Medicare

[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.

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.

I'm sure we had/have different plans.  Ours was over a decade ago, and we paid about $500/year, and they paid who knows how much.

[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.

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?

Ron, The vision and hearing are an insurance rider to my Medex plan.  I do not have an Advantage plan.  I would not be eligible to carry this rider without having the Medex plan.

The dental plan is a separate policy entirely.  Initially, I had purchased a plan through Delta Dental.  They had a reasonable plan and had been my dental carrier through my employer for many years, and I had always been satisfied with them.  However, last year my dentist changed the networks he participated in.  He was no longer in my Delta plan, only a higher cost Delta plan that just didn't make sense to me financially.  He was a provider in a BC/BS plan that did make sense for me, so I opted for that. 

[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?

Ron, The vision and hearing are an insurance rider to my Medex plan.  I do not have an Advantage plan.  I would not be eligible to carry this rider without having the Medex plan.

The dental plan is a separate policy entirely.  Initially, I had purchased a plan through Delta Dental.  They had a reasonable plan and had been my dental carrier through my employer for many years, and I had always been satisfied with them.  However, last year my dentist changed the networks he participated in.  He was no longer in my Delta plan, only a higher cost Delta plan that just didn't make sense to me financially.  He was a provider in a BC/BS plan that did make sense for me, so I opted for that.

Thank you.

Looks like it’s worth it to check the additional plans vs. you needs each years.

We are thinking about going with a concierge set-up at $2500 a year each, but it still rubs me the wrong way. Still…I only have 49% share in voting rights..

[iris lily]

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.

Back in the day when I was working, my workplace offered  optional dental insurance for about the cost of 2 cleanings a year. Insurance was not worth it for us. We just pay the bill when every few years Dh has a tooth event. It is not predictable.

We did not have vision insurance either for the days when he got new glasses every two years and that bill was always around $1,000.He had very bad eyesight before cataract surgery.

Really consider if you NEED these insurance policies.

[tj]

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.

I'm surprised you found one that covers 3 cleanings.

[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.

I'm surprised you found one that covers 3 cleanings.

Me too; I think two is pretty standard.

[tj]

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.

I'm surprised you found one that covers 3 cleanings.

Me too; I think two is pretty standard.

Which one are you using?

[iris lily]

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.

$30,000 is peanuts in a medical event.

[sonofsven]

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.

$30,000 is peanuts in a medical event.

True, but with 20% coinsurance it would be the amount due on a $150,000 bill.
So not peanuts, but still possibly not enough. I just got a new hip that, with the surgery and the pre and post appointments, "cost" $60k.
I had a max oop of $2k (subsidized ACA plan).
But you're right, this is why it's important to get Medigap coverage.

[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.

I'm surprised you found one that covers 3 cleanings.

Me too; I think two is pretty standard.

Which one are you using?

My dental plan is "Dental Blue 65" with BC/BS.

[tj]

I did see that some of these Metlife plans include 3x cleanings.  But not all. Have to look at the plan details.

https://enrollment.ncd.com/663396

[DeniseNJ]

Haven't read every post but some common misconceptions:

Part A is NOT really hospital insurance.  It's inpatient insurance, so hospitals, in patient rehab, skilled nursing care.  But NOT is you are in the hospital for observation or tests or other out patient services.  You could be there two days having all sorts of things done and Part A won't cover it.

Part B covers out patient, doctors, DME and some medications.

Regular traditional Medicare Parts A and B do NOT cover out of the country--unless you happen to be in Canada on your way to Alaska.