap options (I don't think many states provide all 10?). That is because Massachusetts (and I assume Wisconsin and Minnesotta) already had excellent and benefit-full standardized and regulated private Medigap supplements before the Federal government stepped into the market in the late 1980s or early 1990s and regulated Medigap nationwide. Before that much private Medigap insurance in the rest of the United States was crap designed by unscrupulous insurance agents to bilk seniors.

2. Massachusetts "consumer choices for senior citizens on Medicare" are different concerning private Medigap insurance policies only... not for the public Parts of Medicare (A, B, C and D). And the Medigap rules are different basically in that they offer the same coverages under different names (with the exception that we have no Medigap option with annual out of pocket spending protection--as in national templates K and L). As per point 1, the reason is that Massachusetts (and I assume Wisconsin and Minnesotta) had all these benefits and protections from unscrupulous private insurance agents long before the rest of the country

3. It is an erroneous statement in multiple ways to say Massachusetts has "rejected Original Medicare." Here are just three of the ways the commenter is in error:
A. 100% of the people on Medicare in the entire country including Massachusetts are on Original Medicare. You cannot get an individually purchased private supplement or any of the public Medicare options (C and/or D) unless you are first on Original Medicare (either or both A and B depending). That is true in Massachusetts. That is true everywhere else.
B. People in Massachusetts are on "traditional Medicare" (they choose a private supplement usually with Part D instead of Part C) in higher proportion than in the rest of the country. Not only has Massachusetts not rejected traditional Medicare, it has embraced it wholeheartedly. To a great extent that is due to a large number of snowbirds who get out of Dodge every winter
C. No state could reject Original Medicare. I think Vermont tried during its since abandoned (for other reasons) plan to go to single payer health insurance but was denied a waiver to do so... by the Obama administration.

4. Public Part C of Medicare works exactly the same way in Massachusetts as it works in the other 49 states and in DC. Part C is different in Puerto Rico and perhaps some other U.S. possessions. Many of us (including dm200 at 4:20 on July 6 as illustrated in the quote above) have written in this thread that costs and other factors in public Part C differ widely all over the country but Part C costs in Massachusetts are proportional to the costs for all health insurance in Massachusetts (that is, Part C costs in Massachusetts relate to conditions in Massachusetts, not not to anything different about Part C in Massachusetts). That being said, the costs are pretty much the same throughout the Northeast United States and any place with numerous world class teaching hospitals and high overall costs of living unrelated to health care. The commenter's statement must be based on her misunderstanding some source but since the source is not provided we cannot figure out what the person could possibly be thinking of

5. The commenter's statements tend to mirror the statements of some insurance agents (see point 1).
Last edited by dennisbyron on Sat Jul 07, 2018 10:04 am, edited 4 times in total.

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Re: What I spent in 6 months on medicare

Post by dennisbyron » Sat Jul 07, 2018 5:35 am

dm200 wrote:
Fri Jul 06, 2018 3:27 pm
I joined the thread to answer the original question and went off in a few tangents. My opinion would be that looking at 6 months is too short a timeframe no matter what options you are looking at. In now almost 10 years on Medicare (with some serious health episodes), because my provider accepts public Part C (and because the Part C plan works exactly the way his plan worked before I reached Medicare), our ability to choose Part C has saved us about $25,000 or more (see Note) vs if we had had to get a private supplement and Part D and vision and/or dental and pay for annual physicals out of pocket.

But it all begins with "what does your favorite doctor take?"
Oh, yes - 6 months is a short time - but it is enlightening to me since my usage of my plan went up quite a bit - and I still see "reasonable" costs. This discussion has been very enlightening.

We did have to switch all of our doctors - BUT, on balance, all of the new ones are just as good better than the old ones (especially with 20/20 hindsight). Just my current opinion, but keeping favorite doctors is an overrated reason to pick a plan. In the last 7+ years on this plan, several physicians have retired. Still have my (now about 40) PCP - but turnover with all the specialists.
Since some other readers seem to be interested in comparing private supplements to public Part C, there are a few other things to watch for because of the wide difference in rules for private supplements and even Part C in different states:
1. Although it is always easy to drop Part C and add Part D, it is not always easy in some states to then also pick up a private supplement for the first time. There is a grace period of about a year after being first eligible for Medicare where you can make that switch anywhere no questions asked (no underwriting) but after that you might be denied in some states. Ironically, while PPACA removed the "preexisting conditions" rules for most people, it did not remove them for people on Medicare. As you and I have written here multiple times: everywhere is different!
2. Snowbirds need to be especially careful. A Part C plan is OK everywhere for emergencies when traveling (many insurance agents lie and say they are not) or otherwise away from your PCP and network, many people do not like the inconvenience of returning home just for a regular visit or a lingering whatever or follow-ups. On the other hand, some Part C plans cater to snowbirds so again: everywhere is different!
3. One more thing I can think of relative to "favorite doctor:" Increasingly (although still a small trend) and I believe mostly in the Northwest, some providers take only a public Part C Medicare health plan.

Back at you: good discussion

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Re: What I spent in 6 months on medicare

Post by dennisbyron » Sat Jul 07, 2018 6:22 am

jalbert wrote:
Sat Jul 07, 2018 2:57 am
dm200 wrote:
Thu Jul 05, 2018 7:18 pm
One point I was trying to make is that my "out of pocket" amount of $880 + $180 premiums (or about $177 per month) is less than many or most Medigap plans with Original Medicare.
The govt share of the costs is higher for medicare advantage plans than for traditional medicare, so it would be expected that your share would be lower.
It is not correct in general to say that "The govt share of the costs is higher for medicare advantage plans than for traditional medicare." The data to find the true costs of the different approaches is in Table II.B.1 of recent year Medicare Trustee Reports and analogous tables in those reports going back to the creation of public Part C in 1997 (when the table number scheme was different). You also have to know how many people were on Part C each year to do the comparison. That data is also in the annual Medicare Trustees reports and also on cms dot gov

In fact the per person cost of people on public Part C of Medicare is significantly lower on average than the cost of people on traditional Medicare, which in fact is what was expected when the Democrats came up with the idea and President Clinton signed it into law. I have the data for every year back to 2000 but in summary, divide the history of Part C into three eras:
-- Early Part C era (1997-2005) The per person cost for a person on Part C was 5% less than the per person costs of a person on traditional Medicare. That was simply how the original law was written although -- as in all three eras -- there is a lag time to figure out what the per-person traditional Medicare costs are in a given year and county and apply it to calculate the per person capitation fee to a person on Part C the subsequent or second following year (depending on how they did/do it)
-- Mid Part C era (2006-2011). During the early era, Part C was not as popular as expected by the Democrats who came up with Part C's "premium support" idea in 1995 primarily because people then on Medicare had always had and liked (even before joining Medicare) fee for service health insurance with no networks... and really disliked old fashioned original HMOs, which are what most Part C plans then were. These people 15-20 years ago (current members' parents and grandparents) were raised on old fashioned separated Blue Cross and Blue Shield, which is what Part A and Part B are. So in 2003 (effective 2006) special sweeteners were added for union members, for people in rural areas and inner cities who had no or little access to HMOs, and for Part C sponsors in the form of a new bidding system to base the capitation fee on a floor using the traditional Medicare cost rather than making the traditional Medicare per person cost the ceiling. This tilted the difference the other way and on average between 2006-2011 the per-person cost of a person on Part C was 4%-6% higher on average than a person on traditional Medicare. (Many people constantly use the statistic that per person costs for people on Part C are 14% higher; that was true in one year -- 2009 -- and only for people on the special rural plan. It was also calculated by counting all people on traditional Medicare including those -- mostly Federal retirees -- only on Part A, who naturally had a lower per person cost than someone on both A and B. These politicians also often leave out the words "per person." It makes a great political talking point although very misleading.)
-- Current Part C era (2012 to today): PPACA eliminated the special rural/inner-city aspect of Part C passed in 2003 (but grandfathered those policies for those that had chosen them). Another law is eliminating the special deal for union members over time (scheduled to end in 2020). PPACA changed the bidding rules for sponsors slightly but also added a quality bonus scheme for sponsors so those two factors washed. Primarily by eliminating the special deals for union members and the rural/inner-city poor, the average per-person cost of someone on Part C since 2012 has been from 5% less to 1% less than a person on traditional Medicare depending on year. The program has basically achieved the original Democratic idea from 1995. It should be noted that for those over the three era (not the same people obviously) who like HMOs and like the Managed Medicare concept, Part C was always less expensive for both them and the Trust Funds. In fact, it is not fair, but PPACA made Part C a better deal for those on Part C on vanilla HMOs because of the way it was written (which seems the opposite of what the people who wrote PPACA wanted, which was to end Part C.)

However you have to also factor in that during the early era, only about 5% of the people on Original Medicare were on Part C and that during the mid era, only about 15% of the people on Original Medicare were on Part C whereas today 35% of the people on Original Medicare are on Part C (and that that number increases yearly). Weighting for this, makes Part C a great deal for the Trust Funds as compared to what would have happened if the Democrats had not come up with the idea in 1995 that became Part C in 1997.

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Re: What I spent in 6 months on medicare

Post by kaneohe » Sat Jul 07, 2018 7:05 am

Good Listener wrote:
Fri Jul 06, 2018 3:53 pm
dm200 wrote:
Fri Jul 06, 2018 3:08 pm
drawpoker wrote:
Fri Jul 06, 2018 3:05 pm
No, that is incorrect
IRMAA tacks on an additional charge to both Part B and Part D monthly premiums.
I agree with this. What is "incorrect"??

I believe the affects of IRMAA are identical whether on Original Medicare and a drug plan - AND Medicare Advantage plan with the drug plan. Am I correct?
Yes. You must have Part B to get Medicare Advantage and you are subject to the IRMAA for Parts B abnd D regardless. The maximum this year for Part B and both IRMAAs is $503.40. If one adds a supplement like F (most expensive) or G (2nd highest), that is about $200 per month and then a part D for anywhere from $20-75 per month.

And I will add my usual warning that I hate Medicare Advantage, having lived through it for 2 months last year when I was put into it by a company retirement plan. I changed to original Medicare plus the supplement and Part D as soon as I could. With what I now have there are no prior authorizations or any other costs except out of pocket drug copays. It was the prior authorization requirements that got to me. Even if one could get them, it was a nuisance and worry to deal with. MA may give some things like gym memberships and a few bucks to a hearing aid and save premiums but if you can afford it, I would avoid MA.
I have a supplement plan and wife has Advantage. Perhaps I missed it....but I distinctly remember looking at the last annual SS statement which details the charges for Medicare that are deducted from the SS payment. I saw the IRMAA surcharge for pt B on both of our statements , but the pt D surcharge was only on mine. Was wondering if perhaps wife's Advantage plan picked up that charge.

We both do get gym memberships from our health plans.......so possible (but not guaranteed) for both supplement and Advantage, depending on specific plan.

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 9:15 am

jalbert wrote:
Sat Jul 07, 2018 2:57 am
dm200 wrote:
Thu Jul 05, 2018 7:18 pm
One point I was trying to make is that my "out of pocket" amount of $880 + $180 premiums (or about $177 per month) is less than many or most Medigap plans with Original Medicare.
The govt share of the costs is higher for medicare advantage plans than for traditional medicare, so it would be expected that your share would be lower.
In the last few years, the payments for MA plans have been reduced - so I do not believe this is the case. Comparison calculations can be complex - because the two different groups can be different.

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 9:21 am

3. One more thing I can think of relative to "favorite doctor:" Increasingly (although still a small trend) and I believe mostly in the Northwest, some providers take only a public Part C Medicare health plan.
If I interpret this correctly - in this area, a great many Primary Care Physicians will not accept new Original medicare patients - BUT - many of these Physicians are part of Medicare Advantage plans - and will accept new MA patients.

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 9:24 am

dennisbyron wrote:
Sat Jul 07, 2018 6:22 am
jalbert wrote:
Sat Jul 07, 2018 2:57 am
dm200 wrote:
Thu Jul 05, 2018 7:18 pm
One point I was trying to make is that my "out of pocket" amount of $880 + $180 premiums (or about $177 per month) is less than many or most Medigap plans with Original Medicare.
The govt share of the costs is higher for medicare advantage plans than for traditional medicare, so it would be expected that your share would be lower.
It is not correct in general to say that "The govt share of the costs is higher for medicare advantage plans than for traditional medicare." The data to find the true costs of the different approaches is in Table II.B.1 of recent year Medicare Trustee Reports and analogous tables in those reports going back to the creation of public Part C in 1997 (when the table number scheme was different). You also have to know how many people were on Part C each year to do the comparison. That data is also in the annual Medicare Trustees reports and also on cms dot gov
In fact the per person cost of people on public Part C of Medicare is significantly lower on average than the cost of people on traditional Medicare, which in fact is what was expected when the Democrats came up with the idea and President Clinton signed it into law. I have the data for every year back to 2000 but in summary, divide the history of Part C into three eras:
-- Early Part C era (1997-2005) The per person cost for a person on Part C was 5% less than the per person costs of a person on traditional Medicare. That was simply how the original law was written although -- as in all three eras -- there is a lag time to figure out what the per-person traditional Medicare costs are in a given year and county and apply it to calculate the per person capitation fee to a person on Part C the subsequent or second following year (depending on how they did/do it)
-- Mid Part C era (2006-2011). During the early era, Part C was not as popular as expected by the Democrats who came up with Part C's "premium support" idea in 1995 primarily because people then on Medicare had always had and liked (even before joining Medicare) fee for service health insurance with no networks... and really disliked old fashioned original HMOs, which are what most Part C plans then were. These people 15-20 years ago (current members' parents and grandparents) were raised on old fashioned separated Blue Cross and Blue Shield, which is what Part A and Part B are. So in 2003 (effective 2006) special sweeteners were added for union members, for people in rural areas and inner cities who had no or little access to HMOs, and for Part C sponsors in the form of a new bidding system to base the capitation fee on a floor using the traditional Medicare cost rather than making the traditional Medicare per person cost the ceiling. This tilted the difference the other way and on average between 2006-2011 the per-person cost of a person on Part C was 4%-6% higher on average than a person on traditional Medicare. (Many people constantly use the statistic that per person costs for people on Part C are 14% higher; that was true in one year -- 2009 -- and only for people on the special rural plan. It was also calculated by counting all people on traditional Medicare including those -- mostly Federal retirees -- only on Part A, who naturally had a lower per person cost than someone on both A and B. These politicians also often leave out the words "per person." It makes a great political talking point although very misleading.)
-- Current Part C era (2012 to today): PPACA eliminated the special rural/inner-city aspect of Part C passed in 2003 (but grandfathered those policies for those that had chosen them). Another law is eliminating the special deal for union members over time (scheduled to end in 2020). PPACA changed the bidding rules for sponsors slightly but also added a quality bonus scheme for sponsors so those two factors washed. Primarily by eliminating the special deals for union members and the rural/inner-city poor, the average per-person cost of someone on Part C since 2012 has been from 5% less to 1% less than a person on traditional Medicare depending on year. The program has basically achieved the original Democratic idea from 1995. It should be noted that for those over the three era (not the same people obviously) who like HMOs and like the Managed Medicare concept, Part C was always less expensive for both them and the Trust Funds. In fact, it is not fair, but PPACA made Part C a better deal for those on Part C on vanilla HMOs because of the way it was written (which seems the opposite of what the people who wrote PPACA wanted, which was to end Part C.)
However you have to also factor in that during the early era, only about 5% of the people on Original Medicare were on Part C and that during the mid era, only about 15% of the people on Original Medicare were on Part C whereas today 35% of the people on Original Medicare are on Part C (and that that number increases yearly). Weighting for this, makes Part C a great deal for the Trust Funds as compared to what would have happened if the Democrats had not come up with the idea in 1995 that became Part C in 1997.
Thanks for the elaboration ...

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 9:29 am

And I will add my usual warning that I hate Medicare Advantage, having lived through it for 2 months last year when I was put into it by a company retirement plan. I changed to original Medicare plus the supplement and Part D as soon as I could. With what I now have there are no prior authorizations or any other costs except out of pocket drug copays. It was the prior authorization requirements that got to me. Even if one could get them, it was a nuisance and worry to deal with. MA may give some things like gym memberships and a few bucks to a hearing aid and save premiums but if you can afford it, I would avoid MA.
To be fair, I believe what you "hated" was the specific MA plan that you had. A great many of us (including my wife and I) have zero problems or delays or incomveniences by "prior authorization" requirements of our plans - these all happen cery, very quickly and conveniently. You, now, have the added monthly costs for the supplement and Part D.

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Re: What I spent in 6 months on medicare

Post by dennisbyron » Sat Jul 07, 2018 9:38 am

dm200 wrote:
Sat Jul 07, 2018 9:21 am
3. One more thing I can think of relative to "favorite doctor:" Increasingly (although still a small trend) and I believe mostly in the Northwest, some providers take only a public Part C Medicare health plan.
If I interpret this correctly - in this area, a great many Primary Care Physicians will not accept new Original medicare patients - BUT - many of these Physicians are part of Medicare Advantage plans - and will accept new MA patients.
I meant something slightly different but I can see what you suggest happening also. For example, someone (I think you) mentioned Kaiser, which is an integrated health delivery system (with a sort of insurance company attached). Because Kaiser, among many types of coverage, is a Part C sponsor, it might do what you suggest.

I do not know how strict or loose the rules are in terms of providers accepting one type of Medicare patient over another, just that it is happening. The usual thing to watch for is that some doctors will accept no Medicare patients of any kind unless already a current patient aging into Medicare. For those in their early 60s, the message is "get a PCP you like now so that you aren't forced to deal with one you don't like in 3 to 5 years."

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Re: What I spent in 6 months on medicare

Post by FrugalInvestor » Sat Jul 07, 2018 9:44 am

dm200 wrote:
Sat Jul 07, 2018 9:21 am
3. One more thing I can think of relative to "favorite doctor:" Increasingly (although still a small trend) and I believe mostly in the Northwest, some providers take only a public Part C Medicare health plan.
If I interpret this correctly - in this area, a great many Primary Care Physicians will not accept new Original medicare patients - BUT - many of these Physicians are part of Medicare Advantage plans - and will accept new MA patients.
My sense from reading elsewhere, this discussion and my own experience is that things can be very different from area to area. In our area where there is a very large contingent on Medicare, doctors who don't take original Medicare are the rare exception. When I was on an ACA plan I lost my primary care physician but after going on Medicare I am again able to see him. Even a nationally renown facility accepted me for treatment of a very serious condition under traditional Medicare - not under assignment but my plan G supplement pics up 98% of the additional charges. They would not have treated me under any Medicare Advantage plan.

I wouldn't assume anything from reading about my or anyone else's individual experiences especially if they aren't in your immediate area. I also think it's unwise to assume that just because you've always been healthy that you'll always be healthy.
IGNORE the noise! | Our life is frittered away by detail... simplify, simplify. - Henry David Thoreau

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 9:47 am

dennisbyron wrote:
Sat Jul 07, 2018 9:38 am
dm200 wrote:
Sat Jul 07, 2018 9:21 am
3. One more thing I can think of relative to "favorite doctor:" Increasingly (although still a small trend) and I believe mostly in the Northwest, some providers take only a public Part C Medicare health plan.
If I interpret this correctly - in this area, a great many Primary Care Physicians will not accept new Original medicare patients - BUT - many of these Physicians are part of Medicare Advantage plans - and will accept new MA patients.
I meant something slightly different but I can see what you suggest happening also. For example, someone (I think you) mentioned Kaiser, which is an integrated health delivery system (with a sort of insurance company attached). Because Kaiser, among many types of coverage, is a Part C sponsor, it might do what you suggest.
I do not know how strict or loose the rules are in terms of providers accepting one type of Medicare patient over another, just that it is happening. The usual thing to watch for is that some doctors will accept no Medicare patients of any kind unless already a current patient aging into Medicare. For those in their early 60s, the message is "get a PCP you like now so that you aren't forced to deal with one you don't like in 3 to 5 years."
Yes - this is exactly what a great many of my friends and acquaintances are encountering.

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 9:57 am

FrugalInvestor wrote:
Sat Jul 07, 2018 9:44 am
dm200 wrote:
Sat Jul 07, 2018 9:21 am
3. One more thing I can think of relative to "favorite doctor:" Increasingly (although still a small trend) and I believe mostly in the Northwest, some providers take only a public Part C Medicare health plan.
If I interpret this correctly - in this area, a great many Primary Care Physicians will not accept new Original medicare patients - BUT - many of these Physicians are part of Medicare Advantage plans - and will accept new MA patients.
My sense from reading elsewhere, this discussion and my own experience is that things can be very different from area to area. In our area where there is a very large contingent on Medicare, doctors who don't take original Medicare are the rare exception. When I was on an ACA plan I lost my primary care physician but after going on Medicare I am again able to see him. Even a nationally renown facility accepted me for treatment of a very serious condition under traditional Medicare - not under assignment but my plan G supplement pics up 98% of the additional charges. They would not have treated me under any Medicare Advantage plan.
I wouldn't assume anything from reading about my or anyone else's individual experiences especially if they aren't in your immediate area. I also think it's unwise to assume that just because you've always been healthy that you'll always be healthy.
I think there is a big difference between not being treated at a specific facility/provider under a MA plan and not being treated at all for the condition. For example, our Medicare plan will not use a well renowned and very large hospital facility in the area for either hospitalization or surgery or treatments. They used to, but a few years ago dropped that large facility - and beefed up services at several other hospitals. At the participating hospital very close to where we live, there are dedicated wings for our MA as patients and dedicated plan Hospitalists on duty all the time.

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Re: What I spent in 6 months on medicare

Post by dennisbyron » Sat Jul 07, 2018 10:24 am

dm200 wrote:
Sat Jul 07, 2018 9:57 am
FrugalInvestor wrote:
Sat Jul 07, 2018 9:44 am
dm200 wrote:
Sat Jul 07, 2018 9:21 am
3. One more thing I can think of relative to "favorite doctor:" Increasingly (although still a small trend) and I believe mostly in the Northwest, some providers take only a public Part C Medicare health plan.
If I interpret this correctly - in this area, a great many Primary Care Physicians will not accept new Original medicare patients - BUT - many of these Physicians are part of Medicare Advantage plans - and will accept new MA patients.
They would not have treated me under any Medicare Advantage plan.
I wouldn't assume anything from reading about my or anyone else's individual experiences especially if they aren't in your immediate area.
I think there is a big difference between not being treated at a specific facility/provider under a MA plan and not being treated at all for the condition. For example, our Medicare plan will not use a well renowned and very large hospital facility in the area for either hospitalization or surgery or treatments. They used to, but a few years ago dropped that large facility - and beefed up services at several other hospitals. At the participating hospital very close to where we live, there are dedicated wings for our MA as patients and dedicated plan Hospitalists on duty all the time.
I don't think it has been mentioned anywhere in all these comments but there are three or more different types of public Part C plans, one of which is Medicare Advantage. In addition, there are at least five different types of Medicare Advantage plans (more depending on how you count the special deal for unions plans). That is the reason that some public Part C plans are very particular about going out of network and some are not, some are very picky about prior authorization and some are not, and so forth. Also the plan sponsors can change facilities and doctors at any time (a particular bad thing about Part C) although most wait until a new plan year.

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 10:30 am

I don't think it has been mentioned anywhere in all these comments but there are three or more different types of public Part C plans, one of which is Medicare Advantage. In addition, there are at least five different types of Medicare Advantage plans (more depending on how you count the special deal for unions plans). That is the reason that some public Part C plans are very particular about going out of network and some are not, some are very picky about prior authorization and some are not, and so forth. Also the plan sponsors can change facilities and doctors at any time (a particular bad thing about Part C) although most wait until a new plan year.
Good points.

What I also learned recently (from an acquaintence) is that some organizations (her case is public school system) do provide a degree of subsidy for health/medical for retirees - BUT only if the retiree enrolls in a chosen MA plan. Unlike almost all "regular" MA plans, these retiree subsidized plans often have small or no copays and a zero OOP maximum to meet. In her case, she has a good financial deal because she has many, serious medical conditions.

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Re: What I spent in 6 months on medicare

Post by coffeehubcap » Sat Jul 07, 2018 10:35 am

Two healthy people age 74....$22,000 out of pocket in 6 months. This is unreal.

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 11:05 am

coffeehubcap wrote:
Sat Jul 07, 2018 10:35 am
Two healthy people age 74....$22,000 out of pocket in 6 months. This is unreal.
How did you do that??

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Re: What I spent in 6 months on medicare

Post by dennisbyron » Sat Jul 07, 2018 11:11 am

dm200 wrote:
Sat Jul 07, 2018 10:30 am

What I also learned recently (from an acquaintence) is that some organizations (her case is public school system) do provide a degree of subsidy for health/medical for retirees - BUT only if the retiree enrolls in a chosen MA plan. Unlike almost all "regular" MA plans, these retiree subsidized plans often have small or no copays and a zero OOP maximum to meet. In her case, she has a good financial deal because she has many, serious medical conditions.
That might or might not be one of the special deal for unions plans but typically such plans -- called Eggwhips or Employer Group Waiver Plans -- are for people like trade union members who had multiple employers over the years as they moved from project to project. It is more likely just that the public school system decided that its retirement perk would be a particular amount of money (premium support) and then made a deal with a particular MA sponsor that the amount of money would cover almost the entire premium (but retirees would use the money also for more beneficial but more expensive plans and pay the difference)

I do not understand the wording "a zero OOP maximum to meet." No one HAS TO meet an OOP limit on a public Part C plan and of course everyone hopes they will not spend whatever their limit is, no matter how small it is (smallest I've heard of is $2400 in the last few years; was $1500 when I first joined). The advantage of the public Part C annual OOP spend limit is that in case of a dire medical situation, that is the most you will have to spend.

The vast majority of people spend no where near their OOP max; the most I can remember spending OOP over almost 10 years (not counting dental) is under $500 and that year involved biopsies, Pet scans and CAT scans and surgery and follow ups. I could have selected a more expensive Part C plan which would have reduced that to almost zero OOP or I could have selected a zero-premium Part C plan (an option that is also not mentioned in all these comments on this thread) but I would have spent $1000 out of pocket that year. Counting drugs (which are all generic), the average OOP a year for the two of us for almost 10 years is a few hundred bucks.

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Re: What I spent in 6 months on medicare

Post by Turbo29 » Sat Jul 07, 2018 11:34 am

dm200 wrote:
Sat Jul 07, 2018 10:30 am

Good points.

What I also learned recently (from an acquaintence) is that some organizations (her case is public school system) do provide a degree of subsidy for health/medical for retirees - BUT only if the retiree enrolls in a chosen MA plan. Unlike almost all "regular" MA plans, these retiree subsidized plans often have small or no copays and a zero OOP maximum to meet. In her case, she has a good financial deal because she has many, serious medical conditions.
An example for state and local employees covered by the Arizona State Retirement System

https://www.azasrs.gov/sites/default/fi ... eFinal.pdf

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Re: What I spent in 6 months on medicare

Post by jasg » Sat Jul 07, 2018 12:08 pm

JoinToday wrote:
Thu Jul 05, 2018 6:13 pm
$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:

That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
Wife and I have been on Medicare since 2014 - five years of Part B, MediGap F (high deductible) and Part D.

Combined six month premiums:

2014 - $2250
2018 - $2932

That is a 30% increase in just five years...

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dm200
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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 12:37 pm

dennisbyron wrote:
Sat Jul 07, 2018 11:11 am
dm200 wrote:
Sat Jul 07, 2018 10:30 am
What I also learned recently (from an acquaintence) is that some organizations (her case is public school system) do provide a degree of subsidy for health/medical for retirees - BUT only if the retiree enrolls in a chosen MA plan. Unlike almost all "regular" MA plans, these retiree subsidized plans often have small or no copays and a zero OOP maximum to meet. In her case, she has a good financial deal because she has many, serious medical conditions.
That might or might not be one of the special deal for unions plans but typically such plans -- called Eggwhips or Employer Group Waiver Plans -- are for people like trade union members who had multiple employers over the years as they moved from project to project. It is more likely just that the public school system decided that its retirement perk would be a particular amount of money (premium support) and then made a deal with a particular MA sponsor that the amount of money would cover almost the entire premium (but retirees would use the money also for more beneficial but more expensive plans and pay the difference)
I do not understand the wording "a zero OOP maximum to meet." No one HAS TO meet an OOP limit on a public Part C plan and of course everyone hopes they will not spend whatever their limit is, no matter how small it is (smallest I've heard of is $2400 in the last few years; was $1500 when I first joined). The advantage of the public Part C annual OOP spend limit is that in case of a dire medical situation, that is the most you will have to spend.
The vast majority of people spend no where near their OOP max; the most I can remember spending OOP over almost 10 years (not counting dental) is under $500 and that year involved biopsies, Pet scans and CAT scans and surgery and follow ups. I could have selected a more expensive Part C plan which would have reduced that to almost zero OOP or I could have selected a zero-premium Part C plan (an option that is also not mentioned in all these comments on this thread) but I would have spent $1000 out of pocket that year. Counting drugs (which are all generic), the average OOP a year for the two of us for almost 10 years is a few hundred bucks.
Yes - this is a plan for retirees of a very large, local county public school system. County retirees have a similar such plan. For very healthy retirees, they would be better off financially with their own "regular" MA plan - but for those (like our friend) with many conditions - it works out very well. These folks also would need to pay a lot more if they wanted Original medicare.

What I meant about OOP is that regular, purchased MA plans typically have a max annual OOP of several thousand dollars - mine is $6,000. In that plan, the max OOP annually is zero.
Last edited by dm200 on Sat Jul 07, 2018 12:43 pm, edited 1 time in total.

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 12:41 pm

jasg wrote:
Sat Jul 07, 2018 12:08 pm
JoinToday wrote:
Thu Jul 05, 2018 6:13 pm
$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:
That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
Wife and I have been on Medicare since 2014 - five years of Part B, MediGap F (high deductible) and Part D.
Combined six month premiums:
2014 - $2250
2018 - $2932
That is a 30% increase in just five years...
OK - $2932/6 = $489/month for both or $244 per person per month. You each would pay at least $134 for Part B - leaving $110 for Medigap AND Part D. Is that correct? Seems a bit low ?

2015
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Re: What I spent in 6 months on medicare

Post by 2015 » Sat Jul 07, 2018 12:51 pm

dm200 wrote:
Fri Jul 06, 2018 3:27 pm

But it all begins with "what does your favorite doctor take?"
Oh, yes - 6 months is a short time - but it is enlightening to me since my usage of my plan went up quite a bit - and I still see "reasonable" costs. This discussion has been very enlightening.

We did have to switch all of our doctors - BUT, on balance, all of the new ones are just as good better than the old ones (especially with 20/20 hindsight). Just my current opinion, but keeping favorite doctors is an overrated reason to pick a plan. In the last 7+ years on this plan, several physicians have retired. Still have my (now about 40) PCP - but turnover with all the specialists.
Couldn't agree more with your statement in bold. As one who has owned his own health care for well over 20 years, I don't and never will have a "favorite doctor". No health care provider is responsible for the quality of my healthspan and I take complete responsibility for it.

I view all health care providers as (very expensive) consultants who provide me with information on which I make decisions. Based on this model, when the elderly individual I mentioned above with a number of expensive, serious health conditions required a series of hospitalizations (and many other health care interventions), I owned the entire process. Under this MA plan, total costs were less than $1K for the entire year (excluding Part B premiums). Finally, as a result of conducting extensive research well in advance of when needed, the partnership with all providers has been exceptional resulting in optimal outcomes at each stage.

Edited to add: I am well aware that YMMV as health care, like investing, is highly individualistic.

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Re: What I spent in 6 months on medicare

Post by engineerartist » Sat Jul 07, 2018 12:58 pm

I retired August 1, 2014 and my wife and I started Medicare with a Medigap policy at that time.
I don't have a 6-month breakdown, but do have annual totals.
  • 2014 (5 months):
    provider charges - 21,095
    Medicare payments - 896
    Medicare premiums - 747
    Medigap payments - 450
    Medigap premiums - 2,102
  • 2015:
    provider charges - 245,251
    Medicare payments - 16,580
    Medicare premiums - 1,380
    Medigap payments - 2,456
    Medigap premiums - 3,654
  • 2016:
    provider charges - 518,589
    Medicare payments - 41,212
    Medicare premiums - 2,892
    Medigap payments - 5,373
    Medigap premiums - 3,833
  • 2017:
    provider charges - 27,373
    Medicare payments - 2,765
    Medicare premiums - 2,892
    Medigap payments - 953
    Medigap premiums - 4,060
  • 2018 (5 months):
    provider charges - 16,157
    Medicare payments - 1,127
    Medicare premiums - 1,608
    Medigap payments - 630
    Medigap premiums - 1,748
In summary, for the 4 years, our total provider charges (not including prescriptions) was $828,465,
while the discounted amount actually paid by Medicare and Medigap combined was $72,451.
The combined Medicare/Medigap payments to providers were only 9% of the provider charges.
This is a real-life example of Medicare reducing the cost of treatment.

Our total premiums paid was $24,916 (no co-pays).
Our premiums were only 34% of the actual payments - but only 3% of the provider charges!

Yes, comparing the payments by our Medigap insurer ($9,871) to our premiums ($15,397), you could conclude that we have overpaid for our coverage (Medigap Plan F), but I prefer the simplicity and consistency over the alternatives.

Just a reminder that the cost of insurance must be weighed against the risks being covered.

Also - a big Thank You to those of you still contributing to Medicare...
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dm200
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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 1:03 pm

2015 wrote:
Sat Jul 07, 2018 12:51 pm
dm200 wrote:
Fri Jul 06, 2018 3:27 pm
But it all begins with "what does your favorite doctor take?"
Oh, yes - 6 months is a short time - but it is enlightening to me since my usage of my plan went up quite a bit - and I still see "reasonable" costs. This discussion has been very enlightening.
We did have to switch all of our doctors - BUT, on balance, all of the new ones are just as good better than the old ones (especially with 20/20 hindsight). Just my current opinion, but keeping favorite doctors is an overrated reason to pick a plan. In the last 7+ years on this plan, several physicians have retired. Still have my (now about 40) PCP - but turnover with all the specialists.
Couldn't agree more with your statement in bold. As one who has owned his own health care for well over 20 years, I don't and never will have a "favorite doctor". No health care provider is responsible for the quality of my healthspan and I take complete responsibility for it.
I view all health care providers as (very expensive) consultants who provide me with information on which I make decisions. Based on this model, when the elderly individual I mentioned above with a number of expensive, serious health conditions required a series of hospitalizations (and many other health care interventions), I owned the entire process. Under this MA plan, total costs were less than $1K for the entire year (excluding Part B premiums). Finally, as a result of conducting extensive research well in advance of when needed, the partnership with all providers has been exceptional resulting in optimal outcomes at each stage.
Edited to add: I am well aware that YMMV as health care, like investing, is highly individualistic.
I am very, very happy with my PCP for the last seven years. We get along very well - and she is cooperative with my "diligence" in following every test, every situation - in great detail. In fact, at the end of discussions at office visots, she typically asks, "What do you think about that?" In my plan, though, I am convinced there are many other Primary care physicians where I would also be very happy. I also think there are a few with whom I would not be fully satisfied. In my plan, we can switch PCPs instantly for any or no reason. Online, from time to time as well - I look at the names and profiles of available PCPs if/when I need to find a new one. I have also seen two other PCPs when mine is away on vacation.

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Re: What I spent in 6 months on medicare

Post by jebmke » Sat Jul 07, 2018 1:06 pm

Total including $183 deductible for "G" plan: $2,319; this covers B, D and supplemental (G) plus IRMAAs on B and D.

Dental and Eye care will be out of pocket. Last eye exam was $90 -- usually more but for some reason some was covered by Medicare

Dental is about $300 a year unless there is work to be done. Then there is no limit - implants can be thousands. I have a barebones Rx plan so I'm exposed on the upside there but I don't currently use any Rx.
When you discover that you are riding a dead horse, the best strategy is to dismount.

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 1:07 pm

Yes, comparing the payments by our Medigap insurer ($9,871) to our premiums ($15,397), you could conclude that we have overpaid for our coverage (Medigap Plan F), but I prefer the simplicity and consistency over the alternatives.
Just a reminder that the cost of insurance must be weighed against the risks being covered.
Also - a big Thank You to those of you still contributing to Medicare...
Yes - "simplicity" certainly has "value".

I would counter, however, that many MA plans are often (not always) the "simplest". I know our plan is extremely simple to use and get the benefits.

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Re: What I spent in 6 months on medicare

Post by mickeyd » Sat Jul 07, 2018 1:25 pm

DW and I are fortunate enough to be covered by Medicare/Tricare and our entire medical cost is only what is deducted from our SSA each month ($134?). Thank goodness the military (really we generous taxpayers) picks up the tab for all meds, labs etc. and requires no co-pay.

Knowing that our medical expenses will be fairly level in the years to come is a great benefit.
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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 1:30 pm

mickeyd wrote:
Sat Jul 07, 2018 1:25 pm
DW and I are fortunate enough to be covered by Medicare/Tricare and our entire medical cost is only what is deducted from our SSA each month ($134?). Thank goodness the military (really we generous taxpayers) picks up the tab for all meds, labs etc. and requires no co-pay.
Knowing that our medical expenses will be fairly level in the years to come is a great benefit.
Yes - a great financial benefit as well as "peace of mind". This is a part of "total compensation" that everyine involved should know rhw value of.

This used to be very common for government/military and Megacorp retirees. It is almost completely gone from the private sector "(

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Re: What I spent in 6 months on medicare

Post by marcopolo » Sat Jul 07, 2018 1:42 pm

engineerartist wrote:
Sat Jul 07, 2018 12:58 pm

In summary, for the 4 years, our total provider charges (not including prescriptions) was $828,465,
while the discounted amount actually paid by Medicare and Medigap combined was $72,451.
The combined Medicare/Medigap payments to providers were only 9% of the provider charges.
This is a real-life example of Medicare reducing the cost of treatment.
I am not sure how much of the reduction can be attributed to Medicare. I think you would need to compare what Medicare paid to what a sizeable insurance company, or HMO would pay for the same procedure.

As far as I can tell, the provider charges might as well be from a random number generator. Does anyone actually ever pay those amounts? There also does not seem to be any correlation between them and what is actually paid. For some charges, the insurance might pay close to 100%, and for others, the insurance might pay less than 10%.
Once in a while you get shown the light, in the strangest of places if you look at it right.

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Re: What I spent in 6 months on medicare

Post by jasg » Sat Jul 07, 2018 2:23 pm

dm200 wrote:
Sat Jul 07, 2018 12:41 pm
jasg wrote:
Sat Jul 07, 2018 12:08 pm
JoinToday wrote:
Thu Jul 05, 2018 6:13 pm
$2K in 6 months? x2 for husband & wife, approx x2 for whole year. $8K. Wow. :shock:
That is a line item in the budget that I didn't expect. I didn't realize it was so expensive.
Wife and I have been on Medicare since 2014 - five years of Part B, MediGap F (high deductible) and Part D.
Combined six month premiums:
2014 - $2250
2018 - $2932
That is a 30% increase in just five years...
OK - $2932/6 = $489/month for both or $244 per person per month. You each would pay at least $134 for Part B - leaving $110 for Medigap AND Part D. Is that correct? Seems a bit low ?
High deductible F + cheap Humana Part D

2014 - $70 + 12.60
2018 - $89 + 20.40

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Re: What I spent in 6 months on medicare

Post by jebmke » Sat Jul 07, 2018 2:30 pm

^ that looks about right. High F is ~60 if I chose that and cheapest D is about $12-13. Have seen High F under $50 but not any of the major insurers. This is for Maryland.
When you discover that you are riding a dead horse, the best strategy is to dismount.

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Re: What I spent in 6 months on medicare

Post by dm200 » Sat Jul 07, 2018 2:33 pm

marcopolo wrote:
Sat Jul 07, 2018 1:42 pm
engineerartist wrote:
Sat Jul 07, 2018 12:58 pm
In summary, for the 4 years, our total provider charges (not including prescriptions) was $828,465,
while the discounted amount actually paid by Medicare and Medigap combined was $72,451.
The combined Medicare/Medigap payments to providers were only 9% of the provider charges.
This is a real-life example of Medicare reducing the cost of treatment.
I am not sure how much of the reduction can be attributed to Medicare. I think you would need to compare what Medicare paid to what a sizeable insurance company, or HMO would pay for the same procedure.
As far as I can tell, the provider charges might as well be from a random number generator. Does anyone actually ever pay those amounts? There also does not seem to be any correlation between them and what is actually paid. For some charges, the insurance might pay close to 100%, and for others, the insurance might pay less than 10%.
Very confusing indeed!
On my plan, I rarely see the EOB or details - unless I look online for them - usually just pay the copay at the time or get a bill.
For a lot of stuff in the first 6 months, I paid (copays) $880. I went through all the detailed charges for everything (including things like lab tests where I pay nothing) and totaled up:
Total Charges: $11, 605
Plan Covers: $9,555

again - for the first 6 months of 2018.

About $5,000 of the "total" was for outpatient surgery - for which I paid total of $250.

Most of the remaining "total" was for lots of tests, xrays, etc. for a condiiton they are monitoring - for which I only pay $20 for X-Ray and ultrasounds.

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