Two Fold Medicare Question

[Dave Anderson NH]

In our case we used my former employer's insurance agency to help us pick a plan for my wife. They were extremely helpful in explaining all of the ins and outs. It was a BC/BS part B supplement with part D drug plan. Since my wife takes a very expensive drug (retail of $1000 per dose) the risks involved with choosing a Medicare Advantage Plan and then having the plan change were too great. In my case I don't use Medicare. All of my health care is through the Veteran's Administration at no cost. Our local VA has given me nothing but the very best care and in a timely fashion. My only costs are for a modest co-pay on the drugs. If you are a veteran, investigate the VA if they are physically nearby.

[Dave Fritz]

Every US government jurisdiction should have a senior center or resources available. Here it's the Wisconsin: Grant County Commission on Ageing. They have a specialist on board to help with those decisions. They are not SELLING anything! Their services are FREE to residents of the jurisdiction because they're paid for by your taxes. I was on the board of ours for several years and volunteered for many years after helping individuals choose the plan that best fit their needs. The medicare.gov website is excellent. What works well for one person may not work well for you. The Medicare plan finder lists all your options, rates them based on customer satisfaction, deductibles, monthly costs, prescription formularies, drug store options, doctors in system etc. It brought me great joy to see the smiles on people faces when they left and could throw away the bag of junk mail they got selling this or that product. Many seniors can't tell the difference between junk and the necessary letters. We encouraged them to put it all in a bag and have a son or daughter go through it occasionally. For many it brought great relief and piece of mind to their kids who knew what was going on with their parent.

For Ronald who started this thread, here's where I'd start: https://www2.illinois.gov/aging/Pages/default.aspx

[Michael Weber]

I opted for the so called Medigap or supplemental coverage. Cost was greater but what is covered is clear as opposed to Advantage plans. Claim payment on Advantage plans is determined by the insurance company. Too risky for me. Lots of horror stories out there. I investigated for months and while choosing medical coverage was not too confusing, drug coverage was. Because while you know what medication you currently take, what may be a required need next month is generally unknown and that drug may not be in the “formulary” of the chosen company or is in a different “Tier” of coverage. I have personal experience with that as well as in my wife’s coverage. Fortunately drug plans can change yearly and is something that needs to be researched every year as your drug needs change.

[Rich Engelhardt]

I opted for the so called Medigap or supplemental coverage. Cost was greater but what is covered is clear as opposed to Advantage plans. Claim payment on Advantage plans is determined by the insurance company.

Befor you get too confident that you're ok....

I went with a supplement plan also & part D for prescriptions.

I was assured by the part D provider my prescriptions coverage would remain as it has been for the last 5 years - my two nebulizer medications had been 100% covered and I paid zero for them each month.
When I got my first refill this year, I had to pay $49 each for both of them and instead of a 90 day supply, all I got was a 30 day supply.
The insurance company assured me both were still covered, but, they were now covered by Medicare past B - and Medicare part B charges more.

Other than the prescription mess, the supplement plan has worked well.

HOWEVER - I still believe there is now valid reason on this Earth that medical coverage for people over 65 has to be such a mess and so convoluted.

[Jerome Stanek]

I opted for the so called Medigap or supplemental coverage. Cost was greater but what is covered is clear as opposed to Advantage plans. Claim payment on Advantage plans is determined by the insurance company. Too risky for me. Lots of horror stories out there. I investigated for months and while choosing medical coverage was not too confusing, drug coverage was. Because while you know what medication you currently take, what may be a required need next month is generally unknown and that drug may not be in the “formulary” of the chosen company or is in a different “Tier” of coverage. I have personal experience with that as well as in my wife’s coverage. Fortunately drug plans can change yearly and is something that needs to be researched every year as your drug needs change.

My advantage plan costs me nothing but you have to check your area for the plan that fits you. Our state sends out books with most of the plans that are available in our state. you can compare different plans

[Alan Lightstone]

Be careful if you choose a Part C plan (Medicare Advantage) and are on a biologic (which can be staggeringly expensive).

I'm profoundly impressed by anyone who can explain the various stages of Medicare as you pay expenses during the year. First Stage 1 - The Annual Deductible. Then Stage 2 - Initial Coverage. Followed by Stage 3 - Coverage Gap. And then finally Stage 4 - Catastrophic Coverage. Much less the 5 tiers of medications. And this is just for Part D coverage. And of course, there is the out-of-pocket cost.

Whoever thought this system up.....

[Mike Henderson]

Be careful if you choose a Part C plan (Medicare Advantage) and are on a biologic (which can be staggeringly expensive).

I'm profoundly impressed by anyone who can explain the various stages of Medicare as you pay expenses during the year. First Stage 1 - The Annual Deductible. Then Stage 2 - Initial Coverage. Followed by Stage 3 - Coverage Gap. And then finally Stage 4 - Catastrophic Coverage. Much less the 5 tiers of medications. And this is just for Part D coverage. And of course, there is the out-of-pocket cost.

Whoever thought this system up.....

I don't know who thought the Part D system up, but it's actually pretty easy to understand. Prior to my first wife's death, she was on some very expensive medications. The Catastrophic Coverage saved us from financial ruin. The coverage gap - at that time - was not too big, if I remember correctly. We blew through it pretty quickly. I think the coverage gap is even smaller now.

If you are in a situation where you need the Catastrophic Coverage, I guarantee you'll have a very good understanding of the system.

Mike

[Zachary Hoyt]

When I saw the title of this thread I thought that Two Fold Medicare was a new and presumably even more soul-crushingly complex version of the program. I'm glad that it's not as bad as I momentarily feared.

[ChrisA Edwards]

I just signed up a couple of months back.

Had to have a $20K out patient eye surgery about 3 weeks after starting Medicare.

I have a plan D for prescriptions, through Aetna and a plan G through AARP United Healthcare.

Paid the $233 deductible, for the operation, on the plan G supplement and now I will not have any more out pocket expenses during the year for doctors visits. I just pay the Plan G monthly premium($130).

[Ken Fitzgerald]

Ron,

As you can see from the variety of responses to this thread, there are a variety of opinions. It's important that you study the information and determine what's right for you and yours!

[Kev Williams]

I don't even try to figure out the mumbojumbo with advantage plans. But I know this: Wife had a subacrachnoid brain hemorrhage, spent an entire day in the hospital getting poked and prodded and had more vials of stuff pumped in her arms than I ever seen. All that and 3 cat scans later, an ambulance came and took her to another hospital, where she spent 11 days in ICU, which included a few more cat scans, 2 angiograms, and many many many meds...on day 12 they moved her to a private room where she spent 2 days for observation and recuperating. We hadn't spent a dime yet. A few days later we got the total bill, just north of $115k. I was planning on 2nd mortgaging this place to cover our end, which I assumed would be around 15-20% of that. In the end I wrote ONE check that covered everything, the ER, the ambulance, the entire hospital stay, doctors, meds, tests, the whole 9 yards... total out of pocket was just over $1800... A couple of years later she got squashed between our motorhome and the storage lot's chain link fence as I was pulling it out of the lot. That ER visit was over $14k, I wrote a co-payment check for $75 to cover it...

I have no clue how or why our plan works, but we have NO complaints. Doctors and hospitals, that's another story...

[Bill Dufour]

Talk to your doctor and get a list of which medicare plans they accept as full payment. You can change plans every year during open enrollment or if you move.
Bill D.

[Ronald Blue]

Thank you to everyone who has responded at this point and may yet respond. I will make notes of all the good advice and try to determine what's best for me then. This is exactly what I was seeking though. I knew this was the right place to ask as so many people have knowledge of this process.

[Bill George]

To simplify, Parts A & B only cover 80%. you can purchase Medigap Coverage and different plans cover more or less I have Plan F which covers everything. I think Plan G is very close to the same. Part D covers prescription drugs. The HMO and other Medicare plans be very careful a lot just cover in your home area, and if you travel perhaps not.

[Rich Engelhardt]

Another way to look at the Advantage vs supplement decision is - - they push the Advantage plans really, really, really hard.
Seems like every time a commercial comes on, I hear Jimmy "JJ" Walker saying , "Dyno-Mite" or Joe Namath saying something about "free".

One thing I learned on my 70 years on the planet is - nobody pushes anything this hard if it benefits someone else.