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Questions regarding Medicare

Questions regarding Medicare

Old Jan 16th 2022, 5:49 pm
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Default Questions regarding Medicare

Hi - Not sure I am posting this in the correct place but don't know where else to post it. I have a question for all you retired people here in the US regarding Medicare. Just wondering how many of you have Original Medicare (Parts A and B and a prescription plan) or a Medicare Advantage plan that includes prescriptions. Do you like your plans? Are they expensive? Anything that you would like to see changed? I am 68 years old (will be 69 later on this year). I am still working and on my employer's plan. I was planning to work until I was 70, but to be honest find it harder and harder and feel tired a lot of the time. Not sure what to do about the Medicare thing. The Medicare Advantage plans sound like a better deal money wise, but apparently you are limited to doctors/providers in a certain network and that might not work for everyone. I had fairly good health until recently but now have developed an auto-immune disorder and go a specialist 4 times a year. I was chatting to one of my neighbors, she has Original Medicare as she likes being able to go to any doctor, also prescription plan and supplemental insurance - she pays $400 a month which I thought was pricy. I was hoping to keep my costs down to under $300 a month. I am single (divorced) so it would just be for me. Do you feel that supplemental insurance is absolutely essential or do any of you not carry it? Any responses/opinions would be most welcome. Thank you!
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Old Jan 16th 2022, 6:00 pm
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Default Re: Questions regarding Medicare

I too have original Medicare, plus a prescription plan, plus a supplementary plan (the supplementary plan pays for all co-pays and deductibles and also part A and B deductibles). (In other words I have no co-pays or deductibles ever)
My Medicare Original costs me $170 per month, my prescription plan $50 per month, my supplementary $300 per month. So just over $500 per month.
Sure, its expensive but my supplementary plan means comprehensive coverage with any doctor.

Medical Advantage plans look to be pretty reasonable depending on which plan you take - some even have no further monthly premiums and they offer additional benefits(?). However, most of them are HMO's and you can only go to doctors within a certain health group.

Horses for courses.....

If you want to keep your monthly premiums down (and take into consideration that, depending on the plan you take, you would pay for deductibles and copays as you go), then a Medicare Advantage plan is probably for you.
Don't forget too, that Medicare premiums depend on your income.

Last edited by SanDiegogirl; Jan 16th 2022 at 6:56 pm.
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Old Jan 16th 2022, 6:45 pm
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Default Re: Questions regarding Medicare

Originally Posted by SanDiegogirl View Post
I too have original Medicare, plus a prescription plan, plus a supplementary plan (the supplementary plan pays for all co-pays and deductibles and also part A and B deductibles). (In other words I have no co-pays or deductibles ever)
My Medicare Original costs me $170 per month, my prescription plan $50 per month, my supplementary $300 per month. So just over $500 per month.
Sure, its expensive but my supplementary plan means comprehensive coverage with any doctor.

Medical Advantage plans look to be pretty reasonable depending on which plan you take - some even have no further monthly premiums and they offer additional benefits(?). However, most of them are HMO's and you can only go to doctors within a certain health group.

Horses for courses.....

If you want to keep your monthly premiums down (and take into consideration that, depending on the plan you take, you would pay for deductibles and copays as you go, then a Medicare Advantage plan is probably for you)
Don't forget too, that Medicare premiums depend on your income.
Thanks for your response - I appreciate it! $500 per month is a lot, but that's good that you have no other bills or co-pays. My PCP is in the Cleveland Clinic Network but the two specialist doctors that I go to are in University Hospital systems so that could be the problem with a Medicare Advantage plan and having to stay within one network. It is so complicated!
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Old Jan 16th 2022, 7:09 pm
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Default Re: Questions regarding Medicare

Originally Posted by Derrygal View Post
Thanks for your response - I appreciate it! $500 per month is a lot, but that's good that you have no other bills or co-pays. My PCP is in the Cleveland Clinic Network but the two specialist doctors that I go to are in University Hospital systems so that could be the problem with a Medicare Advantage plan and having to stay within one network. It is so complicated!
https://www.medicare.gov/medigap-sup...r=2022&lang=en

Supplementary plans (also known as Medigap plans) are set out by Medicare itself and all the private health insurance companies who can offer Medigap plans have to adhere to the benefits and can only charge what Medicare dictates. So if you go with, say a Plan B with Blue Shield it will cost the same as if you enrolled with a Plan B with Cigna). There are supplement (Medigap) plans which are PPO plans but are cheaper since you pay for deductibles. See above
Depending on where you live will depend on what plans are available.
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Old Jan 16th 2022, 8:19 pm
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Default Re: Questions regarding Medicare

I have a Medicare advantage plan. Partly because my primary care doctor will not take original Medicare and I didn’t wish to change doctors when I was 65. The plan I have is the AARP United Healthcare plan with prescription coverage. It doesn’t cost me anything, except the standard Part B payment deducted from social security. I can only use in network doctors but that hasn’t been a problem, the choice is more than enough and as yet no one my PCP has referred me to has been out of network.

The one thing my plan has which is fun, is they pay me $10 per month for any month where I walk more that 7500 steps for any 10 days. It goes on a refillable gift card. Makes taking the dog for a walk easy.
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Old Jan 16th 2022, 9:19 pm
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Default Re: Questions regarding Medicare

I also have Medicare Advantage with United Healthcare. I’m 71 and have been on Medicare for six years, I guess. My only premium cost is (a) monthly Part B premium, and (b) $16 per month for the advantage plan. So, obviously a lot less than the $500 a month plus that people pay for Medicare with supplement plans.

And, as lansbury mentions, there are teasers from United Healthcare - “our nurse will come to your house, give you a health checkup, and we’ll send you a $50 credit at Target!” (Or whatever.) I generally don’t take up any of those type of offers.

BUT. I never go to the doctor. I’m not on any medication. I spend half my time in England. So, I just took this course of action because the monthly cost was the lowest. Long term, I think that the course of action that SanDiegogirl described is the most prudent one.
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Old Jan 16th 2022, 9:37 pm
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Default Re: Questions regarding Medicare

Originally Posted by lansbury View Post
I have a Medicare advantage plan. Partly because my primary care doctor will not take original Medicare and I didn’t wish to change doctors when I was 65. The plan I have is the AARP United Healthcare plan with prescription coverage. It doesn’t cost me anything, except the standard Part B payment deducted from social security. I can only use in network doctors but that hasn’t been a problem, the choice is more than enough and as yet no one my PCP has referred me to has been out of network.

The one thing my plan has which is fun, is they pay me $10 per month for any month where I walk more that 7500 steps for any 10 days. It goes on a refillable gift card. Makes taking the dog for a walk easy.
That sounds really good! Very affordable!
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Old Jan 16th 2022, 9:40 pm
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Default Re: Questions regarding Medicare

Originally Posted by robin1234 View Post
I also have Medicare Advantage with United Healthcare. I’m 71 and have been on Medicare for six years, I guess. My only premium cost is (a) monthly Part B premium, and (b) $16 per month for the advantage plan. So, obviously a lot less than the $500 a month plus that people pay for Medicare with supplement plans.

And, as lansbury mentions, there are teasers from United Healthcare - “our nurse will come to your house, give you a health checkup, and we’ll send you a $50 credit at Target!” (Or whatever.) I generally don’t take up any of those type of offers.

BUT. I never go to the doctor. I’m not on any medication. I spend half my time in England. So, I just took this course of action because the monthly cost was the lowest. Long term, I think that the course of action that SanDiegogirl described is the most prudent one.
You are lucky you never go to doctor. I was very healthy until I hit my 60s. I have never been overweight, exercise, watch what I eat, etc. Unfortunately when I hit my early 60s my blood pressure started creeping up and then this auto-immune illness was diagnosed a couple of years ago.
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Old Jan 16th 2022, 9:41 pm
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Default Re: Questions regarding Medicare

Originally Posted by SanDiegogirl View Post
https://www.medicare.gov/medigap-sup...r=2022&lang=en

Supplementary plans (also known as Medigap plans) are set out by Medicare itself and all the private health insurance companies who can offer Medigap plans have to adhere to the benefits and can only charge what Medicare dictates. So if you go with, say a Plan B with Blue Shield it will cost the same as if you enrolled with a Plan B with Cigna). There are supplement (Medigap) plans which are PPO plans but are cheaper since you pay for deductibles. See above
Depending on where you live will depend on what plans are available.
Thanks for the link! I appreciate all the info you have provided me
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Old Jan 18th 2022, 10:23 am
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Default Re: Questions regarding Medicare

I wouldn't have a Medicare Advantage plan if they paid me for it.

Sure you might get some small additional benefits, and they do have value, but you are also inviting an insurance company, with a profit motive, into your guaranteed benefits - and turning over ALL the decision making authority to them.

I have seen too many people in my 8 years in the healthcare finance sector get denied for procedures and/or care that were 'not medically necessary' by UHC/Humana/Cigna/Aetna/Wellcare etc that they would have received without question under traditional Medicare.
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Old Jan 18th 2022, 12:13 pm
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Default Re: Questions regarding Medicare

We have Aetna for our supplemental medical insurance. It is a Medicare Advantage plan and the cost for the two of us is $1,600 p.a. It is a PPO which means we can visit any doctor we want. There is a co-pay, however, but there is no deductible that has to be met each year. Would never use a plan that requires authorization before you can see a specialist or have a procedure done. My sister has this type of plan (HMO) and I see the struggle she has with getting approval, etec.

Our plan is not a medigap plan that is advertised on television and includes eyeglasses, dental, hearing aids, etc. I'm not changing what we have for a plan that wants to dictate my healthcare choice.
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Old Jan 18th 2022, 12:21 pm
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Default Re: Questions regarding Medicare

Originally Posted by Rete View Post
We have Aetna for our supplemental medical insurance. It is a Medicare Advantage plan and the cost for the two of us is $1,600 p.a. It is a PPO which means we can visit any doctor we want. There is a co-pay, however, but there is no deductible that has to be met each year. Would never use a plan that requires authorization before you can see a specialist or have a procedure done. My sister has this type of plan (HMO) and I see the struggle she has with getting approval, etec.

Our plan is not a medigap plan that is advertised on television and includes eyeglasses, dental, hearing aids, etc. I'm not changing what we have for a plan that wants to dictate my healthcare choice.
You’ve got to be careful over the terminology. If it is a Medicare Advantage plan, then it is NOT “supplemental Medicare insurance.” They are two completely different tracks. It’s either one or the other.
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Old Jan 18th 2022, 12:26 pm
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Default Re: Questions regarding Medicare

You’ve got to be careful over the terminology. If it is a Medicare Advantage plan, then it is NOT “supplemental Medicare insurance.” They are two completely different tracks. It’s either one or the other.
100% correct

Supplemental Medicare Insurance = Medigap

Medicare Advantage = Medicare Replacement Plan

You cannot have a Medigap plan and have a Medicare Advantage plan. If you do, someone has sold you a bill of goods. The medigap won't cover anything.
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Old Jan 18th 2022, 2:16 pm
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Default Re: Questions regarding Medicare

Originally Posted by civilservant View Post
I wouldn't have a Medicare Advantage plan if they paid me for it.

Sure you might get some small additional benefits, and they do have value, but you are also inviting an insurance company, with a profit motive, into your guaranteed benefits - and turning over ALL the decision making authority to them.

I have seen too many people in my 8 years in the healthcare finance sector get denied for procedures and/or care that were 'not medically necessary' by UHC/Humana/Cigna/Aetna/Wellcare etc that they would have received without question under traditional Medicare.
This just confirms my feelings toward advantage plans. They were instituted by Republicans to “save Medicare” but in reality costs the government 15-20 % more than traditional Medicare. Factor out profit for the insurance company plus the enormous advertising costs as seen in the recent yearly TV blitz to get new customers where is there room for actually paying for health care? But if I lived close to a world renowned hospital like the Cleveland Clinic and an advantage plan run by them was available for less cost I would definitely be interested.

Last edited by ddsrph; Jan 18th 2022 at 2:33 pm.
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Old Jan 19th 2022, 10:16 pm
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Default Re: Questions regarding Medicare

Originally Posted by civilservant View Post
I wouldn't have a Medicare Advantage plan if they paid me for it.

Sure you might get some small additional benefits, and they do have value, but you are also inviting an insurance company, with a profit motive, into your guaranteed benefits - and turning over ALL the decision making authority to them.

I have seen too many people in my 8 years in the healthcare finance sector get denied for procedures and/or care that were 'not medically necessary' by UHC/Humana/Cigna/Aetna/Wellcare etc that they would have received without question under traditional Medicare.
Gosh - that is very worrisome! They are becoming more popular though (probably because they are affordable). I will certainly research them.
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