Medicare with Medigap or Medicare Advantage?
- Thread starter ZZman
- Start date
This thinking is incorrect. You're choosing to suggest you are going to have $500,000 procedures every year and hit that $3,450 out of pocket.
This is my problem with posts, we are making incorrect assumptions, then I let myself get caught up spending time writing a book in these threads *LOL*
1. Your premiums will go up with age regarding the Medigap insurance
2. Your $145 monthly does not include, dental care, eye care, hearing and over the counter products plus the many other perks should you choose to take advantage of them and you are not paying $145, you are paying $320. which will go up every year.
3. How to do you think you will hit $3,450 if you had an Advantage C plan? How can you assume you will? What formula are you thinking about? Ending up in nursing care for months? I dont think you understand "out of pocket'? Out of pocket is not a deductible. So you do not spend $3,450 unless extremely sick every year.
My bills in 2022 were $130,000 (one hundred thirty thousand) my cost was $850, that was all.
IN that cost UHC also paid my $1,200 yearly gym bill, my dental bills, my eye care bills and contact lens and $400 in over the counter items, plus my medications.
All told, they paid me to take their plan, not I them. All this for the $175 automatically already taken out of the SS check.
In case you dont know, your Medigap insurance and Part D drug policy is private medicare too.
Pick your plan, choices are great! No one size fits all, choose what you are comfortable, it's great to hear thoughts from various people but some are misleading. The best source is your own research for your area and then of course listen to what others have to say to help you think and confirm what you read.
Never mind other posted stories, those reading these posts can use the following links to see their costs in their area. This is just a sample there are many other companies out there. I believe the first three are among the largest. I like large, more so if an Advantage C plan. It's why I chose United Heath Care and recently last month switched to Aetna health care because both are all over the country as many others. I just like big. I liked UHC a lot, they are the biggest, but Aetna in my case is putting more money in my pocket, I look at it as almost free coverage with all the perks. What I love about the Advantage plans is I can shop and switch every year as many years as I want and I like shopping! *LOL*
With these links you can look at the costs for Medigap Insurance (dont forget Drug Part D coverage if you choose Medigap) and Advantage C plans. Pick and choose what you are comfortable with not what I say or anyone else. We live in the greatest country in the world and the Medicare system works no matter what you choose.
Medicare Coverage Options from UnitedHealthcare
When it comes to Medicare coverage, it's important to know which coverage is the best fit for you. Learn about Medicare plans offered by UnitedHealthcare.
www.uhc.com
Aetna Medicare
Shop 2024 Medicare Insurance Plans | Humana
Find 2024 Humana Medicare insurance plans, including Medicare Advantage and Part D prescription drug plan options. Learn more.
www.humana.com
Medicare | Wellcare
Medicare is a federal health insurance program. Select your state to find details about your particular WellCare program.
www.wellcare.com
and the mother of all sites, straight from your Government, an incredible resource to help you prepare and learn what is available to you.
Welcome to Medicare
The official U.S. government website for Medicare, a health insurance program for people age 65 or older and younger people with disabilities.
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Well.This thinking is incorrect. You're choosing to suggest you are going to have $500,000 procedures every year and hit that $3,450 out of pocket.
This is my problem with posts, we are making incorrect assumptions, then I let myself get caught up spending time writing a book in these threads *LOL*
1. Your premiums will go up with age regarding the Medigap insurance
2. Your $145 monthly does not include, dental care, eye care, hearing and over the country products plus the many other perks should you choose to take advantage of them and you are not paying $145, you are paying $320. which will go up every year.
3. How to do you think you will hit $3,450 if you had an Advantage C plan? How can you assume you will? What formula are you thinking about? Ending up in nursing care for months? I dont think you understand "out of pocket'? Out of pocket is not a deductible. So you do not spend $3,450 unless extremely sick every year.
My bills in 2022 were $130,000 (one hundred thirty thousand) my cost was $850, that was all.
IN that cost UHC also paid my $1,200 yearly gym bill, my dental bills, my eye care bills and contact lens and $400 in over the counter items, plus my medications.
All told, they paid me to take their plan, not I them. All this for the $175 automatically already taken out of the SS check.
In case you dont know, your Medigap insurance and Part D drug policy is private medicare too.
Pick your plan, choices are great! No one size fits all, choose what you are comfortable, it's great to hear thoughts from various people but some are misleading. The best source is your own research for your area and then of course listen to what others have to say to help you think and confirm what you read.
Never mind other posted stories, those reading these posts can use the following links to see their costs in their area. This is just a sample there are many other companies out there. I believe the first three are among the largest. I like large, more so if an Advantage C plan. It's why I chose United Heath Care and recently last month switched to Aetna health care because both are all over the country as many others. I just like big. I liked UHC a lot, they are the biggest, but Aetna in my case is putting more money in my pocket, I look at it as almost free coverage with all the perks. What I love about the Advantage plans is I can shop and switch every year as many years as I want and I like shopping! *LOL*
With these links you can look at the costs for Medigap Insurance (dont forget Drug Part D coverage and Advantage C plans. Pick and choose what you are comfortable with not what I say or anyone else. We live in the greatest country in the world and the Medicare system works no matter what you choose.
Medicare Coverage Options from UnitedHealthcare
When it comes to Medicare coverage, it's important to know which coverage is the best fit for you. Learn about Medicare plans offered by UnitedHealthcare.www.uhc.comAetna Medicare
enroll.aetnamedicare.com
Shop 2024 Medicare Insurance Plans | Humana
Find 2024 Humana Medicare insurance plans, including Medicare Advantage and Part D prescription drug plan options. Learn more.www.humana.comMedicare | Wellcare
Medicare is a federal health insurance program. Select your state to find details about your particular WellCare program.
and the mother of all sites, straight from your Government, an incredible resource to help you prepare and learn what is available to you.
Welcome to Medicare
The official U.S. government website for Medicare, a health insurance program for people age 65 or older and younger people with disabilities.www.medicare.gov
You do go into detail.
I wasted time this AM typing some of that, also pointing out comparing a MAX to a PREMIUM is apples v. oranges. Then I deleted it all and used my own example.
PS Sick of being snowed in! I went into Playtime and found a PB venue a new place, not far. Only two signed up so far. This late afternoon. Can you catch a flight?
I didnt know you played and only recently thought I saw you reference it.
It's addicting isnt it? We still play outdoors, our community has REALLY nice courts. we ar lucky with daytime highs near 60 but that is going to end starting today
Thing is we cant play at night and indoor is limited but I think they are building places. SO we play during my wife lunch break for 1.5 hours and weekends when we can, looking forward to the longer days as the calendar year moves on!
No snow here! Just cold fronts, followed by warm fronts, its back and forth right now.
Yes, thank you, sometimes I feel insane trying to talk about the Medicare stuff in a sane way typing with words. Max to Premiums, you are right on, Apples to Oranges is correct. Actually they are both fruit, Its more like Apples to SUVs they are so far apart
Really, nothing I wrote was misleading. I was primarily responding to/clarifying for Pablo. A "premium" is ...a premium. They pay a premium for their Advantage plan. Not implying anything. I agree that comparing total costs of your different options is wise. No one is disputing that. My other post was to just to provide some insight that sometimes your total monthly cost/perks/etc. may not be the only thing to consider when making your Medicare decisions. Again, choice is great!
I agree, choice is great.
It’s just with the posts sometimes too much is left with the imagination. Just an example is you say they pay premiums but you leave out how much.
Selecting to pay premiums with an advantage C plan is purely optional.
With Medigap G, N it’s mandatory plus you have to select D for a drug plan
The good news is with the links supplied anyone can check for themselves, with an advantage plan you do not have to pay premiums except the mandatory one that comes out of your Social Security check and even that isn’t mandatory if you don’t want coverage.
We all select what we are comfortable with, and with the links supplied plus the outstanding government Medicare website. One really get a clear idea of what might work for them.
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Be careful if you think you can switch back to original Medicare from an Advantage Plan. The answer is that yes you can switch back to original Medicare, however you can be denied Medigap policies based upon preexisting conditions.
There are a handful of States that require guaranteed issue of Medigap policies, others require underwriting
Do your homework!
There are a handful of States that require guaranteed issue of Medigap policies, others require underwriting
Do your homework!
You are correct though one important point.
You can try an Advantage C plan IF you sign up at age 65 and within one year if it is not something you want, you are guaranteed acceptance into a Medigap plan without penalty or underwriting.
Agree again, it's up to people to do their homework and confirm everything.
Ill never pay for Medigap insurance as now going in the 3rd year of Advantage Plan I never, ever, ever had a medical network or doctor not part of it. IN fact, I make out so good that the way I use my Advatange C plan I come out ahead of even the mandatory $175 a month.
With that said I did chose the big guys United Health and now with Aetna.
For some none believers this is a small screen shot of a family member for 2023 and the Advantage C plan by Humana. Im just showing you 2023, this person had roughly $800,000 in bills the year before (2022) that his Advantage C took care of.
Ok, so 2023 here is the proof $544,554.70 retail cost in medical bills for 2023 and this person did not even hit his out of pocket expense of $2,500
I honestly do NOT care if someone rather have Medigap G (or like) Plus D coverage over an Advantage C plan. I have another family member that loves it and could care less about the extra costs of everything.
I just HATE the misinformation spewed out that are completely false about Advantage C plans. This persons bill contains some of the most advanced amazing medical treatment in the world and the year before that was even more expensive included the most advanced equipment known to man inside his chest, a literal computer with internet access controlling electrical impulses in his heart and reporting any events to his health care network that the computer corrects automatically. All at almost no cost to him.
Its times like this, more so with a loved one that you thank god you live in the USA and have the health system we do.
BTW- this person lives a normal life. You wouldn't know he has this stuff if you met him.
Ok, so 2023 here is the proof $544,554.70 retail cost in medical bills for 2023 and this person did not even hit his out of pocket expense of $2,500
I honestly do NOT care if someone rather have Medigap G (or like) Plus D coverage over an Advantage C plan. I have another family member that loves it and could care less about the extra costs of everything.
I just HATE the misinformation spewed out that are completely false about Advantage C plans. This persons bill contains some of the most advanced amazing medical treatment in the world and the year before that was even more expensive included the most advanced equipment known to man inside his chest, a literal computer with internet access controlling electrical impulses in his heart and reporting any events to his health care network that the computer corrects automatically. All at almost no cost to him.
Its times like this, more so with a loved one that you thank god you live in the USA and have the health system we do.
BTW- this person lives a normal life. You wouldn't know he has this stuff if you met him.
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Wife has PPO Humana AP and she had a lump. After huge 10's of thousands of dollar medical bills that Humana paid for she's now Cancer free. It would've bankrupted us if we'd not had some coverage. Happy with it so far. She even gets the $125 healthy benefits card monthly but I've heard from a couple salesmen that some other companies give out more than that a month for groceries etc.
That is awesome, your experience kind of hits home with my wife, over a decade now and she is cancer free. She still has company health ins though.
Forget salespeople or at least if you listen to them do your own investigating>
I have researched these Advantage C plans for years now. I find they pretty much pay out the same but shuffle around the "perks" to what they think will better sell for the public. SO for me, #1 lowest cost and out of pocket rules. Using the lowest out of pocket then REALLY eliminates the dozens of plans and options>
Once I do that, keeping the lowest out of pocket as a top priority I then choose by the perks what puts the most in my pocket.
I find let's say, in your case, someone says there are better healthy benefits, then look further to see what part of the plan has less of.
Meaning it's normally a shuffling of the perks, you may find some things are higher, MRIs co-pays for specialists or less dental and vision perks. I love this about these plans because I tailor which one works best for me.
Im glad your wife is ok, as mine is, freaking cancer is such a nefarious sneaky disease.
Thank you very much & to the same for your wife. What in the world would we do w/o them.
I've done a lot of research on the lower income set-ups so I'm well in tune with how our state & fed govt work with these plans for us. The point of how other Adv. plans offer different perks is not something I'm familiar with & often wondered "Where" they were taking the money from but it just sounds like they increase costs in other areas. Three months ago I found out that Humana would pay up to $500 for the wife to get contacts. She met some sisters she never knew about (adopted) & one of them had colored contacts so it sparked the interest for her to try them. What do you know she was able to get turquoise colored contacts for a whole year (1 month change type). We'll never pay for a medi-gap plan but that is b/c it's not needed for our situation to get our bills paid.
Interesting discussion, read all four pages.
What I don't see here is people really laying out their situation and making a decision based on their pre-retirement spend. My stuff is pretty expensive (corp family plan) so all of this seems really cheap, even the Medigap G plans, compared to where I am now. My out of pocket premium plus my pre-tax flex spending account and then the spending when we run out of that flex money, is usually pushing $10K/yr. The out of pocket max on my current family plan is $12,500 a year, but of course I'm including my premiums when I talk about my total cost, whereas the insurance company wants $12500 after I pay the premiums. Before my prior spouse passed away at 46 of cancer, was the only time I hit that max and the insurance company paid everything 100% past that.
Dental insurance is a necessity, I just had to have a crown re-done and it was about $550 out of pocket, that's with the higher option PPO dental insurance. The medigap plans don't cover dental? That is a consideration.
What I don't see here is people really laying out their situation and making a decision based on their pre-retirement spend. My stuff is pretty expensive (corp family plan) so all of this seems really cheap, even the Medigap G plans, compared to where I am now. My out of pocket premium plus my pre-tax flex spending account and then the spending when we run out of that flex money, is usually pushing $10K/yr. The out of pocket max on my current family plan is $12,500 a year, but of course I'm including my premiums when I talk about my total cost, whereas the insurance company wants $12500 after I pay the premiums. Before my prior spouse passed away at 46 of cancer, was the only time I hit that max and the insurance company paid everything 100% past that.
Dental insurance is a necessity, I just had to have a crown re-done and it was about $550 out of pocket, that's with the higher option PPO dental insurance. The medigap plans don't cover dental? That is a consideration.
Update: talked to my parents and they have Medigap G. They said they pay for dental out of pocket.
Im trying to understand if I am answering what you are looking for.
Let me try.
Most everyone, except very high income and very low income pay $175 a month taken directly out of their Social Security Check unless they "Opt Out" and do not want any health care coverage with one exception. Free of charge is Hospitalization everything else is that $175 a month taken directly from your check and paid to Medicare. So if you get sick, with Hospitalization and the $175 medical premium, your hospital is basically free and your everything else medical is $175. With those two you are well covered BUT you will be responsible to pay 20% of all your medical bills (except the hospital) with no out of pocket limit, limitless, 20%of everything else.
When price shopping lets say for Medigap G you have to take the Medigap Premium you are being quoted and add in the mandatory $175 a month. So if Medigap G and Part D (prescription drugs) is costing you $165 a month, you then add in the Medicare Premium of $175 for a total of $340 a month. These numbers are on the low side and just an example. Medigap rates increase over time with a few exceptions from UHC PLUS the mandatory Medicare rate increases each year (mostly). With these two you will pretty much never pay a medical bill again. No out of pocket, no deductible (or very low) Medigap plans typically do not contain dentists, eyewear and hearing, and prescription drug which is why you sign up for additional Part D for drugs.
WIth MANY, many Advantage plans there is no premium to pay except the Mandatory Medicare premium of $175 a month. The Medicare system pays the private insurers for Advantage C plans. It's also important to know the government/Medicare system APPROVES each Advantage C plan, needs approval to be offered, in addition they must cover what Medicare covers with very few exceptions.
Yes, you can find some Advantage C plans with additional premiums if you try, for no other reason other than because. There typically are no deductibles but some plans have them, they all have co-pays with out of pocket limits. These out of pocket limits vary across the country, much higher in high cost states and much lower in low cost states.
Living here in the Carolinas my out of pocket limit has never been higher than $4,500 and you would need HUGE medical bills to hit that amount. Below I posted my most expensive year 2022 which was diagnosing an irregular heart rhythm with two specialists and an outpatient Cardiac Ablation.
My total out of pocket cost for the year was $896.32 in Co-Pays and $2040.00 in the mandatory $170 Medicare premium that EVERYONE pays. If I had Medigap I would have paid thousands more in total, premiums, dental, vision, drugs.
These plans contain dental, eyewear, hearing, prescription drugs and many other perks. EACH PLAN has different amounts on what they pay, EACH plan is a one year contract to provide you will service, you are also given multiple chances to switch Advantage C plans during the year. It is true once you go Advantage C after the first year, you are no longer guaranteed to switch back to traditional Medigap plans without going through underwriting.
If you are undecided I think it's safer to go with traditional Medigap G or N and Part D. You can ALWAYS easily switch to an Advantage C plan.
You canNOT easily switch from an Advantage C plan back to traditional Medicare with a few limited time exceptions.
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Thanks for the info, @alarmguy. I just turned 53 so I still have 12 years to go, but better to get ahead of this info now rather than to try to consume it through a fire hose later.
It also helps me with knowing what my parents have going on, as they had me very young, they are not so much older than me as we all get on in years.
What effect, if any, is there if you have a history working for a large employer through which you have a defined benefit pension/annuity? Are there any group Medicare plans or is it all the same for everyone?
It also helps me with knowing what my parents have going on, as they had me very young, they are not so much older than me as we all get on in years.
What effect, if any, is there if you have a history working for a large employer through which you have a defined benefit pension/annuity? Are there any group Medicare plans or is it all the same for everyone?
@Brons2
This was my United Heath Care plan Advantage C for the most expensive year of my life with medial care. I was in NO WAY limited who my Cardiac Specialists were, not limited to any medical group and NEVER held up for an approval of any sort. I am thrilled at the outcome. My heart in great shape for being proactive with an ablation and heart signal timing. It's actually amazing the follow up tests just in 2023 confirmed this. EF score of 60
SO to these costs below just add in the mandatory $170 a month (that year) Medicare premium.
This was my United Heath Care plan Advantage C for the most expensive year of my life with medial care. I was in NO WAY limited who my Cardiac Specialists were, not limited to any medical group and NEVER held up for an approval of any sort. I am thrilled at the outcome. My heart in great shape for being proactive with an ablation and heart signal timing. It's actually amazing the follow up tests just in 2023 confirmed this. EF score of 60
SO to these costs below just add in the mandatory $170 a month (that year) Medicare premium.
You know the joke about lawyers? That 98% of them are crooks that give the rest a bad reputation?
I think it's much the same with Advantage plans. Instead of 98% of them being bad, it may only be 20%, but if you sign up with a member of that 20% it could ruin you financially. I suggest a lot of research with a qualified trustworthy insurance agent before you make a decision.
There is a lot of money to be made by the bad ones, or they wouldn't flood my mailbox with junk mail, nor would they wake me up in the AM twice a week with computerized calls trying to sell their crap.
I do not have a dog in this fight, being retired military. If you really want a great Medicare supplement, the easy thing to do would be to invent a time machine to go back and tell your 18 year old self to sign up for 20 years of service to be covered for the rest of your life.
I think it's much the same with Advantage plans. Instead of 98% of them being bad, it may only be 20%, but if you sign up with a member of that 20% it could ruin you financially. I suggest a lot of research with a qualified trustworthy insurance agent before you make a decision.
There is a lot of money to be made by the bad ones, or they wouldn't flood my mailbox with junk mail, nor would they wake me up in the AM twice a week with computerized calls trying to sell their crap.
I do not have a dog in this fight, being retired military. If you really want a great Medicare supplement, the easy thing to do would be to invent a time machine to go back and tell your 18 year old self to sign up for 20 years of service to be covered for the rest of your life.
False, by not signing up for either a Medigap plan or an Advantage C plan you very well can be ruined financially and owe up to 20% of all your medical care except for hospital.
When you sign up for an advantage C plan you have an annual out-of-pocket limit and you know what that limit is when you sign up and choose a plan you are comfortable with.
An out-of-pocket limit is just that not a penny more.
Medigap and Advantage plans are regulated and must have government approval each and every year. In addition, advantage, plans must cover everything that Medicare does. In addition to that you have opportunity to switch out every year to another plan.
In case you are not aware, it’s the government that pays the advantage C premiums not the person receiving the benefit
There is so much innuendo and misinformation and why I keep posting in here. I posted a previous medical bill for a family member, half $1 million in medical bills and his exposure was less than $3000
The Internet is your friend http://medicare.gov
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Not sure how you came up with that. What is this mechanism? Where are your backing statistics?
So you just popped in here to give us some "wisdom". Amazing.
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