Question about Medicare Crap

There are programs in place that will pay your Medicare Part B premium if your income falls below a certain level. My state (Arizona) pays my premium every month, so I get the entire amount of my Social Security benefit. It’s worth getting in contact with your state’s department of economic security to see what benefits are available to you.

This. Oh, SO this! I got on Medicare early due to disability (and would happily trade Medicare to get rid of the disability). I was very happy to find a plan that meant zero premiums. Yay! Yeah, not so yay. As an insurance clerk at a doctor’s office told me, “Their payouts to doctors are so low, not many doctors take them. It’s one step up from Medicaid.” One time I needed to go to Urgent Care. There was only one place within 50 miles that was covered, and it was terrible.

I’m pretty happy with my Advantage plan now. I perused plans to see what kinds of factors I’d be dealing with, made a list of the benefits most important to me, then scoured plans to find those benefits.

It shouldn’t be that much work. It shouldn’t require the ability to do that much research; what do people who can’t research supposed to do? But that’s the system we have because “choice” (Hahahahahahaha.)is so frickin’ important to people.

FCM, how were you able to keep FCD on your old employer’s insurance? Did you have to use COBRA? Or were you blessed with extraordinarily wonderful insurance? (Either way, glad it worked out.)

That is really good to know. I’m sure most people are not aware. I wasn’t, hence my comment about Joe Namath. However, to be fair, there is no way to know that is what he is referring to.

My guess is that it’s something like my employer’s coverage. I can continue coverage through my employer after I retire. This continued coverage will cost me about $400* per month and my employer will be contributing at least another $600. Once I have retired and have turned 65 ** , Medicare will be primary and my employer’s plan will reimburse my Medicare premiums for myself and my husband. Once they’ve collected $1000 month between my employer and me, reimbursing $288 a month is nothing considering that Medicare will be the primary payer and my employer’s plan will only pay for services Medicare doesn’t pay for.

Medicare advantage plans are paid by Medicare to cover enrollees - it’s a capitation rate, which means the plan gets a flat fee per enrollee per month regardless of how much medical care the person needed. I recall seeing that this fixed payment is around $1000/month. The plans have a lot of freedom regarding networks and copays, so it’s entirely possible that they save enough by those methods to cover the $144/month Medicare premium.

I really wish there was some sort of fee-based advisor you could go to to find out which combination of Medicare/Medicare advantage/Medicare supplement was best for you. My first encounter with this was a couple of years ago when my mother was in a panic because the premium on her supplement was being raised a lot. She was paying for a supplement that covered excess charges - the amount a non-participating provider charges above the Medicare amount. She didn’t need that coverage, and we found a supplement that didn’t include it for a couple of hundred dollars less. When my sister asked why she got a plan with coverage she didn’t need, mom said “the lady said it was the best”. The “lady” was obviously a sales rep, but my mother didn’t understand/acknowledge that.

  • Actually less, because I will get credit for my unused sick leave.
    ** If I am retired and under 65, I will only have my employer’s coverage.

Yeah - there is absolutely no reason it ought to be this complicated.

But don’t you know? The US has the best health care system in the world! :roll_eyes:

I’ve noted on the board, in the past, that, while I work in advertising, one of my areas of focus is health insurance, having had several different health insurance companies as clients over the past 15 or so years. A few years ago, I developed a short presentation about how the U.S. health insurance category is structured, to share with people who are new to the account, and who haven’t worked on the category before.

At the start of the presentation, I always say, “What I’m about to show you is the result of a hundred years of evolution, much of it unintentional. No sane person would set out to create an industry that’s built this way.” :smiley:

Don’t certain persons profit quite obscenely from the US system? I think I recall reading that healthcare industries spend more in lobbying than the next 2 categories (IIRC defense and I’m not sure the other) combined.

There are also Medicare Advantage plans that are PPO, and allow you to go out of network.

Oh my goodness, thank you that is good information. I don’t think health insurance should be so complex.

Not untrue, but when I say that “no sane person would set out to create an industry that’s built this way,” I’m not only talking about the private insurance segment of the industry. I’m talking about the entire structure, the fact that public insurance is a crazy quilt of different types of insurance (some administered nationally, some administered at the state level), and, as demonstrated by the conversation in this thread, if you do have choices in your insurance (i.e., Medicare supplement), it can be incredibly confusing and frustrating to understand.

The fact that some people make a ton of money from the industry doesn’t contradict the observation that the structure of the system itself is insane, and what’s true for American X about their health insurance may have no bearing whatsoever on what is true for American Y.

Dave Barry once wrote that airline ticket prices are determined by a computer that had a jug of Hawaiian Punch poured into it, and ever since its prime directive has been that no two tickets should ever have the same price. I’m seeing certain parallels here.

This is true. I have one. My Advantage HMO plan made it tough to see the specialists I needed, and the only Urgent Care place on my plan was a very poor one. Yes, I paid no premium, but I had to fight to get the care I needed. I pay a little monthly now, but it’s worth it.

The Medicare.gov site is not bad for investigating the options available in your area. For Advantage plans it lists all available, their ratings, and has a link to their sites so you can check out the details. I switched my Plan D this year for drugs, and was pleasantly surprised that my drug list was up to date without me having to enter new drugs. And no advertising.
A lot of it is designed for people a zillion years old without any computer skills, so it should be super clear for any Doper.

Yeah - I was pretty much being snarky. So many things are so offensive about the US health system - it astounds me that more folk aren’t up in arms about it. But didn’t you know? Socialism BAD!

I want to clarify this statement from yesterday. Right now during open enrollment there are several companies HEAVILY promoting their Advantage plans, like Humana and United Healthcare. But those companies also offer Supplemental plans. Yet you rarely, if ever, see advertisements for those plans. So even with all that advertising, it’s still better business for them to sell Advantage plans, rather than Supplemental.

I’m looking over the plan I’m considering one more time before I call tomorrow to make the switch. I compared it again with another plan. What drives me crazy is that it is all so random. Specialist visit on one is $35, the other $20. Urgent care is $60 on one, the other $95. The only thing I might need in the next year is a partial knee replacement. So outpatient surgery is $325 for one, $275 for the other. Rehab? $25 per visit for one, $40 for the other. Thank god I’m not on any prescriptions. Just looking at that section makes me dizzy. I guess if you did the math and added up all the co-pays for everything, the plans equal out somehow. But it really shouldn’t have to be this complicated.

Are you purchasing an Advantage plan?

Yes, I switched to a PPO this year after some of the pre-reqs in my HMO ticked me off. I’ve had United Healthcare Advantage since I turned 65, been pretty well satisfied, they actually dropped all co-pays from April to Oct., which was nice. And it’s a very well known program so most of your providers will know how to do the insurance dance to get stuff thru.

Yes. The one I got when I enrolled in Medicare in January wasn’t accepted by the orthopedist I want to continue seeing. Even though the doctor is listed on their website as a provider. I called the Ortho office to make sure I pick one they accept.

I have a United Healthcare plan now. And it was nice to have no co-pay when I had to get my knee checked out. But the ortho group I want to go to is not a provider. And they are one of the biggest groups in Memphis. So I have to switch.

Sort of depends on what you mean by “better business”. Maybe it’s just me but I got the vibe you meant something close to “Advantage plans are nothing but a high profit ripoff versus the less profitable Supplement plans that offer good value.”

Because the price to the consumer of Advantage plans is zero, you can convert a lot of prospects into sales for very little expense in customer acquisition. And 100% of people over 65 are possible customers. Which makes TV advertising a good fit on shows with that older demographic.

Conversely, selling Supplemental plans is more work since those cost the consumer real money for the premiums. And because they’re rather expensive the advertising needs to be targeted to the more affluent folks. If you watch the Golf channel you’ll see lots of Supplement ads. CBS not so much.