What I spent in 6 months on medicare

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Broken Man 1999
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Re: What we spent in 12 months on medicare

Post by Broken Man 1999 » Mon Jan 13, 2020 5:08 pm

dm200 wrote:
Mon Jan 13, 2020 4:46 pm
Broken Man 1999 wrote:
Mon Jan 13, 2020 3:01 pm
2019 Medical/Pharmacy Expenses for Broken Man 1999 and Mrs. Broken Man 1999
DW and I both on Medicare Advantage Plan PPO via Humana, courtesy of MegaCorp retiree insurance.
01/01/2019 through 12/31/2019

Medicare Part B $135.50 x 2 retirees x 12 months = $3,252.00
DW Medical claims out of pocket = $2,327.79
DW pharmacy claims out of pocket = $64.72
MY medical claims out of pocket = $368.44
MY pharmacy claims out of pocket = $352.18
Total out of pocket for 12 months = $6,365.13
Total average monthly out of pocket = $530.42
Other than the Medicare Part B premium, the largest out of pocket for 2019 was wife's share of knee replacement, and co-pays for many, many PT sessions to regain her range/motion. She worked very hard, and the results are very good.
2020 Events/Opportunities
DW has scheduled her other knee replacement for June of this year. Some of the durable medical equipment she purchased for first knee can be reused.
It is likely my pharmacy expenses will decline as one of my non-generic drugs is my fast-acting insulin. However, there is a generic option working through the various Humana plans. Usually 90 day supplies of generics are free. Currently my fast-acting insulin is $40/90 day supply. It is very affordable, but free would be even better.
We are both very appreciative of MegaCorp's continued support of excellent and affordable insurance plans ($0 premiums for our plan) for retirees. How long that support remains is unknown, but we are good until the end of 2020, at least.
Broken Man 1999
Very informative - in my opinion.
Any idea how much MegaCorp's contribution saves you both per month? You also have a potential benefit of a PPO Advantage plan - if that might be better for you.
Such retiree support after Medicare eligibility has nearly gone away in the private sector. Seems to me that yours could go away at any time. A few years ago, a friend of ours retired from a MegaCorp about when she became Medicare eligible. This Megacorp once was known for providing outstanding benefits - including health/medical for retirees - including those on Medicare. It turned out that this MegaCorp terminated all health/medical benefits for retirees eligible for medicare within a month or so of when our friend retired! So, now, she has Kaiser medicare - paying the same as if she never worked for that megaCorp.
In our Kaiser Medicare plans, first tier generics are zero $$ for refills by mail. I have one of these and DW has one.
Your plan seems very good for part D drugs!
As of now (age 74), I have no knee or hip issues/problems, and I hope it stays that way. My wife (now age 69), however, does seem to be having some joint issues. It sure seems like we know so many folks getting/needing hip or knee replacements.

I don't know about your Humana Advantage plan, but our annual out of pocket maximum (does not count part D drugs) is $6,700. While DW and I have never even come close to this amount, I understand that if we needed Chemotherapy - it might be easy to hit that several years in a row. I understand this financial risk of a Medicare Advantage plan. What I hope and expect is that the yearly savings, so far, we get on our MA plans will offset possible large annual expenses for such things as Chemotherapy.
Our plan iS a PPO, Humana Medicare Advantage PPO.

No idea what MegaCorp pays for our coverage, but we are near a major metro area, and pretty much all the Medicare Advantage PPO plans are reasonable. So, I'm really not too worried about the possibility I might lose coverage provided by MegaCorp. Every year MegaCorp pays is one less year I have to pay.

Our max OOP is $3,000 each, and we have no deductibles, so Humana starts paying immediately. Doctor visit $5.00, specialist visit $20.00.

I'm happy, no reason not to be. Life is good.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

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dm200
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Re: What I spent in 6 months on medicare

Post by dm200 » Tue Jan 14, 2020 9:46 am

Our plan iS a PPO, Humana Medicare Advantage PPO.
No idea what MegaCorp pays for our coverage, but we are near a major metro area, and pretty much all the Medicare Advantage PPO plans are reasonable. So, I'm really not too worried about the possibility I might lose coverage provided by MegaCorp. Every year MegaCorp pays is one less year I have to pay.
Our max OOP is $3,000 each, and we have no deductibles, so Humana starts paying immediately. Doctor visit $5.00, specialist visit $20.00.
I'm happy, no reason not to be. Life is good.
Our Kaiser Medicare Advantage plan also has no deductibles either.

A Max OOP of $3,000 per year is very good! Ours is $6,700.

Leroy Jones
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Re: What I spent in 6 months on medicare

Post by Leroy Jones » Tue Jan 14, 2020 10:17 am

2019 was our first full year on Medicare for the whole year. Total cost for two people for Medicare Premiums, drugs, doctor visits, heart surgery (ablation), no cost advantage plan with drug coverage was $5962.63. or $496.89 per month. So far we are very pleased. Gross cost for the ablation procedure was in the neighborhood of $122,000 my cost was $450. Maximum oop is $6700 each.
Leroy Jones :sharebeer

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dm200
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Re: What I spent in 6 months on medicare

Post by dm200 » Tue Jan 14, 2020 11:29 am

Leroy Jones wrote:
Tue Jan 14, 2020 10:17 am
2019 was our first full year on Medicare for the whole year. Total cost for two people for Medicare Premiums, drugs, doctor visits, heart surgery (ablation), no cost advantage plan with drug coverage was $5962.63. or $496.89 per month. So far we are very pleased. Gross cost for the ablation procedure was in the neighborhood of $122,000 my cost was $450. Maximum oop is $6700 each.
Leroy Jones :sharebeer
Glad it is working out well for you.

There are a lot of interesting videos on Youtube about many aspects of Medicare - I try to stay informed. Of course, it seems to me that many (perhaps most) are not 100% "objective" - often trying to sell something - like Medigap policies.

I keep hoping that the various folks in charge in the US can and will get a handle on these huge expenditures for medical care - and there seem to be some very small steps in that direction. BUT I don't see anyone with a "successful" plan. Although many folks, politicians, etc. want to blame this or that aspect of health insurance and medical care - my opinion is that the causes are many - from physicians practicing "defensive" medicine, to overuse by individuals, to fraud by some providers, to drug companies pushing expensive and sometimes unneeded drugs - and so on.

I actually try to do things to avoid overuse of medical services. However, I find that a huge challenge! How do I know if I really need that expensive CT scan or MRI? How do I know if there is just as effective prescription drug at a fraction of the price?

Most of the Youtube videos on Medicare seem to grealy favor original Medicare with a medigap plan and are against medicare advantage plans. Here is a video by a doctor about the medical benefits of an MA plan: https://youtu.be/sij3XBhu1Ps

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