Medicare: Just as I suspected!
October 3rd, 2019 at 5:33:51 AM permalink | |
odiousgambit Member since: Oct 28, 2012 Threads: 154 Posts: 5055 | My Medicare comments continued, new thread so as to quit hijacking the 'hospital fees rant' thread. I'll abbreviate the type of insurance I'm talking about, called Supplemental or Medigap, as Mgap. TL,DR: once you quit searching for information the dumb way on such, by finding and relying on the Medicare organization and insurance companies [which come up readily when you google], you find the truth is many of us can easily skip Mgap insurance without putting ourselves at great risk. First: THANK YOU! For me, trying to find out the answer to this from Medicare itself, its website and a giant booklet they sent me, was one big waste of time. Googling for the answer, besides the Medicare org. info, is dominated by insurance companies, who, believe it or not, think you should buy the insurance! Trust us! Full background: I have Medicare parts A and B now. Part D [drugs] I am investigating, that might be a new thread later. I had decided I might not get an Mgap plan after discovering, with my wife's Mgap, that it mainly sells itself with a big lie, i.e. that you should get it so that you have something that "covers what medicare doesn't". We promptly found that actually if it is something that Medicare doesn't cover, that the supplemental insurance doesn't cover it either. Now, you might think the rather mundane things you might be doing these days in doctor's visits and minor but needed procedures, would not include things uncovered by Medicare, but for some reason this thing and that thing pops up, and possibly with the lazy or incompetent participation of the billing people, you pay some out of pocket. Usually this is at the merely irritating level of cost so that you decide you won't complain, just glad the medical people didn't kill you, but believe me you get pissed at your insurance company at each and every cent. I wanted no part of this. I also have a Health Savings Account which is there to make sure I can cover minor things and get the tax benefit at least. However! One day I'm talking with friends and one of them, a Phd and an indisputably smart guy, says he thinks we all need Mgap because you otherwise you could be liable for 100s of thousands of dollars! Well, that got me worried that this could possible be true. The cost of Mgap insurance is not up there where I would expect it to be if it was going to cover catastrophic costs; my wife pays $133/mo currently, give me a break! Yet that means even more that I'd have to be stupid to not have it if it amazingly really was the best deal in insurance anybody ever, ever heard of. Really, an absolute case of insurance company generosity! And I said 'no thank you' ?? So I searched differently this time, including the words "not worth it". Lo and behold, turns out there really are some people out there who've questioned this whole business. Read the articles, the below quotes need to be more fully explained. And I question whether Mgap insurance would help in outlier situation anyway. He goes on to say the 20% you pay is subjected to the lower rates that Medicare agrees to pay, an example being "[for an MRI they might] bill Medicare $4,000. Medicare looks at that $4,000 bill and says "we think that MRI is really worth $580 ... [at 20%] you pay $116". Pretty much then asks if you are someone who might get several a year or not; someone who needs medical care a lot then might benefit from Mgap*. He does not say no one should need it.
From the outlier perspective: What is it with those guys? I have a story about them. They seem to get away with stuff. We have Long Term Care Insurance. Emphasis mine. https://www.huffpost.com/entry/medicare-supplemental-policies_b_3901861 https://www.investopedia.com/articles/personal-finance/110514/medigap-insurance-who-needs-it.asp *don't think the insurance company doesn't have ways of shedding clients that are costing them too much; or not have limits to their liability. It's probably there in the fine print I'm Still Standing, Yeah, Yeah, Yeah [it's an old guy chant for me] |
October 3rd, 2019 at 8:35:11 AM permalink | |
SOOPOO Member since: Feb 19, 2014 Threads: 22 Posts: 4157 |
I'll give you a quick synopsis of this one small part of your post..... THERE WOULD BE NO ANESTHESIOLOGISTS if they were only getting Medicare rates for all the cases done. Lets say your total knee replacement the sleep doc gets $1000 from private insurance. Medicare would 'allow' around $250, meaning they would actually pay $200. And I am required to bill the patient for the other $50. NOT AN OPTION. A REQUIREMENT! So added costs to send two separate bills, and you can only imagine what the collection rate is on that $50. You can't even send the second bill until slow as sh.. Medicare has paid the first one. Oh yeah, medicare deducts an extra 2% of this already paltry fee for the "sequester". Oh yeah, you now have to pay a secretary to accumulate 'quality metrics' or else you lose another 5% or so. Oh yeah, if the patient had surgery because of a previous error, the anesthesiologist will get ZERO for this case. Oh yeah, if the patient is also on Medicaid (EXTREMELY common in the elderly poor) you only get the 80% and are FORBIDDEN from billing Medicaid the difference. Oh yeah, my billing people tell me it is way more difficult to code and bill for Medicare than private insurers. I have said this before...... You let the government take over something...... IT DOES NOT GET BETTER! But to answer your overall question, I have heard few complaints from those that have a "Medicare HMO" type coverage. In my town there are 3 big players.... Encompass65, Senior Blue, and Senior Choice. I am sure I wll be signing up for one of them when I hit Medicare age. |
October 3rd, 2019 at 9:50:14 AM permalink | |
odiousgambit Member since: Oct 28, 2012 Threads: 154 Posts: 5055 | Thanks for replying, maybe I stepped on some toes, oops People don't complain generally, I don't think, about any of the ways to do Medigap. HMO and PPO I think are often called Medicare Advantage plans. Then there's simple supplemental, and though I focused on that I think the same question applies to all, is any of this stuff needed? The few complaints thing: once you accept the idea that such could be taking care of the risk of a catastrophic financial hit, like my plenty smart friend who believes that, and I guess, notice that it is reasonably priced, a person is not going to complain. So this Dr. Belk is one who says it's money down the drain. I do wonder if he underplays the outlier possibilities. I'm Still Standing, Yeah, Yeah, Yeah [it's an old guy chant for me] |
October 3rd, 2019 at 11:02:30 AM permalink | |
Evenbob Member since: Oct 24, 2012 Threads: 146 Posts: 25010 | I have Medicare A and B and Blue Cross supplemental. As far as I know I don't need anything else. If you take a risk, you may lose. If you never take a risk, you will always lose. |
October 3rd, 2019 at 1:24:18 PM permalink | |
SOOPOO Member since: Feb 19, 2014 Threads: 22 Posts: 4157 |
If I put you to sleep you would pay me zilch. MC paid 80%. BC the remaining 20%. You'd never see a bill. Just an EOB (explanation of benefits) |
October 3rd, 2019 at 1:46:34 PM permalink | |
odiousgambit Member since: Oct 28, 2012 Threads: 154 Posts: 5055 | Yeah, you do, if you just want to sit back and relax, figuring everything will be paid for. #1... there's plan D medicare, the drug coverage Dr. Belk questions the need for D, but that goes for supplemental too with him. He covers D in the video, but I notice he doesn't mention one scenario: there's only a certain sign up period for D, so even if you plan to sign up only if you need *expensive* drugs, you could have months of paying ridiculous amounts till you're covered. Otherwise he's right, being able to sign up later means it's the way to go a big huge percentage of the time. It's gambling. #2... maybe you have it and didn't say so, but you also need long term care insurance [LTC]. I think this is one of the things he is getting at, our health care system has moved away from keeping you in the hospital for long periods of time. A long time care case means they shuffle you on out to care outside the hospital, and LTC is the only thing that will pay for it except you. When you run out of money it's Medicaid. A recent Atlantic magazine article bemoaned what they do to your assets to get your money; Medicaid will sell your house to get it, according to the article. I don't know what Belk thinks of LTC. I'm Still Standing, Yeah, Yeah, Yeah [it's an old guy chant for me] |
October 3rd, 2019 at 1:54:51 PM permalink | |
rxwine Member since: Oct 24, 2012 Threads: 188 Posts: 18631 |
I think you need a medicare forum with actual people and experiences. I notice AARP has one (I think) Or maybe start one. It sounds like "the weeds" and too much guessing. You believe in an invisible god, and dismiss people who say they are trans? Really? |
October 3rd, 2019 at 2:45:12 PM permalink | |
Evenbob Member since: Oct 24, 2012 Threads: 146 Posts: 25010 |
Blue Cross supplemental pays for all my drugs. My wife's pension pays for Medicare and BC, $4500 a year for both of us. If you take a risk, you may lose. If you never take a risk, you will always lose. |
October 3rd, 2019 at 3:08:42 PM permalink | |
Mosca Member since: Oct 24, 2012 Threads: 22 Posts: 730 | I just signed up this month. It was confusing as hell. I have A and B. For myself, I take 11 pills, so I signed up for D. It’s $72/mo, but there are many choices. The SS/MC website has a calculator where you put your prescriptions in and it sorts them for convenience (proximity) and cost. I could have chosen $15/mo and a deductible, for example. But I have one pill that is $400/mo without insurance, so I took the higher premium. The prescription drug “donut hole” goes away completely in 2020. I also signed up for G, a Medicare supplement plan, also called Medigap. I’m sick a lot, and hospitalized about once a year. One thing people forget is, that bill comes due when you can least afford it. There are many choices here: E, F, G, and more. I only considered G and F. The difference between them is that there is a small deductible on G, $185? I don’t remember. F has no deductible, but costs more than $185 more than G. 2019 is the last year for part F, get it now or don’t get it. Part C plans are private insurance plans called Medicare Advantage. You are limited to a network, and your claims are handled by a private insurance company. All in all, my coverage costs considerably less than what I was contributing to my employee healthcare. |
October 3rd, 2019 at 3:37:23 PM permalink | |
Mosca Member since: Oct 24, 2012 Threads: 22 Posts: 730 | Long Term Care insurance is almost impossible to get once you get older. Most companies that used to write it don’t write it any more. My father’s premium was about $1500/mo. Of course now he is in LTC, and they are paying 80% of the cost, $6600. So, that’s what insurance is for. If you got nothing really to protect, don’t bother. |