MY MEDICARE EXPERIENCE
May 5, 2023
by Jo Zettler
by Jo Zettler
I’ve been on Medicare for 10 years and thought I would share what I think might be of interest to those just signing up (Jody and Steve this year!). We use a MedAdvantage policy just because it cuts down on the paperwork. I pay about $150 for Medicare (deducted from Social Security check) and about $50 for supplemental through Regency Blue Cross/Blue Shield. When I originally signed up, I looked at the options and costs, then went to talk to a specialist at a local senior center to ask my questions. The state requires this service be available to all seniors, and the specialists are all volunteers.
In comparing the many offerings, my criteria included ( in addition to cost vs benefits and ratings) counseling coverage, PT coverage, pick my own doctors, coverage in other countries. At least when I was picking, only about a third of the plans within my price range had all 4 of these, so that narrowed it down.
Re costs, you have to balance three things: deductibles, out of pocket limits, and co-pays for in-network vs out of network. Drug coverage is attached to most, but not all plans. We are lucky to have had little experience with this part.
I think that’s it! Let me know if you have questions!
In comparing the many offerings, my criteria included ( in addition to cost vs benefits and ratings) counseling coverage, PT coverage, pick my own doctors, coverage in other countries. At least when I was picking, only about a third of the plans within my price range had all 4 of these, so that narrowed it down.
Re costs, you have to balance three things: deductibles, out of pocket limits, and co-pays for in-network vs out of network. Drug coverage is attached to most, but not all plans. We are lucky to have had little experience with this part.
I think that’s it! Let me know if you have questions!
Medicare advantage or disadvantage?
March 1, 2023
by Deirdre O'Hearn
by Deirdre O'Hearn
Like it or not, a lot of us in gen 3 will soon need to consider Medicare. Everybody deserves the best health coverage available. But as soon as the words Medicare, Medigap, supplemental, advantage and plans A through H come up - the eyeballs roll to the back of the head. it's only natural. We work really hard to ignore Medicare for as long as possible. Then before you know it, it’s in your own back yard.
As an, ahem, esteemed elder, and having just completed due diligence on the whole process, I thought I could make it a little less scary. I don't know everything of course - but I am glad I chose to look into it and I'm comfortable with my decisions. Honest, it really isn’t as bad as it looks. Just know that Medicare is not the same thing as Medicare Advantage. Medicare is non-profit. Medicare Advantage is for-profit.
There are basically two scenarios:
In the first scenario, Medicare is the primary payer paying 80% of the medical bill. To cover the remaining 20%, you can get a Medigap plan - also known as Supplemental health insurance. The Medigap plan would be the secondary payer.
In the second scenario, Medicare Advantage is the primary and secondary payer. Medicare reimburses them for your health costs. Medicare Advantage plans often charge next to nothing - making them very attractive. They can afford to do that because they get paid for you whether you are sick or not.
The Medicare Advantage plans are privately owned health insurance companies and as such, get a cut of the action. The profit these companies make from Medicare repayments is substantial enough to keep your costs very low.
The downside is that they get to choose who you use and what you are covered for. Not you. Not your doctors.
Your decision will be based on a thousand variables of your own. For myself, the primary thing I'm looking for in any insurance coverage is protection for catastrophic accident and illness. Who would trust an insurance company to take care of that? I’m sure many of them would do the right thing. And I'm sure some would not. It is certainly not their decision.
I dropped my UnitedHealthcare Advantage coverage and selected Medicare and a Mutual of Omaha Medigap (also known as supplemental) policy. The cost to me is $103 for the medigap policy (Plan G) each month.
https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html
https://www.dailykos.com/stories/2022/8/5/2114705/-Stop-the-Medicare-Advantage-Scam-Before-Medicare-is-Dead
The Medicare website is surprisingly helpful. Here is an explanation of how Medicare works and how it compares to Advantage plans.
https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare
https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage
For the Medigap plans A to H (for Pennsylvania) It’s not as complicated as it seems once you glance at them. Below are some actual numbers on medigap (supplemental) plans for a 65 year old. The link will take you to the proper web page where you can enter your own zip & age.
There are small differences in Medigap plans A through H. But within each plan - no matter which insurance company writes the policy - the insurance companies must provide the same services. (Considering those requirements I find the variety of prices curious.) The contract with the government is the same regardless of vendor.
Let me know if you have any questions or if any links don't work for you. And if needed, I have a non-affiliated benefits company that is free and has helped me greatly with the paperwork.
thanks,
Deirdre
[email protected]
As an, ahem, esteemed elder, and having just completed due diligence on the whole process, I thought I could make it a little less scary. I don't know everything of course - but I am glad I chose to look into it and I'm comfortable with my decisions. Honest, it really isn’t as bad as it looks. Just know that Medicare is not the same thing as Medicare Advantage. Medicare is non-profit. Medicare Advantage is for-profit.
There are basically two scenarios:
In the first scenario, Medicare is the primary payer paying 80% of the medical bill. To cover the remaining 20%, you can get a Medigap plan - also known as Supplemental health insurance. The Medigap plan would be the secondary payer.
In the second scenario, Medicare Advantage is the primary and secondary payer. Medicare reimburses them for your health costs. Medicare Advantage plans often charge next to nothing - making them very attractive. They can afford to do that because they get paid for you whether you are sick or not.
The Medicare Advantage plans are privately owned health insurance companies and as such, get a cut of the action. The profit these companies make from Medicare repayments is substantial enough to keep your costs very low.
The downside is that they get to choose who you use and what you are covered for. Not you. Not your doctors.
Your decision will be based on a thousand variables of your own. For myself, the primary thing I'm looking for in any insurance coverage is protection for catastrophic accident and illness. Who would trust an insurance company to take care of that? I’m sure many of them would do the right thing. And I'm sure some would not. It is certainly not their decision.
I dropped my UnitedHealthcare Advantage coverage and selected Medicare and a Mutual of Omaha Medigap (also known as supplemental) policy. The cost to me is $103 for the medigap policy (Plan G) each month.
https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html
https://www.dailykos.com/stories/2022/8/5/2114705/-Stop-the-Medicare-Advantage-Scam-Before-Medicare-is-Dead
The Medicare website is surprisingly helpful. Here is an explanation of how Medicare works and how it compares to Advantage plans.
https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare
https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage
For the Medigap plans A to H (for Pennsylvania) It’s not as complicated as it seems once you glance at them. Below are some actual numbers on medigap (supplemental) plans for a 65 year old. The link will take you to the proper web page where you can enter your own zip & age.
There are small differences in Medigap plans A through H. But within each plan - no matter which insurance company writes the policy - the insurance companies must provide the same services. (Considering those requirements I find the variety of prices curious.) The contract with the government is the same regardless of vendor.
Let me know if you have any questions or if any links don't work for you. And if needed, I have a non-affiliated benefits company that is free and has helped me greatly with the paperwork.
thanks,
Deirdre
[email protected]
Medigap Plans
Once you are on the Medicare website if you click on the ‘View Policies’ button for each plan it will give exact cost per month charged by the different insurers.
https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m/plans?fips=42003&zip=15238&year=2023&lang=en
Once you are on the Medicare website if you click on the ‘View Policies’ button for each plan it will give exact cost per month charged by the different insurers.
https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m/plans?fips=42003&zip=15238&year=2023&lang=en
