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[ 2015 ] Medicare Supplement Not worth it Anymore?

WinniWoman

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My 80 year old friend called me and said she was thinking of dropping her and her husband's supplemental insurance because even with all their medical expenses this year, the insurance company did not pay anything because of their high deductible, which is $3000 each. She wanted to know what I thought and, of course, I do not have enough details to give her any advice.I assume she will be discussing this also with her daughter, whom they will be moving in with shortly.

She said that even with her two cataract surgeries and her husband's bone/blood cancer treatments, emergency room and his hernia surgery this year, she added everything up and she still did not meet the deductible because Medicare picked up everything 80/20 and her premiums for the 2 supplemental policies don't make it worth it.

Her husband gets his meds from the VA. She is only on one or two meds. She did say that perhaps in the future she might need a prescription plan as she ages and could be on more meds. Right now she is a very youngish 80 year old. Up until his blood/bone cancer, so was her husband.

Could this also be a new trend with people having to pay higher and higher deductibles to supplement their Medicare policies? That people simply won't buy them? I have yet to start researching/learning about Medicare.
 

Jason245

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I would probably tell them to contact a financial planner. It sounds like the husband is a vet so they may be eligible for free Planner assistance through the government or a credit union (maybe usaa).. I would start there.

Sent from my SAMSUNG-SM-N910A using Tapatalk
 

WinniWoman

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She even said that one of their doctors said this as well- that it doesn't pay to have the supplemental insurance.
 

csxjohn

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WinniWoman

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Sounds like she must have an Advantage plan.


Why would anyone get an Advantage plan rather than a Medigap policy? Is it a cheaper premium?

I wonder if some of these elderly people do not understand the differences. I also think many of them use agents, which right there there is a conflict of interest.
 

bogey21

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Why would anyone get an Advantage plan rather than a Medigap policy? Is it a cheaper premium?

Out of inertia I kept my ex-employer's plan as a Medicare supplement (my bad) at a cost of about $7,000 per year. The two advantages were that they paid everything Medicare didn't with no questions and I could pick my doctors, hospitals, etc. Prescriptions had very small co-pays.

The problem is that the cost of my premiums were going up every year so for next year I am switching to a $0 premium Medicare Advantage Plan. The negatives are that it is an HMO; I will need a gate keeper for referrals; have to stay in network; and have some co-pays and deductibles. On the other hand annual "out of pocket" is capped at $4,900 which is less than the over $7,000 in premiums I would be paying if I kept my current coverage.

My plan is to put the monthly premiums I won't be paying into a separate bank account out of which I will pay my co-pays and deductibles. Will the potential hassles be worth it? We will see.

George
 

ronparise

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When I turned 65 I did a Medicare advantage plan. With no additional premium And then I had knee surgery my share of the cost was substantial

When my wife turned 65 we looked at the supplemental plans and that's what we did The promise is they we can use any doctor and any hospital and not pay a penny(perscriptions are different) and so far that's been true, but the premiums are high. When I include the Medicare premium and supplement premium and the perescription premium we pay about $800 a month

As long as we stay healthy and I don't need any more new knees or hips it seems a waste. But a heart attack or a cancer or any other big deal illness or injury and it won't seem too bad

Gotta wonder why more folks don't back a national health care plan like Canada
 
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Fern Modena

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Your friends should call or go to the local HIICAP counselors in NY, if that is where they live. This is a part of the State of NY Office on Aging.

In many states this is called SHIP, so if they don't live in NY you can look up the agency they should call in the state they live in.

When they make contact with HIICAP or SHIP, they should provide them with a list of medicines they use, as well as any chronic conditions they have. A counselor (generally a volunteer who has advanced training) will then be able to give them various recommendations for what the best few insurance plans might be for them.

Unless they are either rich or have nothing, I don't recommend going without a supplement. All it takes is one catastrophic medical event or an accident to make it all worthwhile. Nobody plans for these things, but they do happen.

Fern
 

Quiet Pine

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I have a supplement plan F--High Deductible. The deductible is $2,180 a year and never has paid anything. My premiums are $35 a month. I think it's a good deal. Last year my house didn't burn down and my car wasn't in an accident, but I don't regret the insurance premiums. My insurance is just in case.

Plan F covers out of the country (Medicare doesn't), an additional 365 days of hospital care, co-insurance after 20 days in a skilled nursing facility and more. I spend between $100 and $500 a year, out of pocket for medical costs.

My husband (same age as I am) has a regular Plan F that pays for everything. His premium is $224 a month. Even though I cover costs out of pocket, I spend less than half what he does in a year. And if there's a medical catastrophe, I'm covered.
 

bogey21

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When I turned 65 I did a Medicare advantage plan. With no additional premium And then I had knee surgery my share of the cost was substantial.

It looks to me like Medicare Advantage plans have evolved over the years. The one I am going into caps an Insureds "Out of Pocket" expenditures at $4,900 a year. I wouldn't have signed up without the cap.

George
 

WinniWoman

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Your friends should call or go to the local HIICAP counselors in NY, if that is where they live. This is a part of the State of NY Office on Aging.

In many states this is called SHIP, so if they don't live in NY you can look up the agency they should call in the state they live in.

When they make contact with HIICAP or SHIP, they should provide them with a list of medicines they use, as well as any chronic conditions they have. A counselor (generally a volunteer who has advanced training) will then be able to give them various recommendations for what the best few insurance plans might be for them.

Unless they are either rich or have nothing, I don't recommend going without a supplement. All it takes is one catastrophic medical event or an accident to make it all worthwhile. Nobody plans for these things, but they do happen.

Fern

Good advice. I will mention this to them. They do live in NY but are moving to NJ.
 

WinniWoman

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I have a supplement plan F--High Deductible. The deductible is $2,180 a year and never has paid anything. My premiums are $35 a month. I think it's a good deal. Last year my house didn't burn down and my car wasn't in an accident, but I don't regret the insurance premiums. My insurance is just in case.

Plan F covers out of the country (Medicare doesn't), an additional 365 days of hospital care, co-insurance after 20 days in a skilled nursing facility and more. I spend between $100 and $500 a year, out of pocket for medical costs.

My husband (same age as I am) has a regular Plan F that pays for everything. His premium is $224 a month. Even though I cover costs out of pocket, I spend less than half what he does in a year. And if there's a medical catastrophe, I'm covered.

Gee, now I am thinking maybe my friend could have a high deductible supplemental plan and not an Advantage plan. I really don't know. But- it seems to me just by what some of you have posted that the supplemental plans might be better plans then the Advantage plans.

I agree- insurance is in case you need it.
 

Sandy

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Question:

I recently met with a medicare specialist with United Healthcare. He said he can also sell other policies.

My first question is whether it would cost more if I went with him (thinking of salesperson commission) or just called and signed up over the phone. He said that the premiums are the same across the board for whichever policy I choose, and a person signing me up on the phone also has to be a licensed agent.

Among other things of concern to me was the "donut hole" gap. I first heard about the donut hole when a friend was on disability and kept falling into the donut hole. She had to then pay a huge sum, maybe thousands, before the Medicare would pick up again

I thought that these medigap and complete supplements took care of this gap. The agent said "NO." The donut hole still exists, and once you fall into it you must pick up the costs. He said that when my costs of medicines reaches $3300, I must then pay for meds myself until I reach $4850 out of my pocket. Then Medicare picks up again. He specified that the costs of $3300 are actual costs, not just my deductibles or co-pays!:eek:

The names of these plans, medigap, medicare supplement, medicare advantage, are so misleading because they made me think that all could be covered and that there was no more donut hole.

Anyone else have this information similar to what I was given? Or anyone run up against the donut hole?
 

Luanne

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Sandy, the best advice I was given was given to me by my sister and another friend.

The Medicare supplements plans are the same no matter who you get them through. What I mean is, if you are looking at the Supplemental F plan, since it's government regulated all insurers offer the same plan. The advice I got was to go with whoever offered it the cheapest.

I've heard about the donut whole, but I really don't understand it completely. Before I decided whether or not to even take a plan for prescription medication I looked at what my out of pocket expenses would be vs if the had insurance and was paying premiums. It was almost a break even for me and I decided to go ahead and get the insurance in case I need additional prescriptions. I was able to use a tool online provided by my former employer that broke plans down and I picked the own that would be the cheapest out of pocket over all.
 

Fern Modena

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The Donut Hole

Here is information to help you understand what the "donut hole" is.

There are many different policies, some with premiums, some without. Some have a donut hole, and a few of the highest cost ones do not. If you are healthy and take few medicines, or mostly all generics, one of the lower cost ones with the donut hole is probably fine.

I have an employer sponsored plan. It provides coverage during the donut hole, whereby I pay the exact same amount while in the donut hole as I did before that (due to an employer subsidy). Once you have passed through the donut hole, in 2015 your prescriptions then become $10. for name brand and $5. for generic prescriptions for the remainder of the year (for three months! a complete bargain for high priced meds)

Fern
 

isisdave

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The reason you need a Medigap plan is that there is no cap on the 20% you have to pay under Part B for non-hospital services. If you end up on dialysis, or chemotherapy, or physical therapy (all things that we are more susceptible to as we age) these are services that usually are not given in the hospital, so they're under Part B and you will pay.

Some Medigap policies also cover most of the nursing home costs after the basic Part A 20 day coverage.

You might also look at Medigap plan N, which is very much like F except that it doesn't cover the $147 Part B deductible, and SOME doctor visits will have a $20 copay. But it's a third less than F in cost. I'm 66 and it costs me $103 per month.

Some of the Medigap plans go up as you age; others have costs depending on where you live but not on age. See page 18 of the guide mentioned below. So maybe you want an age-rated plan while you're younger, and a community-rated plan when the first one gets too expensive. And it's true: the coverage is the same no matter who sells it, so go with the cheapest (unless they have a rep for bad customer service).

Here is the guide to Medigap: https://www.medicare.gov/pubs/pdf/02110.pdf and Medicare has a site that show you what's available in your zip code.

The advantage to a Medigap plan is that it covers any doctor who takes Medicare, anywhere in the country. A Medicare Advantage plan may have a very low or zero premium, but it has limited coverage outside your home state, and almost all of them are HMOs, which means if you need a specialist, you have to go to theirs, and often you have to wait to do so. I've known people who died because they had to wait a few months.

The good news is that if you guess wrong, you can change to something better next year. And if that's too far away and you're not too ill, you can move to the neighboring state long enough to qualify for a special enrollment period.
 
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WinniWoman

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The reason you need a Medigap plan is that there is no cap on the 20% you have to pay under Part B for non-hospital services. If you end up on dialysis, or chemotherapy, or physical therapy (all things that we are more susceptible to as we age) these are services that usually are not given in the hospital, so they're under Part B and you will pay.

Some Medigap policies also cover most of the nursing home costs after the basic Part A 20 day coverage.

You might also look at Medigap plan N, which is very much like F except that it doesn't cover the $147 Part B deductible, and SOME doctor visits will have a $20 copay. But it's a third less than F in cost. I'm 66 and it costs me $103 per month.

Some of the Medigap plans go up as you age; others have costs depending on where you live but not on age. See page 18 of the guide mentioned below. So maybe you want an age-rated plan while you're younger, and a community-rated plan when the first one gets too expensive. And it's true: the coverage is the same no matter who sells it, so go with the cheapest (unless they have a rep for bad customer service).

Here is the guide to Medigap: https://www.medicare.gov/pubs/pdf/02110.pdf and Medicare has a site that show you what's available in your zip code.

The advantage to a Medigap plan is that it covers any doctor who takes Medicare, anywhere in the country. A Medicare Advantage plan may have a very low or zero premium, but it has limited coverage outside your home state, and almost all of them are HMOs, which means if you need a specialist, you have to go to theirs, and often you have to wait to do so. I've known people who died because they had to wait a few months.

The good news is that if you guess wrong, you can change to something better next year. And if that's too far away and you're not too ill, you can move to the neighboring state long enough to qualify for a special enrollment period.

Thank you for the info. I am going to dinner with her and her husband this week so I will discuss with her further. And thanks everyone else for your input!
 
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bogey21

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The Medicare supplements plans are the same no matter who you get them through. What I mean is, if you are looking at the Supplemental F plan, since it's government regulated all insurers offer the same plan. The advice I got was to go with whoever offered it the cheapest.

Maybe yes, maybe no. Some Insurers may be better paying claims than others.

George
 
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This is my article on Medicare. Technically, I am still a licensed Health Insurance agent, but since I am not appointed (changed career), I can only advise, not sell. The numbers between this article and current numbers may change. And yes, I can find you a local agent if you need.

Medicare

TS
 

b2bailey

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I found the BEST person to help me -- in person.

I had noticed an ad in local (Aptos, CA) newspaper about Senior plans. I finally bit the bullet and made an appointment. It could not have been a more pleasant experience. I went with info I had gathered and I was prepared to pay for a plan through United Health Care that would cost about $150 per month. The agent convinced me I didn't need that one -- the less than $100/mo plan would be better for me. I will need to pay $147 deductible and $20 per doctor visit. Other than that, ALL medical will be covered by regular medicare or this supplement plan. I figure a cost of less than $1,200 per year is a small price to pay for peace of mind. I suppose my personal experience of my husband's medical battle with brain cancer <which he lost> which created bills of nearly a million dollars may have influenced my decision.
 

RonB

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USAA is great

If they are USAA members, they can call and get someone licensed in their state to help them. I went from $32 per month for dr, (with copays),meds, (with copays), and eye care to $0 per month with a smaller copay and $0 out of pocket for meds plus eye care and dental care.

Ron
 

normab

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Just wanted to add a point about the VA coverage. My dad was going to the VA for over 10 years to get his meds. However, when he hit 90, the trip was too far for him to drive. He went a year without coverage and some of his meds were pricey, but he could only enroll once a year and he missed his opportunity. He then had to get medicare prescription coverage, which is separate from the supplement, (His plan is only for medical, not RX).
 
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