Medicare: Just as I suspected!

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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:
Quote: investopedia link
The Medicare website contains hundreds of pages of information, few of which are easy reading. But it's hard to get an answer to the big question: Why should anyone who has Medicare get a Medigap plan?
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. 


Quote: Huffpost-Belk link
Medicare Part A covers up to 60 days of hospitalization for a single price of $1,184. Do you need more coverage than that for hospitalizations? No!
And I question whether Mgap insurance would help in outlier situation anyway.


Quote: Huffpost-Belk link
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.
  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. 


Quote: Huffpost-Belk link
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.



From the outlier perspective:


Quote: investopedia link
If you are admitted to the hospital [Medicare pays] basic bed and board. However, you may owe up to 20% of some other costs, such as anesthesiologist's fees.
What is it with those guys? I have a story about them. They seem to get away with stuff. 
Quote:
If you are in the hospital for more than 60 days, you have to pay $364 per day. There are similar co-payments for long stays in nursing facilities and hospices.
We have Long Term Care Insurance. 
Quote:
Regular doctor visits and outpatient medical care may cost you too. Your deductible is $185 but, after that, you'll pay up to 20% of the Medicare-approved amount for most doctor services. There's no upper limit.
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
Quote: odiousgambit



Quote: investopedia link
If you are admitted to the hospital [Medicare pays] basic bed and board. However, you may owe up to 20% of some other costs, such as anesthesiologist's fees.
What is it with those guys? I have a story about them. They seem to get away with stuff. 
 


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
Quote: SOOPOO
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.
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
Quote: Evenbob
I have Medicare A and B and Blue
Cross supplemental. As far as I know
I don't need anything else.


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
Quote: Evenbob
I have Medicare A and B and Blue
Cross supplemental. As far as I know
I don't need anything else.
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
Quote: odiousgambit
Yeah, you do, if you just want to sit back and relax, figuring everything will be paid for.



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
Quote: odiousgambit
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


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.
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