I’m currently in the process of helping my Dad choose a Medicare Advantage plan to supplement normal Medicare coverage. My Mom died almost 3 years ago, and in that time he’s been covered under a Medicare Advantage plan tied to her pension. Now that’s running out, so we gotta get him something else.
Of course, this being the US, these plans are almost impossible to compare easily. That said, my Dad has his share of medical problems; the last couple years he’s more than met the out-of-pocket maximum on the old plan, which was a relatively low $1700. His total charge that the insurance covered in 2018 and 2019 has hit the $200K mark (:eek:), and I have no reason to believe that 2020 will be any different, at least in the sense that his normal routine care will likely be many thousands of dollars.
So, given that, I’m thinking that all these copays and coinsurance and emergency room costs and all that are inconsequential; the real numbers boil down to the monthly premiums and out-of-pocket max for each policy. I’ll add that all his providers are in-network for all the plans we’re considering, so out-of-plan coverage doesn’t come into play.
So if Policy A has a monthly premium of $113 and out-of-pocket max of $6700, he will end up paying $8056 for his yearly health care (not counting Medicare premiums, which are the same regardless). Policy B is $260/month but the out-of-pocket is $3425, which comes to $6545, so even though Policy B is more per month, it ends up being cheaper when looked at yearly.
Am I missing something?
(and to all you non-US folks, yes, I agree, this is nuts, it’s confusing, and it sucks. I am lucky that my father can afford this extra coverage at all; plain Medicare - the plan all old folks get in the US - sucks even worse. If you can arrange a way for me to move to your country and bring my Dad I would love to come and take advantage of your hugely better health plans, but until then, this is what I’m stuck with.)
Be sure you look at the traditional supplements as well such as Supplement G and F. They are going to have low out-of-pockets. But a bigger advantage is that virtually all doctors take them–unlike the Medicare Advantage plans which have limited networks and it sounds like you Dad could well want a specialist not in a certain Medicare Advantage network.
What are “traditional supplements”? Assume I’m an idiot about Medicare, because I am.
I’m not so worried about out-of-plan specialists; we are in a small area with a big health care system. I’ve never once had an out-of-plan doctor for myself or my parents, both of which have had a gamut of expensive conditions, and I’m a T1 diabetic so I have my own issues. We just seem to have one big system here that every doc is part of. That said, in the few minutes I have right now to look at Supplement F & G, seems like they cover other things as well, like hospital stays, which we do use.
But - that said - if he reaches way more than his max every year and thus stops paying at the out-of-pocket max, do those supplements even come into play?
Just want to add that if you’re switching plans, it’s probably necessary to look at prescription drug coverage (Part D). I’m thinking some Medicare Advantage plans include drug coverage, but supplement plans do not.
Each Part D plan covers a list of drugs at varying coverage levels. Check the list of drug covered to be sure that as many as possible used by your dad are covered by the Part D plan you select. I believe there are websites that can help you with this.
Does your dad have a financial advisor? If so, check to see if they offer help with making these selections. We used the health consultant on staff at our financial advisor company. Also, based on the vast amounts of mail we got when we were turning 65, there are independent consultants that will help you through this at no cost to you. Obviously, you’ll have to vet any you choose pretty carefully.
You don’t just pay the maximum out of pocket cost like you are suggesting. After the deductible is met each procedure, test, office visit, etc has a certain amount the insurance will cover. If a MRI bills for $1000 the insurance company will first of all knock that down to their approved amount, say $750. Then they will pay what the schedule shows. It may be a percentage of that $750 or they may pay a fixed amount. After the insurer pays, the patient pays. Out of that $1000 initial bill you may end up paying $100 or $200. That final amount is what adds up to the max out of pocket and after that they should pay everything up to the total max for the plan.
I just switched plans from Medical Mutual to Blue Cross Basic. On the Blue Cross plan comparison site I could list plans side by side with a direct comparison across the various plans. They also had examples throughout like, “The patient sees their primary care doctor and he sends the patient for an EKG and a cat Scan”, then goes through each example to show what you pay.
To summarize a few example from the booklet I have:
Peg is having a baby. Initial billing was $12,600. Peg ends up paying $260
Managing Joe’s diabetes. Initial billing $7500, Joe ends up paying $2060
A simple fracture. Initial billing $1900, patient pays $460.
It doesn’t sound like you are talking about a Medicare Advantage Plan at all. Your costs are nuts, at least in my experience.
I live in Illinois and my cost per month last year was $28 and I had an OOP Max of $3000. This year I switched to Cigna from BCBS and my monthly premium is $0 and my Max OOP is $2600. Drugs are included.
Co Pay for normal doctor visits is $20 so barring any medical issues I will pay $40 this year for everything.
I do, of course, still have to pay the standard Medicare part B premium that is deducted from my SSA check.
I’m just coming up on this Medicare stuff and just starting to investigate it, but the F supplement has been discontinued for new enrollees. (As near as I can tell, because it covered the most stuff!)
Discussion of various supplement plans, A through G, only relate to traditional Medicare. Medicare Advantage Plans cannot select (don’t need) such supplements.
The OP made it clear he was selecting an Advantage Plan though it appears as though he is not.
The only difference between Plan G and Plan F is that Plan F covers the Part B deductible. There were, I think, two plans that covered the Part B deductible and neither is available to new enrollees.
Yep, I get how that works - I didn’t mean to suggest that I’d just make one big payment and pay off the out-of-pocket or something like that. But given that he will certainly meet the out-of-pocket dollar amount via deductible and co-payments and co-insurance, I don’t think it matters how those costs are calculated. In other words, I’m thinking that the difference between, say, an 80/20 plan or a 90/10 plan or what the copays are don’t matter to us; what matters is that the amount he pays will hit the max out-of-pocket within a few months into the new year, and therefor that is the number we most care about.
Man, I wish I could find plans with that low of premiums/out-of-pocket. You’re right; the ones I’ve found are WAY more than $28/month and a $3K OOP.
barring any medical issues is the relevant point; he has medical issues that are not going away. He will qualify for and use all the physical / occupational therapy benefits he can get. He will visit a specialist for something at least once a month, likely more. He will almost certainly visit the ER once this year; last year, off the top of my head, I know he was in the ER at least 4 times, and I’m guessing there were more that I don’t remember. Getting old sucks.
It would be foolish for us to choose insurance for him based on him NOT using it; rather we have to assume he’ll use a lot of it, so we must look at maximum costs, not minimum. Heck, that’s the same for me when it comes right down to it - as a Type 1 diabetic, I blow through my deductible by March or April every year. I have a high-deductible plan that pays 100% after I reach that deductible, so to me, the deductible amount is the relevant number.
Health insurance is a whole different thing for those of us unfortunate enough to have to plan on using the damn stuff all the time.
I understand that your dad is a heavy user of health care. My late wife was also, maxing out her OOP limit by March each year, so I get it. I was just saying that my total *could *be very little.
My real point is that perhaps you should investigate Medicare Advantage Plans, which you say you are doing but you apparently are not. Medicare Advantage does not use supplemental plans, A through G. You are looking at regular Medicare.
The downside of Medicare Advantage, but what makes them so cheap, is that they are HMO’s so you have to use their doctors. In my case my Primary Physician that I used under regular Medicare is also my PP on Medicare Advantage, so win-win. As for other doctors I might need, I don’t care who sees me. My wife would not have allowed that, just not in her style, so she would not have been a possible candidate. But you sort of imply that your dad is in an area where the possible choices are small anyway so if a Med Adv plan is available that uses those doctors, why not use it?
Anyway, best of luck. Why are you in the market now? The annual time to change plans is long past.
I’m definitely looking at Medicare Advantage plans. Folks upthread mentioned the supplements but I am personally not looking at them, beyond taking a quick look when they were first mentioned then realizing that’s not what I want.
HMO is fine - as I mentioned, we have a big medical community in a small town & everyone is connected to the same network so essentially, any HMO covers every doc around here (and I verified that with the plans I’m looking at.)
I’m in the market now because my mother died almost 3 years ago, and my Dad’s been on her plan via COBRA since then. That coverage was only available for 3 years, meaning it’s gone at the end of January and he’s eligible to change even though it’s not open enrollment.
Now that there’s been answers to the OP, may I ask a sidebar? What you folks are talking about - is that the “Medicare” in the phrase “Medicare for All”? Because it seems awfully complicated for what’s being suggested as a way to get to UHC?
They’re talking about the coverage beyond Medicare. Medicare itself is fairly simple… 80% of your care is covered, you pay the other 20%. But for someone with a lot of medical needs, (most people over 65) that is not sufficient enough to make medical care affordable. So you’ve got a ton of options on how to supplement the coverage.
Short answer is yes, this is the same Medicare politicians are referring to when they say “Medicare for all”. I believe such politicians are counting on the under 65 general public to not understand how Medicare actually works. I wish people would do their research before jumping on the “Medicare for all” bandwagon. In simple terms, you pay a monthly premium for health coverage that pays 80% of the doctor’s bill. The amount the doctor is allowed to charge is determined by Medicare and is significantly less than the “list” price. You have the option of signing up for a supplemental plan to cover the remaining 20%. This is a fee for service arrangement and you are not tied to any particular network. OR, you may sign up for a Medicare Advantage plan in which an insurance company takes the place of Medicare for paying the bills and has a managed care plan that requires that you only use doctors in their network. Generally, the total health care cost per year is least expensive with an Advantage plan. What politicians fail to mention is that the monthly Medicare premium is currently being subsidized by working people under 65. To get an idea what the unsubsidized cost of Medicare might be, look at the last row of the IRMAA surcharge table where your monthly Medicare premium is increased based upon income, namely $460.50 instead of $135.50.
When I was looking at Medicare I bought “Medicare for Dummies” which I found to be very good on the intricacies of the program. I’m sure that there are other good books, but I was satisfies with this one.
While the Advantage program might be good for your area, if your Dad ever travels you should check the coverage in other places.
When I went on Medicare none of the Advantage plans covered the clinic I went to, so they were out. I got Medigap Plan F. I had a lot of medical expenses in 2019, and I paid no copay, which is not doubt why they won’t let new people in.
