Can someone fact check this - no need for Medicare Supplemental Plan

[rahaparta]

I was sent the following text, originally apparently on huffpost and Dr David Belk videos on this topic are on youtube.

Going from ACA Silver Plan with no monthly premiums (yes, very spoiled) to original Medicare A and B next month and had planned on purchasing a High Deductible Plan G with monthly fee 70.00 and annual deductible about 2400.00 so once medicare Plan B deductible 203.00 met, worst case would be about 2600.00 out of pocket

Medicare Part B is 148.50 and Plan G-HD is 70.00 so annual cost would be 2622.00 for premiums.

Here is the commentary from Dr Belk and would appreciate hearing forum response to fact check

Medicare Supplemental Policies: Do You Need One?

Medicare coverage goes far beyond what almost anyone would ever need, so buying a Medicare supplemental policy amounts to little more than giving an insurance company your money so that they can keep it.

By David Belk MD, Contributor
Board Certified in Internal Medicine
09/16/2013 03:22pm EDT | Updated November 16, 2013

If you're on Medicare or about to receive Medicare you might be wondering: "should I also get supplemental health insurance?" The truth is, if you get supplemental insurance for free (for example, from your former employer), then sure. Otherwise, if you have Medicare and buy a supplemental policy with your own money, you are effectively giving an insurance company your money so that they can keep it.

Here's why:

Supplemental insurance (they'll tell you) covers what Medicare doesn't. That's not quite true, but to understand this, let's see what Medicare really covers.

Medicare Part A covers up to 60 days of hospitalization for a single price of $1,184. Do you need more coverage than that for hospitalizations? No! Here's why:

1. The average length of a hospitalization, even for Medicare patients, is about 5 days. Hospitalizations rarely exceed two weeks and 60-day hospitalizations are practically unheard of. Even hospitalizations for heart attacks or major surgeries rarely exceed a week.
2. An average person might expect to be hospitalized a total of four times after they've retired.

Those facts should make it clear to you that you're unlikely to ever owe more than your $1,184 deductible for a hospitalization any year you have Medicare part A.

What about outpatient costs? How well does Medicare cover you for all of the tests, office visits and treatments you might need if you're not treated in a hospital?

If you have Medicare Part B, it will cover 80 percent of all approved charges for doctor's office visits, blood tests, X-Rays, CT scans, MRIs and ER visits. It even covers IV medications when given at an office or hospital infusion center or a nursing home. This is after you pay a $147 deductible each year.

Now, I want to be clear about what it means when I say Medicare covers 80 percent of approved charges. Let's say your doctor orders an MRI of your knee. The hospital where you get that MRI might bill Medicare $4,000. Medicare looks at that $4,000 bill and says "we think that MRI is really worth $580 and not a penny more!" That means that Medicare pays $464 for that MRI, you pay $116, and the remainder is completely disregarded. No health care provider who accepts Medicare is allowed to go after you for any more than what Medicare approves.
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So, if you have Medicare Part B, your out-of-pocket expenses for a doctor's follow-up visit would be about $16 to $25. A plain X-Ray would cost you about $9, and so on.

So now we can talk about Medicare supplemental insurance policies. What do they really cover? How much do they cost? And are they worth it?

We'll start with what they cover. Supplemental insurance is sold to cover "what Medicare doesn't." Remember I said that wasn't quite true. Unless a supplemental policy specifically states otherwise, the most it will cover are the Medicare deductibles ($147 outpatient and $1,187 hospitalization) and the 20 percent co-insurance. Supplemental policies do not usually cover any medical services Medicare won't cover. What's more, Medicare supplemental insurance will only pay health care providers what you would pay if you didn't have the supplemental policy. Providers aren't paid any more for taking care of you if you have one of these policies.

So that's what you get. How much do they cost? I asked several of my Medicare patients how much they paid for their supplemental policies. The lowest price I was quoted for a policy that covers all Medicare deductible and co-insurance costs was just over $200 a month (or $2,400 a year).

Are they worth that much? I guess that really depends on how much medical care you intend on getting each year. For example, if you're hospitalized at least twice a year, every year, then buying a supplemental policy might be worth it. A supplemental policy would also be a good deal if you get:

-- 20 MRIs every year, or

-- 25 CT scans, or

-- You visit your doctor at least 100 times a year (twice a week), or

-- You get between 500 and 1,000 standard blood tests

You buy insurance to cover what you don't expect. Most Medicare patients only see a doctor about 2 to 4 times a year (if that) and get maybe a few blood tests before each visit. If you need at least 20 times more medical care than that every year, a supplemental policy might be a good deal. But Medicare coverage goes far beyond what almost anyone would ever need so buying a Medicare supplemental policy amounts to little more than giving an insurance company your money so that they can keep it.

[cannotWAIT]

Interested to see what others have to say, but I am on my employer's 70/30 insurance and have hit my $5,000 max OOP several years running and that's without any major catastrophes. I think the risk of an unlimited 20% responsibility running to the many, many thousands of dollars is not that remote.

[rahaparta]

If you ask someone who is on Original Medicare (A and B only), most people answer this incorrectly:

1. Patient in hospital 4 weeks, major surgery, organ damage, cancer, what have you, in Intensive Care
2. Hospital sends a bill for 700,000.00
3. How much is patient responsibilty on Medicare A+B ?

The answer is not 140,000.00, it is 1,484.00

[DaMa]

Medicare does not have an out-of-pocket maximum. 
20% of Part B services can add up fast, especially for things like cancer treatment - and that includes chemo infusion drugs.

Is it worth $840 a year to guarantee your $2400 deductible is all you pay?

[Sibley]

It really depends on your financial situation and your health situation.

If you have a healthy amount of retirement savings and thus can afford to pay what Medicare doesn't pay, then no. You don't need a MedSupp plan. On the other hand, if you don't have a lot of retirement savings, you don't have pensions, etc, and you're really living off SS, then the math starts to change.

If you're generally healthy, routine/preventative care only, no prescriptions, then you're working with that reality. Or maybe you have a list of health issues that's a page long, 20+ prescription meds, and have frequent doctor visits. That's a very different reality.

My parents are in the 2nd reality. Mom has significant health problems. Dad's not that bad, but there's some stuff going on. Lots of doctor visits, lots of meds. And their income is around $40k a year, with minimal savings. Not a lot of wriggle room. For them, paying for the MedSupp is very much worth it, and saves them at least $4k a year AFTER accounting for the premiums. For someone else, it may not be. You need to sit down and do the math.

[DireWolf]

Medigap plans are insurance. In most cases, you will come out slightly worse or break even. BUT, in some cases it will prevent financial stress and ruin. If you want to roll the dice that you fall into the first category, go ahead. I will absolutely be buying the policy.

As it happens, I’ve already had cancer and even had it spread. The spread was removed surgically, but if it comes back, and it probably will eventually, I’m most likely looking at very, very expensive cancer drugs. The IV ones would be totally covered by this.

I could still end up on oral meds that fall under Part D, which at the catastrophic level becomes a 5% co-insurance. I could easily be spending $20K/yr because of that, but it beats $100k/yr.

[DireWolf]

It really depends on your financial situation and your health situation.

If you have a healthy amount of retirement savings and thus can afford to pay what Medicare doesn't pay, then no. You don't need a MedSupp plan. On the other hand, if you don't have a lot of retirement savings, you don't have pensions, etc, and you're really living off SS, then the math starts to change.

If you're generally healthy, routine/preventative care only, no prescriptions, then you're working with that reality. Or maybe you have a list of health issues that's a page long, 20+ prescription meds, and have frequent doctor visits. That's a very different reality.

My parents are in the 2nd reality. Mom has significant health problems. Dad's not that bad, but there's some stuff going on. Lots of doctor visits, lots of meds. And their income is around $40k a year, with minimal savings. Not a lot of wriggle room. For them, paying for the MedSupp is very much worth it, and saves them at least $4k a year AFTER accounting for the premiums. For someone else, it may not be. You need to sit down and do the math.

Unfortunately you don’t know your future. You can be healthy (or think you are) at 65 during your window to get a Medigap without underwriting. Then you can find out a few years later you need expensive care if you want to continue living.

And from what I’ve seen, the poorer you are, the more likely you are to roll the dice and gamble. My dad, coming off a divorce and financial ruin, passed on Part D. His blood pressure medicine was cheap at the time. Then, in his mid-70s he needed a drug costing more a month than he has coming in. He’s taking a way older drug that has issues as a result, while his life would be so much better on the pricey new drug. But he would have to pay the Part D penalty at this point, and it isn’t in the cards for him. The guy that *can* self insure is more likely to just pay the smaller monthly and not risk paying out so much of his money later.

[Abe]

I'm a physician but not an expert on insurance policies or health economics. Here is my non-professional advice, which should not be construed as a patient-physician relationship. Discuss with your doctor the specifics.

Most major expenses are incurred while in the hospital, which as others noted, is mostly covered by Medicare. Thus out-of-hospital costs are the major things to consider because of the 20% co-pay and extremely high cost for some drugs.

I'd recommend thinking about the following basic categories:

a) cancer- do you have a strong family history of any cancer (i.e. parent or sibling with a cancer or multiple other relatives with a cancer). Most cancer risks are increased if there is a family history. Charges for chemotherapy alone is usually >$30k (you'd pay 20%). Other associated costs will easily add thousands to this.

b) autoimmune diseases - these are usually treated with very expensive ($50-100k/year - which you pay 20%) monoclonal antibodies with no set end point (unlike cancer treatment, which usually has a set end). These are not usually strongly inherited (but risk does go up slightly if family members have a given disease).

c) severe heart or lung disease - multiple medications' costs can add up. Much of this is predictable from lifestyle (smoking, poor diet, lack of exercise) and/or family history (heart attack, stroke, type 2 diabetes).

If you have, or there is a strong family history of any of those categories, supplemental insurance will probably benefit you eventually. Unless you are prepared to spend large amounts if necessary, having a set fixed cost is better than wildly fluctuating costs depending on what life throws at you. The other point I'd make is that Americans tend to overestimate how healthy we are, especially as we age.

[mathlete]

if you have Medicare and buy a supplemental policy with your own money, you are effectively giving an insurance company your money so that they can keep it.

So in aggregate, this is true of all insurance. Insurance companies issue policies because in aggregate, they expect to collect more premium than they pay out in claims. If the loss ratio (benefits / premium) on a block of business is say, 80%, then in aggregate, people are getting 80 cents on the dollar worth of benefits.

1. The average length of a hospitalization, even for Medicare patients, is about 5 days. Hospitalizations rarely exceed two weeks and 60-day hospitalizations are practically unheard of. Even hospitalizations for heart attacks or major surgeries rarely exceed a week.
2. An average person might expect to be hospitalized a total of four times after they've retired.

This almost borders on innumeracy. Nobody buys insurance to cover typical use cases. The average home is never destroyed by a fire or a hurricane.

Minimum loss ratios on Medicare supplement plans are Federally mandated to be at least 65%. So the question is, "Is the downside risk of uncovered losses worth as much as 35 cents on the dollar to cover?"

The answer for most people may very well be "no", but the arguments belie a misunderstanding of how insurance works.

[Sibley]

It really depends on your financial situation and your health situation.

If you have a healthy amount of retirement savings and thus can afford to pay what Medicare doesn't pay, then no. You don't need a MedSupp plan. On the other hand, if you don't have a lot of retirement savings, you don't have pensions, etc, and you're really living off SS, then the math starts to change.

If you're generally healthy, routine/preventative care only, no prescriptions, then you're working with that reality. Or maybe you have a list of health issues that's a page long, 20+ prescription meds, and have frequent doctor visits. That's a very different reality.

My parents are in the 2nd reality. Mom has significant health problems. Dad's not that bad, but there's some stuff going on. Lots of doctor visits, lots of meds. And their income is around $40k a year, with minimal savings. Not a lot of wriggle room. For them, paying for the MedSupp is very much worth it, and saves them at least $4k a year AFTER accounting for the premiums. For someone else, it may not be. You need to sit down and do the math.

Unfortunately you don’t know your future. You can be healthy (or think you are) at 65 during your window to get a Medigap without underwriting. Then you can find out a few years later you need expensive care if you want to continue living.

And from what I’ve seen, the poorer you are, the more likely you are to roll the dice and gamble. My dad, coming off a divorce and financial ruin, passed on Part D. His blood pressure medicine was cheap at the time. Then, in his mid-70s he needed a drug costing more a month than he has coming in. He’s taking a way older drug that has issues as a result, while his life would be so much better on the pricey new drug. But he would have to pay the Part D penalty at this point, and it isn’t in the cards for him. The guy that *can* self insure is more likely to just pay the smaller monthly and not risk paying out so much of his money later.

Yes, but if you have $3M in the bank, then you're going to be ok without MedSupp. Doesn't mean you can't choose to get it, but the lack won't cause food insecurity. If you don't have silly amounts of money, then rolling the dice is much riskier. Thus cases like your dad.

[Catbert]

I think this is deserves a classic Clint Eastwood/Harry Callahan quote, "You've got to ask yourself one question: 'Am I feeling lucky?'  Well do ya, punk?..."

As others have noted, skipping the supplement might be fine for many people most of the time.  It will be a very expensive mistake for some and you can't tell who will have future expensive medical problems. 

Using myself as an example, I was in excellent health in my late-60s until this year.  I've been down the rabbit hole trying to get a diagnosis for the underlying issue.  I've been seen by ophthalmology (including retina specialist and neuro-opthamologist), neurology, rheumatology, hematology and more specialities that I only saw in the ED.  As it turns out my underlying autoimmune diagnosis can't be cured and the lifelong medication is old and relatively cheap.  I belong to a large HMO and my co-pays are negligible.  However, it could have been a very expensive year if I'd had to pay 20% of full price.  With a different autoimmune disease the future out-of-pocket cost of medication/treatment could cripple a budget.

So, are you feeling lucky?         

[DeniseNJ]

See below from Medicare website.  If you don't take the medi-gap now and decide to get it later bc you do get sick, you may not be able to.

Buy a policy when you're first eligible
The best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period. You generally will get better prices and more choices among policies. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the first month you have  Medicare Part B (Medical Insurance) and you're 65 or older. It can't be changed or repeated. After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more due to past or present health problems.

During open enrollment
Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.

[DeniseNJ]

Also realize that most ppl get Parts A and B all wrong. 

Part A is NOT all hospital.  Part A is inpatient hospital, inpatient psych, inpatient rehab, skilled nursing facilities, and hospice.  If you aren't officially admitted, they don't pay. And if you are admitted, Part A only pays the facility, not the doctors--that's Part B.

Part B is NOT just providers.  Part B is all hospital that is outpatient or observation, even if you get tests, surgery, meds, etc. in a hospital.  If you aren't officially admitted, even after days, it's Part B that pays and you pay 20 percent and there is no limit. And if you are admitted, Part A pays the hospital, but Part B pays all the doctors!
Part B is also DME and prosthetic supplies, as well as some drugs, and any drugs that go with DME, like insulin if you have an insulin pump.

[Runrooster]

DeniseNJ beat me to it, but I came to reply to say the same thing.
I worked until recently for a cardiology practice in their medical billing.  Towards the end I was solely doing hospital billing.
Every day I fielded phone calls from patients who didn't understand who we were and why we were billing them and doesn't Medicare cover 100% of their hospital bills?  No. It Does Not.  And if you don't have insurance but get charity from the hospital, that doesn't carry over to private doctors.  Hospitals get a lot of governmental assistance - my boss always says - that private physicians don't. 

So, to repeat what she said so clearly: Outpatient and observation, including tests, surgeries, meds, and not covered under part A and thus will cost 20%.  Inpatient as well, for our providers, you will still pay under part B.

I also laughed out loud at the idea that most people only encounter 4 hospital visits in their lifetime.  I only saw the cardiology-related hospitalizations and it wasn't unusual to see someone in the hospital every year, and 3-4 visits in a single year as symptoms progressed.  I will say that 60-day hospitalizations were always concerning, and I actually was excited to hear that one patient was discharged after one (the other patient with a long hospitalization died in the hospital).  Still, part A will not cover all the costs of that long hospitalization. 

ETA:  And, yes, my firm will go after an estate for the costs of that hospitalization even if you don't survive it.

[rahaparta]

My plan on purchasing a High Deductible Plan G is still "the plan", will not buy anything else or any other form of extras on top of original medicare

[Car Jack]

I don't see a mention of the part D, drug plan.  I'm well aware how much I spend on drugs (oh wow, man) and our family has already hit our out of pocket max last month for the year.  So when I do go on Medicare, in about 5 months, I know I'll have to get a part D plan.  Insulin that used to cost $30 a vile a decade ago is now a $35 copay.  I just sent in my flex spending receipts (also way over maxed already), so remember this well.

I am no expert on this.  I watched all the Fidelity videos some time ago and with fliers from Medicare companies every day now, I guess I need to learn more.

[rahaparta]

Actually, I am glad Drug Plan D was mentioned.

I purchase with a GoodRx coupon, a prescription drug that costs 50/month or 600/year

With average Plan D deductible 445, that would mean about 9 months of my currect drug cost(s).
If the average cost of a Plan D is around 35-40, annual cost 420-480, it does not appear logical to pay the monthly premium and deductible, even if the co-pay at month 10 drops to One Dollar ?

Yes, I understand penalty later but consider that reasonable and most expensive stuff (relatives & friends) who have a Plan D, found it cheaper at Costco, Publix, Walgreens etc with GoodRx that using their Plan D benefit(s)

[coppertop]

I have a Medicare Advantage plan; have been eligible for Medicare for just a year now.  My Advantage plan has a zero dollar premium, and so far, it has paid 100% for everything submitted, including minor skin surgery and scar tissue removal after cataract surgery.  I have only paid a $40 co-pay for two specialists - my primary visits are free.  I get my thyroid medication every 90 days for $2.  I have no complaints and I don't know why anyone would turn down the Advantage plan for $0 a month.  I guess it helps that I am basically healthy.  I don't know how it would shake out if I were diabetic or had a heart condition etc.

[rahaparta]

But the MedAdv has a cost ? So you pay something more than 148.50/month? Ok, you say no premium, is that forever?

Also, is it true that doctors prefer original Medicare and that OM does not need any referrals, one just picks almost any doc or specialist?

Does MedAdv allow use of anyone any place without any referrals?

[bmjohnson35]

Fortunately, policies only last a year.  If you are hit hard in a year, you can always go back to supplemental policies the following calendar year.  Only you know your health status/history, financial situation and personal risk tolerance. 

[DaMa]

For Part D I recommend going to Plan Finder https://www.medicare.gov/plan-compare/, entering the drugs you take, and buying the plan that is cheapest for you.  You should have lower cost options.  The cheapest plan available to me is $6.90 per month.  Humana has been offering national plans since 2016 that are less than $20 a month.  $240 a year is cheap considering how expensive drugs are today.

Medicare Advantage can be a good option, and always has an OOP max.  Be very careful to know the network limitations.  MedAdv replaces Medicare completely, so if you go outside the network, you have NO coverage.

[stoaX]

Fortunately, policies only last a year.  If you are hit hard in a year, you can always go back to supplemental policies the following calendar year.  Only you know your health status/history, financial situation and personal risk tolerance.

But if you don't sign up for a Medicare supp plan when you are first eligible, you will be subject to medical underwriting.

[rahaparta]

Cheapest listed plans appeared to be around 85/mo and up....so definitely Not an Option.. I like not having any limits on where to go.

Will just skip all MedAdv and Plan D as it makes to sense for me to have anything in addition to original medicare and G-HD

[iris lily]

OP, one of the burdens of having significant assets is that you probably have to pay to protect them.

 I am old, on Medicare, and I don’t play the game of figuring out how healthy I am and what my odds are for hospital stays and long heal care events. I simply pay for a Medigap policy because I want to protect my stash for the time I really need it.

While  I would love to die broke, I don’t know when I’m going to die and I do not want to be impoverished when I am old, Nor do I want to impoverish my spouse.

If you have no assets then whatever, go bare.

[bmjohnson35]

Fortunately, policies only last a year.  If you are hit hard in a year, you can always go back to supplemental policies the following calendar year.  Only you know your health status/history, financial situation and personal risk tolerance.

But if you don't sign up for a Medicare supp plan when you are first eligible, you will be subject to medical underwriting.

So if I understand you correctly, the supplemental coverage/policy may be modified specific to me at a future date because I didn't elect supplemental coverage during my initial coverage eligibility or during a previous coverage year? 

I have seen this with life insurance coverage at my previous employer, but didn't know it existed for health insurance.

[DaMa]

Fortunately, policies only last a year.  If you are hit hard in a year, you can always go back to supplemental policies the following calendar year.  Only you know your health status/history, financial situation and personal risk tolerance.

But if you don't sign up for a Medicare supp plan when you are first eligible, you will be subject to medical underwriting.

So if I understand you correctly, the supplemental coverage/policy may be modified specific to me at a future date because I didn't elect supplemental coverage during my initial coverage eligibility or during a previous coverage year? 

I have seen this with life insurance coverage at my previous employer, but didn't know it existed for health insurance.

After the ACA was passed, medical underwriting was not allowed in almost all health insurance EXCEPT Medigap. 

In the past, you would fill out a form listing all history of health conditions and medical treatment.  Any pre-existing conditions would be excluded from coverage for a time period (12 months?) and premiums would be set based on your health status.  You could also be denied coverage.  If you had a significant claim, insurance companies would pick through your medical record looking for something you didn't report, and then rescind your policy retroactively, based on your exclusion (rescission). 

I believe Medigap can have preexisting exclusions up to 6 months.  Rescission is also allowed.

[bmjohnson35]

Fortunately, policies only last a year.  If you are hit hard in a year, you can always go back to supplemental policies the following calendar year.  Only you know your health status/history, financial situation and personal risk tolerance.

But if you don't sign up for a Medicare supp plan when you are first eligible, you will be subject to medical underwriting.

So if I understand you correctly, the supplemental coverage/policy may be modified specific to me at a future date because I didn't elect supplemental coverage during my initial coverage eligibility or during a previous coverage year? 

I have seen this with life insurance coverage at my previous employer, but didn't know it existed for health insurance.

After the ACA was passed, medical underwriting was not allowed in almost all health insurance EXCEPT Medigap. 

In the past, you would fill out a form listing all history of health conditions and medical treatment.  Any pre-existing conditions would be excluded from coverage for a time period (12 months?) and premiums would be set based on your health status.  You could also be denied coverage.  If you had a significant claim, insurance companies would pick through your medical record looking for something you didn't report, and then rescind your policy retroactively, based on your exclusion (rescission).   

I believe Medigap can have preexisting exclusions up to 6 months.  Rescission is also allowed.

Wow, they really stuck it to seniors! 

[Cranky]

But the MedAdv has a cost ? So you pay something more than 148.50/month? Ok, you say no premium, is that forever?

Also, is it true that doctors prefer original Medicare and that OM does not need any referrals, one just picks almost any doc or specialist?

Does MedAdv allow use of anyone any place without any referrals?

It depends on where you are - advantage plans have a network, and in some places that may be pretty limited.

In my area, the plan I signed up for covers the University health system, so it’s pretty extensive.

[DireWolf]

Wow, they really stuck it to seniors!

Yeah, it’s pretty crappy. That initial open enrollment period is pretty crucial. I have a lot of older family members that based decisions solely on what was cheapest at the time and didn’t think about the long term consequences of those decisions.

[Sibley]

Wow, they really stuck it to seniors!

Yeah, it’s pretty crappy. That initial open enrollment period is pretty crucial. I have a lot of older family members that based decisions solely on what was cheapest at the time and didn’t think about the long term consequences of those decisions.

What's REALLY crappy is expecting seniors, who are much more likely to be dealing with cognitive decline or impairment, to be able to navigate and understand a system that is complex and contradictory. I have a hard time keeping track of the Medicare and I'm not old, prone to being scammed, or sick. (In reality, I've offloaded the Medicare stuff to my sister. I have the parents a mile from me, she helps in other ways.)

[DeniseNJ]

Another really really important thing to please remember is this:  If you have other insurance, be sure to check with them to see if you are required to take Medicare Part B when you are eligible.  If your contract with your insurance says that you must take Part B as soon as you are eligible and you don't do so, they will not pay for any medical treatments--not even the 20% they would normally be responsible for if you had taken Part B.  So you won't have Medicare and your normal insurance won't pay either.  By the time you realize this you've already been to various docs who didn't get paid.

Then you have to wait until open season to sign up for Medicare and then it doesn't start until a few months later.  You could be without insurance for a year.  When you do finally get Medicare you'll have a higher premium bc you didn't take it as soon as you were eligible. 

To my knowledge, most insurance has this requirement.  Only federal employee, FEHB, does not require you to take Medicare.

[Abe]

Thanks for the information! This is super complicated.

[coppertop]

But the MedAdv has a cost ? So you pay something more than 148.50/month? Ok, you say no premium, is that forever?

Also, is it true that doctors prefer original Medicare and that OM does not need any referrals, one just picks almost any doc or specialist?

Does MedAdv allow use of anyone any place without any referrals?

I don't know about forever, but I just got my booklet for 2022, and again I have no - $0 - premium beyond the $148 and change that comes out of my SS deposit each month.  Copay for specialists is being reduced to $35 from $40 for 2022; most other things remain the same.  I don't need a referral for specialists. I have access to Silver Sneakers, although I have not used it during this season of COVID.  I have dental and vision, which again, I have not yet used.  I have only been Medicare eligible for a year, so this is all new to me.  I have my Advantage plan through Independence Blue Cross - it's called Keystone 65.  I live in PA.

[DaMa]

But the MedAdv has a cost ? So you pay something more than 148.50/month? Ok, you say no premium, is that forever?

Also, is it true that doctors prefer original Medicare and that OM does not need any referrals, one just picks almost any doc or specialist?

Does MedAdv allow use of anyone any place without any referrals?

I don't know about forever, but I just got my booklet for 2022, and again I have no - $0 - premium beyond the $148 and change that comes out of my SS deposit each month.  Copay for specialists is being reduced to $35 from $40 for 2022; most other things remain the same.  I don't need a referral for specialists. I have access to Silver Sneakers, although I have not used it during this season of COVID.  I have dental and vision, which again, I have not yet used.  I have only been Medicare eligible for a year, so this is all new to me.  I have my Advantage plan through Independence Blue Cross - it's called Keystone 65.  I live in PA.

I don't know about forever, either, but I can tell you that the plan I worked at was committed to having a $0 cost plan.  They were picking away at the benefits and tightening the network in order to do it.

[mistymoney]

what happens after 60 days inpatient?

[Cassie]

There’s disadvantages to Advantage plans. First you can’t go back to regular Medicare without passing underwriting after a certain amount of time.  They are allowed to do step therapy for your medical treatment. By the time you get to the step you need it may be too late.  If you travel and get sick you may be out of network. Medicare pays the advantage plan a flat fee yearly for your medical care. It’s to the companies advantage to not spend it all on you because if that happens too often they won’t make money.

[DeniseNJ]

what happens after 60 days inpatient?

You pay this:

$1,484 deductible for each benefit period .
Days 1–60: $0 coinsurance for each benefit period.
Days 61–90: $371 coinsurance per day of each benefit period.
Days 91 and beyond: $742 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime).
Beyond lifetime reserve days : All costs.

[rahaparta]

what happens after 60 days inpatient?

$1,484 deductible for each benefit period .
Days 1–60: $0 coinsurance for each benefit period.
Days 61–90: $371 coinsurance per day of each benefit period.
Days 91 and beyond: $742 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime).
Beyond lifetime reserve days : All costs.

If the above true also if you have a 2,370 max deductible met Plan G High Deductible ?

If I understood the "rules of G-HD" correctly, once the 2,370 was paid out of pocket which includes the 203 Part B -- then the G-HD kicks in/on and you pay no more.

[DaMa]

If the above true also if you have a 2,370 max deductible met Plan G High Deductible ?

If I understood the "rules of G-HD" correctly, once the 2,370 was paid out of pocket which includes the 203 Part B -- then the G-HD kicks in/on and you pay no more.

No.  You pay $2370, then the copays are covered, as well as an additional 365 lifetime reserve days.  I believe you'd pay another deductible if you went into another year.

[henramdrea]

I'm not an insurance specialist or hospital billing specialist or coder, but I'm a medical professional who sits in on all the daily patient status meetings at the hospital.  As others have mentioned, going to the ER and then having 48 hours of hospital "observation" can be costly.  Medicare part A does NOT cover observation.  That is covered under your outpatient, part B.  Some people won't sign up for part B (rare, but happens) and they end up being charged for those 2 days.

When it comes to buying supplemental insurance, it ends up falling into the "F-around and find out" scenario.  Better to have it than not, especially if you/I have a pre-existing condition or if you have hereditary tendencies such as cancer or diabetes.  Please don't "F-around and find out".