Medicare Experience

[k0ua]

Of course I have just touched on the tip of the Medicare iceberg. And keep in mind the rules for one state do not apply to another state even though this is a federal program. For instance Missouri is an issue age state and Oklahoma is an attained age state (I happen to know because I am also licensed in OK.) There are big differences in the premiums for the two states and what they will be going forward

 

[atsah]

I have been on Medicare since 2008, considering what original medicare covers I would never go without a gap policy, I have switched a few times to advantage plans to save on the gap policy but we don't really have good advantage plans here in Maine so I stay with the gap, it is pretty costly though..

I was use to getting the best insurance that cost me nothing at work so I consider Medicare a poor excuse for health insurance considering what they actually pay and what you have to pay for, the prescription drug plans are even worse if you need something that is not generic. I take a medication that costs $16,000 a month to buy here in the lower 48 (and I didn't add three extra 0's by mistake), I buy the same medication from a Canadian company for $291.00 for a two and a half month supply, that's how screwed up our health care system is..

 

[rekees4300]

I take a medication that costs $16,000 a month to buy here in the lower 48 (and I didn't add three extra 0's by mistake), I buy the same medication from a Canadian company for $291.00 for a two and a half month supply, that's how screwed up our health care system is..

WOW and I thought $300/mo was outrageous for a medication! Somebody is getting rich and it's not the consumer!

 

[lt190b]

It is not quite that simple. Yes you can change your advantage plan during the fall open enrollment. But switching supplement plans depends on many things. Here in Missouri we can switch to a different supplement of same coverage for a lower price during our anniversary date without going thru medical underwriting, but most states do not allow that. To switch from Advantage to supplement you will have to go thru medical underwriting. This is a very important point. If you are not Healthy and cannot answer no to the medical underwriting questions, you will NOT be eligible for a supplement, like the one time in your life, the 3 months prior to your birth month at age 65 , your birth month and 3 months post your birth month at age 65 upon your initial enrollment. This is the one most important 7 month period of your life where the decision you make COULD affect the rest of your life as pertains to health. If you remain healthy then you have no worries.

What happens is people fall ill and having been on an advantage plan and having hospital stays etc. They get tired of paying out of pocket up to their yearly maximum and decide a supplement plan looks good. Sorry Charlie, ain't gonna happen. You will be stuck in Advantage plan world for the rest of your days. Advantage plan world is not all bad, the monthly premiums are either very low or $0 and the copays are reasonable on most of them. If your remain reasonably healthy, you are going to come out ahead when the final tally is taken. The problem comes when you are diagnosed with "something",, then it can get dicey and most then wish they had taken the supplement when they had that golden opportunity to take it at age 65.

For those that are ill at 65 or know they will soon be ill then it is a no brainer, you choose a good supplement from a reputable company (A rated) and never look back, and don't be lured by the siren song of Advantage plans. You can be near death at age 65 and as long as you can sign the paper or have your POA sign it for you, then you are eligible for a supplement. You cannot be refused by the insurance company. The only reason you can be dropped no matter how ill you become is because you failed to make the monthly payment. This is why I advise everyone to always sign up for automatic bank draft from your account. You DO NOT want to forget to make a payment.

kOua, Thanks for your information. lt190b

 

[atsah]

WOW and I thought $300/mo was outrageous for a medication! Somebody is getting rich and it's not the consumer!

It's crazy.. The pharmaceutical company's are part the problem, greed is prevalent in these company's and they force the hospitals to pay absorbent amounts of money for durable medical supply's and medications and of course the daily cost of a room at the local hospital costs more than any normal person can comprehend.

I'm lucky I live in a state that has a law that says I can legally purchase medications from another country without FDA approval, some people are forced to break the law in there state by doing so.

You know things are screwed up when you go to the pharmacy and they tell you your 30 day supply is going to cost you more than a new tractor. When this first happened I went without for two months until I found that I could buy them in Canada dirt cheap and ended up in a hospital bed half dead so it's something I can't do without.

 

[newbury]

The best deal going is for us retired military. Medicare + Tricare For Life = no bills. Just had a serious call bladder situation and ultimate removal; included ER, 4 days in critical care, and 1 day medical floor plus home care and therapy. Total retail price was over $500K. <snip>

WOW and I thought $300/mo was outrageous for a medication! Somebody is getting rich and it's not the consumer!

Medication and services are priced like tools at Harbor Freight. Nobody pays full price except by mistake.

I recently had a small wart frozen off by my doctor. He spent 3 minutes getting the equipment, 3 minutes putting it away, and about a minute freezing the wart with nitrogen. The charge was about $500 to the insurance company, $10 copay for me.

 

[lt190b]

I have been on Medicare since 2008, considering what original medicare covers I would never go without a gap policy, I have switched a few times to advantage plans to save on the gap policy but we don't really have good advantage plans here in Maine so I stay with the gap, it is pretty costly though..

I was use to getting the best insurance that cost me nothing at work so I consider Medicare a poor excuse for health insurance considering what they actually pay and what you have to pay for, the prescription drug plans are even worse if you need something that is not generic. I take a medication that costs $16,000 a month to buy here in the lower 48 (and I didn't add three extra 0's by mistake), I buy the same medication from a Canadian company for $291.00 for a two and a half month supply, that's how screwed up our health care system is..

[I hope this isn't a hijack ,]atsah, would you share the name or maybe a link to the pharmacy or drug company you use in Canada? I went to the pharmacy Tuesday to pick up an order, they said it would be 1315.80 (my share) 2722.91for the 90 day fill. I am trying now to get the med. reduced to a tier 3 instead of tier 4 med. This crazy! lt190b

 

[k0ua]

You guys with supplements and Part D drug plans, don't forget that they need to be reviewed each year (during the Oct to Dec open enrollment period), and looked at very carefully and compared against each other. It takes some skill to do this on Medicare.gov. My wife is the best at it that I have ever seen at doing this. But you can save hundreds if not thousands each year just by choosing a different Part D drug plan. It is hard to imagine there could be such disparity between the plans, but there is. And what is good this year may or may not be good next year.

 

[Citydude]

You guys with supplements and Part D drug plans, don't forget that they need to be reviewed each year (during the Oct to Dec open enrollment period), and looked at very carefully and compared against each other. It takes some skill to do this on Medicare.gov. My wife is the best at it that I have ever seen at doing this. But you can save hundreds if not thousands each year just by choosing a different Part D drug plan. It is hard to imagine there could be such disparity between the plans, but there is. And what is good this year may or may not be good next year.

Thank you James for sharing your expertise. I'm thinking that this tread will benefit a lot of us approaching Medicare age. My hats off to you.

 

[atsah]

[I hope this isn't a hijack ,]atsah, would you share the name or maybe a link to the pharmacy or drug company you use in Canada? I went to the pharmacy Tuesday to pick up an order, they said it would be over 2000.00 (my share) for the 90 day fill. I am trying now to get the med. reduced to a tier 3 instead of tier 4 med. This crazy! lt190b

Canadadrugs.com is one, I have a cheaper one that doesn't have a website I can pm you the information if you like..

OP, no hijack intended..

 

[lt190b]

You guys with supplements and Part D drug plans, don't forget that they need to be reviewed each year (during the Oct to Dec open enrollment period), and looked at very carefully and compared against each other. It takes some skill to do this on Medicare.gov. My wife is the best at it that I have ever seen at doing this. But you can save hundreds if not thousands each year just by choosing a different Part D drug plan. It is hard to imagine there could be such disparity between the plans, but there is. And what is good this year may or may not be good next year.

kOua, we did compare plans in Oct. Liked the same one from 2016 and kept it. Now the meds are not the same price as in the comparison, on the AON website. We have AON thru wife's company (retired). They (insurance co.)said these prices are "estimates".

 

[lt190b]

Canadadrugs.com is one, I have a cheaper one that doesn't have a website I can pm you the information if you like..

OP, no hijack intended..

THANKS atsha! Please send PM. Information is our friend.

 

[k0ua]

Keep in mind that your neighbors or friends or relatives Part D plan may the the absolute best for them, but that does not mean it is the best for you. It depends on what drugs you take, what is on their formulary and what Tier it falls into, and whether the pharmacy's are preferred or not for those drugs. Also don't forget that while the government does not MAKE you take a part D plan out, if you do not take one out when you are eligible, or don't have other credible coverage, or don't have an advantage plan that also includes a drug plan, then you will be fined 1 percent per month from the time you were eligible for each month until you do take out a drug plan, and it is a LIFETIME penalty.

Many people think "well I don't take any drugs, so why should I want a drug plan?" So they wait lets say 10 years, and fall ill and need drugs and want a drug plan. Now their drug plan will be 120 percent higher than it could have been. It is figured against the national average drug plan which is about $33 per month, (varies by year) So while the penalty seems small on a monthly basis, it adds up after a few years, and it never goes away.

I always recommend that you take the cheapest drug plan you can get even if you don't need a drug plan. That is about $17 a month. Why the government says on the one hand "you don't have to do this" and on the other hand "but if you don't, we will punish you forever" is beyond me.. But many of the other rules don't seem fair to me. But no one asked me.

For those of you with advantage plans that include drug coverage, and most do, you don't have to worry about this. But this is something you will have to deal with if you have a supplement. You will want to take out a part D drug plan. Remember the Part D drug plan has nothing to do with your supplement insurance carrier or likely nothing to do with your agent either. I am not appointed with any of the drug companies and have nothing to do with drug plans other than helping folks to understand and choose one.

 

[check]

Wow, what a complex system. Glad I don't have to fuss with all that.

 

[KennyG]

Wow, what a complex system. Glad I don't have to fuss with all that.

I think this is an area people from other countries don't understand when they criticize the US health system. For all my life I was covered by employer provided health insurance and it was so easy. There were options which were easy to compare and evaluate. Coverage was simple and the insurance seemed to work well for the medical providers. Now that I have entered Medicare I find everything much more complicated and hard to understand. The US is at the top in many ways but our government provided services seem to be dysfunctional compared to the rest of the world. That may give you some insight why we are skeptical of a single payer government provided health care system.

 

[atsah]

THANKS atsha! Please send PM. Information is our friend.

PM sent..

 

[lt190b]

PM sent..

thanks

 

[QRTRHRS]

My wife had gone on Medicare before me. Being that she has several medical issues and we were putting alot out in co-pays under my then employee medical coverage, we went with an "F" plan for her supplement and have not looked back. So, when I went on Medicare, I too chose the F plan even though I had few medical issues. That has all changed and I am super glad that I did.

It may not be much but once on SS, your upfront medical insurance expenses are deductable on your taxes. Those co-pays need to be what 7.5% of your income and if I understand it right, that is rising to 10%. Seems like you have to have pretty much one foot in the grave to hit that level?

 

[Tractor Seabee]

My wife had gone on Medicare before me. Being that she has several medical issues and we were putting alot out in co-pays under my then employee medical coverage, we went with an "F" plan for her supplement and have not looked back. So, when I went on Medicare, I too chose the F plan even though I had few medical issues. That has all changed and I am super glad that I did.

It may not be much but once on SS, your upfront medical insurance expenses are deductable on your taxes. Those co-pays need to be what 7.5% of your income and if I understand it right, that is rising to 10%. Seems like you have to have pretty much one foot in the grave to hit that level?

With my Medicare/Tricare program I have a hard time getting to that IRS threshold for tax purposes. A lot of dental bills this year plus my income driven add on to cost of medicare I may get there for last year.
probably do not file Schedule A so that credit is not there.

Ron