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I had no idea how complicated Medicare was


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Part ABCDEFG... add on coverage, supplementary plans. What in the world.

FIL just moved into our county and none of us knew that he would have to change insurance plans because of it. He chose his current plan 15 years ago and it costs him nothing and covers everything. Sadly, that unicorn has flown away and now we have to figure out what to do next.

I'm going to call an insurance agent, I think, because this is too much for me to wade through. What happens if you don't do the extra plan? Does just plain medicare even exist?

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Yes, traditional Medicare exists.  Typically, the monthly premium is deducted from the recipient's Social Security check.  The individual is responsible to pay the first $198 in annual medical bills (the $198 is at contracted rate, assuming the individual sees doctors who are contracted with Medicare) and then is responsible to pay 20% of medical expenses after that.  The issue here is that there is no annual cap on medical bills.  You could pay 20% of however much care you end up needing.

That is why some people choose a supplement plan ("letter" plan) which pays some or all of the amount the individual would normally be responsible for paying.  The coverage depends on which letter you choose -- you can find a chart online that lays out the coverage details.  The cost for these can range to upwards of $200 per month.  Many companies sell them (AARP, Mutual of Omaha, etc.) but every "G" plan has the exact same coverage even if different companies charge different monthly premiums.

Some people prefer to get a Medicare replacement plan instead ("MedAdvantage" plan).  This takes the place of Medicare + supplement.  There may or may not be a cost to the individual in addition to the monthly premium deducted from the Social Security check.  The plan may also cover some things that Medicare doesn't normally cover, like dental care or eyeglasses.  Usually these plans assess a copay for doctor visits, and they usually have an annual cap on medical expenses.  BUT you will find that some plans require the individual to get care from a restricted network of medical providers; if they want to see an out of network doctor, they'll usually have to pay the entire cost of the visit.  And if the individual travels and wants to get non-emergency care in another geographic area, this could also result in the individual being responsible for the whole bill. 

And I'll add here, that if your FIL has minimal assets, he may qualify for a Medicare/Medicaid plan that will have a smaller network of doctors, but can reduce his medical costs. It is a Medicare replacement plan similar to what I described in the previous paragraph.

Boy, that sure got long! 

Edited by TrixieB
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Oh, I forgot to say - you might want to check whether your FIL has any retiree benefits for medical coverage.  Some employers pay part/all of the supplement cost for their retirees, or offer secondary insurance coverage, or contribute toward the cost of a MedAdvantage plan, etc. This is more common with unions, but other employers also offer these benefits.

Edited by TrixieB
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Forgot something.  Don't forget about prescription drug coverage.  Some MedAdvantage plans include Rx coverage.  Traditional Medicare, with or without a supplement, doesn't include Rx coverage so you'll need to choose an Rx plan. To compare those, compile a list of his meds and go from there.  

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Talk to someone who sells insurance. Plans are different by state and what part of the state  you live in. You need someone to wade thru all that information for you. We are starting the discussion and I was overwhelming . 

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Last spring, MIL ended up in the ER for a fall. We're told she has no medical coverage?!  She mentions that over the winter, "some form arrived and I filed it out"  She has not idea what the form was or where she send it. It asked about income. Our best guess is she put a few too many zeros on the income line. 🙄

Very, very long story...shortened....there's a person at the hospital that it's his job to help the elderly with insurance. He was amazing and incredibly patient. I'm sorry but I don't know the job title.

Edited by amyx4
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I'd personally run far away from insurance agents. We've tried several and none have been as well informed as we are. They've tried to push plans that would have cost way more than others we found on our own.

For Medicare questions contact your state's SHIP (State Health Insurance Assisting Program). All states have them, and they're free. They're the Medicare/Medicaid experts. This Medicare page has a link with each state's SHIP contact info.

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5 hours ago, Pawz4me said:

I'd personally run far away from insurance agents. We've tried several and none have been as well informed as we are. They've tried to push plans that would have cost way more than others we found on our own.

For Medicare questions contact your state's SHIP (State Health Insurance Assisting Program). All states have them, and they're free. They're the Medicare/Medicaid experts. This Medicare page has a link with each state's SHIP contact info.

LOL that’s why I said an HONEST, KNOWLEDGEABLE agent is a blessing!

You are right about having to educate yourself first, though, thus the book. I forget all the details now, but back then we found that selecting a plan that cost a bit more was actually a better bet for a medically fragile person on a small fixed income. The monthly payments were higher, but there would be no sudden demand to pay a bill. The insured’s specific needs really do come into play, there’s no across the board best plan to easily pick. The wonderful agent we had helped us choose which company to go with, once we decided what type of coverage was needed. 

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Dh is an agent - he will only do people in person (now he has to do it on the phone.)

what works for a person varies.

yes plain medicare exists - BUT you can substantially improve coverage with a supplement with zero premium.

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15 hours ago, KatieinMich said:

Talk to someone who sells insurance. Plans are different by state and what part of the state  you live in. You need someone to wade thru all that information for you. We are starting the discussion and I was overwhelming . 

this.

dh has had people call him after they've dug themselves into a hole because they thought they could do it themselves.  He was able to help them, but it was a mess.

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On 7/13/2020 at 3:36 AM, Pawz4me said:

I'd personally run far away from insurance agents. We've tried several and none have been as well informed as we are. They've tried to push plans that would have cost way more than others we found on our own.

For Medicare questions contact your state's SHIP (State Health Insurance Assisting Program). All states have them, and they're free. They're the Medicare/Medicaid experts. This Medicare page has a link with each state's SHIP contact info.

Thank you for this. I have an appointment set up with a SHIP counselor on Thursday.

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