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0 monthly premiums/ 0 doctor/specialist visits
$15/mo Durezol
$999 max out of pocket cap
Costs for original/ medigap/part d
$115/mo premium for medigap $50/mo premium for part d
$10-45 for specialist visit
$94/mo Durezol
$2500 max out of pocket for HD plan G
Does an HD-G actually cost $115/mo. in your state? UHC doesn't do HD-G. What carrier are you looking at? Generally, the cost is around $75. Won't make a big difference in your bottom line, however.
You wouldn't be alone if medication is your decider. Many people are on Advantage for drug coverage.
Quote:
Originally Posted by thrillobyte
because only 10% of people are with Advantage.
Actually, that number is closer to 40%. The govt (politicians in the pockets of the insurers), in order to shift profits via taxpayer dollars to private insurers, is backpedaling Original Medicare and pushing Advantage. Advantage plans are huge cash cows for the insurers. Advantage plans spend less on the patient care and cost the govt more than Original Medicare.
Patient care is second. Read the following link carefully and think about the data:
But as to the actual care does original provide better care than advantage? For example, my nearest hospital is Glendale Adventist. Say I have to be hospitalized for something. Will GA give me better care if I am on original than if I am on Advantage?
ADVANTAGE PLANS (for profit) CAN DELAY, DENY AND CUT SHORT SERVICES.
Once again, read this carefully on real life experiences w/Advantage:
Why are an overwhelming number of Americans with original when it is so much more expensive????????
It isn't expensive if one has a major illness and reaches the MA out-of-pocket maximum of $5-$8k which is far more than the cost of a Medigap.
So, it appears we have come full circle. Here is an excerpt from my original answer:
Quote:
Originally Posted by Ariadne22
These are the reasons people purchase a Medigap.
Provider flexibility
No insurer oversight/approvals
Medical costs limited to premium for Part B/Medigap - with exception of $203 Part B deductible and services not covered by Medicare - and Part D premium/copays.
For anyone concerned about "freedom" and cost control - Original Medicare + Medigap is as good as it gets.
1. Medigap MUST PAY its share of any expense covered under Medicare. They cannot deny any Medicare approved service.
5. There is NO OUT OF POCKET with a Medigap, other than the Part B deductible and tiny cost-sharing w/Plan N (up to $20 dr. appt./$50 ER if not admitted to hospital). Advantage plans have an out of pockekt exposure generally of somewhere between $5k-$8k. Some plans as high as $13k. Advantage plan out-of-pockets can be twice the cost of a Medigap, if not more, if one encounters a health crisis or has a chronic ailment.
6. Medigaps provide COMPLETE PROVIDER FLEXIBILITY - see any Medicare provider, anywhere. Advantage plan enrollees are restricted to providers in that plan's network.
In short, Advantage is good until it isn't as many have cited on this board.
Last edited by Ariadne22; 11-15-2021 at 01:58 PM..
If something truly awful happens and you land in a skilled nursing facility, original Medicare + supplement allows 100 days. With Advantage you get 14-21 days. I don't want a plan that would push me out when I most need care. Medicare + supplement may cost a bit more, but you'll be able to see the doctor you want and you won't have to battle over treatment. Mathjak in the Retirement forum posted about a friend with thyroid cancer, and the Advantage plan would only approve removal on one side, not both (when the doctor had said both needed to be removed).
It's my view that our younger selves need to choose the best insurance to care for our older selves. I chose original Medicare + AARP/UHC Plan G. After reaching the $203 Part B deductible in 2021, there were no bills. In 2022, it will be $233. When I'm old-old, I also don't want to deal with keeping track of lots of medical paperwork and paying balances.
It's my understanding that if you sign up for original Medicare + supplement, you can easily switch to Advantage later on. But the reverse is not true: you can't start with Advantage and then move to original Medicare + supplement unless you go through underwriting -- then you could be rejected or your premiums could be higher. For me, I wanted the peace of mind that if the worst happened, I'm only responsible for the $203 Part B deductible ($233 in 2022) with original Medicare + UHC Plan G.
$115/mo premium for medigap
$50/mo premium for part d $10-45 for specialist visit $94/mo Durezol
$2500 max out of pocket for HD plan G
Correction: Remove the $10-$45 from this worst-case calculation as doctor copays are not in addition to, but ARE INCLUDEDIN the $2,490 HD-G deductible. HD-G pays 80% of Medicare approved rate. You pay the remaining 20% until deductible is met. If Medicare-approved rate for a specialist visit is $175, you pay $35 - again INCLUDED towards satisfaction of the deductible.
Also, just as with regular Plan G, the $233 Part B deductible must be paid before Medicare pays its 80%. That $233 also goes to satisfying and is INCLUDED in the $2,490 deductible.
If you don't doctor a lot, your customary and ordinary expenses would be limited to $233 Part B deductible, plus the odd 20% copay here and there for occasional doctor appointments.
So, realistically, HD-G might cost $1,200-$1,300 year, including the premium (not including Part D costs). Many healthy people on HD-G never reach the deductible. But the broad coverage and flexibility of a Medigap is there should catastrophe strike. Similar to high deductible homeowners or auto insurance.
Again, the $115 premium seems high for an HD-G. In WI, where rates are higher than other parts of the country, at 79 y/o, my HD-G rate would be $70 approximately.
Last edited by Ariadne22; 11-15-2021 at 07:24 PM..
Thanks Ariadna for info about the HDG plan. However, I am finding conflicting info on who is even eligible to have this plan. It appears to be only those new to Medicare or after 2020. Husband signed up in 2019 for K plan.
Does an HD-G actually cost $115/mo. in your state? UHC doesn't do HD-G. What carrier are you looking at? Generally, the cost is around $75. Won't make a big difference in your bottom line, however.
You wouldn't be alone if medication is your decider. Many people are on Advantage for drug coverage.
Actually, that number is closer to 40%. The govt (politicians in the pockets of the insurers), in order to shift profits via taxpayer dollars to private insurers, is backpedaling Original Medicare and pushing Advantage. Advantage plans are huge cash cows for the insurers. Advantage plans spend less on the patient care and cost the govt more than Original Medicare.
Patient care is second. Read the following link carefully and think about the data:
It isn't expensive if one has a major illness and reaches the MA out-of-pocket maximum of $5-$8k which is far more than the cost of a Medigap.
So, it appears we have come full circle. Here is an excerpt from my original answer:
In short, Advantage is good until it isn't as many have cited on this board.
Red (read) the links. Interesting info. I'd red Tim's story before. Sad. I get that I'm better off with original plus plan d. It's the cost of my durezol that is the hangup. I just chatted with a 2nd agent from UHC. They don't carry the drug. If they don't have it (one of the biggest) I doubt anyone does. You quoted $47 in your other post. Which company was that?I couldn't pay for this out of pocket as PP.
Correction: Remove the $10-$45 from this worst-case calculation as doctor copays are not in addition to, but ARE INCLUDEDIN the $2,490 HD-G deductible. HD-G pays 80% of Medicare approved rate. You pay the remaining 20% until deductible is met. If Medicare-approved rate for a specialist visit is $175, you pay $35 - again INCLUDED towards satisfaction of the deductible.
Also, just as with regular Plan G, the $233 Part B deductible must be paid before Medicare pays its 80%. That $233 also goes to satisfying and is INCLUDED in the $2,490 deductible.
If you don't doctor a lot, your customary and ordinary expenses would be limited to $233 Part B deductible, plus the odd 20% copay here and there for occasional doctor appointments.
So, realistically, HD-G might cost $1,200-$1,300 year, including the premium (not including Part D costs). Many healthy people on HD-G never reach the deductible. But the broad coverage and flexibility of a Medigap is there should catastrophe strike. Similar to high deductible homeowners or auto insurance.
Again, the $115 premium seems high for an HD-G. In WI, where rates are higher than other parts of the country, at 79 y/o, my HD-G rate would be $70 approximately.
Thank you. Yes, this is what I'm reading a lot from posters. Advantage is fine until you start running into problems. Advantage doesnt mind you nickel and diming them, but when something big like dialysis or cancer comes up then they act like any other big insurer and cut coverage in lots of arts of treatments. It's a hell of a spot to be in.
I'm getting at the point where I'm seeing a lot of specialists trying to pin down the source of a couple of health problems I'm starting to have. Nothing major yet, but trying to find a diagnosis is time consuming when I have constantly go back to my PC to get a referral.
If something truly awful happens and you land in a skilled nursing facility, original Medicare + supplement allows 100 days. With Advantage you get 14-21 days. I don't want a plan that would push me out when I most need care. Medicare + supplement may cost a bit more, but you'll be able to see the doctor you want and you won't have to battle over treatment. Mathjak in the Retirement forum posted about a friend with thyroid cancer, and the Advantage plan would only approve removal on one side, not both (when the doctor had said both needed to be removed).
It's my view that our younger selves need to choose the best insurance to care for our older selves. I chose original Medicare + AARP/UHC Plan G. After reaching the $203 Part B deductible in 2021, there were no bills. In 2022, it will be $233. When I'm old-old, I also don't want to deal with keeping track of lots of medical paperwork and paying balances.
It's my understanding that if you sign up for original Medicare + supplement, you can easily switch to Advantage later on. But the reverse is not true: you can't start with Advantage and then move to original Medicare + supplement unless you go through underwriting -- then you could be rejected or your premiums could be higher. For me, I wanted the peace of mind that if the worst happened, I'm only responsible for the $203 Part B deductible ($233 in 2022) with original Medicare + UHC Plan G.
Trick is to time it so you get really sick during Jan-Mar. Then you can quickly switch from Advantage to original. But then Medigap would probably turn you down (sigh)
Thanks Ariadna for info about the HDG plan. However, I am finding conflicting info on who is even eligible to have this plan. It appears to be only those new to Medicare or after 2020. Husband signed up in 2019 for K plan.
NOT TRUE.
It is only Plans F/HD-F which are not available to those 65 y/o after January 1, 2020. The govt is trying to get out of first dollar coverage, so has closed all Plans F to those newly eligible for Medicare in 2020. HD-F was replaced with HD-G.
Because hubby was 65 y/o before January 1, 2020, he can still purchase full Medigap F, an HD-F, a full Medigap G and an HD-G.
The only difference between the HD-F and G is the $233 (2022) Part B deductible, as follows:
HD-F - Medicare pays 80%, you pay 20% up to $2,490 deductible; thereafter plan pays 100%, includes excess coverage. All copays count toward $2,490 deductible.
HD-G - after satisfaction of the $233 Part B deductible, Medicare pays 80%, you pay 20% up to $2,490 deductible; thereafter plan pays 100%, includes excess coverage. The $233 Part B deductible and all copays count toward satisfaction of the $2,490 plan deductible.
In other words, the plans are identical in benefits - except there will be a $233 cash outlay before Medicare begins paying its 80%. Again, govt attempting to reduce its first dollar coverage exposure.
In the end, your exposure remains at $2,490 no matter which plan he chooses.
Please post the links where you found this misleading information.
Last edited by Ariadne22; 11-15-2021 at 08:44 PM..
Trick is to time it so you get really sick during Jan-Mar. Then you can quickly switch from Advantage to original. But then Medigap would probably turn you down (sigh)
Kinda like trying to buy homeowners insurance when the house is on fire.
Ariadne,
gomedicap.com states:
"Wondering if you’re eligible for an HD Plan G? If you become eligible for Medicare on or after January 1st, 2020, you’re eligible to apply for HD Plan G. If you were eligible for Medicare before January 1st, 2020, you won’t be able to apply for it. Instead, you’re eligible for High Deductible Plan F."
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