BS: USA-Shopping for a Medigap Policy

Subject: BS: USA-Shopping for a Medigap Policy
From: Janie
Date: 21 Jun 16 - 08:11 PM

Hoping to hear from USA folks who have already shopped for Medicare Supplement insurance policies - especially those have been retired for several years and have had major medical expenses about your experiences with healthcare costs, availability of Medicare assigned providers in your area, and also dental/orthodontic and eye glass expenses.

I'm hoping to retire in November, and whether I do or not, I will be enrolling in Medicare. I know I will purchase a Medigap policy.

My mailbox is flooded with offers and information, and yes, I have looked at the government website offering information about the differences among types of medigap policies.

I feel overwhelmed by the number of variables to consider. Also aware I may tend to over-insure after years of working with people with modest or low income who are disabled or retired and have Medicare, but who have been wiped out by high medical bills or unable to afford or replace dentures and bridges and such, not to mention get root canals done - since Medicare doesn't cover dental. And eyeglasses are expensive.   I think I most want to try to resist the temptation to over-insure - retirement income will be sufficient for a few years but less so due to inflation over time. But also don't want to end up toothless or with huge unpaid medical bills.

At a minimum I know I will opt for a policy that will cover charges under Part A and Part B that are covered under Medicare up to the allowable Medicare charge. Beyond that, I am very uncertain.

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: Rapparee
Date: 21 Jun 16 - 09:49 PM

AAARP (United Health) has been pretty good so far this year. I do NOT recommend Aetna for prescription coverage -- check cms and get a four or five star one.

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: Joe Offer
Date: 22 Jun 16 - 05:48 AM

We had AARP Medigap coverage for my mother-in-law for a number of years, and we were very happy with it. Never a hassle. I get a good plan through my government pension, but I'd take AARP if I didn't have the pension coverage.
Gee, Janie, you're catching up to me in age!
-Joe-

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: Greg F.
Date: 22 Jun 16 - 09:24 AM

Another vote for AARP. Membership also gives you reduced rate on a whole buncha other stuff.

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: Donuel
Date: 22 Jun 16 - 12:35 PM

United health care AARP and extended care.

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: Bev and Jerry
Date: 22 Jun 16 - 02:54 PM

Janie:

Medigap policies are standardized into 10 types (see here. What you are choosing is the type. The company you get it from depends on how you feel about that company (Aetna, etc.)

We have been on medicare for 12 years. When it came time to make a choice about medigap policies, we opted not to do it at all and have never regretted the choice.

We made a list of all of the things covered by any of the 10 types of policies and decided which ones we could not afford to cover on our own. There were only three. One was drugs which are now covered under Medicare Part D which we have. Another was the fact that medicare does not cover you at all if you leave the country. We take care of that by buying medical insurance for each foreign trip we take. It's expensive but way cheaper than a medigap policy. Finally, medicare coverage for hospitalisation ends after 150 days. The worst thing (financially) that can happen to you is to be hospitalized without insurance. We asked several health care providers and it was hard to conceive of a situation in which we would be hospitalized for 150 days without either dying or recovering. It's not impossible (e.g., Cyril Tawney) but it's so unlikely we decided to risk it.

One final note. Medigap advertising is filled with threats about how much medicare does not cover. Just remember two things. First, when you are hospitalized, you pay a deductible of about $1100 and there are no further charges from the hospital no matter what. Second, you are responsible for 20% of other medicare adjusted charges (doctors, labs, etc.) not 20% of what is billed. That's a big, big difference. Jerry has had two spine surgeries for which he was hospitalized over night. Total cost to us for each one was less than $2000 including the hospital, surgeon and all the other bills.

So, look at all 10 types of plans and decide what you can afford to cover on your own. Remember that if an insurance company covers it, you pay for their profit, too

Bev and Jerry

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: Bev and Jerry
Date: 22 Jun 16 - 03:26 PM

Janie:

After re-reading your OP, here's a little more. If you think you may have trouble paying for dental work or eye glasses which medicare does not cover at all, consider a Part C plan commonly known as Medicare Advantage. These plans claim they cover this kind of thing but we have no direct experience. In general, though, insurance companies have no scruples. They say they cover everything when selling you the policy but when you have a claim it's, "Oh, we don't cover that."

One more piece of advice. When considering the cost of Medicare Advantage or medigap, don't just look at the monthly premium. Multiply that by 12 to get the annual cost and then by the number of years you expect to live. Also, include the fact that the premiums will increase by at least 5% per year and probably 10%. If you add all that up for, say, 30 years, we think you will be stunned by the result. That's why we decided to skip it and just put the money in the bank until it was needed to pay a medical bill.

Bev and Jerry

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: ChanteyLass
Date: 22 Jun 16 - 10:04 PM

In Rhode Island, workers at senior centers are available to explain the plans offered in this state. The good thing about talking to one of them is that they don't work for any insurance company and receive no commission. You might check to see if this service is available at senior centers in your state.

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: John on the Sunset Coast
Date: 22 Jun 16 - 11:04 PM

The first few years we were covered we used an HMO advantage plan, and it worked well, if not a bit clunky getting service. But six years ago (yes we're that old old) my wife got a lesion in on her big toe. Sans details, it took over three years to get proper treatment, which by that time became a major surgery situation with many follow-up visits to wound care.

The wife and I have no been with AARP-United Health Care PPO. The premium is not something we had budgeted for in retirement, but peace of mind is worth it. Pick our own doctors and specialists with with no referral required. No co-pays or other payment on any procedure which is medicare covered. My wife had a small lesion on her foot (same one as above) earlier this year. Her doctor recommended removal, a surgeon concurred and from discovery to removal was three weeks, not three years.
Soon my son is about to get treatment from an HMO for a problem what is clearly neurological, but what, for over two years, that HMO considered a physical problem. He had to win a grievance hearing to get this treatment.

Personally, I feel HMOs should be outlawed as violating restraint of trade laws, but that's a discussion for another time.

But in the end, get what you are comfortable with.

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: Janie
Date: 23 Jun 16 - 08:34 PM

Appreciate y'all responding. I'm leaning toward an AARP-UHC policy, but mulling whether to pay more for a policy that covers excess charges.

A lot of practices don't accept Medicare assignment. I live near a large public medical school hospital and healthcare system that takes Medicare assignment throughout the system - so don't have to worry about not being able to find a doctor to avoid excess charges. However, it can take months and months to get an appointment with one of their specialty clinics. I don't mind waiting if not urgent - but otherwise....

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: Joe Offer
Date: 23 Jun 16 - 09:22 PM

I'm undecided about insurance for long-term care. My dad took care of my mom for two years, so she could stay at home. Then she had to spend the last six months of life in a nursing home, and it cost a lot. My dad bought nursing home insurance for himself after that. It was expensive, but it has paid for his last two years in assisted living. He died as his policy was about to run out, but everything worked as he had hoped it would.
If I were single, I'd seriously consider buying nursing home insurance.

-Joe-

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: John on the Sunset Coast
Date: 24 Jun 16 - 01:07 AM

Janie, PM me if you have questions about AARP-UHC of actual plan F users--my wife and me. We are extremely satisfied with it, not-with-standing that we really didn't want to pay a low multi-thousand dollar premium. But we sucked it up and are so much better treated medically.
John

Subject: RE: BS: USA-Shopping for a Medigap Policy
From: EBarnacle
Date: 24 Jun 16 - 11:48 PM

If you have a good relationship with your dentist, negotiate a break from the practice. I have found that I save more than the cost of the insurance this way.

For eyeglass care, either reuse good but old frames or buy your glasses on line.

If your job covers a piece of hearing aid costs, don't wait. There are hearing aid insurance programs, such as EPIC [based in Texas] which give you a substantial break but even so, those little gadgets ain't cheap.

If you have to have surgery or any other major procedure tell your doctor IN WRITING not to bring in any out of network physicians to work on you. Because of that last Lady Hillary was able to beat back several hundred thousand dollars in doctor billings from having had two major spinal surgeries. Her doctor persuaded them to accept the out of network reimbursement rate after being reminded of that instruction.

As has been said above the insurance companies exist to make a profit. That's why we don't have single payer here in the US--lobbying. Be very careful about reading fine print to find out what is covered as well as what is not.

I recommend against HMOs because they have too many rules and generally have limited service areas.

Above all, be you own best advocate. You are the one who cares most about your interests.