Medicare Muddle - What Plan to Choose?

chisueNovember 6, 2008

I'm finding the number and variety of choices are too much for me. Is there a worksheet I can fill in that would help?

DH and I have Medicare A + B + a United HealthCare policy through his former employer. The policy is not a Medigap policy but does have good drug benefits (via mail order).

I'd like to compare what we are paying with Medigap plus Drug policies. When I go online it looks like I will be annoyed by a dozen or more insurance salespeople if I fill out their forms! There are 45 plans offered in my Chicagoland area.

DH takes two inexpensive generics daily (retail cost $18/mo or $216/yr).

I take one expensive non-generic twice daily (Advair - retail cost $180/mo or $2160/yr).

Under our current policy DH paid $72.40/yr and I paid $280/yr for these meds. We paid another $175 for antibiotics, etc. So...our out-of-pocket drug costs totaled $527 for the year -- plus the cost of the policy premium (which will be $1776 for 2009 -- covers us both).

In 2008 we've paid $2500 out-of-pocket for MDs and tests not fully funded by Medicare.

In 2009 I will have the usual medical expenses like a Physical, GYN checkup, mammogram, ENT (chronic sinusitis), and I never get through a year without some MD visit for some sinus or asthma-related infection.

DH will have a Physical, colonoscopy, dermatologist. (If we don't have a Medigap policy we'll be paying 20% of those bills.) Let's use $2000 for our 2009 projected out-of-pocket 'medigap' bills.

That all adds up to the following for the two of us:

Medicare A + B = $2314

UHC Premium 1776

O-O-P 'gap' 2000

UHC Drugs 352

Antibiotics 175

Medicare Deduc. 270

UHC Deduc. 2000

I think I must be able to do better than $8887!

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Hard question to answer. If we only knew what's going to happen down the line!

My husband and I got drug coverage at what we thought was an excellent price. $19.95 per month plus $100.00 deductable for each of us. Each year the premium and the deductable increased. 2009 will see us paying over $40.00 a piece per month with a deductable of almost 300.00 My husband, if he stays as healthy as he is now, won't even use up the deductable next year. That's about 10,000 a year for the both of us. I suspect that most plans will work that way......low intitial cost until they get your business and then big jumps each year afterwards.

BUT, and it's a big BUT, as we get older, we probably will need the insurance more and more, BUT we also are going to have a harder time making the premiums. Do we drop it? "They" say it will cost us much more if we drop it and try to enroll again later on. I am soooooo tempted to gamble on our continuing good health.

Good Luck with whatever you decide.

    Bookmark   November 6, 2008 at 12:48PM
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Hello, agnespuffin. I have a plan! Well, I think I do...

In addition to funding our Medicare Parts A & B, I'll get a Medigap policy for both of us and a Drug policy for just me. (DH's drugs only total $212/yr. retail.)

Medigap: DH's former employer is offering Aetna Traditional Choice Plans A or B. No copays, no limits. Plan A has no deductibles. Plan B has the two usual Medicare deductibles of $135 and $1068 each. Plan A runs $61/mo. for us both. Plan B is $19/mo., but considering that we will surely reach the $135 deductible for office visits it's really $41/mo. No drug coverage on either.

Drug Plan: AdvantraRX Value just for me with my expensive Advair and some antibiotics, etc. running about $2500/yr. retail. This is $498 for mail order and my Advair will be $25.50 each month.

I hope this combination will do the trick. If you spot any holes, please speak up. Do you think it's worth an extra $230/yr. to buy the no-deductibles Aetna medigap Plan A over the Plan B?

It is so helpful to have a sounding board. Thank you!


    Bookmark   November 6, 2008 at 3:38PM
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