William: The health insurance racket has just about ruined medicine. When I turned 65, on advice of an “agent” that I trusted, I went straight Medicare and purchased a Supplement policy, which turned out to be a wise choice. The upside is that most - but not all-providers “accept” Medicare. In doing so, providers agree to accept less than the “going rate” for services in return for “guaranteed” timely payment. Medicare pays 80% of the agreed upon “charge,” and the Supplement pays the remaining 20%. This has worked well for my wife and me, enabling us to avoid huge unexpected medical expense, which we would have had, inasmuch as my wife has experienced a number of conditions requiring hugely expensive treatment and aftercare. Of course, the premium for our Medicare Supplement has doubled in the ensuing 15 years, now approaching $1,000/month, and you can forget “shopping” for lower Supplement premiums with any “preexisting conditions.” We have always maintained separate Part D (drug) coverage and change plans nearly every year. Medicare.gov provides a comparison tool (based generally on out-of-pocket expense for the specific drugs one requires) for all “approved” plans that, so far, has proved reliable and valuable. The whole matrix is a variation on the Good/Fast/Cheap Paradox (you can only have two). Our method is not cheap - our out-of-pocket health insurance expense, excluding Medicare premiums deducted from Social Security benefits is at least $11K/yr at age 80. BUT we are also $800K to the good in terms of value received, which is, after all, why one buys “insurance.” So there’s that. On the down side, Medicare imposes all kinds of regulation on providers in terms of what treatments they can render in what circumstances, with what frequency and in what order, which, in my opinion, has greatly reduced the overall “quality” of medical care. Avoiding the Advantage type plans sacrifices a lot of illusory bells and whistles (eye care, dental care, hearing aids,,etc), but, as a Veteran, I (rather late in the game) discovered that I was eligible for generous benefits in the form of dental insurance at low cost/high benefits and top of line hearing aids for FREE. Hope this adds to your data bank.
Thank you for taking the trouble to provide such a thorough and helpful account of your experience. This is precisely the kind of information that will help others.
Well said. Thank you. My experience as well. Although I was tempted for a time to look in to MA plans. Thinking it through, it wasn’t too hard to figure out that if they’re giving so many extra perks for free, that the freebies are subsidized by cuts elsewhere in coverage. You can be sure that MA plan providers $ cost of giving those extra perks are not being deducted from their profit margin. Those cuts resulting in severe limitations, would not be apparent until you run right smack in to them and are unable to get the care you need. In many geographical areas that are not near a major city or metro area, there are few doctors to choose from as it is, and adding the low pay to doctors and increased restrictions of MA further reduces availability. Folks can really get themselves in a pickle, and then have to wait a whole year to change back to regular Medicare.
That said, I think MA plans can work for some people, in some larger population areas where there is a concentration of providers. That is, if they have the ability and patience to navigate and endure all of the additional levels of bureaucracy.
I agree. I’ve found navigating the supply of available in-network providers in the Raleigh area to be quite taxing—despite our abundance of medical schools and other resources.
This is precisely why I decided to become a Medicare agent (CA only, at the moment). It’s very complicated and can be time consuming. Someone like me can do the heavy lifting. MA plans can be the best choice for some people. To say that you should never have bought one, full stop, is a bit naive. There aren’t a whole lot of options and not supplementing Medicare at all is a HUGE gamble. Everyone, please find an agent licensed in your state to help you. It should cost you nothing to get help.
As a 74 yr old retired RN who became disillusioned with the allopathic medicine paradigm many years ago and left nursing prior to age 62 because I could no longer in good conscience peddle medications which are not only not beneficial but are actually toxic, I offer an alternative viewpoint to our concept of "healthcare" in this country.
I take zero prescription drugs, play racquetball weekly with guys 30-40 years my junior and regularly beat them. Do my own vehicle maintenance, run my old backhoe to keep up our wooded property.
I have not been sick to the extent of needing to stay in bed all day for over 14 years now.
Sure, I've developed a sniffle for a couple of days about once every 3-4 years and my wife seems to get dragged down with an assortment of vague and varied symptoms for a few days nearly every time she flies commercial- but we are seeing more evidence coming out recently of that possibly being due to horrible cabin air quality thanks to jet exhaust contamination.
We bought an infrared sauna 18 months ago and use it 3x\week. Best $1600 I've ever spent. The improvement in sleep quality alone is more than worth it.
My wife (also retired RN) and I garden and eat virtually nothing which is not certified organic, eat no red meat and poultry or fish weekly.
Both of us have studied the use of herbs for healing and maintenance of health and take a fair handful of them regularly, along with several supplements including vits B,C,D,E, K, minerals, curcumin and a few others.
We visit a PHCP yearly for blood work mainly to monitor our serum vit D levels and to check on wife's thyroid status (she successfully recovered from hyperthyroidism a number of years ago by utilizing herbs and supplements-much to her endocrinologist's dismay-he had pushed strongly for immediate treatment with radioactive iodine, an irreversible procedure leaving you dependent for life on a synthetic, incomplete thyroid hormone).
We neither drink nor smoke, though we both drank in our younger\dumber days and rarely eat out due to the difficulty of finding truly healthy organic food in restaurants.
Neither of us has had a "vaccination" since before the turn of the century, nor will we ever again. We were ostracized by some of the vaxx true believers during the plandemic but are so grateful we had the courage of our convictions not to give in, as we now have seen multiple vaxxed relatives and friends develop serious health conditions including rapid spinal degeneration and turbo cancers. Two have died, and more are well on their way to that end...
Are we just lucky or blessed with our continued robust health? Maybe-but we contend that our lifestyle and avoidance of the crumbling "sickcare" system in this country has made the difference.
We bought into the idea 14 years ago that no one will really care about our health as much as we will and that we are totally responsible for our own health and well-being.
I work for an MCO. These govt contracts are lucrative. Stick with the govt plan. It is only going to get worse as the for profit model leads to further reduction of benefits.
I retired at 62 and was able to continue on my employer’s medical and dental plan, at a hefty monthly cost, until I reach 65, about eight months from now. I have already been advised to contact an insurance agent, which I plan to do later this summer, for advice.
I appreciate the information; I never realized Medicare (Mediocre?) could be so confusing.
Many Offices of Aging have Medicare expertise employees whom can help you research plans. When you contact a broker they are eager to enroll you in Managed Plans.
The research you do on the plans should include exploring the companies scorecard, reading reviews of customers experiences etc. You do actually want to get in the weeds to see specifics in regard to specialty care. I actually go to the plan itself to get a sense of the prior authorization process.
Having someone help you sort through the plans whom has no vested interest financially is better than listening to a sales pitch .
United Health Care is starting to have a reckoning .
Investors aren’t happy with below projection performance. They are being investigated for practices related to vertical integration of their own providers .
Also getting slammed on denials , and people are starting to wise up to the barriers when more expensive care requests are denied.
The difficulty will be once the government realizes that a fine is not going to be the remediation.
My husband and I were fortunate enough to have a friend who was an insurance consultant. When my husband retired 8 years ago, she strongly encouraged us to go with plain Medicare, and we are still happy with that choice. I have friends with Medicare Advantage plans, and they seem to work well for them…until they don’t. Private insurance is just a nightmare.
You're absolutely right...for the short-term, when one is "young-ish". And healthy-ish. But start to age, and more importantly, start to get sick, and the true (and truly impoverishing) costs of those ZERO PREMIUM ADVANTAGE PLANS!!!! become apparent. Meanwhile, those with the $4500/year (the approx cost of trad Medicare) can actually use their insurance and get services.
It's a terrible paradox, and one that we wouldn't face if we came to our senses, passed healthcare for all, and banished for-profit health insurance companies to the hell they so richly deserve.
My wife and I (78 & 77) began with traditional Medicare & a supplement. When that got to be too expensive we switched to a Medicare Advantage plan, which is essentially an HMO. It's a zero cost plan, which so far has been great. Our PCP is in a corporate practice, which is owned in part by the insurance company. We've been through two surgeries, with minimal co-pays and never reaching our out-of-pocket maximum. I think there are two main reasons this works well for us:
1. We live in a suburb of a very large city. Almost no doctors accept traditional Medicare, but there are plenty of specialists that are in our network.
2. (Most important) We have done everything possible to ensure our health, from diet to a 3 mile daily walk. We have only one prescription between us, and it is fully covered.
One note about prescriptions - when we first signed up for Medicare we had none, so we did not purchase coverage for them under part B. As a result we now have to pay a penalty of around $250 per year, since prescription coverage is mandatory under our MA plan.
Many thanks for your response. As you can probably see, your experience reflects an alternative, positive view of MA plans. My own circumstances are very close to yours. Anyway, people need this kind of information to make good decisions.
I also selected original Medicare and a supplemental plan. On a single year my supplemental insurer received a 66% rate increase.
I contacted the Center for Medicare/ Medicaid to voice my concern that I felt insurance companies were trying to price supplemental plans in a way intended to drive consumers into managed plans that maximize their profits. And despite record profits on advantage plans ; the insurance companies also get a huge hike on the original Medicare supplemental side as well.
Currently , there are far more seniors whom cannot afford to pay those types of premiums than can. So what choice do they really have?
I had less expensive and more robust coverage through the NY healthcare exchange.
So even if you understand that original Medicare allows for less complicated approvals ,you face as an average income senior the barrier to affordability.
I was fortunate that my provider agreed to retain me as a patient once I converted to Medicare.
Most people discover that only hospital based clinics accept new Medicare clients. Imagine what will happen if the current plan for cuts to Medicaid and Medicare are approved. Hospital based clinics will become part of the disappearing landscape of available care.
In those situations there are often changes in the personnel as medical residents complete training or leave to join hedge fund based practices.
That leaves you with practice inconsistencies ; as provider rotation prevents you from building a sustained relationship.
Switching off a MA plan is complicated by the presence of preexisting conditions.
I believe that there should be a profitability cap for MA plans .
Just fix original Medicare won’t you please ; so it can be obtained with a reasonably priced supplemental plan. That way seniors on a fixed income can finally have the care without sudden premium escalations.
Most insurance consultants advise MA plans if you are healthy and don't have too many medical concerns. I have had MA Humana. I pay no premium and do not have to pay the Medicare part B either. It is a PPO plan. I don't need referrals to see specialists. Copays are low. Urgent care and primary care drs have no copay. I will have cataract eye laser treatment - my copay is only $175. There are plenty of in network doctors. My dentist is out of network but the plan only pays for x rays and fillings. I guess it just depends on where you live. Florida has an abundance of hospitals and doctors.
I will be retiring at 65 early next year with a good amount in an HSA. No clue what I’m going to do beyond signing up for Medicare, but that HSA feels like a decent buffer.
I also have a nephew who works for the state Health Care Authority and one of the smartest guys I know.
Although I think we’ll be fine (wife is 6+ years older than me and retired for several years), I’m scared of the system.
Thanks for the post and the other commenters, keep the info coming!
I think you’re in pretty good shape. Be sure to sign up for a supplemental insurance plan within the first 6 months of becoming a member of original Medicare if that’s the way you want to go.
Just know that once you sign up with a company for supplemental insurance you will be charged a penalty if you later change companies. The insurance company will raise your premiums as you get older, so you are in a way locked in.
In NC, in Durham, I used the free services provided by Senior Pharmassist to understand my choices for Medicare, both their online sessions and an in-person appointment. They were great at helping me understand my choices, which ones would be the best and least expensive fit for my medical and medication needs, including pulling in their pharmacist to review my meds and decide which Part D would be best. I also found SHIPP, Seniors Health Insurance Information Program, a free, government-funded program that provides Medicare information and counseling, to be useful, too.
In my case, the one huge reason I ended up with MA was the out of pocket cap. No non-MA plan offers a cap at a price anywhere near. I'd be perfectly happy with vanilla Medicare if only there was something like a $10k/year cap.
MAs have been closing down suddenly in my area. Received a nervous call from friend who had been notified she was no longer covered and she couldn't find a dr who took any MA. It's a huge burden on people to have to suddenly make many phone calls to find a provider, and then you don't even know if you'll like the dr. MAs are HMOs.
I am very tired of hearing the younger generation claim that boomers stole everything and have bankrupted their future. We did not. That was the bankers. And we are paying a lot more than they do for health insurance. If you're generally healthy you may just have part A/B and be fine. My friend just had total hip replacement on it and didn't pay anything.
Thanks for your experience. I have been on MA for 9 years and have never had an issue or complaint. Of course, I have no medical issues and take no medications. I have paid no premiums for 9 years which means I have saved at least $20,000 I would have spent on a Medicare supplement plan over that time. My maximum out of pocket in my current plan is $6,000, so even if I had a major illness or injury I would still be way ahead. I have had routine exams, a colonoscopy, a basil cell removal and some stiches over this time which has amounted to no more than $500 out of pocket. I replaced my glasses this year at Costco and with the $200 reimbursement they cost me a little over $100.
I work in the insurance business and routinely help my customers shop for plans that work for them. I always research to make sure their Primary is in network and if they have major illnesses I will guide them into a supplement plan that will cover all of their out of pocket expenses.
I live in the NC Triangle area so most of our customers are either in the Duke or UNC coverage area and most good plans include both in their plan coverage area.
Medicare is confusing and most people are inundated with mail, email and phone calls from every company and agent in their area so reaching out to a trusted advisor who is independent is always advised.
You might want to try a service like eHealth Insurance Services Inc. http://ehealthmedicareplans.com/my%20account 877/524-2097. I would think there are other such services that represent a number of carriers & can offer Medicare Advantage & Medicare Supplements.
Regarding MA plans, eHealth allows you to filter various carriers & plans that show if your primary & specialty doctors are “in-network”, along with your eye care & dental services/providers (having doctors & providers “in-network” in these MA PPO plans is critically important to keep your out of pocket costs down). You can also filter plans by price, coverage, etc. & then pull up a side by side comparison of the plan coverages. There are some MA plans that have “0” premium to you (the participating MA carriers do get paid your monthly Medicare Part A & B premium from Social Security vs going directly to Medicare & I would think there is some type of government subsidy). If you need assistance or just have questions, eHealth has “licensed advocate agents”, that are licensed in your state. Once you determine a plan you want, the enrollment can easily be done on-line after you have set up an eHealth account & one of their licensed advocate agents can help walk you through the enrollment process. Switching plans during open enrollment is exceptionally easy & notifications are automatically sent to Social Security who administers Medicare, so no coordination is needed in your part.
I live in IL & have used eHealth (whose corp office is in CA, I think) for the past 5 years since I’ve retired & I became eligible for Medicare. I use them to shop around my coverage during the annual open enrollment period for Medicare (Oct 15 - Dec 31, I believe). If eHealth doesn’t offer coverage in your state, I would think there are other similar services that do. Definitely using a service (i.e. essentially an insurance agency) that represents multiple health carriers is far easier than trying to compare carriers & their plan on an individual basis.
PS - I have no monetary (or any other) affiliation with eHealth & never heard of them before I retired & became eligible for Medicare five years ago. Hope this info is helpful to someone entering into the sometime confusing world of Medicare.
William: The health insurance racket has just about ruined medicine. When I turned 65, on advice of an “agent” that I trusted, I went straight Medicare and purchased a Supplement policy, which turned out to be a wise choice. The upside is that most - but not all-providers “accept” Medicare. In doing so, providers agree to accept less than the “going rate” for services in return for “guaranteed” timely payment. Medicare pays 80% of the agreed upon “charge,” and the Supplement pays the remaining 20%. This has worked well for my wife and me, enabling us to avoid huge unexpected medical expense, which we would have had, inasmuch as my wife has experienced a number of conditions requiring hugely expensive treatment and aftercare. Of course, the premium for our Medicare Supplement has doubled in the ensuing 15 years, now approaching $1,000/month, and you can forget “shopping” for lower Supplement premiums with any “preexisting conditions.” We have always maintained separate Part D (drug) coverage and change plans nearly every year. Medicare.gov provides a comparison tool (based generally on out-of-pocket expense for the specific drugs one requires) for all “approved” plans that, so far, has proved reliable and valuable. The whole matrix is a variation on the Good/Fast/Cheap Paradox (you can only have two). Our method is not cheap - our out-of-pocket health insurance expense, excluding Medicare premiums deducted from Social Security benefits is at least $11K/yr at age 80. BUT we are also $800K to the good in terms of value received, which is, after all, why one buys “insurance.” So there’s that. On the down side, Medicare imposes all kinds of regulation on providers in terms of what treatments they can render in what circumstances, with what frequency and in what order, which, in my opinion, has greatly reduced the overall “quality” of medical care. Avoiding the Advantage type plans sacrifices a lot of illusory bells and whistles (eye care, dental care, hearing aids,,etc), but, as a Veteran, I (rather late in the game) discovered that I was eligible for generous benefits in the form of dental insurance at low cost/high benefits and top of line hearing aids for FREE. Hope this adds to your data bank.
Thank you for taking the trouble to provide such a thorough and helpful account of your experience. This is precisely the kind of information that will help others.
Well said. Thank you. My experience as well. Although I was tempted for a time to look in to MA plans. Thinking it through, it wasn’t too hard to figure out that if they’re giving so many extra perks for free, that the freebies are subsidized by cuts elsewhere in coverage. You can be sure that MA plan providers $ cost of giving those extra perks are not being deducted from their profit margin. Those cuts resulting in severe limitations, would not be apparent until you run right smack in to them and are unable to get the care you need. In many geographical areas that are not near a major city or metro area, there are few doctors to choose from as it is, and adding the low pay to doctors and increased restrictions of MA further reduces availability. Folks can really get themselves in a pickle, and then have to wait a whole year to change back to regular Medicare.
That said, I think MA plans can work for some people, in some larger population areas where there is a concentration of providers. That is, if they have the ability and patience to navigate and endure all of the additional levels of bureaucracy.
I agree. I’ve found navigating the supply of available in-network providers in the Raleigh area to be quite taxing—despite our abundance of medical schools and other resources.
This is precisely why I decided to become a Medicare agent (CA only, at the moment). It’s very complicated and can be time consuming. Someone like me can do the heavy lifting. MA plans can be the best choice for some people. To say that you should never have bought one, full stop, is a bit naive. There aren’t a whole lot of options and not supplementing Medicare at all is a HUGE gamble. Everyone, please find an agent licensed in your state to help you. It should cost you nothing to get help.
Thanks so much for your thoughtful reply. This is exactly the kind of discussion I was hoping for. Your comment could help a lot of people.
As a 74 yr old retired RN who became disillusioned with the allopathic medicine paradigm many years ago and left nursing prior to age 62 because I could no longer in good conscience peddle medications which are not only not beneficial but are actually toxic, I offer an alternative viewpoint to our concept of "healthcare" in this country.
I take zero prescription drugs, play racquetball weekly with guys 30-40 years my junior and regularly beat them. Do my own vehicle maintenance, run my old backhoe to keep up our wooded property.
I have not been sick to the extent of needing to stay in bed all day for over 14 years now.
Sure, I've developed a sniffle for a couple of days about once every 3-4 years and my wife seems to get dragged down with an assortment of vague and varied symptoms for a few days nearly every time she flies commercial- but we are seeing more evidence coming out recently of that possibly being due to horrible cabin air quality thanks to jet exhaust contamination.
We bought an infrared sauna 18 months ago and use it 3x\week. Best $1600 I've ever spent. The improvement in sleep quality alone is more than worth it.
My wife (also retired RN) and I garden and eat virtually nothing which is not certified organic, eat no red meat and poultry or fish weekly.
Both of us have studied the use of herbs for healing and maintenance of health and take a fair handful of them regularly, along with several supplements including vits B,C,D,E, K, minerals, curcumin and a few others.
We visit a PHCP yearly for blood work mainly to monitor our serum vit D levels and to check on wife's thyroid status (she successfully recovered from hyperthyroidism a number of years ago by utilizing herbs and supplements-much to her endocrinologist's dismay-he had pushed strongly for immediate treatment with radioactive iodine, an irreversible procedure leaving you dependent for life on a synthetic, incomplete thyroid hormone).
We neither drink nor smoke, though we both drank in our younger\dumber days and rarely eat out due to the difficulty of finding truly healthy organic food in restaurants.
Neither of us has had a "vaccination" since before the turn of the century, nor will we ever again. We were ostracized by some of the vaxx true believers during the plandemic but are so grateful we had the courage of our convictions not to give in, as we now have seen multiple vaxxed relatives and friends develop serious health conditions including rapid spinal degeneration and turbo cancers. Two have died, and more are well on their way to that end...
Are we just lucky or blessed with our continued robust health? Maybe-but we contend that our lifestyle and avoidance of the crumbling "sickcare" system in this country has made the difference.
We bought into the idea 14 years ago that no one will really care about our health as much as we will and that we are totally responsible for our own health and well-being.
I work for an MCO. These govt contracts are lucrative. Stick with the govt plan. It is only going to get worse as the for profit model leads to further reduction of benefits.
Agreed!
I’m very very happy with my MA plan.
Thanks for your input.
I retired at 62 and was able to continue on my employer’s medical and dental plan, at a hefty monthly cost, until I reach 65, about eight months from now. I have already been advised to contact an insurance agent, which I plan to do later this summer, for advice.
I appreciate the information; I never realized Medicare (Mediocre?) could be so confusing.
Many Offices of Aging have Medicare expertise employees whom can help you research plans. When you contact a broker they are eager to enroll you in Managed Plans.
The research you do on the plans should include exploring the companies scorecard, reading reviews of customers experiences etc. You do actually want to get in the weeds to see specifics in regard to specialty care. I actually go to the plan itself to get a sense of the prior authorization process.
Having someone help you sort through the plans whom has no vested interest financially is better than listening to a sales pitch .
Thanks for your very helpful advice. I agree.
Thanks. I agree.
United Health Care is starting to have a reckoning .
Investors aren’t happy with below projection performance. They are being investigated for practices related to vertical integration of their own providers .
Also getting slammed on denials , and people are starting to wise up to the barriers when more expensive care requests are denied.
The difficulty will be once the government realizes that a fine is not going to be the remediation.
I hope your transition goes smoothly.
My husband and I were fortunate enough to have a friend who was an insurance consultant. When my husband retired 8 years ago, she strongly encouraged us to go with plain Medicare, and we are still happy with that choice. I have friends with Medicare Advantage plans, and they seem to work well for them…until they don’t. Private insurance is just a nightmare.
In the end, I favor getting private insurance out of the game. Thanks for your input.
You never should have purchased an advantage plan in the first place. Period, full-stop, simple truth.
I agree. It was offered by my previous employer as a retirement benefit for a very reduced rate to me.
💯 %.. But the paradox is that most people simply cannot afford the monthly costs of Medicare.. “Period, full-stop, simple truth.”
That seems to be the major reason why many, myself included so far, have selected MA plans.
You're absolutely right...for the short-term, when one is "young-ish". And healthy-ish. But start to age, and more importantly, start to get sick, and the true (and truly impoverishing) costs of those ZERO PREMIUM ADVANTAGE PLANS!!!! become apparent. Meanwhile, those with the $4500/year (the approx cost of trad Medicare) can actually use their insurance and get services.
It's a terrible paradox, and one that we wouldn't face if we came to our senses, passed healthcare for all, and banished for-profit health insurance companies to the hell they so richly deserve.
My wife and I (78 & 77) began with traditional Medicare & a supplement. When that got to be too expensive we switched to a Medicare Advantage plan, which is essentially an HMO. It's a zero cost plan, which so far has been great. Our PCP is in a corporate practice, which is owned in part by the insurance company. We've been through two surgeries, with minimal co-pays and never reaching our out-of-pocket maximum. I think there are two main reasons this works well for us:
1. We live in a suburb of a very large city. Almost no doctors accept traditional Medicare, but there are plenty of specialists that are in our network.
2. (Most important) We have done everything possible to ensure our health, from diet to a 3 mile daily walk. We have only one prescription between us, and it is fully covered.
One note about prescriptions - when we first signed up for Medicare we had none, so we did not purchase coverage for them under part B. As a result we now have to pay a penalty of around $250 per year, since prescription coverage is mandatory under our MA plan.
Many thanks for your response. As you can probably see, your experience reflects an alternative, positive view of MA plans. My own circumstances are very close to yours. Anyway, people need this kind of information to make good decisions.
I also selected original Medicare and a supplemental plan. On a single year my supplemental insurer received a 66% rate increase.
I contacted the Center for Medicare/ Medicaid to voice my concern that I felt insurance companies were trying to price supplemental plans in a way intended to drive consumers into managed plans that maximize their profits. And despite record profits on advantage plans ; the insurance companies also get a huge hike on the original Medicare supplemental side as well.
Currently , there are far more seniors whom cannot afford to pay those types of premiums than can. So what choice do they really have?
I had less expensive and more robust coverage through the NY healthcare exchange.
So even if you understand that original Medicare allows for less complicated approvals ,you face as an average income senior the barrier to affordability.
I was fortunate that my provider agreed to retain me as a patient once I converted to Medicare.
Most people discover that only hospital based clinics accept new Medicare clients. Imagine what will happen if the current plan for cuts to Medicaid and Medicare are approved. Hospital based clinics will become part of the disappearing landscape of available care.
In those situations there are often changes in the personnel as medical residents complete training or leave to join hedge fund based practices.
That leaves you with practice inconsistencies ; as provider rotation prevents you from building a sustained relationship.
Switching off a MA plan is complicated by the presence of preexisting conditions.
I believe that there should be a profitability cap for MA plans .
Just fix original Medicare won’t you please ; so it can be obtained with a reasonably priced supplemental plan. That way seniors on a fixed income can finally have the care without sudden premium escalations.
I agree with all that you say. How can elders be motivated to use their considerable political power to effect such changes?
Most insurance consultants advise MA plans if you are healthy and don't have too many medical concerns. I have had MA Humana. I pay no premium and do not have to pay the Medicare part B either. It is a PPO plan. I don't need referrals to see specialists. Copays are low. Urgent care and primary care drs have no copay. I will have cataract eye laser treatment - my copay is only $175. There are plenty of in network doctors. My dentist is out of network but the plan only pays for x rays and fillings. I guess it just depends on where you live. Florida has an abundance of hospitals and doctors.
I will be retiring at 65 early next year with a good amount in an HSA. No clue what I’m going to do beyond signing up for Medicare, but that HSA feels like a decent buffer.
I also have a nephew who works for the state Health Care Authority and one of the smartest guys I know.
Although I think we’ll be fine (wife is 6+ years older than me and retired for several years), I’m scared of the system.
Thanks for the post and the other commenters, keep the info coming!
I think you’re in pretty good shape. Be sure to sign up for a supplemental insurance plan within the first 6 months of becoming a member of original Medicare if that’s the way you want to go.
Just know that once you sign up with a company for supplemental insurance you will be charged a penalty if you later change companies. The insurance company will raise your premiums as you get older, so you are in a way locked in.
In NC, in Durham, I used the free services provided by Senior Pharmassist to understand my choices for Medicare, both their online sessions and an in-person appointment. They were great at helping me understand my choices, which ones would be the best and least expensive fit for my medical and medication needs, including pulling in their pharmacist to review my meds and decide which Part D would be best. I also found SHIPP, Seniors Health Insurance Information Program, a free, government-funded program that provides Medicare information and counseling, to be useful, too.
Great advice! Thanks.
In my case, the one huge reason I ended up with MA was the out of pocket cap. No non-MA plan offers a cap at a price anywhere near. I'd be perfectly happy with vanilla Medicare if only there was something like a $10k/year cap.
MAs have been closing down suddenly in my area. Received a nervous call from friend who had been notified she was no longer covered and she couldn't find a dr who took any MA. It's a huge burden on people to have to suddenly make many phone calls to find a provider, and then you don't even know if you'll like the dr. MAs are HMOs.
I am very tired of hearing the younger generation claim that boomers stole everything and have bankrupted their future. We did not. That was the bankers. And we are paying a lot more than they do for health insurance. If you're generally healthy you may just have part A/B and be fine. My friend just had total hip replacement on it and didn't pay anything.
Thanks for your interesting comment. You illustrate clearly what a mess our healthcare insurance system is.
Thanks for your experience. I have been on MA for 9 years and have never had an issue or complaint. Of course, I have no medical issues and take no medications. I have paid no premiums for 9 years which means I have saved at least $20,000 I would have spent on a Medicare supplement plan over that time. My maximum out of pocket in my current plan is $6,000, so even if I had a major illness or injury I would still be way ahead. I have had routine exams, a colonoscopy, a basil cell removal and some stiches over this time which has amounted to no more than $500 out of pocket. I replaced my glasses this year at Costco and with the $200 reimbursement they cost me a little over $100.
I work in the insurance business and routinely help my customers shop for plans that work for them. I always research to make sure their Primary is in network and if they have major illnesses I will guide them into a supplement plan that will cover all of their out of pocket expenses.
I live in the NC Triangle area so most of our customers are either in the Duke or UNC coverage area and most good plans include both in their plan coverage area.
Medicare is confusing and most people are inundated with mail, email and phone calls from every company and agent in their area so reaching out to a trusted advisor who is independent is always advised.
You might want to try a service like eHealth Insurance Services Inc. http://ehealthmedicareplans.com/my%20account 877/524-2097. I would think there are other such services that represent a number of carriers & can offer Medicare Advantage & Medicare Supplements.
Regarding MA plans, eHealth allows you to filter various carriers & plans that show if your primary & specialty doctors are “in-network”, along with your eye care & dental services/providers (having doctors & providers “in-network” in these MA PPO plans is critically important to keep your out of pocket costs down). You can also filter plans by price, coverage, etc. & then pull up a side by side comparison of the plan coverages. There are some MA plans that have “0” premium to you (the participating MA carriers do get paid your monthly Medicare Part A & B premium from Social Security vs going directly to Medicare & I would think there is some type of government subsidy). If you need assistance or just have questions, eHealth has “licensed advocate agents”, that are licensed in your state. Once you determine a plan you want, the enrollment can easily be done on-line after you have set up an eHealth account & one of their licensed advocate agents can help walk you through the enrollment process. Switching plans during open enrollment is exceptionally easy & notifications are automatically sent to Social Security who administers Medicare, so no coordination is needed in your part.
I live in IL & have used eHealth (whose corp office is in CA, I think) for the past 5 years since I’ve retired & I became eligible for Medicare. I use them to shop around my coverage during the annual open enrollment period for Medicare (Oct 15 - Dec 31, I believe). If eHealth doesn’t offer coverage in your state, I would think there are other similar services that do. Definitely using a service (i.e. essentially an insurance agency) that represents multiple health carriers is far easier than trying to compare carriers & their plan on an individual basis.
PS - I have no monetary (or any other) affiliation with eHealth & never heard of them before I retired & became eligible for Medicare five years ago. Hope this info is helpful to someone entering into the sometime confusing world of Medicare.
Thank you for such a detailed response. I'm sure that this will help many people who are making such decisions now.