The Medicare / Supplement / Bear In The Buckwheat Thread...

[Murph]

It's about that time. Between Joe Namath, J.J. Walker and Captain Kirk, there are a helluva lot of people out there fighting for my attention. Here's what I think I know...

The best option out there, if money is no object, is a plan G supplement along with Medicare A & B. Along with a prescription supplement maybe.

The plan N also looks like it might be a good option as well, and I'm debating these now.

The "Advantage" plans, all 782 million of them, have all kinds of co-pays, limits, tiers, and are like a big weird HMO with certain Drs. that they allow you to use and you need a permission slip for some things.

I haven't figured out if there is a big difference in plan G cost among different companies, I mean a few bucks a month, or more. Or other differences. 

This thread is for the experienced brains to educate those of us about to enter this web of confusion.

[SteveFord]

I just looked at my notes from a 2 hour seminar at work - I thought I knew what I was doing but those notes look pretty perplexing!

[Twang Gang]

I have found that a Medicare Advantage plan works well for me.  Co-pays are reasonable although they can vary if you need a specialist.  My doctor is in the network, so no copay when I go there.  Local hospital is also in the network.  I take five different meds per day and they are covered.  And best of all the premium is zero - you just pay the Medicare premium that they deduct from your social security check anyway so no additional cost.  To me that makes up for a few co-pays during the year.

If your doctor and/or local hospital are not in the plan's network it would not work as well for you.

Figuring out all the options on your own is pretty tough to do.  An insurance agent that specializes in Health Insurance can be a great help.  They work with it all day every day and depending on your health history can make a recommendation that will work best for you at the lowest cost.  It's free advice as they are paid a commission from whoever they place you with and it's a lot easier than trying to figure out the myriad of option by yourself.    

[Whitefang]

As a GM retiree all I changed when turning 65 was switch my BC/BS  PPO  to Medicare Plus Blue Shield PPO.  Already had dental and eyeglasses covered as a GM retiree. 

But I'm STILL wondering what the f-ck my zip code has to do with anything. I live ONE BLOCK from the border of a different zip code.  I'd hate to imagine because there's people living two blocks over from me that they're getting better insurance coverage than me.    The border is Brest St.  Resident on both sides of the street.  That means one side is in a different zip code than the other.  And are we to believe that it might be that people ACROSS THE STREET have available better coverage just because they live across the street?

Talk about a shameless come-on.  

Whitefang

[kidblast]

Can you imagine being 87, (like my mother inlaw) and trying to figure out all this crap?

The stuff they send out from what I've seen it's hard for me to understand

She reads this stuff and has no idea WTF to make of any of it.  My wife has to try and walk thru it and try to make her understand.

The people running these systems have long ago lost touch with "who" they are actually running these systems and services for.

 

 

 

 

[GuitarsAnn]

I have the Advantage plan from United Health Care. The copay is basically zero, except specialists ($50.00) and maximum out of pocket is $6800.00. I needed my knee replaced a few years ago and thought I would need the $6800.00 for that. Turns out the plan paid for all but about $800.00 for surgery and hospital stay and I needed to kick in about $1400 for PT. I have been with UH for 7 years in the Advantage plan and think it is great. I am in good health and rarely need to see a doctor. If your health isn't so good, maybe one of the more inclusive and very expensive plans may work better for you. If you are in good health, save your money and go Advantage.

[badbluesplayer]

Not sure what plan G or plan N are.  Maybe those are some of the plan options that you've seen on the medicare website?  I'm not familiar with them.  I have a medicare supplement plan - in addition to the Medicare A&B that everybody gets.  It covers the stuff that medicare A&B doesn't cover so that you end up with "full" coverage, similar to what you'd have with a regular plan like most employers offer.  They're offered by most major health insurers like Blue Cross Blue Shield, United Healthcare, Humana, and  many others.  They will appear on the Medicare.gov website as options available in your area depending on... your zip code - dynomite!

The best thing to do is check the medicare.gov website - they will show you all the available plans from the different companies for you.  Then you can select one and sign up from that website.  No need to call Joe Namath or Bill Shatner or any of those companies directly.  If you've been on medicare.gov, then you're on the right track.

Deductibles and copays vary with the premniums for each plan - there's usually like 20 differnet plans available when me and the wife sign up.  From maybe five or six iunsurers with about three plans each.

Me and the wife are paying $89 a month each for a pretty decent plan with Blue Cross.  Medicare kicks in another $150 or so - the money that will be taken out of your check.  It pays for all kinds of stuff - dental, vision, meds...

Keep us posted.  If you have any questions, pipe up!

 

Edited October 8, 2022 by badbluesplayer

[fortyearspickn]

KidBlast, they work for themselves, not us.  Became obvious when they supported the concept of health insurance being required by federal law.    
WhiteFang -  use to be companies just wouldn’t have billboards or stores in markets they didn’t think they could sell enough in to make it worth their while.  Today selling stuff with different terms based on zip codes is exploding: Bank of America offers much better terms for mortgage loans in certain zip codes, to promote Equity.  Of course, those in the other zip codes pay more so BoA can still make the same level of profit. 
The 2 things to be sure of first is that the company will insure whatever providers (doctors & hospitals, etc) Medicare  covers,  and, that they will pay the balance of whatever Medicare does not.  The catch, of course, is that Medicare doesn’t cover certain procedures, so will your Supplemental policy cover those.  Usually Medicare covers  only 80% of those they DO cover and your Supplemental plan SHOULD COVER the other 20%. But there are, I think around 10,000 different procedure, and trying to figure out which ones you Might need, to then find out if your supplemental plan covers it - is impossible.   This is sort of the opposite of auto insurance:  Universal Coverage came along because there were too many gray areas re. “Who caused the accident?”.   Imagine if Your auto insurance company said they’d repair your fender but not paint it.  Or only pay 80%  for the fender because, while the other guy clearly caused the accident,  the GPS chip in your car said you were going 40 in a 30.  These Medicare Supplement companies have several different plans: bare bones to  Full Coverage. But if you are “only in your 60s” and in great health, getting a full coverage plan might be a waste of $.  But the multiple plans and their confusing coverages are meant to confuse us.  If you buy too much or not enough - the insurance company wins and you lose.  If you guess the right one - you do the best you can, but the insurance company still makes a profit, albeit less.  Ad on tv right now: United Healthcare, which uses AARP as a front to sell insurance.  

[Whitefang]

22 hours ago, kidblast said:

Can you imagine being 87, (like my mother inlaw) and trying to figure out all this crap?

The stuff they send out from what I've seen it's hard for me to understand

She reads this stuff and has no idea WTF to make of any of it.  My wife has to try and walk thru it and try to make her understand.

The people running these systems have long ago lost touch with "who" they are actually running these systems and services for.

 

 

 

 

Age really isn't the barrier in any of that.  You speak of your 87 year old Mother in law.  But people less than half her age have trouble understanding that crap.  My daughter and I were talking about that some time ago.  We both remember that in high school they had French and Spanish classes.   But if schools were serious about preparing students for life in the real world they'd offer classes in learning how to speak and understand legalese and "Insurish".   Both languages as hard to understand as Inuit or Mandarin.  And languages those students will have to deal with more in "real life" than any other tongue. 

FORTY:   Thanks.  What you're alluding to is that by checking my zip code insurance companies can determine if I can better afford their rates because certain codes consist of particular income levels.  That makes despicable sense.  I figured it was a "come on" to get people to call and once they got you on the phone they can really give  some serious pitching. 

2 hours ago, badbluesplayer said:

 

Me and the wife are paying $89 a month each for a pretty decent plan with Blue Cross.  Medicare kicks in another $150 or so - the money that will be taken out of your check.  It pays for all kinds of stuff - dental, vision, meds...

I have no idea what it's like to pay a monthly premium for healthcare insurance.  I was always either covered under my step Dad's policy, or later provided BC/BS coverage as part of the hospitalization  benefit while working for GM.  Never paid anything out of pocket for it.  While my wife was laid off for a long spell I put her on my policy, and once she returned to work, got back her own BC/BS and kept her own policy after she retired.  All her home care after her stroke was covered by her Blue Cross and Medicare.  People suggested that since she had her own income that was low enough to qualify her I should try to get her on Medicaid.  But she died while in the middle of getting it arranged.

Whitefang

[Murph]

Touche'.

[Larsongs]

Different States have different Premiums or Rates. Which is why we can’t Shop & compare State to State.. Calif & NY are the most costly.. All Insurance costs are not equal, which is BS, depending on where you live.. 

[Whitefang]

Then there's the life insurance hustle these days.  My 86 year old brother in law came up with something the other day.  He said, "I've made life insurance payments ever since getting my policy when me and Anita got married in 1957.  I was 21.  She never got a policy because we figured, like most people do, that I'd be gone before her, so I got insurance to make sure she'd be taken care of when I was gone.  But had I known then that she'd go before me I could have put those monthly life insurance payments into a bank account and leave it all to my next of kin. "

I have no idea what those payments were, and he did start getting payments back from Met Life since he was 66.   And not knowing what his monthly life insurance payments were, it'd be hard to guess how much money we're talking about. 

Whitefang

[fortyearspickn]

Whole Life you can get money back, Term Life is cheaper, but you can't.  In neither case do you come out ahead unless you die before the actuaries predict for you.  Well, YOU don't come out ahead  EVER.  Your beneficiaries may.    Life insurance and Auto Insurance are in no way comparable to the Health Insurance Scam. 

 

[Murph]

The plan G will pay everything (except your part B deductible) that Medicare pays 80% of.

Everything. No co-pays, no tests, no ifs ands or buts. No tiers, no questions.

It appears, in my research, to be the Cadillac of medigap plans available today.

But it'll cost you a few bucks. On top of your regular Medicare bill, which will come out of your Social Security check.

If you choose it during your initial enrolment period, there are no health questions. If you want it later, you'll have to qualify.

[Larsongs]

5 hours ago, Murph said:

The plan G will pay everything (except your part B deductible) that Medicare pays 80% of.

Everything. No co-pays, no tests, no ifs ands or buts. No tiers, no questions.

It appears, in my research, to be the Cadillac of medigap plans available today.

But it'll cost you a few bucks. On top of your regular Medicare bill, which will come out of your Social Security check.

If you choose it during your initial enrolment period, there are no health questions. If you want it later, you'll have to qualify.

Then the next question becomes who accepts your Insurance? 

[Murph]

8 hours ago, Larsongs said:

Then the next question becomes who accepts your Insurance? 

It's accepted anywhere Medicare is accepted.

Those plans are sold by United Healthcare, Humana, Mutual Of Omaha, all the big boys.

[Whitefang]

23 hours ago, fortyearspickn said:

Whole Life you can get money back, Term Life is cheaper, but you can't.  In neither case do you come out ahead unless you die before the actuaries predict for you.  Well, YOU don't come out ahead  EVER.  Your beneficiaries may.    Life insurance and Auto Insurance are in no way comparable to the Health Insurance Scam. 

 

Yes, I know whole life is the one that pays back.  And when you're a 21 year old newlywed in 1957(like Stan) it's the one you get.

Car insurance is an entirely different scam.

Whitefang

[Larsongs]

2 hours ago, Murph said:

It's accepted anywhere Medicare is accepted.

Those plans are sold by United Healthcare, Humana, Mutual Of Omaha, all the big boys.

Just an FYI, Not all Dr’s, Specialists, Hospitals, Urgent Care & ER’s accept all Supplemental Insurance Plans..  Anthem Blue Cross & Blue Shield are the Big Boys in most cases.. 

[Cougar]

On 10/7/2022 at 4:36 AM, Murph said:

The best option out there, if money is no object, is a plan G supplement along with Medicare A & B. Along with a prescription supplement maybe.

I just went through this and that's pretty much what I finally decided, too.  Since I was pretty healthy, I went with the "high deductible" plan in both cases.  This really cuts down on the monthly premiums.  Medicare always pays for 80% anyway, and a full-featured Plan G would pay the remaining 20%, but I figured I could handle that 20% for office visits and whatever. 

As luck would have it, though, I promptly came down with (1) walking pneumonia, (2) some little heart anomaly that required fancy nuclear isotope imaging tests, carotid artery imaging tests, and a pharmacological stress test (all came back normal), (3) a weird blind spot in my right eye that was originally thought to be a detached retina but turned out to be an "eye stroke," so there's nothing that can be done about it.   So I'm now partially blind.  I can see fine with my left eye, but the bottom left quarter of my right eye's view is now just a big blind spot.  WTF?  This has not been a good month!  Maybe I should have gone for the full-featured Plan G!  Since I just take a couple generics, I'm just paying a minimal $6 a month for prescription medications, which has something like a $2,000 deductible, but it saves being penalized if I later want to change to a lower deductible. 

AFAIK, you are wise to decide against the "Advantage Plans." 

[MissouriPicker]

Medicare and its various options are confusing as all hell.  As suggested, find an insurance dude/dudette that specializes in this stuff.  What he/she doesn’t know, they’ll find out for you.  A knowledgeable agent is a necessity.  My wife and I talk with our’s whenever we have any questions.……..Otherwise, it’s an “I’m from the government and I’m here to help” situation.

[Murph]

21 hours ago, Cougar said:

I just went through this and that's pretty much what I finally decided, too.  Since I was pretty healthy, I went with the "high deductible" plan

You went with a high deductible G?

There is also a plan N that's getting popular, I've read that it might have "less" price increase over the years because of the co-pays and "overage" charge. That "overage" is what scares me. 15% of 100K is a chunk, and the way stuff is going up, 100K could be a broken arm...

 

[fortyearspickn]

May not be spelling it right - but there is a law -  "Paretto's Law"   which, not legal but statistical, indicates that almost always -80% of an occurrence is found in 20% of a population.   So, for example - 80% of the ice cream is eaten by 20% of the kids at a party.    80% of the jello shots are consumed by 20% of your guests.  (mostly your brother in law)..     In healthcare - they've found basically the same thing -  80% of your healthcare occurs in the last 20% of your life.  From age 20 - 60, you might consume  $4k on average (what it costs the providers, not what your out of pocket or premiums are).  But that amount triples when you go from 65 - 75.        People who like to dabble - question whether it is logical to spend $100K in the last year of every Medicare recipient's life on healthcare.  These dabblers would like to see that amount of tax money going to Medicare go somewhere else.  Especially as the Baby Boomers get older.  Usually these pundits are millennials.  

Growing old is not for the faint of heart.

[Larsongs]

I went to an Urgent Care with an injury a few years back.. They said, what kind of Insurance do you have.. I said, United Healthcare.. They said they didn’t accept United Healthcare & referred to another Urgent Care 10 miles from there…. Thank God it wasn’t a life or death situation…

[Whitefang]

Then again it's not always the insurance that's the problem.  Back in the early '90's we went to te Kresge Eye Institute to get some eye procedure done for my wife's eyes .   When filling out all the pre treatment paperwork we informed them that my wife, a GM worker, was carrying a hospitalization policy with a company called SELECTCARE.  All went well until two weeks after the procedure we got a bill from Kresge for over $2000.  When calling them to explain they told us they didn't accept that insurance!  I told them they had ample opportunity to tell us that when we told them that was her insurer before the procedure was done.  Luckily, as GM employees, the U.A.W. benefits rep stepped in and got it straightened out.

Whitefang

[Larsongs]

4 hours ago, Fish Crumpet said:

A life or death condition would have meant the emergency room where they would have had to treat you and where UHC would have been required to cough up.

A couple years ago my daughter was visiting from Houston.. She was having pain in her side. It got so bad I took her to the ER at Eisenhower Hospital in Rancho Mirage, Ca.. (Where the Presidents go).. Her husband is a 20 year Executive with Exxon Mobil & has excellent Insurance.. we sat in the ER for 5 hours.. Then I got passed & asked for whoever was in charge.. Explained the situation.. They examined her & determined her Appendix had burst.. They decided to finally do something.. Put on a Cart & took her to another floor where we waited 2 more hours to get a Room.. Then waited another 5 hours before they finally took her to Surgery..

They had a Cadillac Plan..