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Old 10-16-2015, 08:16 PM
eok eok started this thread
 
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For example, what if I need outpatient surgery? Would I only have to pay 20% with Original Medicare? What ballpark is that likely to be? I have no idea what the bills might be for outpatient surgery. Or what if I have to stay in the hospital for a day or two? I see in the online information that I would have to pay a copayment with the Medicare Advantage plans of around $300 per day. But then the surgery would be on top of that?

The Medigap plans I qualify for are too expensive.

The Medicare Advantage plans available to me are mostly from Humana and Anthem.

Anthem seems to have a 25% coinsurance payment for outpatient surgery. Which seems to be more than Original Medicare. Humana seems to have a copayment about the same as one day in a hospital.

I don't presently take any expensive drugs, but I put some random drugs in at the Medicare website, for Humana and Anthem HMO's, and my out of pocket cost per year for those would be $4000+ with Anthem and $40,000+ with Humana. Just a bunch of random drugs taken from some lists of drugs I mostly never heard of.

Anthem's website, and some interaction I had with them years ago, give the vague impression of incompetence. As if their office consisted of zillions of piles of paper falling off desks and nobody doing much work nor doing any of it carefully. Humana's website is much better. But a doctor once told me he hated Humana and I should get any insurance but Humana. I'm worried that if doctors hate Humana, their hatred might carry over to their Humana patients.

Besides the risk of expensive copayments, and the risk of having to pay for expensive drugs, what are the other disadvantages of Original Medicare without Medigap, compared to the Medicare Advantage plans?
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Old 10-16-2015, 10:03 PM
 
Location: Chesapeake Bay
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Could be that your doctor hated Humana because they wouldn't pay. They are known for that, even with Advantage plans.

As far as Anthem goes, I'd be very worried about about any Advantage plan that did not have a set copay for outpatient. You could wind up paying your max out of pocket for the year on one procedure.

Are there any other Advantage plans in your area aside from those two rated 4 stars (or better)?

You might look at the high deduct plan F. It is usually much cheaper than plan F and can be a very good deal. Still need a drug plan with it though.
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Old 10-16-2015, 10:14 PM
 
Location: Texas
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HD plan F will not cover you for any pre existing consultations or planned surgeries.

The questionnaire is very explicit, just went through the process.

4 years ago had outpatient surgery, $19000 for hospital alone, plus doctor, pathology, anesthesiology and on and on, total for the whole show was $23,000
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Old 10-16-2015, 10:21 PM
 
Location: Chesapeake Bay
6,047 posts, read 4,221,943 times
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Quote:
Originally Posted by BestintheWest View Post
HD plan F will not cover you for any pre existing consultations or planned surgeries.

The questionnaire is very explicit, just went through the process.

4 years ago had outpatient surgery, $19000 for hospital alone, plus doctor, pathology, anesthesiology and on and on, total for the whole show was $23,000
It depends on when you apply. Guaranteed enrollment when first eligible. As I remember reading though, if you do not meet that condition the questionnaire only goes back a few months, not years.

Last edited by Weichert; 10-16-2015 at 10:45 PM..
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Old 10-16-2015, 10:22 PM
 
484 posts, read 451,575 times
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First, start with some basics.

My understanding is that Medicare Advantage plans are managed care Medicare plans offered by insurance companies. Rather than have Medicare pay your medical costs, you instruct Medicare to send the money that you've contributed to Original Medicare to an insurance company. The Medicare Advantage plan then is your medical insurance. Some people love this idea, others hate it. If you believe that government workers can do few things well, and that competition in the marketplace is what produces excellence, Medicare Advantage plans may be a good fit for you. If you believe that government administration results in economies of scale and that government produces impartial decisions that benefit large numbers of people, Original Medicare may be a better fit.

Medigap plans are another tool entirely. They do not pay for the same things that Medicare Advantage/Original Medicare pay for. Medigap plans are designed to fill some of the "gaps" in Original Medicare. The Medigap plan is designed to fit on top of your existing, core Medicare health insurance, be that Medicare Advantage or Original Medicare.

For example, Original Medicare will pay 80% of a hospitalization bill. Some Medigap plans will pay the remaining 20%. But if you didn't have the Original Medicare, and instead just bought a Medigap plan, you'd have to pay for the 80%, and your Medigap plan would still pay the same 20%.

1. Are you about to become Medicare eligible?
2. Do you have doctors that you like?
3. If you had to be hospitalized, what hospital(s) in your area would you like to be in?

If you have doctors that you like, call their office administrator and ask "What Medicare Advantage plans are you an IN NETWORK provider?" Medicare Advantage plans do not pay for providers or hospitals that are out of their network. Yes, you can go to an emergency room if you are traveling, but past the immediate medical emergency, they strictly limit what they will pay for at an out-of-network hospital.

If you want to go to an out of network physician for out-patient care, Medicare Advantage won't pay a thing. Which is why it is crucial to know which providers you like take which Medicare Advantage plans.

4. Do you plan to live x number of months a year in one location (Florida, Arizona, Hawaii, Gulf Coast) and x number of months somewhere else? Ask any Medicare Advantage plan whether they would cover you both places.

I know there are others who will contribute suggestions to your strategy,
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Old 10-16-2015, 11:42 PM
 
8,440 posts, read 11,945,777 times
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Quote:
Originally Posted by Inquring81 View Post
First, start with some basics.

My understanding is that Medicare Advantage plans are managed care Medicare plans offered by insurance companies. Rather than have Medicare pay your medical costs, you instruct Medicare to send the money that you've contributed to Original Medicare to an insurance company. The Medicare Advantage plan then is your medical insurance. Some people love this idea, others hate it. If you believe that government workers can do few things well, and that competition in the marketplace is what produces excellence, Medicare Advantage plans may be a good fit for you. If you believe that government administration results in economies of scale and that government produces impartial decisions that benefit large numbers of people, Original Medicare may be a better fit.

Medigap plans are another tool entirely. They do not pay for the same things that Medicare Advantage/Original Medicare pay for. Medigap plans are designed to fill some of the "gaps" in Original Medicare. The Medigap plan is designed to fit on top of your existing, core Medicare health insurance, be that Medicare Advantage or Original Medicare.

For example, Original Medicare will pay 80% of a hospitalization bill. Some Medigap plans will pay the remaining 20%. But if you didn't have the Original Medicare, and instead just bought a Medigap plan, you'd have to pay for the 80%, and your Medigap plan would still pay the same 20%.

1. Are you about to become Medicare eligible?
2. Do you have doctors that you like?
3. If you had to be hospitalized, what hospital(s) in your area would you like to be in?

If you have doctors that you like, call their office administrator and ask "What Medicare Advantage plans are you an IN NETWORK provider?" Medicare Advantage plans do not pay for providers or hospitals that are out of their network. Yes, you can go to an emergency room if you are traveling, but past the immediate medical emergency, they strictly limit what they will pay for at an out-of-network hospital.

If you want to go to an out of network physician for out-patient care, Medicare Advantage won't pay a thing. Which is why it is crucial to know which providers you like take which Medicare Advantage plans.

4. Do you plan to live x number of months a year in one location (Florida, Arizona, Hawaii, Gulf Coast) and x number of months somewhere else? Ask any Medicare Advantage plan whether they would cover you both places.

I know there are others who will contribute suggestions to your strategy,
This is a good post. I'd just add either look online Medicare.Gov or call their 800 # and talk to them. The Medicare folks are quite knowledgeable. They have information for every state. They answer the phones 24 hrs/day. 1-800 -Medicare or
800- 63342273.

Good luck

MSR
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Old 10-17-2015, 02:06 AM
eok eok started this thread
 
6,684 posts, read 3,529,002 times
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Quote:
Originally Posted by BestintheWest View Post
4 years ago had outpatient surgery, $19000 for hospital alone, plus doctor, pathology, anesthesiology and on and on, total for the whole show was $23,000
A hospital charged $19,000 for you to be there a few hours? Was this while you were on Medicare? Or did you have other insurance? How much of that $19,000 did your insurance actually pay?
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Old 10-17-2015, 06:24 AM
 
3,613 posts, read 3,426,174 times
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Quote:
Originally Posted by eok View Post
For example, what if I need outpatient surgery? Would I only have to pay 20% with Original Medicare? What ballpark is that likely to be? I have no idea what the bills might be for outpatient surgery. Or what if I have to stay in the hospital for a day or two? I see in the online information that I would have to pay a copayment with the Medicare Advantage plans of around $300 per day. But then the surgery would be on top of that?

The Medigap plans I qualify for are too expensive.

The Medicare Advantage plans available to me are mostly from Humana and Anthem.

Anthem seems to have a 25% coinsurance payment for outpatient surgery. Which seems to be more than Original Medicare. Humana seems to have a copayment about the same as one day in a hospital.

I don't presently take any expensive drugs, but I put some random drugs in at the Medicare website, for Humana and Anthem HMO's, and my out of pocket cost per year for those would be $4000+ with Anthem and $40,000+ with Humana. Just a bunch of random drugs taken from some lists of drugs I mostly never heard of.

Anthem's website, and some interaction I had with them years ago, give the vague impression of incompetence. As if their office consisted of zillions of piles of paper falling off desks and nobody doing much work nor doing any of it carefully. Humana's website is much better. But a doctor once told me he hated Humana and I should get any insurance but Humana. I'm worried that if doctors hate Humana, their hatred might carry over to their Humana patients.

Besides the risk of expensive copayments, and the risk of having to pay for expensive drugs, what are the other disadvantages of Original Medicare without Medigap, compared to the Medicare Advantage plans?
First of all, the MA plans would have an out of pocket maximum for medical care and the Plan D guidelines would also limit (although it's high) how much you pay for prescriptions. I'm guessing the 40K med you found is not on the formulary, however. Look and see what the max out of pocket would be the the MA plan, usually that is around $6000 or so. Whatever that number is would be the most you would pay in a plan year for covered expenses.

Also, add up the total costs. If you anticipate needing surgery, are the Gap premiums really more than the MA plan when you factor in premiums and out of pocket costs. Typically you have little to no out of pocket costs after you pay your premiums with Plan F, for example.

Are you are first time enrollee in Medicare?
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Old 10-17-2015, 09:43 AM
 
Location: Texas
2,847 posts, read 2,132,093 times
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Quote:
Originally Posted by Weichert View Post
It depends on when you apply. Guaranteed enrollment when first eligible. As I remember reading though, if you do not meet that condition the questionnaire only goes back a few months, not years.
wrong, just did the questionnaire, several questions generalized about any problems ever with heart, cancer, aides etc, others referred to "in the past year".
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Old 10-17-2015, 09:46 AM
 
Location: Texas
2,847 posts, read 2,132,093 times
Reputation: 1754
Quote:
Originally Posted by eok View Post
A hospital charged $19,000 for you to be there a few hours? Was this while you were on Medicare? Or did you have other insurance? How much of that $19,000 did your insurance actually pay?
Correct, in the hospital for about 4 1/2 hours from check in to check out. only had medicare part A&B, hospital accepted medicare assignment, I paid about $4000 for everything, including hospital, doctor, pathology, anesthesiology.
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