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Old 11-18-2020, 09:19 PM
 
1,397 posts, read 2,989,078 times
Reputation: 916

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I don't understand why health insurance is so pricey in some cases. Seniors are all on Medicare part A and B. I chose Caremore Anthem Senior Plus. They take the money out of my SS check that would typically go back to the government so I have no premiums monthly. There are no co-pays for PCP doctors or specialists. My max a year out of pocket is $1600. In patient hospital is free for the first 3 days. Cost out of pocket for prescriptions is approx. $2. Physical Therapy, Lab and blood tests is free. I take an eye drop for glaucoma that is $270 a month and pay out of pocket $40.

On the subject of the posters budget, clothing isn't mentioned. Savers in Summerlin is a wonderful place to shop. Their merchandise is from the homes of Summerlin. Most of the clothing is name brand; Dana Bachman, Ann Taylor, Chico's, Inc., Bob Mackie. You can often find clothes that were never worn and still have the original price tag hanging on them.
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Old 11-18-2020, 10:07 PM
 
Location: Lone Mountain Las Vegas NV
16,945 posts, read 6,997,364 times
Reputation: 7919
Quote:
Originally Posted by jjameson922 View Post
I don't understand why health insurance is so pricey in some cases. Seniors are all on Medicare part A and B. I chose Caremore Anthem Senior Plus. They take the money out of my SS check that would typically go back to the government so I have no premiums monthly. There are no co-pays for PCP doctors or specialists. My max a year out of pocket is $1600. In patient hospital is free for the first 3 days. Cost out of pocket for prescriptions is approx. $2. Physical Therapy, Lab and blood tests is free. I take an eye drop for glaucoma that is $270 a month and pay out of pocket $40.

On the subject of the posters budget, clothing isn't mentioned. Savers in Summerlin is a wonderful place to shop. Their merchandise is from the homes of Summerlin. Most of the clothing is name brand; Dana Bachman, Ann Taylor, Chico's, Inc., Bob Mackie. You can often find clothes that were never worn and still have the original price tag hanging on them.
JJ the problem is I have a well established line of physicians. 6 at the moment. I do not want to change the Cardiologist that I have used for 23 years. I trust him with my life. And his knowledge of my history is a thing that keeps me going. So I do not want to go to a closed system. Too big an adjustment.

I would also note that our regular medical billings exceed $250,000. And in 2019 when I got into major cardiac stuff they went to almost $600,000. The closed plans generally will resist all that. And in A and B you could end up paying 20% of $600,000. I would rather not.
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Old 11-18-2020, 11:05 PM
 
Location: NNV
2,924 posts, read 1,947,199 times
Reputation: 5640
Quote:
Originally Posted by jjameson922 View Post
I don't understand why health insurance is so pricey in some cases. Seniors are all on Medicare part A and B. I chose Caremore Anthem Senior Plus. They take the money out of my SS check that would typically go back to the government so I have no premiums monthly. There are no co-pays for PCP doctors or specialists. My max a year out of pocket is $1600. In patient hospital is free for the first 3 days. Cost out of pocket for prescriptions is approx. $2. Physical Therapy, Lab and blood tests is free. I take an eye drop for glaucoma that is $270 a month and pay out of pocket $40.
Because you don't understand the payment mechanisms involved. When you signed up for Anthem, you signed over your Medicare benefits to them. Anthem reports you as a member of their plan to Medicare, Medicare pays Anthem a monthly amount to take care of you. The amount generally varies by state and counties. Not sure how much that is nowadays...maybe somewhere around $1,000 a month, maybe more. You are also limited to Anthem's provider network.

Just because you aren't paying anything doesn't mean somebody isn't paying for your care.
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Old 11-19-2020, 02:41 PM
 
Location: Southern Highlands
2,161 posts, read 1,337,493 times
Reputation: 1886
Quote:
Seniors are all on Medicare part A and B.
Part B is optional.
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Old 11-20-2020, 04:04 PM
 
1,397 posts, read 2,989,078 times
Reputation: 916
Quote:
Originally Posted by Vic Romano View Post
Because you don't understand the payment mechanisms involved. When you signed up for Anthem, you signed over your Medicare benefits to them. Anthem reports you as a member of their plan to Medicare, Medicare pays Anthem a monthly amount to take care of you. The amount generally varies by state and counties. Not sure how much that is nowadays...maybe somewhere around $1,000 a month, maybe more. You are also limited to Anthem's provider network.

Just because you aren't paying anything doesn't mean somebody isn't paying for your care.
I totally understand that. Possibly I did not explain it that clearly in my writing. In my monthly SS check, I believe an amount close to $139 is deducted which the government keeps for my Part B Medicare. Now, they don't take it out and keep it. It is supposedly remitted to Caremore Anthem. Caremore Anthem is gambling that they can do better with that money than the government. Bottom line, I am paying out monthly the same as I already had. Big difference, regular Medicare would make me pay 20% of every medical cost. With Caremore Anthem, I pay nothing. Straight Medicare makes you pay until you reach a co-pay out of pocket of $2500. With C.A. max out of pocket is $1600 a year.
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Old 11-21-2020, 02:44 AM
 
Location: NNV
2,924 posts, read 1,947,199 times
Reputation: 5640
Quote:
Originally Posted by jjameson922 View Post
I totally understand that. Possibly I did not explain it that clearly in my writing. In my monthly SS check, I believe an amount close to $139 is deducted which the government keeps for my Part B Medicare. Now, they don't take it out and keep it. It is supposedly remitted to Caremore Anthem. Caremore Anthem is gambling that they can do better with that money than the government. Bottom line, I am paying out monthly the same as I already had. Big difference, regular Medicare would make me pay 20% of every medical cost. With Caremore Anthem, I pay nothing. Straight Medicare makes you pay until you reach a co-pay out of pocket of $2500. With C.A. max out of pocket is $1600 a year.
The tradeoff is you have to use Anthem's provider network. They won't pay any providers outside their network other than emergencies. Medicare supplement plans don't have those restrictions. That's what your paying for...flexibility. If you are happy with Anthem's network and referral process, then that's fine.
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