# Retirement, Medicare, drugs, supplemental insurance general discussion



## Milkman (Dec 9, 2016)

The other recent thread got me thinking more about retirement, specifically medical expenses. So as not to derail it I am asking on this one. I am a little over 3 years out from being eligible for Medicare.

Before she passed away my mother had her Medicare through Humana and it covered her medical and drug needs kinda like an HMO. I used to help her with that and it seemed like a good way to go. 

What have you folks who are retired or disabled and on Medicare insurance doing to assure coverage? 

Do you have part D ? 

Do you have a supplemental policy?

Please share your experiences.


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## Armyhunter17 (Dec 9, 2016)

I work in nursing home industry and for any type of short term rehab (knee, hip, post stroke etc...) Medicare or the replacements pay only 20 days at 100% after that you are looking at almost $200 a day.  Look at a supplement.  Traditional medicare is just fine, unless you need the price break on medications that many of the replacements give you.


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## Hooty Hoot (Dec 9, 2016)

I am also at an age where Medicare is fast approaching. The more I research, the more confused I get. There are to many traps along the way without complete information. It seems as though there should be some kind of seminar available that would allow questions and provide answers. There may be but I am not aware of any. My experience with insurance companies has been one that lacked transparency until after the fact. I would like to make a fully educated decision.


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## Milkman (Dec 9, 2016)

Hooty Hoot said:


> I am also at an age where Medicare is fast approaching. The more I research, the more confused I get. There are to many traps along the way without complete information. It seems as though there should be some kind of seminar available that would allow questions and provide answers. There may be but I am not aware of any. My experience with insurance companies has been one that lacked transparency until after the fact. I would like to make a fully educated decision.



True words.   That is why I would like to hear from some folks who are walking that mile today.


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## Milkman (Dec 9, 2016)

Armyhunter17 said:


> I work in nursing home industry and for any type of short term rehab (knee, hip, post stroke etc...) Medicare or the replacements pay only 20 days at 100% after that you are looking at almost $200 a day.  Look at a supplement.  Traditional medicare is just fine, unless you need the price break on medications that many of the replacements give you.



I am aware of long term care insurance being available for purchase pre-need.  Do many of the clients you work with have that sort of insurance ?


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## Oldstick (Dec 9, 2016)

Not quite there yet, but I can vouch for what others said, it is unbelievably confusing and complicated.  I've spent the past year or so trying to help my in-laws sort theirs out.  MIL had to go into a nursing home 6 months ago.

In 2015 My FIL had called up the AARP plan, which is United Health Care wanting to get a supplement plan that covered the 20% stuff that Medicare doesn't pay.  He has been in chemotherapy since early 2015 and the 20% had added up to well over 10K.  But instead of a supplement they sold him their "Medicare Advantage" PPO plan which basically pays the same as Medicare A and B with some added drug, vision and dental benefits so basically he didn't have to get a separate Part D plan for drugs.

He still pays the Part A&B premiums then something like $40 extra to be in the "Advantage" Plan.  The advantage plan did have one benefit of a limit on your out of pocket costs, so around July of this year, the Advantage plan started paying all the claims.  So this is one plus for having that.

But not really enough in his case, so that is where the "Medi-gap" supplement plans come in.  Without a supplement plan, be prepared for a $300 per day hospital co-payment and the 20% of medical care not covered can also add up very fast for those with big health issues.

Hopefully we have him squared away, back on standard Medicare plus Part D plus a supplement plan starting next year.


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## Milkman (Dec 9, 2016)

Oldstick said:


> Not quite there yet, but I can vouch for what others said, it is unbelievably confusing and complicated.  I've spent the past year or so trying to help my in-laws sort theirs out.  MIL had to go into a nursing home 6 months ago.
> 
> In 2015 My FIL had called up the AARP plan, which is United Health Care wanting to get a supplement plan that covered the 20% stuff that Medicare doesn't pay.  He has been in chemotherapy since early 2015 and the 20% had added up to well over 10K.  But instead of a supplement they sold him their "Medicare Advantage" PPO plan which basically pays the same as Medicare A and B with some added drug, vision and dental benefits so basically he didn't have to get a separate Part D plan for drugs.
> 
> ...



Good information !! 

If I understand you correctly your FIL had what sounds like good coverage with the plan he had through AARP.  Why did yall want to change from that to what you are planning to have in January ?


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## georgia357 (Dec 9, 2016)

In my opinion, the Advantage plan is good for somebody that is in good shape and plans on staying that way.  The monthly payments are close to 0 for the plan which almost always covers most drugs.  The most popular Medigap plans are Part F and Part G.  The cost per month for Part G for me is about $100.  The Medigap plans seem to work best for being able to pick your doctor and hospital, Advantage plans are usually harder to pick who and where you want to go to.  With the Medigap plans, you will also have to pick a Part D which is for the drugs, I think my plan is about $25 a month.  I've had quite a few tests done to check for any possible heart or head problems without having to pay a penny out of pocket.  Same for my wife who broke her shoulder and had two operations for it.  If I was a gambler, I would probably have chosen an Advantage plan but I can sleep better knowing that we are covered for anything that comes up.  Somebody with an Advantage plan can, under the right illness and accidents happenings, be in a very deep hole very quick.


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## Oldstick (Dec 9, 2016)

*K*



Milkman said:


> Good information !!
> 
> If I understand you correctly your FIL had what sounds like good coverage with the plan he had through AARP.  Why did yall want to change from that to what you are planning to have in January ?


 
It was a little better than the original Medicare but they still only paid 80% of medical with the same big hospital co-payments as Medicare.  The main benefit was it started paying 100% after he reached an "out of pocket" limit, which I think was around 6K.  So they let him rack up only 6K for the year vs the 20K from the year before on regular Medicare.

So now he is going to have Medicare plus a supplement plan which costs an extra $200 a month and supposed covers all the expenses not paid by Medicare.  It is a gap Plan type F, as mentioned by Georgia357.  We figure he will come out ahead each month that way, or we hope so anyway.

And I forgot to mention, he had no choice in dropping the United Medicare Advantage plan because they chose to drop out of coverage for GA in 2017.  But that gave him an opportunity to sign up for a gap/supplemental plan, which is what he wanted to start with when he called AARP last year.  I didn't know it then, but he most likely didn't qualify for the gap plan last year, because of his severe health.  These plans are totally private companies (with rules and standards imposed by Medicare) but they don't have to accept you if you health doesn't qualify.  But this year he did qualify due to a rule stating he has a guaranteed issue right to either switch to another Advantage plan or to a gap plan when your current plan drops out of the area.


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## Milkman (Dec 12, 2016)

Oldstick said:


> It was a little better than the original Medicare but they still only paid 80% of medical with the same big hospital co-payments as Medicare.  The main benefit was it started paying 100% after he reached an "out of pocket" limit, which I think was around 6K.  So they let him rack up only 6K for the year vs the 20K from the year before on regular Medicare.
> 
> So now he is going to have Medicare plus a supplement plan which costs an extra $200 a month and supposed covers all the expenses not paid by Medicare.  It is a gap Plan type F, as mentioned by Georgia357.  We figure he will come out ahead each month that way, or we hope so anyway.
> 
> And I forgot to mention, he had no choice in dropping the United Medicare Advantage plan because they chose to drop out of coverage for GA in 2017.  But that gave him an opportunity to sign up for a gap/supplemental plan, which is what he wanted to start with when he called AARP last year.  I didn't know it then, but he most likely didn't qualify for the gap plan last year, because of his severe health.  These plans are totally private companies (with rules and standards imposed by Medicare) but they don't have to accept you if you health doesn't qualify.  But this year he did qualify due to a rule stating he has a guaranteed issue right to either switch to another Advantage plan or to a gap plan when your current plan drops out of the area.



Thanks for the details


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## jimbo4116 (Dec 13, 2016)

JUst some anecdotal info.

Used my medicare for the first time about a month ago.
Skin lesion removed and biopsied.

Total charges, doctor, lab, etc. was $389.  

I am still covered under my wife's FEHB insurance. She is not on Medicare yet so it is her primary and my secondary insurance.

Of the $389 I have to pay the $40 co-pay.  Medicare paid $7.39 and BC/CensoredCensored paid the rest.  Don't know if this is normal but it is worrisome.  We had intended to drop her FEHB when she became Medicare eligible and get a less expensive medicare supplement. However this one visit paid the premium for 1 month.  

What range do the premiums for a Medicare Supplement policy run?


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## Milkman (Dec 13, 2016)

jimbo4116 said:


> JUst some anecdotal info.
> 
> Used my medicare for the first time about a month ago.
> Skin lesion removed and biopsied.
> ...



Jimbo,
I dont know if all cases are the same, but a friend who is disabled has medicare. His wife is working and has him covered as well.  
In his case her coverage is primary and medicare is secondary.  You may want to look at the claim you posted from that regard.  Was the amount Blue Cross paid consistent with them being secondary? (20%)


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## jimbo4116 (Dec 13, 2016)

Milkman said:


> Jimbo,
> I dont know if all cases are the same, but a friend who is disabled has medicare. His wife is working and has him covered as well.
> In his case her coverage is primary and medicare is secondary.  You may want to look at the claim you posted from that regard.  Was the amount Blue Cross paid consistent with them being secondary? (20%)



NO, it wasn't consistent.  I would have to look it up. According to the booklet from Medicare the BCBS is primary on her and secondary on me. BCBS paid the entire bill less the 7.39 by MC and $40 copay for BCBS.

I can say this.  Very few things confuse me, but the Explanation of Benefits statement from MC did just that.


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## hipster dufus (Dec 13, 2016)

here is what i know/plan to do. medicare A is free,medicare B is approx 105 month. i have a cheap,280$ a month, hmo. when i am 65 i will get just medicare B . that should leave me w minimal out of pocket. then when wife is 65 that will add another 105 a month.i have a pension and am at this time ineligible for socsec. i hope to have enough qtrs to receive a big enough check to cover medicare B. couple of people i know pay a little less then 200 mo for B and a supplement.u should be able to find decent coverage for 200-250 a month per person.


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## jimbo4116 (Dec 13, 2016)

hipster dufus said:


> here is what i know/plan to do. medicare A is free,medicare B is approx 105 month. i have a cheap,280$ a month, hmo. when i am 65 i will get just medicare B . that should leave me w minimal out of pocket. then when wife is 65 that will add another 105 a month.i have a pension and am at this time ineligible for socsec. i hope to have enough qtrs to receive a big enough check to cover medicare B. couple of people i know pay a little less then 200 mo for B and a supplement.u should be able to find decent coverage for 200-250 a month per person.



My Medicare part B is $126 per month.  My wife's insurance pays for drugs.  Medicare A & B do not.  YOu have to have Part D coverage for drugs.  While I have only one prescription and my cost after wife's insurance pays is $2.30 per month, 50 without insurance. the wife takes 3 or 4 perscriptons. Hers us a couple hundred without insurance.  Have a brother who is a year away from Medicare, no drug insurance. His drug costs are $450 per month.  So it seems to me if you only have part A and B you are exposed on the drugs.  

At this point she is covered and I am covered and this coverage can be carried after she begins Medicare for about 300 per month.  Unless the Part D plans are really cheap I don't see a reason to change from a known quanity to the unknown.


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## deerhunter092 (Dec 13, 2016)

*Medicare Coverage*

Hey Fella's, I work as an insurance broker and specialize in helping Medicare beneficiaries choose the type of supplement or advantage plan that fits their particular needs. Having been around the business my whole life ( my mother started her office approx 20 years ago) i grew up learning the in's and out's of Medicare Insurance. Having Medicare alone in today's society is a very scary place to be in- You are open to deductibles with The part A deductible of $1,316 Per benefit period, not yearly,  and a part B deductible of $183 per year. Part A does not have a premium and cover hospitalization and part B covers Dr visits and etc. After the deductibles are met you then have an 80%/20% coinsurance with medicare only. Drug plans have been around since 2006 and are not mandatory to purchase- the kicker to that is you will be penalized for the months that you do not have a drug plan . Medicare advantage plans and Medicare Supplement plans work two totally different ways- one is not better than the other and vise versa. Everyone's situation is different and everyone's needs for coverage are different. With that being said, it is more efficient to talk to somebody one on one and assess their particular situation to help them decide their best route. I am an independent Broker and represent multiple different companies that offer medicare advantage and medicare supplemental plans, i will be more than happy to answer and help any of my fellow woody's members with their plans. Pm me for any additional questions that you may have.


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## deerhunter092 (Dec 13, 2016)

Milkman said:


> I am aware of long term care insurance being available for purchase pre-need.  Do many of the clients you work with have that sort of insurance ?



Long Term Care insurance is great to have that will cover nursing homes, assisted livings, and in home care. They will have to be taken out separate than medicare advantage or medicare supplemental plans. Medicare alone and medicare advantage plans will typically only cover 100 days in a nursing facility.


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## Milkman (Dec 13, 2016)

jimbo4116 said:


> NO, it wasn't consistent.  I would have to look it up. According to the booklet from Medicare the BCBS is primary on her and secondary on me. BCBS paid the entire bill less the 7.39 by MC and $40 copay for BCBS.
> 
> I can say this.  Very few things confuse me, but the Explanation of Benefits statement from MC did just that.



So was the amount blue cross paid more consistent with them being primary coverage? (80%)


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## Milkman (Dec 13, 2016)

deerhunter092 said:


> Hey Fella's, I work as an insurance broker and specialize in helping Medicare beneficiaries choose the type of supplement or advantage plan that fits their particular needs. Having been around the business my whole life ( my mother started her office approx 20 years ago) i grew up learning the in's and out's of Medicare Insurance. Having Medicare alone in today's society is a very scary place to be in- You are open to deductibles with The part A deductible of $1,316 Per benefit period, not yearly,  and a part B deductible of $183 per year. Part A does not have a premium and cover hospitalization and part B covers Dr visits and etc. After the deductibles are met you then have an 80%/20% coinsurance with medicare only. Drug plans have been around since 2006 and are not mandatory to purchase- the kicker to that is you will be penalized for the months that you do not have a drug plan . Medicare advantage plans and Medicare Supplement plans work two totally different ways- one is not better than the other and vise versa. Everyone's situation is different and everyone's needs for coverage are different. With that being said, it is more efficient to talk to somebody one on one and assess their particular situation to help them decide their best route. I am an independent Broker and represent multiple different companies that offer medicare advantage and medicare supplemental plans, i will be more than happy to answer and help any of my fellow woody's members with their plans. Pm me for any additional questions that you may have.



Thanks for chiming in !!! 

Since you are in the business you should be able to answer general questions here in the thread.  Personal information should be done by PM as you suggest.


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## deerhunter092 (Dec 13, 2016)

jimbo4116 said:


> My Medicare part B is $126 per month.  My wife's insurance pays for drugs.  Medicare A & B do not.  YOu have to have Part D coverage for drugs.  While I have only one prescription and my cost after wife's insurance pays is $2.30 per month, 50 without insurance. the wife takes 3 or 4 perscriptons. Hers us a couple hundred without insurance.  Have a brother who is a year away from Medicare, no drug insurance. His drug costs are $450 per month.  So it seems to me if you only have part A and B you are exposed on the drugs.
> 
> At this point she is covered and I am covered and this coverage can be carried after she begins Medicare for about 300 per month.  Unless the Part D plans are really cheap I don't see a reason to change from a known quanity to the unknown.



Jimbo- i sent you a Pm about your situation.


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## Oldstick (Dec 13, 2016)

deerhunter092 said:


> Everyone's situation is different and everyone's needs for coverage are different. With that being said, it is more efficient to talk to somebody one on one and assess their particular situation to help them decide their best route. I am an independent Broker and represent multiple different companies that offer medicare advantage and medicare supplemental plans, i will be more than happy to answer and help any of my fellow woody's members with their plans. Pm me for any additional questions that you may have.



That is very good advice, it took me months of digging and reading before I had even weak grasp of how all that stuff worked.

Someone asked about the general price of the supplement plans and seems most of them charge according to your age.  The older, the higher of course.  And you don't automatically qualify, depending on your health history.  They offer several different ranges of coverage and the prices we found for a 78 year old were $120 to $300 or so a month, according to what coverage.


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## KyDawg (Dec 13, 2016)

I signed up for long term healt care about 4 years before started receiving SS. If you do it early enough the cost is very low. I would suggest that you talk to several providers of medicare supplements and develop a better understanding of what you are paying for.


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## jimbo4116 (Dec 14, 2016)

Milkman said:


> So was the amount blue cross paid more consistent with them being primary coverage? (80%)



No.  BCBS paid 100% of the Doctor and Lab Charges less $40 copay after MC paid the $7.39.  Wife keeps all those records. I will try to remember to get her to pull them out. 

I do remember the $7.39 because it was an odd amount. Didn't correlate to 20% of anything.

Like I said it confused me and I just put it aside.  In the end everything was paid so I didn't worry with it anymore.  Which is part of the healthcare insurance problem.


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## Milkman (Dec 14, 2016)

jimbo4116 said:


> No.  BCBS paid 100% of the Doctor and Lab Charges less $40 copay after MC paid the $7.39.  Wife keeps all those records. I will try to remember to get her to pull them out.
> 
> I do remember the $7.39 because it was an odd amount. Didn't correlate to 20% of anything.
> 
> Like I said it confused me and I just put it aside.  In the end everything was paid so I didn't worry with it anymore.  Which is part of the healthcare insurance problem.



Sounds like your coverage is like my buddy mentioned above. Your wife's coverage is primary and medicare is secondary.


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## Milkman (Jan 2, 2018)

Ok
Let’s see what anyone has to add to this subject.


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## jimbo4116 (Jan 2, 2018)

Since my last post here I spent 4 days in the hospital.  I recieved a explanation of payment from MC that was for the first 2 days.  A week or so later I received another for the last 2 days.  Seems their "periods" ended during my stay so my MC payments were in two different time periods.

After trying to understand the "explanations" of payment I filed them away.  Now I don't even bother to open them up. They are hazardous to your health.  

Everyone gives BCBS a bad rap, but I have say they have paid every dime Medicare didn't.


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## KyDawg (Jan 2, 2018)

We have medicare and the supplement. We also got a long term health care policy to cover nursing home expenses. I hear people say they they will never go into a nursing home, but some times that decision can be out of your hands. We have one that the premium stays the same, but coverage is increased every year we don't use it. Does not take long in some of those places can wipe out a lot of money. I am not necessarily talking about spending the rest of your life in one, because a good one can do a good job of rehab, to the point you can return pretty much to a normal lifestyle. If so you do not want to do that, way down on money due to nursing home bills.


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## Oldstick (Jan 2, 2018)

I will add that my father-in-law has come out ahead of the game with a Medicare supplement plan.  He signed up with a supplement type F plan from Mutual of Omaha, beginning last January, for $198 a month.  He has to have a type of chemo treatments for a blood marrow disorder every week.  His portion, after Medicare pays, is at least $300+ a month.

The only way he qualified for the supplement plan, due to his pre-existing health, was the Medicare rules that require them to cover you when one of the "Medicare Advantage" plans drops coverage in your area.

So my advice to anyone who's not in the super wealthy classification, is to get a Medicare Supplement plan while you are able, unless you already have an employer or retiree plan available that can act as the supplement.

Medicare Advantage plans are not the same as Medicare Supplement plans, as he found out the hard way, thanks to some help from the phone salesman at "AARP Advantage".


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## BassRaider (Jan 3, 2018)

Retired 8 yrs ago(57). Medical went from $300 mo to $1600 mo ('16). On top was meds and deductibles to the tune of $22k yr. Last year we both turned 65 and our yearly medical was $12k. This year estimates to be $6k + meds and co-pays.
We had to make drastic changes:
I went with Kaiser for $91 mo (doctor $5, specialist $33 + meds) I am more than satisfied with the care the provide.
My wife went with United Health ($192 mo/$89 mo for Rx). She wanted her same doctors.
We each have $134 deducted from SS for Medicare.


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## Oldstick (Jan 16, 2018)

As a heads up, my Mom has discovered a flaw in the system for those with both Medicare and supplement plan.  It shows up when you go to a pharmacy to get "medical equipment" such as diabetic test strips or needles, etc.

Medicare covers equipment under Part B, instead of Part D (prescription drugs).  And for some reason the pharmacies say they cannot file with the supplement plans, so they charge you the coinsurance that part B doesn't pay.  But then evidently, Medicare automatically forwards the claim to your supplement plan which also pays the same coinsurance amount to the pharmacy.

The pharmacy never contacts you or issues you an automatic refund.  She has had this happen both with local pharmacies and with the big chains.  The supervising pharmacist at Wal Mart told her it was a known problem in the system and supposedly a fix is being worked.  In the meantime, she has to make a second visit with her receipts and insurance statements to get her refunds.

Why a double payment like this is not automatically flagged in anyone's accounting systems, is beyond me.


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## Milkman (Feb 22, 2018)

Bump


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