Medicare

[mistymoney]

I feel like this board is mostly on the younger side, but also very planful and forward looking!

I'm trying to plan out how to incorporate medicare when I get there. and estimate those costs.

Which option are you thinking to take or have taken?
Approximate monthly cost (on top of whatever medicare premiums you have)?

Other consideration you took into account when deciding?

Or any other thoughts or questions you may have?

[Sandi_k]

My understanding is that traditional Medicare is the only plan that covers you when you're traveling; Medicare Advantage is an HMO.

That makes my decision for me.

[mistymoney]

My understanding is that traditional Medicare is the only plan that covers you when you're traveling; Medicare Advantage is an HMO.

That makes my decision for me.

Thanks Sandi! that is a good thing to keep in mind. I think I have heard that people can purchase travel insurance? Or get covered in various countries?

I know when I did college work exchange in London, I paid into national health and was covered by it.

[Sandi_k]

TI works if you're out of the country. I don't think you can get it for within the US.

[Catbert]

I am a retired Federal employee who was able to carry my health benefits into retirement.  I pay the same premium still working Federal employees do and there is no requirement to take Medicare at any age. 

[Dee18]

I chose Medicare + Medicare Supplement (also known as medigap) because I had close friends whose Medicare Advantage did not include MD Anderson in Houston which had the best cancer treatment for their kind of cancer.  (They mortgaged their house in order to pay for it.) I have other friends who initially chose Medicare Advantage and are now switching because it has been a hassle to get referrals. They have to pay a bit more for signing up late.  I am really glad I chose traditional Medicare and  the supplement because I am now spending almost half the year in another part of the country (something I had not  imagined doing when I made my Medicare choices)  and I have had no problems with coverage. 

I signed up for my supplemental Medicare through a group called Boomer Benefits which was recommended by a friend who is a retired physician.  If you ever had a problem they will represent you.  I had an instance where there was an issue about the code used for billing.   Boomer benefits made the necessary calls, with me on the line, and the matter was quickly resolved. They really made it easy.

[hooplady]

Those of you choosing Medicare + Medigap, are you self-funding prescriptions? I had thought I might go that route until I realized that not selecting an Rx plan means I'll have a penalty for life.

I've had Aetna for years so I'm considering an Aetna Advantage plan, I checked it out and it will cover all of my current doctors and meds. I'm currently paying for a high-deductible plan and their Advantage plan is free, so I think I should come out ahead (famous last words!).

[Cranky]

I have an advantage plan. I’m in an area where most employer based insurance is one of the HMOs that also offer advantage plans. Mine has an extremely large network and it’s as fine as health insurance in the US ever is.

My dh has a traditional plan plus supplements that are partially subsidized by his pension plan. He goes to the same doctors that I do and has a potentially slightly lower OOP than I do, but my drug coverage is actually better than his.

[LaineyAZ]

Those of you choosing Medicare + Medigap, are you self-funding prescriptions? I had thought I might go that route until I realized that not selecting an Rx plan means I'll have a penalty for life.

I've had Aetna for years so I'm considering an Aetna Advantage plan, I checked it out and it will cover all of my current doctors and meds. I'm currently paying for a high-deductible plan and their Advantage plan is free, so I think I should come out ahead (famous last words!).

My supplemental Medicare plan also offers a separate prescription coverage for an additional price, so I use that.

And my .02, please be super careful about going with any Medicare Advantage plan.  They'll hook you in with their low/no premiums and some freebies, but have a higher rate of claim denials.  And ditto to not being covered with travels outside their coverage area. 

[Cassie]

I have regular Medicare with a supplement plan and a prescription plan which is part D. People have died because their advantage plan denied needed medications, treatments, etc. 60 minutes did a show on it. In some states once you have an advantage plan you can’t switch to regular Medicare without passing medical underwriting which can be hard to do in your senior years.

[hooplady]

Those of you choosing Medicare + Medigap, are you self-funding prescriptions? I had thought I might go that route until I realized that not selecting an Rx plan means I'll have a penalty for life.

I've had Aetna for years so I'm considering an Aetna Advantage plan, I checked it out and it will cover all of my current doctors and meds. I'm currently paying for a high-deductible plan and their Advantage plan is free, so I think I should come out ahead (famous last words!).

My supplemental Medicare plan also offers a separate prescription coverage for an additional price, so I use that.

And my .02, please be super careful about going with any Medicare Advantage plan.  They'll hook you in with their low/no premiums and some freebies, but have a higher rate of claim denials.  And ditto to not being covered with travels outside their coverage area.

I have indeed heard nightmare stories about denied claims, that's the big unknown that's impossible to evaluate. Yeah sure it will cover the known doctors and meds that I have now, but what if I have one new crazy health event? No telling.

[hooplady]

In some states once you have an advantage plan you can’t switch to regular Medicare without passing medical underwriting which can be hard to do in your senior years.

Well that's new information...you mean during regular re-enrollment I can't just switch back to regular Medicare? How can I find out if my state is one of these?

[Fomerly known as something]

I selected unsure.  I’m also Other for now.  Currently I’m covered under FEHB so I can continue that after 65.  But who knows what congress will do in the next 19 years.

[Cassie]

In some states once you have an advantage plan you can’t switch to regular Medicare without passing medical underwriting which can be hard to do in your senior years.

Well that's new information...you mean during regular re-enrollment I can't just switch back to regular Medicare? How can I find out if my state is one of these?

You will have to research to find out. Medicare rules to be able switch vary among states. For instance in New York State they can switch yearly during open enrollment but that’s unusual. Some states have a birthday rule that lets people switch supplemental plans for an equal or lesser plan but not a higher plan.  I remember reading that when you first switch to an advantage plan you are allowed to switch back to a regular plan within a certain period of time and can only do it once.

Advantage plans are also allowed to do step therapy instead of just using the treatment you need. By the time you go through all the steps that don’t work the expensive treatment will no longer work or you’re already dead.

[Telecaster]

Medicare Advantage is a ripoff for everybody except the insurance companies.   

[rosarugosa]

In the year leading up to my 65th birthday, I got loads of marketing materials for Advantage plans, which told me a lot.  I have read that Advantage plans have far greater denial rates than Original Medicare.  I have also read that Advantage plans are only a good choice if you can't afford OM plus a Medex plan.

I elected Original Medicare and a Medex/Supplement plan from BC/BS. The prescription plans are all pretty crappy.  I went with a Wellcare plan that is only $13 per month.  They pay for my statin and all my vaccinations in full.  I get my other meds from Mark Cuban's Cost Plus pharmacy, which has saved me a bundle.  Cost Plus does not require an enrollment or a premium.

You asked about costs.  There are mine per month in MA:
Medicare $185
BC/BS Supplement (with rider for vision and hearing): $133
Dental (also from BC/BS) $41.00
Prescription (Wellcare) $13

I would be happy to answer any other questions if I left something out.

[Ron Scott]

You get what you pay for so stick with original Medicare and a supplemental plan. Choose a supplemental plan based on how often you see a doctor. For example if you go once or twice a month, just get Plan N since the copays won’t exceed the premium bump for G, etc. And you need a drug plan.

If you have money, don’t assume all this will be cheap. Taxes in the form of higher premiums will be imposed so you pay “your fair share”. It never ends…

Make sure you factor all this into your expense projections.

[jim555]

Since I can buy a Medigap at any time in my state I would wait until I get sick to buy it. 

[reeshau]

TI works if you're out of the country. I don't think you can get it for within the US.

Yes, you can!  And, if you have ACA coverage (at least in Texas) you need it!

The plans available to me don't even go outside the city for non-emergency coverage.  So, I'm happy we were familiar with travel insurance, because we use it a lot more frequently now.

[Ron Scott]

Since I can buy a Medigap at any time in my state I would wait until I get sick to buy it.

This is a strategy used by a lot of NYers. But it’s once a month and fails if you need immediate care as I understand. Great for planned procedures tho.

[jim555]

Since I can buy a Medigap at any time in my state I would wait until I get sick to buy it.

This is a strategy used by a lot of NYers. But it’s once a month and fails if you need immediate care as I understand. Great for planned procedures tho.

Hi-deductible G is another strategy.  Then go full G if you get sick.

[Sibley]

Those of you choosing Medicare + Medigap, are you self-funding prescriptions? I had thought I might go that route until I realized that not selecting an Rx plan means I'll have a penalty for life.

Part D is separate. So its potentially Medicare + Medigap + Part D + vision/dental.

[Sibley]

Who knows what the options will be when I'm old enough, but for now my parents are on traditional Medicaid plus medigap, plus a part D plan, plus dental/vision coverage. Dad has a few meds, mom has a lot. They use Boomer Benefits to assist, and my sister handles whatever is needed insurance-wise. I advise re finances.

[Ron Scott]

Since I can buy a Medigap at any time in my state I would wait until I get sick to buy it.

This is a strategy used by a lot of NYers. But it’s once a month and fails if you need immediate care as I understand. Great for planned procedures tho.

Hi-deductible G is another strategy.  Then go full G if you get sick.

I don't know how many states allow all these switcharoos. Not many I think.

[jim555]

Since I can buy a Medigap at any time in my state I would wait until I get sick to buy it.

This is a strategy used by a lot of NYers. But it’s once a month and fails if you need immediate care as I understand. Great for planned procedures tho.

Hi-deductible G is another strategy.  Then go full G if you get sick.

I don't know how many states allow all these switcharoos. Not many I think.

Probably only NY.

[Ron Scott]

Those of you choosing Medicare + Medigap, are you self-funding prescriptions? I had thought I might go that route until I realized that not selecting an Rx plan means I'll have a penalty for life.

Part D is separate. So its potentially Medicare + Medigap + Part D + vision/dental.

Refraction, glasses/contacts, and dental are outside original Medicare. My understanding is that most people who choose original Medicare with a supplemental plan typically self fund these expenses, because while separate insurance is available most of their providers don’t participate.

It seems a lot of what people have to do with Medicare is overly complex for what it is, but you have to understand the system and how your state implements it…and not rely on ads and brokers. There are a number of moving parts but most people get it pretty quickly.

The moving parts include:
1. Deciding between Medicare + Supplemental and Part D VS. Medicare Advantage
2. Assuming original Medicare, deciding on a Supplemental Plan (written by Medicare)
3. Choose an insurer for the Plan you selected.
4. Using the meds formulary to choose an insurers for Part D
Am I missing anything?

If there’s ONE LESSON here its probably “Go with Medicare + Supplemental Plan, and Part D (drugs) unless you’ve clearly thought through all the reasons not to and have talked with your doctors about it—or if you just can’t afford it.”

[Louise]

I need to start researching this for my spouse. I've been kind of ignorant because we've always had an employer health plan and my spouse still enjoys working. I'm a little confused on what Medigap covers (and what Medicare does not) and if it's necessary. Or if we can self insure that part. Does any one do this? We do have an HSA we can use, but it only has about 30K.

I know we won't use a Medicare Advantage plan. We have been getting a lot of brochures in the mail though!

[Ron Scott]

I need to start researching this for my spouse. I've been kind of ignorant because we've always had an employer health plan and my spouse still enjoys working. I'm a little confused on what Medigap covers (and what Medicare does not) and if it's necessary. Or if we can self insure that part. Does any one do this? We do have an HSA we can use, but it only has about 30K.

I know we won't use a Medicare Advantage plan. We have been getting a lot of brochures in the mail though!

When your time comes you will need to fully understand your options. Thankfully:
a) while there are complexites, it’s not brain surgery and you will definitely get it together;
b) some towns/libraries offer educational sessions for newbies that can be excellent AND handle any state-specific issues well; and
c) there are easy-to-read books (I think Medicare for Dummies is good, and there’s one on avoiding the top 10 mistakes, etc.)
You just need to do your homework.

Regarding your specific issue bolded above, Medicare leaves a significant gap in the amount you are charged by hospitals and healthcare providers and what it will cover for you. “Medigap” (Supplemental Plans) help make up a lot of that gap. There are a number of plans to choose from. All plans are insurance policies—written by the government and sold by insurance companies—so you can compare insurers’ pricing for each specific Plan. In general the more you pay for a plan, the more coverage you get AND since you might not need all that coverage you might be better off with a plan that covers less for a lower premium.

Note that the vast majority of original Medicare enrollees DO get a Supplemental/Medigap Plan because they are VALUABLE and typically worth the money.

Here’s the government brochure which you should read: https://www.medicare.gov/publications/10050-medicare-and-you.pdf

Here’s a place to compare Supplemental/Medigap Plans:
https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m/?year=2025&lang=en

[hooplady]

I need to start researching this for my spouse. I've been kind of ignorant because we've always had an employer health plan and my spouse still enjoys working. I'm a little confused on what Medigap covers (and what Medicare does not) and if it's necessary. Or if we can self insure that part. Does any one do this? We do have an HSA we can use, but it only has about 30K.

I know we won't use a Medicare Advantage plan. We have been getting a lot of brochures in the mail though!

Yeah, there's a whole lotta selling going on around Advantage plans. The only resource I really trust for all of this stuff is the official Medicare.gov site. And even if you plug that into your browser, you may get other sites that pop up first.

Now I'm learning that there's only one open enrollment period for Medigap, not an annual one. So I've switched up my thinking, I may go for Medigap and a Part D plan and see how that works.

[mistymoney]

I need to start researching this for my spouse. I've been kind of ignorant because we've always had an employer health plan and my spouse still enjoys working. I'm a little confused on what Medigap covers (and what Medicare does not) and if it's necessary. Or if we can self insure that part. Does any one do this? We do have an HSA we can use, but it only has about 30K.

I know we won't use a Medicare Advantage plan. We have been getting a lot of brochures in the mail though!

I wouldn't think 30k would be enough to fund DIY coinsurance. Is your HSA invested? How many years until on Medicare?

This is my understanding of the way it works. Appreciate any updates if I have it wrong:
If you go into the hospital and say you spend a month there - medicare definitely whittles the bill down to medicare approved amounts and the hospital has agreed to that as the payment - so if the hospital charge is 1200/day for the bed and the medicare approved payment is 575/day - the hospital accepts 575/day as the charge.

medicare then pays 80% of that, after dedcutible. Deductible is 1676 per google, so the first ~3 days you pay  1676, then 4th-30th, you pay 20% which is 120/day, so you are at $4780 just for the bed. If you are getting surgery, imaging, therapies, medication, all that will be a reduced "medicare approved" amount that you will need to pay 20% of. Could be very pricey. A 100K hospital stay seems rather pedestrian these days, and you would be on the hook for about 20k

I'm nearing about 45k in my HSA, and I have a few years to get to medicare, and have some invested and planning more. I'm not sure I want to risk not have supplement which it seems I'm seeing rates of 2-300/month.

It does add up, and if you don't have anything happen for 20 years and invested HSA assets are growing, could be a good deal.

But of course, insurance is for the unexpected/can't afford it categories of things.

[mistymoney]

other side is that maybe you can negotiate the coinsurance similar to a cash pay patient? May need to provide tax return info for a deal so if you keep income low might work. Not sure if they would ask about assets?

Maybe have coinsurance first 10 years or so until HSA growth is solid? I think dropping would be easy, but getting it back likely not.

I think I would want to have about 100k in HSA at 65 to even think about self insuring the copayment part. Or like at a 2% WR on the rest of assets or soemthing.

I think 4 people voted self insuring the copayment. If any reading - can you let us know how you made that decision? What asset you are relying/how much/at what age?

[sonofsven]

I've only started looking at it recently, but here is my limited knowledge:
Part A is what you get at 65. There is no premium cost. It covers hospitals.
Part B costs $185/mo (or more for high income individuals, see IRMMA). It covers doctors .There is a 20% coinsurance clause, which is one of the reasons to get a Medigap or supplemental plan.
Parts A and B are known as Original Medicare. You have to have Original Medicare to buy a Medigap plan.
Part C is Medicare Advantage that you can choose instead of Original Medicare. These plans vary wildly in coverage and by state, and are the source of many of the Medicare horror stories. They are sometimes very low cost and are often chosen for just that reason. You have to be careful when re signing up because the plans often change year to year.
Parts D, F, G, K, L, M, N are all supplemental Medigap plans that you buy from an insurer, prices vary by state and insurer.

https://www.medicare.gov/health-drug-plans/medigap/basics/costs

[Louise]

@Ron Scott @hooplady @mistymoney

Thanks for your replies! Yes, my husband is eligible this year, so I really do need to look into this sooner than later. How long he will work is up in the air, could be 2 months, could be five years! We are maxing out our HSA and will continue doing so as long as he's working. It's mostly invested, except for a few thousand if we need it. The medigap plans seem important for hospital stays. I'll start my reading with the government brochure.

[mistymoney]

I've only started looking at it recently, but here is my limited knowledge:
Part A is what you get at 65. There is no premium cost. It covers hospitals.
Part B costs $185/mo (or more for high income individuals, see IRMMA). It covers doctors .There is a 20% coinsurance clause, which is one of the reasons to get a Medigap or supplemental plan.
Parts A and B are known as Original Medicare. You have to have Original Medicare to buy a Medigap plan.
Part C is Medicare Advantage that you can choose instead of Original Medicare. These plans vary wildly in coverage and by state, and are the source of many of the Medicare horror stories. They are sometimes very low cost and are often chosen for just that reason. You have to be careful when re signing up because the plans often change year to year.
Parts D, F, G, K, L, M, N are all supplemental Medigap plans that you buy from an insurer, prices vary by state and insurer.

https://www.medicare.gov/health-drug-plans/medigap/basics/costs

Thanks sonofsven! very informative, didn't realize the diversity of plans!

medigap is it's own wormhole.

[mistymoney]

@Ron Scott @hooplady @mistymoney

Thanks for your replies! Yes, my husband is eligible this year, so I really do need to look into this sooner than later. How long he will work is up in the air, could be 2 months, could be five years! We are maxing out our HSA and will continue doing so as long as he's working. It's mostly invested, except for a few thousand if we need it. The medigap plans seem important for hospital stays. I'll start my reading with the government brochure.

I think there is an age limit to the HSA contribution with having medicare.

[Louise]

@Ron Scott @hooplady @mistymoney

Thanks for your replies! Yes, my husband is eligible this year, so I really do need to look into this sooner than later. How long he will work is up in the air, could be 2 months, could be five years! We are maxing out our HSA and will continue doing so as long as he's working. It's mostly invested, except for a few thousand if we need it. The medigap plans seem important for hospital stays. I'll start my reading with the government brochure.

I think there is an age limit to the HSA contribution with having medicare.

My understanding is that you can still contribute if you are still on an employer's plan and not on Medicare.

[mistymoney]

ah! makes sense!

[iris lily]

TI works if you're out of the country. I don't think you can get it for within the US.

what is TI?

[iris lily]

Too many warnings about “Advantage “plans scared me off of it.

At the time we retired, we were going back-and-forth between two regions or networks or whatever they call it because we had a weekend house. We went to a Medicare advisor to weigh  all the choices and at the time she suggested, since money wasn’t really a problem for us, a Medigap plan that seemed to cover most networks. Or something. I just remembered geography was a factor.

Now we live in one place so we should probably reevaluate the choices we made 6 years ago, but I’m too lazy and I don’t really care what it costs in monthly premiums, and if I remember correctly, the Medigap plan we have is no longer offered for new enrollees in some states anyway, and that suggests to me it must be pretty good.

 

[reeshau]

TI works if you're out of the country. I don't think you can get it for within the US.

what is TI?

Travel insurance

[geekette]

I've been deep diving into this, since I'll start Medicare in a month (and 8 days, but who's counting).

I asked my doctor about Medicare A, B, D vs an Advantage plan.  He said "Well, Medicare isn't trying to make money off you".  Got it.

Good, free, non-biased info is available - https://www.shiphelp.org. So much is state dependent, so they're very helpful.

You have 3 months before your 65th birthday, the month of your birthday, and 3 months after to decide what you want.  If you don't sign up within that timeframe, there is a lifetime penalty. Both my brother in laws are paying it.  Stupid mistake.

The Medigap plans are standardized, so it's generally recommended that you pick the cheapest (although some do offer some extras, like gym memberships, and a broker can look into their history of rate increases).  Once Medicare pays their part, they pay their part - no funny stuff like Advantage plans.

The price of Medigap plans can and will increase, usually with age, also with inflation. 

Most friends I've talked to seem to go for Plan G (which pays the 20% after the Medicare deductible) or Plan N (which pays the 20% less some small copays).  The company I'm looking at, G is $116/mo at 65, up to $290/mo at 80+.  N slightly less.

I'm actually looking at G-HD, which very few even consider.  I'll be responsible for the 20% up to $2,800, but it's $36/mo at 65, and $42/mo at 80+.   I figure the crossover point is around $5k of billed services, so if I stay out of the hospital, most likely it'll end up cheaper overall.  If I do end up in the hospital or get diagnosed with cancer, I'm covered for potentially huge bills.

The company I'm looking at allows you to change supplement plans yearly without underwriting (my state does not), so I can switch to a different plan if this ends up being a stupid idea.

Part D is another decision, although you can change it yearly.  If you don't take any expensive meds, you should just get the cheapest plan.  Usually there's a free one with a $590 deductible.  If you do take something expensive, there are "enhanced" plans with no deductible and some weird rules on what counts toward your $2k yearly limit on prescription cost per year (not including your premium).  I'll be paying $95/month, but my $25k in prescriptions per year will cost me <$500.  I hope that this new "no donut hole" Part D survives this administration.

[MrGreen]

Assuming it hasn't been completely privatized by the time I'm 65, I'll take Medicare and Medigap plans. I'll never willingly choose Medicare Advantage because of the horror stories I've heard. Advantage plans were some of the ones UHC was caught using AI to discharge elderly patients from rehab facilities before they could function on their own. I know of multiple personal examples where Medicare Advantage has restricted someone's options where the truly appropriate level of care is not available because the insurance company won't allow it.

[Dicey]

In his working days, DH's company had amazing coverage through a huge HMO (Kaiser). Virtually no deductibles, miniscule co-pays, one-stop-shopping, etc. He also gets a healthcare stipend as part of his retirement package. Now that he's retired, he's paying OOP to stay on the company plan. I'm a bit older, so I have Medicare Senior Advantage with Kaiser via his former employer.

The catch is once you leave the former (pension paying) employer, that's it, you're out. You still get the stipend, but you can never go back to their Kaiser plan. Confused yet?

Another wrinkle: Since I qualified for Medicare, I've had breast cancer and a couple of other outpatient surgeries and Kaiser's been great.

That being said, until DH qualifies for Medicare in 1.5 years, together we're $1500 OOP per month. The stipend is $550 per month, but it's taxable.

We're starting to think there might be better options, which is why I responded to this poll. Sorry that my input probably isn't useful for anyone, but quite selfishly hope I might learn of something that will save us a few bucks.

[geekette]

I'm not sure what you're looking for, Dicey, if you don't want to leave Kaiser.  I haven't heard horror stories about Kaiser, but you still may have problems with access or if you're traveling.

If you do want to change, in general, you can't switch from a Medicare Advantage plan to OG Medicare plus a supplement unless you can pass underwriting.  You can move to Medicare with no supplement, but there's no OOP max, so yikes.

Exceptions include if the MA company goes out of business, or you move out of their service area, or if you've been on MA for less than a year.

According to this insurance sponsored site, there's an exception in CA for moving from an employer sponsored plan to medigap w/o underwriting.

You can check prices on Medicare.gov, make an appointment with a Ship counselor, or talk to a broker.

[jrhampt]

Wow, there's no OOP max for Medicare if you just have parts A and B??  Good to know.  This thread has been very informational for me...I had already decided on no Medicare Advantage but it's interesting to see what other combinations people are using for supplemental + dental.

[geekette]

Even when we had dental and vision through an employer, it wasn't worth it the money they (and we) were paying.  We just pay OOP for those. 

[rosarugosa]

The vision and hearing rider on my BC/BS Medex plan is $2.62 per month.  I get an exam and new eyeglasses every 2 years from Costco, which is out of network, but the plan reimburses me up to $200 for exam and glasses.  Therefore, I pay $62.88 every two years for a guaranteed $200 benefit. I used to self insure when I was working, because the cost/benefit was not as favorable.  I've not needed the hearing benefit yet, so cannot comment on that.

For the dental, I pay $40.94 per month, so $491.28 per year.  My dentist charges $170 for an exam and cleaning and the plan covers 3 exams/cleanings per year ($510), so it's worth my while to carry the coverage just for the cleanings, not even taking into account x-rays or fillings, etc.  I had considered self-insuring for dental because the maximum yearly benefit is $1250.  Paying $491 for a potential $1250 in insurance coverage doesn't make sense in absolute insurance terms, but when there is a definite cost advantage just based on predictable routine maintenance needs, then it didn't make sense not to carry the coverage.  I should add that I like to have really clean teeth, so I would not consider getting my teeth cleaned less that 3 times per year.

[Ron Scott]

The vision and hearing rider on my BC/BS Medex plan is $2.62 per month.  I get an exam and new eyeglasses every 2 years from Costco, which is out of network, but the plan reimburses me up to $200 for exam and glasses.  Therefore, I pay $62.88 every two years for a guaranteed $200 benefit. I used to self insure when I was working, because the cost/benefit was not as favorable.  I've not needed the hearing benefit yet, so cannot comment on that.

For the dental, I pay $40.94 per month, so $491.28 per year.  My dentist charges $170 for an exam and cleaning and the plan covers 3 exams/cleanings per year ($510), so it's worth my while to carry the coverage just for the cleanings, not even taking into account x-rays or fillings, etc.  I had considered self-insuring for dental because the maximum yearly benefit is $1250.  Paying $491 for a potential $1250 in insurance coverage doesn't make sense in absolute insurance terms, but when there is a definite cost advantage just based on predictable routine maintenance needs, then it didn't make sense not to carry the coverage.  I should add that I like to have really clean teeth, so I would not consider getting my teeth cleaned less that 3 times per year.

This is interesting and I hope you can clarify some things for me. I’m not familiar with how things work in Mass.

I typically think of vision and dental as associated with Medicare Advantage, not an original Medicare + Supplemental plan. Is the vision and dental coverage you’re talking about offered as a separate plan—on top of a Medicare Supplemental plan, or are you on Medicare Advantage? Also, can you go to any dentist you choose and get reimbursement to a limit?

[Cassie]

I need to start researching this for my spouse. I've been kind of ignorant because we've always had an employer health plan and my spouse still enjoys working. I'm a little confused on what Medigap covers (and what Medicare does not) and if it's necessary. Or if we can self insure that part. Does any one do this? We do have an HSA we can use, but it only has about 30K.

I know we won't use a Medicare Advantage plan. We have been getting a lot of brochures in the mail though!

I wouldn't think 30k would be enough to fund DIY coinsurance. Is your HSA invested? How many years until on Medicare?

This is my understanding of the way it works. Appreciate any updates if I have it wrong:
If you go into the hospital and say you spend a month there - medicare definitely whittles the bill down to medicare approved amounts and the hospital has agreed to that as the payment - so if the hospital charge is 1200/day for the bed and the medicare approved payment is 575/day - the hospital accepts 575/day as the charge.

medicare then pays 80% of that, after dedcutible. Deductible is 1676 per google, so the first ~3 days you pay  1676, then 4th-30th, you pay 20% which is 120/day, so you are at $4780 just for the bed. If you are getting surgery, imaging, therapies, medication, all that will be a reduced "medicare approved" amount that you will need to pay 20% of. Could be very pricey. A 100K hospital stay seems rather pedestrian these days, and you would be on the hook for about 20k

I'm nearing about 45k in my HSA, and I have a few years to get to medicare, and have some invested and planning more. I'm not sure I want to risk not have supplement which it seems I'm seeing rates of 2-300/month.

It does add up, and if you don't have anything happen for 20 years and invested HSA assets are growing, could be a good deal.

But of course, insurance is for the unexpected/can't afford it categories of things.

If you have regular Medicare you should buy a supplement plan to cover the 20% that Medicare doesn’t cover.

[mistymoney]

Even when we had dental and vision through an employer, it wasn't worth it the money they (and we) were paying.  We just pay OOP for those.

can you provide more details? My vision insurance is less than $2/paycheck, and dental maybe 15/paycheck. Would need to check. preventative cover, one year got max benefit of 2k on dental.