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Old 10-01-2019, 12:18 PM
 
Location: Wisconsin
23,548 posts, read 50,140,471 times
Reputation: 18192

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Quote:
Originally Posted by 4khansen View Post
I agree that Original Medicare plus a Part D prescription plan and a medigap HD-F or G is the way to go! You can get all three if you are around 65 years of age for around $210 a month (depending on your income level) if you shop around.
For OP's information, the $210 a month cited above refers to a full Medigap G + Part D. Full Medigap G pays all but $185 Part B deductible. So, $2,200 would not apply.

An high deductible F or G, otoh, costs only $40/$50 month - deductible for 20% not paid by Medicare is currently $2,300. As stated, Medicare copays are ridiculously low. So, cost for hd plan + Part D might be $100/mo. But one does have the $2,300 exposure which is hard to meet for the healthy person.

Less expensive full Medigap option is Plan N, which requires no more than $20 copay, or 20% of the charge, whichever is less, for each doctor visit. No excess charges, no foreign travel, but for most people N is very adequate and has a noticeably lower premium just because of the doctor visit cost-sharing.

In the long run, if it appears one will be needing regular medical care, a high-deductible plan is not recommended. Best to get a full Medigap G or N. If dad isn't traveling overseas or planning to see a clinic such as Mayo, he will be very happy with Plan N.

Quote:
Originally Posted by 4khansen View Post
That $2,200 deductible you may have to pay could be divided and possibly paid over 12 months at around $180 more per month (worst case scenario). Other than you might have to pay it in one lump sum if you have a castastrophic illness or injury.
Again, to clarify for OP, this is for the high-deductible plan. The regular Medigaps G and N do not have this deductible.

OP - you probably should also read this thread:

//www.city-data.com/forum/healt...i-missing.html
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Old 10-05-2019, 06:03 AM
 
Location: Colorado Springs
6,070 posts, read 6,381,640 times
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My experience: At 65 we went on a Medicare Advantage plan and initially, it was wonderful.

Their clinic and pharmacy were nearby and they were convenient and we enjoyed the additional perks like free vision exams.

But then, at age 68, my wife started to have big medical problems. We went through a year with many clinical visits and tests with high co-pays. That was endurable until they started pushing back. They denied a cat scan request from her doctor. They were very nasty about appeals. They even outsourced the decision to a firm that would not talk to us or our doctor.

That was resolved when, after 5 weeks of enduring lots of abdominal pain, she ended up in crisis in the ER and that doc just did the cat scan without asking for authorization. He discovered the root cause of her distress and we got it fixed.

Since then we switched to original Medicare with a "G" supplement from AARP/United Health.

Luckily, she was able to get in. At first, I thought she would be rejected.

When I added up the co-pays from that year, they exceeded the amount of yearly premiums for the G plan.

Bottom line: A Medicare Advantage plan is swell until it isn't.
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Old 10-06-2019, 06:01 AM
 
993 posts, read 1,147,664 times
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Quote:
Originally Posted by Vision67 View Post
My experience: At 65 we went on a Medicare Advantage plan and initially, it was wonderful.

Their clinic and pharmacy were nearby and they were convenient and we enjoyed the additional perks like free vision exams.

But then, at age 68, my wife started to have big medical problems. We went through a year with many clinical visits and tests with high co-pays. That was endurable until they started pushing back. They denied a cat scan request from her doctor. They were very nasty about appeals. They even outsourced the decision to a firm that would not talk to us or our doctor.

That was resolved when, after 5 weeks of enduring lots of abdominal pain, she ended up in crisis in the ER and that doc just did the cat scan without asking for authorization. He discovered the root cause of her distress and we got it fixed.

Since then we switched to original Medicare with a "G" supplement from AARP/United Health.

Luckily, she was able to get in. At first, I thought she would be rejected.

When I added up the co-pays from that year, they exceeded the amount of yearly premiums for the G plan.

Bottom line: A Medicare Advantage plan is swell until it isn't.
Thank you. This information is basically what everyone else said but I'm glad I got a real world example.

Are the G plans fixed costs like apart B or will we have to shop around? Where should I start?

So in your case you need B, D (prescriptions) and G (medigap) policy to cover everything?

Thank you.
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Old 10-06-2019, 06:21 AM
 
Location: Colorado Springs
6,070 posts, read 6,381,640 times
Reputation: 21018
Quote:
Originally Posted by UntilTheNDofTimE View Post
Thank you. This information is basically what everyone else said but I'm glad I got a real world example.

Are the G plans fixed costs like apart B or will we have to shop around? Where should I start?

So in your case you need B, D (prescriptions) and G (medigap) policy to cover everything?

Thank you.
Yes, B, D, and G covers everything. Remember that G has a small initial co-pay.

Since then we had two MRIs, an ER visit, and several GI tests with zero additional expense.
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Old 10-06-2019, 04:21 PM
 
993 posts, read 1,147,664 times
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Quote:
Originally Posted by Vision67 View Post
Yes, B, D, and G covers everything. Remember that G has a small initial co-pay.

Since then we had two MRIs, an ER visit, and several GI tests with zero additional expense.
I'm sure I will have my dad purchase a G plan, but if we choose not to, is there a yearly out of pocket maximum for regular Medicare?
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Old 10-06-2019, 05:05 PM
 
Location: Wisconsin
23,548 posts, read 50,140,471 times
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Quote:
Originally Posted by UntilTheNDofTimE View Post
I'm sure I will have my dad purchase a G plan, but if we choose not to, is there a yearly out of pocket maximum for regular Medicare?
No maximum. That 20% exposure is unlimited. The purpose of a supplement is to insure against that.
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Old 10-24-2019, 03:59 PM
 
993 posts, read 1,147,664 times
Reputation: 1504
Quote:
Originally Posted by Ariadne22 View Post
No, what you need to be wary of are onerous oversight/approvals and never-ending copays should your dad become chronically ill. Which is why Advantage plans have maximum out-of-pockets ranging from $5K-$8K.

Advantage is NOT Medicare. Advantage is a private for-profit insurer dispensing Medicare benefits. So, beware.

We've had a number of posts over the years from people who found Advantage plans twice as expensive than a Medigap would have been when disaster struck. Others who didn't like network restrictions and oversight on services.

I had a neighbor who had Advantage. The copays were killing her because she required a lot of home health services for wound care.

A nurse in NJ moved her mother from PA to NJ and immediately put her on a Medigap. When mom was in PA, Advantage would not approve some SNF therapy and rehab and the copays ran to over $7k. She considers Medigap a bargain.

On oversight, one ridiculous case cited by mathjak of a friend's experience, an Advantage plan would approve removal of only half a cancerous pituitary gland when Medicare would have paid for removal of the entire gland.

A regular Medigap G, worst case, at age 65 may cost $2k year, and will cover all Medicare allowed services with no copay after payment of the Medicare Part B $185 deductible. Your doctors decide what services you need, not the Advantage plan. No preapprovals necessary for Medicare. No HMO. Complete provider flexibility. See any doctor who accepts Medicare patients anywhere in the US.

Part D plan should be chosen on basis of your dad's formulary. Part D plans have deductibles and copays.

Know that if you choose Advantage now, assuming he is age 65, under Medicare Trial Right #4, your father has one year to change his mind and return to Original Medicare and purchase a Medigap without health underwriting.

https://www.medicare.gov/find-a-plan...otections.aspx

After that, unless he is in a guaranteed issue state or moves out of his Advantage plan's service area, should his health issues worsen he might find it very difficult to switch to a Medigap.

Depending on your carrier, Advantage can work very well or be a nightmare. Given his health issues which will only get worse, if he can afford a Medigap that's what you should be focusing on. Life is so much easier with a Medigap when dealing with chronic illness.

You can price UHC plans, here. Look at G or N:

https://www.uhcmedicaresolutions.com...ent-plans.html
Thanks again for all your info. I’m looking to purchase a Medigap policy here soon. Was looking at Medigap plans G and N. I see why G is a no brainer. $185 deductible and then everything is covered. Why is N also recommended? In previous post you mention never ending copays as a downside to Medicare advantage. Wouldn’t part N be never ending copays as well? I don’t see my dad having many doctors visits but G looks more appealing.

If my dad enrolls in Part G and for example wants to switch to part N years down the line does he avoid underwriting? Or does he need to stay in part G forever once you pick that type of Medigap policy.

Thanks.
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Old 10-24-2019, 05:40 PM
 
Location: Wisconsin
23,548 posts, read 50,140,471 times
Reputation: 18192
Quote:
Originally Posted by UntilTheNDofTimE View Post
Thanks again for all your info. I’m looking to purchase a Medigap policy here soon. Was looking at Medigap plans G and N. I see why G is a no brainer. $185 deductible and then everything is covered. Why is N also recommended? In previous post you mention never ending copays as a downside to Medicare advantage. Wouldn’t part N be never ending copays as well? I don’t see my dad having many doctors visits but G looks more appealing.

If my dad enrolls in Part G and for example wants to switch to part N years down the line does he avoid underwriting? Or does he need to stay in part G forever once you pick that type of Medigap policy.

Thanks.
Copays in Advantage are far more than just a maximum of the Plan N $20 copay per doctor visit - $50 specialist, coinsurance on tests, etc., etc., etc. Some here have spent over $5k year on on rehab and other copays when on Advantage. It's apples and oranges.

Many here have N and never cite the occasional doctor copay as an issue. It's pennies, generally. The copay factor allows the insurer to offer a much lower premium for Plan N. At my age, in WI, there is an $80/mo. difference between G and N - or the equivalent of 48 doctor visits assuming $100 Medicare reimbursement. Doctor reimbursements I've seen are often in the $70 area, which means copays of no more than $14 - and even more visits.

At the moment, UHC is allowing a downgrade from G to N without underwriting. There are no guarantees that will continue. At one time one could downgrade from F to G without underwriting. UHC ended that practice a year go.
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Old 10-24-2019, 06:39 PM
 
993 posts, read 1,147,664 times
Reputation: 1504
Quote:
Originally Posted by Ariadne22 View Post
Copays in Advantage are far more than just a maximum of the Plan N $20 copay per doctor visit - $50 specialist, coinsurance on tests, etc., etc., etc. Some here have spent over $5k year on on rehab and other copays when on Advantage. It's apples and oranges.

Many here have N and never cite the occasional doctor copay as an issue. It's pennies, generally. The copay factor allows the insurer to offer a much lower premium for Plan N. At my age, in WI, there is an $80/mo. difference between G and N - or the equivalent of 48 doctor visits assuming $100 Medicare reimbursement. Doctor reimbursements I've seen are often in the $70 area, which means copays of no more than $14 - and even more visits.

At the moment, UHC is allowing a downgrade from G to N without underwriting. There are no guarantees that will continue. At one time one could downgrade from F to G without underwriting. UHC ended that practice a year go.
Thanks again. You truely are an asset to the readers of this forum.
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Old 10-25-2019, 12:06 AM
 
Location: Buckeye, Arizona
378 posts, read 209,130 times
Reputation: 505
Default to clarify

Quote:
Originally Posted by Ariadne22 View Post
For OP's information, the $210 a month cited above refers to a full Medigap G + Part D. Full Medigap G pays all but $185 Part B deductible. So, $2,200 would not apply.

An high deductible F or G, otoh, costs only $40/$50 month - deductible for 20% not paid by Medicare is currently $2,300. As stated, Medicare copays are ridiculously low. So, cost for hd plan + Part D might be $100/mo. But one does have the $2,300 exposure which is hard to meet for the healthy person.

Less expensive full Medigap option is Plan N, which requires no more than $20 copay, or 20% of the charge, whichever is less, for each doctor visit. No excess charges, no foreign travel, but for most people N is very adequate and has a noticeably lower premium just because of the doctor visit cost-sharing.

In the long run, if it appears one will be needing regular medical care, a high-deductible plan is not recommended. Best to get a full Medigap G or N. If dad isn't traveling overseas or planning to see a clinic such as Mayo, he will be very happy with Plan N.

Again, to clarify for OP, this is for the high-deductible plan. The regular Medigaps G and N do not have this deductible.

OP - you probably should also read this thread:

//www.city-data.com/forum/healt...i-missing.html

ariadne22 said that the $210 a month refers to a full Medigap G + Part D. That is not how I was trying to relate the information. I considered the $210 a month to include original Medicare $135.50 PLUS a high-deductible plan of $35-50 a month PLUS a Part D plan which averages around $25 or so. This is where I came up with the $210 a month. He is looking at the $210 a month as just the amount for the medigap (non-high deductible) and the Part D.
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