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Yves here. I recognize some readers are either past the point of no return with Medicare plans or are many years away from having to make choices. But I am appalled at the incessant barrage of Medicare Advantage plans now that I am party to old people TV by virtue of being around a 93 year old. And as I look at my mother’s card, it says, right under the plan name and over all her member ID numbers, something the ads gloss over:
“A Medicare Advantage Plan – Medicare limiting changes apply”
The quotation marks are on the card too.
By Harris Meyer. Originally published at Kaiser Health News
Medicare’s annual open-enrollment season is here and millions of beneficiaries — prompted by a massive advertising campaign and aided by a detailed federal website — will choose a private Medicare Advantage plan.
But those who have instead opted for traditional Medicare face a critical decision about private insurance. Too often the import of that choice is not well communicated.
If beneficiaries decide to use traditional Medicare when they first join the program, they can pick a private supplemental plan — a Medigap plan — to help cover Medicare’s sizable deductibles and copayments for hospital stays, physician visits and other services.
But many people don’t realize that, in most states, beneficiaries have guaranteed access to a Medigap plan for only six months after they enroll in Medicare Part B — either at age 65 or when they leave private health insurance and join Part B.
While the Medicare.gov website offers a guide to these Medigap plans — labeled A through N — it’s a complicated decision because each plan provides different kinds of coverage — for 10 categories of benefits. Then there are the variants with high deductibles and limited provider networks. Premiums vary sharply, of course. And because seniors enroll in these plans throughout the year as they reach Medicare eligibility, there is far less publicity about the options.
As long as a beneficiary pays the premiums, they cannot be disenrolled from a Medigap plan.
For many who opted at some point for Medicare Advantage but decide later to move to traditional Medicare, getting a Medigap policy may be extremely difficult or impossible.
Lots of people making their plan choice this season may have missed their narrow window for Medigap enrollment. That means they may be stuck in Medicare Advantage or their current Medigap plan.
Ken Singer, 68, of Bridgewater, New Jersey, who retired from an investment management firm, didn’t know about the limited opportunity to sign up for a Medigap policy. “Nobody told me that,” he said. “I did a lot of reading about Medigap, but I found it kind of confusing.” He wants a policy because he’s leaving his wife’s employer-based health plan.
“Not that many people aging into Medicare at 65 fully understand that moment may be their only opportunity to opt into Medigap,” said Brian Connell, executive federal affairs director at the Leukemia and Lymphoma Society. “If you miss that short window, you’re left without protection from high out-of-pocket costs.”
While Medigap plans typically carry higher premiums than Medicare Advantage plans, the more expensive ones offer greater out-of-pocket cost protection.
After a beneficiary’s initial six-month window, federal law does not prohibit Medigap insurers from rejecting applicants or charging a very high premium if they have a preexisting medical condition, unlike in the Affordable Care Act insurance market for people under 65. Only four states require insurers to offer Medigap coverage to applicants regardless of age or health. Medigap covers nearly 13 million beneficiaries.
In contrast, federal rules require Medicare Advantage plans to accept all applicants and charge the same premium regardless of their health. Out-of-pocket costs in Medicare Advantage plans are capped at $7,550 this year for in-network care, not counting prescription drugs. Traditional Medicare has no cost cap, but some of the Medigap plans cover the vast majority of those expenses that otherwise would be out-of-pocket.
At least partly because of these unequal consumer protections, 17% of the 33 million people in traditional Medicare have no supplemental insurance, according to Tricia Neuman, executive director for Medicare policy at KFF. Their out-of-pocket costs can reach tens of thousands of dollars a year for serious conditions like cancer or kidney disease.
Linda Ginsburg of Jacksonville, Florida, unknowingly missed her chance to buy a Medigap policy last year when she turned 65.
Because she has cancer, the retired medical office manager qualified for Medicare through Social Security Disability Insurance before turning 65, and she enrolled in a Medicare Advantage plan. She was paying a $385 monthly premium — $4,620 a year — and facing $7,000 a year in out-of-pocket costs, not counting her big prescription drug bills. So last year before her birthday, she called two insurance brokers about switching to traditional Medicare and getting a Medigap plan, which she thought would offer better, cheaper coverage. Medicare rules offer a Medigap open enrollment opportunity for disabled beneficiaries when they turn 65.
Both brokers told her, inaccurately, that she couldn’t switch because she has cancer. “They said insurers aren’t going to take you, you should stay where you are,” Ginsburg recalled. “They absolutely were unaware that was a period when I could have gotten in without being asked about my cancer.”
Now she’s stuck — and angry. “I thought screening for preexisting conditions is against the law,” she lamented. “But it’s not true when you hit Medicare age.”
Part of the confusion is due to states’ very different rules governing Medigap policies. Connecticut, Maine, Massachusetts and New York require insurers to accept any applicant regardless of age or medical history, according to KFF.
In other states, people over 65 receive federally guaranteed access to a Medigap plan only under limited circumstances, such as if they move or switch out of a Medicare Advantage plan in their first year of Medicare. Twenty-eight states ensure people access to a Medigap plan if their employer terminates their retiree health benefits.
Then there are widely varying state rules for how Medigap insurers can price their plans. Eight states bar charging people more because they are older or sicker. The remaining states allow setting premiums based on age, meaning a Medigap policy may well be unaffordable for older seniors.
The situation is worse for the nearly 9 million beneficiaries younger than 65 who qualify for Medicare because of a long-term disability. Just 31 states require insurers to sell a Medigap policy to people in this group.
Members of a subgroup — kidney dialysis patients under 65 — have even more limited access to an affordable Medigap policy. Only 14 states mandate that insurers offer them affordable coverage. Starting last year, the federal government guaranteed them access to Medicare Advantage plans but not to a Medigap policy. But Medicare Advantage plans may not include the providers that dialysis patients need, said Holly Bode, vice president of government affairs at the American Kidney Fund.
Guaranteed access to an affordable Medigap policy is important, consumer advocates say, because beneficiaries who develop serious medical conditions disproportionately want to leave their Medicare Advantage plan for the broader choice of providers available through traditional Medicare.
A Government Accountability Office report in July urged Medicare officials to examine why beneficiaries in their last year of life switched from Medicare Advantage to traditional Medicare at more than twice the rate of other Medicare Advantage enrollees.
Some legislators are already pushing to revamp the Medigap market. The Close the Medigap Act, recently reintroduced by Rep. Lloyd Doggett (D-Texas), chair of the House Ways and Means Health Subcommittee, would ensure that beneficiaries with preexisting conditions could buy a Medigap policy anytime and wouldn’t face higher premiums.
Another House bill, sponsored by Rep. Jaime Herrera Beutler (R-Wash.) and Rep. Cindy Axne (D-Iowa), would require Medigap insurers to offer the same plans to kidney dialysis patients under 65 that they offer to beneficiaries 65 and up.
Health insurers generally have opposed bills that require them to guarantee coverage or affordable pricing of Medigap plans, arguing that would raise premiums for current policyholders. AHIP (America’s Health Insurance Plans), an industry lobbying group, has taken no position on these two bills.
Neither bill, however, is included in the Democrats’ broad legislative package to expand health and social programs. In a written statement, Doggett expressed disappointment, saying that extending preexisting condition protections to the Medigap market is “one of the important pieces of unfinished business remaining from the Affordable Care Act.”
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When I retired at 71, I went on Medicare Part B & got Medigap part H. Came out of retirement & went back on employers Cigna. When I retired again due to Covid, was informed that, due to preexisting conditions, I was subject to underwriting & ineligible for Medigap. Currently on straight Medicare. Be extremely careful about eligibility issues.
Yes, one’s initial, when eligible, first enrollment in a Medigap plan is not subject to underwriting. If you leave a Medigap plan and then later decide to re-enroll in a Medigap plan during the open enrollment window your application is/may be subject to underwriting. This acts like a one-way ratchet to push people into Advantage plans, imo.
I go on Medicare 1st of next month, After reading NC’s postings on the Advantage plans vs. Medigap I opted for Medigap, Plan N with Cigna. Thanks NC! I donated and urge everyone to do so. The information available here is priceless.
Yes Jack, We’re lucky to have the comentariate and NC staff themselves to work through this maze. Who reads the NYT anymore? Pas moi.
Jack (and others) – We are heading to Medicare coverage 7/1/22. I am convinced vanilla Medicare is the way to go. How did you learn about the “gap plans” or maybe the question should be WHERE did you go to learn about them? After 38+ years the Fortune 500 Co. offers $1800 x 2 annually to retiree plus spouse IF we join the UHC Medicare (Dis)advantage plan for that Co….. Not going to happen… Now I am tasked with learning how to make the “gap” choice… HELP is APPRECIATED!!!! Call me Lost in NC…
Dear Lost;
Your State Insurance regulator will have the Medigap plans listed. They regulate these plans, and set the parameters for plan implementation. Each state has it’s own rules. Many states have a method whereby you can begin applying for Medigap plans several months ahead of your 65th birthday.
Don’t forget that you and you’re spouse must apply separately. Each is governed by either your birthday or when you drop off of the company plan. As someone below said; “Americans love their complexity!” More appropriately, American Insurance Companies love complexity. Complexity equalls more ways to ‘drive revenues.’
Good luck!
See the Medicare.gov site for info.
https://www.medicare.gov/
Particulary see the above site for traditional Medigap plans:
https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
Adding: original MC was the last New Deal policy enacted in the US. Since then both the GOP and the “new” Dems have worked to whittle it down and down in favor of private insurance profits. imo.
Medigap plans are required by law to offer exactly the same benefits. However, because they are offered from private insurance companies the costs may differ.
https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
adding, there’s an exception to the general plan coverage for Minnesotans. If you live in Minnesota then you get better coverage in general in the traditional plans. The Minn Farm-Labor-Dem party had pull back then and knew what they were about.
https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies/medigap-in-minnesota
No… actually in North Carolina (NC)! My husband and I are both over 65. Latest word from my “better half” is this coming summer he hands over his role to others and finally retires. We are currently covered under a company PPO but will both go Medicare Q3 at age >65… Thanks for the links you provided… the “NC” followers are simply awesome!!
Adding: Not just in Minnesota. From above link:
“In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.”
Per Ambrit above, see your state’s MC plans information.
Some states have insurance brokers that are trained and qualified in medigap (the SHP folks) insurance. If you know an insurance broker (your company may use one that you can access), you can ask them. You might also try your state’s insurance sites. There’s lots of good nfo on SHP further down. The key is to find a trained broker to help you out. It may not be optimal, but at least it gets you to a place where you can do your own investigations.
I recommend Medigap Plan F, the most comprehensive Medicare supplement, for people who turned 65 before Jan. 1, 2020. If you’re too young for Plan F, I recommend Medigap Plan G. The difference is that with Plan F, I’ve never seen a bill or claim form. Everything is automatically covered at the 98% of U.S. doctors and hospitals who accept traditional Medicare. I never experience preauthorization requirements or care or coverage denials. This is also true for the more than 100 Medicare experts, patients, and family members I’ve interviewed. With Medigap Plan G, your annual Part B deductible is not covered. Plan N and any Medigap plans that require copays increase paperwork, record-keeping, time on hold for medical receptionists, and paperwork handed back and forth, which is risky if you’re sick or Covid is around. Medigap Plan G’s lack of coverage for your annual Part B deductible creates the risk of losing your coverage if you’re incapacitated in January / at the beginning of the Medicare plan year, and no one makes sure your medical bills are paid by you till you have met your $200 or so annual Part B deductible. Re: four states that guarantee no-underwriting Medigap coverage later: I don’t really count Maine, because it only guarantee no-underwriting access to one skimpy Medigap plan. The other three states (New York, Connecticut, and Massachusetts) guarantee no-underwriting access to all Medigap plans, including F and G. My plan F is from United-AARP, the only plan overseen by a powerful nonprofit. (I’m not compensated, directly or indirectly, by any insurance company.) Medigap benefits and billing practices, unlike those of Medicare Advantage managed care, are standardized, and summarized on widely available one-page charts and in the Medicare guide “Medicare and You 2022.” A wise counselor at NYS HIICAP (a state agency offering Medicare enrollment advising) says that if you truly can’t afford the monthly premiums of Medigap F or G, she’d recommend high-deductible F or G. This requires someone to be healthy enough to monitor payments and deductible-meeting to providers till you hit the plan deductible. Both regular and high-deductible Medigap plans will make your medical bills predictable and will keep your total monthly medical expenses close to your monthly premiums for Medicare Part B and Medigap F or G. Once on a Medigap policy, stay on it for life, or you’ll lose access to it in all but four states. Furthermore, in NY state, if you go off a United-AARP Medigap in NY and want to go back on it later, they can charge you double, according to a United-AARP agent I spoke with on the phone within the past couple of months.
This is the link to the CA Health Advocates which provides background to SHIP (state health insurance programs) that provide help to medicare beneficiaries. Unlike other providers of “free” medicare information, it is not affliated with insurance companies.
https://cahealthadvocates.org/medigap/guaranteed-issue/
The open enrollment period is 6 months, but generally if you initially joined a medicare advantage program, you have a year to switch back to original medicare, and then be able to purchase a medicare supplement (i.e., officially a medicare supplement is what the policy that is an adjunct to medicare is named, but it is commonly called a medigap policy).
Both brokers told her, inaccurately, that she couldn’t switch because she has cancer. “They said insurers aren’t going to take you, you should stay where you are,” Ginsburg recalled. “They absolutely were unaware that was a period when I could have gotten in without being asked about my cancer.”
Now she’s stuck — and angry. “I thought screening for preexisting conditions is against the law,” she lamented. “But it’s not true when you hit Medicare age.”
If the information you were provided is incorrect, you have the right to appeal. My own experience however, is that most people just do not have the patience, energy, or knowledge of how to deal with the medicare appeal process. And unfortunately, PAID shills (we won’t mention well past their prime Broadway playboys) and incessant TV advertizing direct people to BROKERS who have the agenda of getting one into medicare advantage plans. SHIP organizations have essentially inconsequential advertizing budgets, and I dare say 99% of people are completely unaware of them. I wonder why that is…
CAVEAT – my experience is only in CA. There may be extra or different protections in your state.
… but generally if you initially joined a medicare advantage program, you have a year to switch back to original medicare, and then be able to purchase a medicare supplement…
So, one has only one year after their initial, Advantage enrollment to switch back to a traditional Medicare Medigap politicy without encountering Medigap insurance policies’ financial underwriting? Ah. Good to know.
Much shorter: the rules that benefit the general populace aren’t advertised. These days, rules that benefit the general populace are never advertised. Learn the all rules before making important decisions. My 2 cents.
I actually work at a Senior Center, and there is a dedicated office in the basement staffed by super helpful SHIIP* counselors. This is in Eastern Iowa, and so people should check around their local community. This service is free.
https://seniorsresourceguide.com/directories/National/SHIP/
*Note the spelling varies.
I JUST WANT TO SCREAM. I’ve been a single-payer activist and advocate since the U.S. health insurance racket killed my husband in 1997. I’ve had Medicare “coverage” for several years, and I DO NOT UNDERSTAND MEDICARE. It’s utterly incomprehensible to me.
Yes, I choose a Medicare Advantage plan knowing there might be consequences leading me to change to Medigap later, but NEVER being told my ability to do so would be foreclosed in six months.
I always say we need “Expanded, Improved Medicare for All” but the crapification of Medicare is making the very term itself toxic. I am in despair for our country.
Can I scream along with you? I’m just a year away from Medicare eligibility and I’m confused already. Especially by the barrage of mailings. I can’t help thinking that most Medicare Advantage premiums go to pay for these things.
I’ll scream along with you, Slim.
Since Medicare doesn’t cover dental, I’ve been researching private dental plans.
Geesh. Trying to decide if I’m better off self-insuring for dental.
but,but, but…we have the BEST healthcare system in the world!!!
I’ll add a sub-sonic ‘Rebel Yell’ to this chorus.
“Just who won that war anyway?” Ol Massa was replaced with New Massa back in the 1870s. Now we are left dealing, thanks to Bill Clinton and the ‘Democratic Leadership Council’, with the “Sons of the New Massa.”
Funny how it is that no one near the top of the “Official” political class mentions plain old National Health.
As a more radical acquaintance of mine puts it: “The problem with politics today is money. The best way to drive Gold out of politics is with Lead.”
Most people used to view him as a harmless crank. The general consensus about his views is shifting towards being more positive.
And note the article in today’s links about the CDC relying on Covid data from other countries to make decisions. If we had single payer, there is a better chance we could have decent data about what is actually going on with covid.
Israel has a universal health care system for all citizens and permanent residents. So does the U.K., another country that the U.S. looks to for COVID-19 data. Beyond the health care benefits that such policies provide to residents, universal health care has a clear advantage for data scientists seeking to answer medical questions. When every person in the country is plugged into the same health care system, it’s very easy to standardize your data.
“During the pandemic, very rapidly, detailed datasets were created that link primary care records, secondary care records, national testing data, and vaccination data,” said Jonathan Sterne, a statistician at the University of Bristol who studies vaccine effectiveness in the U.K.
The standardized COVID-19 data “enabled extraordinary research based on the whole population,” Sterne said. Once a researcher gained National Health Service authorization, they could essentially download anonymized health records for the entire country, with information ranging from a patient’s most recent COVID-19 test to their body mass index.
In the U.S., vaccine research is far more complicated. Rather than one singular, standardized system housing health care data, 50 different states have their own systems, along with hundreds of local health departments and thousands of hospitals. “In the U.S., everything is incredibly fragmented,” said Zoë McLaren, a health economist at the University of Maryland. “And so you get a very fragmented view of what’s going on in the country.”
@antidlc
November 9, 2021 at 12:02 pm
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I sold life and health insurance for 15 years, including dental.
The problem with dental insurance is that it’s self-selected for adverse underwriting. In other words, the only people who purchase it are the ones who need it. The insurance companies know they are essentially buying claims. Thus, they usually have very low limits on annual claims paid in order to protect profits. The hope is that buyers will only use some of the free benefits for cleaning and an x-ray, etc. Those who need serious work will be limited to, e.g., $1,500 in claims paid for the year.
If you are conscientious about semi-annual check-ups, etc., and can take advantage of the free benefits, I would recommend checking your dentist’s prices for those procedures and comparing it to annual premiums. It might be worthwhile if it saves you enough.
“I would recommend checking your dentist’s prices for those procedures and comparing it to annual premiums. It might be worthwhile if it saves you enough.”
Precisely what I have been looking at. I may just self-insure — no real problems (yet).
You just never know when you might crack a tooth. But, as you said, the serious work has very low limits for coverage. The most coverage I found was max payout of $2,000 per year.
Thanks.
And many, if not all, policies cover a percentage of the cost of an expensive procedure, not the whole thing.
So, if you need a $1200 crown on a cracked tooth, insurance will typically cover 50% and you will be responsible for the other $600. After your deductible has been satisfied and up to the annual maximum limit.
“Free stuff”–exams, x-rays, cleanings–don’t generally count toward your deductible, and even procedures covered at 100% are subject to the deductible before the insurance pays anything.
To make it even more fun, all dentists do not necessarily accept all insurance. Sometimes they’ll tell you that BEFORE you have the work done.
The trouble with dental insurance — and ALL health insurance — is that it just raises the cost of all of those services for everyone, with no corresponding increase in value. Sorry, John Zelnicker, I like you from what I know about you from this site, but my life’s experience has taught me that insurance is a criminal industry. As is for-profit health care, including vision, dental and hearing.
And we just keep giving them more power. My spouse pointed out this Medigap “de-emphasis” in what she received in the mail, and she’s been on Medigap from the beginning. Every doctor has told her: don’t go on MA.
The intent is clearly to handle the Medicare “deficit” by pushing people onto the medical insurance industry’s Medicare Advantage. In essence, this is outsourcing the “death panels” so decried by opponents of Obamacare a few years back.
My guess is that the decisionmakers involved know as well as you and I do that this “deficit” is a scam. It’s just a handy number to hang your hat on when you want to limit expenditures in a certain area. It never seems to apply to military budgets or billionaire tax cuts which shows how seriously they take “deficits.”
@Carla
Absolutely! I can remember a time when dental work, eye checkups, hearing aids, and meds were all outside the purview of the insurance claims world. And all were affordable to blue-collar folks such as me and mine.
Insurance has only added a middleman, hidden the actual pricing, and increased cost across the board.
@Carla
November 9, 2021 at 1:37 pm
——-
No worries. At least you like me. ;-)
There are plenty of criminals in the insurance industry, both the property and casualty side and the life and health side.
However, the real purpose of insurance is to take the risk of the cost of catastrophic events off of the insured, e.g., folks buy Homeowners Insurance because they don’t have enough resources to rebuild if the house burns down (especially if they have a mortgage). That risk is spread over all of the policyholders as part of their premiums, so it doesn’t amount to a whole lot per person.
Life insurance is purchased to provide for final expenses, burial, and, perhaps to provide an inheritance. A lot of life insurance is bought to protect businesses if the owner(s) dies.
Health insurance should be outlawed and Enhanced Medicare for All needs to be implemented, but it likely won’t happen in my lifetime (I’m 71).
Here in southern Middle Tennessee my young dentist offers his own plan, called the Smile Club. For $25/month or $300/year one is allowed two dental cleanings with dentist exam and one xray at no extra charge. All other procedures, crowns and fillings and extractions as examples, have a percentage off–from %20 to %25.
This may be a nationwide concept.
Hi, tennesseewaltzer — when your dentist says “All other procedures, crowns and fillings and extractions as examples, have a percentage off–from %20 to %25,” — I must ask, off of WHAT? Has she/he upped their price for those procedures before applying the discount (very common in retail — and what, really, is the difference between health care and retail?)
Yves often refers to the dangers of low-trust societies. Well, I don’t know how my trust level could get any lower, but I do have faith in capitalist America to find a way to may that happen.
He’s a charter member of the smile club – he smiles all the way to his bank!
Americans just love complexity!
In my own recent experience signing-up for Medicare Part B it’s been quite evident that my former employer and all the insurance brokers out there have absolutely no idea of what their own offerings are, let alone what’s available on the market. I’m vested in a very good retiree plan and I think that I’ll stick with it rather than try to save a couple of hundred bucks on a pig-in-a-poke plan from some ignorant insurance broker.
“Americans just love complexity! ”
Americans just LOVE to go shopping. We are all healthcare CONSUMERS!
We are one messed up country.
American love their health insurance!
My insurer gave me a plastic card that is perfect for scraping my windshield! The only thing it is good for.
My insurer gave me a plastic card that is perfect for scraping my windshield!
That and a Covid vaccination. (Which would be free anyway.)
I have an expensive Plan F. The advantage is that it covers everything Medicare doesn’t, the doctor’s love it because they get all their money. I like it because I have no out of pocket expenses or restrictions. Lucky for me there is no Plan C in my county
I was too late for that party. Congress decided all you F plan people use too much healthcare and eliminated it for new enrollees.
While the deductible is manageable, if I don’t need to pay it every year, it is yet another deterrent to getting healthcare. Mind you I would need to find a doctor but that is a whole other discussion.
Note I do feel lucky, I fully expect to live in NY till the end, but I was told about the problems getting a Medigap policy if I waited. And one never knows.
Yea I’m reluctant to leave it, because I can’t come back and one day I’ll really get sick and need to use it. Which is what insurance is all about, just in case.
You live in NY. It’s one of the Four Good States where you can switch to Medigap/Supplement plans at any time (though perhaps limited in most cases to the annual enrollment period–I haven’t checked yet) just as you could when you first signed up for Medicare. Read the posting, and especially the KFF article that it clicks through too, for details.
Where you live makes all the difference.
Also, this is a ridiculously complicated setup with enormously important consequences. State by state: in this case, NY is good.
‘A Government Accountability Office report in July urged Medicare officials to examine why beneficiaries in their last year of life switched from Medicare Advantage to traditional Medicare at more than twice the rate of other Medicare Advantage enrollees.”
Can someone please explain how someone can make this switch? Beneficiaries in their last year of life probably have significant health issues, no? Then how can you switch from a Medicare Advantage plan to traditional Medicare? Do these beneficiaries switch to traditional Medicare, but go without a supplemental plan? Supplemental plans in most states would force you to go through underwriting and if you have significant health issues, you could be denied a supplemental policy or have to pay expensive premiums.
Maybe they live in CT, ME, MA or NY.
The last year of one’s life is the most expensive one medically. This just proves that the MA people are skimming off the healthy oldsters and then screwing them when they get sick, forcing them back onto the feds to pay up.
Medicare co-insurance should not be necessary. Rather than providing inadequate dental coverage and vouchers for eyecare, kill off the entire co-pay system. It costs more for the co-insurance that covers 20% of the medical bill than it costs me to pay for Medicare that covers 80%. Pay it all and raise the medicare premium by 20%. We’d all be way ahead.
Yes. Michael has described the problem accurately.
Medical care has become so expensive that being without enough “insurance coverage” can be financially disastrous. The co-insurance from private companies that covers the 20% “gap” in standard Medicare coverage have become too complex and costly (premiums) for many.
The Medicare Advantage Plans appear to be price attractive; until you attempt to get the medical care you thought you were paying for.
This “Open Enrollment” period that you first-timers are experiencing is an ANNUAL event. The time and aggravation does not go away. (Just received in the mail a letter from my drug plan that the plan has changed substantially and that I need to review/acknowledge ALL the changes. The premium will certainly go UP!)
The TIME waste is enormous. Single Payer healthcare is the solution.
I entered the “Fools Golden Years” this spring. I went on regular Medicare Parts A and B automatically, somehow. I later managed to squeak into a Medigap N plan at the last moment.
Adding it all up:
Medicare Part B: $148.50 per month.
Medigap policy (all such vary from place to place,): $95.50 per month.
So, subtract $254 USD per month from Social Security (for a lifetime of itinerant working at the working class level,) roughly $1200 per month, for a ‘net’ income of $950 per month.
The above is individual. Phyl has her own figures, a bit smaller that mine since she stopped formal work to stay at home and care for our children.
Add to the above that the Medicare part B ‘premium’ rises each year, and the Medigap policy has built in rate rises based on increases in age.
[Don’t get me started on Medicaid. At least the way it is structured here in Mississippi, it looks to be worked out to encourage peonage. As someone, somewhere, once said: “There are some things I will not do for money.”]
I very much echo the comments above, especially FresnoDan, in that I encourage an early and thorough study of your options. Start the year before you turn 65, at the latest.
I went for a G plan, but haven’t fully retired yet. That might not be manageable when I do. But with the cheap D drug plan, my monthly premium(s) is still less than my catastrophic ACA marketplace plan with more than double the deductible and 50% copays. I can actually afford to go the doctor now. That was not the case for a friend who was paying the premiums for her union health plan due to Covid shut down.
They do not make it easy.
We are a cruel and sadistic country.
FYI.
At the top of this screen, in the top right hand corner, I see an ad for Medicare Advantage plans.
That figures if the Ad placement is run by an algorithm. All it sees is a mention of Medicare. That triggers the placement function for Medicare Advantage Ads.
The dirty little secret about internet ads is sheer volume.
I see speakers. But face it it’s that time of year. I get emails, postal mails and tv ads galore for advantage plans.
My wife and I each have a high deductible Medigap Plan F. Together we pay less than $100 per month.
My wife is a heavy user of healthcare services. I am not. The standard Medigap Plan F would have cost us several hundred dollars per month more. It is not worth it, since Medicare is so good that even my wife’s higher expenses don’t result in enough in out of pocket cost to justify the standard plan.
In addition Medicare Plan F covers medical expenses incurred outside the US, though you must submit the bills.
If anyone is interested, you can view the broker compensation for Advantage plans at the cms.gov webisite:
https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/AgentBroker
Some years ago some former servicemen sued the government over promises of “healthcare forever”, but the courts ruled that enlistment inducements weren’t contractual. However, Congress in its infinite wisdom did pass a bill that created a “free to user” medigap policy, intended to wrap around medicare A/B and provide part D equivalent benefit, to the extent that the Tricare insurance program covers user costs. There used to be a separate retiree dental insurance program, but Congress got rid of that and instead made military eligible for federal employee dental and vision insurance.
My father lives with us and has an Advantage PPO plan which so far has been OK for him. His former employer funds an HSA to about $1100/yr which he uses to pay the premiums.
Just wanted to re-post this since I’m always late. SHIIP or SHIP counseling is free in every state.
https://seniorsresourceguide.com/directories/National/SHIP/
Finally had something to contribute to NC!
From the perspective of a New York senior–remember, NY is one of the Four Good States–Medicare Advantage isn’t so bad. For one thing, the Medigap/Supplemental plans cost an additional $200-300/month; as I can switch to one if, as, and when it makes sense, it doesn’t make sense to pay the additional premium now. For another, NYC is a high-cost area for medical coverage as well as other things, and my suspicion based on what I heard for many years is that NYC doctors aren’t very fond of Medicare reimbursement rates and, even more, Medicare reimbursement hassles and delays.
So Medicare Advantage seemed a better option, as the doctors presumably get paid something approaching ordinary insurance rates due to capitation and the subsidy. That seems especially so since I’m on the UHC plan, which now provides nationwide coverage at in-network costs when you see any provider in the UnitedHealthcare Medicare National Network. Coyly noting that exclusions may apply–and I haven’t dug up the exclusions yet–on its face this sounds like a non-narrow network, though I also haven’t tried to see who’s on the national network. If I did, since doctors aren’t required to accept Medicare, I’d have to figure out (a) which doctors I wanted wherever I had in mind and (b) whether they were in UHC’s Medicare National Network, original Medicare, both, or neither.
It took me months of casual and weeks of intensive research to try to figure out what my best options were when I went on Medicare. As so many of you have commented, it’s ridiculously complicated. If it’s helpful, the first thing I did was see what insurance my doctors accepted. I also checked the AARP-affiliated plans, on the theory that they should have at least some negotiating power due to their size; in NY, they go with UHC. And all my doctors took the UHC MA plans that I had in mind.
So after that I did a spreadsheet comparing the various premiums, copays, etc., etc. and made my decision. So far, so good. But I’m keeping in mind the ability to switch to original Medicare plus gap/supplement, if it turns out to be better as I get older. If, of course, my doctors take it….
This so-called system is way too complicated to be workable for ordinary people with things to do besides analyze Medicare. I had time to spend on it, and it cost me many, many hours. Which I’m reinvesting right now to figure out whether I should change plans during the annual enrollment period. Crazy and cruel.
I am 71. I live in NYstate. I have been on AARP/UHC medigap Part N now for 6years.
I strongly suggest people look at this plan.
It is $176 per month. But if you feel you might need hospitalization its well worth it.
The plan covers most everything.
1)There is a deductible for Part B, 2)copays that are never more then $20 for any MD. 3)And there is an ambulance fee, i believe, of $50 (forgiven if one is admitted to the hospital, i believe). But that is it, plus the premium. Out of pocket costs ANNUALLY, for me, have been approx, $450.
So the annual premium is $2112 and out of pocket costs $450, together, cost $2500 together. . One has complete anxiety free medical care for that. Just flash the Plan N card.
Plan F which covers everything has a GIGANTIC premium. Plan G has a large premium and covers little else then Plan N.
Plan N which i think, is by far, the best plan, in NY can cost more for other insurers. AARP/UHC just seem to have been the lowest cost past 6years. I used to check the other plans but they were higher and all Plan N medigap plans are exactly the same.
There is one thing people should know. One needs to purchase Part D (drug plan) when getting a Medigap plan. One does not HAVE to purchase it. But if you don’t purchase it at 65yrs old, then when you do purchase it, later on, the govt charges a higher fee, for the premium, for as long as one lives.
The Part D plan i use in NY is Humana, Walmart. Its approx $20. The cost of my 6 meds, are very cheap, i get them mail order (nexium, imdur, alzuprosin, singular, roustavastiin (crestor). I also use dymista but i get that from Canada, as its too expensive here in the states.
If one needs expensive medications , one should check with the Part D plan, PRIOR to purchasing any Part D plan. Each company charges didn’t prices depending on the tiers. And i have changed companies because, i recall, once, Caremark, jacked up the price of Nexium, enormously. Don’t be afraid of changing companies. I call them each year and tell them my medications and see what they will chrarge each year.
Lastly, one should, if there medications become too expensive, do a price check with Canadian pharmacies. Some of the prices are far cheaper for some mediications. And they are all good. Usually coming out of the EU or India or Turkey. Hope this helps.
One other thing i didn’t mention. Regarding Dental.
Every dental plan for seniors, i have seen, is as worthless as a pecker on a pope.
To reduce costs, it might be worth it to get EXTRA cleanings.
I have a first rate dentist. The charge for the scaling is $95 and i have it done 4 times per year. Believe it or not, by keeping the plaque off ———— its possible, in the long run, one might save on gum surgery and root canals. At least that is what i am betting on. At 71 i am having good luck. If one does the math, 3-4 prophys are a good deal less then major work. This is just a guess on my part.