Community Chat

[gertrudecloset]

https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plan...

ALWAYS START AT MEDICARE.GOV!

[Katcat1]

My Part D is covered with my Humana supplement insurance.  It starts off normal pricing and then goes into the donut whole which certain drugs are very expensive and then back down to normal pricing.

[gertrudecloset]

These plans and costs are State Specific for me.  They may or may not be in your State.

Medigap Plan N

Plan DetailsView Policies

Monthly CostPremiums range from $190-$282 for a 65 year old Female that doesn't use tobacco

Doesn't include:
$148.50 Standard Part B premium

Medigap Plan M

Plan DetailsView Policies

Monthly CostPremiums range from $524-$524 for a 65 year old Female that doesn't use tobacco

Doesn't include:
$148.50 Standard Part B premium

Each of these various Medigap/Supplement plans offer different benefits. 

[gertrudecloset]

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@Katcat1 wrote:

My Part D is covered with my Humana supplement insurance.  It starts off normal pricing and then goes into the donut whole which certain drugs are very expensive and then back down to normal pricing.

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I haven't reached the doughnut hole yet.  Thank goodness, I always come under.  It's worse if you drugs don't have a generic and/or if it is not on the formulary for a particular insurance plan.  That's another reason why I shop around every year and compare the plans in my area.  Drug coverage can change.  That usually means they stop covering something I take or they put it in a high tier like a Tier 4 or Tier 5.

[CelticCrafter]

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@gertrudecloset wrote:

These plans and costs are State Specific for me.  They may or may not be in your State.

Medigap Plan N

Plan DetailsView Policies

Monthly CostPremiums range from $190-$282 for a 65 year old Female that doesn't use tobacco

Doesn't include:
$148.50 Standard Part B premium

Medigap Plan M

Plan DetailsView Policies

Monthly CostPremiums range from $524-$524 for a 65 year old Female that doesn't use tobacco

Doesn't include:
$148.50 Standard Part B premium

Each of these various Medigap/Supplement plans offer different benefits. 

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You should really list the state you are referring to when you are quoting numbers.

My husband and I are both over 65, both have Plan N supplements and our combined monthly premiums for just Plan N are a few pennies less that $254. 

We live in NJ.

[Silverfox1]

Yes every state has different plans.

You may purchase a Medicare plan BUT you have to qualify for that plan and then you are limited in somes cases.

My DH and I live in Wisconsin.  I am 74 and my husband just turned 75. We live on our SS benefits with some savings. As stated before our income is okay...we live a normal life. We haven't had a vacation in years but that's okay since both of us have health problems.

We pay for  Medicare with a deduction from our SS checks. 

Every year we go to Medicare. gov.t to see if we qualify for anything new.  We call Medicare and have long conversations with them which always ends up that we do not qualify for such options as dental care and vision or any money back. As stated in my previous post we have Supplemtntal Ins. thru ARRP which is big in Wisconsin. 

We pay $35.00 to see a specialist.  We pay $35.00 to see a Nurse Practioner. ARRP pays little but we have it just in case, you have to...in some cases I see them pay $1.17 on a claim.  I have seen in Medicare where a doctor can make a claim of $394.00 for services get less than $100.00.  My husband says that's why doctors charge so much since they get very little from the insurance companies, lol! We must pick up 20% to pay.

Other costs for us are what I consider unblieveable...We pay out of pocket every month anywhere from $150.00 to $300.00 for our medications, this does include generics with some.  If one of us should have to go into the hospital we have to pay for the first 5 days.  In 2019 I had to go in 4 times....the costs for us were to the sky and back but we paid them off. An ER visit starts at $90.00.

So what am I trying to say?  My feeling is that the average guy has to pay.  There are no freebies for us.  Let me state again our income is just okay for living on SS.  I am not complaining.  It is what it is.  We do alot of asking when it comes to choosing our Medicare plan and other insurance.  This is what we qualify for in Wisconsin.

So different states off different plans.  I think we can agree to that. There is no reason to argue with the government...it doesn't pay. 

I have said many times we should all agree to disagree, imo.

One last thing...those medicare commericals. PLEASE don't have millionares tell me they qualify for freebies....when we don't!

Eveyone stay safe and be thankful for what you have, IMHO!

[Carmie]

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@CelticCrafter wrote:

@Carmie  we were told the excess fees were limited to a certain percentage over the assignment?  Is that true?

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Yes, that is true.  The percentage is 15%.  It wasn't always that way though.  It used to be they could charge what they wanted to.

In some states, doctors are not allowed to charge you an excess fee.  My state of PA is one of them.

The other states are CT, MA, MN, NY, OH, RI and VT.

[Carmie]

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@gertrudecloset wrote:

All of the lettered plans people are talking about are TYPES OF SUPPLEMENTAL PLANS.  F, K, A, B and so on.

I was not referring to Medicare SUPPLEMENT PLANS.  I'm referring to Medicare.  Medicare C is what is called an Advantage Plan.

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare.  If you join a Medicare Advantage Plan, you still have Medicare.  These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).  SOME MA OR PART C PLANS DON'T COVER DRUGS.

If they don't you can get a stand a lone Part D Prescription Drug Plan.  NOT A PART D SUPPLEMENT PLAN.

THE SUPPLEMENT PLANS ARE LETTERED LIKE THE ADVANTAGE PLANS AND ORIGINAL MEDICARE. 

Original Mediare Part A

Original Medicare Part B

Advantage Plan Part C

Medicare Drug Coverage Part D.

Not all Medigap policies will be sold in every state.  Medigap is also known as a Supplement plan.  They too are lettered like Plan F, K, and they each have differing monthly costs and structures for your needs. 

Example for my area of a Supplement Plan A

Medigap Plan A

Plan DetailsView Policies

Monthly CostPremiums range from $169-$331 for a 65 year old Female that doesn't use tobacco

Doesn't include:
$148.50 Standard Part B premium

Medigap Plan B

Plan DetailsView Policies

Monthly CostPremiums range from $226-$510 for a 65 year old Female that doesn't use tobacco

Doesn't include:
$148.50 Standard Part B premium

Medigap Plan D

Plan DetailsView Policies

Monthly CostPremiums range from $391-$502 for a 65 year old Female that doesn't use tobacco

Doesn't include:
$148.50 Standard Part B premium

You can not have a Medicare Advantage Plan and a Medigap (supplement plan at the same time).  It's illegal.  You can only purchase a Medigap plan when using your stand alone TRADITIONAL Medicare.  Those monthly premiums you pay will help offset some of the 20% out of pocket costs that Medicare doesn't pay.  That's what the premium is for.  No one's gonna pay for your 20% share for nothing.  Either you pay a premium for it monthly or your income is so low that you get Special Needs plans that cover more for you.  It is not free.  You might not have to pay a dime, but SOMEONE IS PAYING IT FOR YOU.  If you live below the poverty line with a State that offers Medicaid then your state can supplement your Medicare with Medicaid.  This is all based on income.  Some people meet the qualifications, but their state Medicaid will tell them to spend a certain amount first, then they will pick up the rest.  It's called a "draw down."

The best thing to do when you're ready to get Medicare is to peruse the Medicare.gov website.  You can create an account, look at plans and speak to insurance agents of the particular plans your'e interested in. 

I do it every single year.  This way there is not cost to you.  I am not eligible for a Medigap/SUPPLEMENT policy (OF ANY KIND) as one must be a certain age (65) to purchase.  That's the law and it does not depend on your State.  It's a Medicare rule.

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Not everyone pays $148.50 for Medicare Part B.  many pay a lot more than that.  There are members in this board who would be happy to just pay $148.50. Medicare Part B is billed differently  based in your income.

There is no standard Medicare Part B fee.  The fee is based in your income.

You  keep referring to the 20% Medicare part B coinsurance  and say everyone must pay for it and it is not free.  No one is debating that.

But, I keep telling you that if you have Medicare advantage  ( Part C) there is NO 20% that needs to be paid.  Some of those Advantage Plans pay 100%.  And there is no monthly fee to purchase them after you have paid the Medicare B amount.  

So many people have the Medicare Part B preminum taken from their SS check monthly and pay nothing else for insurance and most of their medical bills are paid at 100%, except for RX drugs.

if you don't understand this there is nothing I can do to convince you.  The info is on the  Medicare website in case you need to see it in writing.

[NickNack]

@Carmie   I am in Tennessee and have an Advantage plan.  I just turned 65 this month and have been on Medicare for a few years due to disability.  I wish I had you to help me choose the best plan for me.

I pay nothing monthly for the plan except for my part B payment.  I am very happy with my plan and would continue with it except for something that happened recently.

I have Prolia injections every six months because of osteoporosis.  I have them at an infusion center even though they are just an injection.  I usually pay $100+ per injection, which is fine with me. I pay very little for my prescriptions otherwise.  This time I got a letter of denial from Blue Cross for this.  They said it was because the maximum benefit allowance was reached.  I have another injection scheduled for December and know that I can't change my plan before then.

Who should I call to help me choose a plan that is best for me?  I don't want this to happen again.  Prolia is very expensive but very necessary for me.  My osteoporosis has improved a lot since starting it.  Of course there are many considerations in the plan to consider.

Are Advantage plans that have a monthly charge better in general?  I do study the differences each year but have a hard time with it.  I appreciate all that you post on this subject.

[gertrudecloset]

@Silverfox1  That's the point I was trying to make.  The Federal Government will get it's 20% for Medicare whether you pay it or a subsidy pays it.  That's a fact.  No one is getting their other 20% for free.

Your post is spot on.