Bye-Bye, Obamacare.

dspelman

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We went with a Medicare Supplement, PLAN G. It’s about $140-ish per month, each.

IMHO, plan G’s are the only way to go. You’re not buying them for today, but for down the road.

If you get a Medicare Advantage plan (Plan C), you may never be able to switch. And if your heath deteriorates, you will never be able to switch.

Those annual out of pocket costs will suck you dry.
We have my wife on standard Medicare with a supplement plan and a Part D (prescription drugs) plan. The main reason is that she's a breast cancer patient and City of Hope isn't part of any network. When you first sign up for a supplement program, any supplement program has to take you regardless of your health or pre-existing conditions. But if you change plans along the way, the new supplement provider CAN take your current health into consideration when figuring your premiums, because a Supplement Plan is ALWAYS run by a health insurance company (Aetna, etc.).

You also need to know what your max out-of-pocket number is, and you should be aware of the "donut hole" with reference to prescription drugs. If you're on something like Ozempic or insulin, you can end up paying a lot out of pocket for a period late in the year.

You also need to note that with Medicare, you're always paying the Part B premium (currently $170) in addition to any Supplement premiums.

But please don't put out misinformation about Advantage plans.

Here in LA (and not necessarily anywhere else) there are a pot load of Advantage Plans. You can switch your Advantage Plan once a year to another Advantage Plan during the normal sign-up period. You can switch your Advantage Plan to a five-star Advantage Plan at any time. There's one five-star plan in LA and that's Kaiser.

Last year, SCAN (Advantage Plan) Classic covered the Medicare Part B premium and there were no premiums required for the plan itself. In short, no charge. Doctor visits were a zero co-pay, Part D drugs are part of the plan as well. It's an HMO (as are most Advantage Plans). Medicare, in general, is a PPO. You can go out of network on an HMO plan, but you'll pay for it. You can switch your Personal Care Physician once a month if you don't like him/her/it. In essence, aside from drug co-pays, I paid zero for healthcare (except for some modest drug co-pays) last year with SCAN. My wife paid Part B ($170), Supplement ($155) and about $20 a month for Part D. Her co-pay for drugs runs about $2 a month.

If you're on Social Security, you can have them pay your Part B automatically for you, but you're still paying.
 

SteveC

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But please don't put out misinformation about Advantage plans.

My only concern with the Advantage Plans is that once you are on one, yes - you can switch to another Advantage Plan during the annual Open Enrollment. However, it is almost impossible to switch from an Advantage Plan to a Plan G, without Medical Underwriting.

And, from what I understand, when you try to do that - *if* they take you, your premiums will most likely be substantially higher, if you have any kind of medical condition (and who doesn't), or take prescription medication. Why? Because the law permits them to that - greedy bastids, that they are.

Also, they can refuse you for ANY reason whatsoever.

Plan G is something you really should consider choosing when you are FIRST eligible for Medicare, because as you say -- they have to take you, and your premiums are age/group based, not medically based.

Advantage Plans are typically very good for younger, healthier folks. This is where your out-of-pocket costs can add up, if you are not. And, there is a good chance you will not be, as you advance in years.

Whereas on a Plan G, your max annual out of pocket is whatever the Part B deductible happens to be that year (currently around $200 for 2022).

I would not want to deal with cancer, or other serious medical condition with an Advantage Plan.

And, lastly... as you said, 99% of Advantage Plans are HMO based. Fuck that. I don't want my healthcare "cost contained".
 

dspelman

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My only concern with the Advantage Plans is that once you are on one, yes - you can switch to another Advantage Plan during the annual Open Enrollment. However, it is almost impossible to switch from an Advantage Plan to a Plan G, without Medical Underwriting.

And, from what I understand, when you try to do that - *if* they take you, your premiums will most likely be substantially higher, if you have any kind of medical condition (and who doesn't), or take prescription medication. Why? Because the law permits them to that - greedy bastids, that they are.

Also, they can refuse you for ANY reason whatsoever.

Plan G is something you really should consider choosing when you are FIRST eligible for Medicare, because as you say -- they have to take you, and your premiums are age/group based, not medically based.

Advantage Plans are typically very good for younger, healthier folks. This is where your out-of-pocket costs can add up, if you are not. And, there is a good chance you will not be, as you advance in years.

Whereas on a Plan G, your max annual out of pocket is whatever the Part B deductible happens to be that year (currently around $200 for 2022).

I would not want to deal with cancer, or other serious medical condition with an Advantage Plan.

And, lastly... as you said, 99% of Advantage Plans are HMO based. Fuck that. I don't want my healthcare "cost contained".
The ONLY time you don't have medical underwriting requirements on a Supplement plan is when you opt into one the *first time* when you turn 65. In my experience, premiums routinely get higher year to year.

You can't get onto an Advantage plan as a younger healthier folk -- they only apply beginning at age 65 anyway. Depending on your Advantage Plan, you may not have many out of pocket costs at all.

Worth noting that we HAVE already run into instances where a Supplement plan (in this case, Blue Shield) will choose not to cover something. CostCo makes Shingrix (shingles) shots available. My Advantage plan covered it, the Supplement plan would not ($159, as I recall). And it's not a Prescription Drug, so the Part D didn't apply. Pretty good example of "cost containment" by a Supplement Plan.

There really isn't a major difference between a good Advantage Plan and a Supplement Plan regarding cancer (our experience), depending on your location. My wife was on Kaiser through her work when she was diagnosed. Her employer was taken over by another company and the plan changed (no longer Kaiser) and she lost her doctors and care and had to hunt down an alternative. As it turned out, City of Hope trained most of the local Kaiser doctors and they recommended she go there on her new plan. She aged into Medicare as her care was lost to company downsizing during Covid, thus the Supplement and Medicare combination. She could easily return to Kaiser at this point, to the same doctors that she had at diagnosis, via their Advantage Plan, but for now City of Hope has become familiar, she likes the doctors and there's really no good reason to change other than economic.

The issue with PPO (and standard Medicare) can be that some doctors and facilities don't want to deal with Medicare and won't accept Medicare patients. That's probably the prime example of your healthcare being "cost contained." There *are* PPO Advantage plans, but they're difficult to find and generally far more expensive (premiums). And they may not be available at all, depending on your location.

The local Advantage Plans also tend to offer additional features that Supplement Plans might not. SCAN (in my area) has a Vision feature that covers one eye exam a year (very important for diabetics to catch retinal issues early) plus a $250 allowance for glasses/frames every two years. There are Dental features (haven't looked at those, but likely to be minimal) and new Mental health features (these are *really* difficult to find on most supplement plans). They also offer free transportation, Silver Sneakers gym membership and sometimes even grocery delivery. Some offer a free pedicure once a month. That sounds silly, but it's preventative maintenance that ensures that your feet are inspected that often (some folks can't bend over that far due to arthritis, etc.). Prevents a lot of serious infections and amputations, it turns out, and catches circulation issues early.
 

dspelman

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"Affordable" Care Act
Yeah, I know. But there are a lot more people who can qualify for some kind of medical insurance who couldn't get it at all with pre-existing conditions. At any price.

The ACA includes all the Medicare Advantage Plans as well, none of which existed prior to the ACA.

And aside from those states who've refused it, there has been a ton of money available to expand Medicaid, which has relieved a lot of pressure on various agencies and charities to provide care for both kids and adults who are below the poverty level. There are also "dual" Advantage Plans that provide both Medicare and Medicaid services for those over 65.
 

dspelman

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Seem likey like you trying to chunk sturgeons agin
When my sister and I were very young, my parents would often offload us to local Ojibwe, from whom we learned to fish. Sturgeon was highly sought after and we learned to clean and smoke them in the big smoke houses. God that stuff was good. In that area, we also pulled out a lot of yellow perch, walleyes, northern pike, muskies, bullheads...and leeches. I think I cleaned about a billion fish, mostly without losing a finger.

We spent a lot of summers in canoes fishing, hunting and harvesting wild rice (Minnesota) and a lot of winters in snowshoes (learned to make my own as well as more for sale to the tourists) running the traps, hunting, cutting ice (to be stored underground in straw-lined caves for summer) and doing more fishing (ice-fishing in this case).
 

edro

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When my sister and I were very young, my parents would often offload us to local Ojibwe, from whom we learned to fish. Sturgeon was highly sought after and we learned to clean and smoke them in the big smoke houses. God that stuff was good. In that area, we also pulled out a lot of yellow perch, walleyes, northern pike, muskies, bullheads...and leeches. I think I cleaned about a billion fish, mostly without losing a finger.

We spent a lot of summers in canoes fishing, hunting and harvesting wild rice (Minnesota) and a lot of winters in snowshoes (learned to make my own as well as more for sale to the tourists) running the traps, hunting, cutting ice (to be stored underground in straw-lined caves for summer) and doing more fishing (ice-fishing in this case).
Sounds like my kind of fun.... We were going through some mountains and I said I'd like to go up in the mountains on foot and primitive camp for a few days... Nerp. She told me real quick 'If you were to go up in the mountains, knowing you, you'd never leave....Never to be seen in public again... I told her 'Country boy can survive...' ;)
 

judson

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In less than one hour, I officially become part of Medicare. Fuck you Big Insurance. You will no longer be ass-raping me. The only ones left with their fist up my ass will be Big Pharma. But, we don't have but a few generic prescriptions, so it won't be that bad.

Going from $867 per month to $170 per month for healthcare premiums is a BFD. Actually, it's really going to be $305 per month, since I am getting a Plan G and a Plan D supplement.

Still, that is a savings of over $560 per month.

Retiring early cost me (and my wife) over $60,000 for healthcare premiums. Everyone in Big Insurance and Big Pharma should all die screaming in a fire. Cocksuckers.

I've been waiting for this day for a long time.
screw buying more guitars...you got those!

hookers and blow you can never get enough....if you do you die...oh well shit happens!
 

SteveC

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The ONLY time you don't have medical underwriting requirements on a Supplement plan is when you opt into one the *first time* when you turn 65. In my experience, premiums routinely get higher year to year.

You can't get onto an Advantage plan as a younger healthier folk -- they only apply beginning at age 65 anyway. Depending on your Advantage Plan, you may not have many out of pocket costs at all.

Worth noting that we HAVE already run into instances where a Supplement plan (in this case, Blue Shield) will choose not to cover something. CostCo makes Shingrix (shingles) shots available. My Advantage plan covered it, the Supplement plan would not ($159, as I recall). And it's not a Prescription Drug, so the Part D didn't apply. Pretty good example of "cost containment" by a Supplement Plan.

There really isn't a major difference between a good Advantage Plan and a Supplement Plan regarding cancer (our experience), depending on your location. My wife was on Kaiser through her work when she was diagnosed. Her employer was taken over by another company and the plan changed (no longer Kaiser) and she lost her doctors and care and had to hunt down an alternative. As it turned out, City of Hope trained most of the local Kaiser doctors and they recommended she go there on her new plan. She aged into Medicare as her care was lost to company downsizing during Covid, thus the Supplement and Medicare combination. She could easily return to Kaiser at this point, to the same doctors that she had at diagnosis, via their Advantage Plan, but for now City of Hope has become familiar, she likes the doctors and there's really no good reason to change other than economic.

The issue with PPO (and standard Medicare) can be that some doctors and facilities don't want to deal with Medicare and won't accept Medicare patients. That's probably the prime example of your healthcare being "cost contained." There *are* PPO Advantage plans, but they're difficult to find and generally far more expensive (premiums). And they may not be available at all, depending on your location.

The local Advantage Plans also tend to offer additional features that Supplement Plans might not. SCAN (in my area) has a Vision feature that covers one eye exam a year (very important for diabetics to catch retinal issues early) plus a $250 allowance for glasses/frames every two years. There are Dental features (haven't looked at those, but likely to be minimal) and new Mental health features (these are *really* difficult to find on most supplement plans). They also offer free transportation, Silver Sneakers gym membership and sometimes even grocery delivery. Some offer a free pedicure once a month. That sounds silly, but it's preventative maintenance that ensures that your feet are inspected that often (some folks can't bend over that far due to arthritis, etc.). Prevents a lot of serious infections and amputations, it turns out, and catches circulation issues early.

I'm glad things are working out for you and your wife, healthcare wise. It can be very painful and expensive - emotional pain aside - dealing with the costs associated with a major illness. It's great to hear that you guys are getting what you need from the providers you want.

I'm aware that none of these plans are available for people under 65. By younger, I meant 65-70.

I guess we all have our own experiences and stories. Most of mine have shown that while the little perks (dental, vision, gym, et) of Advantage plans are nice, choosing your own providers and facilities is nicer. And, not being constrained with potential large annual out of pocket annual costs is even nicer.

Generally, those Advantage plan perks are with contracted providers, none of which are any of our dental, or vision providers.

Interestingly enough, I do know people who were fortunate to not have had to undergo medical underwriting and premium pricing when switching from Advantage plans to supplements. I suspect those cases are now extreme outliers these days. Now, you pretty much pick your poison at 65, and live with it.

One of the first things my wife did last year when she became eligible for Medicare was get her "65 yo vaccinations" - shingles, pneumonia, etc. All were covered at 100% at our local CVS. I'm not sure why your Supplement plan didn't cover Shingrix. I have an appointment next week to get mine, along with the new formula 'rona vax & annual flu shot. I double checked -- all free.
Never mind that I'll be a pin cushion.

I do know that some of the laws are different, state by state, though. Here in PA, doctors/facilities are not allowed to surcharge (otherwise know as excess charge) above the Medicare contracted rate, so our Plan G costs are lower, since we don't 'ned' that coverage here.

No bashing of Advantage Plans -- they work for some folks. I just feel that there is too much risk, later in life, with them. They are a non-starter option for us. And, we are healthy people (now).
 

dspelman

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One of the first things my wife did last year when she became eligible for Medicare was get her "65 yo vaccinations" - shingles, pneumonia, etc. All were covered at 100% at our local CVS. I'm not sure why your Supplement plan didn't cover Shingrix. I have an appointment next week to get mine, along with the new formula 'rona vax & annual flu shot. I double checked -- all free.
The local CostCo nailed me with the Covid booster (Moderna, I think) in the left arm, flu shot in the right this afternoon. Over the last couple of years I've done the pneumonia and shingles shots (SCAN took care of those for free as well) and even a Hepatitiis series (two shots) because someone in the meat department had it. I really don't know why her Shingrix shot wasn't covered; makes little sense. But you don't know these things until you run into them sometimes.
 

dspelman

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Sounds like my kind of fun.... We were going through some mountains and I said I'd like to go up in the mountains on foot and primitive camp for a few days... Nerp. She told me real quick 'If you were to go up in the mountains, knowing you, you'd never leave....Never to be seen in public again... I told her 'Country boy can survive...' ;)
I'm still backpacking throughout the Sierras; sometimes with hiking buddies, sometimes on my own. Very lightweight gear. My nephew, on the other hand, gets together with a bunch of "overlander" friends with Toyota 4WD trucks with big tires and they "glamp". They'll do a little off-roading up a stream bed or something and then stretch out in a campground with everyone chipping in on the food. They have pull-out kitchens, car-top tents, showers, huge 270 degree surround awnings, etc.

I took the nephew out backpacking and when we came back he complained that he had to walk 20 miles with a pack on this back and then put up a tent *on the ground* and then eat freeze-dried food, yada yada.
 

SteveC

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The local CostCo nailed me with the Covid booster (Moderna, I think) in the left arm, flu shot in the right this afternoon. Over the last couple of years I've done the pneumonia and shingles shots (SCAN took care of those for free as well) and even a Hepatitiis series (two shots) because someone in the meat department had it. I really don't know why her Shingrix shot wasn't covered; makes little sense. But you don't know these things until you run into them sometimes.

I'm going next week, now that I'm a ward of the state - LOL.

Wednesday
Flu
New 'Rona Booster

Friday
Shingrix
Pnumonia

I picked up my Atorvastatin script yesterday... 90 days, $0.00 Compared to $14.50 under Obamacare.

So far.... so good!
 

dspelman

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I'm going next week, now that I'm a ward of the state - LOL.


I picked up my Atorvastatin script yesterday... 90 days, $0.00 Compared to $14.50 under Obamacare.
The ACA (Obamacare) has been responsible for gradually closing the "donut hole" coverage gap (it will likely eventually disappear altogether) for Part D. The ACA has been responsible for pretty widespread health care reforms, not just for premiums on normal health care insurance for the middle income crowd.
 

SteveC

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I believe that if the ACA did nothing else, "guaranteed issue" and "preexisting conditions" provisions, probably were worth the price of admission. I had hopes of seeing those provisions carried over to Medicare, so that seniors could shop for insurance after enrolling in their initial choice.

We do need to get our arms around the Pharmaceutical Industry and Medicare drug plans. What is in place today is (IMHO) a fucking crime. The fact that worlds largest consumer of pharmaceuticals (Medicare) is not allowed to negotiate drug prices is fucking insane.

However, I am afraid that the 'climate' and the industry lobbyists are never going to allow that to happen. More fuckers who should die screaming in a fire.
 

RhytmEarl

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I pay nothing a month. It's been like that all my life.

Well, except those 4 years I worked in LA.
 

Soul Tramp

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We have my wife on standard Medicare with a supplement plan and a Part D (prescription drugs) plan. The main reason is that she's a breast cancer patient and City of Hope isn't part of any network. When you first sign up for a supplement program, any supplement program has to take you regardless of your health or pre-existing conditions. But if you change plans along the way, the new supplement provider CAN take your current health into consideration when figuring your premiums, because a Supplement Plan is ALWAYS run by a health insurance company (Aetna, etc.).

You also need to know what your max out-of-pocket number is, and you should be aware of the "donut hole" with reference to prescription drugs. If you're on something like Ozempic or insulin, you can end up paying a lot out of pocket for a period late in the year.

You also need to note that with Medicare, you're always paying the Part B premium (currently $170) in addition to any Supplement premiums.

But please don't put out misinformation about Advantage plans.

Here in LA (and not necessarily anywhere else) there are a pot load of Advantage Plans. You can switch your Advantage Plan once a year to another Advantage Plan during the normal sign-up period. You can switch your Advantage Plan to a five-star Advantage Plan at any time. There's one five-star plan in LA and that's Kaiser.

Last year, SCAN (Advantage Plan) Classic covered the Medicare Part B premium and there were no premiums required for the plan itself. In short, no charge. Doctor visits were a zero co-pay, Part D drugs are part of the plan as well. It's an HMO (as are most Advantage Plans). Medicare, in general, is a PPO. You can go out of network on an HMO plan, but you'll pay for it. You can switch your Personal Care Physician once a month if you don't like him/her/it. In essence, aside from drug co-pays, I paid zero for healthcare (except for some modest drug co-pays) last year with SCAN. My wife paid Part B ($170), Supplement ($155) and about $20 a month for Part D. Her co-pay for drugs runs about $2 a month.

If you're on Social Security, you can have them pay your Part B automatically for you, but you're still paying.


My wife and I are on Advantage plans. She's had two back surgeries over the past two years. Total bills were $100K+, our out of pocket was around $800.

I've had several people tell me I should go the route of @SteveC (D&G plans), but it doesn't seem to be worth the $3K+ a year.
 

SteveC

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The Advantages Plans work out great for some (many?) folks, until they don't. Unfortunaltey, if (when?) that time comes, it may be (will be?) too late to change to a D&G Plan.

I suspect, as with all insurance, it's all about risk tolerance.

Today, $150/month for each of us is not any kind of a financial burden on me. I know that even as premiums increase, they will not ever get to be a financial burden on me. In fact, my life budget has $170K for each of us, for medical premiums.

What could be a burden, however, would be getting to a point where I have to pay whatever annual maximum out of pocket costs could be, later in life, year-after-year, and/or paying for 100% of what procedures/drugs that the HMO won't cover, as I am trying to maintain what's left of my finances.

I don't have D&G plans for today; I have them for the future.

Hopefully, I am wasting my money and will never need them. But, I don't want to find out differently in my later years.

This is all one big crap shoot. I'm hedging my bets.
 

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