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Medical & Drug Deadline Nears

Posted by chisue (My Page) on
Tue, Nov 22, 11 at 17:36

My DH and I, both Seniors, must decide on medical and drug insurance by the end of the week. Before we make a change, may I run it past y'all? We talked to the SHIP person at our senior center, but that wasn't much help.

For 2011 we've had a Medicare supplement with Aetna from my DH's former employer. It paid 100% of every medical balance that Medicare did not pay. We each had a Part D plan that discounted our drugs. Were we to continue this way in 2012 the supplement + our two Part D premiums + our costs for our prescriptions totals $5367.

DH's company offers an Aetna PPO plan for 2012. We'd both be covered for a single premium of $1224. It has a $250 pp medical deductible, so I'm figuring $500 up front. After that is satisfied there is the usual 20% copay. Our current prescriptions would cost us $1680. So...this totals $3404, with the 20% copays an unknown.

It seems to be a straightforward gamble. Under the first plan our current meds cost us much more. Any new meds would cost more. We'd pay more if the retail on current meds increases.

Under the second plan, we'd save almost $2000 upfront because our current meds cost less with the PPO. We'd pay less on any new meds. We'd pay less if retail on current meds increases. However, if we do have a lot of medical bills, we have those 20% copays. (THe PPO plan has a $4100 pp OOP maximum.)

I'm *guessing* we would not have $2000 in medical copays.

I *know* we will be taking these expensive prescriptions forever.

Our MD will bill Aetna's PPO. Our hospitals too.

Is there something ELSE I need to look at here?

Thank you!


Follow-Up Postings:

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RE: Medical & Drug Deadline Nears

I know this is asking a lot, but I'm very nervous about how to place this 'bet'. Any thoughts?


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RE: Medical & Drug Deadline Nears

I just don't like the PPO plan. I like more of a sure thing, and less in the way of co-pays. Yes, it might cost you more....

OTOH, if you are budgeting very closely, and can absorb the unknown costs, the PPO will be ok.

I think about a friend whose husband had a stroke at age 63. Two months in a nursing home. That's your gamble.


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RE: Medical & Drug Deadline Nears

sushipup -- Many thanks. You are always able to sharpen the focus for me!

Yes, if we take the PPO we could be on the hook for $8200 in medical expenses. ($4100 pp OOP.) I'm 70 and DH is a couple years older.

Perhaps we'll stay with the Medicare Supplement, each buy a cheap premium Part D -- and buy our meds from Canada! (I would look into that if I knew how.)


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RE: Medical & Drug Deadline Nears

If you can afford the maximum co-pays should the need arise, it would be better to take the cheaper Medicare Advantage Part C plan rather than continue with what you have now -- I'm guessing Original Medicare Part B plus a Medigap Plan F, and the Part D drug coverage.

In general, it's always better to self-insure as much as you can afford to because the odds are you'll wind up paying less over time. The insurers need to make a profit on the products they sell, and the more complete the coverage you buy, the greater the profit they make. Of course, if you don't have the financial depth to switch over, you should keep what you have or possibly switch you Medigap F plan to a cheaper one.

I would opt for a PPO-type plan myself, but we split our time between Michigan and Arizona, which would take us out of any PPO coverage area for half the year.


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RE: Medical & Drug Deadline Nears

Just to be clear, if you have a Medigap plan F, do NOT downgrade that to a cheaper plan. Maybe shop aorund for a cheaper plan, but once you step down in grade, you cannot go back without health clearances loke regular insurance. but you can shop around and see if there is a cheaper F Plan available.


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RE: Medical & Drug Deadline Nears

I respectfully disagree with you, sushipup. Obviously you should shop around for the cheapest plan at any level, but the question always should be "what makes the most financial sense for me?" You shouldn't atomatically opt for the highest coverage, Plan F, just just to avoid underwriting in the future because you might wind up paying a lot more for your coverage right now.

Plan F coverage is the most complete and the most expensive. It covers even the small Medicare Part B yearly deductable (which dropped to $140 for 2012), plus all the other gaps in Original Part B Medicare. Plan G covers all the gaps except the $140 deductable. According to an instant online quote I just received from Mutual of Omaha, my monthly premium for Plan F would be $31.23 more than for Plan G, which amounts to $374.76/year. That's a lot to pay, isn't it, to avoid a $140 yearly deductable?

It could well be different with other insurers, but, in general, if the difference between Plan F and Plan G respective monthly premiums for 2012 is more than $11.66, Plan F is is a bad deal financially. Yet, Plan F remains by far the most popular choice among Medicare recipients.


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RE: Medical & Drug Deadline Nears

Just so that people understand that they cannot go back to a more comprehensive plan ever, not without passing physical tests. So rather than be short-sighted and look at your premiums for one year, what about looking down the line when you are a lot older and may have more needs?

It's insurance, you make the bet.


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RE: Medical & Drug Deadline Nears

Medicare plans vary by state, in my state (California) if the only PPO is discontinued, a medicare recipient can go to any other plan based on the discontinuation of their present plan.
I reviewed all the plans when looking for a plan for my DH, in his circumstance it didn't make sense to pay monthly premiums for something he may not need, the "free" PPO maximum annual out of pocket is (I think) $3600, versus a guaranteed HMO premium of $2400. I asked an agent why does he want an HMO, and said I only saw the future risk of not qualifying, he said it isn't much of a risk because he can stay on his PPO, if they change anything about the plan he is eligible to move to another without qualifying, it may not be that way in another state, but it is in California.
It is difficult to discuss the "best" plan between individuals needs and also different states. Individual people and states have different needs and coverages.


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RE: Medical & Drug Deadline Nears

Sushipup

If the conly difference between Plan F and Plan G is the part B deductable ($140 for 2012), why in the world would you pay a much higher premium for that coverage now just to reserve the absolute right in the future to continue doing the same thing? It just doesn't make sense to suppose that the future deductable will EVER be more than the premium difference between F and G, which would be the only reasonh you'd want Plan F.

Sorry, but I just don't get it. Maybe I'm missing something here but you haven't told me what it is.

cmarlin

Your post appears to be about Medicare Advantage plans (Medicare Part C), not Medigap plans. I don't know as much about them, but I believe that having to qualify for a new plan only happens when you voluntarily leave a plan, not when the plan changes your coverage, and this is a Medicare regulation and true in all states.


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RE: Medical & Drug Deadline Nears

G pays 80% of the excess part B charges, while F pays 100%. I think there are other differences as well.
Has that been changed in 2012 to $140 total for the year?


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RE: Medical & Drug Deadline Nears//

plan comparisons

Here is a link that might be useful: plan comparisons


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RE: Medical & Drug Deadline Nears

You are right about the 80% vs 100% of excess Part B charges. However, extra charges are applicable only if you use doctors who don't accept accept assignment -- the standard Medicare Part B reimbursement. Under Plan G, you would have to pay 20% of the excess these doctors charge over the Medicare reimbursement. However, the excess charges are limited to 15%. So, under a Plan G, the most you would be responsible for is 20% of the maximum 15% excess charge. For example, if the standard Medicare reimbursement for an office vist is $100.00 and your out-of-assignment doctor charges the maximum of $115.00, you would have to pay $3.00 under Plan G, but there would be no charge under Plan F.

I guess if you currently use out of assignment doctors and frequently use their services, it's possible the extra charges could add up to enough to justify the added cost of Plan F premiums. I still don't think this slight extra benefit justifies Plan F's added cost -- typically about $260/year ($400 higher yearly premium minus the $140 deductable) -- for most people. In any case, you should know exactly what you're getting for that higher Plan F premium and decide if it's worth it to you over the long haul.


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RE: Medical & Drug Deadline Nears

cmarlin
Your post appears to be about Medicare Advantage plans (Medicare Part C), not Medigap plans. I don't know as much about them, but I believe that having to qualify for a new plan only happens when you voluntarily leave a plan, not when the plan changes your coverage, and this is a Medicare regulation and true in all states.

Yes, I am referring to Plan C in my case mentioned, but I was really addressing sushipup who said :
Just so that people understand that they cannot go back to a more comprehensive plan ever, not without passing physical tests. So rather than be short-sighted and look at your premiums for one year, what about looking down the line when you are a lot older and may have more needs?

This is not true, if you present plan changes in any way, even if present change by $1, you are then eligible to changes plan without qualifying, therefore I don't see this as an obstacle to going with a lesser plan in the beginning. Doesn't every plan change at least in some form of coverage if not every year at least every two years?

My point about Plan C, I like choices that one doesn't have in an HMO, the bonus with Plan C is it is free, why would I pay more for limited choices?


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RE: Medical & Drug Deadline Nears

"if you present plan changes in any way, even if present change by $1, you are then eligible to changes plan without qualifying, therefore I don't see this as an obstacle to going with a lesser plan in the beginning. Doesn't every plan change at least in some form of coverage if not every year at least every two years?"

Two points. A Medigap provider cannot, by law, change the extent of the year-to-year coverage of any of the plans it offers because the various plans and the benefit levels they contain are established by Medicare, not by the insurers. That is, the Plan F offered by all insurers must include the exact Plan F benefits Medicare has established, and the same is true for all the other Medigap Plans.

Second, I don't think a change in premium cost, alone, would excuse you from the underwriting requirement if you decide to drop a lower benefit plan and instead buy a higher one. However, if the insurer decided not to continue offering that level plan in your state, that would excuse you from underwriting, as would also be the case if the insurer went out of business.

But I agree with you that it's wise to run the numbers and buy the plan that makes the best financial sense for you. People who are in good health and have the financial resources to absorb increased health costs in the future should their health worsen, would often be better off saving money now by choosing a lower benefit plan. Being overinsured usually doesn't make financial sense, but a lot of people do it because it gives them peace of mind, which is nice, but be aware that it does come at a cost.


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