Budget for ACA to Medicare transition

[blue_green_sparks]

Transitioning from ACA to Medicare with medigap G next year and trying to budget the range of possible costs for healthcare per person. Fl resident. Does this seem about right, disregarding any need for long-term care?

Sure costs
medigap g   $201.00   $2,412.00/yr
medicareb   $174.70   $2,096.40/yr

Possible addon costs
Partb deduc               $240.00/yr
drug cap                    $2000.00/yr

Total costs range from $4,508.40 min to $6,748.40 max per year

[Dee18]

Before I signed up for Medicare a couple years ago a friend (who is a retired doctor) advised me to sign up through Boomer Benefits  at https://boomerbenefits.com/

They will sort through all the options for you and make comparisons.  There is no fee; I think they get a commission (like so many web sites do) from the medigap providers. 

But the reason to use them is that forever after if you have any issues about charges or reimbursements with medicare of your supplemental provider they will handle them for you.  This has been tremendous for me when I was wrongly billed twice in my first year.  They are happy to be on a call with you or handle it independently.  I cannot say enough nice things about them. 

[blueberrybushes]

We were on ACA for 4 years before qualifying for Medicare.  We opted for an Advantage Plan through Kaiser instead of a Medigap plan.  Our Kaiser Basic Advantage plan was +/- $40/month for 4 years until this year when the premium changed to $0.  So, on the surface, it looks "cheaper" than Medigap G.

Beyond the Medicare B ($174.70/month)and Medigap G (or Advantage premium in our case), I have been surprised by the medical costs my DS and I have incurred (doctor co-pays, dentists, procedures, etc.).  Seems like the check-engine light comes on every year.  Our out-of-pocket costs (beyond the premiums) have been:

2019 - $7,200 (back surgery and costco hearing aids)
2020 - $4,500 (rotator cuff)
2021 - $5,100 (knee replacement, eye glasses)
2022 - $7,600 (crown replacement was $2,000 plus lumpectomy/radiation and eyeglasses)
2023 - $4,000 (other rotator cuff)
2024 - $4,700 YTD (including new costco hearing aids @ $1,600 and new eyeglasses @ $600)

Pretty consistent at $5,000/yr plus one off events.  I consider us healthy, active seniors without obvious healthcare problems - yet aging continues to catch up to us.  Knock on wood, 2024 looks like a low cost medical expense year.

Even though Medicare/Medigap do not cover dental, don't forget this piece as it gets very expensive very fast.

Hope this helps a bit.

[blue_green_sparks]

Before I signed up for Medicare a couple years ago a friend (who is a retired doctor) advised me to sign up through Boomer Benefits  at https://boomerbenefits.com/

They will sort through all the options for you and make comparisons.  There is no fee; I think they get a commission (like so many web sites do) from the medigap providers. 

But the reason to use them is that forever after if you have any issues about charges or reimbursements with medicare of your supplemental provider they will handle them for you.  This has been tremendous for me when I was wrongly billed twice in my first year.  They are happy to be on a call with you or handle it independently.  I can not say enough nice things about them.

I believe that coverage under any 'G' medigap plan is identical by rule, however the monthly premiums vary. I will give that site a try, thanks....especially helpful if it tracks the % increases the various providers have been charging each year.

[blue_green_sparks]

We were on ACA for 4 years before qualifying for Medicare.  We opted for an Advantage Plan through Kaiser instead of a Medigap plan.  Our Kaiser Basic Advantage plan was +/- $40/month for 4 years until this year when the premium changed to $0.  So, on the surface, it looks "cheaper" than Medigap G.

Beyond the Medicare B ($174.70/month)and Medigap G (or Advantage premium in our case), I have been surprised by the medical costs my DS and I have incurred (doctor co-pays, dentists, procedures, etc.).  Seems like the check-engine light comes on every year.  Our out-of-pocket costs (beyond the premiums) have been:

2019 - $7,200 (back surgery and costco hearing aids)
2020 - $4,500 (rotator cuff)
2021 - $5,100 (knee replacement, eye glasses)
2022 - $7,600 (crown replacement was $2,000 plus lumpectomy/radiation and eyeglasses)
2023 - $4,000 (other rotator cuff)
2024 - $4,700 YTD (including new costco hearing aids @ $1,600 and new eyeglasses @ $600)

Pretty consistent at $5,000/yr plus one off events.  I consider us healthy, active seniors without obvious healthcare problems - yet aging continues to catch up to us.  Knock on wood, 2024 looks like a low cost medical expense year.

Even though Medicare/Medigap do not cover dental, don't forget this piece as it gets very expensive very fast.

Hope this helps a bit.

Thanks. This sort of thing is not unfamiliar. Just had my gallbladder removed last month and the past 3 years it's been one thing or another. I have a healthy lifestyle, but genetics does not care sometimes. I will avoid advantage plans and we do have dental insurance, but I'll admit for major work, it's only 50% coverage.

[blueberrybushes]

Admittedly, I don't know how Medigap plans work.  Still - I have been pleased with the Advantage plans because I know my costs in advance.  For example:

- $215 for a Total Knee Replacement
- $215 for a colonoscopy regardless of what they find.
- $215 for a Rotator Cuff repair
- $215 for back fusion plus $1500 for 5 nights in the hospital (total cost approached $90K or more)
- $215 for a lumpectomy

Yes, there are the $35 copays for PT and specialists.  If we exceed $4900/year in those out-of-pocket, we don't pay anything.  Yes, we pay $174.70/month for the benefit of fixed expense.

Plan D has been inexpensive because we have not needed drugs beyond hormone therapy for breast cancer.

[jim555]

In NY monthly income under $2,355 gets your Part B paid for under the QI (Qualifying Individual) program.

[bmjohnson35]

Spouse transitions to medicare next year and I will remain on ACA.  I'm also in research mode on this topic.  The one issue I'm still trying to flush out is the issue of pre-existing conditions.  It's my understanding that health issues that arise while under advantage plan can impact you adversely (lack of coverage), if you want to switch to traditional medicare plan down the road.  I'm not sure if the same issue exists for a switch from traditional medicare to an Advantage plan. Once again, I'm just digging into this, so don't fully understand it yet.

[iris lily]

Spouse transitions to medicare next year and I will remain on ACA.  I'm also in research mode on this topic.  The one issue I'm still trying to flush out is the issue of pre-existing conditions.  It's my understanding that health issues that arise while under advantage plan can impact you adversely (lack of coverage), if you want to switch to traditional medicare plan down the road.  I'm not sure if the same issue exists for a switch from traditional medicare to an Advantage plan. Once again, I'm just digging into this, so don't fully understand it yet.

Depending on the state you’re in, there’s all kinds of “gotchas” about Advantage  plans. There’s a reason they dangle all those seemingly freebies in front of you to get you to sign up for an Advantage plan.

We didn’t risk it.

[Ron Scott]

Avoid Medicare Advantage plans unless you live in a state like NY that allows you to switch back and forth throughout the year. Enough with HMOs and gambling…

Additional G vs. N costs work—in general—if you’re going to get hit with a copay every week. Otherwise N is cheaper.

[Car Jack]

I would greatly recommend watching this guy's videos:  https://www.youtube.com/watch?v=MYNz_ufyMOg   Tons of videos, clearly talked about with about every topic Medicare throws at us.  When one of you is signed up for Medicare (even just part A, pre 65), make an account on Medicare.gov and look around.  It's very confusing and complicated and very 1980's website but you can do comparisons of various plans for drugs and you should choose all 5 allowed pharmacies to find the best price.  Beyond that, look at every pharmacy for every drug.  I have one that is most expensive at my "preferred" pharmacy.  A little less at the "in network but not preferred" and with no insurance and a GoodRx sign up I go to another pharmacy and pay 1/4 the cost.

I went through his agency to choose my coverage and they educated me greatly and I get my part 1A (Massachusetts version of G) along with my part D drug plan through them. 

The out of pocket limits you cite will be a huge decrease in costs compared to this year for me. 

[blue_green_sparks]

I am certain Supplemental Plan G is my best value to reasonably prevent a sudden large unplanned expense.  The main concern is that plan G premiums can go up over time and to switch insurance companies to save on premiums you may have to go under medical underwriting (unless you meet some other requirements such as the company leaving your state, etc.)

Of, course drug coverage, dental and vision are not included with Plan G, however, looking at Part D options, I see that between the premiums ($159.60/yr) and $280 deductible you can limit your total drug costs to around $439.60/yr. Knowing what drugs you need, you can shop around. I pay $288/year for dental insurance now that covers everything except the big stuff like crowns or root canals, which I have to pay 50%. I have a vision plan for $99 that covers the exam and some other stuff, I need to look into that again, no pun intended.

So, a few thousand more quid per year for dental, vision and drugs are not worth the risk of having an Advantage Plan where procedures may be denied, and/or costs can rack up should bad luck visit you. I can certainly see why people are attracted to these zed or low premium plans.

Sure costs
medigap g   $201.00   $2,412.00/yr
medicare b  $174.70   $2,096.40/yr
Part D         $13.30     $159.60/yr
Dental                        $288/yr
Vision                         $99
Possible addon costs
Partb deduc               $240.00/yr
D deductable             $280.00/yr

My revised total costs range from $4,767 min to $5,287 max per year plus 50% of any big dental works.

When DW hits 65, it seems my teeny pension may just about cover the two of us for a while, yey!

[Car Jack]

Drugs are grouped into tiers.  Tier 1 has lots of generics and the costs are low.  Mine cost zero.  Tier 2 is more expensive.  Generics are available but not as cheap as tier 1.  I get a tier 2 from Wegman's with a goodRx card and no insurance.  I've paid from $30 to $12.  Tier 3 is high cost drugs with fat people dancing in their TV commercials.  Think Jardiance and Eliquis.  Here's where I just received my 90 day supply from a Canadian pharmacy.  With shipping, it was about $239.  If I were to get it through Medicare, it would have cost me $715. 

Medicare goes into what's known as the doughnut hole when your drugs have totaled a bit over $5k.  With the Wegmans and Canada pharmacy and convincing my doctor that I won't be getting the other TV med, I'll be lucky enough to stay out of the doughnut hole.  So instead of being in the hole and paying $2k for a 90 day supply, I'll stick with the "outside Medicare" suppliers.

Others have had success with Amazon pharmacy and that Shark Tank guy who started a drug company. 

[jim555]

Medicare out-of-pocket drug costs will be capped at $2,000, starting in 2025 thanks to the Dems efforts to close the doughnut hole.