Medicare advice

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I have Humana Gold for my Medicare.
I keep seeing that Kaiser is the highest rated provider.
Its so hard to compare plans.
Any thoughts from users?
 
When I lived in Colorado, I had Kaiser and thought it was excellent. The doctors were very good and the cost was reasonable.

As I type this now, I'm in Denver...and you're up early...

grin.gif


Cheers,
Astro
 
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I will need to look into all that stuff in the next 10 months.

Is there any info on AARP or Consumer Reports?

I will likely end up with an employer provided Medicare supplement I think.
 
Kaiser is excellent.

If you consider anything with AARP remember that they are very politically active. You might want to look into their politics because you might have different ideas. They place their politics front and center and whatever else they do, it always comes back to their original focus. Behind the scenes, they are a political fundraising operation.
 
Originally Posted By: OneEyeJack
Kaiser is excellent.

If you consider anything with AARP remember that they are very politically active. You might want to look into their politics because you might have different ideas. They place their politics front and center and whatever else they do, it always comes back to their original focus. Behind the scenes, they are a political fundraising operation.


+1
 
My wife applies for Medicare in March. So I've spent about 15 hours on line the past couple of weeks researching the heck out of the best way to go. I knew next to nothing about Medicare/Soc Sec a month ago. It's not such an easy choice between Orig Medicare + Drug plan, or a Medigap plan (F,N,G) + Drug plan, or a Medicare Advantage Plan (HMO, PPO, etc.) for which nearly all include a drug plan. Statistics say about 1/3 are enrolled in MA plans and 2/3 in Medigap plans. Plan ratings don't matter much for Medigap as those benefits are standardized among each lettered plan. HMO/PPO ratings could be an issue. All of them in my state have ratings of 3.5-4 stars out of 5. You will always find complaints. A couple of insurers in my state stick out for "bad" reps, yet they still get 3.5 stars. For me, plan coverage details are what's most important.

If you're quite healthy and can expect to stay that way, the HMO/PPO plans seems the most reasonable. But I found that the "cheaper" HMO plans (some with $0 monthly premium and $0 drug plan deductible) bury the medicare part A $1316 deductible in your first 3-6 days of a hospital stay...and most only offer 20% co-insurance on the outpatient hospital visits (others might cap those costs at $200-$750 per visit but make up for it with a higher monthly premium). The Medigap plans offer A-N selections (not in all states) but it seems to me that only the F, N, G plans make sense out of the 10 types offered. While they all cover the $1316 part A deductible, that gets paid for in the monthly premium. Medigap plan premiums will range from $145-$295/month premiums for "competitive" plans in my state....they can go higher for non-competitive plans. Most states won't allow you to switch from a MA plan to a Medigap plan after you've had your plan for a year... w/o first having to go through pre-screening/medical evaluation. That's not the case for your initial 7 month medicare sign up period (guaranteed issuance). Connecticut and New York are guaranteed issuance states that give you more flexibility in switching plans. 3 other states do things a bit differently (MA, MN, WI?).

No matter what plans you sign up for, you still pay the $109-$134/month medicare part B premium. Some will have to pay a part A premium if they don't qualify on there own (or spouse's) work history. Only the Medigap plan F covers all the part A and B gaps in Original Medicare coverage. It's also the case that you will pay the highest premiums for a Medigap Plan F. Plans F is being retired for new enrollees in 2020 because they gov't wants everyone to have more "skin" in the game with premiums (previous enrollees will be able to stay on). No one seems to know if Plan F premiums will get out of whack past 2020 as the member pool shrinks. With the pat D prescription plans or drug coverage, there are always gaps, if not just the large "donut" hole which can run you thousands before you reach the catastrophic care coverage rate of "only" 5% co-insurance when you're out of pocket expenses have exceeded approx $5K-$10K depending on plan.

In the case of very rare extended medical care that exceeds a year over what Medicare authorizes (1 yr + 90 days + 60 reserve days), or Skilled Nursing Facility Care that exceeds 100 days or more, you typically pay all costs. The only plans I see in my state that say differently are the United Health Care HMO plans (ie say they cover in-patient stays "beyond 90 days."). None of the Medigap plans A-N say that. Then again, most will never have to deal with a hospital say longer than say 1-2 weeks. The first agent I talked to said that with a a plan F you never pay anything more than their monthly premium...EVER. He was emphatic on this point. But, go beyond the limitations of original medicare for hospital or SNF stays and you can pay more...a lot more. At least that's my understanding so far.

I'm still tossing things around for a Medigap Plan F/G/N, and a number of HMO plans in my state. The choice is not that simple imo. You have to know what your health situation will be in the next several years to pick the most advantageous one. Literature I read seemed to suggest that those starting off on Medicare Adv plans often made the switch to Medigap plans down the road as they got fairly sick. Then you have to deal with pre-screenings, pre-existing conditions, coverage being denied, etc. Fwiw, in my state AARP teams with United Health Care of their only "endorsed" PPO plan.
 
It's the doctor that makes the difference. If the Kaiser doctor you get is good for you, the rest, the facilities and all that are as good as any. I have Blue Shield PPO through my employer I retired from, as Kaiser isn't available in the town I now live in. If not through an employer I hear people happy with the AARP supplemental. Both Kaiser and AARP are for the ACA, so if that bothers someone it can be a factor. Not a factor for me. I look at the benefits I receive and the price. Kaiser is non profit so they are hard to beat on price. My supplemental has no copays of any kind and a generous drug plan. It went up $8/mo for next year, so not bad at all.
 
There are two types: Medicare Supplement (Medigap) and Medicare Advantage Plans.

https://www.ehealthmedicare.com/about-medicare/compare-medicare-advantage-and-supplement/

The Advantage Plans are not regulated to the extent that Supplemental Plans are. If you initially choose an Advantage plan. You may not be able to get the Medigap at a later time. Seriously consider the Medigap vs Advantage. It may be more expensive but imn my Part F I have only paid one $20 tab and that'
s a long story. Also with Medigap you need to purchase a Drug plan or rely entirely on medicare.
 
The regular Medigap Plan F is typically not the best deal in Medigap plans. Rather, plans N, G, and F-HD ($2200 high deductible) are usually the best bang for the buck. The regular F's are typically priced more than the cost of that $2200 high deductible plan F (ie $183.33/month). If you don't have any major medical issues that year, that $183/month stays in your pocket. In my state, the plan F's cost from $185-$556 per month more than the F-HD. None are worth the extra premium. Of the 5 companies offering both F and F-HD competitively, they charge on average an extra $304/month ($3648/yr) to cover the annual $2200 deductible. That's like paying $16.5K/yr to get $10K worth of insurance. The plan F's are also usually priced higher than the N and G plans after factoring in the deductible differences between them. It's simpler to keep the extra cash on your own.
 
My brother is with K.P. in the U.S., His wife had some pretty big health problems that were almost fatal and were happy with their treatment and coverage. FWIW.

cheers3.gif
 
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I gave up on AARP for several reasons. Really an organization that exists for high salary execs. The companies they endorse are not necessarily the best choice but the company that paid AARP big $$$ for the endorsement.Hartford automobile insurance is not the best or cheapest by a long shot. I sent AARP's monthly membership offer back for years in the no postage required envelope until they wised up and started sending postage required for return. Still sending the offers though.
 
Originally Posted By: 69GTX
The regular Medigap Plan F is typically not the best deal in Medigap plans. Rather, plans N, G, and F-HD ($2200 high deductible) are usually the best bang for the buck.

Depends on your state of health and as mentioned, if you pass on part F you can't go back (as a practical matter). And there is NO DEDUCTIBLE with part F. So if you have one event in a year the HD is a looser.

And its recognized that Advantage plans are cheaper. But this cheapness comes with a price ..no regulation...limits on coverage..and again once you sign on to an advantage plan you are there for life.

I am more than financially comfortable and I can afford to pay for peace of mind..knowing I will never have a medical bill. But that's just me. I am certainly not criticizing others' decisions.
 
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Originally Posted By: Al
Originally Posted By: 69GTX
The regular Medigap Plan F is typically not the best deal in Medigap plans. Rather, plans N, G, and F-HD ($2200 high deductible) are usually the best bang for the buck.


Depends on your state of health and as mentioned, if you pass on part F you can't go back (as a practical matter). And there is NO DEDUCTIBLE with part F. So if you have one event in a year the HD is a looser.

And its recognized that Advantage plans are cheaper. But this cheapness comes with a price ..no regulation...limits on coverage..and again once you sign on to an advantage plan you are there for life.

I am more than financially comfortable and I can afford to pay for peace of mind..knowing I will never have a medical bill. But that's just me. I am certainly not criticizing others' decisions.


In my state, and several others, you can go back to a Plan F almost any time you want, without penalty or being turned down for pre-existing conditions, assuming you had no coverage gaps along the way. You also have one year after picking your first medicare plan (initial enrollment period) where you can go back and choose any plan you like. After 1 yr it gets harder in most states.

In my state, I would need more than 1, and often 2 in-patient hospital stays per year to make a Plan F-HD a "loser." In my state, the ONLY time a plan F-HD is a loser to a regular Plan F is when your out of pocket expenses exceed $2200-$3500 or more per year. If you're healthy, and only visit a hospital once every 3-10 yrs, the F-HD is a far better choice. I will get peace of mind by knowing I might not have to fork over $3,000 every year in premiums for a Plan F (cheapest available) even if my only medical care for the year is a routine physical (up to $4,600 on the highest cost plan F in my state). With a plan F-HD, my only cost will be the $600-$950 annual premiums. And in the event I do run into something major, my "medicare" limit out of pocket would be $2200. That's the only difference between F and F-HD....the one annual deductible. Each year you don't have a major medical event or emergency, you pocket that $2400 difference (in my case). Do that for a few years and a plan F will have a hard time catching up to an F-HD. No matter, in 2020....both plans disappear for new enrollees. There's also no guarantee that the plan F (G or N) premiums won't go through the roof down the road. For 2018, my state authorized average increases of 25% on plan F's. The increases among the insurers ranged from +6% to +35%.

We can all still get bills on medicare, regardless of plan F or any other. All you have to do is exceed medicare limits for hospital stays (>1 year + 150 days), for skilled nursing facilities (>100 days), and even part D prescriptions at the catastrophic levels. There's no limits on any of those 3 unless your plan specifically states it. I've seen a couple HMO plans that say they will cover hospital stays >90 days w/o limit. I've not seen any Medigap plan F that does that. They stop paying for you after the above limits of 1 yr + 150 days. Any agent that tells you it's impossible to have to pay a bill besides your monthly premium each month is blowing smoke.

Kaiser sounds good. Wish it was an option in my state.
 
There is a trial period for people who try Medicare Advantage for the first time. If you decide to dis-enroll from the plan and go back to Original Medicare within the first 12 months of Medicare Advantage coverage, then you can return to your Medigap plan with no underwriting. After the 12 months is up, then you are subject to underwriting.

It's also the case if you move out of the area of your MA plan, you have a short window to apply for Medigap w/o underwriting. And if your MA plan is no longer being offered, you can shift to Medigap too. Of the several states that have more lenient Medigap switching requirements, your odds are at least 19% you live in one of them.

In Calif. you can shift to Medigap when your Medicare Advantage (MA) plan increases your premium, increases
your cost - sharing, reduces your benefits, or terminates its relationship with a medical provider who is treating you.
...lots of rules to keep up on.

BoomerBenefits
 
Originally Posted By: 69GTX
I will get peace of mind by knowing I might not have to fork over $3,000 every year in premiums for a Plan F (cheapest available) even if my only medical care for the year is a routine physical (up to $4,600 on the highest cost plan F in my state). With a plan F-HD, my only cost will be the $600-$950 annual premiums. And in the event I do run into something major, my "medicare" limit out of pocket would be $2200. That's the only difference between F and F-HD....the one annual deductible. Each year you don't have a major medical event or emergency, you pocket that $2400 difference (in my case). Do that for a few years and a plan F will have a hard time catching up to an F-HD. No matter, in 2020....both plans disappear for new enrollees. There's also no guarantee that the plan F (G or N) premiums won't go through the roof down the road. For 2018, my state authorized average increases of 25% on plan F's. The increases among the insurers ranged from +6% to +35%.


We can all still get bills on medicare, regardless of plan F or any other.
Everyone has their priorities. So it again depends on the individual and their resources. The money on premiums (for me) is chump change when compared to concern about truly big money for catastrophic illnesses. And as long as Medicare approves the PROCEDURE you will pay nothing till the dust settles. If the hospital/Dr. suggests a procedure that Medicare does not recognize you must sign off on it (in writing.) So again you will never get a bill with part F...unless you know something I don't and I doubt you do.

Sure part F may go through the roof someday and so may the same advantage plan. I think we are all smart enough to moniter dynamic conditions.
 
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Originally Posted By: Al
So again you will never get a bill with part F...unless you know something I don't and I doubt you do.


Typical Medigap coverage on plans A, F, F-HD, N, G

Look up on page 11 of the above link. You will see when a plan F shifts to "you pay ALL costs." That occurs when you've stayed in a hospital beyond the medicare + plan F stay limits (>515 days). Very simple. You also will pay when you exceed SNF stay limits (>100 days). And you will pay if you get sick overseas (20% co-insurance and everything above $50,000). Whether your Plan F sends you the bill or not is irrelevant. You're on the hook for these limitations. Apparently, I do know something that you don't.

Maybe there's some specific plan F's that are written differently. But, I doubt it. They are meant to be identical in coverage for a reason. I don't want anyone here to think that a Plan F covers you for EVERYTHING possible. Medicare was not designed for that...neither are the supplemental plans that are only intended to cover some or all of the "medicare coverage" gaps....not every possibility. While the odds are exceptionally rare of this ever occurring to a typical person, the odds are not zero.
 
Originally Posted By: OneEyeJack
Kaiser is excellent.

If you consider anything with AARP remember that they are very politically active. You might want to look into their politics because you might have different ideas. They place their politics front and center and whatever else they do, it always comes back to their original focus. Behind the scenes, they are a political fundraising operation.


AMAC is a good alternative to AARP...
 
Originally Posted By: 69GTX
Originally Posted By: Al
So again you will never get a bill with part F...unless you know something I don't and I doubt you do.


Typical Medigap coverage on plans A, F, F-HD, N, G

Look up on page 11 of the above link. You will see when a plan F shifts to "you pay ALL costs." That occurs when you've stayed in a hospital beyond the medicare + plan F stay limits (>515 days).

Yea you are right..I forgot about hospital stay limits.
 
I would like to thank all the posters who replied.
Very informative.
Still have not decided, but I am considering Kaiser.
 
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