Medical Insurance

[Luanne]

This is a supplement plan through my state retirement system. I should mention that all the expenses I mentioned above is for both my wife and I.

That still sounds high per month even if it's for you and your wife. Dh and I pay somewhere around $300/month for the two of us. We both have Plan F supplemental plans.

 

[rapmarks]

We are on state plan and pay just About $575 a month each for Medicare and supplement and surcharge for part D

 

[VacationForever]

That still sounds high per month even if it's for you and your wife. Dh and I pay somewhere around $300/month for the two of us. We both have Plan F supplemental plans.

I think some Supplement plans are age-based. If so, the rates would go up with age.
https://www.medicare.gov/find-a-plan/staticpages/learn/how-insurance-companies-price-policies.aspx

 

[Luanne]

I think some Supplement plans are age-based. If so, the rates would go up with age.
https://www.medicare.gov/find-a-plan/staticpages/learn/how-insurance-companies-price-policies.aspx

That still sounds expensive.

 

[geekette]

Are Medicare supplements state-based? That might explain cost differences. "Reasonable and customary" costs will vary by area so I would expect insurers to cover their butts per territory. Insurers are not obligated to cover every area so I would expect they cover the profitable ones and make sure of their profit ahead of your ability to afford care.

 

[PamMo]

Can I make you feel better if I tell you we (DH and I) pay $2,200/mo for a plan that covers two annual physicals? Otherwise, we pay all medical costs up to $6,500 each, before any coverage kicks in.

 

[bogey21]

We both have Plan F supplemental plans.

If you are healthy, you might consider a High Deductible Plan F. Mine is way less costly than the regular Plan F and is identical except that it has a deductible of about $1,800. I have had mine for about 5 years and the most I have ever had to cover is around $400. Divide that by 12 and compare to the monthly premium differential and I have saved a ton of money...

George

 

[WinniWoman]

My friends in their mid and late 80's pay $600 per month for the two of them plan F and Part D.

 

[simpsontruckdriver]

As a Florida Licensed Health Insurance Agent, there are 3 options: Medicare Paid-Fee-For-Service (aka "basic Medicare"), Medicare Supplement (high premiums), or Medicare Advantage HMO (zero or low premiums), all available at 64 yrs 9 months, or 24 months after beginning Social Security Disability Income (aka "Disability"). What sucks is I knew a truck driver who had Medicare in Mt Shasta California. But, every single Medicare Advantage plan pulled out, the only things he has available is a supplement, which is both expensive AND they're subject to underwriting (pre-existing conditions). But, here in the Orlando area, most MAPDs premiums less than $10/month with low copays and $5000-7000 max out-of-pocket.

TS

 

[Luanne]

If you are healthy, you might consider a High Deductible Plan F. Mine is way less costly than the regular Plan F and is identical except that it has a deductible of about $1,800. I have had mine for about 5 years and the most I have ever had to cover is around $400. Divide that by 12 and compare to the monthly premium differential and I have saved a ton of money...

George

Out of curiosity, what is your premium for the High Deductible Plan F?

 

[rapmarks]

I don’t think $1800 is high deductible.

 

[clifffaith]

Cliff is very happy with his Medicare HMO through Healthnet. He had Healthnet before he retired and it was a seamless transition using his same Doctor. Just last year they started wanting an extra $20 per month (not sure why) so when I get a bill I pay for three months at a time. Healthnet is the same HMO I had for about 30 years until he retired and they had an opportunity to kick me and my migraines (now happily post menopausal vanished) to the curb. But if they'll have me back when I am Medicare worthy, I suppose they'd be my first choice. Big question will be which plan will allow me to stick with the back/pain Doctor (assuming we still live here), which plan is available in San Diego County, and what our situation looks like as far as actually moving to Carlsbad (we expect to be at the top of the CCRC waitlist right about the time I'm of Medicare age). If my mom needs or wants to move in with us here we have plenty of room, so we'd stay put for a while.

 

[Luanne]

Cliff is very happy with his Medicare HMO through Healthnet. He had Healthnet before he retired and it was a seamless transition using his same Doctor. Just last year they started wanting an extra $20 per month (not sure why) so when I get a bill I pay for three months at a time. Healthnet is the same HMO I had for about 30 years until he retired and they had an opportunity to kick me and my migraines (now happily post menopausal vanished) to the curb. But if they'll have me back when I am Medicare worthy, I suppose they'd be my first choice. Big question will be which plan will allow me to stick with the back/pain Doctor (assuming we still live here), which plan is available in San Diego County, and what our situation looks like as far as actually moving to Carlsbad (we expect to be at the top of the CCRC waitlist right about the time I'm of Medicare age). If my mom needs or wants to move in with us here we have plenty of room, so we'd stay put for a while.

I have a question about a Medicare HMO. Since, to my understanding, an HMO is kind of a closed network, what happens if Cliff has to go out of network, or needs medical care when he is out of state?

As to your other questions, and I can only go by my experience, you need to check with YOUR doctor to see what his policy is about Medicare patients. Some doctors will accept new Medicare patients, some won't. Some will let current patients who go on Medicare remain as their patient. For the Supplemental plans they are accepted by ANY doctor who accepts Medicare patients. What dh and I both did was decide which Supplemental plan we wanted, then search for the cost of the lowest provider.

 

[clifffaith]

I have a question about a Medicare HMO. Since, to my understanding, an HMO is kind of a closed network, what happens if Cliff has to go out of network, or needs medical care when he is out of state?

As to your other questions, and I can only go by my experience, you need to check with YOUR doctor to see what his policy is about Medicare patients. Some doctors will accept new Medicare patients, some won't. Some will let current patients who go on Medicare remain as their patient. For the Supplemental plans they are accepted by ANY doctor who accepts Medicare patients. What dh and I both did was decide which Supplemental plan we wanted, then search for the cost of the lowest provider.

Luckily for 80 years old he is healthy as a horse, rarely even getting a cold and then it only lasts two days. We have always been happy with the doctors we've seen with the HMO (20 years with our current GP). My (I'm sure naive) feeling is that anyone he needs to see will be in network, and if we had to and thought we needed to we could go out of our own pocket for a second opinion. I think out-of-state medical is a crap shoot no matter what. If he thinks he's broken a wrist in a fall, I assume we'd call the phone number on the back of his card and find out where to go. In an emergency I think he'd be covered, and in any case I'd whip out the credit card and notify his insurance as soon as I could.

Good point about whether my back doctor would even still want to see me as a medicare patient. Given what a hard time my insurance first gave him, and that he basically worked for free during 2017, I don't think it will be an issue. I have a big note on this year's calendar that I can enroll in Medicare in Feb 2020 to start in Dec 2020, so I hope to have time to figure out my options before they kick in.

 

[Luanne]

Good point about whether my back doctor would even still want to see me as a medicare patient. Given what a hard time my insurance first gave him, and that he basically worked for free during 2017, I don't think it will be an issue. I have a big note on this year's calendar that I can enroll in Medicare in Feb 2020 to start in Dec 2020, so I hope to have time to figure out my options before they kick in.

When we moved to New Mexico dh was Medicare eligible, I wasn't yet. Our primary care physician was accept new Medicare patients so we both went with him. I started with an OB/GYN a few months before I became Medicare eligible. She was not accepting new Medicare patients, but if you were an existing patient she would continue to see you when you got to Medicare age.

 

[VacationForever]

I have a question about a Medicare HMO. Since, to my understanding, an HMO is kind of a closed network, what happens if Cliff has to go out of network, or needs medical care when he is out of state?

As to your other questions, and I can only go by my experience, you need to check with YOUR doctor to see what his policy is about Medicare patients. Some doctors will accept new Medicare patients, some won't. Some will let current patients who go on Medicare remain as their patient. For the Supplemental plans they are accepted by ANY doctor who accepts Medicare patients. What dh and I both did was decide which Supplemental plan we wanted, then search for the cost of the lowest provider.

Medicare Advantage comes in many flavors. For instance, with Aetna Medicare (Advantage plans) where we live, they sell HMO, PPO Choice and PPO Select, with HMO being the most restrictive. My husband has PPO Select which is the highest level of the 3, and we have yet to find a doctor who is not on the PPO network. I won't go with a HMO based on having been on both sides, HMO vs. PPO. With HMO, you are stuck with the specialists sent by your PCP, both with quality and wait time.

 

[bogey21]

I don’t think $1800 is high deductible.

The $1,800 is the deductible on the Supplement which is separate and above the deductibles on the basic insurance...

George

Note: as you will see from a later post I just pulled out the paperwork and see that the deductible is now $2,300...

 

[John Cummings]

Cliff is very happy with his Medicare HMO through Healthnet. He had Healthnet before he retired and it was a seamless transition using his same Doctor. Just last year they started wanting an extra $20 per month (not sure why) so when I get a bill I pay for three months at a time. Healthnet is the same HMO I had for about 30 years until he retired and they had an opportunity to kick me and my migraines (now happily post menopausal vanished) to the curb. But if they'll have me back when I am Medicare worthy, I suppose they'd be my first choice. Big question will be which plan will allow me to stick with the back/pain Doctor (assuming we still live here), which plan is available in San Diego County, and what our situation looks like as far as actually moving to Carlsbad (we expect to be at the top of the CCRC waitlist right about the time I'm of Medicare age). If my mom needs or wants to move in with us here we have plenty of room, so we'd stay put for a while.

We are also very happy with our Health Net Gold Select Medicare Advantage plan. I have NO co-pays for doctors ( including specialists ), nor deductibles. I have been in the hospital 4 times in the last 3 years and had 2 surgeries including a full hip replacement and it hasn't cost me a cent. My plan also includes prescription drug coverage, dental insurance, vision, transportation, and free gym membership.

My only cost is $135 month for Part B Medicare that is deducted from my Social Security.

We have our choice of 32 different plans.

The Medicare Advantage plans work very well where there is a large subscriber and provider base like we have in Southern California.

 

[bogey21]

Out of curiosity, what is your premium for the High Deductible Plan F?

The answer to your question was "I don't know" so I went and checked. I bought the policy about 5-6 years ago. My recollection is that the premium back then was about $60 per month and the deductible was around $1,500. Since then I haven't paid much attention to it as the premiums come out of my Bank Account automatically and I have never hit the deductible. After digging it out I'm more than just a little surprised. My current premium is $82.47 per month and the deductible is now $2,300...

George

 

[Luanne]

The answer to your question was "I don't know" so I went and checked. I bought the policy about 5-6 years ago. My recollection is that the premium back then was about $60 per month and the deductible was around $1,500. Since then I haven't paid much attention to it as the premiums come out of my Bank Account automatically and I have never hit the deductible. After digging it out I'm more than just a little surprised. My current premium is $82.47 per month and the deductible is now $2,300...

George

Thanks. I was just wondering how much less it was than the "regular" Plan F. I'm paying $155 and dh is paying around $180.

 

[isisdave]

I have Plan N and recommend that people considering either F plan to check it out.

It's basically the same, except (1) it doesn't cover the (currently) $185 deductible; (2) there can be an office visit copay of $20 -- sometimes this is charged, sometimes it isn't -- I haven't figured this out yet; (3) it doesn't cover "excess charges" which are apparently not a thing in SoCal, as I've never heard of anyone being charged one. But Plan N costs about a third less than plan F, so for me $150 instead of $225. And my BlueShield Medigap rates go up every two years.

Plan G is also something to consider. Also, Plans C and F will be discontinued for new subscribers starting 1/1/2020, but if you enroll this year you can keep them.

 

[WinniWoman]

I don’t think $1800 is high deductible.

Yeah. For sure. Try $6000 as is in our health insurance plan through my husband's employer! And that is in network. Out of network is $12,000!

 

[WinniWoman]

Medicare Advantage comes in many flavors. For instance, with Aetna Medicare (Advantage plans) where we live, they sell HMO, PPO Choice and PPO Select, with HMO being the most restrictive. My husband has PPO Select which is the highest level of the 3, and we have yet to find a doctor who is not on the PPO network. I won't go with a HMO based on having been on both sides, HMO vs. PPO. With HMO, you are stuck with the specialists sent by your PCP, both with quality and wait time.

What about when traveling with these Advantage plans?

Also, I am hearing from friends- one lives in Connecticut and one lives in New Jersey- and they have switched from Advantage plans to Medigap. I am not sure why, but it seems like after awhile being on the Advantage plans they decided to go with Medigap

 

[bogey21]

I have a question about a Medicare HMO. Since, to my understanding, an HMO is kind of a closed network, what happens if Cliff has to go out of network, or needs medical care when he is out of state?

I had a Medicare Advantage HMO Plan for about 3 months a number of years ago but switched back to traditional Medicare with a Supplement and a Prescription Drug Plan. The premium on the Advantage Plan was $0 but I didn't want to have to go through the deferral drill or be limited to where I could go for treatment it something really serious befell me. This cost me more money but I am happy with what I did...

George

 

[simpsontruckdriver]

Regarding Medicare Supplements... the best time to sign up is right when you turn 65 (Guaranteed Issue). There are also times like Annual Enrollment when you can sign up or change. Other than those times, if you change, you're subject to underwriting, which means your pre-existing conditions will not be covered. Also, if you were in the hospital within the last 90 days, you're not able to sign up for a supplement. My in-laws have basically a Plan-F in Massachusetts (where I am not licensed), they pay a certain amount and do not pay copays/coinsurance for Part-A and Part-B costs. Basically, with those plans, you could go to the hospital a few times a year and spend 2+ weeks at a time, and not pay anything over premiums. Supplements are regulated by your state. Some states like Florida have it where your premiums will not go up very much, but premiums are dependent on age.

At least Medicare Advantage plans with Prescription Drugs (MAPD) do not have underwriting, you can sign up at 65 or during Annual Enrollment Period (AEP), or other special enrollment periods. But, they are regulated by Medicare (CMS), and premiums/copays depend on federal funding. I'm not sure about other MAPDs, but with Humana (one that I am appointed with), if you have a specialist you like, you can call customer service to find out which doctors refer patients to that specialist. That way, you can meet that doctor, and they can refer you to your specialist. I'm talking about HMO (Health Maintenance Organization). With a Preferred Provider Organization (PPO), you go to whomever you want, but you pay less if you go "in network" (insurer has negotiated lower copays with them).