Medicare, Supplemental, Advantage, and other Insurances, Oh My Aching Wallet

shapeshifter · May 3, 2022

A topic about medical insurance, especially what's not covered by Medicare Part A that you get for "free" after paying for it out of taxed income for 40 or so years.
This is a very complicated topic. There is no "one size fits all."
Any information is helpful.

Posts so far (brought over from the Chit Chat thread as recommended by the Mod) include:

On 4/26/2022 at 12:26 PM, shapeshifter said:

Does anyone here have any positive experience with choosing health insurance to supplement Medicare (either for yourself or perhaps for your older relatives)? Is there a site that's not scammy? I will get kicked off of my former employer's plan in a year, so I need to start figuring this out.

On 4/26/2022 at 1:50 PM, shapeshifter said:

On 4/26/2022 at 1:34 PM, kristen111 said:

I don’t know much about that as husband takes care of the insurances, but we have Medicare and Cigna as a secondary. It works out pretty good. Don’t know the particulars and don’t want to.

And it is those "particulars" that make one plan good for someone and not someone else, which is why I'm wondering if any of those companies that supposedly have data on all of the insurance carriers and can figure out what is best for me are genuine or scams. And how do they get paid? Probably bonuses if I sign up? Ugh.
This is just like trying to learn about any other once-in-a-lifetime thing that isn't taught or passed down: birth, death, taxes, etc.
But thanks, @kristen111!

On 4/27/2022 at 3:30 PM, EtheltoTillie said:

Once again, I say "call the Medicare Rights Center." I think they are very good at explaining things, and they may have a function for helping you choose between a supplement for straight Medicare and a Medicare Advantage plan, which is more like an HMO, but will be cheaper premium wise. They are a nonprofit.

On 4/28/2022 at 3:06 PM, Bastet said:

I second this. Medicare is both complex and crucial, so something you want information on from an independent source that knows the program inside and out. That's them.

To be continued on next post. . .

Edited May 3, 2022 by shapeshifter

shapeshifter · May 3, 2022

And, the rest of the posts from the Chit Chat thread posted through 5/1/22:

On 4/27/2022 at 4:29 PM, peacheslatour said:

I have an insurance broker who lays it all out for me. Completely free as he is compensated by whichever company I choose.

On 4/28/2022 at 9:22 AM, kristen111 said:

Medicare has very good representatives. They answer the phone promptly, give good information and are very nice and helpful. So far anyway.

On 4/28/2022 at 11:32 AM, EtheltoTillie said:

I'm posting this article because it just appeared in the New York Times today, and everyone's been talking about insurance on this forum.

https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html

I practice as a lawyer in the area of Medicaid insurance issues and sometimes Medicare. My entire life is spent in combating prior approval issues where people need care and can't get it because they get false medical necessity denials. That's why I am so sensitive to this. I would not say that Medicare/Social Security is the best informant for anyone, nor is an insurance broker, who may get incentives for selling one policy over another. That's why I'm always recommending the Medicare Rights Center. They're the people I call when I need the right legal research.

This article is about why a Medicare Advantage plan might not be for you. Remember, a Medicare Advantage plan is an HMO. So you usually pay your Part B premium and you don't have to pay an additional premium for one of the supplement plans. Some people can't afford the extra premiums. Some people maybe can afford them but don't want to pay them. So this all-in-one coverage sounds great--until it's not. It's important to think about the type of health care you need. These plans can be problematic if you fall prey to the cost incentive issues around HMOs. If you can't afford the extra premiums, then you should be aware of what you are up against.

Costs: You may pay your basic $170 per month per person for Medicare Part B (current rate) plus about $250 or more per person for the supplement or nothing extra if you enroll in the Advantage plan. If you have a high income, you will get a surcharge on the $170 from the federal government. I'm putting aside what you have to pay for a drug plan--part D. Some Medicare Advantage plans may fold in drug coverage.)

The simplistic view is this: If you stick to straight Medicare with the supplements, you don't usually face the same issues of medical necessity denials. And you won't have co-pays. And you can go to any doctor who accepts Medicare. (I will skip the issue of doctors who opt out . . . another problem.)

Because the government does not make those medical necessity decisions in advance for most things, you will get your care in straight Medicare. Sometimes the government audits doctors if they think the doctors are billing fraudulently, but by that time the patient has received the treatment and the patient will not be responsible for paying anything back. If you are an ordinary patient your doctor is probably not committing fraud by treating your heart disease or diabetes, or whatever. If he/she is billing Medicare for invisible no-show patients, that's another story. Whereas with HMO/Medicare Advantage Plans, they are paid a capitated rate per patient by the government and they have an incentive to deny care so they can keep more of the premium.

Sorry for the long rant. I hope this is helpful.

On 4/29/2022 at 1:35 AM, roseha said:

@shapeshifter, I just saw your question re Medicare. I've had plain Part A and B plus D (for prescriptions) for the past few years but I've just signed up for a Medicare Supplement, in New York it's Plan G (through Empire). The reason I did this is because one of my specialists wants me to try a treatment that is frankly expensive and I'm hoping the supplement will cover the extra Part B cost. My understanding is that everything else would stay the same, I don't want to be changing my doctors, for instance.

I don't know if this relates to your question but I hope it helps.

On 4/29/2022 at 3:17 PM, annzeepark914 said:

@shapeshifter: We have AARP United Healthcare as our secondary to Medicare. It's been excellent.

On 4/29/2022 at 3:35 PM, peacheslatour said:

That's what my dad and husband have. Hubby is not impressed with his.

On 4/29/2022 at 6:48 PM, annzeepark914 said:

We have Plan F... it's expensive but I'm making good use of it with all my back issues, PT, MRI's, etc.

On 4/29/2022 at 9:16 PM, SuprSuprElevated said:

We have Plan G, which at the time we chose it, we were told it was a popular choice. In the 2+ years since my hubs had to retire, we have spent very little out of pocket, after Medicare and our Mutual of Omaha supplement pays. Considering my husband's poor health, I feel fortunate. We pay around $165/mo for the supplement.

These Medicare Advantage plans (Part C), if I'm correctly remembering when we were advised, is for those who are quite healthy, and aren't expecting a lot of Dr visits/procedures.

On 4/30/2022 at 7:30 AM, annzeepark914 said:

Re: Medicare Advantage--that's what we were told. That you'd better be in very good shape & not need much medical attention. With Plan F, I don't pay anything and I've had several surgeries, MRI's, lots of physical therapy, shots for my back.

On 4/30/2022 at 5:44 PM, athousandclowns said:

Boy I’m doing something wrong my anthem Blue supplement is 309.72 a month and my United RX is 102. It is one of on RX plans that covers a Ned I’ll be on for rest of my life. I’ve known my doctor for almost 40 years before and after coming back to my Hime city

On 5/1/2022 at 12:11 AM, Yeah No said:

After thinking about this, I think the site I was looking at was on Medicare itself. You can compare plans and all coverages on their website. That's about as impartial as it gets. You don't even have to log in to do it, just put in your zip code for the supplemental plans and providers available to you. Plus it explains a lot of stuff about all the plans from A to whatever.

Here it is:

https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m?year=2022&lang=en

I didn't include the link to the Advantage plans because I'm assuming you wouldn't be interested in one. I know I won't be because I have to continually monitor a few things.

Edited May 3, 2022 by shapeshifter

shapeshifter · May 3, 2022

And the last of the posts on this topic from the Chit Chat thread:

46 minutes ago, ECM1231 said:

@shapeshifter, we have Emblem Health/GHI as our secondary to Medicare. Hubby is a retired NYC employee, and his union reimburses him once yearly for Medicare part B, which is deducted from his monthly Social Security check. I became eligible in December and since I am not yet 66 and 4 months of age, which is my full retirement age to collect Social Security benefits, I pay the quarterly amount for Medicare B, which is billed to me. Every year the cost increases, as does the yearly deductible you have to fulfill before they start paying out.

We're fortunate that my husband's union pays for this, as well as giving us prescription coverage, but this year Emblem Health/GHI, our secondary insurance, began to charge co-pays. I was shocked b/c that was one of the perks of being on Medicare. You no longer had to pay a co-pay for any lab work, any diagnostic test, x-rays, office visits, etc.

Also, the city is currently fighting to have all retirees switch to a Medicare Advantage Plan. We were supposed to switch over as of January 1, then it got postponed until April 1, and now it's still not into effect. I had read that the NYC teacher retirees were fighting the switch as well.

I talked at length to a Medicare Advantage rep and also availed myself to a Zoom meeting that my husband's union offered which explained the plan in more detail.

If we don't switch over to the Medicare Advantage plan if and when it goes into effect, then we will be responsible for paying the entire yearly cost of Medicare. And then we will also have to continue paying co-pays, which we never had to do before. That will set us back close to $4100 this year for Part B, as well as paying all those co-pays. I've heard various opinions on Medicare Advantage Plans, some good and some bad. I think the city is trying to switch over b/c it's less costly for them.

I'm wondering if those of you who have secondary insurance in addition to part B Medicare, also have to pay co-pays, which we never did before. NYSHIP, which is New York State Health Insurance Plan is very big here on Long Island. Library employees, school employees, county employees, all are covered under it. My son is a school employee, and he has United Health Care under NYSHIP. It's a very good health insurance plan, but I don't know how it carries over in retirement.

38 minutes ago, kristen111 said:

Yes. We have Medicare and Cigna. We pay a small amount of co-pays if some doctors send a bill. Some do .. some don’t. No more dental since hubs retired. We live on Long Island also. Prices of everything going up. Gas, forget it.

athousandclowns · May 3, 2022

My Medicare and Blue shield never a co-pay nor have have I ever had to submit billing . Once years ag some blood test amongst my normal ones wasn’t covered and I had to pay $18. I used to have co pays with United RX plan until I signed up for their mail order company. I remember a couple years ago about the increase in SS payments and the increase of what they took out for Medicare made it a push. When I need a one time medication like a pain pill I get it filled locally . Let’s face it all the times that go bad with age eyes, hearing and teeth are not covered. The eye exam is I believe. A former friend who worked for the county gets his Medicare withdrawal back as well as his level of insurance with Kaiser paid for 3/4 of hearing aides.

Edited May 4, 2022 by athousandclowns

shapeshifter · May 4, 2022

More not good news:
https://www.npr.org/sections/health-shots/2022/05/03/1095946813/medicare-drug-costs-spike

Gramto6 · May 9, 2022

On 5/3/2022 at 11:31 PM, shapeshifter said:

More not good news:
https://www.npr.org/sections/health-shots/2022/05/03/1095946813/medicare-drug-costs-spike

Wow! That is scary! I'll be 73 next month and I have never even considered changing my supplemental ins. I am on my late DH's company plan as surviving spouse. It is through United Health Care, I don't pay any monthly fee, my yearly out of pocket expense is $1500 then they pay 100% of what Medicare doesn't pay. Any rx a dr prescribes goes through them and it costs me $2 for a 3 month supply. The costs never change (once they raised the rx to $5 but corrected when I asked why). It is a lifetime fixed plan as long as I don't remarry or sign up for some other service (why would I do either???) I knew it was a cadillac plan, but never realized how good it really was. I have no dental or optical (but as a diabetic Medicare does cover my yearly eye exams) and I can foot the bill for the rest as needed.

BradandJanet · June 10, 2022

I have Medicare and BC/BS as a supplement. I also have a cheap drug plan (Wellcare) that provides surprisingly good coverage but not great customer service.

I'm 75 and have some health issues. I also had a major surgery and some expensive procedures in the last two years. My out of pocket has been about $100. I like that I can go to any doctor who takes Medicare (and most here do) without a referral. While I let my primary care doctor coordinate treatment plans, I have the flexibility to disagree. My dentist offers an in-house plan that covers routine charges, and my annual eye exam is covered, but I buy new glasses only when I need them.

I looked into an Advantage plan and decided not to switch. Most of my doctors weren't on the plan, and I've heard that while going to an Advantage plan is easy, going back to Medicare and a supplement can be difficult. I'm also sick of the pushy ads with old football players yelling about how everyone should get on these plans. Advantage plans add a private middleman between the doctors and Medicare, who have an incentive to make profits by cutting costs any way they can.

When I retired, I was overwhelmed by the choices and complications of health insurance. I spoke to a SHINE counselor at the local senior center. She explained Parts A and B to me, and helped me pick the cheapest Part D plan that met my needs.

shapeshifter · June 10, 2022

37 minutes ago, BradandJanet said:

I have Medicare and BC/BS as a supplement. I also have a cheap drug plan (Wellcare) that provides surprisingly good coverage but not great customer service.

I'm 75 and have some health issues. I also had a major surgery and some expensive procedures in the last two years. My out of pocket has been about $100. I like that I can go to any doctor who takes Medicare (and most here do) without a referral. While I let my primary care doctor coordinate treatment plans, I have the flexibility to disagree. My dentist offers an in-house plan that covers routine charges, and my annual eye exam is covered, but I buy new glasses only when I need them.

I looked into an Advantage plan and decided not to switch. Most of my doctors weren't on the plan, and I've heard that while going to an Advantage plan is easy, going back to Medicare and a supplement can be difficult. I'm also sick of the pushy ads with old football players yelling about how everyone should get on these plans. Advantage plans add a private middleman between the doctors and Medicare, who have an incentive to make profits by cutting costs any way they can.

When I retired, I was overwhelmed by the choices and complications of health insurance. I spoke to a SHINE counselor at the local senior center. She explained Parts A and B to me, and helped me pick the cheapest Part D plan that met my needs.

Only if you feel okay sharing:

In what state are you located?
How much are your premium, deductible, and out-of-pocket maximum for your BC/BS?

BradandJanet · June 10, 2022

I'm in Massachusetts. BC/BS, the lower of two tier choices, is 116.00 mo., per person. Wellcare, Part D., is $13 mo., per person. Most of my medications are free, but some have very small copays. This is in addition to regular Medicare monthly payments.

We could probably do without the BC/BS supplement since Medicare covers a lot, but I don't want to take a chance. For two of us, insurance adds up to quite a bit per month, but is doable. I don't know what the max is on the BC/BS.

Other than the hundred dollars from the surgery, I rarely see a bill. Once in a while, something strange like an $8 charge used to come through, but those seemed to have stopped.

I wish there was some coverage for hearing aid costs, which seem excessive. Even Advantage plans don't seem to cover all the charges for hearing services.

StatisticalOutlier · July 11, 2022

I did the deep dive into Medicare recently. Every time I hear someone cheer "Medicare for All!!!" I want to say, "Do you actually know anything about Medicare?"

Aah, the irony. The ACA prohibits any pre-existing condition exclusions. But Medicare allows them. Yes, young people have guaranteed-issue insurance, but except in just a few states, the elderly are subject to medical underwriting when buying a supplement outside their initial enrollment period. How backwards is that?!? And does that surprise you? It sure did me. And here's more...

On 6/10/2022 at 6:26 PM, BradandJanet said:

We could probably do without the BC/BS supplement since Medicare covers a lot, but I don't want to take a chance.

Medicare Part B (doctor visits) covers 80%, and it's 80% of the approved Medicare reimbursement, which is notoriously low. The Medicare beneficiary's 20% coinsurance is therefore pretty low, and the $233 deductible isn't a big deal. But remember, this is in addition to the $170.10/month premium for Medicare Part B (it's more than that if you make more than $91,000/year). So it could seem reasonable to not buy a supplement, which will probably cost about $120/month when you sign up for Medicare at 65, and will get considerably more expensive as you get older.

HOWEVER, what if you go into the hospital? That's covered under Medicare Part A (hospitalization), which most people don't have to pay a premium for because they have enough work credits. But Medicare beneficiaries pay an in-hospital deductible of $1,556. Okay, that's not horrible. But if you're in the hospital for over 60 days, you pay coinsurance of $389 per day for days 61-90, and $778 per day for "lifetime reserve days" (you get 60 of those over your lifetime, and once you've used 60, any future hospitalizations will cost the deductible and then $389 per day for days 61-90, and after that, you pay everything).

The coinsurance for a skilled nursing facility is $194.50 per day for days 21-100.

I don't know about anybody else, but all of this was an absolute shock to me. And this hospitalization business is why I bought a supplement, even though I'm healthy, don't go to the doctor, and don't take any medications and am unlikely to incur even $233 in coinsurance costs for doctor visits. But the supplement will pay the hospital deductible and coinsurance. Plus I found a supplement that includes gym memberships. That makes my $120/month premium for my supplement more palatable, but beware--I've found only one supplement that has that benefit; typically gym memberships are available only with Medicare Advantage plans (the ones advertised on TV).

Oh, and annual physicals and screening bloodwork aren't covered by traditional Medicare! Old people don't have annual physicals covered, but young people with ACA plans get free ones. Surprise! And Medicare doesn't cover Shingles vaccines, either. So if you have insurance, get your Shingles shots before you get on Medicare. Or, actually, Shingles vaccines are covered if you have Medicare Part D (prescription medication plan), but the Part D deductible is likely to be $480, which is about the cost of the two Shingles shots. But Shingles shots are covered as preventive care under ACA plans, and if you get it done in accordance with their rules (from a doctor, or from certain pharmacists), you pay nothing.

Or, actually, annual physicals and Singles vaccinations probably are covered by Medicare Advantage plans (these are called Medicare Part C). I didn't look deeply into those because I can afford traditional Medicare plus a supplement. But be aware that the TV ads say they're free. Well, not exactly. The Medicare Advantage company doesn't charge its members a premium, but members still have to pay their Part B $170.10/month premium. Funny how Joe and JJ don't mention that part.

And Medicare Advantage plans may be free (as they define "free"), but generally are HMOs, with networks, referrals required, copays, and general overlording of your care. If you can swing the Part B premium ($170.10) but not a supplement, then you're pretty much forced into Medicare Advantage unless you want to accept the risk and burden of coinsurance under traditional Medicare Parts A & B.

But don't be complacent with your supplement. There are now "Medicare Select" supplements that DO have a network for hospitals. It's another assault on traditional Medicare, part of the inexorable attempt to push everyone out of traditional Medicare and into Medicare Advantage. (And by the way, Medicare Advantage was pitched to the government as a cost-saving measure, because their managed care will be cheaper. Turns out...not so much.)

And I haven't even touched on the array of Medicare supplements (a/k/a Medigap because more words for the same thing is always good). Supplements are an alphabet soup of plans, from Plan A to Plan N. Note these are Plan A, not Part A. Very different things. And different supplement plans have different coverages (e.g. Plan G vs. Plan N), but every plan within a letter (e.g., all Plan G plans) have the exact same coverage. But the premiums vary all over the place. Why? Who knows. And it really doesn't matter which company you choose, since they have no say over anything. If Medicare pays 80%, the supplement pays the your 20%. If Medicare doesn't cover it, the supplement doesn't cover it. Period. The supplement has no choice.

Aah, but the company might matter after all, because there's this thing they do where they stop offering a plan to new subscribers ("closing the books"). The problem with that is that if you're on that plan, there won't be any new, younger people joining, so the plan's costs for older sicker people won't be offset by lower costs for younger healthier people, and that will be reflected in the premiuims. And depending on your health, if you're in a state that allows underwriting for supplement plans, you might not be able to change to another company, so you're stuck.

And then we get into attained age, age-at-issue, and community based premium pricing for supplements. Only...the community based one? Yes, there's a "standard" premium for the community (which appeals to my socialist heart), but people get a discount depending on their age. Which sure makes it look like an attained age premium structure to me.

This is no way to treat old people.

And as bad as all that is, drug plans are even worse. If you don't get one when you're first eligible, if you later get one you'll pay a penalty for the rest of your life. And how do you pick a drug plan? You enter all the drugs you take into a data cruncher and it tells you which drug plan will be the cheapest for your drugs. What if you get put on a heinously expensive drug for a new illness you have? You hope it's covered well by the insurance you've chosen. If it's not, tough tacos. You should have predicted you would get a disease you had no way of knowing you'd get AND which drugs you'd be prescribed for it, loser.

Or, well, the typical answer is that you can change your drug plan every year during open enrollment, at which point you'll put that expensive drug in the data cruncher if you're still taking it, but if you're going to stop taking it soon, should you not put it in the data cruncher because it will affect what you're paying for your other drugs for the next year? And don't forget to predict which drugs you'll be prescribed next year for conditions you don't know you have.

And don't forget about the famous donut hole, which I'm not going to bother to try to deeply understand because it's there and people can't do a damn thing about it. Well, except maybe use GoodRx instead of your Part D plan, to delay entering the donut hole, but if you use GoodRx instead of your insurance, you're not putting anything toward your deductible.

This is no way to treat old people, and it's definitely no way to treat all people. (Medicare for all!!!!!) I'm appalled at the amount of decision making a person must do with respect to Medicare, and the possible financial implications the vast majority of them have no understanding of. And to no one's surprise, a lot of people have no idea what they have. My brother is a psychologist and he's had lots of people make an appointment with him and tell him they're on Medicare, and it turned out they were on Medicare Advantage, and he had to explain to them that they had a network and he wasn't in it.

This is our gold standard for health coverage. Medicare for all!

Edited July 11, 2022 by StatisticalOutlier

shapeshifter · July 11, 2022

Thank you, @StatisticalOutlier, for putting down all of that information. I will come back to it later. 🙃
I suppose the insane complexity of Medicare gives the congress people a teensy weensy bit of an excuse for not realizing that Medicare is not free and that "Medicare for All!" is more of curse than a blessing.
But not really.
Wasn't it Congress people who came up with obfuscations like "Plan A, not Part A"?

Last week I called the Medicare Rights Center (recommended above).
After a lengthy chat, she emailed me a number of links specific to my questions/situation, which I still need to look at:

Quote

Dear Helpline Caller:

You recently called our helpline to ask us about Medicare benefits. Thank you for your call. Below you will find additional information to help answer your question. Click on the following link(s):

Medigaps in New York State - Medicare Interactive
Whole-Medigap-Packet-(NY).pdf (medicarerights.org)
Note: For the high-deductible Plans F and G you pay the Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of$2,490 before the plan pays anything.

Differences-Between-OM-and-MA.pdf (medicarerights.org)

Medigaps-vs.-Medicare-Advantage.pdf (medicarerights.org)

Medicare-Advantage-Plan-Questions.pdf (medicarerights.org)

Medicaid eligibility for Medicare beneficiaries who need long-term care in the home or community - Medicare Interactive

Please visit our website at www.medicareinteractive.org for additional information about Medicare. If you have additional questions or concerns, please call us again at 800-333-4114.

Sincerely,
Claire
Helpline Counselor

The most interesting takeaway was that the State of NY apparently does not have a pre-existing condition exclusion.
Of course, I will now need to double and triple check that and wonder if it could change.

Edited July 11, 2022 by shapeshifter

StatisticalOutlier · July 11, 2022

3 hours ago, shapeshifter said:

The most interesting takeaway was that the State of NY apparently does not have a pre-existing condition exclusion.
Of course, I will now need to double and triple check that and wonder if it could change.

Aah, I forgot about that. I edited my post slightly to reflect that. New York, Connecticut, and Washington are the best ones for that, and a handful of other states have some situations that prohibit medical underwriting, like around your birthday or your anniversary date.

And there is a "free look" situation where you can enroll in a Medicare Advantage plan one time and drop it and you can get back to your supplement without underwriting. As you would expect, it's complicated. 😀

shapeshifter · July 11, 2022

4 minutes ago, StatisticalOutlier said:

And there is a "free look" situation where you can enroll in a Medicare Advantage plan one time and drop it and you can get back to your supplement without underwriting

Oooo. This sounds like something I should be looking at now, since the my current secondary insurance (secondary to Medicare) is through the employer that retired me, and it goes away in September of '23 when I turn 70.
Is the "free look" standard, or . . . ?

roseha · July 11, 2022

Just one comment about the annual physical under Medicare. The first time I had mine with my doctor, the office apparently didn't code it as a "wellness visit" which is what Medicare insists on calling it. They tried to charge me over $500. I notified the office and after some wrangling the fee was reduced to the very small "wellness" charge.

No problem since. I do live in New York by the way, in regard to some of the other issues.

I've recently had a couple of xrays and an ultrasound to figure out why I was having a lot of pain in my left thigh and am being charged very little although whether Part G is helping there I'm not sure. (The pain is much less since I've had a lot of PT fortunately.)

Drug costs are outrageous I agree. I take eyedrops (timolil) and can't get anyone to fill it for less than $100 though I swear they used to be closer to $10. Fortunately the little bottles last a very long time.

shapeshifter · July 11, 2022

5 minutes ago, roseha said:

take eyedrops (timolil) and can't get anyone to fill it for less than $100 though I swear they used to be closer to $10. Fortunately the little bottles last a very long time.

Do you have Part D or a secondary insurance covering drugs?

roseha · July 11, 2022

22 minutes ago, shapeshifter said:

Do you have Part D or a secondary insurance covering drugs?

Yes, I have Part D and also a discount drug card that came with Part G. Neither seems to help. Thanks

The eye drops cost is still a mystery. I may ask the eye doctor about it next time I see him.

StatisticalOutlier · July 12, 2022

3 hours ago, roseha said:

Just one comment about the annual physical under Medicare. The first time I had mine with my doctor, the office apparently didn't code it as a "wellness visit" which is what Medicare insists on calling it. They tried to charge me over $500. I notified the office and after some wrangling the fee was reduced to the very small "wellness" charge.

It sounds like you ran afoul of the confusion between annual physicals and annual wellness visits. Medicare doesn't cover annual physicals. It does cover one "Welcome to Medicare" visit, and "annual wellness visits," but these are not physical exams. Here's an article about it by the Kaiser Family Foundation. It starts with an example that sounds like your situation--a woman got a routine physical and was surprised to be billed for it because she assumed Medicare would cover it:

https://khn.org/news/medicare-covers-wellness-visit-not-annual-physical/

The article includes this explanation of why annual physicals (as most people understand them) aren't covered:

Quote

When the Medicare program was established more than 50 years ago, its purpose was to cover the diagnosis and treatment of illness and injury in older people. Preventive services were generally not covered, and routine physical checkups were explicitly excluded, along with routine foot and dental care, eyeglasses and hearing aids.

As for the "very small 'wellness' charge" you mentioned, wellness visits are free. Did you have to pay that charge?

3 hours ago, roseha said:

I've recently had a couple of xrays and an ultrasound to figure out why I was having a lot of pain in my left thigh and am being charged very little although whether Part G is helping there I'm not sure. (The pain is much less since I've had a lot of PT fortunately.)

It's Plan G, not Part G. (A pox on Medicare for its confusing lettering system.)

But you said you're being charged very little. What do you mean? Are you paying anything out of pocket?

Medicare pays 80% of covered services. You are responsible for the other 20%, and you pay that out of your pocket if you don't have a supplement, or your supplement pays your 20% it if you do have a supplement. If your supplement is paying your 20%, then you shouldn't be paying anything. Unless you haven't met the Medicare Part B $233 deductible yet, and if that's the case, Plan G is still involved because it's applying your payments to your deductible.

Or are you looking at the Medicare-approved charge compared to what the provider claims its fee is. In many cases, the Medicare-approved charge is alarmingly lower, and Medicare pays 80% and you pay 20% of that (or your supplement pays your 20% once you've met the $233 deductible).

3 hours ago, roseha said:

Drug costs are outrageous I agree. I take eyedrops (timolil) and can't get anyone to fill it for less than $100 though I swear they used to be closer to $10. Fortunately the little bottles last a very long time.

Do you mean Timolol? What strength (.25% or .5%) do you use, and how big is the bottle (2.5ml, 5ml, 10ml or 15ml)?

shapeshifter · July 12, 2022

4 hours ago, roseha said:

I take eyedrops (timolil) and can't get anyone to fill it for less than $100 though I swear they used to be closer to $10. Fortunately the little bottles last a very long time.

26 minutes ago, StatisticalOutlier said:

Unless you haven't met the Medicare Part B $233 deductible yet

Does Medicare Part D have a deductible too?
Since Roseha was used to paying around $10 for the same medicine that is now $100, and since that medicine lasts a long time, perhaps the next time Roseha fills it there will only be about $10 owed or even less or even nothing?

I don't have Part D yet because my drugs are covered by my former employer's insurance plan for another year (which runs about $140/mo.).
But at the beginning of the year I always get a sticker shock for medications (as well as for office visits or or procedures) until I've met the annual $750 deductible.
I also have a $2500 out-of-pocket max, but I don't think that applies to medications.

My only regular medication is sumatriptan for migraine, which is very cheap now because it's been available since the 1990s.
Still, I always fill the prescription once more before the end of the calendar year so I "feel" like I got more for my deductible for that year.

roseha · July 12, 2022

Actually yes @shapeshifter Part D does have a deductible. What I get is timolol 0.5 gfs, gel solution, 90 days worth. I think there is a generic version out there but I am not sure what it is, I will have to ask the doctor.

@StatisticalOutlier I checked and my last wellness visit aka physical back in November was no charge to me. As far as the supplement goes I've only had it since May 1, so it hasn't applied to all my claims but I will see what happens for the ones that haven't actually charged me yet. There may be a deductible involved there also.

StatisticalOutlier · July 13, 2022

On 7/11/2022 at 10:11 PM, roseha said:

Actually yes @shapeshifter Part D does have a deductible. What I get is timolol 0.5 gfs, gel solution, 90 days worth. I think there is a generic version out there but I am not sure what it is, I will have to ask the doctor.

Timolol is the generic. I asked what size bottle to check prices on the discount prescription websites, but it's easy enough for you to do it yourself. Plus, there's an ophthalmic version and a gel version and I have no idea what any of it is.

Something interesting--on one discount prescription site, I checked the price for Timolol .5% in different sizes of bottles. I don't know if what I'm looking at is what you're actually prescribed, but it's illustrative regardless.

For a 2.5 ml bottle, it's $59.13 at Walgreens. For a 15 ml bottle, it's $16.62 at Walgreens. That's 6 times more Timolol for less than 1/3 the price. If I needed only 2.5 ml of the stuff, I'd be happy to be prescribed six times more than I need if it means I pay 70% less, and I'd even squeeze 80% of it down the drain in front of the pharmacist to ensure I don't take home more than I'm supposed to.

Actually, if I needed 2.5 ml, I'd get 5 ml for $8.28, and squeeze out only half of it. Less wasteful.

Here's the pricing:

2.5 ml = $59.13

5 ml = $8.28

10 ml = $13.66

15 ml = $16.62

I know you pay a premium for little bottles (like in the travel section), but this is really something, and of course the patient (and probably the doctor) would have no idea when the prescription is being written.

(Assuming I'm understanding this correctly, which is always a crapshoot when dealing with medical costs.)

And just for the record, the 15 ml bottle that's $16.62 at Walgreens? Here are the prices at other pharmacies (not including a "first-time" coupon):

Costco, Jewel-Osco, Hy-Vee, Meijer: $7.92

Walmart: $17.75

Target: $21.22

CVS: $22.80

Suffice to say I'm never going to say, "Call it in to X pharmacy" again. Unless I'm actively dying, I'm taking a paper prescription with me, and looking up the costs before I get it filled. And I have Medicare!

On 7/11/2022 at 9:11 PM, shapeshifter said:

Does Medicare Part D have a deductible too?

It depends on the plan. Not all do. If they do, it's a maximum of $480.

I mentioned upthread that the advice is to, during every open enrollment, enter all your drugs into the data cruncher thing and it will tell you which drug plan will be the cheapest for you. But of course, as I said, it's literally impossible to know what drugs you'll actually be taking for the next year, so I just can't see that it's such a great thing. Better than nothing is about how I'd judge it.

But it's even worse. The drug prices the data cruncher uses can change after you pick your plan, and you're stuck with it until the next open enrollment. Not only that, according to this article, drug companies usually raise their prices in January--right after open enrollment ends on December 7, which means the numbers the data cruncher uses to pick your plan won't even be valid for more than a few weeks.

https://www.npr.org/sections/health-shots/2022/05/03/1095946813/medicare-drug-costs-spike

stewedsquash · July 13, 2022

Another thing to check on with medicines is having good communication between yourself, your doctor, and your pharmacist. I myself have not been to a doctor in probably 15 years. My husband is on many medications. His doctors and pharmacist have work arounds when writing and filling prescriptions to get lower costs. His primary doctor recently changed the days on his insulin injections. Not the dosage or type. 28 days was $60 copay which is what he had, 32 days also $60, 30 days $30. So the doctor wrote him a 30 day prescription for lesser copay. Some insurances will have a small copay if you get a prescription for over the counter meds. When prilosec went otc my copay was $5 for a three month otc supply versus $25 for the 42 otc price if I got it off the shelf and versus a prescription pill 30 day supply for $30 copay. With my otc prescription pharmacist would walk out and get the boxes from the public shelves and put a prescription label on them. If I got the prescription pill that the pharmacist put in a bottle from a huge bottle it was $25 for 30 days. All three were comparing same 40 mg dosages.

Edited July 13, 2022 by stewedsquash
Numbers

StatisticalOutlier · October 2, 2022

Here's something else I ran across. If you're not in one of the few states that allows you to switch supplements without medical underwriting, beware of Mutual of Omaha. They have a history of a practice where they "close the book" on a supplement-providing company of theirs, which means that company quits selling its policies to new people but continues to service the policies for people who already have that plan with them. That means there aren't new (i.e. younger) people being added to the pool of people in that plan, and a plan with only old people, including those who can't pass medical underwriting to switch to another plan, will suffer premium rises faster and higher than plans that have new people coming in to balance the old people.

Then they start a new company that offers policies to anyone, but it will mostly be young people who have guaranteed issue, or healthy people who can pass medical underwriting, which means they can offer attractively lower premiums because of the generally healthy policyholders. But then the people with that plan get older, and Mutual of Omaha closes the book on that company and repeats the process.

It's all completely legal, believe it or not. And it's entirely possible that Mutual of Omaha customer service people, and even agents, won't know what you're talking about if you ask about "closing the book."

There's nothing preventing any other company from doing it, but Mutual of Omaha has a known history, so it might be a good idea to at least consider avoiding them from the get-go.

shapeshifter · December 2, 2022

5 days left to the Medicare open enrollment deadline.
I am so stressed.

I went ahead and canceled my $170/mo. insurance through my former employer (which required me to be paying for Medicare Part B at $135/mo. too), which was going to end in September anyway.

I "enrolled" in [Excellus] Blue Choice Access PPO, in part because it's the only one one my current dentist accepts——although I was initially put off by their website's glitches in comparison with other brands'.

Then they sent 10 printed page in the mail threatening, for example, to bill me extra unless I snail mailed or faxed proof of my previous drug insurance. I called and was told that my former insurance, United HealthCare, doesn't give them that information, and, no, I cannot provide proof online because People My Age (Medicare elligible) Aren't Tech Savvy(!!😡!!).

I did raise my voice a bit, but did not use expletives (because expletives don't explain why I am outraged) and said that was an insulting, inappropriate, ageist assumption, and pointed out that my generation was the one that wrote the code for the apps we are now using.
Of course, my rant fell on deaf ears, which should not be surprising since Blue Cross/Blue Shield/etc. is clearly firmly planted in the 20th century and only hires people with that perspective.

I wound up talking to 2 more representatives, and all of them insisted 95% of their clients are not tech savvy, and 95% of the time United HealthCare does not provide the information they need, and no way for me to submit to BC information online.
Note: My out-going snail mail does not always get picked up or arrive.

I was given an email address with no subject line where I could submit the form I scanned. Yeah. Right. Like that would work. Idiots.
But, no, I did not call them idiots.

Supposedly all calls are recorded for quality and training purposes. Yeah. Right. Like anyone listens.

So I looked at Humana, however, while the total out-of-pocket maximum is $4500/yr. vs. Blue Cross's $7900/yr., it seems with Humana I would be likely to spend close to the $4500, whereas I would spend about half that with Blue Cross unless I currently have stage 4 cancer again and do not know it.

I wish I'd just kept my employer's insurance until September and gotten a bunch of tests done before then, but the window for that opportunity slammed shut on November 18.

Now I'm looking into "Wellcare Value Script" with a high-deductible Plan F.

StatisticalOutlier · December 3, 2022

On 12/2/2022 at 10:15 AM, shapeshifter said:

So I looked at Humana, however, while the total out-of-pocket maximum is $4500/yr. vs. Blue Cross's $7900/yr., it seems with Humana I would be likely to spend close to the $4500, whereas I would spend about half that with Blue Cross unless I currently have stage 4 cancer again and do not know it. ...

Now I'm looking into "Wellcare Value Script" with a high-deductible Plan F.

It sounds like you're looking at Humana and Blue Cross Medicare Advantage plans (since you cited their out-of-pocket maximums), but at the end you mentioned a high-deductible Plan F, which is a supplement for traditional Medicare.

You said you're likely to hit Humana's $4,500 out-of-pocket maximum. For that kind of spending on healthcare, traditional Medicare plus a supplement might be a wiser choice than Medicare Advantage. As you've found, Medicare Advantage can be a pain in the ass to work with, and you haven't even gotten to where they're requiring you to get referrals and whatnot. You said the Blue Cross plan is a PPO, which is vastly better than the Medicare Advantage plans that are HMOs, but even with a PPO, there's still a network. With traditional Medicare, there is no network--a provider either accepts Medicare or doesn't, and most do.

And the supplement has no say in anything, so it doesn't really matter what company you go with when it comes to paying. If Medicare pays its 80% of the cost, then your supplement pays your 20% of the cost on your behalf (subject to Medicare's deductible of $233/year and any deductible a particular supplement might have). (But as noted upthread, it could matter what company you go with if it has a history of closing the book and not letting new people join the plan, which makes premiums go up for the ones who are already in that plan.)

Is there a reason you're looking at Plan F? Since Plan F is no longer open to younger enrollees, the thinking is that premiums will rise faster than other plans, as the Plan F enrollees age and have higher healthcare costs with no younger people coming in to offset it. One fantastic thing about Plan F, though, is that it covers your $233 deductible, so people with Plan F never have to pay any sort of bill. With Plan G (which is the corollary to Plan F), enrollees have to pay the $233 deductible, so they have to pay the providers themselves for the first few visits, until they meet the deductible.

However, I gather you're in New York? If so, you're on easy street when it comes to making decisions on which supplement to get. Because of medical underwriting, people in most states can inadvertently make a permanent decision when they first choose a supplement company, but New York allows people to change their supplement whenever they want, with no medical underwriting.

So, for example, if Plan F is cheaper than Plan G for you right now (remember to factor in the deductible you'll have to pay if you have Plan G), then get the Plan F. If your premium goes up, if you're in New York, you can shop around to see if there are other plans that are cheaper. And you should shop around every year. Plus if you're in New York, you don't care if Mutual of Omaha closes the book, because you have a right to pick any other supplement you want at any time. If they raise the premium for whatever reason, you can just change companies.

I don't know what New York's laws are on changing Medicare Advantage plans, but for supplements, it's the best situation possible, except that premiums tend to be high in New York because the supplement companies can't pick and choose which people they want to accept.

But for you, and if you are in New York, I don't think you need to panic. While supplements don't have the "extras" that Medicare Advantage plans have, like dental or hearing or vision coverage, or free rides to the doctor, there is no uncertainty with respect to what they cover (although of course Medicare itself could refuse to cover something (like annual physicals, discussed above)), but Medicare is generally pretty straightforward on coverage.

If you're going to go with Medicare Advantage, there's another open enrollment period at the beginning of next year that I think allows people (not just in New York) to switch Medicare Advantage plans, but I'm not 100% sure it applies to MA plans that people picked in the Fall open enrollment. You'd need to check on that.

But If you're going to go on (keep?) traditional Medicare Part B and add a supplement, you can just pick one just to have coverage, and then really look into the options at your leisure, since you can change any time you want (if you're in New York).

But with Part D prescription drug coverage, which you should have if you are on Part B because you'll be penalized if you don't have it and want to get it later, I don't think New York lets you change plans other than during the Fall open enrollment, so you need to pick that one carefully now. You can go on the Medicare site and enter your drugs and dosages, and it will spit out how much each plan will cost you for the year. Pretty nifty, but obviously only for maintenance drugs, because you can't enter a drug you don't know you'll be prescribed next June.

But it's an excellent idea to do the Part D comparison every year. I'm currently doing it for a friend of mine who has a Medicare broker. My friend can't change his supplement because he won't pass medical underwriting, and when he calls his broker during open enrollment his broker tells him that and talks about how insanely busy he is at this time of year. But my friend CAN change his drug plan, and I ran the numbers for him (fuck that broker).

His current drug plan will be $108/month. I found one for $16/month that actually provides better coverage for the maintenance drugs he's on. Under his current plan, the six drugs he's on will cost $732/year at Walgreens. Under the plan I found, the six drugs will cost $192.

But that's just the drug costs--don't forget the premium. By paying a premium of $16/month instead of $108/month, the total cost (premiums + drugs) for his new plan will be $389/year, compared to $2,028/year under the plan his broker is fine with him keeping. That's $1600/year I'm saving him.

So I'll say it again: Fuck that broker.

ETA: I forgot you mentioned a high-deductible supplement. I pretty much never go to the doctor so a high-deductible supplement would most likely save me money, but I decided my gift to myself, since I can afford it, would be to just pay a higher premium and have a supplement that has me paying only the Medicare $233 deductible, so I wouldn't have to deal with billing except for the first couple of visits haven't met the deductible yet. But what I don't know is if you're in New York and can willy nilly switch from plan to plan, what that would do to your deductible if you're on a high-deductible plan.

I know that on Obamacare, if you have a plan at your primary residence and go to Florida for the winter and want to switch to a Florida plan for when you're down there, your deductible will be reset with the new plan, which can be a significant thing if you have an $8,000 deductible. And on Obamacare, those are yearly deductibles that get reset on January 1 no matter what.

The Medicare $233 deductible is also the type that gets reset on January 1, but I don't know about the deductibles for high-deductible supplements. I assume they, too, get reset on January 1, but I imagine if you switch a supplement during the year, it won't affect the fact that you've met Medicare's $233 deductible but you'll start over on the deductible on the new supplement.

Yet something else for us oldsters to juggle, and another reason to barf when people chant Medicare For All!

Edited December 4, 2022 by StatisticalOutlier

shapeshifter · December 4, 2022

Yes, @StatisticalOutlier, I'm in NY.
The problem is that my health could go either way.
Someone I spoke to last year suggested a Plan F and WellCare.
So when I signed up for Blue Cross for next year and right off the bat they were threatening to bill me extra if I didn’t swear that United HealthCare really had been providing me with credible drug coverage for the last 20 years (they don’t “reach back out to them for proof” unless I do swear and sign to it),
I thought: Whoa. This is going to be a nightmare to get them to cover anything.

And all the insurance sales folks who said my 3-year post-cancer colonoscopy would be free were wrong because for me it's "diagnostic" not "routine."
And it turns out the WellCare deductible on Tier 3 and above drugs is over $500, and the only colonoscopy prep that I can get down and that is still on the market is Tier 4 and $140.
I also may be needing to renew another drug that is Tier 4. Or not.
Both of these are not things I regularly use. Many years I just fill my Tier 2 sumatriptan a few times.

Similarly, I was told I should get an endoscopy when I get the colonoscopy, and I need to see a dermatologist for something that may need to be removed. Any of these could turn out to be more costly cancer treatments.

But maybe not.

And now all my notes on all of this are just muddled in my mind and/or scrawled on paper and/or in any of several folders on my laptop.
I don't know how you keep it straight.
Maybe I should have made a spreadsheet, but that's impossible without already having a handle on what the hell I'm comparing——and neither the online info nor the telephone advisors have accurate info.
I hate this.
The process feels like cruel and unusual punishment just because I was forced to retire, and am too old (and tired) to start over, and am not a member of congress with free health care.

Edited December 4, 2022 by shapeshifter

Yeah No · December 4, 2022

On 7/11/2022 at 12:57 AM, StatisticalOutlier said:

And Medicare doesn't cover Shingles vaccines, either. So if you have insurance, get your Shingles shots before you get on Medicare. Or, actually, Shingles vaccines are covered if you have Medicare Part D (prescription medication plan), but the Part D deductible is likely to be $480, which is about the cost of the two Shingles shots. But Shingles shots are covered as preventive care under ACA plans, and if you get it done in accordance with their rules (from a doctor, or from certain pharmacists), you pay nothing.

In case you haven't learned about this new development since this post, I thought the following would interest you. Starting in 2023 Medicare will cover vaccines like the ones for Tetanus and Shingles with no out of pocket cost:

Quote

People with Medicare could also save money on vaccines. Starting January 1, 2023, Part D-covered adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including the shingles and Tetanus-Diphtheria-Whooping Cough vaccines, will be available with no deductible and no cost-sharing to people with Medicare prescription drug coverage.

This entire page details some of the other changes to Medicare prescription drug coverage starting next year:

https://www.cms.gov/files/document/10522-external-faqs-about-inflation-reduction-act.pdf

I will be going on Medicare in August of 2023 so this stuff is of interest to me now. My husband is already on it and some friends so I have learned a lot from them, but it is news to me that an annual physical with lab tests is not covered by Medicare. I'm reading that Advantage plans don't cover them either, but to make matters even more confusing, this flyer from United Healthcare seems to indicate Advantage plan coverage for both wellness visits AND an "annual physical", although just exactly what they define that as is not explained. I haven't found anything specifically about supplemental Plan G coverage and these things, though it probably wouldn't cover an annual physical with lab tests based on everything I've read. Which sucks because I'm interested in Plan G. I don't think an Advantage plan would be right for me for other reasons but how to deal with the lack of an annual physical is going to be a PITA.

StatisticalOutlier · December 4, 2022

8 hours ago, Yeah No said:

I haven't found anything specifically about supplemental Plan G coverage and these things, though it probably wouldn't cover an annual physical with lab tests based on everything I've read.

Supplements don't cover anything on their own. Medicare Part B pays 80% of medicare approved charges, and you are responsible for the other 20%. If you buy a supplement (like Plan G), it pays your 20% on your behalf. The supplement company doesn't determine coverage any more than you do. If Medicare pays, the supplement pays; if Medicare doesn't, the supplement doesn't.

And even if you think paying the 20% on your own isn't a big burden, and it probably isn't because 20% of the charge Medicare allows generally isn't very much, be aware that there is no out-of-pocket limit if you're on traditional Medicare. The only way to limit your exposure to financial ruin on Medicare is to either have a supplement with traditional Medicare, or go on a Medicare Advantage plan (all Advantage plans have an out-of-pocket limit).

(And actually, some supplements do provide standalone coverage, for international travel; in that case they get to decide what they'll pay for. Medicare isn't involved in that coverage at all.)

ETA: I forgot to point out that every Medicare Advantage plan I've seen DOES cover annual physicals as most of us understand them--an exam where the doctor puts his hands on you and orders tests to see if anything's wrong that you don't know about. Medicare Advantage is a managed care operation, and as such, likes preventive care and encourages people to get it by making it free. Traditional Medicare was originally enacted as paying for hospital bills, and its focus has never been on keeping seniors healthy. Its enacting legislation prevents it from covering annual physicals and hearing aids, two things that Medicare Advantage plans tout as benefits. And they definitely are benefits, but come at the cost of having your care managed.

Edited December 4, 2022 by StatisticalOutlier

StatisticalOutlier · December 4, 2022

9 hours ago, shapeshifter said:

I thought: Whoa. This is going to be a nightmare to get them to cover anything.

So am I right that the Blue Cross is an Advantage plan? If that's the case, they do have a say in what they'll pay for, which is one of the disadvantages of a Medicare Advantage plan. Of course if you have traditional Medicare, Medicare dictates what is covered and what isn't, but it doesn't seem to be as capricious as Medicare Advantage plans have a reputation for being. And with traditional Medicare, there aren't delays waiting for approval.

Then again, supplements with traditional Medicare can be expensive, and Advantage plans generally aren't. And Advantage plans provide coverage for things like hearing aids, eyeglasses, rides to the doctor--all kinds of stuff. (I'll add that they also pay higher commissions to brokers than supplements do, which isn't of utmost importance but should be kept in mind if dealing with a broker.)

I don't know about New York, but some states have Medicare Advantage plans that look pretty good. They have a network, but they do provide coverage if you go out of network (unlike most HMOs, where it's the network or nothing, and only certain Advantage plans have this out-of-network coverage--look carefully when shopping). Like, you'll have a $20 copay if you go in network, and a $70 copay if you go out of network. And there are Advantage plans that say they'll cover any doctor who takes Medicare, although I can't really get a bead on the on-the-ground operations of these plans, like do you just go to whoever you want, or do you have to ask your Advantage plan first? Also, some providers are saying they won't accept any Medicare Advantage plans (e.g., the Mayo Clinic has announced that it won't take Advantage at its clinic in Phoenix). I guess they ask when you make an appointment what insurance you have, and refuse to see you?

It's all that uncertainty that made even a cheapskate like me with zero healthcare costs go with traditional Medicare and a Plan G supplement and Part D drug coverage. And I could have saved money by getting a high-deductible plan, but as a present to myself, I got a plan that I don't have to hassle with. I'll have to pay my 20% to providers until I meet my $233 deductible, but after that, I won't have to ever even look at a bill for the rest of the year. And I have hearing aids and wear glasses, so the Medicare Advantage extra benefits would indeed be beneficial. But no, I'm willing to pay extra to protect my sanity.

And @shapeshifter, if you get Plan F (which you can do because you meet the age restriction--65-year-old enrollees can't get Plan F), you won't ever have to look at a bill at all because Plan F pays your deductible for you. My friend with Plan F is paying more in premiums than what Plan G +$233 (the deductible) would cost, so he'd like to switch to Plan G, but he can't because he can't pass medical underwriting. That's where being in New York is a HUGE advantage.

And to reiterate--Plan F and Plan G are exactly the same when it comes to coverage (they simply pay your 20%), except Plan F covers your $233 deductible for you while Plan G doesn't. So if Plan F premiums are more than $233/year more than Plan G premiums, Plan G is the better deal, except you'll have to pay some of the early bills yourself.

At first I couldn't figure out why Blue Cross was so insistent about your previous drug coverage, but maybe it has to do with the penalty people incur if they ever don't have Medicare drug coverage when they were eligible. It's a lifetime penalty that is added to your Part D drug premium if you ever decide to get drug coverage after all, but I don't know how it would work (or if it's even applicable) if you have a Medicare Advantage plan that includes prescription drug coverage.

But if Blue Cross is an Advantage plan, there will very likely be interactions with them over approvals and referrals, and your experience so far doesn't bode well for your sanity when dealing with them. I hear you loud and clear, and that's why my advice is that if you can afford it, get traditional Medicare and a supplement. You'll never have to deal with your supplement company because they pay the provider directly. Really, the only time I ever hear about people fighting about provider bills under traditional Medicare is on the annual physical thing, plus the "wellness visit" thing because Medicare has very strict rules on when those can be done and if you get one even one day early they'll reject it.

As for your drugs, what a mess. Have you put them into Medicare's cost calculator? Or at least the ones you know you'll have to be taking? You don't even have to worry about what tier they are--you put in your dosage and how often you get them and it calculates all that for you.

My friend who I'm saving $1600 for by changing his drug plan found out the other day that he might have to be on a new drug permanently. He got his first batch and the pharmacist said, "That'll be $1,468" and my friend balked. The pharmacist fiddled around and then said, "Okay, that'll be $45." Huh?? Of course my friend thought Walgreens was giving him some sort of generous discount.

But I figured out that by getting the three-month supply that was prescribed, he entered the donut hole of Part D coverage, where you pay a percentage of the retail cost of the drug rather than a copay. So the pharmacist gave him just a one-month supply, the retail cost of which wasn't enough to push him into the donut hole, and he just had to pay the usual $45 copay. HOWEVER, this worked only because it was at the end of the year, and if he gets it filled again before the end of the year, he's going to be in the donut hole. And if he gets it filled next year, he's going to go into the donut hole almost immediately.

And of course all of this depended on the pharmacist understanding the donut hole and working around it. Good for him, and good for my friend that he has a pharmacist who can understand the impossibly complicated donut hole. But needless to say, it shouldn't be this way.

And as annoying it is for people who do take drugs, it's not much better for those of us who don't. I just pick whatever Part D plan has the cheapest premium, and hope for the best if I end up being prescribed drugs. I suppose I could pay $11/month instead of $6/month, but that doesn't mean the particular drugs I end up getting will be covered better. You simply can't know, and that's ridiculous.

10 hours ago, shapeshifter said:

I hate this.
The process feels like cruel and unusual punishment just because I was forced to retire, and am too old (and tired) to start over, and am not a member of congress with free health care.

I think it's a bit like childbirth (not that I've ever given birth). It's horrible and painful, but you somehow forget it after it's all over. People go through this when they first go on Medicare, and then they just stay with whatever plan they have and forget how awful it was.

Well, assuming they even know what they have. My brother is a psychologist and can't count the number of times a prospective patient would call for an appointment and he'd ask what insurance they have and they'd say Medicare, but it was Medicare Advantage, and he didn't take any Medicare Advantage plans. They had no idea they didn't have "Medicare." That's one reason to do some questioning if you're asking people what they have--get a feel for whether they even know and if there was any decision-making that went into it.

I have a friend who went on Medicare last year and I asked what she has, and she said traditional with a G supplement, as suggested by a broker her financial advisor referred her to (she's rich). (Although I'll note that it's a Mutual of Omaha supplement, which I warned against upthread, but it doesn't really matter for her because the only problem with closing the book on a plan is that the premium will go up, but she can afford it. However, I look askance at brokers who sell the MofO plans with warning about (or probably even knowing about) closing the book (including Boomer Benefits, which is very popular).)

But my friend warned me away from "crappy" Medicare Advantage plans like her husband has, who's been dealing with colon cancer for like five years. I have no idea how he ended up on a Medicare Advantage plan (he's a smart guy and he certainly didn't need to save money), and I don't want to ask because she's already mad enough at him for not getting timely colonoscopies.

Let's just say there's a lot of ignorance out there about Medicare, and I feel deeply for people who actually try to be informed consumers. I cut my teeth on Obamacare for traveling fulltime RVers, and naively thought such expertise wouldn't be necessary when I moved to Medicare. I couldn't have been more wrong, but hey, I'm already used to digging into the impenetrable.

One more thing about supplements: One of the benefits Advantage plans tout is Silver Sneakers, which provides free gym memberships. Supplements don't offer that, or didn't, until AARP/UHC started its own "Renew Active." You can get Renew Active if you buy an AARP/UHC supplement that comes with "wellness benefits." (Not all areas have plans with wellness benefits.) My G Supplement costs like $10 or $15 extra a month over the G without wellness benefits. Also, the wellness benefits purportedly give discounts for eye care and dentists and hearing aids, but in the little bit of calling around I did, they're bogus. And really, the Renew Active is kind of bogus--on its list of providers, it has all sorts of places that aren't even gyms, but for example are an early learning center by a YMCA.

However, despite its bogosity, Renew Active worked great when I was in the Chicago suburbs. It got me a free membership to the YMCA down the street, and it gives me four reformer classes a month at Club Pilates, which I used religiously. It also includes Yoga Six, Pure Barre, Orange Theory, and some others that might just be regional. I'm in Orlando now, and went to the Y here and told the guy I was Renew Active, and when he found out I was going to be here for only a week, he just gave me a week pass instead of having me do an actual membership with key tag or whatever, which was easier for both of us. I also squeezed in three classes at Club Pilates.

Because I travel, Silver Sneakers was an attractive benefit and actually had me considering Medicare Advantage so I could go to gyms wherever I happened to be, even though Medicare Advantage is generally not a good fit for people who don't stay in one place. With Renew Active, I get the benefit of Silver Sneakers (there's a lot of overlap between Silver Sneakers and Renew Active) without the restrictions of Medicare Advantage.

And it made it easy to pick my G Supplement, because AARP/UHC is the only one that has it.

Anyway, if anybody wants gym memberships included with their Medicare, it's possible to get it with a supplement. You can see who participates here:

https://uhcrenewactive.com/home

Yeah No · December 4, 2022

3 hours ago, StatisticalOutlier said:

Supplements don't cover anything on their own. Medicare Part B pays 80% of medicare approved charges, and you are responsible for the other 20%. If you buy a supplement (like Plan G), it pays your 20% on your behalf. The supplement company doesn't determine coverage any more than you do. If Medicare pays, the supplement pays; if Medicare doesn't, the supplement doesn't.

And even if you think paying the 20% on your own isn't a big burden, and it probably isn't because 20% of the charge Medicare allows generally isn't very much, be aware that there is no out-of-pocket limit if you're on traditional Medicare. The only way to limit your exposure to financial ruin on Medicare is to either have a supplement with traditional Medicare, or go on a Medicare Advantage plan (all Advantage plans have an out-of-pocket limit).

(And actually, some supplements do provide standalone coverage, for international travel; in that case they get to decide what they'll pay for. Medicare isn't involved in that coverage at all.)

ETA: I forgot to point out that every Medicare Advantage plan I've seen DOES cover annual physicals as most of us understand them--an exam where the doctor puts his hands on you and orders tests to see if anything's wrong that you don't know about. Medicare Advantage is a managed care operation, and as such, likes preventive care and encourages people to get it by making it free. Traditional Medicare was originally enacted as paying for hospital bills, and its focus has never been on keeping seniors healthy. Its enacting legislation prevents it from covering annual physicals and hearing aids, two things that Medicare Advantage plans tout as benefits. And they definitely are benefits, but come at the cost of having your care managed.

Yup, exactly, that's what I'm reading. Am I wrong to think that there are other ways people on Medicare handle getting lab tests covered other than at an annual physical, though? These days I'm finding that by the time I go for my annual physical I've already been sent for most of the tests it covers within the past year by specialists monitoring my "numbers", such as blood sugar, thyroid hormone, cholesterol, etc. Should I presume that tests ordered by specialists monitoring these things would be covered if one has regular Medicare plus a supplemental or an Advantage plan? I'm still learning about this stuff!

Edited December 4, 2022 by Yeah No

Yeah No · December 4, 2022

23 minutes ago, StatisticalOutlier said:

So am I right that the Blue Cross is an Advantage plan? If that's the case, they do have a say in what they'll pay for, which is one of the disadvantages of a Medicare Advantage plan. Of course if you have traditional Medicare, Medicare dictates what is covered and what isn't, but it doesn't seem to be as capricious as Medicare Advantage plans have a reputation for being. And with traditional Medicare, there aren't delays waiting for approval.

Then again, supplements with traditional Medicare can be expensive, and Advantage plans generally aren't. And Advantage plans provide coverage for things like hearing aids, eyeglasses, rides to the doctor--all kinds of stuff. (I'll add that they also pay higher commissions to brokers than supplements do, which isn't of utmost importance but should be kept in mind if dealing with a broker.)

I don't know about New York, but some states have Medicare Advantage plans that look pretty good. They have a network, but they do provide coverage if you go out of network (unlike most HMOs, where it's the network or nothing, and only certain Advantage plans have this out-of-network coverage--look carefully when shopping). Like, you'll have a $20 copay if you go in network, and a $70 copay if you go out of network. And there are Advantage plans that say they'll cover any doctor who takes Medicare, although I can't really get a bead on the on-the-ground operations of these plans, like do you just go to whoever you want, or do you have to ask your Advantage plan first? Also, some providers are saying they won't accept any Medicare Advantage plans (e.g., the Mayo Clinic has announced that it won't take Advantage at its clinic in Phoenix). I guess they ask when you make an appointment what insurance you have, and refuse to see you?

It's all that uncertainty that made even a cheapskate like me with zero healthcare costs go with traditional Medicare and a Plan G supplement and Part D drug coverage. And I could have saved money by getting a high-deductible plan, but as a present to myself, I got a plan that I don't have to hassle with. I'll have to pay my 20% to providers until I meet my $233 deductible, but after that, I won't have to ever even look at a bill for the rest of the year. And I have hearing aids and wear glasses, so the Medicare Advantage extra benefits would indeed be beneficial. But no, I'm willing to pay extra to protect my sanity.

And @shapeshifter, if you get Plan F (which you can do because you meet the age restriction--65-year-old enrollees can't get Plan F), you won't ever have to look at a bill at all because Plan F pays your deductible for you. My friend with Plan F is paying more in premiums than what Plan G +$233 (the deductible) would cost, so he'd like to switch to Plan G, but he can't because he can't pass medical underwriting. That's where being in New York is a HUGE advantage.

And to reiterate--Plan F and Plan G are exactly the same when it comes to coverage (they simply pay your 20%), except Plan F covers your $233 deductible for you while Plan G doesn't. So if Plan F premiums are more than $233/year more than Plan G premiums, Plan G is the better deal, except you'll have to pay some of the early bills yourself.

At first I couldn't figure out why Blue Cross was so insistent about your previous drug coverage, but maybe it has to do with the penalty people incur if they ever don't have Medicare drug coverage when they were eligible. It's a lifetime penalty that is added to your Part D drug premium if you ever decide to get drug coverage after all, but I don't know how it would work (or if it's even applicable) if you have a Medicare Advantage plan that includes prescription drug coverage.

But if Blue Cross is an Advantage plan, there will very likely be interactions with them over approvals and referrals, and your experience so far doesn't bode well for your sanity when dealing with them. I hear you loud and clear, and that's why my advice is that if you can afford it, get traditional Medicare and a supplement. You'll never have to deal with your supplement company because they pay the provider directly. Really, the only time I ever hear about people fighting about provider bills under traditional Medicare is on the annual physical thing, plus the "wellness visit" thing because Medicare has very strict rules on when those can be done and if you get one even one day early they'll reject it.

As for your drugs, what a mess. Have you put them into Medicare's cost calculator? Or at least the ones you know you'll have to be taking? You don't even have to worry about what tier they are--you put in your dosage and how often you get them and it calculates all that for you.

My friend who I'm saving $1600 for by changing his drug plan found out the other day that he might have to be on a new drug permanently. He got his first batch and the pharmacist said, "That'll be $1,468" and my friend balked. The pharmacist fiddled around and then said, "Okay, that'll be $45." Huh?? Of course my friend thought Walgreens was giving him some sort of generous discount.

But I figured out that by getting the three-month supply that was prescribed, he entered the donut hole of Part D coverage, where you pay a percentage of the retail cost of the drug rather than a copay. So the pharmacist gave him just a one-month supply, the retail cost of which wasn't enough to push him into the donut hole, and he just had to pay the usual $45 copay. HOWEVER, this worked only because it was at the end of the year, and if he gets it filled again before the end of the year, he's going to be in the donut hole. And if he gets it filled next year, he's going to go into the donut hole almost immediately.

And of course all of this depended on the pharmacist understanding the donut hole and working around it. Good for him, and good for my friend that he has a pharmacist who can understand the impossibly complicated donut hole. But needless to say, it shouldn't be this way.

And as annoying it is for people who do take drugs, it's not much better for those of us who don't. I just pick whatever Part D plan has the cheapest premium, and hope for the best if I end up being prescribed drugs. I suppose I could pay $11/month instead of $6/month, but that doesn't mean the particular drugs I end up getting will be covered better. You simply can't know, and that's ridiculous.

I think it's a bit like childbirth (not that I've ever given birth). It's horrible and painful, but you somehow forget it after it's all over. People go through this when they first go on Medicare, and then they just stay with whatever plan they have and forget how awful it was.

Well, assuming they even know what they have. My brother is a psychologist and can't count the number of times a prospective patient would call for an appointment and he'd ask what insurance they have and they'd say Medicare, but it was Medicare Advantage, and he didn't take any Medicare Advantage plans. They had no idea they didn't have "Medicare." That's one reason to do some questioning if you're asking people what they have--get a feel for whether they even know and if there was any decision-making that went into it.

I have a friend who went on Medicare last year and I asked what she has, and she said traditional with a G supplement, as suggested by a broker her financial advisor referred her to (she's rich). (Although I'll note that it's a Mutual of Omaha supplement, which I warned against upthread, but it doesn't really matter for her because the only problem with closing the book on a plan is that the premium will go up, but she can afford it. However, I look askance at brokers who sell the MofO plans with warning about (or probably even knowing about) closing the book (including Boomer Benefits, which is very popular).)

But my friend warned me away from "crappy" Medicare Advantage plans like her husband has, who's been dealing with colon cancer for like five years. I have no idea how he ended up on a Medicare Advantage plan (he's a smart guy and he certainly didn't need to save money), and I don't want to ask because she's already mad enough at him for not getting timely colonoscopies.

Let's just say there's a lot of ignorance out there about Medicare, and I feel deeply for people who actually try to be informed consumers. I cut my teeth on Obamacare for traveling fulltime RVers, and naively thought such expertise wouldn't be necessary when I moved to Medicare. I couldn't have been more wrong, but hey, I'm already used to digging into the impenetrable.

One more thing about supplements: One of the benefits Advantage plans tout is Silver Sneakers, which provides free gym memberships. Supplements don't offer that, or didn't, until AARP/UHC started its own "Renew Active." You can get Renew Active if you buy an AARP/UHC supplement that comes with "wellness benefits." (Not all areas have plans with wellness benefits.) My G Supplement costs like $10 or $15 extra a month over the G without wellness benefits. Also, the wellness benefits purportedly give discounts for eye care and dentists and hearing aids, but in the little bit of calling around I did, they're bogus. And really, the Renew Active is kind of bogus--on its list of providers, it has all sorts of places that aren't even gyms, but for example are an early learning center by a YMCA.

However, despite its bogosity, Renew Active worked great when I was in the Chicago suburbs. It got me a free membership to the YMCA down the street, and it gives me four reformer classes a month at Club Pilates, which I used religiously. It also includes Yoga Six, Pure Barre, Orange Theory, and some others that might just be regional. I'm in Orlando now, and went to the Y here and told the guy I was Renew Active, and when he found out I was going to be here for only a week, he just gave me a week pass instead of having me do an actual membership with key tag or whatever, which was easier for both of us. I also squeezed in three classes at Club Pilates.

Because I travel, Silver Sneakers was an attractive benefit and actually had me considering Medicare Advantage so I could go to gyms wherever I happened to be, even though Medicare Advantage is generally not a good fit for people who don't stay in one place. With Renew Active, I get the benefit of Silver Sneakers (there's a lot of overlap between Silver Sneakers and Renew Active) without the restrictions of Medicare Advantage.

And it made it easy to pick my G Supplement, because AARP/UHC is the only one that has it.

Anyway, if anybody wants gym memberships included with their Medicare, it's possible to get it with a supplement. You can see who participates here:

https://uhcrenewactive.com/home

Thanks, this was very helpful. I did some calculating on the UHC site and found that plan F would have cost about $67 per month MORE than plan G for me (although I am not eligible for plan F). So it looks like plan G is a better alternative for me anyway.

Also, plan G for me does provide coverage for gym memberships although I'm not seeing the particulars on that.

It would be great to go with an Advantage plan but even though they are supposedly pretty good in CT my local friends all seem to think otherwise and have settled on plan G after trial and error, so I'm defaulting to their collective wisdom for now.

My husband's employer doesn't provide health insurance but he reimburses us for our premiums, even my husband's Medicare premiums, which is great.

Oh, and I found this helpful on the AARP site.

Edited December 4, 2022 by Yeah No

shapeshifter · December 4, 2022

Thank you, @StatisticalOutlier, for your detailed posts (including).

I'm leaning towards staying with the Blue Cross Advantage plan for the next year, despite the obnoxiousness and incompetence of their agents and their website dysfunctionality. I will just have to stay on top of things to avoid paying for things I should not have to pay for.

My son-in-law is going to look at it and the other Advantage plans (as well as F and maybe G) with me tomorrow. He sold health insurance until a couple of years ago, and has not wanted to advise me because he didn't feel he was up on either the current plans or even plans in this state (they lived in PA then), but he's between jobs again now, so has time, and he can at least make sure I didn't misinterpret something.

On 7/11/2022 at 12:57 AM, StatisticalOutlier said:

My brother is a psychologist and he's had lots of people make an appointment with him and tell him they're on Medicare, and it turned out they were on Medicare Advantage, and he had to explain to them that they had a network and he wasn't in it.

According to the BCBS online documentation (not sure if that link will work), my therapist is in network. If not, that is ironically(?) the least of my worries.

And thanks too for giving me a new word for my Arsenal of Loquacity😉:
bogosity
I look forward to sneaking it into a conversation when I do not want a BCBS agent know how outraged I am because I need something from them.

Edited December 4, 2022 by shapeshifter

supposebly · December 4, 2022

Holy Hell, this sounds complicated. While I can complain about the Canadian system all day long, at least it's simple and doesn't require spreadsheets!

ebk57 · December 4, 2022

Mr. ebk was just reading an article about Medicare advantage plans that said the way they make money is by denying claims. If the claim is appealed, there's a very high chance it will be paid, but over 90% of denials are not appealed. Sigh...

I'm so grateful that he was in a union and has a pension and insurance. And that I'm on the insurance with him. I don't know how I'd manage all of this otherwise. Although, if I was still single, I'd just probably continue working. I do like working...most of the time.

StatisticalOutlier · December 5, 2022

2 hours ago, supposebly said:

Holy Hell, this sounds complicated. While I can complain about the Canadian system all day long, at least it's simple and doesn't require spreadsheets!

What's even worse is that THIS is the SOLUTION to our health care coverage crisis. It's horrible, but at least it's somewhat affordable, although you could have knocked me over with a feather when I found out that Medicare isn't free. Everybody has to pay the Medicare Part B premium of $164.90 a month, including Medicare Advantage plans that advertise $0 premiums. That's $0 in addition to the $164.90. Although some Advantage plans actually kick back some of that to you. That seems like one hell of a deal if you're poor--money ADDED TO YOUR SOCIAL SECURITY CHECK! So of course they get a Medicare Advantage plan without understanding it's not "real" Medicare.

That's one thing about Obamacare. It's excellent insurance, and it's really really cheap for low-income people. Of course they can't be TOO low income because then they're put on Medicaid, which is health coverage for poor people. Or, poor people in states that expanded Medicaid to adults. In states that didn't, if you don't make enough money to qualify for Obamacare, there's no health care coverage for you. Nada. Zilch. If you need health care, you either go to the emergency room and rack up enormous bills there that you have bill collectors coming after you for, or if you're lucky your city might sponsor a clinic for low-income people.

But I'll tell you--you get a single adult who's making $18,000/year who's been getting a free insurance policy under Obamacare, and if he was savvy enough to pick a Silver plan, it's likely to have an out-of-pocket limit of like $500. Then he turns 65 and has to go on Medicare and finds out he has to pay $165/month no matter what kind of plan he picks. That guy's not going to be thrilled about getting on Medicare.

6 hours ago, Yeah No said:

Also, plan G for me does provide coverage for gym memberships although I'm not seeing the particulars on that.

If it's an AARP/UHC plan, then it's Renew Active (their proprietary version of Silver Sneakers). You can go to the link I provided upthread and put in your zip code (it always uses zip code, which is SO annoying for those of us who travel because I don't ever know what zip code I'm in) and find the participating locations. I listed the "premium" places, where you get 4 classes a month, but it's also good at lots of YMCAs, as I said, plus national chains like Planet Fitness, Anytime Fitness, and Crunch, and some awful boot-camp type places that sound like real exercise. Yuck. You get a code number from Renew Active that you give to the gyms when you sign up for the membership, and they bill Renew Active when you visit.

6 hours ago, shapeshifter said:

I'm leaning towards staying with the Blue Cross Advantage plan for the next year, despite the obnoxiousness and incompetence of their agents and their website dysfunctionality. I will just have to stay on top of things to avoid paying for things I should not have to pay for.

I can't say enough how lucky you are to be in New York, where you can change your plan without medical underwriting. So you can try the Advantage plan for a year, and next open enrollment decide whether you want to switch to traditional Medicare without worrying whether the supplement will accept you. (Anyone can always switch from Advantage to traditional Medicare during open enrollment, but if you're in a state that doesn't have any guaranteed-issue periods, you might not be able to find a supplement that will accept you.)

And remember, if you're on traditional Medicare Part B, you can change your supplement any time during the year. People think it's only during open enrollment, but it's not. The only issue is passing medical underwriting, if you're in a state that allows supplements to do that.

In fact, I'd suggest if someone wants to change their supplement, they do it outside open enrollment because it won't be such a busy time for insurers and brokers/agents.

But if you want to change your Part D prescription drug coverage, that can be done only during the Fall open enrollment that's ending this week.

6 hours ago, Yeah No said:

Am I wrong to think that there are other ways people on Medicare handle getting lab tests covered other than at an annual physical, though? These days I'm finding that by the time I go for my annual physical I've already been sent for most of the tests it covers within the past year by specialists monitoring my "numbers", such as blood sugar, thyroid hormone, cholesterol, etc. Should I presume that tests ordered by specialists monitoring these things would be covered if one has regular Medicare plus a supplemental or an Advantage plan? I'm still learning about this stuff!

It's the screening tests, I think they're called, that Medicare doesn't cover. Like you go for an annual physical even though you don't have any complaints and the doctor orders blood tests to see if anything's wrong (which is why I don't have annual physicals 😀--I'm still smarting from being deemed uninsurable by Blue Cross many years ago because I'm hard of hearing, and I didn't want to uncover any other conditions that don't bother me and I wouldn't seek treatment for but would similarly make me uninsurable, or at least be considered a pre-existing condition that results in an increased premium). (Never mind that my insurer at the time I applied to Blue Cross (I was looking for cheaper insurance) subsequently went out of business and transferred everybody to...Blue Cross. To whom I dutifully paid my premium for years and didn't have any claims, even though they insulted me by deeming me uninsurable. God damn, I hate health insurance in the U.S.

But back to the tests--it's all in the coding. A doctor can do what is actually a physical exam but code it as a "wellness visit" and get it paid for by Medicare. And maybe he doesn't even know that's what happened--his billing people did it. Who the hell knows.

And some people say that anybody who's 65 will be having tests done for actual problems, so they'll get covered that way, wink wink, but NOT everybody has regular tests done. And LOTS of people are surprised when they go for an annual exam and get hit with a bill from their doctor because among the forms they sign is one that says if insurance doesn't pay then they'll be responsible for the charges. And since insurance (Medicare) didn't pay, the amount charged is the retail rate, not the Medicare-approved amount.

It's possible to badger a doctor's billing office to get them to code it in a way that will get it paid, but I've read stories about people who just couldn't get their doctor to bill it "right." (Depending on one's definition of "right," of course.) And there are doctors who (or whose billing people) know how to bill things in a way they'll get covered by Medicare, but you can't know going in if your doctor is one of them. I do know that one person said their doctor is a gerontologist and doesn't know how to work the Medicare system to get annual physical exams covered.

And there are some people whose doctor does it without their even knowing it's hinky. They'll insist to their dying day that Medicare covers their annual physicals.

1 hour ago, ebk57 said:

Mr. ebk was just reading an article about Medicare advantage plans that said the way they make money is by denying claims. If the claim is appealed, there's a very high chance it will be paid, but over 90% of denials are not appealed. Sigh...

Not long ago I found an actual government document that gave the numbers for appeals, for each Advantage plan in each state. I was surprised by how many denials were reversed, because of Advantage's reputation for denying claims. But then I noticed just how few appeals there were in the first place. Shit, they could reverse every one of the appeals without even considering the merits and still make money overall.

(Something similar happened with Social Security Disability in the 1980s. The government started a policy of rejecting every single SSDI claim automatically, and actually looking at them only if they were appealed. I knew a couple of lawyers who did nothing but SSDI appeals, and it was really depressing because sure, there are people who aren't really disabled and file for SSDI, but there were plenty who very obviously qualified for SSDI but whose benefits were delayed because of the automatic rejection AND they had to pay a lawyer to get them the money they deserved in the first place. Massive rejection followed by massive reversals on appeal is not a good system. Or, not good for the people with the claims, anyway.)

Another way Medicare Advantage makes money is by "upcoding." That's where they get doctors (remember, Advantage plans have networks of doctors they contract with) to diagnose people as sick as possible, because the government pays Medicare Advantage more for members who are sicker.

Basically, the government pays Medicare Advantage for each person who enrolls in the plan, and the payment is higher for sicker people. Advantage gets the money and in return pays for all the healthcare for its members. So the less they spend on healthcare claims, the more they get to keep. That presents an incentive to deny claims.

Medicare Advantage initially came about because, as usual, private industry said they could do it better and cheaper than the government. And, oops! The government actually pays out more for Advantage members than it does for people on traditional Medicare. So Advantage members cost the government more AND they have to deal with denials of coverage and other Medicare Advantage hoops.

That was actually another reason I was resisting Medicare Advantage for my coverage--on principle. I understand why people would choose an Advantage plan over traditional Medicare, but I just don't feel good about supporting that model. I just saw an article from 2018 that said 1/3 of Medicare people are on an Advantage plan, and I think the current number is like 40%. That's the future.

Actually, I just checked actual numbers and the Kaiser Family Foundation (who I trust) says it was 37% in 2018 and 48% in 2022. I guess those TV commercials work. This is where Medicare is headed, and I don't like it. And they're making inroads even outside Advantage with "Select" supplements that have networks, which COMPLETELY messes up the simplicity of "If Medicare pays, your supplement pays."

Nobody's ever going to repeal Medicare, but they're going to cause its death by a thousand cuts.

shapeshifter · December 5, 2022

1 hour ago, StatisticalOutlier said:

And remember, if you're on traditional Medicare Part B, you can change your supplement any time during the year. People think it's only during open enrollment, but it's not. The only issue is passing medical underwriting, if you're in a state that allows supplements to do that.

In fact, I'd suggest if someone wants to change their supplement, they do it outside open enrollment because it won't be such a busy time for insurers and brokers/agents.

. . .

1 hour ago, StatisticalOutlier said:

But if you want to change your Part D prescription drug coverage, that can be done only during the Fall open enrollment that's ending this week.

So then if I understand correctly, if I go with an Advantage plan——which includes "creditable drug coverage" in lieu of (I guess?) Medicare Part D——I cannot change my plan again until open enrollment next fall for the following calendar year?
(in NY state)

Edited December 5, 2022 by shapeshifter

StatisticalOutlier · December 5, 2022

1 hour ago, shapeshifter said:

So then if I understand correctly, if I go with an Advantage plan——which includes "creditable drug coverage" in lieu of (I guess?) Medicare Part D——I cannot change my plan again until open enrollment next fall for the following calendar year?
(in NY state)

Of course not, because this is Medicare and there's an "extra" open enrollment period during which the changes you can make are different from what you can do during the Fall open enrollment period!

We're currently in what's called "Medicare Open Enrollment" (October to December). Confusingly, there's also a "Medicare Advantage Open Enrollment" period from January 1 - March 31, during which you can switch from one Advantage plan to another, or "revert" to traditional Medicare However, I've never found a definition for "revert" in this context--did you have to originally be on traditional Medicare at some point in order to be able to "revert," or does "revert" actually mean more like "default" to traditional Medicare even if you've never had traditional Medicare? I'm pretty sure it's the latter, but have never found anything that makes that clear; everything uses "revert."

One way to think about it is that everybody on Medicare can make changes during the Medicare Open Enrollment period, and only people on Medicare Advantage can do things during the Medicare Advantage Open Enrollment period.

If you have an Advantage plan and change from that to traditional Medicare during the January-March Medicare Advantage Open Enrollment, you can also get a Part D prescription drug plan at that time. That makes sense. (Hurrah! Something makes sense!) And in your case you can get a supplement to go with your Part B traditional Medicare with no problem because New Yorkers have guaranteed issue rights to supplements. People in other states would be able to move from Medicare Advantage to traditional Medicare during the January-March Medicare Advantage Open Enrollment period and get a Part D drug plan, but might not be able to get a supplement if they have health issues that run afoul of medical underwriting.

So if you choose a Medicare Advantage plan during the current open enrollment, you actually have until March 31 to make a decision between Medicare and Medicare Advantage (or between two Medicare Advantage plans) that can't be changed until next year's Fall open enrollment period. But be aware that if you do change to a different Advantage plan during the January-March period, you'll get the deductibles and out-of-pocket limits reset when that plan becomes effective.

One difference between the Fall open enrollment and the January-March open enrollment is that in the Fall period you can choose a plan and then unchoose it and choose a different one, as many times as you want, until the last day of the open enrollment period. All changes that everybody makes during the Fall open enrollment period take effect January 1, and whatever plan you're on record as choosing when the enrollment period ends is the one you will have on January 1.

But during the January-March Medicare Advantage Open Enrollment period, you can change once, and only once. The date the new plan (either a different Advantage plan or the switch to traditional Medicare and a Part D drug plan) takes effect will depend on when you made the change (unlike the Fall open enrollment period's January 1 effective date for all changes anybody makes, the January-March period has a rolling effective date that is triggered by the date you make the change).

And just to not let this get lost in the mush: the only changes you can make to Part D drug coverage during the January-March Medicare Advantage Open Enrollment period is to buy it anew due to switching from Advantage to traditional Medicare. If you're on (or change to) traditional Medicare during the Fall open enrollment and pick a Part D drug plan at that time, it becomes effective on January 1 and you're stuck with it for the rest of the year. That's because you're on Medicare, and only Medicare Advantage people can make changes during the Medicare Advantage Open Enrollment Period.

(Actually, you can qualify for a special enrollment period if you're defrauded in making your choice of a Part D drug plan, but I'm not going there.)

Just so you know, we'll be on the road tomorrow so I won't be on the computer. I hope a moment of clarity bubbles up to the top for you.

Dancing bear · December 5, 2022

Coming down to the last minute - rethinking my part D plan.

Medicare since November, 2020. Went with plan G, Humana Walmart part D, my vision and dental continued COBRA/BCBS for 18 months. My former employer had paid my insurance to age 65.

I have continued with plan G and Humana part D but seriously looking in to other part d plans due to Humana is over $30 and my meds don't even come to $300 a year. When the COBRA dental/vision ended I went with a Delta Dental individual plan (for seniors) through my local insurance company. I didn't want to go with any Advantage Plan since I didn't want copays and expense for any testing/procedures AND the dental benefits they offer - very few dentists. The dentists listed are Aspen Dental (not interested in them at all) and what I'd call the bottom of the shelf dentists. I have periodontal issues plus a mouth full of old crowns so I knew I needed to maintain an individual dental plan.

All these insurances cost money and the only one I see to save money is changing part D. A month or two ago I posted on this forum, asking questions about part D plans. The one that sticks out in my mind is the WellCare part D plan. I guess I'd have to change from Walmart to CVS to reap the most prescription benefits but that's not a problem.

So NOW FINALLY - anyone who has Wellcare, are you happy with the plan? Any other info helpful.

TIA

StatisticalOutlier · December 5, 2022

7 hours ago, Dancing bear said:

A month or two ago I posted on this forum, asking questions about part D plans.

I don't see that post here. I've been embroiled in Part D for a couple of months now, and surely would have responded if I'd seen it.

7 hours ago, Dancing bear said:

The one that sticks out in my mind is the WellCare part D plan. I guess I'd have to change from Walmart to CVS to reap the most prescription benefits but that's not a problem.

Why does the WellCare plan stick out in your mind? Have you run your drugs through Medicare's cost-estimator plan-picker?

If not, go to the Medicare website and click on FIND HEALTH AND DRUG PLANS. Input your zip code and select DRUG PLAN (PART D) and then click APPLY and then click START. When it asks if you want to see drug costs when you compare plans, say YES and enter your drugs. If you're logged in, it might populate the list for you (it (surprisingly) did for the friend whose Part D I'm helping him with).

Once your drugs are in there, what I do is click on a few representative pharmacies (like Walgreens, CVS, Walmart, and the local grocery stores convenient to you) to "compare," and click DONE in the lower right corner. That will bring up a list of all the plans available (including the plan's "star rating"), and you can sort by "lowest drug + premium cost." Then on any of the plans, click VIEW DRUGS & THEIR COSTS and you'll get very detailed information about the cost at the pharmacies you are "comparing."

Of course that tells you absolutely zero about a drug you don't know you're going to be taking, and whether it will even be on a given plan's formulary, but it's all we've got.

7 hours ago, Dancing bear said:

So NOW FINALLY - anyone who has Wellcare, are you happy with the plan? Any other info helpful.

It all depends on what drugs an individual is prescribed and how the plan treats them (e.g., which tier, what the copay is, whether they're on their formulary at all). So a plan that one person is happy with might make another person very unhappy due to which drugs they take and how the plan treats them with respect to tier and copay. And a person might be very happy with a plan when he's taking his usual maintenance drugs because they're zero copay, but become very unhappy when he's prescribed a drug that isn't on that plan's formulary at all.

Generally, the advice is to put the drugs you know you take into the cost estimator thing and go for the cheapest one. You can look at a plan's star rating, but click on STAR RATING to see what gets factored into it and whether those consideration are important to you.

Edited December 5, 2022 by StatisticalOutlier

shapeshifter · December 5, 2022

On 12/5/2022 at 12:58 AM, StatisticalOutlier said:

We're currently in what's called "Medicare Open Enrollment" (October to December). Confusingly, there's also a "Medicare Advantage Open Enrollment" period from January 1 - March 31

Wow. Is this the best kept secret in MedicareLand or what? https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan
Thanks again, @StatisticalOutlier.

This is a huge relief. Of course, it also means I can now spend 3 more months obsessing 🙃 because:

On 12/5/2022 at 12:58 AM, StatisticalOutlier said:

But during the January-March Medicare Advantage Open Enrollment period, you can change once, and only once.

@Dancing bear, I have similar dental issues. So far, most dental insurance has been barely a discount (government jobs seem to have better). I have at least 8 crowned molars, or, as I say: Enough crowns to be Queen for a Day for a week and then some. I also say every crown equals a laptop, and that's with insurance.
Please post here if you find some worthwhile dental insurance.
Actually, the reason I looked a Excellus Blue Cross for Medicare Advantage was because the dentist I've been seeing only accepts that insurance, or I can pay their office about $400/year upfront for their in-house insurance which then covers 2 cleanings and checkups and x-rays, with a bit of discount for anything else (like most dental insurance).
But, supposedly, if I need, say, to replace another crown, the Blue Cross salesperson said that since the dentist accepts their plan, Blue Cross might reimburse me for some of what I paid after the dentist's in-house insurance.

Edited December 6, 2022 by shapeshifter

Bastet · December 5, 2022

16 hours ago, StatisticalOutlier said:

Nobody's ever going to repeal Medicare, but they're going to cause its death by a thousand cuts.

Exactly. I took a gerontology class in college on programs and policies affecting the elderly, so learned all about the creation of Medicare (and Social Security, and numerous other programs) and its changes up to that point. So, ever since, as things have been in the news about it, I pay attention. As per usual, these goddamn private insurers lobbying their way into the mix is a problem, and going to become an even bigger one.

roseha · December 5, 2022

On 12/4/2022 at 1:41 AM, Yeah No said:

I will be going on Medicare in August of 2023 so this stuff is of interest to me now. My husband is already on it and some friends so I have learned a lot from them, but it is news to me that an annual physical with lab tests is not covered by Medicare. I'm reading that Advantage plans don't cover them either, but to make matters even more confusing, this flyer from United Healthcare seems to indicate Advantage plan coverage for both wellness visits AND an "annual physical", although just exactly what they define that as is not explained. I haven't found anything specifically about supplemental Plan G coverage and these things, though it probably wouldn't cover an annual physical with lab tests based on everything I've read. Which sucks because I'm interested in Plan G. I don't think an Advantage plan would be right for me for other reasons but how to deal with the lack of an annual physical is going to be a PITA.

@Yeah No in case anyone hasn't replied to this, I see my doctor for a "wellness visit" every year which covers what he would cover in a physical. The first time I went to him under Medicare Part B the office didn't code it as a wellness visit and I almost had to pay about $550. The office fixed the coding and I didn't have to pay for it.

I would think a supplement would also help if you get it but I haven't needed it in the past (only got it this year for other reasons).

StatisticalOutlier · December 6, 2022

14 hours ago, roseha said:

@Yeah No in case anyone hasn't replied to this, I see my doctor for a "wellness visit" every year which covers what he would cover in a physical. The first time I went to him under Medicare Part B the office didn't code it as a wellness visit and I almost had to pay about $550. The office fixed the coding and I didn't have to pay for it.

And that's the problem. They didn't "fix" the coding, because it wasn't wrong. If what your doctor did was what he would do for an annual physical, it was not a wellness visit. When it was properly coded as an annual physical, Medicare properly rejected it.

What your doctor's office did was change the coding to something Medicare would pay for, even though the service performed does not actually meet Medicare's definition of a wellness visit. It's not that Medicare insists on calling an annual physical a wellness visit and won't pay for it unless it's coded that way. It's that Medicare doesn't cover annual physicals but does cover wellness visits, but they are not the same thing and coding for them isn't interchangeable.

It's always possible to ask/demand that a doctor's office change the coding for an annual physical to something Medicare will pay for, but they're under no obligation to do so because the coding isn't actually wrong. And some doctors won't do it; I don't know if it's because they want to extract more money from their patient or if they're simply complying with Medicare's rules, but nobody should expect an annual physical exam to be covered by Medicare because annual physical exams aren't covered by Medicare. Wellness visits are, but they're not the same thing.

People will rant about the doctor's billing office's incompetence because they can't get the coding right, but what they don't realize is that the coding isn't wrong. The billing office is coding it correctly, but the result isn't what they want. But that's not the billing office's fault; it's their fault for expecting Medicare to pay for something Medicare is prohibited by law from paying for.

14 hours ago, roseha said:

I would think a supplement would also help if you get it but I haven't needed it in the past (only got it this year for other reasons).

I'm not sure what you're referring to. A supplement would help what?

Have you not needed a supplement in the past because your 20% responsibility under Medicare has never been more than the Part B deductible?

I'm a very very infrequent consumer of healthcare, but when I got on Medicare, I was like Yippee! and decided to get some physical therapy for my knees. They hurt like hell going up and down stairs and Dr. Internet told me I needed to strengthen the surrounding muscles, but all the exercises (like leg extensions on a machine) hurt my knees.

I wanted a physical therapist to tell me what I should be doing, and in Illinois you don't have to have a prescription for physical therapy. However, Medicare requires a prescription order to pay for physical therapy. So I grudgingly went to the doctor and it turned out great because he prescribed some steroids plus physical therapy, and the steroids were a miracle drug. I went to physical therapy 6 or 8 times, found out I should actually be strengthening my hips and legs and not the muscles around my knees, and was able to start the exercises without pain because of the steroids. I'm good as new.

I almost never go to the doctor and got a supplement mainly to cover me if I'm hospitalized (Part A), which could be financially ruinous without a supplement (this is something I haven't even touched on here--traditional Medicare has no out-of-pocket limit). To my surprise, just that little bit of medical care for my knees pushed me over the Part B $233 deductible, even though under Part B I'm responsible for only 20% of the Medicare approved charges.

Also...even though I have Part D coverage, I used GoodRx for my steroids prescription because it was cheaper than going through my Part D. I hate the data collection and brokering that GoodRx is no doubt doing, but I leaven it a little by not having their app on my phone (ha ha ha--my flip phone), and looking at the prices on their website on my computer, and printing out the coupon.

EtheltoTillie · August 2, 2023

@Mountainair I have a couple of comments on your insurance post. The ACA is supposed to cover mental health in all plans--that was one of the important tenets--so there shouldn't be a plan that "doesn't cover mental health." I don't know what state your are in, but please check this out. I know that it might be hard to get an appointment with someone in your network--that is an issue. But there shouldn't be "no coverage."

Another thing is the federal EPSDT program for children. It should be part of their Medicaid and should make sure they get covered for everything. There are Legal Aid and other public interest lawyers in every state who handle disability related denials for these sorts of things also, and they can help you. (Fun fact--I am one of those lawyers in NYC.) There are administrative hearings available to you.

Yeah No · August 2, 2023

Well, August 1st was my first day on Medicare. I'm all signed up for everything now - Parts A and B, a supplemental and Part D. Thanks to @StatisticalOutlier and others for your guidance on this. I also had the help of my husband, who has been on Medicare for 2 years now and one good friend.

Although I have to say that not ONE Medicare counselor or any of the literature on Medicare that we saw online or otherwise told us that when you're on pandemic Medicaid (which for me was not due to expire for me until October) that you have to actually ASK Medicaid to terminate your coverage when your Medicare starts. Otherwise you end up in a situation where neither one wants to pay and they point the finger at each other over who's responsible. All the Medicare counselors (and I spoke to several over the years) told us that you can be on both Medicare and Medicaid and that Medicaid would pick up whatever Medicare didn't pay, plus pay your premiums for you, but I later found out that that only works for people that qualify under a special category to be on both programs at once, NOT people on that special pandemic Medicaid. None of the Medicare counselors seem to know this, not even the ones highly recommended by friends who used them. I only found this out when my husband ended up in that situation and had to go through the 9 circles of hell over several months to straighten it all out. No one even at Medicare or Medicaid seemed to understand his special situation and he ended up in an endless loop of hell for months until he finally was able to get through to someone at Medicare who knew how to help him. No one shares that information with you either, even if they are aware of it, unless you come to them with it and you manage to get past the first level to speak to someone who knows the answer and can help you. It's unbelievable, but that's the truth. My girlfriend, who seems to listen to every Medicare podcast and online seminar out there told me she stumbled across a discussion about this situation, but only ONCE in her entire experience!

I have to admit I'm afraid of coming off Medicaid where everything was paid for, to go back to paying premiums, copays and deductibles, although I was very familiar with that from my working days. Thankfully, Medicare has online automatic billing set up to have premium payments charged to a bank account or credit card. We are in that category where we are not yet collecting Social Security, so our Medicare premiums are not automatically taken out of that and we have to pay them ourselves.

I'm also a little nervous given what my husband went through when he first went on Medicare. I don't trust that anything is going to go the way it should with this. He has already had to deal with his doctor's office making coding mistakes (which were actual coding mistakes that they later apologized for). He still goes to the practice where our old (now retired) PCP worked. I always had trouble with their coding mistakes, which is one reason I didn't continue with them after that doctor retired. But I don't know how much better my current PCP's office will do on that since I've been on Medicaid and didn't have to deal with all of that. I guess I'll find out.

shapeshifter · August 2, 2023

@Yeah No, while your specifics are very different than mine were, we were equally fed a lot of misinformation by certified, trained professionals who were supposed to be knowledgeable about Medicare and health insurance.

I can say that now, after a year, Medicare is much better than I'd worried it might be, and surprisingly, better than the temporary, post-retirement health insurance my former employer offered, even though the Medicare advisors had said the opposite, encouraging me to stay on it longer than I might have.
Of course they did.🙃😠🫤🧐🙃

But.
At least not this:

image.png.bd189a98bc8944a2c14cb71b58c2e97d.png

Edited August 2, 2023 by shapeshifter

Laura Holt · August 2, 2023

2 hours ago, shapeshifter said:

I can say that now, after a year, Medicare is much better than I'd worried it might be, and surprisingly, better than the temporary, post-retirement health insurance my former employer offered, even though the Medicare advisors had said the opposite, encouraging me to stay on it longer than I might have.
Of course they did.🙃😠🫤🧐🙃

We are looking ahead to retirement for my husband right now and his insurance through his employer also offered post-retirement insurance. We did the math and, well, no, when we looked into this it seems to be more geared to those lucky people who are able to retire before reaching official retirement age, which here in Canada would be 65 when govt benefits will kick in to help with dental and prescriptions. As a consequence that supplemental coverage is $$$.

Edited August 2, 2023 by Laura Holt

Yeah No · August 2, 2023

4 hours ago, shapeshifter said:

@Yeah No, while your specifics are very different than mine were, we were equally fed a lot of misinformation by certified, trained professionals who were supposed to be knowledgeable about Medicare and health insurance.

I can say that now, after a year, Medicare is much better than I'd worried it might be, and surprisingly, better than the temporary, post-retirement health insurance my former employer offered, even though the Medicare advisors had said the opposite, encouraging me to stay on it longer than I might have.
Of course they did.🙃😠🫤🧐🙃

But.
At least not this:

Thanks for the encouragement. 🙂 I guess it depends on where you worked as to the company post-retirement benefits. My good friend retired from NYU at 62 and was able to continue on their health insurance. Then when she turned 65 it converted into a Medicare supplemental plan through United Healthcare, similar to plan G, only she pays very little in premiums for it, something like $15 a month, which is about half what it would normally cost. So far she is complaining because for the first time she actually has some out of pocket costs. It seems that NYU's regular health coverage was spectacular when compared to what most people get. I was lucky that way too in that the companies I worked at offered fantastic coverage and it was a shock when I stopped working and my husband and I had to go on something through the "Connecticut Marketplace" (AKA Obamacare).

I didn't work anywhere that offered post-retirement health benefits, although my husband is lucky that his boss, who doesn't offer any health insurance is picking up all our premiums. It still seems like a lot to us because it isn't cheap and my husband pointed out that he is still having deductions from his paycheck for Medicare even though he is ON Medicare. I don't know if I think that is fair, but it is what is done and there's no way around it.

StatisticalOutlier · August 2, 2023

6 hours ago, Yeah No said:

All the Medicare counselors (and I spoke to several over the years) told us that you can be on both Medicare and Medicaid and that Medicaid would pick up whatever Medicare didn't pay, plus pay your premiums for you, but I later found out that that only works for people that qualify under a special category to be on both programs at once, NOT people on that special pandemic Medicaid. None of the Medicare counselors seem to know this, not even the ones highly recommended by friends who used them.

That's interesting. I stay out of the Medicaid angle of Medicare, as well as the still-employed arena. I have enough trouble keeping the "regular" stuff straight.

Who are you consulting? Insurance agents or SHIP counselors? Are there other people who do this? How are they paid? (Agents make a commission, and SHIP counselors are volunteers for a government program.)

I actually wondered if I should try to be a SHIP counselor, since I like helping people navigate this mess, but I'm gathering that there are (understandable) restrictions on what SHIP counselors can tell people. Like, I know they can't recommend specific companies, but I wonder if they can even mention them. I wouldn't like not being able to tell someone that Cigna is being sued for using AI for claims evaluations in their Advantage plans. I'm not even sure they can talk about how Advantage plans reverse the vast majority of their denials on appeal, which sounds great until you know that almost nobody actually appeals.

Or, as I mentioned above, that Mutual of Omaha is known for closing the books on supplements, resulting in people who can't switch supplements being trapped and suffering extreme premium increases. And for the record, my understanding is that both Aetna and Cigna are known for doing this, as well, although not to the extent that MoO does it. And MoO doesn't do it in every state.

So my advice would be to beware of these three companies, especially if the premium is a lot lower than other companies, because it might be a teaser rate. But I don't think SHIP counselors can do that.

Well, that is, if they even know. I was reading a discussion forum where a SHIP counselor told about a client he'd worked with who was suffering high premium increases and only in reading that discussion about closing the books did he grok to what might have been going on.

Quote

Thankfully, Medicare has online automatic billing set up to have premium payments charged to a bank account or credit card. We are in that category where we are not yet collecting Social Security, so our Medicare premiums are not automatically taken out of that and we have to pay them ourselves.

I'm not taking social security yet, either.

Are you using Medicare Easy Pay for recurring payments? When I go to sign up, it says, "Pay your premiums with automatic recurring payments from a checking or savings account with Medicare Easy Pay." It doesn't give me the option to use a credit card. But I can use a credit card for a one-time payment, so I log in every three months and put it on the credit card.

Yeah No · August 2, 2023

4 hours ago, shapeshifter said:

@Yeah No, while your specifics are very different than mine were, we were equally fed a lot of misinformation by certified, trained professionals who were supposed to be knowledgeable about Medicare and health insurance.

BTW, I wanted to clarify that my husband was repeatedly fed misinformation by both Medicare and Medicaid. They both confirmed for him that he would not have to cancel Medicaid when he went on Medicare. That was despite him explaining that he was on pandemic Medicaid. They even told him that his Medicare premiums would be picked up by Medicaid and he never even received a bill from the government for that either. Then after 6 months his part B was cancelled for lack of payment! Unbelievable! And no one could explain why, either! He spent hours and hours on the phone begging for help and to speak to higher levels, but even when he did get that far he kept going round and round with no resolution in sight. So he didn't even have part B for months - and even after he got Medicare to send him a bill and he paid it up to date, they didn't restore his part B for months, despite telling him they would.....Honestly, he had the patience of Job. I would have been ballistic after all of that!

This wouldn't have been so bad, but what if he had a medical emergency in the interim? As it turns out he was postponing doctor appointments for a year already because of the pandemic, then another year because of this. When he finally was able to have a physical he found out he was a type 2 diabetic. He was damned lucky he didn't have any serious consequences from that. BTW, he has lost 40 lbs. and is doing very well now with no complications from the diabetes.

StatisticalOutlier · August 2, 2023

4 hours ago, StatisticalOutlier said:

So my advice would be to beware of these three companies, especially if the premium is a lot lower than other companies, because it might be a teaser rate. But I don't think SHIP counselors can do that.

I'm quoting myself, but I want to clarify that if you're in a state that gives you guaranteed issue rights at any point in the year, I can't think of any reason not to chase the lowest-priced supplement there is every single year, regardless of the company, because you know you won't be stuck with it forever if you can't pass medical underwriting. If Mutual of Omaha gives teaser rates in your state, take 'em. And then change when they jack them up.

I haven't looked into guaranteed-issue rights in the various states because it doesn't apply to me, but I think in some states, your guaranteed-issue rights extend only to lateral moves, or maybe within the same company, and some states limit your guaranteed-issue period to some time around your birthday. Everyone should check to see what their state provides with respect to guaranteed-issue rights, and use that information to decide whether they really care if a company has a reputation for jacking rates up.

Also, upthread I talked about community-rated supplements, where everybody pays the same premium regardless of age. My experience was only in Texas, where the community-rated supplements are from AARP/UHC, which technically has a single rate for everybody, but offers a discount to younger people, which results in the usual younger-people-pay-less-than-older-people premiums that attained-age policies have. However, there are states where all policies are required to be community rated, and people with a given supplement really do all pay the same premium regardless of age. Younger people pay more than they would with an attained-age policy, and older people pay less than they would with an attained-age policy; the state has made the decision to have everyone share the burden equally.

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