62 replies to this topic

[Phil Smith]

Sorry for the late reply. I had my grandson yesterday.

 

Thanks again everyone!

 

I'm going to break down and contact an agent as many of you have told me to do. But I'd like to go in well prepared.

 

I don't like the idea of having to see in network doctors like you have to with an Advantage Plan, so I think I'm going to opt for a Plan G. A few more questions for those of you with Plan F or G. Let me know if I have this right.

 

Plan A is free.

 

Plan B cost the same and covers the same things regardless of who you get it from. This is by law. "The standard Part B premium amount is $144.60 (or higher depending on your income)"

 

Plan G varies in price a lot as far as I can tell. But just like Plan B, they all cover, again by law, the exact same thing. Once you meet the Plan B deductible ($198), Plan G pays 100%. I do not see why one would opt for anything other than the absolute cheapest plan available.

 

The above info is covered at:
https://www.medicare...sts-at-a-glance

 

If I get a Plan G. Do I still need to get a plan D (drug plan)?

[Pablo]

I turn 65 this August, and I'm (sort of) in the same boat. I say "sort of" because I'm retired military with full benefits. My mailbox is overflowing with people wanting to supplement my Medicare, and the only ads on TV seem to be for drugs and Medicare supplements. They know I'm getting crusty and they know my parts are going to start failing    And as the ship sinks, they want as much of the pie as possible.

 

I'm fortunate, being retired military with full benefits. Tri-Care Prime military is my insurer; once I turn 65 it becomes "Tri-Care for Life". My point isn't to brag, it's to make sure you understand Medicare (government program) becomes your main provider, and anything else is supplemental insurance by private companies designed to ease your financial burden of the things Medicare doesn't fully cover. In my case, all I need to do is play by the rules and sign up for Medicare Parts A and B (four months out) from my 65th birthday, Then I automatically switch from Tri-Care Prime, to Tri-Care for Life. 

 

In the case of civilians, you sign up for the Medicare parts you choose, and either, 1. you pay out of pocket for what Medicare doesn't cover, or  2. you go to a private insurance provider and buy their package, be it as it may. Medicare is a government plan to keep the oldster populace as healthy as possible. They only pay for part. You pay the rest. How you choose to do that is on you.

 

There are a million medicare gap coverage companies out there, as we've discussed here on Slotblog. Let's be clear, all those companies have zero official affiliation with Medicare. They invent a million clever names to make dummies THINK they are THE OFFICIAL source of Medicare gap coverage.

 

Having said that, based on what I know so far, if I was a civilian faced with Medicare gap coverage, I personally would chose a company with a known track record that has been around helping seniors for decades - AARP. If I didn't have Tri-Care military coverage, that's what I would do. I'm no expert. If anything I said is wrong, please tell me. 

 

When my parts start failing, please just numb me up and let me go 

[Phil Smith]

 

Let's be clear, all those companies have zero official affiliation with Medicare. They invent a million clever names to make dummies THINK they are THE OFFICIAL source of Medicare gap coverage.

 

That's no lie! I almost fell for one. Something didn't seem right about the info they wanted, so I checked web address and it was a .com address, not a .org.

[Bill from NH]

AARP health insurance is provided by the United Health Group (United Health Care). My former employer provides me the option of a PPO from uhc. It has worked out well.

[Jay Guard]

To try to make a long and complicated subject short, here are the basics. I'm certainly no pro here but having recently gone through this maze this is what I believe is correct.

 

1) You can go on Medicare and they will pay 80% of covered problems. To add to this you can then buy a "Supplimental Plan" (sometimes called "Medigap") from any number of insurance companies which have a finite number of standardized plans (plans A-?) to cover some or all of the costs Medicare doesn't cover. Medicare is your prime insurer and the private company is the secondary insurer.

 

2) You can go with an "Advantage" plan which is not medicare. Basically the government turns over all of the medical insurance burden to a private insurance company whom the government pays. But be aware that depending on the specific Advantage plan you choose you may or may not have to pay additional over and above what the government has paid. The most important thing to realize is that you are technically not covered by Medicare and your Medicare card will mean absolutely nothing at a medical facility.

[Phil Smith]

Forgive me if what I ask has already been covered.

 

I couldn't' figure out how to sign up for Medicare. I finally broke down and called. Turns out I had to sign up to Social Security's website, and sign up for Medicare there. This was a while back. My Medicare card  arrived in the mail this week, and now I have my Medicare number, which allowed me to create an account on Medicare's website. That's kind of a screwy way of doing things, but hey, it's the government.

 

They automatically signed me up for Parts A and B.

 

I'm going to get a Medigap plan (a plan G I think?) suggested by MattD.

 

Now all I need is a drug plan. The Medicare website gives you all your options. I entered the meds I take and it gives me my yearly total costs, including monthly payment, deductible and out of pocket. There is a huge difference in the price of the plans. The yearly cost of the most expensive is probably 6 times the cost of the cheapest. Other than cost and different deductibles, they all seem the same to me.

 

So my question is, is there any benefit to going with a more expensive drug plan?

[Dave Crevie]

After my recent heart episode, the total hospital and doctor bills totaled $51,370. The combination of Medicare and Medigap part F covered every cent of it.

As to the Part D, it depends more on what you can afford for deductible and co-pays. Now, with the co-pays of my meds coming to over $1100/month, I wish

I had opted for one of the plans that cover more, even though the monthly premium is much more.  

[MattD]

Dave just pointed out the advantage of the "F" plan. It is  one of the highest cost plans, but he doesn't end up owing $10k for his part of the hospital bill. You figure 75%  or more of us will probably have  a major hospitalization like this, maybe two-three times. $50 K is not even the tip of the iceberg. 

 

I had Davinci surgery for Prostate Cancer 11 years ago and that bill was $90K. I'm sure bypass where they crack the chest is well over $100k.

 

You do get some piece of mind knowing that you won't have worry about a big bill if you do have to go through this stuff.

 

The part D is a real disaster; it couldn't have been screwed up more if they had tried. I don't know why they couldn't have offered a couple plans that paid 50%, 70% or 90%, and had thecost based on which plan you bought, that would be a lot easier to figure out which plan is probably best for you. All these guys have the computer program to enter your drugs and tell you  which plan works best for you. After that you are on your own.    

 

We went with Silver Scripts which is one of the cheapest plans, but we take most generic stuff and not anything terribly expensive. One thing I found is Kroger has a plan, called RX something. You pay a membership fee, and get some generics free or really cheap. This looked good as my BP meds are on the list for free. Silver Scripts  sent me a note that the doc could switch one drug and it would be cheaper.   Doc said there was no difference with the drug I currently take. Now both the BP meds cost me $1.99 each for a three-month supply with Silver. The membership to get them free was $35 a year, I think. So the membership deal my BP meds cost $35 a year but free after I pay $35.

 

With Silver the meds cost me $16 a year, but I pay $24 a month for the insurance. When I also get a few other drugs during the year and the cost is usually around $5-$10. This works best for us with the lower level drugs which is what we seem to get. You got to look close at this stuff! Like trying to get through a minefield.    

 

A little rant, instead of these (insert your own word here) in Washington worrying about tariffs, walls, starforce, more free stuff for non-workers, and other BS stuff, it would be nice if they could revamp this system for us retirees to something we could understand and that was simple to look at the different plans and see  the cost and % coverage. I know that is not possible.

[Cheater]

Matt, it's called Kroger Rx Savings Club and I also have it to go along with my Advantage plan, chosen because of the few drugs I take.

 

On Wednesday, I went to my PCP (in network, of course) to have the doc look at a persistent rash on the back of my left calf below the knee that OTC ointments weren't helping. She diagnosed it as psoriasis and prescribed a corticosteroid ointment which does seem to be helping.

Picked up the ointment, about the size of a regular toothpaste tube, at Kroger and the next day, they seemingly wanted to help me feel better by sending an email about how much I had saved at the Kroger pharmacy. Unfortunately, it only made me extremely angry. I suspect I won't need to explain why.

 

 

Not sure whether my Advantage plan or Kroger Rx Club made the big difference here, but who cares? The list price for that corticosteroid ointment is just simply criminal. 

 

(Other drug is simvastatin, 90-day supply.)

[Mike K]

Also go to GoodRX online for any prescriptions that are not covered under your plan. You can get a coupon for most that will give big discounts just like the Kroger plan.

[Dave Crevie]

My problem with the drug cost is that four of the seven meds I take have no generic. A couple, apixaban (for Eliquis) and dronedarone (Multac) have been tied up in the FDA waiting for approval for five years. The metoprolol (Lopressor) has been approved but not widely distributed yet.  Add atorvastatin (Lipitor), hydrochlorothiazide (Microzide), lisinopril and albuterol sulfate, and I've become a walking drugstore. Coverage for tier 4 and 5 drugs is minimal for all the plans. 

 

But they are keeping me alive. (And right now I'm not so sure that is such a good thing).  

[Cheater]

As far as I am concerned, it is a damned good thing...

[MattD]

Back to my post this morning. It's like trying to navigate a mine field trying to figure what coverage is best and affordable. Kind of political but it needs to be said. Much like Medicare is a socialist plan that we all work and pay into so we all have some basic level of care when we turn 65. Drug coverage should be the same. We all pay an equal share so Dave doesn't get bankrupted buying meds and some us make out OK. Seems better if we all paid in and all got treated fair, no BS from the drug companies and gov't. Has there ever been a politician who was not going to hold hearings or legislate some kind of crap for getting reasonable drug prices?

 

The drug companies say these high prices are needed because developing new drugs is so expensive. I just wonder why Americans have to pay all these costs and people go across borders and in those countries the cost is much lower? Make the development cost shared around the world!

 

Greg goes to get a tube of $10-20 cream and they say he saved $1,000. What kind of BS is that?

 

Glad it is helping you, though.

[Bill from NH]

We have the same companies selling the same drugs for different prices, depending upon in which country they're selling it. Yet they say the high US costs are due to developmental costs. That's BS!  Medicare negotiates a maximum selling price with the drug's manufacturer before it's covered in the Medicare system.

[Phil Smith]

Much like Medicare is a socialist plan  that we all work and pay into so we all have some basic level of care when we turn 65,   Drug coverage should be the same.    We all pay an equal share so Dave doesn't get bankrupted buying meds and some us make out OK.    Seems better if we all  paid in and all got treated fair, no bs from the drug companies and gov't.

 

Exactly. Shared expenses. Or in the case of insurance, shared risk. It should work, but of course the gov is involved so it doesn't.

 

What's crazy about stuff like Greg's cream, is that I see that all the time on my med receipts from Walgreens. This is in spite of the fact that my insurance doesn't pay for a penny of it. The lower price is simply a price that was agreed upon when the pharmacy was negotiating to be in the insurance companie's network.

 

And if you don't have insurance, you have to pay that crazy high price. I went through this on a CAT scan. It was ordered by my doctor but for some reason was being held up by my insurance. I told the CAT scan people that my insurance isn't going to pay for any of it, so no need waiting on them, let's just do it. They came back with a price that was three times as high. It didn't matter what my doctor wanted, only what the insurance company wanted.

 

I greatly resent my insurance dictating my health care. That's why I was not interested in an Advantage plan.

 

I've been studying my options for most of the day. I signed up for a plan G. $128 a month. I'm still trying to figure out  a drug plan. I'm probably going to go with a Humana plan. It's really cheap, especially if I use Walmart. I've read bad revues about just about all of them. Hopefully it will be OK. Last thing I need is more insurance frustration.
 

[DavidR]

I went with advantage PPO from Humana no referrals needed and they pay $50 per month of my Medicare part B fee of $135, so only $85 a month is deducted from my SS deposit each month. They also have free generic prescriptions, it's covered every thing I've needed with nothing but a copay,

[Dave Crevie]

The high prices are to cover the insanely high upper management and BoD salaries. I like expensive cars but I fail to see how I could possibly spend $120 million dollars a year, plus just as much in expenses and perks.  

[MattD]

My wife had Humana Walmart, but we switched to Silver Scripts after the first year. Walmart at times was out of a med and she would have to wait three-five days for them to get re-supplied and service was not as good as Kroger and the drive thru window.  $4-$5 more per month, but worth it for us to not have to go in Walmart.

 

Much like the argument over this bailout money coming now, you wonder how much of the "development money recoup" is going to CEO salraies and bonus.

 

Basically kind of sinful that these ceos make $40-$150 million a year, of course that's our country, grab all the money you can. You can run and catch a ball, that ought to be worth 40-50 million for a couple years.

 

It always comes down to the biggest share of cost comes to middle America.

[Phil Smith]

I went with advantage PPO from Humana no referrals needed and they pay $50 per month of my Medicare part B fee of $135, so only $85 a month is deducted from my SS deposit each month. They also have free generic prescriptions, it's covered every thing I've needed with nothing but a copay.

 

That's sounds like a great deal, but I'm determined to get insurance companies out of my life as much as possible. Even with PPO, your doctors still have to be in network. Depending on the insurance company, the network can be extremely small. There were much cheaper options available to me than the Blue Cross I currently have, but the cheaper options had tiny networks compared to Blue Cross. A chemo doctor told me that she had a patient that had one of those cheap plans, and they couldn't find a hospital in the DFW area, a 4-5 million people area, that would take that person's insurance!

 

I think I read that 81% of doctors take Medicare, and probably every hospital, so for that reason alone I don't mind spending more.

 

My wife had Humana Walmart, but we switched to Silver Scripts after the first year. Walmart at times was out of a med and she would have to wait three-five days for them to get re-supplied and service was not as good as Kroger and the drive-thru window. $4-$5 more per month, but worth it for us to not have to go in Walmart.

 

I don't like the idea of having to go to Walmart either. But you actually don't have to go to there. Walgreens, CVS, and Kroger as well as many others are also in network.

 

When comparing plans on Medicare's website, there's a big, sudden jump from the cheaper plans to the much more expensive plans. Four or five times more expensive. I called Silver Script, who is one of the super expensive ones, to ask why. It's because generic Lunesta (sleeping pills) is not approved. If it's approved it cost $20-30 a month. If it's not approved it's $350-375 a month.

 

So my options are limited to the six-seven plans that cover Lunesta. Oddly, my current Blue Cross insurance approves Lunesta. Their Part D plans do not.

 

This insurance stuff is not fun!

[Dave Crevie]

What doctors take from Medicare is the "assignment", that is, what Medicare decides the doctor's services are worth. It is considerably less than what you see on the bill. After the doctor is paid, you will get a statement from Medicare or your insurance company, or both, that describes exactly what they paid for the service. That is partly why the amounts you see on your initial bill seem outrageous. What they actually get is much less. Doctors who don't take assignment won't be listed as "in network".     

[MattD]

You'll be fine with Kroger, Walgreens, or CVS. I think CVS might own Silver Scripts.

[Thom]

One fun thing Ive found since joining Medicare is that my chosen provider AARP United Healthcare sends my wife and I $50 vouchers each quarterly to be used for healthcare items. A catalog full of different choices of vitamins, pain relievers, toothpaste, etc.

 

After making out our list this last time we both had a few dollars left, so back through the catalog. I came across battery-operated toothbrushes, bingo! I now have four new slot car motors

[fxgeorge]

I went with advantage PPO from Humana no referrals needed and they pay $50 per month of my Medicare part B fee of $135, so only $85 a month is deducted from my SS deposit each month. They also have free generic prescriptions, it's covered every thing I've needed with nothing but a copay,

Does this PPO plan have a reasonable monthly premium?

 

I pay the full Part B every month.  My United Healthcare Medicare Advantage Plan has a $0.00 monthly premium.  I like my primary care physician for a $15 copay.  I do not need a referral to see a specialist which is a $45 copay.  My psychotherapist is only a $25 copay and she is great helping me with my slot car addiction.  Can't say I have any complaints about this Advantage Plan.  But, PPO sounds very interesting, so I'm wondering if it has a monthly premium.  

[Phil Smith]

Most people can save using these sources for medications:

GoodRX which is a free service and not insurance, with zero cost to you to use. We use it because it saves money over even Costco or Walmart in most cases.

We do not use a supplement for Medicare or the Prescription plan because the cost of the monthly premium is not cost effective. Why pay another $150 plus your medicare for coverage? In my opinion the supplement plans are a ripoff and not worth the added expense anymore than the Medicare are prescription plan.

In some situations there are plans available to help pay the Medicare base premium if you meet the low income requirements. Check medicare or your state for information...

 

 

Also go to GoodRX online for any prescriptions that are not covered under your plan. You can get a coupon for most that will give big distuacounts just like the Kroger plan.

 

My current drug cost is less than $100 a month. Possibly a lot less. I've never added it up. This is with me paying 100% because I haven't met my deductible. My insurance doesn't pay a penny.

 

For Medicare part D, I chose the plan with the cheapest yearly cost. It was less than $1K a year, about the same I'm paying now. But it dawned on me recently that's for the rest of this year. 8 months. The 12 moth cost is ~ $1,300!

 

I had checked GoodRX when you guys first mentioned them and at the time it seemed like it would be higher. But not now! It's actually a much better deal.

 

So I do online chat with Medicare. I ask if there's any penalty to dropping Part D. And there is. And you have to pay that penalty yearly for the rest of your life.

 

Pretty irritating that my med cost is going to go up. That seems the opposite of what it should be.

[Pablo]

I share your pain, Phil. The entire system is very confusing. I got my Medicare card in the mail yesterday. It says Medicare Part A and Part B are automatic, unless you decline. My (retired military full benefits) Tricare tells me I absolutely HAVE to agree to Medicare A and B to receive Tricare for Life. So I complied, and did not decline. 

 

The scary part for me, personally, is, I absolutely cannot find an answer to my question: how much is Medicare is going to cost me?. As a fully retired military guy, after three wars with full decorations, I shouldn't pay a dime. But here I am, and they just keep slicing my benefits decade after decade.

 

Bottom line of my frustration is, I won't know how much Medicare will cost me until I get the bill. I don't like surprises. I wish I could have calculated how much Medicare will cost me, BEFORE I made my choice. I could have chosen no Medicare, and gone the VA choice, but I didn't.

 

I feel as if I was forced to make a choice before all the info becomes available. Just like Pelosi: "We have to approve the bill before we can know what's in it"

 

That's how I feel right now. Medicare is being shoved down my throat and I have no clue how much it's going to cost me. I've been doing my homework for months now and this is where I am as a 20 year US Navy retiree. 

 

And I'm not even sick! All I need is BP and chol. meds and leave me alone, I'm fine! And I can't even get that now, since I'm not sick I can't get a doctor appt. therefore I can't renew my meds. 

 

I really hope this pandemic ends up improving the medical system. It was broken long before Corona and it needs to be fixed!