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Medicare Supplement Policies


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Well it's finally time for us to choose Medicare Supplements and I stumbled across this article. Of course this now adds to the confusing mix of choices. Anyone care to comment? Any and all discussion welcomed.

 

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.

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.

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Medicare pays more than $580 for a MRI. And while you are healthy it sounds great, but it doesn't take much to generate significant co-pays. Try dermatologist visit, plus 2 skin biopsies, plus MOH surgery for scalp squamous cell lesion, plus more pathology, plus 20 days of radiation therapy, plus 3-4 follow up office visits. That doesn't begin to take in internist/cardiologist visits, plus retinologist exam, etc. Yes, we've spent the winter in physicians offices and this hasn't been usual for us, but as we age the body takes more upkeep.

 

Barb

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His referenced low quote of $200/mon seems high based on my experience. I have a Med Suppl Plan F, one of the higher priced plans that covers everything with no deductible, and it costs me $127/mon. But the price can vary by state, provider and age.

medical insurance is one I always hope I'm paying for something I won't use. but it doesn't take much these days to run up a significant bill. I think the supplement plans are worth the cost, and there are several variations available, so if you prefer to take more risk while healthy and pay a lower premium, go for that option.

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Insurance is one of those things that is only a good deal if you need it. Lower cost supplements also pay for less so you have to balance one against the other. Between the two of us we pay out more than I ever get for mine as I have very little medical needs but Pam has saved a great deal as she has had a major joint replacement surgery about every three years in the past 10 and that has caused our supplements to be a good buy, along with the fact that she has 5 doctors which she sees at least once a year and her primary every three months.

His referenced low quote of $200/mon seems high based on my experience. I have a Med Suppl Plan F, one of the higher priced plans that covers everything with no deductible, and it costs me $127/mon. But the price can vary by state, provider and age.

I agree that the price was high as compared to the lowest cost supplements as Plan F is one of the most expensive and we both have Plan F and we each pay just over $200/month. But we are also both past 70 years old and age is a factor in your premiums, as is your domicile.

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buying a Medicare supplemental policy amounts to little more than giving an insurance company your money so that they can keep it.

 

In 2011, 2012, 2013 I paid out for a F plan a total of $7,914.55

The F plan paid out to doctors, etc. $24,324.81 durring those same 3 years.

Yep! I had MRI's, CAT scans, chemo, radation, operation's etc.

 

You can self insure if you want. But I will keep paying the insurance company.

They may make money on me this year. But that is OK with me.

But I do want them to be there if needed again.

 

I keep paying insurance on my MH and Toad also.

Last time insurance company paid anything out for me was in 1981.

So insurance company has keep all I have gave them since 1981.

But I just keep giving them money every 6 months over and over. :(

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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.

 

This is simply not true if you have a Plan F plan that covers "excess charges". In that case the Supplemental will cover up to 15% above the Medicare payment

 

 

 

In addition, quite a few Supplemental plans provide significantly better "out of the US" benefits than are provided by Medicare parts A and B. Also, some Plan F's cover the copays for skilled nursing care during days 20-100 when Part B only covers 80%. That could be a very significant cost.

 

As for costs, the $200/mo used as an example is excessive IMHO. My wife and I are currently engaged in a complete redo of our insurance because of major changes by how my former employer will handle retiree medical. We're using a major broker that does this sort of thing for large employers and through their website we've been able to compare all the Medigap and Advantage plans available to us in South Dakota (and there are quite a few). We'll be signing up for Plan F Medigap including nursing home and excess charge coverage at a cost of ~$150/mo each. If we wanted less coverage, we could have reduced the cost significantly.

 

IMHO the OP's article is significantly flawed and should not be used by anyone as a guide. It's the sort of misinformation that causes seniors to make poor choices.

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You can only estimate how often or what type of medical care you will require in the future. Your share of the cost without

a supplemental policy could be a lot more then you think. We are all getting older and the cost of health care is only going to go up, maybe large increases.

Many who buy the Medicare supplemental policies feel that they no longer have to worry it.

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This is a good thread for me as we are just beginning to research our Medicare alternatives. I've been trying to see if the plan offered through our retirement package is a good one or if we should look elsewhere. At this time I'm thinking it is worth keeping. It's really option F plus prescription, dental, eye care for just under $200 each (plus Medicare itself).

 

What do you folks think?

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The OP quoted a Huffington Post article that can be found here.

 

Here are some other articles from a very quick Google search on the same subject:

 

https://www.senior65.com/medicare/article/cant-afford-medigap-plan-f

 

http://www.cbsnews.com/news/should-you-buy-a-medigap-or-medicare-advantage-plan/

 

http://www.seniorliving.org/healthcare/buying-medicare-medigap/

 

 

I think that most of us hope that we would never have more than $2400 year in medical bills on top of our Medicare coverage. But after this winter, I can tell you that it can happen very quickly over something as minor as a small skin lesion that turns out to be cancerous and most of us didn't remember our sun screen protection when we were younger!

 

Barb

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The OP quoted a Huffington Post article that can be found here.

 

Thanks for the link, Barb.

 

The author is a David Belk, M.D., who is an internist in California. Just because he's a doctor, doesn't make him an expert on Medicare.

 

I haven't done any in-depth research, but it seems that the answers to the questions (or comments in the article, in this case) could be found at www.medicare.gov.

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I think that most of us hope that we would never have more than $2400 year in medical bills on top of our Medicare coverage.

 

My wife's current supplemental policy paid ~$2k for Medicare copays in 2014. It was an "above average year" but as Barb said, at our ages it's not all that difficult to get to these levels. With our new Plan F we will know precisely what our medical costs for the year will be; for us it's peace of mind.

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We're using a major broker that does this sort of thing for large employers and through their website we've been able to compare all the Medigap and Advantage plans available to us in South Dakota (and there are quite a few). We'll be signing up for Plan F Medigap including nursing home and excess charge coverage at a cost of ~$150/mo each. If we wanted less coverage, we could have reduced the cost significantly.

 

IMHO the OP's article is significantly flawed and should not be used by anyone as a guide. It's the sort of misinformation that causes seniors to make poor choices.

Is you and/or their website available to the general public or is it a consequence of your former employers change?

 

I do agree that this article seemed flawed but wanted to run it past those that have "been there done that".

 

I have a phone appointment with a broker this evening and am leaning to either "F" or "N" (along with part D). "N" was recommended by a family friend/broker in another state as a better value but I'll have to weigh the costs.

One question this group might be able to answer is - How ofter do you incur excess charges? IIRC, I think (other that the annual deductible) that is the main difference between "F" and "N".

 

All comments very welcome.

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My understanding of the primary difference between "F" and "N" is that "N" allows for per-visit copays and "F" does not plus the fact that the "N" covers the Part B deductible. The excess charge issue is minor compared to this difference IMO.

 

For us the cost of Plan F this year will be significantly less than what we were paying for the traditional indemnity plan my former employer had been sponsoring. We had a "Cadillac" plan but we were paying a lot for it. So we see enough of a savings that the monthly cost of Plan F appears low! <_<

 

As for the "broker" website I referred to, it is only available to people using this brokerage as retirees of specific corporations. Sorry.

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"One question this group might be able to answer is - How ofter do you incur excess charges? IIRC, I think (other that the annual deductible) that is the main difference between "F" and "N"."

 

Excess charges rarely occur for most. Any doctor who accepts Medicare patients has already signed a Medicare Assignment agreement that requires them to accept the fixed Medicare value for each service. Excess charges could apply if you went to a specialist or lab that doesn't normally deal with Medicare. In such cases the "excess charge" they are permitted is capped at 15%. Plus there are about 10 states that by state law, completely prohibit "excess charges" for Medicare patients.

 

The primary difference in the N plan is it costs you a $20 copay for every office visit, or $50 for an emergency room visit, and the current $147 annual deductible.

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...Any doctor who accepts Medicare patients has already signed a Medicare Assignment agreement that requires them to accept the fixed Medicare value for each service. Excess charges could apply if you went to a specialist or lab that doesn't normally deal with Medicare. In such cases the "excess charge" they are permitted is capped at 15%...

We have had a couple of instances where the doctors we contacted first would not accept medicare patients at all. This is becoming more common and when you are in new territory while traveling can be one more aggravation to have to deal with.

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We have found that all of the "doc-in-a-box" clinics take Medicare as do all of the hospital emergency rooms. As for specialists, most who deal with chronic diseases of the aging population (cardiac, orthopedic, opthalmologic, neurologic, dermatologic, etc.) all accept Medicare. We needed new primary care physician this winter and used one of the Clinics that a major hospital in the Phoenix area has established - no question about having Medicare and our supplemental insurance - just wanted the numbers ahead of time so that they had it all verified when we arrived.

 

Barb

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