4 ms·

Something to be aware of is that when using Original Medicare you will want to also get a Medicare Supplement (Medigap) plan. Medicare only pays 80%, the Mediga

by erentz 4y ago

Something to be aware of is that when using Original Medicare you will want to also get a Medicare Supplement (Medigap) plan. Medicare only pays 80%, the Medigap pays the extra 20% (no questions, anything approved by Medicare they cover the gap on). But you are only guaranteed to be able to join Medigap during your initial enrollment at 65. If you switch back from Medicare Advantage to Original Medicare you are not guaranteed to be able to get Medigap. This can leave you stuck. It will possibly vary from state to state so it pays to get up to speed with the rules in your local state. If you're expecting to be sick in old age or if you get Medicare due to a disability that is likely to have a lot of expensive treatment or require you to see different doctors in different areas it is best (IM-somewhat-experienced-O) to take Original Medicare.

tpmoney 4y ago
This sort of crap is part of why so many people are scared of the idea of a national healthcare plan. You would think Medicare would be easy, medical coverage for people over 65 or the disabled, paid for by the taxes you (and others) are paying your whole lives, simple and done. Except it isn't easy at all. Only Part A (hospitalization) is covered by the taxes. And it only only pays 80% of costs, with no annual out of pocket max (remember how having that was a huge selling point for ACA plans?). Oh and there's also a PER INCIDENT deductible for each in-patient hospitalization. And you better hope you don't need a visit longer than 60 days in the hospital, or 20 days in a skilled nursing facility or you're going to start paying for that too. Then if you want to, oh I don't know, see a doctor so you don't go to the hospital in the first place, that's Part B, but now you're paying a premium, and also have a new deductible (thankfully only once per year for this one). Still only covers 80% of the costs, still has no out of pocket max. And all that "in network / out of network" crap you have to deal with in private insurance? Yeah that's still a thing, they just call it "participating" and "opt out" providers. Only unlike a lot of private plans where at least there's some (crappy) out of network coverage, if you see an "opt out" provider, medicare won't pay at all, no matter if you submit the claim yourself or if the service was a medicare approved service. So that's nice. Oh and if you don't sign up for part B What's that you say? You'd like to be able to take life saving medications and prescriptions that could also keep you out of the hospital? Why that's yet ANOTHER plan (Part D) you need to sign up for, with yet another premium (medicare currently claims between $4 and $150 monthly in my state). And then like always, drugs tiers with co-pays and then the infamous "donut hole" (I worked IT for a pharmacy, the number of their patients who just... stopped being patients when they hit that donut hole every year was disturbing). Don't worry though, Medigap is here, an insurance policy you can buy to pay for the stuff your national insurance that you're already buying doesn't pay for. For a mere $200 - >$1000 / month, some or all of those deductibles listed above can be covered. Oh and did we mention that if you fail to sign up for part B or part D within 60 days of being eligible you might have to pay an additional penalty on your premiums for life? And as you pointed out, you might never be eligible for medigap if you don't get it the first time around. And none of that includes vision or dental coverage. So how much does it cost to be covered by medicare? Well with all the plans and a medigap plan as well, anywhere from $200 - $2000 / person / month just in premiums. Yeah ...
- erentz 4y ago
  I mean I agree it's been made pointlessly complicated. But this is all born out of the fact that everything we do in the US we insist on finding silly ways to insert unnecessary private middle men. But the fixes people are calling for with national healthcare policies like Medicare For All are precisely to do away with the problems you bring up AND extend the resulting system to everyone. I think a good start is just doing away with the things you bring up even if it's just for 65+ at least. FWIW I am on Medicare (due to disability) and I expletive love the experience compared to the gold plated, Silicon Valley tech company, private insurance I had before I became eligible. I've not had to think about a prior-auth or appeal in the entire time. I've had no reduction in the doctors I can see (I saw specialists across the country). And I receive about $8,000 of specialty drugs a month without any questions.
  - tpmoney 4y ago
    While I appreciate that's the goal of the proponents, my personal opinion is they won't succeed in it. As you point out, historically we generate "worst of both worlds" policies at the federal level, and I have no reason to believe that history won't bear itself out again. I also personally think regardless of whether they succeed in making it better, making it available to all is inevitable, but only because for many people who are paying all or part of their premiums, you could probably slap a flat 10% income tax on top of what they're already paying in taxes and even with current medicare's benefits, most wouldn't even be any worse off.

by erentz 4y ago

tpmoney 4y ago

This sort of crap is part of why so many people are scared of the idea of a national healthcare plan. You would think Medicare would be easy, medical coverage for people over 65 or the disabled, paid for by the taxes you (and others) are paying your whole lives, simple and done. Except it isn't easy at all. Only Part A (hospitalization) is covered by the taxes. And it only only pays 80% of costs, with no annual out of pocket max (remember how having that was a huge selling point for ACA plans?). Oh and there's also a PER INCIDENT deductible for each in-patient hospitalization. And you better hope you don't need a visit longer than 60 days in the hospital, or 20 days in a skilled nursing facility or you're going to start paying for that too. Then if you want to, oh I don't know, see a doctor so you don't go to the hospital in the first place, that's Part B, but now you're paying a premium, and also have a new deductible (thankfully only once per year for this one). Still only covers 80% of the costs, still has no out of pocket max. And all that "in network / out of network" crap you have to deal with in private insurance? Yeah that's still a thing, they just call it "participating" and "opt out" providers. Only unlike a lot of private plans where at least there's some (crappy) out of network coverage, if you see an "opt out" provider, medicare won't pay at all, no matter if you submit the claim yourself or if the service was a medicare approved service. So that's nice. Oh and if you don't sign up for part B What's that you say? You'd like to be able to take life saving medications and prescriptions that could also keep you out of the hospital? Why that's yet ANOTHER plan (Part D) you need to sign up for, with yet another premium (medicare currently claims between $4 and $150 monthly in my state). And then like always, drugs tiers with co-pays and then the infamous "donut hole" (I worked IT for a pharmacy, the number of their patients who just... stopped being patients when they hit that donut hole every year was disturbing). Don't worry though, Medigap is here, an insurance policy you can buy to pay for the stuff your national insurance that you're already buying doesn't pay for. For a mere $200 - >$1000 / month, some or all of those deductibles listed above can be covered. Oh and did we mention that if you fail to sign up for part B or part D within 60 days of being eligible you might have to pay an additional penalty on your premiums for life? And as you pointed out, you might never be eligible for medigap if you don't get it the first time around. And none of that includes vision or dental coverage. So how much does it cost to be covered by medicare? Well with all the plans and a medigap plan as well, anywhere from $200 - $2000 / person / month just in premiums. Yeah ...

erentz 4y ago
I mean I agree it's been made pointlessly complicated. But this is all born out of the fact that everything we do in the US we insist on finding silly ways to insert unnecessary private middle men. But the fixes people are calling for with national healthcare policies like Medicare For All are precisely to do away with the problems you bring up AND extend the resulting system to everyone. I think a good start is just doing away with the things you bring up even if it's just for 65+ at least. FWIW I am on Medicare (due to disability) and I expletive love the experience compared to the gold plated, Silicon Valley tech company, private insurance I had before I became eligible. I've not had to think about a prior-auth or appeal in the entire time. I've had no reduction in the doctors I can see (I saw specialists across the country). And I receive about $8,000 of specialty drugs a month without any questions.
- tpmoney 4y ago
  While I appreciate that's the goal of the proponents, my personal opinion is they won't succeed in it. As you point out, historically we generate "worst of both worlds" policies at the federal level, and I have no reason to believe that history won't bear itself out again. I also personally think regardless of whether they succeed in making it better, making it available to all is inevitable, but only because for many people who are paying all or part of their premiums, you could probably slap a flat 10% income tax on top of what they're already paying in taxes and even with current medicare's benefits, most wouldn't even be any worse off.