I am on Medicare and have liability and medical. What do you think and have?
Do you need private medicare insurance if you are on Medicare?
- Thread starter Silver Ghost
- Start date
Help Support Yamaha FJR Motorcycle Forum:
SwollenRaccoon
Well-known member
Just started Medicare 7 months ago. Short, correct answer; Yes. Get supplemental coverage. Worth it.
Yes, get supplemental insurance, which will cap the deductible amount that you have to pay if you have a major illness. I chose a plan that costs me ZERO dollars per month!
I have my retiree health insurance AND am just now of Medicare. No way would I drop everything else to depend on that as my sole means of health care. Some places won't accept medicare because of the hoops they have to jump through and the time taken to reimburse (and at what %)? Not unlike all insurance but the difference is that there are options for providers that are less burdensome. If all insurance companies pressed for pricing limits and such like M does, then they'd have fewer ways to dodge, but that's not reality.
Don't delay signing up though. I will never qualify for SS because I don't have enough quarters. I thought that meant I also didn't qualify for Medicare. Oops. Wrong. I waited until I was 67 because it was only then that I learned otherwise. I now (and for the rest of my life) will pay an extra 20% (10% per year) because I DIDN'T use taxpayer's money for 2 years.
08FJR4ME
-WYNPRO-
Blue Cross Blue Shield Advantage Plan. Max out of pocket $5,600 a year. Doesn't cost me a dime. I am reasonably healthy. I can easily come up with the deductible if needed. So I don't worry about the rest.
JMT, Dave
JMT, Dave
Fontanaman
Robin Trower
Hi Silver Ghost. Please call Oklahoma's Senior Health Insurance Counseling Program (SHIP) Toll Free: (800) 763-2828 Local: (405) 521-6628
Oklahoma's web site for Senior Health Insurance Counseling Program https://www.oid.ok.gov/consumers/information-for-seniors/ is full of information to help understand Medicare.
The State Health Insurance Counseling Program (SHIP) is a non-profit organization helping to inform the public about Medicare and other senior health insurance issues. This division provides accurate and objective counseling, assistance, and advocacy relating to
Medicare
Medicare supplements
Medicare Advantage
and other related health coverage plans for Medicare beneficiaries, their representatives, or persons soon to be eligible for Medicare.
The SHIP program is your advocate to make informed Medicare choices unlike the medical insurance brokers.
I used to be a qualified SHIP advisor in Washington State. I stop serving because Medicare was extremely complicated especially for people with disabilities or receiving state assistance. It was the most difficult job I ever had.
Things to consider beside the monthly cost of Medicare include:
If you choose an Advantage Plan (Plan C), please note:
They offer limited coverage outside the county you live in much less the state you live in unless the service is deemed an emergency by the Plan.
Doctor and care received are often limited to facilities and Doctors in the Plan. So if you need surgery for X you may not have coverage to see the best Doctor available.
The Insurance Commission in Washington had many more complaints from consumers about Advantage Plans than Supplemental Plans.
Advantage Plans are offered based on the zip code or county you live in. If you move you may have to change plans. Typically in rural areas there are few plans to choose from.
Most Advantage Plans require prior approval for every procedure, xray, CT scan or test. My preference is to limit to the extent possible the Insurance Company's involvement in my health care choices and those of my Doctor.
Please get a copy of Medicare and You: https://www.medicare.gov/medicare-and-you
Above all go to Oklahoma's web site for Senior Health Insurance Counseling Program https://www.oid.ok.gov/consumers/information-for-seniors/ because there are decisions that are a one way gate or can also affect you for the rest of your life.
Oklahoma's web site for Senior Health Insurance Counseling Program https://www.oid.ok.gov/consumers/information-for-seniors/ is full of information to help understand Medicare.
The State Health Insurance Counseling Program (SHIP) is a non-profit organization helping to inform the public about Medicare and other senior health insurance issues. This division provides accurate and objective counseling, assistance, and advocacy relating to
Medicare
Medicare supplements
Medicare Advantage
and other related health coverage plans for Medicare beneficiaries, their representatives, or persons soon to be eligible for Medicare.
The SHIP program is your advocate to make informed Medicare choices unlike the medical insurance brokers.
I used to be a qualified SHIP advisor in Washington State. I stop serving because Medicare was extremely complicated especially for people with disabilities or receiving state assistance. It was the most difficult job I ever had.
Things to consider beside the monthly cost of Medicare include:
If you choose an Advantage Plan (Plan C), please note:
They offer limited coverage outside the county you live in much less the state you live in unless the service is deemed an emergency by the Plan.
Doctor and care received are often limited to facilities and Doctors in the Plan. So if you need surgery for X you may not have coverage to see the best Doctor available.
The Insurance Commission in Washington had many more complaints from consumers about Advantage Plans than Supplemental Plans.
Advantage Plans are offered based on the zip code or county you live in. If you move you may have to change plans. Typically in rural areas there are few plans to choose from.
Most Advantage Plans require prior approval for every procedure, xray, CT scan or test. My preference is to limit to the extent possible the Insurance Company's involvement in my health care choices and those of my Doctor.
Please get a copy of Medicare and You: https://www.medicare.gov/medicare-and-you
Above all go to Oklahoma's web site for Senior Health Insurance Counseling Program https://www.oid.ok.gov/consumers/information-for-seniors/ because there are decisions that are a one way gate or can also affect you for the rest of your life.
Can of worms just opened.
As said: you definitely want something more than just regular Medicare part A and B (the defaults).
Your primary options are to add supplement plans, aka Medigap (at added cost to you) or to get a Medicare Advantage Plan.
Much of the decision on which way to go is dependent on your state of health and your location.
Traditional Medicare A & B covers most things, but only 80% of the allowable charges, which means you have to come up with the other 20%. If you have even one serious health problem you could be financially ruined (20% of 1M = 200k). That’s why they call the Supplements Medigap, it covers that gap.
The very best Supplemental Plan is G, which covers everything (except outpatient drugs) 100% after your part B deductible, and naturally it costs the most. Here in the northeast a plan G costs right around $300 per month (per person). So for us it would be $7200 in premiums per year in addition to the $175/mo part B premiums they subtract from your social security. And of course you pay those premiums year after year whether you are sick or not. Premiums are also not fixed and can go up.
The opposite end of the spectrum is a Medicare Advantage plan. These are “managed care” plans run by private insurance companies. If you had group health insurance through an employer previously you probably had a managed care plan.
Many MA plans are offered at zero additional premium. You still will have the part B premium subtracted from your SS, and that is what the insurance company gets.
There are two types of MA plans: HMO and PPO. This has to do with the insurer’s network and out of network coverage. The strictest is HMO. Out of network coverage is all but excluded. PPO gives a better coverage in network but still allows some coverage out of network. In both cases you will have deductibles, and co-pays that vary by MA plan. You have to shop around for the best plan that has a good network, ideally one that your preferred physicians and hospitals participate in. MA plans will have a “maximum out of pocket” of what you could have to pay in these deductibles and copays that will be pretty high, generally $5k or more, again varies widely by plan.
With a plan G you will pay a lot in premiums. $7200 over 30 years is $216,000. But you have everything covered.
With a MA plan you would save that $216k, but may have a few years of bad luck and hit the max out of pocket a few times. You’d have to hit max out of pocket of $5k less than 43 times to break even or better.
So it really comes down to whether you can tolerate being in your “network”. Around here our network includes the best doctors and hospitals in the area, so we have a MA plan, but it’s not for everyone.
As said: you definitely want something more than just regular Medicare part A and B (the defaults).
Your primary options are to add supplement plans, aka Medigap (at added cost to you) or to get a Medicare Advantage Plan.
Much of the decision on which way to go is dependent on your state of health and your location.
Traditional Medicare A & B covers most things, but only 80% of the allowable charges, which means you have to come up with the other 20%. If you have even one serious health problem you could be financially ruined (20% of 1M = 200k). That’s why they call the Supplements Medigap, it covers that gap.
The very best Supplemental Plan is G, which covers everything (except outpatient drugs) 100% after your part B deductible, and naturally it costs the most. Here in the northeast a plan G costs right around $300 per month (per person). So for us it would be $7200 in premiums per year in addition to the $175/mo part B premiums they subtract from your social security. And of course you pay those premiums year after year whether you are sick or not. Premiums are also not fixed and can go up.
The opposite end of the spectrum is a Medicare Advantage plan. These are “managed care” plans run by private insurance companies. If you had group health insurance through an employer previously you probably had a managed care plan.
Many MA plans are offered at zero additional premium. You still will have the part B premium subtracted from your SS, and that is what the insurance company gets.
There are two types of MA plans: HMO and PPO. This has to do with the insurer’s network and out of network coverage. The strictest is HMO. Out of network coverage is all but excluded. PPO gives a better coverage in network but still allows some coverage out of network. In both cases you will have deductibles, and co-pays that vary by MA plan. You have to shop around for the best plan that has a good network, ideally one that your preferred physicians and hospitals participate in. MA plans will have a “maximum out of pocket” of what you could have to pay in these deductibles and copays that will be pretty high, generally $5k or more, again varies widely by plan.
With a plan G you will pay a lot in premiums. $7200 over 30 years is $216,000. But you have everything covered.
With a MA plan you would save that $216k, but may have a few years of bad luck and hit the max out of pocket a few times. You’d have to hit max out of pocket of $5k less than 43 times to break even or better.
So it really comes down to whether you can tolerate being in your “network”. Around here our network includes the best doctors and hospitals in the area, so we have a MA plan, but it’s not for everyone.
wfooshee
O, Woe is me!!
I went with a Plan G for mine, because the no-addition-premium Advantage plans don't cover dialysis, and while you can change from one of those plans to a Supplement like Plan N or Plan G and get that coverage, you can't switch once diagnosed as needing dialysis.
My kidney lab numbers are not great, and there is family history, with my dad having been on dialysis for years. I have not been told I need dialysis, but were I on an Advantage plan, I would be stuck with it once I did get told so, and that would guarantee that I reach my out-of-pocket limits every year once dialysis starts (assuming it has to start.)
I couldn't wait to get off of my employer's health plan, which is a high-deductible plan, pays nothing until you reach $5000 for the year, and even then still has copays until you hit an even higher out-of-pocket max. (I pay a lot more in premiums now, but EVERYTHING is covered after the Part B deductible.) I still work there, but I'm coming up on 67, so Medicare it is! I dropped their health plan, but I kept their dental and vision, which is better than anything in Medicare, anywhere.
I also have a prescription plan that started at 11 bucks and change a month, but all my scripts were 100% covered. The premium for my prescription plan dropped to ZERO this year! And my meds are still 100% covered, as generics. So while looking around, DON'T forget about a prescription plan!
Plan N would be cheaper, but involves networks, deductibles, and copays, which Plan G doesn't care about.
Personally, the Advantage plans are a sucker bet. Yeah, they don't cost anything over your Part B premium, they are better coverage than Part B alone, but you can easily run afoul of out-of-network and out-of-pocket expenses. Plan G is pretty much everything over the Part B deductible, including excess charges from doctors who have not agreed to accept Medicare's pricing for services. Plan N is cheaper, has copays and networks, and doesn't cover excess charges, but it's still more comprehensive coverage than just about any Advantage plan.
I visited a Florida Blue office last year, who happens to be an IT customer of my employer, and got all the needed information, presented very clearly and understandably. He resolved all of my confusion and got me set up properly. He's the one that told me about being diagnosed as needing dialysis would remove my eligibility for a plan that covered it.
Weird thing about the Supplemental plans is that they are priced according to your location, even what city or county you're in. I pay twice what some people pay, and less than half of what others pay, for my Plan G. it went up almost 20 bucks a month this year, but with my prescription dropping from nearly 12 to 0 per month, I'm not crying too badly.
My kidney lab numbers are not great, and there is family history, with my dad having been on dialysis for years. I have not been told I need dialysis, but were I on an Advantage plan, I would be stuck with it once I did get told so, and that would guarantee that I reach my out-of-pocket limits every year once dialysis starts (assuming it has to start.)
I couldn't wait to get off of my employer's health plan, which is a high-deductible plan, pays nothing until you reach $5000 for the year, and even then still has copays until you hit an even higher out-of-pocket max. (I pay a lot more in premiums now, but EVERYTHING is covered after the Part B deductible.) I still work there, but I'm coming up on 67, so Medicare it is! I dropped their health plan, but I kept their dental and vision, which is better than anything in Medicare, anywhere.
I also have a prescription plan that started at 11 bucks and change a month, but all my scripts were 100% covered. The premium for my prescription plan dropped to ZERO this year! And my meds are still 100% covered, as generics. So while looking around, DON'T forget about a prescription plan!
Plan N would be cheaper, but involves networks, deductibles, and copays, which Plan G doesn't care about.
Personally, the Advantage plans are a sucker bet. Yeah, they don't cost anything over your Part B premium, they are better coverage than Part B alone, but you can easily run afoul of out-of-network and out-of-pocket expenses. Plan G is pretty much everything over the Part B deductible, including excess charges from doctors who have not agreed to accept Medicare's pricing for services. Plan N is cheaper, has copays and networks, and doesn't cover excess charges, but it's still more comprehensive coverage than just about any Advantage plan.
I visited a Florida Blue office last year, who happens to be an IT customer of my employer, and got all the needed information, presented very clearly and understandably. He resolved all of my confusion and got me set up properly. He's the one that told me about being diagnosed as needing dialysis would remove my eligibility for a plan that covered it.
Weird thing about the Supplemental plans is that they are priced according to your location, even what city or county you're in. I pay twice what some people pay, and less than half of what others pay, for my Plan G. it went up almost 20 bucks a month this year, but with my prescription dropping from nearly 12 to 0 per month, I'm not crying too badly.
Last edited:
Similar threads
