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Sorry, I read all these threads but I still can't figure out what we should do.
We have been self pay for most of our lives. In the last several years we belonged to a healthcare sharing ministry to assist with medical bills. Besides the fact that it worked wonderful for us, my main reason for appreciating it is that we didn't have any insurance company lording over us telling us what doctors to see or deciding what services we could get. Everything has been between doctor and patient.
I'd like to keep that freedom as much as possible. We rarely go to the doctor so we don't have a regular physician. We don't have any chronic conditions. We don't take any meds. I'd rather have a lower premium every month with a larger deductible. I don't care about extra dental or vision coverage.
From what I've read, an HD-G medigap might be what we need. Do I still have to get part B?
It sounds like HD-G would be what you are looking for.
Yes, you still have to pay the Part B premium.
May I also suggest that you seriously consider a Part D prescription plan. My spouse is a physician and, following her prompting, I looked at several of the very expensive prescriptions she mentioned that one might need (mainly related to cancer treatment). They were exorbitantly expensive - tens of thousands of dollars.
Consider at least getting one of the inexpensive Part D plans available as cheap insurance - mine is $7.30 a month.
I have plan G and once the part B is paid, I haven't paid a cent. No referrals needed. Had extensive shoulder rotator cuff surgery Jan 2021, with extended PT and never paid a dime. Picked my own surgeon.
Charlie~ I should get a part D, at 70 now, you never know what will happen in the future.
It sounds like HD-G would be what you are looking for.
Yes, you still have to pay the Part B premium.
May I also suggest that you seriously consider a Part D prescription plan. My spouse is a physician and, following her prompting, I looked at several of the very expensive prescriptions she mentioned that one might need (mainly related to cancer treatment). They were exorbitantly expensive - tens of thousands of dollars.
Consider at least getting one of the inexpensive Part D plans available as cheap insurance - mine is $7.30 a month.
I never thought about that in terms of cancer drugs. We don't have any family history of cancer so we were looking at the other drug discount programs. Definitely will consider this.
I never thought about that in terms of cancer drugs. We don't have any family history of cancer so we were looking at the other drug discount programs.
Just because someone doesn't have a "family history" of a particular serious health problem doesn't mean it can't happen. Every individual is just that...an individual. No one is a carbon copy of their siblings, parents or anyone else. Every time I read some poster's comment about "always been healthy...I don't need health insurance." my toes curl a little. While I'm a pretty positive thinker in general, that's just denial. Life has this bad habit of happening while you were busy planning something else.
Just because someone doesn't have a "family history" of a particular serious health problem doesn't mean it can't happen. Every individual is just that...an individual. No one is a carbon copy of their siblings, parents or anyone else. Every time I read some poster's comment about "always been healthy...I don't need health insurance." my toes curl a little. While I'm a pretty positive thinker in general, that's just denial. Life has this bad habit of happening while you were busy planning something else.
But that doesnt mean the patient has to accept the treatment the dr recommends. Whatever the disease. All depends on an individuals view of life. What is right for one, doesnt mean its right for another. and there is nothing wrong in choosing which path to take. Even the unpopular one.
But that doesnt mean the patient has to accept the treatment the dr recommends. Whatever the disease. All depends on an individuals view of life. What is right for one, doesnt mean its right for another. and there is nothing wrong in choosing which path to take. Even the unpopular one.
That is not what I wrote. I happen to agree with you about the freedom to choose a course of treatment. What I don't agree with is willful ignorance while it happens to be convenient, then demanding miracles or whining that no one can restore their health once something does go wrong. Not all preventive medicine is a crock. Sometimes it does save someone from much, much worse. BTDT. Rare is the person whose health situation doesn't end up impacting someone else: spouse, parent, children, dear friends.
Open enrollment is here again, right now I have United Health Care Medicare Advantage (PPO)through my former employer. I know most posters here say Traditional Indemnity is better than Advantage, but when I looked at the comparison chart, the percentages of coverage are the same except for a few minor categories where Traditional covers 90%, but Advantage has no copay.
The monthly price difference is about $170 more for Traditional, but I don't understand why there is a big price difference for the same coverage (or are the costs really the same?). I was hoping someone could steer me in the right direction on where to look in the comparison charts to find out what warrants the price difference. A Medicare employee told me a hospital stay costs more under Advantage, but the charts say they both pay 80%. Am I missing something?
I do know some of the doctors in my area don't accept Advantage and one hospital doesn't. Is that the only reason Traditional is better because the docs get paid more money and don't refuse any patients?
One thing I don't like about Advantage is they push the House Call program (I refused because of covid), and they inquire if you had certain medical testing, I don't think Traditional does that. It seems like Advantage tries to control what you do.
Open enrollment is here again, right now I have United Health Care Medicare Advantage (PPO)through my former employer. I know most posters here say Traditional Indemnity is better than Advantage, but when I looked at the comparison chart, the percentages of coverage are the same except for a few minor categories where Traditional covers 90%, but Advantage has no copay.
The monthly price difference is about $170 more for Traditional, but I don't understand why there is a big price difference for the same coverage (or are the costs really the same?). I was hoping someone could steer me in the right direction on where to look in the comparison charts to find out what warrants the price difference. A Medicare employee told me a hospital stay costs more under Advantage, but the charts say they both pay 80%. Am I missing something?
I do know some of the doctors in my area don't accept Advantage and one hospital doesn't. Is that the only reason Traditional is better because the docs get paid more money and don't refuse any patients?
One thing I don't like about Advantage is they push the House Call program (I refused because of covid), and they inquire if you had certain medical testing, I don't think Traditional does that. It seems like Advantage tries to control what you do.
Employer-retiree Advantage is often a better performer for the patient than plans sold to the general public. For most retiree plans, once you leave you cannot return. So, examine your situation carefully.
The price difference between a Traditional Medicare w/Medigap and Advantage is all about insurer profit. Advantage plans are in control of your care. Whatever they don't spend on you, goes to their bottom line.
Not true for Medigaps which must pay their share of any Traditional Medicare approved service. Medigaps cannot deny payment of a claim, have no say in your treatment, have no control over their costs for any particular patient. This is why the price differential.
$170 is the cost of Part B for most Medicare beneficiaries, usually deducted from your SS benefit. Enrollment in Part B is required for participation in an Advantage plan or the purchase of a Medigap.
As it happens, $170 can also be the average premium for a Medigap, depending on your age and state. This cost can be mitigated with the purchase of a high-deductible Medigap, premiums usually in the area of $50-$60/mo. Medicare pays its 80%, you pay 20% up to the deductible of $2,490 (2022). Medicare/Medigap pay 100% after satisfaction of the deductible. Healthy people generally don't see their 20% share being more than a few hundred dollars a year. For most people, the hd plan will save many thousands in premiums over time.
Hospital stays under Advantage usually require a copay for the first five-seven days of admission. Per diem cost varies by plan, usually in the area of $150-$275. Under a full Medigap, you would not experience this - Medicare/Medigap would pay 100%. If you purchased a high-deductible plan, you might experience some costs depending on how much of your deductible had been satisfied for that year.
Traditional doesn't necessarily pay more. Advantage plans often pay their providers less, but promise the doctor more patients. The reason some docs in your area don't take Advantage is because of low pays AND very slow pays AND onerous oversight on patient treatment requiring docs to jump through hoops for approvals, possibly insisting on a less expensive treatment first (step therapy) rather than the one recommended by the doc - and delayed approvals and occasional denials.
The main reason many patients prefer a Traditional Medicare w/Medigap is they can see any doctor which accepts Medicare (not just those in-network). Plus, oversight on procedures, etc. is, for the most part, nonexistent. Traditional Medicare w/Medigap makes life much easier for the doc and patient.
Advantage does try to control what you do because the plans are issued by for-profit, private insurers which are paid x dollars per enrollee by CMS. Whatever Advantage doesn't spend on its patients goes to its bottom line. So, their profit motivation often can interfere with your treatment.
But, again, generally employer plans function better than retail MA's in respect to oversight, payment, etc. Network restrictions appear to be your primary issue with your employer plan.
Definitely consider a high-deductible Medigap if you decide to leave your employer plan. Many here have them. You would also need a Part D plan. Cost as low as $7/mo up to $40/mo depending on your drug formulary.
Last edited by Ariadne22; 09-27-2022 at 05:28 PM..
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