Everything @wolfpup is correct, but there is one giant gap in the system. My wife and I have been using the same family doctor for 40 years and he is retiring next month. There are no family doctors or medical clinics that take new patients, at least anywhere within ten miles of where I live. The reason is that a few decades, Quebec decided to alleviate the shortage of doctors in the boonies, they would limit the number of doctors allowed to start practicing in Montreal and they still are. Last November I registered with a provincial site that is charged with finding everyone a doctor. After I jumped through all their hoops, I was told that the average waiting time for people in my area to get assigned a practitioner was about 15 months! And, needless to say there were no guarantees it would be anywhere near us. Or, for that matter, that my wife and I would get assigned the same doctor or even clinic. So we are likely to go nearly a year with no family doctor.
And I forgot to mention that there are a slew of foreign trained doctors driving taxis because they must undergo a local residency in order to be licenced and the number of residencies is strictly limited.
That said, when the system works it is wonderful, but when it doesn’t…
BTW, we got our vaccinations yesterday. It went very smoothly.
Exactly what I meant ! And thank you for being so face-saving of me about it. You are a great teacher/guide/mentor.
I’d keep that site in your bag of tricks and drop it into your insurance tutorial series often. Mortals like me don’t know what we don’t know to ask for.
Good information, OP. I’m one of the fortunate ones who has Tricare, the only real, tangible benefit from my 23 years in the military. Having that means that neither I nor my wife have to wade through the morass of the different “parts” of Medicare. We have a government-provided long term healthcare policy in the event of catastrophic illness, and we both have good teeth, so dental insurance is not cost effective for us. I really feel for those who have to deal with the Medicare system. I’ve stood in line to close out a medical procedure and listened to each person in front of me (in the case of cataract surgery) fork over $500 on top of their insurance. My turn comes and it’s zero. Surgery on my neck: zero. I need to remind my wife not to remarry when I’m gone. 
Yes, because she may lose every single benefit which passes to her upon your death, including pensions, etc.
Chefguy - My sister worked for years, mostly for the insurance (the 6-figure salary didn’t hurt, but they didn’t need it). It was only after her retired-military husband’s death did she find out that she’d been eligible for Tricare the whole time. Because of his accepting some sort of early-out retirement, they thought she wasn’t covered.
One of my other sisters is also married to retired military. She has cancer now, and through the surgeries, the chemo, the tests, she hasn’t had to pay out of pocket.
StG
Finding a family doctor can sometimes be a challenge anywhere, but Quebec has a number of unique problems besides the one you cite, exacerbated I’m sure by the parochial language culture and draconian attitude towards the French language, which in turn has seriously hobbled their economy. According to Stats Can, nearly 25% of Quebecers were without a family doctor in 2015, compared to 8.3% in Ontario. This in turn has a cascading effect on emergency room wait times, another infamous Quebec problem. Also, in 2015 Ontario had 1,897 nurse practitioners – senior nurses with advanced medical training. Quebec? Just 225.
Sometimes Quebecers actually head to Ontario for emergency health care services:
Thanks John. I may reach out.
I’m going to try to talk myself into dealing with this pretty soon.
I consider myself reasonably knowledgable about the medicare system, but I didn’t know there was only a 6 month open enrollment period for medigap. Do people who miss that window just never qualify for it, and spend the rest of their lives facing a risk of a 20% copay on what medicare B charges them? How is anyone over the age of 65 supposed to pass a physical test to qualify for a medigap plan after this period is over?
Looking online, some states have annual open enrollment instead apparently. So thats good. Maybe a person could move to Oregon to get medigap if they missed the 6 month window.
I guess my plan is just to leave the country when I’m older. This country is such a shameful mess.
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Yes, for guaranteed issue, only a 6 month window. Technically, however, it’s a full year given various provisions (“take back”) which allow someone to get a MS beyond this window.
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If you don’t get the MS plan, get the MA plan. That will protect you from the 20%, many times at $0 premium, via the mechanism of “Maximum Out of Pocket”, which featured heavily in my original 3 posts.
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Many people do pass the underwriting, but note that the price can be adjusted to match the findings:
In the 6-month guaranteed window your plan offerings and premiums are based upon, to put it simply, the “average” of your county (it’s more complicated than this, but this is the gist of it). If you still have your Army Sgt boot camp physique and box, run, etc, you could very well get a lower rate than this average via medical underwriting… but most people wisely play it safe and take the initial offering. In addition, you may have a wider variety of plans to select from during the guaranteed window than you do during an underwriting window.
If you decide to change your Medigap plan after this, after underwriting you may find the plan offerings limited compared to the Guaranteed Issue enrollment period, and your premium may be adjusted to reflect your health, so that your $155 premium is now $305.
“Why would you want to change your Medigap plan?” you may ask? Well, because the Powers that Be introduced ‘competition’ to those plans too, so there are different plans which cover the exact same thing at different prices.
“What good does it do anyone to offer 17 different Medigap plans between 13 different companies to the same market, when the Medigap plans effectively do the same thing?” Fuck if I know.
Oh, wait… I do know. I said so in the first post: Competition! Freedom! Choice! Markets! Capitalism!
These ideological principles have turned health insurance into shit, and even the ones who are winning this sickening game are also repulsed by it. Which brings me to…
My understanding, when I enrolled, was that there were some Medigap plans which increased premiums significantly with age, basing premiums on the pool at a given age, and sowere lower at the beginning, and some which were somewhat higher at first and based premiums on the entire pool, no matter what the age.
And yeah, all the plans were identical across providers except for price.
Douglas, or how to do Medicare correctly
Talked to Douglas today, early 70s white guy from Illinois… Chicago, I think, executive type, you can tell by the language and tone. Love talking to these people, throwing $ figures at them, making them realize that they’re not the only professional on the phone.
But Douglas was smart, or his wife was. He did, as much as he could, do everything correctly, where he and his wife are fully insuring themselves for $4,000/year in total, or $2k per person.
They got their MS plans during their Guaranteed Issue window, she at age 65, he at age 68, when he retired and lost his employer insurance (he then applied for Part B, got it, this gives him that 6 month window mentioned above). They also got dental/vision/health, combo plans which combined all three.
His plan: $155
Her plan: $135
Dental: $60
Monthly Total: $350
Annualized: $4,200
Per-Person Annualized: $2,100
This may seem like a lot of money, but given that the best $0 Medicare Advantage plan has a MOOP of $4,500 per person, if/when their health takes a turn for the worse, the difference is $9k vs $4k.
Get the Med Supp. I’m telling you. And if you can get somebody else to pay for it, all the better.
Yes. Fake “competition” offering fake “choice” when the best solution is to put all 50,000,000 damn seniors into 1 single Med Supp pool. Or, better yet, all 340,000,000 citizens into a single Med Supp pool!
But that would be socialism!
I’m going to quote this again because this is a perfect example of the mendacious bullshit which occurs in this industry in the name of “competition” and “choice”. Think about what the above implies:
You retire. You’re on a fixed income. SS, Pensions, some passive income, whatever. Some dipshit comes along and says “Hey, I can get you FULL COVERAGE for only $50/mth, compared to these other plans which are $150. There’s a small catch, but…” and you look at it and you’re not financially sophisticated and you’re not a Straight Dope reader participating in this thread and, my God, age 85 is so far away because it’s always been so far away and that $100 looks enticing now and you agree…
To a situation where:
- Your income is most likely decreasing
- Your health needs, and expenses, are likely increasing
- During the period in which your health insurance policy goes from $50 to $450 every month, and your declining health prevents you from changing it
- Yes
- No
And they sell that shit! And call it “choice”!
100% agree. We only knew about this because my father-in-law got dropped from his school district health insurance plan when he was about 98, because he was the only one still alive in it. (Probably illegal, but not worth fighting.) At 98 the general pool plan was a lot cheaper than the by age plan.
The horrible thing is that despite all the problems with Medicare, it is still simpler than finding a private plan when you are under 65. I looked. I put off retirement until my wife and I could stay covered by my employer’s plan until we hit 65.
I found this stuff a bit confusing. I can only imagine what people without PhDs in computer science find it.
You have TRICARE now… under 65. When you turn 65 you MUST take Medicare Part B or lose your Tricare benefits. TRICARE-for-life (for those over 65) covers medications but there is a co-pay unless you live close to a military facility where you can get your medications. My wife and I are both retired military. We’re paying more for Medicare in one month than we paid for a whole year for TRICARE.
I’m 73 and did the right thing with Part B. Tricare usually picks up the co-pay costs for procedures, which is a really good benefit to have. We get our meds through Express Scripts which charges a flat cost of $10/per, which for me works out to be about $20/month. The premium for Medicare is about $1700/year ($140/mo) for each of us (automatically deducted from Social Security), which is pretty cheap for medical insurance.
JohnT, you are my hero for pointing all this out. I knew much of it but was having trouble getting someone to listen to what I was saying. Maybe if she reads it, she’ll understand better.
Medicare Primer - Part 2
So, really, it’s all about money. At least to me and, I’m pretty sure, most of the people I talk to. And there are ways you can save money on Medicare and prescription drugs, including:
Extra Help. EH is a means-tested prescription drug benefit which 40% of all my clients participate. As a general rule, if you can comfortably support that supplement, you likely will not qualify for EH.
State Pharmaceutical Assistance Programs, various Pharm programs run by the various states. Not all states have a SPAP, nor is there any consistency in what they cover - TX has 2 which covers very specific medical conditions, for example, other states are far broader.
Medicaid, for the truly needy, Medicaid can be hard to qualify for in many states, but if you get it… depending upon level… you will find it to be comparable to a supplement plan, one in which you also get your $148 Part B premium refunded to you!
For specific drugs, many of the manufacturers will offer coupons or have various discount programs. Do not hesitate to ask, they have more money than you, fuck 'em.
If you’re in the Medicare Advantage space, you will want to do the following to minimize your expenses:
… focus on three figures: Copays, hospitalization, and Max out of pocket:
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Max out of pocket. This is the maximum amount you can pay for medical expenses not covered by the plan, at which point the MA plan effectively becomes a MS plan and pays for everything. So, if the worse happens and you get into a debilitating car accident on the same day you received a very bad cancer diagnosis, the max out of pocket will determine whether you stop paying at $3,000 or $7,500. I prefer $3k myself.
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Hospitalization. You will get hit with a copay for every day for up to X number of days, after which the stay is $0/day. There are two ways you can look at this:
Plan A: $340/day from days 1-4
Plam B: $250/day from days 1-6
Plan A is more expensive on a per day basis, but on a long-term stay it is cheaper by $140.
Now, whether a lower long-term payment is preferable to a smaller per-day stay for short stays… that’s up to you. All I want to impart here is to be sure to look at both values: Per day, and the maximum which can be charged to you.
C. Copays. Many plans have $0 copays to see your primary care physician, some even have $0 copays for specialists. If you don’t like reaching into your pocket, be sure to keep an eye out on those copays - you really shouldn’t be paying $25 and $50, unless in a shitty market.
… Don’t pay a premium. For the most part, you should find a decent $0 plan.
… The Part B “Buyback” plans, the ones which refund $ on your social security. Get asked about these all the time, so here’s the skinny:
… … Some are fantastic, some are shitty. You can tell the shitty ones if they have “20%” coinsurance rates where you would expect copays (doc visits, hospitalization, etc)
… … They do tend to lack in those other “extra benefits” you see in the commercials. Don’t expect a Part B buyback with thousands in dental and OTC benefits, for the most part.
… … Most of the companies which offer them tend to do so for market share purposes, it seems to me. The bigger established firms (Humana, etc) seem to have fewer PBB’s than, say, WellCare.
… … You won’t get your first increase in your SS check until the month AFTER the month the plan takes effect. Get a plan to start in April, you won’t see the increase until May. So don’t freakin’ call me, k, thx, bye.
… … If you don’t go to the doctor very often, and you have financial resources, they’re not bad plans. If you’re flat broke, don’t sell your damn health insurance quality for a fuckin’ $55/mth. That’s stupid.
… … The ads on the TV can say whatever they want as long as it is true in a single county, so, yes, there is a county out there in FL which offers the entire $144 back. But nowhere else.
… The “Chronic disease” plans are really hit or miss when it comes to whether or not they are better than “regular” plans. Some are, some aren’t.
OK, that’s enough learnin’, it’s Friday night. But one last thing I need to add in my ETA time:
DON’T GIVE YOURSELF ANY SHIT ABOUT NEEDING EXTRA HELP OR WHATEVER ASSISTANCE PROGRAM. YOU WORKED YOU ASS OFF FOR 40+ YEARS, PAID INTO THE SYSTEM, IT’S NOW TIME TO TAKE. SO, PLEASE, QUALIFY FOR ALL THE SHIT YOU CAN QUALIFY FOR BECAUSE YOU EARNED IT.
Dave
I’m not a good salesperson. If there’s anything which I have learned in this sojourn into insurance sales it is that I’m not a good salesperson. I fully expect to lose this job within three, four weeks, at the end of OEP, and while I’m expecting it, it does mean that I wasted a good part of four prime earning years in a field in which I understand and can relate, but cannot close, and it also means I get to start over @ 54 which is just chef’s 
But you keep grinding along and today was just usually bad, not a single sale and I don’t give a shit about Alec Baldwin, these aren’t the Glen Garry leads, y’all. But at 5:30 I logged back on for one more shot and met Dave.
Dave is trying out for the Nomadland lifestyle, he and his wife in an RV, going from place to place in Texas and Florida, where they have family. Dave owns a home, rents it out to his kid, and they sleep there every once in a while, but for the most part they were on the road a lot.
Needed dental, hearing aids, not uncommon, but here’s the kicker - he needed, in his words, a “plan which travels”, which in my world means “he needs a PPO, a HMO-POS, or a PFFS plan”.
So I need to look for three variables - which of those above network types (PPO, etc) had the best combined dental and hearing coverage. I defined a PPO above, here are the others:
PFFS - Private Fee For Service. You can go to any doctor which accepts PFFS plans, but not all doctors do. PFFS plans tend to have premiums and they’re not very common. You also will pay the doctor whatever their PFFS rate is, and it can vary wildly by doctor.
HMO-POS - HMO with a “Point of Sale” clause, allowing you to go out of network anywhere in the US for a 35% coinsurance.
Dave already had a decent plan, but for the two things he wanted, it had nothing worthwhile. Fortunately, he’s one of those guys who believes God put him on this Earth so he could never see a doctor nor have a prescription, so I didn’t have to bother with finding an in-network doctor or worry about whether his drugs were affordable because Dave is organic, natural, homeopathic, drug-free, and only takes supplements created by the finest and rarest herbs in Asia shipped to some company in Alpharetta, GA, where they are packaged and sent to Dave (and me, if I wanted) for a mere $69/mth.
Yes, I got pitched on my own sales call.
Anyway, I got Dave enrolled, his wife is going to enroll tomorrow (she was too engrossed in “her stories”, as Dave put it), and I got off the schnide on the last call of the day.
*Lesson for you: If you plan on travelling (especially within the lower 48), and are in the MA space, some networks (PPO, HMO-POS, and PFFS) are better for that than others.