How much do YOU think YOU need to retire? ...and at what age will you (and spouse) retire? (Part 1)

Parents Forum Parent Cafe
14081

I have a Medicare Advantage HMO plan. All I pay is $105/month taken out of my social security check. In 2017 I had three hospitalizations for pancreatitis after an endoscopy, open gallbladder surgery and knee replacement surgery. All I paid for an ER visit, two (I think) CAT scans, one MRI, three (I think) endoscopies, around 15 days total in the hospital, and many physical therapy sessions after knee replacement surgery was my total deductible amount, $6600…

I saw first-rate doctors in each of the major hospital networks in NYC and an excellent physical therapist. All took my HMO.

Oh, and it includes a Medicare Part D prescription plan.

I am very, very grateful for this coverage.

14082

If you accept Medicare I it means you accept assignment. The remaining 20% is picked up by your Secondly or not.

Advantage plans pay about 60% of what they consider appropriate , which is a lot less than Medicare. In my state. And you have to be on their network. And they can ask for a refund months later.

14083

I and my hubby have AARP’'s Medicare Advantage plan and it covers virtually every non RX cost. Our Walgreen Advantage D plan costs us $28/ month. And both are covered all across the US.
We are in Calif, and we were both self employed and self insured prior to turning 65 last year.
Our health insurance costs WERE $2800/ month , with a $20000 premium.
With NO RX coverage.
Now our costs are $375/ month for everything. Both of us were in the hospital this year for surgery[ him] / and an emergency [me] . We did not have to pay 1 thin dime for either instance.
Phew!!! :smiley:

14084

So you can use Medicare anywhere in the country?

14085

Yes you can use regular Medicare anywhere in the country…as long as the doctor takes Medicare patients.

With Medicare Advantage…it depends on the policy. I have a PPO that covers me in the Anthem network everywhere.

If you have a HMO, it would be more limited.

14086

"So you can use Medicare anywhere in the country? "
yes of course you can.
it is administered by the US government, not by individual states or private companies.
I HIGHLY recommend AARP’s Medicare Advantage plans, which are available in every state.
There is strength in numbers.
And one final note- dont let ANYONE you know who is about to turn 65 “forget” Or put off signing up for Medicare B plans.
they DON’T want to make the same mistake as this man did!

"Twenty years ago, George Zeppenfeldt-Cestero left his job as a hospital administrator in New York to open a one-person health care consulting firm.

Since he was losing his employee medical coverage, he shopped around and bought a private health insurance plan through Aetna.

It was expensive, with premiums starting at about $1,000 a month, but “it paid for all my doctors’ visits and my medications,” he said. “I was a satisfied consumer.”

But several years ago, Aetna informed him that it was discontinuing that plan, sending him scrambling for another insurer. That’s when, applying for coverage through the state marketplace under the Affordable Care Act, Mr. Zeppenfeldt-Cestero learned that he (and, he argues, Aetna) had made a serious error.

He SHOULD have signed up for Medicare Part B three years earlier when he turned 65.

By delaying, he had missed the best window — the so-called Initial Enrollment Period — to apply for Part B, which covers much of what we consider health care: doctor visits, tests, injectable drugs (including chemotherapy), ambulances, physical therapy and other non-hospital services. As a result, he has to pay PERMANENTLY higher premiums, and he had to endure an unsettlingly long period — from December to July — before the coverage actually kicked in.

“It was very nerve-racking,” Mr. Zeppenfeldt-Cestero, now 71 and still working. “For six months, I was without any coverage whatsoever.”

Such Part B mistakes appear to happen with some frequency. Last year, nearly 700,000 Medicare beneficiaries were paying Part B penalties, according to the Centers for Medicare and Medicaid Services."

https://www.nytimes.com/2018/10/26/health/medicare-part-b.html

14087

AARP offers several Medicare Advantage plans through UnitedHealthcare. Provider networks vary based on the type of plan: https://www.aarpmedicareplans.com/health-plans/medicare-advantage-plans.html

14088

Well, while we were in Ireland this year, I required emergency treatment in the middle of the night. A physician came to our hotel room at 2AM, performed an exam and a urinalysis right in the room, gave me some pills, wrote a prescription, and stayed for 45 minutes to monitor my response to the meds and only left when I was stable. Because I was not a member of the Irish national healthcare system, we had to cough up the entire out-of-network cost: $40. Oh, and he called the next day to follow up.

DH had an eye emergency while he was working in Istanbul a few years ago. He went to the healthcare facility near his hotel and had his eye examined, irrigated, and patched by an opthamologist (yep, the actual surgeon) and given a prescription that was filled right there in the opthamologist’s office, also out-of-network/full cost for both exam and meds: $65.

To be clear, when I say “out of network,” I mean our insurance didn’t play a role at all. We just payed the cost those countries required of anyone outside their systems for those services.

Something is wrong with our system.

14089

I am covered by former employer for supplemental. I think it’s PPO.

14090

I had to go to the emergency room 2 years ago when we were in Singapore. I think my total costs including a couple of prescriptions was $125. I got reimbursed for this through my healthcare flex account when I returned home.

14091

A small amendment: if you’re still working at age 65 and covered by health insurance through your (or your spouse’s) employer or union, you don’t need to sign up for Medicare part B at the age of 65. You can continue to use the employer- or union-sponsored health insurance until you retire, and enroll in Medicare part B when you retire (or when the coverage otherwise ends) without penalty. This is called a “special enrollment period.”

There’s no reason NOT to sign up for Medicare part A (hospitalization) as soon as you turn 65; it costs you nothing. But for part B (outpatient medical care) you’ll pay a monthly premium, and if you already have good health coverage through an employer or union, the part B coverage might never pay out any benefits because your employer-sponsored health insurance will be primary. And the part B premium you pay might be higher than the basic premium, depending on your income.

This also might matter if if one of the spouses is younger and not yet eligible for Medicare, or if you have a child under 26 covered through a parent’s employer- or union-sponsored insurance… I’m 66, still working, with excellent employer-sponsored health insurance that also covers my spouse, age 61, and the younger of our two daughters, age 23. I could decline my employer-sponsored coverage and go on Medicare part B, but then my spouse and daughter would need to get individual coverage on the exchange or otherwise in the private market. Clearly a losing proposition for us. So I plan to continue working and using my employer-sponsored health insurance for myself and my family until DW is 65 and can go on Medicare. By then DD will also be 26 and no longer eligible for coverage through my employer.

14092

Yep. DH signed up for Part A only at age 65 because he is totally covered by an employer sponsored plan. But believe me…when that is about to end…he will I mediately sign on for part A and the rest. No penalty.

And yes…we crunched the numbers between him taking Medicare totally now and ditching his employer sponsored plan. His employer pays almost the full cost…so that is the better dollar figure right now.

14093

Actually, there is one reason to not sign up for Part A: if you are covered by a high deductible plan/HSA at work and you want to max out HSA. (You must stop HSA contributions 6 months prior to enrolling in Medicare.)

14094

In some areas, family practitioners ‘balance’ their patient base, because if they had too heavy medicare patients, they couldn’t effectively cover their overhead. So if you stay in an area, get ‘in’ with your PCP. Specialists from what I have seen (for example orthopedic surgeon who see a high number of elderly people and people in all age ranges) almost always take whatever insurance plan people have. Certainly there are people here with specifics on their medical care, and can talk to their doctor offices about how coverage under medicare or other plans work with bills there.

The only time a family member in our nuclear family went to the ER was when DD went to a medical clinic and got orders from that doctor for what needed to be done at ER (steroid shot and CT scan) - and she needed to be admitted and days after IV antibiotics have surgery. The ER bill and the MD ER bill would have been really high had it not been trimmed to accepted rates by BCBS and then our co-pay was a % of that. Once DD1 when she was young had a fall and there was a possibility of a broken arm, but one of the docs I worked for ordered a XRay (in our medical building) and it was fine - never got billed. Any other health issues, I always tried to address during office hours. Once DD1 as a baby was throwing up and throwing up over the evening - I was worried about dehydration etc - and pediatrician talked to me several times that night and we got through it.

Out of network is more of a concern within the US. Cousin was in Italy, got dehydrated and had a ER visit - since they have nationalized medical care, no charge. Several examples up-thread about a few other countries. I would be very cautious if insurance plan was limited. At 65, with MC and supplement, reasonable and comprehensive coverage.

14095

@bclintonk , very helpful. When I turn 65, my wife my wife will be 62. She is self-employed. My current employer is owned by me. So I am paying for health insurance. I wonder if it would be cheaper for me to take part b and getting insurance for her. I’m not sure this would lead me to cancel.

14096

@SOSConcern – Interesting to read of your mention of orthopedic surgeons. These are the only doctors I have encountered who often do not participate in any network insurance plans. Probably a regional difference.

14097

A further interesting thing about orthopedic surgeons: the only bill that I have refused to pay, in my 60+ years of being alive, has been to an orthopedic surgeon. A child’s cast was put on in the ER, was well done, and healing proceeded on schedule. At the time of cast removal, and mind you, this was 20 years ago, back when medical costs were not as insane, the orthopedic surgeon removed the cast and gave us a mimeographed sheet of exercise instructions. The amount charged to the insurance company was more than $800! I refused to pay my 20% and called the insurance company to say that the charge was fraudulent: it was billed as “surgery.”

The office manager and I went back and forth for a while. I said that my credit history was stellar, that I had requested that the insurance company refuse to pay their 80%, that she was welcome to try to go to collections or ding my credit history, but that I’d go to court before I’d pay the bill. Eventually they stopped sending me bills.

ETA: I remembered another bill, for a consultation at my son’s birth by some physician. It was billed just as he went to his first week of Montessori. I said that any bill that stale was not reasonable; I couldn’t possibly remember any and every doctor who had walked by the birthing room. They understood and dropped it.

14098

Yeah, I did fight when I got a bill for D’s birth when she was 2years old. I asked for an itemization as S’s birth was 100% paid by our insurer, except for the $10 tyvek jumpsuit H got to wear for the birth that he had forgotten to do but brought and wore for D’s birth. I had received a bill shortly after each birth and it had seemed ok at the time.

The hospital said it was too long ago so they couldn’t itemize and I could just ignore the bill. I never received another bill for either birth. Wacko billing system!

14099

"I wonder if it would be cheaper for me to take part b and getting insurance for her. I’m not sure this would lead me to cancel. "
When are you turning 65?
the best thing to do is run the #'s for current individual H.I. plans in Calif and your current state of residence.
they are unlikely to go up a lot in Calif because of State insurance regulations here.
Just remember, you will pay a life long penalty IF you dont sign up for Medicare part B when YOU are initially eligible. I’m guessing that H.I. for her could end costing $24000/ year for the 3 years before she turns 65 with a high deductible plan.

14100

@menloparkmom , thanks. Very helpful. I turn 65 in June. We live in Massachusetts but have considered making Sausalito a second home (bad tax consequences I know). I think we pay well over 24k per year for our plan for both of us. I will compare rates in CA. My current premiums are tax-deductible for my company. Would want to make sure that remains.

I was just in Palo Alto and Sausalito this week. Visited my son, spent time with the new team from a company I am co-founding out there, met with VCs, had dinners with my son and various of his startup-y friends, gave a talk at Stanford, had meetings with prospective clients for my existing firm and visited a friend with cancer. Love the area.