Medicare holes

Lots of doctors restrict the number of Medicare patients they have.

No cap on how much you have to pay (for your 20% part).

The law was passed to provide for an out-of-pocket cap but they raised the cost of Medicare, people complained, so they did away with the cap. Which is why you feel like you have to buy an extra, private "gap" policy. Dammit.

More people are getting private "Medicare Advantage" but it's basically managed care with a list of in-network doctors and facilities, that constantly changes. Plus, you have to get the insurance company's permission for procedures. It sucks. Don't get it. Unless you like arguing on the phone all day for a scan.

Coming up on retirement here, and holy shit is the whole Medicare thing confusing!!!! How on earth do you choose plans that provide good service and aren't horribly expensive? Part A, Part B, Part D, Medigap, Advantage? Wasn't this supposed to be easy?

One of the reasons I don’t retire.

you have to enroll at age 65, retired or not R5

Part B premiums are based on your income two years prior. It almost makes sense to quit any high-paying job you have two years before you retire and sling burgers at McDonalds so you pay less for Part B when you finally do retire. WTF??

Use an insurance broker. They are free to you (commission is paid by the insurance company). You tell them what you want covered, how much you want to pay, and they come up with a list of options. Problem solved.

R8, I used Garrett Bell at Secure Medicare Solutions. Only broker who did the whole thing by email--everybody else insisted on phone calls, even if they promise an email quote on their website. The closer you get to 65, the more spam calls you'll get.

No drug coverage - you have to buy a separate policy for that.

No hearing aid coverage.

Medicaid is pretty good, though.

Are you guys for real?

Jesus, the amount of ignorance on this thread.

R12 can you be more specific?

Not there yet. The the hubs and I are nearly lifelong Californians who are approaching retirement. I will be Medicare eligible within the next ten years. We both have Kaiser now, with which I am very satisfied (same for husband). I have had it for most of my life. I have had two heart attacks and received excellent care. Total hospital bill from each heart attack: 0$! Unless something radically changes, we will likely stick with Kaiser for the Medicare Advantage option. The caveat is if we end up full time in Italy. I am very grateful for my excellent health care, I realize I am very fortunate.

I was able to keep my employer-sponsored health care for life (paying the same portion of the premium I paid when I was working, which works out to about $300/mo. I decided not to get Medicare Part B because I'd have to pay another large monthly premium on top of that, and the benefits (like eliminating copays) didn't seem to be worth it to me. Only problem is that if at some point down the line I decide I need to get Part B, I'm going to have to pay a huge penalty for not signing up when I turned 65.

Welcome to America.

R15, you may not have penalties if you can show that you have had doctor and prescription coverage since you turned 65.

R14, you are very, very lucky. I worked for an American health insurance company last year (Medicare division) and I couldn't believe the lack of service and coverage. Imagine being in the Boston area and not being able to find a primary care doctor. Or having your medications covered at first then you get into the donut hole (that's what it's called) and having to pay everything out of pocket. You can pay and pay and pay and still not have coverage for certain things. The American healthcare system is so bad that you have your own version of socialized medicine, it's called GoFundMe.

Medicare’s lack of dental service is especially egregious because so many dire health issues are caused by the elderly not treating infected teeth. But Medicare only pays for the actual infection, so preventative care is ignored.

r17 I think that only applies if you're employed past 65. I retired at 58.

R20, you are probably right. I worked past 65 and had employer insurance until work ended and I went on Medicare.

I haven't found a doctor that doesn't accept Medicare, r18.

There are 30,694 Medicare doctors listed in Boston.

I've had many insurance plans before enrolling in Medicare and would never choose to go back with an Advantage plan.

If it's covered, it's covered (under straight A & B). There's no fighting and proving that a procedure ordered by a medical professional is medically necessary.

This thread is bait for insurance industry shills. I'd suggest having a look at the site before making judgment on the program.

There's no out-of-pocket limit with original Medicare A, B, and D and that prospect is scary. There is an annual out-of-pocket limit with the Medicare Advantage plans. That's why I went with an Advantage plan. And my doctors were in the plan I chose. Was that a mistake?

Did someone say holes? 🕳

R6 yes you do have to enroll at 65 in Part A which is free but you don’t have to enroll in B until you retire.

My mother has a Blue Cross Advantage plan, the cheapest one, something like $35/mo. It has drug coverage, and basic dental and vision. Works for her for now. If she starts to spring leaks, she will buy the next level up, etc.

R15, if you have qualifying insurance when you become eligible for Medicare you do not have to pay a penalty if you decide later on to sign up for Medicare.

R27, please clarify. Does she have Medicare *and* Blue Cross?

Yes R29, her Blue Cross is the supplemental B and D.

r28 As I said above, that only applies IF YOU'RE EMPLOYED.

[quote]but you don’t have to enroll in B until you retire.

Or at all, for that matter.

Maximum Out of Pocket Limits- Advantage Plans

Out-of-network Part A and Part B medical costs may be excluded from MOOP or your plan may have a separate higher out-of-network MOOP limit.

Some types of Medicare Advantage plans (such as HMOs) may not include out-of-network coverage as part of the plan's MOOP limit.

However, some Medicare Advantage plans (such as HMO-POS plans) include out-of-network coverage as part of the plan's higher-costing MOOP. The Medicare-established annual maximum combined (in-network / out-of-network) MOOP limit will increase in 2021 to $11,300 from the 2020 combined MOOP of $10,000.

Your Medicare Advantage plan's MOOP can change every year.

Medicare Advantage plans may also change the MOOP limits for in-network and out-of-network Part A and Part B coverage.

Part D out of pocket limit isn't exactly non-existent. Once you hit $4130 in costs, there is a 75% price discount and beyond $6550, you pay 5% only. Further, if you're low income, the Extra Help program is designed to ease your financial burden and many drug manufacturers have patient assistance programs (with higher income limits).

Ugh the dreaded DONUT HOLE for prescriptions. It's Hell. I hope this doesn't turn people off from pursuing medicare for all though, because there's positives about it too and when I envision it, supplemental is the deal maker. My supplemental covers those things missing from the OP and it's only a couple hundred dollars a month vs $500 + I'd pay on my own for high deductible insurance. Plus if your work/ pension insurance is usable that way.

Oh and I'm youngish, with the best plan offered, which is why that seems like a lot. Supplemental is your primary insurance, so that's what counts for your care. If a doctor doesn't take medicare, that doesn't matter because that's not technically your insurance. Same with being out of your area if you got a supplemental that covers that. Medicare also offers special add on plans (as one person said, $35) that are cheap for side issues, like prescriptions, dental, etc.

I really like Medicare and think it's a great plan for everyone if we went in that direction. There's always room for improvements too if that were to happen -- and if so, a bigger pool to sip from would mean the ability for wider coverages.

No one said existing Medicare structures have to be exactly what's used for everyone if we did that.

R19

Dental care coverage period is a big deal in USA. Employer plans on average range from adequate to bare bones coverage with unions maybe a bit better or same.

Even with dental coverage often things are limited or not covered at all. Know two persons dealing with periodontal issues and over years it has been a struggle to get good care at affordable rates (neither of their employer based dental covers much or any it).

First World "problems". GFY!

Single payer! Hello?

[quote] My supplemental covers those things missing from the OP and it's only a couple hundred dollars a month

I'm sorry, but there's something very wrong when someone has to pay more for a Medicare supplement plan that only covers up to 20% of the charges, as opposed to the actual Medicare plan that covers up to 80% of the charges.

Medicare Advantage Plans -- bah!

I signed up for Medicare A, B & D and then bought a supplemental plan.

I never want a goddamn health insurance company telling me what they'll cover and what they won't EVER again.

Health insurance companies make OBSCENE profits. Fukkum all!

R40, is there a limit on your out-of-pocket expense?

R37 The US health care system is hardly "first world." We would know.

There's a reason why the health care in Russia and Cuba is some of the best in the world. Doctors in those countries do not become rich from their work and drug prices are heavily controlled by the state.

It's going to go bankrupt with all those Boomers heading into their 80s.