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Old 08-26-2015, 02:00 AM
eok
 
6,684 posts, read 4,232,392 times
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Quote:
Originally Posted by Ariadne22 View Post
So, the answer to your question is - yes - the Advantage premiums can change independently and with no regard whatsoever to what you are paying for Part B - and is determined, instead, by the Advantage company's bottom line/profits.
Thanks. That's a good and clear explanation.

So the money the advantage company gets from Medicare is exactly the same regardless of whether the hold-harmless law affects me. Right?

And that means I can freely switch from one advantage company to another, or back to original Medicare, at the end of the year, and will still be held harmless. Right?

And I get the impression you consider original medicare plus medigap to be a better deal than an Advantage plan, in most cases. Right?

Is the average amount paid by original Medicare for each beneficiary known? In other words, the total payments they make to all medical providers divided by the number of beneficiaries? Is that amount per beneficiary more or less than the amount Medicare pays Advantage companies per beneficiary?

I personally think, even though HMO's are probably a bad deal for most people, they might be a good deal for me. But, from my point of view, for it to be a true HMO, it has to not refer me to anything out of network, nor make me responsible for verifying that any referrals are in network. And if, for a particular medical service, there is no provider in network, the HMO should pay for an out-of-network provider because it's their fault there is none in network. And I shouldn't have to do any paperwork or anything, because of any such complications. The whole idea of good HMO's is to make things simpler and more cost-effective for the patient. The only disadvantage to me should be that I have to use whatever providers they provide, instead of whatever providers I choose. And that's actually fine with me, because I would probably choose the wrong ones anyway. And they should never let any medical providers charge me directly for anything. A good HMO might work very well for a lot of people. But a complicated HMO, where the patient has to constantly pay careful attention to in-and-out-of-network rules and traps, and gets billed directly for things the HMO declines to pay, would be a nightmare for almost anyone.

My present Advantage is a PPO, which I had in a smaller city, where it seemed like the only reasonable option. But this year I'm going to have more options. Which is part of the reason why I asked so many questions. I was worried that the hold-harmless law might somehow impact my ability to choose other options, or that I might have to hurry and choose one before 2016 or something. But no, it seems from what you said, all I have to worry about is which options are best, and just ignore the hold-harmless law because it covers me regardless of whatever option I might choose.
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Old 08-26-2015, 08:30 AM
 
37,315 posts, read 59,690,076 times
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Does anyone know how long after applying for SS that it takes to receive that first check--
Say I apply mid September would I have a check by Dec 31?
I will need to likely do a face to face
Would be filing for me and husband and asking for reduction of current income used to calculate Medicare premiums
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Old 08-26-2015, 01:15 PM
 
Location: Wisconsin
25,591 posts, read 56,363,195 times
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Quote:
Originally Posted by eok View Post
So the money the advantage company gets from Medicare is exactly the same regardless of whether the hold-harmless law affects me. Right?
Yes.

Quote:
Originally Posted by eok View Post
And that means I can freely switch from one advantage company to another, or back to original Medicare, at the end of the year, and will still be held harmless. Right?
Yes.

Quote:
Originally Posted by eok View Post
And I get the impression you consider original medicare plus medigap to be a better deal than an Advantage plan, in most cases. Right?
Depends. Cost is the primary motivator in the purchase of an Advantage plan - which initially appear to be a "good deal" because of zero or low premium and bundling drugs. For healthy people who rarely doctor, MA's can make sense. Perversely, we have people on CD who incurred enough in the way of copays and deductibles (hospitalization) and other out-of-pocket costs that the MA proved to be a false economy.

Medigaps, otoh, will cost you more in premiums - usually in the area of $130-$250/mo. depending on age, location and pricing (community, issue-age, attained-age) of plan, + Part D coverage. But, after the drug copays, you shouldn't have any other medical costs - provided Medicare approves the service.

Medigaps come with provider flexibility, no hassles with the insurance company, first dollar coverage - at a price.

Suggest you read:

Does Medicare part C cripple part A/B ?

Quote:
Originally Posted by eok View Post
Is the average amount paid by original Medicare for each beneficiary known? In other words, the total payments they make to all medical providers divided by the number of beneficiaries? Is that amount per beneficiary more or less than the amount Medicare pays Advantage companies per beneficiary?
It has been costing Medicare 14-17% more to pay MA's to service Medicare benefits. Therefore, govt will be reducing over time what it pays MA's - essentially not paying more as health care costs increase, thus shifting more of the cost to the MA. MA's are already subtly cutting benefits here and there to compensate for this lost revenue. MA's have been huge cash cows for the insurers.

Quote:
Originally Posted by eok View Post
My present Advantage is a PPO, which I had in a smaller city, where it seemed like the only reasonable option.
If you're going to have an MA, a PPO at least provides some out-of-network coverage. If you travel, you should never have an MA HMO. MA HMO will pay for an emergency service, but generally not subsequent rehab and other care outside of the HMO's service area. We had a case recently in WI of a UHC MA insured who wintered in Texas. An HMO is ALWAYS a bad idea for this person. He had a heart attack in TX, had surgery. UHC MA paid for surgery and hospital, refused to pay for rehab. Patient had to hire a private aircraft to bring him home for rehab b/c no commercial carrier would take him. Don't expose yourself to something like this.

Any further discussion on the pros and cons of Medicare/Medigap/Advantage health insurance - start a new thread here -

http://www.city-data.com/forum/health-insurance/

as this issue is off topic to this thread and has been discussed extensively on the health insurance forum.

Last edited by Ariadne22; 08-26-2015 at 02:02 PM..
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Old 08-26-2015, 01:22 PM
 
Location: Wisconsin
25,591 posts, read 56,363,195 times
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Quote:
Originally Posted by loves2read View Post
Does anyone know how long after applying for SS that it takes to receive that first check--

Say I apply mid September would I have a check by Dec 31?
Apply mid-September, you could have your first payment in November, possibly even in October depending on whether you are paid the 2nd, 3rd, or 4th week of the month - this is birhdate dependent.

You need to tell SS when you want your benefits to begin. If you say, November, applying in mid-September should not be a problem.
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Old 08-26-2015, 02:30 PM
 
Location: Near a river
16,042 posts, read 21,937,686 times
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Quote:
Originally Posted by Ariadne22 View Post

And, no, the fact that premiums may increase is not the biggest disadvantage of an Advantage plan.

The biggest disadvantage is that you have now turned over all decisions on your health care to a PRIVATE INSURER. Some MA's behave very badly, denying mandated benefits, deny receiving claims, drag their feet on approval for services, strict and onerous oversight on services for chronic conditions, do not pay providers for up to a year. Your MA may be behaving very well and you have not encountered these issues.

Second biggest disadvantage of an MA is the restricted provider network. Instead of the ability to see any Medicare doctor anywhere in the country, unless the plan is a PPO - and most are HMO's - you are stuck with their providers.

Don't worry about the MA premium. Worry more about the oversight, provider network, and whether or not the coverage is hassle-free as far as access to services and approval and payment of benefits.
There's no way to really know the disadvantages of the Advantage plan until one actually uses it and see what is billed and what isn't.

The other thing to be aware of, at least where I live, is that doctor coding at the time of visit means everything. If you go in for your annual "wellness" visit, you are typically not charged. That's supposed to be an annual benefit of your plan. But as soon as you ask a question..."doc, my shoulder hurts"....that can easily turn into a "medical consultation" and the few minutes the doc spends with you on that issue will be billed. I learned that to avoid payment for the annual "free visit" it's best to keep my mouth shut.

But...what the h*ll kind of healthcare is that?
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Old 08-26-2015, 02:35 PM
 
Location: Durham NC
5,061 posts, read 3,676,818 times
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Quote:
Originally Posted by loves2read View Post
Does anyone know how long after applying for SS that it takes to receive that first check--
Say I apply mid September would I have a check by Dec 31?
I will need to likely do a face to face
Would be filing for me and husband and asking for reduction of current income used to calculate Medicare premiums

You will get your check the month after election. Say you work the entire month of September and will not be receiving any paychecks for the month of October. October would be your month of election if you want to start receiving benefits as soon as possible. You will get your first SS check in November which will in effect be your October paycheck. They pay a month behind.
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Old 08-26-2015, 03:34 PM
 
37,315 posts, read 59,690,076 times
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https://www.kitces.com/blog/social-s...babae-57064613

I read this article...

He says the MINIMUM premium for new Medicare enrollee and for those who don't fall into the "hold harmless" category might go up $50 a month or $650 a year...
Does that hold true for Medicare enrolled people with high income--
We have had unusual income past two tax years and pay highest Medicare premiums...
If we can't document our current reduced income for 2015 ongoing (which is under the threshold for excessive income) when we apply for SS-- will we have an extra 1300 total for our Medicare premiums?

And if our income is not adjusted until 2016 --even if we apply for SS--will premiums stay at the increased level if there is no COLA for 2016?

This just seems like one of the black holes that when/if you fall in, you can't get out...
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Old 08-26-2015, 03:58 PM
 
Location: Wisconsin
25,591 posts, read 56,363,195 times
Reputation: 23297
Quote:
Originally Posted by loves2read View Post
https://www.kitces.com/blog/social-s...babae-57064613

I read this article...

He says the MINIMUM premium for new Medicare enrollee and for those who don't fall into the "hold harmless" category might go up $50 a month or $650 a year...

Does that hold true for Medicare enrolled people with high income--
Yes. Lenora has already answered that here:
Quote:
Originally Posted by lenora View Post
The "hold harmless" clause does not apply for several groups. One group consists of the high earners, those singles earning $85 thou and those couples earning $170 thou.
Quote:
Originally Posted by loves2read View Post
We have had unusual income past two tax years and pay highest Medicare premiums...

If we can't document our current reduced income for 2015 ongoing (which is under the threshold for excessive income) when we apply for SS-- will we have an extra 1300 total for our Medicare premiums?
Yes.

Quote:
Originally Posted by loves2read View Post
And if our income is not adjusted until 2016 --even if we apply for SS--will premiums stay at the increased level if there is no COLA for 2016?
Yes. Unless Medicare changes its pricing.
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Old 08-26-2015, 05:44 PM
 
37,315 posts, read 59,690,076 times
Reputation: 25340
Thanks
I am trying to get my husband to agree we should do this before October but he doesn't think it is that big a deal and our financial planner has not mentioned it to us...
Admittedly we have assets but if the calculations don't count your non-interest paying assets then why not try to get reduced premiums for forseeable future
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Old 08-28-2015, 09:22 AM
 
Location: Summerville, SC
142 posts, read 163,734 times
Reputation: 68
I'm currently in the "File & Suspend" category. Do we know when this Part B increase becomes effective ??

Do you have to be on the Social Security payroll by October 2015 ?? or some other month ???
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