Trying to provide information/advice concerning Medicare choices

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dm200
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Trying to provide information/advice concerning Medicare choices

Post by dm200 » Mon Dec 02, 2019 1:29 pm

Without getting into the Medicare Advantage discussion/debate - I find that friends/acquaintances with the same Medicare Advantage provider (Kaiser) seem to choose the more expensive plans and options - even when (it seems clear to me) that, for them, they seem to be paying much more in the monthly premium than they are likely to receive in lower costs for copays, scans, hospitalization, etc.

There seems to be a "mentality" that spending more for monthly premiums (sometimes a lot more) is always "better". This "mentality" seems to be true - whether the person is lower income/asset, middle income/asset or high income/asset. Also, the potential financial risks of the lower cost monthly premium is only for up to a year (commonly less)- since the plan/option can be changed during the annual "open enrollment" window. Often, these are seemingly well educated and informed folks. I might better understand if they were subjects of a "hard sell" - but there do not seems to be Kaiser folks that do any such "hard sell".

They seem to not ask or think about the first question I ask myself when reviewing choices: "What exactly do I get by paying more?" and the followup: "How likely am I to need, want or use that?" . Also, the very related (in my opinion) : "If I do not choose to pay more, how likely is it that I am actually significantly financially impacted?"

I don't know what my wife would choose if completely "on her own", but we are now facing several plan/options with our Kaiser Medicare. The monthly premiums vary from ZERO to about $200. After considerable discussion with me, my wife chose the ZERO premium. She narrowed it down to either $25 or zero - then after weighing spending $300 per year on premiums vs. the added copays/scan costs/etc. - she decided that she could financially handle such costs if she had a lot of such needs AND that she would probably spend less than $300 extra in the next year.

In my case, I judged/estimated that I was somewhat more likely to spend over $300 extra next year if I chose zero. So, I chose the $25 per month premium. Then, there is a $25 per month option for much better dental benefits, eyeglasses added discount and hearing aid discount. Because of my dental needs and expected dental work, I chose to add the $25 - making a total of $50/month premium.

To summarize, I am so puzzled and perplexed that so many folks do not (or cannot?) do such a basic analysis of what you get for paying ore - and how great or small are your financial risks.

In general discussions with such folks, they mention that they are paying from $100 to $200 or so per month for their Kaiser Medicare - but don't seem to have a clue about what they get for this $100 - $200 per month vs. what I pay and get. They don't seem to understand or care! Then I "back off".

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Re: Trying to provide information/advice concerning Medicare choices

Post by Shallowpockets » Mon Dec 02, 2019 1:36 pm

I am in the zero extra money also. I figure like you do. What is the cost versus what I might utilize.
AND, here is the thing. You can change it up in a year if you want. So you don’t have to gauge it as a lifetime commitment.

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dm200
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Re: Trying to provide information/advice concerning Medicare choices

Post by dm200 » Mon Dec 02, 2019 1:54 pm

Shallowpockets wrote:
Mon Dec 02, 2019 1:36 pm
I am in the zero extra money also. I figure like you do. What is the cost versus what I might utilize.
AND, here is the thing. You can change it up in a year if you want. So you don’t have to gauge it as a lifetime commitment.
What is there, though, about this concept that so many folks do not get? Why do so many seem to believe that paying more is almost always better?

Depending on all the details and my situation, I fully review my coverage and cost choices every year.

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Svensk Anga
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Re: Trying to provide information/advice concerning Medicare choices

Post by Svensk Anga » Mon Dec 02, 2019 5:45 pm

A large segment of the population is math-phobic. They would not have a clue how to go about evaluating the cost/risk trade-off.

Also, it has been drilled into folks' consciousness that healthcare in this country is crazy expensive. From this they extrapolate that they ought to protect themselves with the very best insurance. Also a payment focused mentality makes a high but consistent monthly premium preferable to small premium plus random chance of large expenses. Even if there is little chance of the small premium plus large expenses exceeding the sum of the higher monthly premiums for top notch insurance.

Me, I jumped on the opportunity to elect a high deductible health plan when it was first offered for myself and my kids. I knew we were minimal users of health care and my employer made the HDHP very attractive. But I can do the math and have the means to take the risk.

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Re: Trying to provide information/advice concerning Medicare choices

Post by RickBoglehead » Mon Dec 02, 2019 8:56 pm

In addition, many are simply not smart enough to figure this kind of stuff out.
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Re: Trying to provide information/advice concerning Medicare choices

Post by rockylou » Mon Dec 02, 2019 9:13 pm

My husband is on supplemental plan F, the most expensive option. He has had prostate cancer but is otherwise healthy and on no prescriptions. I understood that if he moved to a lower cost plan that he would not be able to go back to that plan/option, even during open enrollment. Does this depend on what State someone lives in?

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Re: Trying to provide information/advice concerning Medicare choices

Post by dwickenh » Mon Dec 02, 2019 10:32 pm

rockylou wrote:
Mon Dec 02, 2019 9:13 pm
My husband is on supplemental plan F, the most expensive option. He has had prostate cancer but is otherwise healthy and on no prescriptions. I understood that if he moved to a lower cost plan that he would not be able to go back to that plan/option, even during open enrollment. Does this depend on what State someone lives in?
Some states guarantee the ability to join a medigap plan with pre-existing conditions. I am not sure that would include Plan F as it is
being phased out for new enrollment.

This article may help: https://www.kff.org/medicare/issue-brie ... ss-states/


"Only 4 states (CT, MA, ME, NY) have guaranteed issue protections for Medigap either continuously or annually, for all Medicare beneficiaries ages 65 and older"
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Re: Trying to provide information/advice concerning Medicare choices

Post by drawpoker » Tue Dec 03, 2019 12:32 am

dwickenh wrote:
Mon Dec 02, 2019 10:32 pm
"Only 4 states (CT, MA, ME, NY) have guaranteed issue protections for Medigap either continuously or annually, for all Medicare beneficiaries ages 65 and older"
To be absolutely accurate - Calif and Oregon have what is called the "birthday" rule.

Someone on a Medicare supplement plan may, once a year on birthday, downgrade from present plan to a another plan with lesser benefits without medical underwriting, i.e., going from "F" to "G", for ex. Or "G" to "N".

Note, however, the catch is - they are allowed to switch to a downgrade with no underwriting. The law does not provide for people to go upwards; that depends on the indiv. insurer and present health of applicant.

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Re: Trying to provide information/advice concerning Medicare choices

Post by celia » Tue Dec 03, 2019 1:06 am

dm200 wrote:
Mon Dec 02, 2019 1:29 pm
Without getting into the Medicare Advantage discussion/debate - I find that friends/acquaintances with the same Medicare Advantage provider (Kaiser) seem to choose the more expensive plans and options - even when (it seems clear to me) that, for them, they seem to be paying much more in the monthly premium than they are likely to receive in lower costs for copays, scans, hospitalization, etc.

There seems to be a "mentality" that ....
This thread started by talking about the Medicare Advantage plans (which are usually HMOs).
rockylou wrote:
Mon Dec 02, 2019 9:13 pm
My husband is on supplemental plan F, the most expensive option. He has had prostate cancer but is otherwise healthy and on no prescriptions. I understood that if he moved to a lower cost plan that he would not be able to go back to that plan/option, even during open enrollment. Does this depend on what State someone lives in?
... then this post morphed into the Medigap plans, which are different than the Medicare Advantage plans. Many of the same points apply to people not knowing why they choose what they choose, but for the Medigap plans, Plan F is the most advantageous and historically had the most enrollees. In recent years, Plan G started up which has the same comprehensive coverage except that there is a deductible each year. I don't know anything about the differences in Medicare Advantage plans.

OP, Did your point apply to just Medicare Advantage plans or are you looking at all options for those over 65?

I recently read that about 1/3 of seniors choose a Medicare Advantage plan, about 1/3 choose a Medigap plan, and another 1/3 stay on an employer plan.

I also think that if someone is willing to spend $200 a month on health care premiums, why not choose the Medigap plan that meets your needs so you can go to any place that is contracted with Medicare instead of limiting yourself to one HMO?

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Re: Trying to provide information/advice concerning Medicare choices

Post by drawpoker » Tue Dec 03, 2019 1:35 am

celia wrote:
Tue Dec 03, 2019 1:06 am

This thread started by talking about the Medicare Advantage plans (which are usually HMOs)....
... then this post morphed into the Medigap plans, which are different than the Medicare Advantage plans.....
Yup. Then, it veered off into posts not having one whit to do with Medicare insurance - just general health insurance for young'uns :o

Um, seems like old times, doesn't it. Happens every time a Medicare thread gets started.

[quote="Svensk Anga"
"Me, I jumped on the opportunity to elect a high deductible health plan when it was first offered for myself and my kids. I knew we were minimal users of health care and my employer made the HDHP very attractive."

:oops:

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Re: Trying to provide information/advice concerning Medicare choices

Post by oldcomputerguy » Tue Dec 03, 2019 7:17 am

This topic is now in the Personal Finance forum (insurance issue). Please keep replies centered on the OP's subject (cost and benefit analysis).
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Re: Trying to provide information/advice concerning Medicare choices

Post by andypanda » Tue Dec 03, 2019 8:58 am

" I fully review my coverage and cost choices every year."

I see these types of topics discussed frequently and I feel so lucky that I don't have to shop for insurance every year. I've felt this way since I retired in 2012. Maybe some folks prefer paying the extra $100 or $200 per month instead of using some of their remaining time making spreadsheets of plan benefits and costs.

I'm a government retiree on Medicare and I am forced to use the retirement system's Medicare coordinating plan at $294 per month. It's Anthem fwiw. If I drop it I lose the health care insurance benefit forever. I suppose I could save a few dollars by dropping the dental/vision coverage, but what the heck. It's only money. :)

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Re: Trying to provide information/advice concerning Medicare choices

Post by Nowizard » Tue Dec 03, 2019 9:08 am

The simplest approach is to go to medicare site, enter your meds and compare rates. Though there may be as many as 30 plans for Part D and a similar number of Advantage plans, the site is reasonably easy to negotiate. If they are computer averse, sit with them. We know the comparison of more coverage but fewer providers with the Advantage plan, so consideration of what is important should be made. A friend who has a relative who advises regarding plans suggested he use an Advantage plan when purchasing hearing aids and then switch to a standard B and D plan, for example. Similarly, a switch from Advantage to standard Medicare plans saved a relative over $2,000 based on expensive medications being taken. One will not know which is best without comparing and doing so as health issues change.

Tim

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Re: Trying to provide information/advice concerning Medicare choices

Post by dm200 » Tue Dec 03, 2019 12:43 pm

andypanda wrote:
Tue Dec 03, 2019 8:58 am
" I fully review my coverage and cost choices every year."
I see these types of topics discussed frequently and I feel so lucky that I don't have to shop for insurance every year. I've felt this way since I retired in 2012. Maybe some folks prefer paying the extra $100 or $200 per month instead of using some of their remaining time making spreadsheets of plan benefits and costs.
I'm a government retiree on Medicare and I am forced to use the retirement system's Medicare coordinating plan at $294 per month. It's Anthem fwiw. If I drop it I lose the health care insurance benefit forever. I suppose I could save a few dollars by dropping the dental/vision coverage, but what the heck. It's only money. :)
We do not "shop" every year, but within our Medicare plan, we have choices every year of options/levels of coverage.

Are you a federal government retiree or a state/local government retiree? Your case (paying $294 per month) I think illustrates one aspect of what I am talking about. What, exactly, benefit(s) do you get for this (to me) large monthly amount? On top of that, what exactly do you receive (over a normal Medicare recipient) as a government retiree? Do you pay for Medicare part B? On the surface, it looks to me that you may be paying more for your supposedly government subsidized Medicare benefits than I pay as a regular, vanilla Medicare Advantage enrollee. I find so many Medicare enrolees that seem to have never asked/answered what, exactly, they get for what they pay and/or if a retiree with added retiree health/medical benefits - what, exactly do I get and how much do I pay? Some (perhaps many) to me seem to be paying MORE in premiums/copays for LESS healthcare benefits. Or, optionally paying for things they are very, very unlikely to use - and which they could handle themselves.

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Re: Trying to provide information/advice concerning Medicare choices

Post by andypanda » Tue Dec 03, 2019 3:26 pm

State.

"What, exactly, benefit(s) do you get for this (to me) large monthly amount? "

Uh, I get to keep my eligibility for retiree insurance, come what may. It's the same Anthem plan I had as an employee except Medicare pays first. I pay for Medicare Part B and this is the supplemental coordinating plan with Part D. I could get the same insurance for less if I drop dental and vision.

I had bilateral cataract surgery last year at a well-known eye institute and it cost about $200, or whatever the Medicare yearly deductible was that year. I haven't used the insurance much, but the few prescriptions I've needed were inexpensive.

Looking at the cost. My wife retired a month ago from the state. She won't be 65 until April, so she has to pay the entire bill every month for her health insurance. The cost is $850 a month. It's the same plan she had, that I have, etc. I've been through this. I retired at 62 in 2012 and had to pay the full premium for 3 years, but back then it was only $650. The state does pay a monthly supplement in your retirement check based on years of service... $4/month for every year of service. 30 years = $120/month. Fwiw, I had 38 years. :)

It's just money and I don't expect anything for free. I don't think I'm paying very much compared to a lot of my friends. According to my self employed buddies buying individual/family plans, I'm paying peanuts. Good thing I started buying stock in the '60s and living reasonably. My last car payment was in 1986 and I've always purchased new cars. My home was paid off in '97.

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Re: Trying to provide information/advice concerning Medicare choices

Post by dm200 » Wed Dec 04, 2019 10:31 am

State.
"What, exactly, benefit(s) do you get for this (to me) large monthly amount? "
Yes - simple and logical question to me - but many folks seem to think and believe: 1. They are much safer (lower financial risk) by paying more; and 2. If I pay more, I MUST be getting real benefits.

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