Here comes Medicare
- Thread starter AZjeff
- Start date
Here are my final totals with United Health Care Advantage C Plan 2
(important to note plan benefits are location specific and vary)
Important to pay attention of the words "TOTALS for 2022" and "Your Share"
So, my medical costs out of my pocket for the year 2022 was $823.74 out of $122,752.17 billed
My drug costs out of my pocket for the year 2022 was $72.58 out of $391.70
With that said remember I also got free dental check ups and cleanings two times in 2022
Free eye check up and $300 in contact lens at no cost (in my area you only get $300 every two years $150 a year)
Free Premium Gym Membership at Orange Theory over $1200 it would have cost me for the year
Free over the counter medical stuff, everything from Suntan lotion to cold medicine to shower stuff totaling $400
Free $120 prepaid Visa card for doing healthy activities such as annual check up, walking a certain amount every month.
So pretty much my net health cost for the year was $0.00 and my providers and drug store charged retail price of over $123,000 (one hundred and twenty three thousand dollars)
Gosh what a great system! My premiums for all the above, TOTAL price out of my Social Security Check was less than or equal to $200 a month.
(important to note plan benefits are location specific and vary)
Important to pay attention of the words "TOTALS for 2022" and "Your Share"
So, my medical costs out of my pocket for the year 2022 was $823.74 out of $122,752.17 billed
My drug costs out of my pocket for the year 2022 was $72.58 out of $391.70
With that said remember I also got free dental check ups and cleanings two times in 2022
Free eye check up and $300 in contact lens at no cost (in my area you only get $300 every two years $150 a year)
Free Premium Gym Membership at Orange Theory over $1200 it would have cost me for the year
Free over the counter medical stuff, everything from Suntan lotion to cold medicine to shower stuff totaling $400
Free $120 prepaid Visa card for doing healthy activities such as annual check up, walking a certain amount every month.
So pretty much my net health cost for the year was $0.00 and my providers and drug store charged retail price of over $123,000 (one hundred and twenty three thousand dollars)
Gosh what a great system! My premiums for all the above, TOTAL price out of my Social Security Check was less than or equal to $200 a month.
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Medicare pays for those things? I had no idea!!
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- Jun 22, 2022
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- 1,361
Advantage plans are good if you don't need care. As soon as you need healthcare, they will deny it. It's the most profitable scam in the healthcare insurance industry.
Best source of information is always http://www.medicare.gov
Anyone getting near that age should spend a week 5 or 6 hours a day reading everything on the site.
I say this so no one misinterprets what I post as correct and it's IMPOSSIBLE to put all the information in a post.
With that said;
1. Everyone gets Medicare Part A at no cost, it's automatic. It covers hospitalization.
2. Everyone is automatically enrolled in Part B at age 65 (unless you opt out when notified) and currently will deduct just shy of $170 out of your Social Security check but can be much higher depending on income.
3. Part A and Part B take care of most stuff but must be aware they cover 80% with no out of pocket limit. Get real sick and run up $300,000 in bills and you will owe 20% = $60,000
So to avoid that $60,000 you will need supplemental Coverage,
Typically plan G or N very good plans and you barely will have to pay a doctor bill again. Thing is plan G and N will cost you an additional up to $150 a month or so in addition to the Part B cost of $170 (varies GREATLY on your age ect as this is private insurance supplement. Most rates go up as you age.
4. Part A and B and G or N does not cover prescriptions so you will need additional Part D at your expense if you want drug coverage. Again private insurance supplement .
5. None of the above cover dental, vision, hearing or any perks at all.
6. You have the option to skip all the above and go into a Medicare approved Advantage C plan that covers all the above typically at no cost other than the $170 taken out of your Social Security Check or in my case with my plan I pay an additional $24 a month on top of that because I like my plan.
Advantage C plans are private health insurance and medicare pays those companies the heath care premium.
Advantage plans are many, all must be approved by medicare and they MUST at least cover everything medicare does.
Typically they also cover dental, vision, hearing, gym memberships, drug plans and other perks.
Typically there is NO DEDUCTIBLE they pay from your first visit.
So what is the catch?
1. Nothing is free, one, there are networks that you have to stay in, unless an emergency so you need to make sure your health care providers are in the network, ALL the providers provide the search engine for you to check before signing up as well as the government website will help you also. In my area every medical provider where I live which is near the state capital takes my plan, heart hospitals and the TWO major well respected hospital and care networks do too. (lets be real, many workers corporate health plans require you to stay in network too)
2. These Advantage C plans have cost sharing and you will have co-pays when you go to the doctor and for procedures. They typically have out of pocket limits, some of those limits are getting high, my experience as I posted has been you REALLY have to run bills well into the hundreds and hundreds of thousands to hit the limit. My out of pocket limit is $4,500 but other plans get near $8000.
I paid out of pocket as my previous post shows, $900 for the year out of a billed amount over $120,000
3. Even though I paid out of pocket $900 I got back Well over $2000 in perks as posted in my previous post.
Choices are wonderful. I LOVE the Medicare system, there is no right or wrong whatever you are comfortable with.
4. Final = for me I could care less if its an HMO or a PPO the only thing I care about with an HMO is not have to see my primary doctor for a referral to see a specialist, even though that isnt a big deal, for me, I am a thinker and rather just be able to make a call to a specialist without talking to my doctor first. With my HMO plan there is no gate keeper I can call anyone I want, any specialist without a referral from my primary doctor.
If I didnt have that option for me personally I am not sure if I would take the plan and only because it's just another phone call or visit to make, your primary will do anything you want as far as this. Not all HMOs are like this.
One other cool thing about Medicare the burden to make sure you are covered is on the provider/doctor or hospital. IF they provide a procedure that is not Medicare approved they do not get paid and you are not responsible for the cost.
I will be moving to North Carolina soon and I am having fun deciding if I will keep my current plan which id a little different there or go to a new company. My plan will go from being an HMO to a PPO in the new location but Im not as excited about that because there are some changes and I like the HMO thing because I know my costs, if I go to PPO and stay in network the costs are the same but you also have the option to go out of network with what would be the new plan at much higher cost.
Choices are great and I am NOT going to proof read this insanely long post.
but is in reference to my previous one.Also no matter what anyone says educate yourself at http://www.medicare.gov
It's a fantastic site.
My costs are posted a few posts up and also here
https://bobistheoilguy.com/forums/threads/here-comes-medicare.351935/page-3#post-6390069
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Just went on Medicare recently ( both of us ) . Plan G through BC/BS . We used the Via Benefits advisor and it was a big help . My former employer gives us $2050 reimbursement per year to spend on anything medical or health related . We chose to apply it toward our premiums .
It looks like everything is going go smoothly .
It looks like everything is going go smoothly .
Trying to understand this, is this some kind of pension plan?
Your retired and your former employer is giving you $2050 a year for health insurance?
i wasn't even aware of it until It came time to start researching my Medicare supplement options . They refer to it as a reimbursement . I can use it for co-pays , otc purchases and like I said , even insurance premiums . It's $1025 per person . So it comes to $2050 for the both of us . And I'm tickled to get it !
@AZ whot did yhou do. Hope you want with "G" it was "F" when I enrolled. Advantage is way more cheaper BUT: There are limits of coverage and you have out of pocket.
With "B" you pay nothing - ever. Except there are limits on amount of hospitalization. But no out of pocket ane it is 100% seamless. If Medicare pays anything. "G" pays the rest. The only time I had to pay something is when it was not a Medicare covered expense.
One other thing in the Medicare Supplement "G" there is no physical and enrollment is guaranteed. If you re3fuse "G" you are not guaranteed to get back on it. You can always go Advantage Plan if you are unhappy with G.
With "B" you pay nothing - ever. Except there are limits on amount of hospitalization. But no out of pocket ane it is 100% seamless. If Medicare pays anything. "G" pays the rest. The only time I had to pay something is when it was not a Medicare covered expense.
One other thing in the Medicare Supplement "G" there is no physical and enrollment is guaranteed. If you re3fuse "G" you are not guaranteed to get back on it. You can always go Advantage Plan if you are unhappy with G.
Completely false and 30 million Americans 46% and still growing are using Advantage C plans.
I posted my personal story for 2022 above. It was stupid simple for all my health care which was billed at over $120,000 in 2022. I never had to wait one day for any approvals. I was even surprised, everything is so simple for the patient.
Any insurance plan has denials not matter what it is. From company provided plans to Government medicare to Advantage C plans.
Yes, good news is, with Medicare and Advantage C plans, if you're denied a procedure, they make it easy to appeal and the process is swift.
Things can be denied for so many reasons it's almost stupid but chances are it's because your doctors office left out important information or yes, an employee of the insurance company messed up. An appeal takes care of this and unlike regular company health care when you are still working for a company. An appeal for TRADITIONAL MEDICARE OR ADVANTAGE C has written mandatory procedures that insurance companies must follow. No denying there are more appeals with Advantage C plans and something like 2/3s of appealed procedures are overturned once reviewed and given the green light.
Another built in protection is, the burden is on the health care provider to make sure the procedure is covered, if they do a procedure and it's not covered, guess what? they are reasonable for the cost, not you. You cant not be charged.
If you are in the Medicare system, both Traditional Medicare or Advantage C both plans are mandatory to the same standard.
Meaning if Medicare itself covers a procedure your Advantage C pays.
There is no conspiracy here but like anything in media it can sound like it.
Fact is, Medicare pays the Advantage C plan you freely choose from whatever company that you want and they must follow Medicare rules or they would not be in the system. You can also freely change Advantage C plans once a year, maybe twice.
You can also try out an Advantage C plan, one time, for up to one year and switch back with no underwriting.
I just wanted to post this once but not going to get caught up in insurance debates as no matter what is involved, cars, homes, boats, motorcycle, health Insurance there is always a debate. We all choose what is good for us and we are comfortable with.
Me, I always get what I pay for and I find the system works great.
Any statements made in a forum should always be confirmed by ones self and its easy to do at http://www.medicare.gov
One year update for me. As I originally replied to this thread my advisor put me on original Medicare plan withe the various supplements. Not cheap. However, it paid a 24 hour- $16,000.00 hospital stay. I paid about $100.00 of that. This past open enrollment we took a look at it again. It turns out I was going to the same doctors, hospital, etc as one of the Medicare Advantage plans sponsored by the defacto medical provider in my state. No pre- approvals needed. So I enrolled in their plan- got additional benefits and saved $2,500.00 a year. You really need to review once a year with somebody who does plans for a living. As stated by Alarmguy- Advantage plans have changed dramatically ( for the better) in the last several years and are highly regulated. BTW- emergency medical care is covered anywhere in the U.S. by most plans. Not covered out of country- but most seasoned travellers know this and buy travel Insurance.
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It's the one government run program that actually works in my opinion.
I have an Advantage "C" plan at almost no cost other than the monthly deduction from Social Security and assume you saw my 2022 bill from above which included a heart procedure.
Over $122,000 in billed medical expenses for the year. I paid $823.24 of that billed amount, Plus got free dental, contact lens, over $1200 in gym membership, $400 in over the counter products and $120 for healthy activities.
With that said, certainly Medicare A, B, D, and a supplemental plan (G or N) is fine for those who wish too! We all choose what works for us as individuals, no right or wrong. I have family members in both plans. I say over and over, it's a great system.
It would be great if everyone followed up with updates in here. Hospitals are costly that comes free with Medicare A. I was in for 7 hours and the heart procedure billed over $87,000, my cost (on previous page) $295, key point is to have insurance what one chooses!
PS, whenever I see CKN I think CSN = Crosby Stills and Nash
I still listen to that album.
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