Medicare with Open Eyes

[JD8]

Just to refute ONE falsehood in that video concerning hospital stays... here's what Medicare part A pays for

Inpatient Hospital Care Coverage

In need of inpatient hospital care coverage? Get professional info, tips on cost estimation, semi-private rooms, meals. Learn more at Medicare.gov.

www.medicare.gov

Here's what you pay for......

You pay this:

• $1,484 ($1,556 in 2022)
  deductible for each
  benefit period .
• Days 1–60: $0 coinsurance for each benefit period.
• Days 61–90: $371 ($389 in 2022) coinsurance per day of each benefit period.
• Days 91 and beyond: $742 ($778 in 2022) coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime).
• Beyond lifetime reserve days : All costs.

One hospital stay with a supplement for an age 65 individual and you've broken even with a year's worth of premiums if anything for just covering the ~$1500 deductible.

Either way you might want to look up what respective supplements would pay.

 

[JD8]

Let’s see if I can explain, if you have an acute (requires hospitalization) or chronic (copd/diabetes,chf, hypertension,etc..) you will not get near the coverage, your available network shrinks considerably. An example, for home health there is probably a 100 agencies that cover the Okc metro but if you go to a Medicare advantage plan you are looking at only 10-15 home health cares and pre-authorization can take days and you are very limited on what the plan will allow.

If you are healthy you can gamble and take advantage but once you have an acute/chronic condition you will probably regret that plan.

Stick with Medicare is the bottom line. We have Tricare and it’s getting harder and harder to find doctors for a plan that used to be taken everywhere. Almost everyone takes Medicare and they pay 100% for home health and hospice.

Ok. It seems you're conflating Medicare advantage plans and Medicare supplements. Two completely different coverages. This would make sense as to what your wife was saying but you have to understand, it seems she's talking about medicare advantage. In which you completely forgo your medicare "rights" and sign them away to a private insurance company...... and yes..... the sicker you are.... the more you gamble. If that's what she's talking about then she's right, the private insurance company can limit your options, network, and coverage at their will. Either way,his cannot happen with a medicare supplement which compliments traditional medicare part a and part b because of medicare assignment previously mentioned.

Y'all can go here for the Oklahoma Insurance Depts breakdown....

201023_Medicare-Supply-Buyers-Guide.pdf


So you have two main ways to go about your medicare coverage....and yes it's confusing.


1- Stay on traditional Medicare.

Part A Hospital
Part B Doctor
Supplement (Optional) Several plans available <----- Do not confuse with "part C"
Part D Drug Plan (Optional). Several plans available


2- "Medicare" Advantage AKA Part C (optional)

You assign all medical coverage, doc, hospital, drugs to a private carrier..... like AARP and the government pays them a fee every year to administer your health.

IT is my opinion that the government puts confusing information out there so that many take "Medicare" Advantage AKA Part C.... but that's just me.

 

[OldDad]

The Area Agency on Aging in your area will offer free help deciding and signing up for all plans

 

[Raido Free America]

Give a listen to this doc. He is an advocate for just having Medicare A and B....Original Medicare without purchasing any supplemental coverage (Plan G, N etc and Part D).

He argues that having only Part A and B is excellent coverage and everything else we hear online is smoke and mirrors designed to convince us to buy the very expensive supplemental plans. I'm trying to shoot holes in his points but not having any success. He seems correct.

It appears we are being snookered with a one-two punch: All the nice friendly independent medicare brokers warning us about Medicare Advantage are right but then they steer us toward the Supplemental Plans, which we almost always do not need.
As a bonus, he trashes AARP.

Check out the links to the 6 or so additional videos and his website at the top of the comment section

I disagree! I'm on Medicare, and have a good supplement insurance, Aetna, I have had two knee, and one hip replacement surgeries, while on medicare. The surgeon that did my surgeries will not accept Medicare patients unless they have a GOOD supplement Insurence! If there is one thing I have learned from being retired, it is DO YOUR OWN HOME WORK on all the things you NEED to have a sucessful retirement! Don't take anyones word for anything, this important! Check it out for yourself! I only payed the $15.00 Co-pay for office calls, during all three of these surgeries, and I'm sure the total bill would have been way into the six figures!

 

[okcBob]

I disagree! I'm on Medicare, and have a good supplement insurance, Aetna, I have had two knee, and one hip replacement surgeries, while on medicare. The surgeon that did my surgeries will not accept Medicare patients unless they have a GOOD supplement Insurence! If there is one thing I have learned from being retired, it is DO YOUR OWN HOME WORK on all the things you NEED to have a sucessful retirement! Don't take anyones word for anything, this important! Check it out for yourself! I only payed the $15.00 Co-pay for office calls, during all three of these surgeries, and I'm sure the total bill would have been way into the six figures!

I have heard that some supplements have a high monthly premium, where the MCR replacement plans are much more addord

 

[dennishoddy]

I have heard that some supplements have a high monthly premium, where the MCR replacement plans are much more addord

I think I mentioned this in this thread or maybe another thread, but I have Aetna as a secondary. Less than $200 a month. (My accountant is in bed asleep as we speak)
Every 5 weeks I get an injection in the eye that runs around 3K. I pay nothing but a small deductible at the first of the year.
Never had to make a copay after the deductible has been met. The math is easy to justify.
If one has to go to a rehab center, the advantage plans only offer 5 days, after that you're out unless close to death. Medicare offers 20 days, and if your still not ready to go home, another 20 days is available. Rehab centers charge anywhere from $4500 to whatever they want so if your advantage or Medicare plans run out, you're on the hook if you don't have long term care insurance. That insurance is cheaper the earlier you start it.
We just went through all of this in OKC when my sister had a heart ablation. We saw so many insurance and advantage plan advisors that I can't count. Advantage plans are great for someone like RickN and my sister. Your stationary with the same doctors and same hospitals in the plan.
One can go bankrupt medically with the advantage plans if you require emergency care and are not in the advantage plan network of hospitals and doctors or if you're in the hospital for months after a major incident treated by an out of Network Doctor. Never happen with the right supplement.
Speaking of long-term care insurance. My MIL and FIL started a policy in the late 90's. FIL developed Alsheimer's three years ago and was admitted to a memory care unit in Tulsa. MIL stayed home until she couldn't drive and moved into assisted living in the same facility so she could be close to her husband.
FIL passed a year ago and MIL still in good health is living in the assisted living facility to this day. The cost between them would have been almost $8000 a month as they got a discount for two living there. She is currently and will never pay anything until she passes which considering her current health may be awhile because of the long-term care insurance policy. You don't pay into the policy once you're in the system.
Because of that reality check we looked into long term care insurance. Both of us are in good health, but one never knows what the future brings. We know lots of people that have spent many years in long term care.
It's a personal choice what one wants to do later in life, but your health is never going to get better no matter what one does. It's a downhill slide so one has to prepare as one chooses.

 

[ttown]

I went with Medicare A and B with plan N ($77, $233 dect pat B, $20 doctors, $50 emergency). Part D was $6.80 that covers my medication for $1.

Seems to me $170.10 + $77 + 6.70 = $253.80 mo

seems a bargain to me with high cost. I want options if I get sick

 

[THAT Gurl]

Well that's interesting.

In about 6 months I'll be signing up for Medicare and I've been trying to study this as best as I can.

It's about as clear as mud, and the devil is in the details.

I've talked to quite a few family members who are on Medicare and they love it. Each has purchased a supplemental plan that covers everything. For example, my sis had a major surgery, her husband just got cataracts done, and they paid exactly Zero. Nothing.

I suppose if you *think* you're very healthy, and you have a lot of money, these supplements may mean nothing for you.

However, if you have only A & B, and have a drastic to cathastropic health event, you could owe many many thousands of dollars.

In the end, it's insurance just like everything else. You pay to get your butt covered. It's all a calculated risk.

If you have a really good regular pension bringing in a lot of money, and have a LOT in retirement asset dollars, you can probably cover yourself with out any supplements.

Yep. My accident last year has cost us $0.00 out of pocket. That's transportation to 2 hospitals -- first one didn't have the ability to treat my injuries. A couple of extra trips to ER when I had problems after they sent me home (sent me home WAY early because of COVID with directions to return to an ER if I developed certain symptoms. I took them seriously 'cause I wasn't interested in becoming paralyzed.) We've come to the realization that Grumpy will probably work until he dies -- just because of his insurance.

 

[Dale00]

Medicare.gov offers a search engine to show how much medical proceedures cost a patient who is covered only by original Medicare (parts A & B), no supplimental coverage. Link

Perhaps someone who knows medical terminology/codes can better look up the most costly medical proceedures (e.g. heart transplant, lung transplant etc.)

Here is what I found as average costs for a few proceedures (Surgery Center first, Hospital Outpatient second)
Hip Replacement $2,027.....$1,748
Cataract Replacement $316....$524
Pacemaker $1,683....$1590

 

[turkeyrun]

Yep. My accident last year has cost us $0.00 out of pocket. That's transportation to 2 hospitals -- first one didn't have the ability to treat my injuries. A couple of extra trips to ER when I had problems after they sent me home (sent me home WAY early because of COVID with directions to return to an ER if I developed certain symptoms. I took them seriously 'cause I wasn't interested in becoming paralyzed.) We've come to the realization that Grumpy will probably work until he dies -- just because of his insurance.

Yep, my retirement has been postponed until Wif gets well, because of my insurance.