Original Medicare With Frills Nearly As Expensive as Private Insurance (plan, hospital)

[thrillobyte]

So I recently enrolled in Medicare Advantage because my wife retired and electing Cobra under her Blue Shield was $500/mo with $2000 cap and $20PC/$40specialist co-pay. I switched to Blue Shield 65 Plus Advantage which has no co-pays for Dr visits and no cost for hospital stay and a $2800 cap on out-of-pocket but my Ophthalmologist dropped me because she said she couldn't do any more for my eye condition so I signed up for Kaiser which has $1650/1st 7 days in hospital, a $4400 ceiling out of pocket and $10PC/$20specialst co-pay--much worse but it has lots of in-house Ophthalmologists which is what I need.

But here's what floored me: on my way to kaiser I called about original Medicare in which one should buy Medigap for part B and a drug plan for Part D. Here's my quotes from Blue Shield for Medigap for Plan F (most popular):$184/mo and then for Part D: $167mo

So I have Part B: $134; Medigap: $184 and Drug: $167 for a total of $485, That's nearly as expensive as Cobra. If Kaiser doesn't pan out I'll go with the cheapest out of pocket I can find which right now is $1900 no co-pays no hospital costs for admittance. It's all a ripoff.

Does anyone have original Medicare and why is it so damn expensive compared to Advantage?

[Ariadne22]

Originally Posted by thrillobyte

So I recently enrolled in Medicare Advantage because my wife retired and electing Cobra under her Blue Shield was $500/mo with $2000 cap and $20PC/$40specialist co-pay. I switched to Blue Shield 65 Plus Advantage which has no co-pays for Dr visits and no cost for hospital stay and a $2800 cap on out-of-pocket but my Ophthalmologist dropped me because she said she couldn't do any more for my eye condition so I signed up for Kaiser which has $1650/1st 7 days in hospital, a $4400 ceiling out of pocket and $10PC/$20specialst co-pay--much worse but it has lots of in-house Ophthalmologists which is what I need.

But here's what floored me: on my way to kaiser I called about original Medicare in which one should buy Medigap for part B and a drug plan for Part D. Here's my quotes from Blue Shield for Medigap for Plan F (most popular):$184/mo and then for Part D: $167mo

So I have Part B: $134; Medigap: $184 and Drug: $167 for a total of $485, That's nearly as expensive as Cobra. If Kaiser doesn't pan out I'll go with the cheapest out of pocket I can find which right now is $1900 no co-pays no hospital costs for admittance. It's all a ripoff.

Does anyone have original Medicare and why is it so damn expensive compared to Advantage?

A lot of people here have Original Medicare with a Medigap F/G/N, or high-deductible Medigap F. The reason primarily is (1) provider flexibility - no HMO/no network - see any Medicare provider anywhere in the country; and (2) no oversight and OOPs which can become an issue with Advantage plans for those chronically ill; and (3) covers excess charges for those wanting to utilize places like Mayo.

Limiting provider networks is significant tool used by MA's in controlling expenditures along with sometimes onerous oversight. That said, Kaiser is pretty much immune from the oversight issue because it owns its own facilities, employs its own doctors, and keeps all monies in-house.

Medigaps do run around $160-$180 increasing to well over $250/mo. as one ages, but in some parts of the south and southeast can be had for closer to $120/mo. for younger people. Area matters a lot.

The alternative to a Medigap would be a high-deductible Medigap F which costs 50-75% less than a regular Medigap. A lot of people here have the high-deductible Medigap F. After you've paid your 20% of any Medicare charges up to deductible of $2,200, Medigap pays all Medicare approved balances 100%. If you're healthy, a high-deductible Medigap is the way to go. Caps maximum costs, reasonable premium, and see any Medicare provider. Keep in mind you'd need to incur $11,000 in Medicare approved charges to reach the $2,200 deductible. This wouldn't happen unless disaster struck.

That said, Part D @ $167 is a REALLY HIGH PREMIUM. Are you figuring copays into that cost? Most Part D's run in the area of $40-$50/mo.

Yes, a retiree who isn't on Advantage can see insurance premiums as follows:

$134 - Medicare Part B
$180 - Medigap
$x50 - Part D

or $365/mo. without drug copays. Depending on region, many older retirees are paying well over $200/mo for a Medigap - usually between $235-$275.

Community rated Medigaps, generally only offered by AARP UHC, cap the premium at around $280/mo. regardless of age. However UHC doesn't offer these in all states. Florida is one state where UHC offers issue-age - probably because too many elderly in FL. We've had reports here of people paying well over $400/mo. in their 80's b/c their policies were attained-age and the insurer was very aggressive in raising rates. Mutual of Omaha is one of those.

You may want to read this: //www.city-data.com/forum/43835454-post8.html

[JRR]

Here in Tennessee, I have original medicare $134, High Deductible F $38 and Part D 76.10 for a total of 248.10 per month. The part D is a bit expensive but a 90 day supply of my six prescriptions runs me a total co-pay of $25, so it works out overall as the least expensive plan to have.

[rothbear]

I was going to say the same thing about the Part D being pretty high. Currently hubby and I each have Medicare at $134, AARP Medigap plan F for age 65 at $139 (their rates just went down a bit) and Part D Humana/Walmart for $17. Co pays for our drugs even for 3 months are dirt cheap, but then again we both only take basic generic drugs.....a statin and low dose HBP for hubby and the generic of Zanaflex for me for my back pain.

Unfortunately even these are still more than what we were paying on our ACA policy. But with that probably going down the drain I'm glad we moved on.

[thrillobyte]

Originally Posted by Ariadne22

A lot of people here have Original Medicare with a Medigap F/G/N, or high-deductible Medigap F. The reason primarily is (1) provider flexibility - no HMO/no network - see any Medicare provider anywhere in the country; and (2) no oversight and OOPs which can become an issue with Advantage plans for those chronically ill; and (3) covers excess charges for those wanting to utilize places like Mayo.

Limiting provider networks is significant tool used by MA's in controlling expenditures along with sometimes onerous oversight. That said, Kaiser is pretty much immune from the oversight issue because it owns its own facilities, employs its own doctors, and keeps all monies in-house.

Medigaps do run around $160-$180 increasing to well over $250/mo. as one ages, but in some parts of the south and southeast can be had for closer to $120/mo. for younger people. Area matters a lot.

The alternative to a Medigap would be a high-deductible Medigap F which costs 50-75% less than a regular Medigap. A lot of people here have the high-deductible Medigap F. After you've paid your 20% of any Medicare charges up to deductible of $2,200, Medigap pays all Medicare approved balances 100%. If you're healthy, a high-deductible Medigap is the way to go. Caps maximum costs, reasonable premium, and see any Medicare provider. Keep in mind you'd need to incur $11,000 in Medicare approved charges to reach the $2,200 deductible. This wouldn't happen unless disaster struck.

That said, Part D @ $167 is a REALLY HIGH PREMIUM. Are you figuring copays into that cost? Most Part D's run in the area of $40-$50/mo.

Yes, a retiree who isn't on Advantage can see insurance premiums as follows:

$134 - Medicare Part B
$180 - Medigap
$x50 - Part D

or $365/mo. without drug copays. Depending on region, many older retirees are paying well over $200/mo for a Medigap - usually between $235-$275.

Community rated Medigaps, generally only offered by AARP UHC, cap the premium at around $280/mo. regardless of age. However UHC doesn't offer these in all states. Florida is one state where UHC offers issue-age - probably because too many elderly in FL. We've had reports here of people paying well over $400/mo. in their 80's b/c their policies were attained-age and the insurer was very aggressive in raising rates. Mutual of Omaha is one of those.

You may want to read this: //www.city-data.com/forum/43835454-post8.html

Thank you, Ariadne22 and to the others for the very helpful info. So basically original Medicare has greater flexibility as it can be taken anywhere in the country and being essentially PPO it costs more just like regular PPO would under a private plan. For someone like myself who is essentially in good health but has only an eye condition that needs watching perhaps Advantage is the better choice. I found one that is rated 4 and a half out of 5 stars by US News that only has a $1900 out of pocket and no copays for Dr visits and hospitalizations so I'll probably go with that.