In answer to the premium cost question – the answer is “it depends” – but here is what I have and what I am paying for it. I started Medicare January 1, 2019; I am in Northern California (greater Bay Area). I chose regular Medicare in part because the Medicare Advantage plans are all HMO’s and their premiums aren’t much different than what I am paying for a supplement. Also, in California, the law allows everyone with a Medigap supplement plan to switch to a different plan each year for a 60 day period starting on their birthday – so that keeps the plans priced competitively and also means that I won’t get stuck down the line with a premium I can’t afford.
Regular Medicare: There is a premium of roughly $150/month for Medicare Part B that is paid quarterly.
Plan D: Drug plan: I don't take any regular prescription meds, so I opted for the cheapest plan, with was $13/month last year but is going up to $15/month this year There are a couple of newer plans that I could switch to this year that are cheaper (around $12) , but IF I get prescribed a more expensive brand-name prescription drug, then my $15 plan has a lower copay so decided to stick with the current plan. One factor about the drug plans is that they almost all have participating pharmacies where there are extra discounts -- such as paying anything from 0 to about $3 for basic level generic drugs -- these are major retail pharmacies so you are sure to live near one of them, but it is a factor to check before enrolling.
Medicare Supplement (Medigap): I am with Blue Shield of California, with their Plan F + Extra plan. The "Extra" is something authorized in this state -- probably not available in most other states -- it means that in addition to the basic F benefits (which are standardized from one plan to another), I also get some limited vision coverage, silver sneakers gym memberships, discounts on hearing aids, and a personal emergency response system (the "I've fallen and I can't get up" system). I don't need hearing aids and I haven't bothered with the PERS - but the vision benefits save me about $300 in expenses I would otherwise pay for routine vision care & contact lenses, & I've definitely gotten my money's worth with the gym membership. There was a first year $25/monthly discount on my premium so I paid $115/month this past year, but that will go up to $140/month in 2020.
So basically in 2020 I’m looking at $150 (medicare part B) plus $15 (Part D) plus $140 (Supplement) - or $305/monthly.
By way of comparison, if I were to sign up for a Medicare Advantage plan in my area, then there would be a monthly premium of between 0 and around $100 on top of the Medicare Part B – but they are all HMO’s with copays – so I’d have to go back to figuring out which doctors were in-network for me and be paying more out of pocket along the way. So at least for me, I’m happy with what I’ve got.
But again – options are going to vary widely depending on where you are. I think you have to consider some personal preference factors as well.
It is open enrollment time of year now, so we are deluged (probably get 2 or 3 mailers every day for weeks) with offers for Medicare Advantage plans. It’s funny, some are big glossy obvious ads, others are very official looking envelopes with “IMPORTANT MEDICARE” written on them.
I am determined to stick with traditional Medicare (I have plan G, wife has F high deductible). The Medicare Advantage advertising is very persuasive and pricing very attractive (Premiums as low as ZERO!!) but I read an article that explained that ultimately Medicare Advantage plans are sold by profit making companies and they would be more likely than traditional medicare to deny you life saving treatment at some point in your life. So, accurate or scare tactic, it worked on me.
I haven’t read all the thread, so maybe I’m repeating what’s already there. If so I apologize.
if you’re doing Medicare supplement, not a Medicare advantage plan, it makes absolutely no difference what company you’re with. Their coverage is all identical. In our state, one company processes all the claims for all the different insurance companies. I’m guessing it’s that way everywhere but I’m not sure. but regardless the coverage they have to provide is mandated, they don’t really have any choice. It’s purely shopping by price.
Medicare advantage is more like what we are used to for regular insurance. Coverage can vary from company to company, and you can run into weird rules where you can get caught.it’s similar to other private insurance. I’m not a big fan, but most doctors around here still take Medicare patients so that isn’t as big of a concern.
Part D is something that the agents make next to nothing on. But the good news is you can go online yourself, plug in the prescriptions that you take, and it will tell you what the lowest out of pocket plan is. Just ask an agent for the website, they will be happy to give it to you because they don’t want to deal with it. off the top of my head I don’t remember what it’s called. It’s probably easy to find on Google too.
This is not quite true. I’d give it about 95% in terms of accuracy – that is a G plan is a G plan is a G plan.
But some states, like California, allow companies to tack on extra – in California it’s called “innovative benefits” and that is why I have a supplement that also comes with Silver Sneakers, and various discounts for vision care & hearing aids. Last year, the F plan with the extras was actually priced with a lower premium than the simple F plan – I figured that was because California also allows for Medigap customers to switch plans annually, so the extra stuff is a way for some companies to lock in customers. (We aren’t really “locked in” — but the point is we’ve bought into something extra that we might have to give up if we switch. )
And this definitely is not limited to California - it is somewhat of an evolving landscape:
And for anyone who does buy into a plan with tacked on benefits, then the specifics offered by the company may matter. My optometrist is on the vision network that my Medigap F extra plan offers – so I got the benefit of a discount that might not have applied with an out-of-network provider.
Perhaps you are in a small state, but the large Medigap carriers in CA process their own claims. So, for example, AARP-United Healthcare processes its own claims, as does Anthem, as does USAA…
But the important part is simply that the Medigap provider has no discretion – they can’t deny or refuse to pay their share once Medicare has approved the underlying charge. That’s the whole point of the “gap” coverage – for the most part, they are simply paying the patient’s share of costs (deductible, co-pay, etc.).
Dollar wise, it is a good deal for the insurance companies – some even argue that Medigap coverage is unnecessary, because it is so unlikely that the “gap” will exceed the costs of premiums. (See https://www.huffpost.com/entry/medicare-supplemental-policies_b_3901861 ) I’d rather buy the coverage – because I like the peace of mind of simply not having to deal with the bills — but I do think it’s important to understand that a Medigap policy is simply insurance to cover Medicare copays & deductibles. I think Medigap makes the most sense for people who are financially at middle levels – financially strong enough to pay the monthly premium, but not so rich that they know they could easily pay those extra costs at a time when they were experiencing serious medical problems. The other problem is simply that if you don’t buy the Medigap at the outset, you might not be able to get it at the point where you need it the most.
Also agree that not all “G” plans (or other Supplement options) are the same. The minimum coverage is set by Medicare rules, but how they charge and any perks they want to add (as Calmom noted), can vary.
Here are some examples of the differences we found comparing G Supplemental plans in our state. (More to make your head spin):
*Some included Silver Sneakers. Others did not. United used to include, but eliminated it.
*. Some (like United) are offered in multiple states and can be easily switched if you move to one of their other coverage states. The new premiums are then calculated based on the new location (can be higher or lower than your current state). The policy we purchased (not United) is not offered in most other states. As a result, we supposedly can keep our current plan as-is, if we move to a state it is not sold. The only difference is they can charge us the highest premium allowed in our current state (which varies by county).
Different companies use different pricing methods. For example, Most companies in our state used "attained-age-rating". Rates start low and increase as you age. Some max out above a certain age. Others don't. But this is based on historical data, not on contract language. United used "community- rating" (everyone pays the same rate no matter your age). They offer a temporary discount to compete with other local companies, but that is eliminated after a number of years. At a certain point, if you live long enough, the community rating method is better. But the break-off point can change as companies change their rates, so it is nearly impossible to compare apples to apples and expect the rules will be the same in 10 or 20 years.
Thank you so much for your comments here & in the other thread re: Medicare. The comments in the other thread were very, very helpful when I was beginning to learn about the various options & eventually selecting a plan. And, the ones here are so spot-on that I find them reassuring.
One question now – If one starts with Original Medicare, then switches to a Medicare Advantage Plan, and still later, wants to switch back to Original Medicare; will preexisting conditions not be a factor, as far as underwriting, because one began with Original Medicare. (I realize this is really in the weeds, as far as details. I ask because you were very thorough with your research on medicare.)
You MAY be subject to underwriting if you want to switch back to regular Medicare from an advantage plan.
In my case, I’m a member of a rather large group that offers both options. We are able to switch back without underwriting but that might be because it’s a large group plan.
Oh my - I would NEVER be without a supplement if on Medicare. One day in the hospital wipes out any ‘savings’ from not having a Medicare supplement. Also, from our state eligible Medicare Advantage Plans for 2020 open enrollment (AL), the annual maximum out of pocket ranges from $3400 in network to out of network or total maximum of $10,000. That of course doesn’t include the initial deductibles being satisfied.
It seems a little clearer on looking at the Part D Prescription Drug Plans - many are on medications that one can see a plan stand out better than others; while any one else needs to just think through ‘what if’ on prescriptions and how to weigh out the various choices.
We are not eligible for Medicare until 2021 - but looking at the information now and during next year’s open enrollment. The current annual enrollment deadline is 12-7-2019. Since I work in health care, I will also ask some of the business office people on the plans I am looking at…
@ManhattanBoro – in general, if you don’t sign up for a Medigap (supplement) policy in the original enrollment period and maintain that policy continuously, and instead start with or switch to Medicare Advantage, you may be precluded from getting the Medigap policy later on due to medical history. There are some exceptions, both in state laws and some other time limits tied to the process of switching from a supplement to an MA plan – so it’s not an absolute. But there is a take it or potentially lose it aspect to the supplement plans that don’t apply to Medicare Advantage plans – which are always available during open enrollment. The more likely problem you would run into with MA is needing to go with a higher-priced plan because of the underlying medical condition - for example, if someone knows that they have to take an expensive prescription drugs and make frequent doctor visits to monitor their health, then they might need to shop for a MA plan with better drug coverage or lower copays. The MA plans all cover the basics, but they can be very different in terms of out-of-pocket costs along the way.
But of course you would be able to go back to standard Medicare Parts A & B any time – it’s just that you could also be subject to the Medicare copays and general 20% patient responsibility if you couldn’t get a supplement. In some circumstances that might be the better option – for example, if the Medicare Advantage plan is an HMO or PPO that won’t pay for a specialized out-of-network hospital that the patient prefers, and the patient or their family is willing to pay their share in order to get the preferred care.
But that was a big factor in my choosing a Supplement. One insurance broker I talked to put it this way: all of their clients love their Medicare Advantage plans… until they get sick. You will generally pay less in premiums for the MA plan … but in the end you are pretty much getting what you pay for.
I’d add that if a person is dead broke – no assets, no income outside of their social security – they typically will qualify for medicaid – and in that case their medicaid can be the secondary insurer and pick up what Medicare doesn’t cover. Obviously a Medicare Supplement isn’t going to work for someone who can’t afford to pay the premiums – you can have that policy for 15 years straight and it’s still going to lapse if premiums aren’t paid.
I agree with you about wanting the supplement – but you are mistaken on the math. In-patient hospital care is covered by Medicare Part A – there is a deductible of roughly $1400 that a supplement plan would pick up, but then Medicare pays everything for up to 60 days of care during a benefit period. It just really needs to be understood as a secondary insurer, akin to an umbrella policy. So it is on day #61 when care starts really adding up. If you think about it, the insurance companies need to set premiums high enough to cover the Medicare deductibles and their profit margins. But one advantage for the Medigap insurers is reduced administrative costs - they don’t need to scrutinize bills or be in the business of determining whether to authorize medical procedures.
One more note - for those of you with spinning heads – if you are NOT YET ELIGIBLE for Medicare, you don’t need to know all of this. There is a lot of fluctuation in the market as to the availability of plans and pricing for each – so it makes no sense to get down to comparing brass tacks until you are close enough to the enrollment dates to have current figures.
I’m going to sit down with DH in a few days and review all of this. He had surgery on Friday, so going to wait until he’s recovered to get his thoughts.
Thank you all.
And if anyone else has anything to add, please do!
I went to three financial counselling offices at three local hospitals, and also went to the senior center SHINE program- and all 4 suggested a Medicare Advantage Plan through Blue Cross/Blue Shield, which is a PPO , not an HMO, so I can go to any doctor without a referral. My premium is $79/month. There is an annual cap on annual out of pocket expenses at $3500 I believe. It covers basic dental, hearing, and vision. I have been very happy.
It is true, however, that for me ERis $90, MRI or CT is $250, and PT is $40/visit.
Nevertheless, I am surprised more people aren’t on Advantage Plans.
We met with our accountant the other day. It is clearly currently financially better for me to stay on DH’s company health insurance than to go on Medicare B. Wine we do eventually go on Medicare B, we happen to have a reasonable sum of $ in our HSA. I think someone upthread said we couldn’t use it to pay for (or reimburse ourselves for) a supplement plan. At present, neither of us are on any costly RX (yes I know we could) and the funds in our HSA could cover the 20% OOP for a medicare B plan. So… can we wait on buying a supplemental plan and get one a few yers after we sign up for Medicare B? Yes I know we could have some catastrophic situation, but short of that, is there a possibility to wait a year or to to get a supplemental and see how much we would be using from our HSA?
For the most part, those meetings are all hosted by Medicare Advantage plans so is should be no surprise that they recommend MA plans.
The Advantage PPO plans are relatively new and not offered in all areas.
That being said, I (and Calmom) have Original Medicare Plan F-Innovative which has all the Plan F benefits (zero deductible, zero copayments, zero out of pocket, choose your own doctor)+ vision+hearing+silver sneakers, and it is less cost than regular Plan F. (no dental, however.)
