Health insurance is stopping us

[Kirk W]

34 minutes ago, Blues said:

Oh, I know there's an open season in which you can change plans.  But the worst that can happen is that on January 2, and not in the middle of the year, you are prescribed a very expensive drug that isn't covered by your plan. 

That is it in simple terms. There are services available that will help you to figure out what plan will serve you best (an example is AON) as well as Medicare has some help if you register for an account with them.  What happens is that you plug in all of the drugs that you currently use and the helper will run those against the formulary lists of the various providers. In most cases, the lower premium plans have higher out of pocket costs if you use many drugs or any of the less common drugs. In our case, my wife has 9 maintenance prescriptions, while I have only 2 and those are very common drugs. In nearly all cases the generic drugs are much more likely to be covered than are name brands, if both are available and in many cases there are differing levels of coverage for drugs that have several choices. Of course, just as you mention this is all based upon what you now take so changes can cost you at least until the first of the next year when any change that you make takes effect. 

34 minutes ago, Blues said:

I bet the vast vast majority of people who aren't on Medicare have no idea how complicated it is,

I am quite sure that you are correct about this, at least for most people. Health insurance has become a very complicated situation and seems to get worse each time that our government medals with it. 

34 minutes ago, Blues said:

Which plan should that person pick?

Drugs, or part D is only half of the issue as your Medigap plan is nearly as complicated, even though there aren't as many plans to choose from. Each type of plan comes with different levels of coverage and a new set of premiums. We are very fortunate that my previous employer subsidizes the Medigap and drug plans, as we could not afford the coverage that we have if that were not the case.

[richfaa]

We were very fortunate to be able to carry over a very good BC/BS plan provided by our employer .Helen and I worked for the same employer, It still cost us  with Medicare over 9K a year for coverage but many pay much more than that. Few years ago Helen had  non life threating surgery that from start to finish had a bill of over 65 K.I think it cost us around 3K out of pocket. We would have been done in had we had to pay that entire bill.

[docj]

2 minutes ago, richfaa said:

Few years ago Helen had  non life threating surgery that from start to finish had a bill of over 65 K.I think it cost us around 3K out of pocket.

With all due respect, I'm not sure why you consider the plan to be all that good.  My spouse has had several surgeries since she went on Medicare and none of them have cost us even a dime.  We have Plan F supplementals which have now been superseded by Plan G.

Our total annual premium costs, including long term care, are less than the $9k you mentioned.

[2gypsies]

29 minutes ago, docj said:

With all due respect, I'm not sure why you consider the plan to be all that good.  My spouse has had several surgeries since she went on Medicare and none of them have cost us even a dime.  We have Plan F supplementals which have now been superseded by Plan G.

Our total annual premium costs, including long term care, are less than the $9k you mentioned.

I agree.... we've had multiple surgeries,including cancer, and never paid anything with Medicare and our supplement with under $9,000/yr cost.  We were also able to carry our previous employers' insurance but declined because of the cost.

Edited September 18, 2020 by 2gypsies

[Kirk W]

35 minutes ago, docj said:

Our total annual premium costs, including long term care,

We carry plan G, and have for some time now. Previously we had plan F but found that the only difference between the two was that G you have to pay the Medicare deductible and our premiums decreased enough to save us about $30/year each by taking on those deductibles. In her case the premiums are $235/month (she is 78), or $2,820 per year. In 2018 she had back surgery for which Medicare approved a cost exceeding $40k and paid 80% of that, with our plan G picking up the remainder. 

One question however. Since all plan G policies must cover the same things, are you sure that yours covers Long Term Care? We have a paid up policy for that and I was sure that no Medigap policy covers it. 

[richfaa]

Our Medicare  premium  is 2942  for the both of us. The BC/BS which was a Federal Government  plan since we both were Federal employees  was 6080 total .  That =  9022 .Medicare did pick up 80 % of the bill.The  out of pocket was for additional cost we choose to incur like private room , TV, Phone and special diet.

This is a edit   We had to go back and check numbers. We made a mistake on our Medicare premium. 

We usually do not have to  pay anything between our  BC/BS and Medicare  BTW our BC/BS plan is 253.00 per month per person for those who may have been federal employees that is code 104 self only was less than self and family. The additional cost was personal choice

 

Edited September 19, 2020 by richfaa

[docj]

21 hours ago, Kirk W said:

One question however. Since all plan G policies must cover the same things, are you sure that yours covers Long Term Care? We have a paid up policy for that and I was sure that no Medigap policy covers it. 

Sorry, I didn't mean to imply that our long term care policy was through Medicare; it's not.  

I went back and looked at our most recent tax returns.  We paid ~$10.5k for health and dental insurance (including  Medicare Part B, Supplementals and Part D) and ~$2k for long term care insurance in 2019.  When I had said $8k I wasn't thinking of the Part B premiums.

Edited September 19, 2020 by docj

[Blues]

On 9/18/2020 at 2:41 PM, Kirk W said:

Drugs, or part D is only half of the issue as your Medigap plan is nearly as complicated, even though there aren't as many plans to choose from. Each type of plan comes with different levels of coverage and a new set of premiums.

True.  And you're not even getting into the quagmire that is Medicare Advantage.  Although Joe Namath assures me that I can get excellent coverage, including rides to the doctor's office, for zero dollars, so maybe that's not all that complicated after all.

Back to the "Medicare for all" cry--all that does it indicate how hopelessly screwed up insurance for non-seniors is, if this Medicare mess is seen as so much better.

 

[Kirk W]

1 hour ago, Blues said:

Back to the "Medicare for all" cry--all that does it indicate how hopelessly screwed up insurance for non-seniors is, if this Medicare mess is seen as so much better.

It gets more complicated and more costly, every time that politicians go to work to fix the health care system, no matter what political party is in control. 

[docj]

2 hours ago, Blues said:

And you're not even getting into the quagmire that is Medicare Advantage.  Although Joe Namath assures me that I can get excellent coverage, including rides to the doctor's office, for zero dollars, so maybe that's not all that complicated after all.

Back to the "Medicare for all" cry--all that does it indicate how hopelessly screwed up insurance for non-seniors is, if this Medicare mess is seen as so much better.

I don't see Medicare as being a "mess" at all.  Yes, it's more complicated than necessary, but it pays our bills and we don't have to fill out ANY paperwork.  Neither my wife nor I have paid for anything other than prescription co-pays and premiums in >8 years.  

As for Medicare Advantage, that was foisted on Medicare by the managed care industry which lobbied Congress so it could get a piece of the Medicare "pie."  They convinced Congress that they were so much more efficient in delivering care that they could provide far more services for the same or less money! 

I've personally never been a fan of managed care, since I like getting the best treatment I can, not  the "best one my plan will pay for!"  I'm sure we all have our favorite managed care horror stories.  Mine is from a friend in TX whose plan wouldn't approve treatment of his wife's cancer at MD Anderson in Houston.  By the time they did approve it, nothing could be done.

[richfaa]

We have no problem with Medicare it has served us well with no problems what so ever...….. Yet. Between our Federal BC/BS and Medicare  it is rare that we  pay any out of pocket.

[Barbaraok]

Medicare is pretty straight forward, 80% of approved charges are paid.  Yes, the 20% could be huge, but once you figure your risk level, then hall  of the supplement insurances must provide the same benefits in each class.  
 

Part D was added later by pharmaceutical interests in the hopes of forestalling Medicare from negotiating drug prices for all beneficiaries.  There is no need for it to be this way.    Worst thing that ever happened was allowing the advertising of prescription drugs to the general public!

and Medicare Advantage programs are good for the companies, not for people.     

[JimK]

16 hours ago, Barbaraok said:

Part D was added later by pharmaceutical interests in the hopes of forestalling Medicare from negotiating drug prices for all beneficiaries.  There is no need for it to be this way.    Worst thing that ever happened was allowing the advertising of prescription drugs to the general public!

 

I agree 100%.  It is way past time for Medicare to negotiate all prices.  On top of that it is very clear that there has been collusion between manufacturers to restrict competition and increase the price of generics.  There have been some major investigations leading to legal action.  Unfortunately it will be years and years before there is any hope of correcting the issue and that will only happen it some highly execs end up in jail.  Sadly it sometimes seems that are government is incapable of doing anything right.  I am still waiting to see some progress on reducing spam calls.  That is my canary in the coal mine.  

[docj]

11 minutes ago, JimK said:

It is way past time for Medicare to negotiate all prices.

When Part D was enacted, Medicare was specifically forbidden by legislation from negotiating drug prices.  The drug companies got what they wanted--a government program to pay for drugs and no ability for the government to negotiate prices! 

[GR "Scott" Cundiff]

I don't think the OP ever returned to the conversation but I agree with JimK (the very first response) that putting off retirement is a prudent thing to do.

Meanwhile, they can start downsizing, getting a rig ready to go, and "practicing" by making local camping trips. 

 

[Bill&Anneli]

YES, health insurance is our biggest bill.... VERY expensive. We are also many years away from medicare. Have been on COBRA thru a former employer, that is about $1,700 per month, which will expire in November this year.

We have shopped a bit, and depending on your income you may  qualify for premium tax credit thru the market place (healthcare.gov). And you can call the insurance agents affiliated with escapees (look under Benefits, endorsed vendors), they offer a different type of coverage that may work for you depending on your health and risk tolerance.

You may want to review the other threads on this forum on this topic. lots of people provide links to different websites with info.

Sorry, yeah, health insurance is a total mess in this country...

[Jacks60]

Thank you for responses relating to my post.  I am aware of the Medicare issues as I am a volunteer advocate for an organisation called  MMAP, Inc (Medicare/Medicaid Assistance Program) In Michigan. It is a free health-benefit counseling service provided to Michigan residents. It's a very intensive/rigid training course where you not only learn about Medicare inside out but the 100 related programs Michigan offers.  I probably didn't make myself clear, but I guess I wanted to ask, how many out there  just have catastrofic  or have found a reasonably priced plan that would bridge the gap until medicare?  The only issue I have is a little arthritis in my hands.

[Randyretired]

On 9/20/2020 at 2:57 PM, Barbaraok said:

 

and Medicare Advantage programs are good for the companies, not for people.     

Millions of people disagree with you and my wife and I are among them.  We have an employer provided Medicare Advantage Program from my DW's former employer.  We have a choice between a Medicare Supplement or this Advantage Plan and we have had both.  The Advantage Plan is best for us.  My DW's former employer picks up the entire tab for either one.  These employer Advantage Plans are different than generally available but still offer some perks like eye glasses and hearing aids.  It would be disappointing if we had to go back to the supplement and more costly.

[Solo18]

On a slightly different topic, but still very important, is what happens when you require a very expensive medication for something like cancer.  The newest cancer "targeted" drugs are very expensive.  I participated in a research study and got all my drugs free, but over 15 months, my total drug bill without Medicare would have been $13,000 per month for one new medication that came in pill form and about $100,000 for a year of the other, which was a monoclonal antibody--a total of about $250,000 for just the meds, let alone the other medical costs.  (A year later, price is still $13,000 per month for the pills, but I am done with them, hopefully, forever.)   I chose the research study for reasons other than drug cost, but the drug cost was shocking.  (The new drug would not have been available to me other than in a research study for various reasons, and I wanted this drug because it had fewer side-effects and was only for 12 months, etc.  I also liked the idea of being followed by a research physician who specialized in my condition.  You get excellent care in most research studies!)

The maximum copay for Medicare Plan D is $10,000 per year, but even that is way out of the means for many people.  However, if you need an incredibly expensive drug, manufacturers do have programs to help you.  Also, there are non-profit organizations that will give you a grant for the co-pay.  I had a choice of another drug, not part of a research study, that would have cost about and because my income was less than five times the poverty level, I was given a grant for the entire $10,000 copay.  I did not use the grant because I did not choose that treatment plan, but it helped me choose which treatment I wanted to choose without considering cost.  (Cost of that medication was $7,000 - $10,000 per month for the rest of my life.)

The important thing is that you need to work with your doctor and hospitals to apply for and get such grants.  No one will offer them to you unless you ask and pursue them.

[vermilye]

I suggest that anyone considering a Medicare Advantage plan over straight Medicare and travels to make sure the Advantage plan will cover you on the road.  Many are extremely localized.  

[Zulu]

19 hours ago, Jacks60 said:

I probably didn't make myself clear, but I guess I wanted to ask, how many out there  just have catastrofic  or have found a reasonably priced plan that would bridge the gap until medicare?  The only issue I have is a little arthritis in my hands.

You were perfectly clear. Since most forum members here know about Medicare but next to nothing about pre-Medicare coverage, that's what they talk about -- Medicare.

Just look at the three posts that came right after your above post -- all Medicare related. You were totally ignored. This thread was hijacked starting from just the 3rd post.

OP, besides the link in Blues previous post, also try this Escapee-sponsored site Health Insurance for RVers which offers options other than the ACA . . . just investigate each option fully.

Finally, my guess is that after the presidential election -- regardless of who is elected -- your health care options will change. Since you planned to retire next year, this may be good or bad news. Wait and see.

[sandsys]

Jacks60, Most escapees are not healthy enough to have only catastrophic care insurance. Most of us are now old and our bodies are showing the results of our lifestyles. So, we aren't really a good group to ask about this issue. I'm sorry we aren't able to give you the answer you need.

Linda Sand

[Jacks60]

Zulu, thank you.  I did feel I was left behind a little.  I certainly will look at the posts you suggested and the link you suggested.  One way or the other we will do this. 

[Jacks60]

That's ok Linda, I just assumed there would be people on here our age, 63 and 65 who were in the same boat.

[Kirk W]

26 minutes ago, Jacks60 said:

I just assumed there would be people on here our age, 63 and 65 who were in the same boat.

Actually I believe that there are some of them but for some reason things did get diverted. Forums tend to be rather like a campfire discussion and wander if the person asking doesn’t get things back on track. Having been on Medicare for 10+ years and before that on an employee’s plan, I’m not much help. 
 

Someone who has other coverage, please join in.