Medicare- The Health Care Standard Everyone Should Have

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philip964
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Re: Medicare- The Health Care Standard Everyone Should Have

#16

Post by philip964 » Fri Aug 16, 2019 9:08 am

It is all very confusing. Especially for someone who is just turning 65, all these letters.

A and B. D for drug and yeah I think I have F. What is surprising is that you paid into Medicare your entire working life yet it still is what $300 a month per person. I see the ads for the Advantage plans, they are cheaper, and cover dental and eyeglasses, but so far I have resisted the temptation.

Near as I can tell I don't think anyone has asked me for money for anything since then. It does seem to pay for it all. No problems with anyone accepting it.

Except drugs.

Pretty much everything we take is now generic, but even with that, Part D from Blue Cross Blue Shield seems to not cover any of it. But my CVS pharmacist works magic and figures out how to work around with these other cards he gets from who knows where, and now my out of pocket for drugs is very small. That wasn't always the case. When a medication is non generic and is $300 for 30 tiny pills and your not really sure it really does anything, its easy to say, bad word that and not take it.

That still does not mean there are still not problems with drugs. "your more than three days early, I'm not allowed to fill this yet", and then going out of town for a while "we don't have those pills in stock, but I cannot transfer the prescription to the pharmacy across the street who has them because it is across a state line (Kansas City Mo.)" ,"your doctor will not allow refills, until you visit him", but he has no appointments for a week and a half, I really should not be off my blood pressure medicine that long.

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Re: Medicare- The Health Care Standard Everyone Should Have

#17

Post by KLB » Fri Aug 16, 2019 9:22 am

jason812 wrote:
Thu Aug 15, 2019 7:56 pm
AARP lobbied for Obamacare. Why? Probably cause AARP knew it would make billions.
AARP is a left-wing lobbying organization that sells insurance and offers a few side benefits to obscure its true nature. I won't have anything to do with them.

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Re: Medicare- The Health Care Standard Everyone Should Have

#18

Post by RoyGBiv » Fri Aug 16, 2019 9:46 am

jason812 wrote:
Thu Aug 15, 2019 7:56 pm
Not Medicare story. I'm not old enough but 5 years ago when my wife was prego with my daughter, we put money in a flexible spending account. What a joke. There was no flexibility. The insurance company took money out of it automatically when I went to the dr or when my wife went for check ups. I only wanted to use it for the birth but didn't get the chance. Trying to navigate that paperwork and do the math to keep track of it all made me feel like I needed to be an astro physicist.
I'm curious about this.... When we had an FSA, it was 100% under our control. Now we have a MSA (with HDHP) and again, nobody can touch that money unless I hand them the Debit card that is attached to it.

Do you know what rules changed to allow your insurer to touch the funds in your FSA without your permission?

:confused5
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Re: Medicare- The Health Care Standard Everyone Should Have

#19

Post by RoyGBiv » Fri Aug 16, 2019 9:53 am

WTR wrote:
Fri Aug 16, 2019 8:49 am
Second GoodRX. They have an app that you may check Drug prices on. My wife saved her Mom about $350.00 a month by following GoodRX.
I like GoodRx. I recently had a new prescription for a med that my insurance company didn't want to cover. Long story short, it was a higher concentration than what is normally recommended, but was approved by my doctor. Insurance denied it and instead approved the lower concentration version.

The pharmacy tells me that I can pay for the prescribed concentration out of pocket, at a cost of $1,012, for a 2-month supply. :grumble
Good Rx had a coupon for the correct (higher) concentration med for $79.

I'm going to try the lower concentration version to see if it works. The higher concentration version worked quite well. My insurance will cover the lower concentration version for a $5 copay. For the name-brand med, not the generic. Lol. I suppose I can just use more if it doesn't work quite as well. :lol:
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Re: Medicare- The Health Care Standard Everyone Should Have

#20

Post by joe817 » Fri Aug 16, 2019 10:01 am

KLB wrote:
Fri Aug 16, 2019 9:22 am
jason812 wrote:
Thu Aug 15, 2019 7:56 pm
AARP lobbied for Obamacare. Why? Probably cause AARP knew it would make billions.
AARP is a left-wing lobbying organization that sells insurance and offers a few side benefits to obscure its true nature. I won't have anything to do with them.
Wrong. AARP does NOT sell insurance. They sponsor. They have nothing to do with the overseeing, administration, execution, etc of the plan. The plan is through United Health Care. It's UHC's health plan, and only UHC's health plan. Google it. Look it up. ;-)
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Re: Medicare- The Health Care Standard Everyone Should Have

#21

Post by RoyGBiv » Fri Aug 16, 2019 10:13 am

joe817 wrote:
Fri Aug 16, 2019 10:01 am
KLB wrote:
Fri Aug 16, 2019 9:22 am
jason812 wrote:
Thu Aug 15, 2019 7:56 pm
AARP lobbied for Obamacare. Why? Probably cause AARP knew it would make billions.
AARP is a left-wing lobbying organization that sells insurance and offers a few side benefits to obscure its true nature. I won't have anything to do with them.
Wrong. AARP does NOT sell insurance. They sponsor. They have nothing to do with the overseeing, administration, execution, etc of the plan. The plan is through United Health Care. It's UHC's health plan, and only UHC's health plan. Google it. Look it up. ;-)
AARP gets money from UHC for selling it to AARP members.
AARP lobbied heavily for Obamacare, so they could sell it to their members and make money.
If I said what I thought about AARP, I'd be in violation of forum rules, so, here's a published story about it.
https://www.forbes.com/sites/theapothec ... 9ca0fb5935
Here’s how it works. AARP isn’t your every-day citizens’ advocacy group. The AARP is also one of the largest private health insurers in America. In 2011, the AARP generated $458 million in royalty fees from so-called “Medigap” plans, nearly twice the $266 million the lobby receives in membership dues.

.....

But the AARP aggressively, and successfully, lobbied to keep Medigap reforms out of Obamacare, because AARP receives a 4.95 percent royalty on every dollar that seniors spend on its Medigap plans. Reform, DeMint estimates, would have cost AARP $1.8 billion over ten years.
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Re: Medicare- The Health Care Standard Everyone Should Have

#22

Post by joe817 » Fri Aug 16, 2019 10:41 am

Well, that was certainly an eye opener. Thanks for posting Roy. I'm surprised that the article didn't mention even one time United Health Care. If it was there I missed it. If that's the case I claim a senior moment. Lol.
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Re: Medicare- The Health Care Standard Everyone Should Have

#23

Post by jason812 » Fri Aug 16, 2019 4:32 pm

RoyGBiv wrote:
Fri Aug 16, 2019 9:46 am
jason812 wrote:
Thu Aug 15, 2019 7:56 pm
Not Medicare story. I'm not old enough but 5 years ago when my wife was prego with my daughter, we put money in a flexible spending account. What a joke. There was no flexibility. The insurance company took money out of it automatically when I went to the dr or when my wife went for check ups. I only wanted to use it for the birth but didn't get the chance. Trying to navigate that paperwork and do the math to keep track of it all made me feel like I needed to be an astro physicist.
I'm curious about this.... When we had an FSA, it was 100% under our control. Now we have a MSA (with HDHP) and again, nobody can touch that money unless I hand them the Debit card that is attached to it.

Do you know what rules changed to allow your insurer to touch the funds in your FSA without your permission?

:confused5
I have no idea but it did not work the way we were told by HR. At the time (5 years ago), I was working for a major corporation and they were headquartered out of Illinois. Our health insurance was through United Health Care (who I think are dirty as can be). I never once used the debit card.

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Re: Medicare- The Health Care Standard Everyone Should Have

#24

Post by RoyGBiv » Fri Aug 16, 2019 4:47 pm

jason812 wrote:
Fri Aug 16, 2019 4:32 pm
RoyGBiv wrote:
Fri Aug 16, 2019 9:46 am
jason812 wrote:
Thu Aug 15, 2019 7:56 pm
Not Medicare story. I'm not old enough but 5 years ago when my wife was prego with my daughter, we put money in a flexible spending account. What a joke. There was no flexibility. The insurance company took money out of it automatically when I went to the dr or when my wife went for check ups. I only wanted to use it for the birth but didn't get the chance. Trying to navigate that paperwork and do the math to keep track of it all made me feel like I needed to be an astro physicist.
I'm curious about this.... When we had an FSA, it was 100% under our control. Now we have a MSA (with HDHP) and again, nobody can touch that money unless I hand them the Debit card that is attached to it.

Do you know what rules changed to allow your insurer to touch the funds in your FSA without your permission?

:confused5
I have no idea but it did not work the way we were told by HR. At the time (5 years ago), I was working for a major corporation and they were headquartered out of Illinois. Our health insurance was through United Health Care (who I think are dirty as can be). I never once used the debit card.
Wow. That's definitely a headscratcher. :headscratch
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Re: Medicare- The Health Care Standard Everyone Should Have

#25

Post by RoyGBiv » Fri Aug 16, 2019 4:50 pm

joe817 wrote:
Fri Aug 16, 2019 10:41 am
Well, that was certainly an eye opener. Thanks for posting Roy. I'm surprised that the article didn't mention even one time United Health Care. If it was there I missed it. If that's the case I claim a senior moment. Lol.
The Forbes article is relatively dated. UHC may not have been involved back then.
I don't fault UHC. IMO, AARP was the lobbying group that pushed obamacare across the finish line.
"Representing" seniors, in their own self interest. :mad5
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Re: Medicare- The Health Care Standard Everyone Should Have

#26

Post by Oldgringo » Fri Aug 16, 2019 4:58 pm

We have a Plan G with Continental Aetna and it has worked well for us here and when we were in Montana.


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Re: Medicare- The Health Care Standard Everyone Should Have

#27

Post by chasfm11 » Fri Aug 16, 2019 9:37 pm

Looks like I may be the odd man out on this so I'll share my experience.

I'm on an advantage plan through Aetna. My premiums are ridiculously low (pubic forum, not sharing here). I had a multi-day hospital stay in 2017 that cost me a couple of hundred dollars. My drugs (4) are all classed as Tier 1 and I get them in 90 day supplies through CVS for $0 co-pay on the advantage plan (no separate plan d) I even went with a doctor who is "out of network" on my plan. I pay every time that I see him. In the past three years, I've paid less than a third of what I was paying on my monthly premiums before I switched to the advantage. I got flu shot, etc covered. The new shingles vaccine cost me $160 per dose.

My wife, who has had many medical issues from knee replacements to cancer is on standard Medicare and the UHC/AARP plan F with an Express Scripts plan D. Her combined premiums are 10X mine. Her she takes some of the same medications but none of hers are tier 1 and her co-pays range from $12-75 per medicine per 90 days. She has one drug that costs us $350 for the first period and $75 every 90 days afterward each year. Her plan gave her a $140 copay for the shingles shots.

Our combined premiums are over $3k per year and we average that much in doctor costs. Because of her history, I was paying $1,100 a month under my previous employer's plan and there were lots of co-pays. I cannot afford to change plan her because, unlike the non-Medicare plans, there is not provision for uninsurable coverage with the Medicare supplements and she could be in a position where none of them would take her. I'm going year to year. If it looks like I'm going to have more trouble than I do not, I'll pick up a standard plan/supplement on renewal.
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Re: Medicare- The Health Care Standard Everyone Should Have

#28

Post by The Annoyed Man » Fri Aug 16, 2019 11:52 pm

I’m on Medicare parts A and B, and a Medicare supplement called Plan G from Mutual of Omaha, plus a drug plan from Express Scripts. The combined monthly cost for Part B, Plan G, and Express Scripts is roughly $250/month. When I was hospitalized last May, the ER bill (not counting Dr fees) was a little over $12,000. The in-patient hospitalization total was a little over $72,000. The operating room was around $15,000. And then the various in-hospital Dr consultations, the anesthesiologist, the surgeon's fee were maybe $4000 or so more. So the total came to something right around $103,000.

I didn’t have to pay a thin dime out of pocket. What Parts A&B didn’t cover was covered 100% by Plan G. With only a couple of exceptions, Express Scripts drug prices have been pretty low. Rarely does something cost more than $5.00 ... usually less. There have been a couple of things prescribed that were pretty expensive because they were off-plan, but I was able to consult the pharmacist for a generic alternative that Express Scripts would cover, and he was able to get the Dr to reissue the prescription for that drug.

That’s the good part. Medicare has been a good experience for me....so far.

The bad part is that I’m philosophically opposed to gov’t entitlements, and I struggle with some amount of occasional guilt for betraying that principle. But I came to this way of thinking later in life, and I didn’t spend a large part of my most productive years managing my finances in such a way as to have more independence from healthcare issues in the season of life that I live in now. Since (a) I paid into Medicare all of my working life, and (b) since my retirement income is mostly non-taxable such that my taxable income falls below the minimum threshold to qualify for an ACA subsidy, and (c) since that puts Obamacare outside of my price range, I decided to go ahead and use Medicare as my insurance. I actually DO feel bad about passing that cost on to my grandkids, and I regret that this is also costing YOU guys something, but I don’t have a lot of choice at this point in my life.

But guilt about that aside, Medicare has been much easier for me than I thought it would be. My previously existing providers all accept it, and I’ve had no trouble finding new providers or specialists who take it. My out of pocket remains solely that roughly $250 for the combined plans, and I haven’t had a copayment of any kind to worry about. I’ve gotten excellent care, both from my regular physician, and from the medical facilities and specialists I’ve had to see. And as I was laying in the hospital, white as a ghost and weak as a kitten from all the blood loss, I had the peace of mind of never wondering once, "How am I going to pay for all of this?"

Anygun, PM me if you want to know more about my Plan G and Express Scripts.

Btw, I did get a phone call the other day from someone with a heavy Filipino accent, questioning me about a pain med I have a prescription for, and take maybe once or twice a week. He identified his company, but it didn’t sound like one of mine. It could have been that I didn’t hear him clearly or he mispronounced it, but he started right off asking me about my pain, where it was on my body, and how much it hurt. My answer was, "I’m not going to discuss my personal medical history with some random stranger on the telephone. If you have questions, call my doctor," and I hung up on him.

We'll see where that takes is, if anywhere.
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Re: Medicare- The Health Care Standard Everyone Should Have

#29

Post by anygunanywhere » Sat Aug 17, 2019 8:21 am

Thanks TAM and others for your responses. Lots of great information here, much more than I had before I signed up for my advantage plan. I need to discuss this with the wife.
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