My maximum out-of-pocket cost for 2022 is $7200. I have a Medicare Advantage PPO policy in Brooklyn, NY and I have no monthly cost except the Medicare Part B taken out of my social security direct deposit. This includes prescription drugs.
My primary doesnāt take Medicare. This will be interesting.
Hereās a scenario I havenāt seen discussed here: I will turn 65 before my H. H is planning to work til at least 67.5 (end of the year after he reaches SS NRA). I am on his medical plan, and for good reason ā Iām on a ton of meds, including one thatās a Tier 5 drug under Medicare. (I hit my out-of-pocket max in June this year.)
Does Medicare become my primary at 65 because Iām not the one whoās still working, even though I am still eligible for coverage under Hās plan? Trying to suss out how this works. I know Iām eligible to stay on Hās plan after he retires (and we will probably pay for both the work plan and Medicare because of my issues.) TIA!
My parents paid for a private insurance medicare plan for years, @$239/mo. Each. Plus the $99 for the part B. They had pretty large co-pays for doctor visits and needed referrals for specialists. No vision or dental.
That company left the state so they had to switch and went to a MA plan. I think the premium was about $150 the first years, but every year it went down and more benefits were added. They wished theyād switched years earlier.
For the last few years, my mother had cancer and other medical problems, and the only complaint she had was the donut hole for prescriptions. She went to pick up a prescription on a Friday and it was $117 and she said no, sheād see what her doctor had to say about it. She fell on Sunday and died the next Friday. TG she didnāt pay that $117 as she would have been furious!
Her plan really did get better and cover more every year. She had an insurance broker who was great and knew the programs. My mother referred many people to the broker and weāve all been happy. Not everyone picks the same plan so sheās good about figuring out what that person needs (drugs, therapies, basics, etc). As my friends have been hitting 65, we send them to Peggy.
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Here are the rules: https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65.
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Thanks, @kelsmom! Just what I needed.
I am curious if anyone has delayed a Plan D to avoid IRMMA? My husband and I each take only a couple of medications (cholesterol & thyroid,) both that cost next to nothing with GoodRx, but would be free with one plan as a Tier 1 drug. The other 2 medications while covered, are cheaper with GoodRx; even with out traditional health insurance, we didnāt put medication through our plan as selfpay was much cheaper. My agent does not recommend going without, he did ask if it was something we had thought about. Even with the cheapest Plan D, our coverage would cost 7 times more than if we didnāt have coverage. Of course we would have to pay the penalty for late enrollment, and take a gamble that one of us didnāt need some expensive medication while not on a plan.
Again, not something we are willing to gamble on at this point, but wonder if others have done so, or thought about it.
Donāt forget, that the late enrollment penalty is forever, i.e., until you die, unless you have other credible coverage (such as thru an employer).
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IRMMA isnāt just for Part Dā¦there is an IRMMA for Part B as well, I believe.
My regular Medicare would be $170 a month. Itās $340 because my husband was still working and earned a high salary.
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Oh, I am aware! While some would consider not having prescription coverage, I imagine not as many would go without medical coverage.
It works the same way here - Canadian healthcare is awful, you canāt get surgery, all the Canadians come to the US for care. Having just signed up for Medicare, I would prefer the Canadian system.
Iām changing my work hours and wonāt get benefits so did regular Medicare for DH and an advantage plan for me. We used a broker to figure it all out. Weāre in MA which is one of the 3 states that allows you to go to regular Medicare from MA without restriction, so it seemed worth the risk for a year. I was nervous about the United PPO because we had such a problem with them years ago as an HMO but the finance office at Dana Farber recommended them, fingers crossed.
They donāt come here for major things like modern cancer therapy and heart transplants because itās far too expensive.
Some Canadians do have private insurance, whether thru their workplace or independently. They are the ones who are more likely to come to the US for healthcare.
When John Mackey was CEO of Whole Foods, he said they had no problem getting workers in Canada because WFās health insurance was quite good and therefore appealing to Canadians. I expect thatās the case for a number of global employers.
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It is also cheaper to provide private insurance to Canadians than to Americans, since it is an add-on to the public insurance. I.e. paying only for the additional stuff, not paying to replace everything including the basic stuff that public insurance covers.
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But, can they use it in the US where costs are substantially higher?
Presumably, it depends on the specific private insurance.
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I took a community course on Medical Insurance systems throughout the world, given by a former Insurance specialist. Very enlightening. The general summary was that all systems have issues. US Healthcare coverage is typically excellent for specialist care, but lousy for preventative care. As a result, patients often need specialty care because issues were not caught early. There are also not enough general MDās, largely due to huge pay differences, and need to pay off substantial loans. Many of the other systems, are far better for daily and preventative care.
Specific to Medicare, I have been extremely disappointed regarding what they cover for preventative care, and how varied it is by office or by specific plans. One MD shared that technically, Medicare only covers a āwellnessā exam every, which imho is laughable. Patients are asked a few questions (about memory, and depression), and thatās about it. A true physical is not covered, and would be out-of-pocket. Other offices do include a physical (hands on, a few lab tests) which is a step above. Weāve experienced both types of offices, and I always caution friends to verify with their MDās when choosing a Medicare plan.
Medicare Wellness also covers the basic vitals: height, weight, bp, & routine lab work, all covered at 100%. For the healthy, thatās about all they need.
OTOH, most seniors have health issues and are taking more than one medication. For those folks, the Wellness Visit is not of much value. But itās important when making the appointment to let the office know that you ONLY want the Medicare wellness exam. If you want to go into depth about your high bp, your heart murmur, or something else, that becomes a medical visit subject to deductibles & copays.
Some of us on Medicare Advantage plans have no copay for visits with PCP.
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I have a Medicare wellness exam yearly; it covers the basic vitals as @bluebayou notes. Flu shot, pneumonia shots, etc are covered also. My doctor schedules a yearly mammogram and bone scan for me and checks to make sure Iām up-to-date on colonoscopies. He discusses whether or not I need an appt. with my cardiologist (high cholesterol). The yearly mammogram and bone scan are covered by medicare. A colonoscopy would be also, if needed.
The wellness exams Iāve had tend to be more comprehensive than a few questions. I even had an evaluation of my gait this year to see if I am susceptible to falls. Admittedly I am healthy, so it works for me. My yearly physical prior to Medicare didnāt really do anything more than the above. (On the other hand, I adore my doctor. I have heard of wellness exams much less comprehensive.)
I am on standard Medicare - Plan G with a supplement that has just gone up to $137 a month and a drug plan of $6.60. Once the Medicare deductible is covered, Iām done ā¦ no bills/no co-pay.
If I see a specialist for some reason, I simply ask if they take Medicare.
I donāt want an Advantage plan simply because I donāt want to have any curbs on which doctors I want to see. I live in the city with the largest medical complex in the world. Lots of choices on who I can see medically. I canāt answer about other Advantage plans but I have two friends - different Advantage plans. One desperately wanted to move her father to a different practice for his cancer treatment and was denied because it wasnāt in her network. The other has to get approval for all kinds of things. I donāt have to mess with either of those scenarios.
@ignatius I signed on to my Medicare Advantage PPO plan after checking on the issue of limits on who I could see. There must be differences on this in different plans and different states. It may also be that there are medical systems that I cannot access but I have not run into that at all. I see doctors in different systems with no problems (four in all).
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