health insurance for old folks... some boring comments

[rockriver]

a little story from 2 old folks .. this info is primarily good for those on medicare or "hope to be" in coming years!
obviously, i'm a youngun and none of this is personal info.. i'm just relaying what i learned! AND i need to add, maybe i just made all this up. you need to do your own research... don't make any decision based on anything i write here or elsewhere... i'm not responsible for your mistakes, and don't expect you to pay for mine! lol.
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old man.
worked for a big company. retired early. one benefit of retiring early was that his health insurance was still available till age 65. old man had to continue paying the employee rate
for family plan health insurance... one warning he learned.... is that if he let it drop for non payment he would not be able to "reinstate" the health insurance.
his wife was on his health insurance under the "family plan," therefore she had health insurance until she reached 65. in order to not let it drop for non payment, old man paid it up for a year. his ex employer did not like the yearly payment but could not refuse it. old man suspects that ex employer got to close out some retirees as many of them let a payment get late!!

Advice 1. keep your normal group insurance as long as you can...

old man's wife:
wife worked for the gov't until her retirement... she was able to have gov't health insurance but preferred the group plan provided by old man's employer. so she did...
wife had always heard that gov't employees that retired could have gov't provided health insurance until their medicare years (age 65) that is sort of true but there is a requirement that applied to wife. to get the gov't provided health insurance during her pre-65 years, she needed to have been covered under the gov't plan during her final years of employment.

Advice 2... start learning about health insurance in detail long before you "early retire."

then the couple went on medicare at age 65

Advice 3. do this before your 65th birthday! old man says it wasn't difficult, but make sure it's done.

Advice 4. get a medicare supplement.

neither me nor old man are medicare supplement knowledgeable! so... here are some comments.

dental.
dental supplements are expensive. old man and wife got one through a group plan associated with her group of retirees.
but the payout is usually something like 60% of dentists bills and lots of internal limitations and exclusions.
ex: old man needs a root canal. which will destroy the tooth. neighboring teeth are ok.. best option is to get an implant.
dentist just sent in a request to insurance to see what they will pay. digging the tooth and root out and placing a "pin" will cost about 3000.
dental insurance will pay about $250. of that bill reason. small print excluded implants! and old man will still need another ?1500 for a crown (new tooth to replace the one they dug out!

Advice 5. take care of your toothies whether you get the dental plan or not!

computer keeps goofing up, or maybe i'm goofing up, but stopping and will continue this yarn.

[rockriver]

continued tale.
old man keeps seeing ads on tv and on his computer and in the mail about what a wonderful plan he can get for his medicare supplement. they will provide money for otc drugs and dental and food brought to your house and someone to drive you to the doctor and extra money on your soc. sec. check and all kind of bennies... old man isn't getting all those benefits but he has friends who do! bunch of folks getting free sheet and he ain't
old man keeps hearing tales about horrible doctor visits and doctor visits that are scheduled months away and the folks need care now...
what's going on?
he doesn't know... but here's his guess.
super duper insurance company goes to his region and presents all the medical providers/doctors, hospitals/ with a proposed list of what they can charge super duper's patients. these rates are very low. the provider says "heck no, we can't get by on that low of a rate." super duper ins. company continues their speech with the following. "sir, for every patient that you send out the door with a less than average charge, per diagnosis, we will reward you at the end of a year." "your reward will be xx % of the money that is less than the starndard billing for that diagnosis!"
doctors with spare time on their schedules might be inclined to accept this billing structure?

possible example: relative of old man's is a senior. real senior. relative had a stroke. went to local hospital. doctor ran tests. relative had brain bleed and needed immediate surgery, but he was not qualified. local hospital didn't have staff nor equipment for surgery. relative would need care at great big hospital 100 miles away. so relative went by ambulance to great big hospital and brain surgeon there agreed. brain surgery needed as soon as swelling comes down. for 3 days, nurses - doctors agreed, brain surgery scheduled. then suddenly relative sent home!! no clear explanation. the best was that patient was too old for brain surgery, but age was known all along. old man would sure like to know if doctors, got a bonus commission for sending patient home after they healed her!

back to the tale,
old man
he is in fairly good health. he had obtained a normal medicare supplement. he has a small deductible of about 300 per year and no co-pays.
ex: he gets a growth cut off (frozen) charge is 313. medicare pays 159. his plain jane supplement plan pays 32. old man owes nothing.
in 2022 old man's supplement plan spent a total of 318. he paid about 1400 (he forgot the number) insurance company made big money!
for 2023 old man's supplement plan price went to about 2250!!! sheesh.
old man can see any doctor or hospital that treats medicare patients. he has had no problem getting appointments and getting appointments timely.

old man's wife
overall health has not been as good as old man. she sees more doctors.

oops temperature is up and time to see if citrus is still good since it got frozen.... will continue later.

[rockriver]

short deviation. we just picked 5 walmart bags bulging of satsumas from trees that are badly hurt by freezing over Christmas... ?if they'll live?

old man's wife.
has the same plain jane medicare supplement plan as old man. she is seeing top doctors in area. two examples of billing.
1. office visit 200 billed. medicare approved 55. and paid 43 and supplement paid 11 wife owe's 0
2. fancy dancy shot for bone health... takes about 3? minutes to administer. and had other blood/specimen tests. 5500 billed. medicare approved 5500. medicare paid 5217 and supplement paid 279 wife owes -0-
how medicare decides what to cover i nor old man knows...
but having medicare frequently gets the bill reduced...

Advice! having medicare to cut the bill is a huge benefit!

i have heard of folks not getting medicare for religious or other reason... i don't see the problem. i paid for this all my working days. i have an associate who has declined to have medicare, but he expresses the need for folks to help him pay his bills because he is a worker for God and he needs help. i have declined to help him with his bills and ,he is off my donation list for several reasons including his refusal to accept medicare... he has let me know that i'm not listening to God... he has a right to have his opinion. i'm glad i know what his opinion is! i support his right to refuse the coverage. but that doesn't mean i should have to help him pay his bills... it probably does affect me though... if he refuses to pay doctor then doctor needs to get his sustenance from somebody, increasing the need to charge me more!.

bottom line on medicare supplement
we travel a little bit and sometimes out of state. if we need medical care in a far off area, i want to increase the chance that the medical folks will treat me and do some timely. we will keep normal medicare supplement as long as we can afford it. i do not think that most doctors would refuse to treat me if i were sick, but i do think that they may tell me, that they do not have any openings on their schedule for 3 months.
i think getting one of the "advantage" plans (there is an initial that also defines advantage, but i forgot it... maybe "g" ? changes what medicare pays the doctor. old man asked his doctor about getting one of the advantage plans and they very carefully worded advise that he keep what he has!

[surviort_wwdnet]

We looked at Medicare supplement plans but stayed with our free advantage plans. My husband, who has a serious medical condition, also has VA healthcare and they take care of all his Rx needs, even a couple that normally run into six figures annually. They even provide his vitamins and supplements at no charge. I only have one regular Rx and I get it at no charge through my advantage plan's mail order pharmacy.

Due to my husband's medical condition, there's little chance we're going to travel very far away, so the advantage plans work for us. As of Jan. 1st, we're no longer required to get referrals from our PCP to see a specialist. Since I (in great health) normally only see my PCP once a year, it's working for us.

For someone with major health issues, and no VA healthcare or other coverage, a Medicare supplement plan can be a financial lifesaver. My brother had cancer and would have been in debt for hundreds of thousands of dollars had he not had a Medicare supplement plan. He was hospitalized for several weeks, then had radiation and chemo for months afterward. They paid nothing out-of-pocket. I'm not sure why he didn't take advantage of his VA healthcare for any of this?

Weigh your options based on your health and medical needs to make the best choice.

[rockriver]

great comment. thanks.

[Patriotic Sheepdog]

So, I will chime in here. I recently just went on Medicare this month (Dec 2022). As most know, I am in medicine and understand a bit about medical insurance. I was/am a specialist, so not a PCP and can only attest to that side of things.

Rates: What I have heard from some of my PCP friends, they get a set $$ amount from insurance company per month for people that signs up with their office as a PCP. The goal is to try and keep that money in your account, as every time you refer someone to a specialist, it comes (or a percent comes) from your amount. That is why, if you have a HMO, they will drag their feet sending you to a specialist. I do not know how it affects you if you needed surgery...do they still drag their feet??? They also get gigged if they recommend a procedure, lets say a colonoscopy, and you REFUSE to get it done. The PCP friend that told me this a few years ago was, well lets say mad. He had it documented and had written referrals, and patient(s) never go get them so they get "dinged" which affects their income from Insurance carrier. Simple things like a referral to a Nutritionist for a diabetic patient, colonoscopy, mammogram, etc....

Bills: Now, let me start by saying I was/am a provider, but I work(ed) for someone else. I did not do the billing and can only go off what I saw and what was told to me, and my own experience using private insurance over the years. My bill may be $150 lets say for a particular visit with a minor procedure done. Your Co-pay may have been $50, but your insurance only will pay $75. As you can see, there is $25 still not paid. That is when you will get a bill in the mail if that is your responsibility, or if your insurance says that is all you get then my office will "write off" that bill for taxes. (Now do not get mad at me, as I have nothing to do with the system. Many times I would do a quick procedure for gratis as I knew the patient could not afford it or it wasn't covered by their insurance). {SIDE NOTE} I know, that yearly there are contracts with insurance companies for what we get paid for what level visit and what procedures. This is essentially a one way contract as the docs "need" these big insurance companies patients (that may total 50,000 or 100,000 insured by that company in your area) so if the insurance company says, "we are paying you 8% less this year overall", you have to decide if that is worth it or not. Now, funny thing is, if you had told us you did not have insurance, we may have said "you pay the Medicare rate" which may be only $100. Yeah...there are two rates...Medicare and private insurance. Anyone can do this to help offset you cost...I did this when my son and daughter both needed a MRI within a couple months from each other a few years ago. WITH my private insurance my cost out of pocket was close to $700 for the first one. The second time around, I told the MRI place I was self-pay and they said "$200 please"....It is a numbers game and most people do not know it is a game...

Medicare: I went with a supplement plan. Sure I have to pay a bit monthly, but to me it is worth it in the long haul. I am in great shape, and take zero Rx meds, but I do not know what event could happen in 5-10-15 years from now and I do not want a surprise big bill from a hospital (medical bankruptcy). There are two ways to go with Medicare...supplement plans and advantage plans. Everyone needs to do their own research on what is the best plan for you. I started researching one year ahead of when I needed it, and had easily 100 hours into research over the year. Wife and I came up with a Supplement plan and decided on plan G, but plan G may not be the one for you so research it and talk to an expert.

As for your friend Rockriver, that does not have Medicare, well if he worked and paid into Medicare for at least 40 quarters, he has at least Medicare Part A, which is hospitalization and it only pays for 80% and there is a big ($1500 comes to mind) deductible each time you are hospitalized...so if you get hospitalized 4 times one year, that is $6000 just for the deductible...and who knows how much for the 20% you have to pay of the bill. Part B covers doctor visits and labs and such IIRC, and then you have a Rx plan you can get. In the Part B, you have supplement plans and advantage plans...and there are several "plans" to choose from in each of those categories. Now if you happen to be reading this in 1-2 or even 5 years from now, all this info could be obsolete as Medicare is always changing.

Oh, and a quick note...I was told if you do not "register" with Medicare when you turn 65, there can be a fine...Now, you do not have to go on Medicare at 65 if you are working and have private insurance thru your work AND they insure at least 20 people. So, even if I had stayed working full time I would have had to go on Medicare as there are only about 7 people in our office that gets health insurance thru our office..the others either get it from Healthcare.gov, spouses workplace, or do not have any.

Hope this sheds a bit of light on things....

[rockriver]

thanks patriotic.
it's great to get info from the "inside!"