Husband 65 in 3 Mo - Medicare Decisions - Where to Begin?

[GreenSky]

It appears that the small difference in premium between a Med Supp and an MA plan most probably isn't a major concern to her. I would think that the availability of the best quality of health care would be of primary importance.

As people get older the one thing in life that will insure that they have the best quality of life possible is the availability of the best quality of health care this country has to offer. It is just my personal opinion but I don't believe that an MA plan affords that total freedom and flexibility.

If one develops a particular kind of cancer, and there is a cancer treatment center in Texas that has had great success in treating that kind of cancer and they live in Ohio, don't you think that person would want to be able to go to Texas for treatment? I sure would.

Med Supp Plans D, G, F or N will give her husband that flexibility. Plan F would be my last choice for several reasons. It is over priced in many areas across the country, not all, and typically receives the highest percent of increase.

That being said the only decision would be which company to use. I would recommend the one that has the lowest premium. All Med Supps are standardized and all pay claims exactly the same way. No one company is "better" than another.

They will all have premium increases and there is no way of determining which company will have the lowest increase the next time premiums go up. Premium increase history is not an accurate way of making that determination especially now since the new Modernized Plans were introduced earlier this year.

I'm trying very hard to find fault with this post. I'll get back to you when I do.

Rick

 

[sman]

Always looking for the negative, huh?

I'm trying very hard to find fault with this post. I'll get back to you when I do.

Rick

 

[pipedream]

If I understand correctly, it appears that Med Supp is the best way to go based on our circumstances. I hadn't thought about needing or wanting to go to a facility outside of our region because most everything we've needed up to now has been available in Pittsburgh. But my husband has had cancer twice and though he has beaten it twice (so far as we know....the last surgery was just in October, clean margins, no chemo or radiation contemplated unless the cancer markers rise), I would hate to give up flexibility now that we might dearly wish for later.

In addition, we have a son living in London and a daughter living in Hawaii, both of whom we plan to visit. We would want to have coverage if medical care is needed during those visits. I'm pretty sure a Med Advantage plan would not provide such coverage.

I've talked briefly with agents (who called us - probably have access to a data base of people turning 65 soon) from Mutual of Omaha and Banker's Life and Casualty and am gathering information on the various plans/prices, etc... I have yet to talk to an independent agent who represents more than one company but plan to do so. Limited time has prevented me from moving ahead faster but I wanted to thank everyone who weighed in on this discussion and educated me about things we should be considering before making a decision. I very much appreciate the time you took to respond and willingness to share your expertise.

 

[Fisher]

I would hate to give up flexibility now that we might dearly wish for later.

Smart lady.

 

[Josh]

In addition, we have a son living in London and a daughter living in Hawaii, both of whom we plan to visit. We would want to have coverage if medical care is needed during those visits. I'm pretty sure a Med Advantage plan would not provide such coverage.

Most MA plans do have out of the country coverage. Hawaii is still this country, so that's even less of an issue. Also and not for nothing, but the the Highmark plan is a PPO and if enrolled your husband would have access to visit any healthcare provider he wished. There would be more exposure there (out of pocket max would most likely be more than the premium), but depending on the premium it might make infinitely more sense to do the MA. I.E. If part d premium and supp premium are a total of $2,400/year but the OOP (out of pocket max) is only $4,000 (not sure what it is, you'd have to check), then you're paying $2,400 in the hopes of not having to pay another $1,600 in the event extensive out of network care is needed. If your husband goes a year without needing the extra care then you're already ahead. Using the $2,400 example (supp plus part d) in 4 years you would have paid almost $10k in premium vs potentially $0. Take that out 10 years and it's over $20k. You should talk to a supp agent after you talk to the MA plan to make sure you're working with the right numbers, but in your area with the plans that are available I think you're much more likely to save thousands in premium vs potentially saving a few thousand bucks, especially if you look at it for more than a one or two year period.
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If I understand correctly, it appears that Med Supp is the best way to go based on our circumstances. I hadn't thought about needing or wanting to go to a facility outside of our region because most everything we've needed up to now has been available in Pittsburgh. But my husband has had cancer twice and though he has beaten it twice (so far as we know....the last surgery was just in October, clean margins, no chemo or radiation contemplated unless the cancer markers rise), I would hate to give up flexibility now that we might dearly wish for later.

Just to reiterate, the Highmark PPO would let you go anywhere you'd like. It would also have an out of pocket maximum, your cost exposure out of network (assuming it even was out of network) might be much lower than you think. You should also make sure you check the part b covered drug coverage on the MA. Honestly I think you're too readily discounting the MA.

 

[Frank Stastny]

Smart lady.

Yes she is.

 

[bdoucet]

I'm trying very hard to find fault with this post. I'll get back to you when I do.

Rick

I have some questions about your statement regarding an F plan, why would that be your last choice? If this woman wants 100 percent coverage with no copays or deductibles than that would be a great plan for her. If she sees a doctor often, another good reason for her to select the plan. It's all about what best fits her situation.
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How come nobody has mentioned Bankers Life and their Colonial Penn Supplement?

I'm weary of recommending MA plans because the future state of the Medicare Advantage program is uncertain. The governement doesnt like them and they're trying to do away with them. IF Medicare still offered their J plan I would certainly recommend that option. It's 100 percent coverage with a little coverage for home health care. I'm a big fan of the N plan because it's 100 percent coverage and your only out of pocket is 20 dollars if you go to the doctor, plus you part b deductible of 162.

 

[JamesCoon]

I have some questions about your statement regarding an F plan, why would that be your last choice? If this woman wants 100 percent coverage with no copays or deductibles than that would be a great plan for her. If she sees a doctor often, another good reason for her to select the plan. It's all about what best fits her situation.
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How come nobody has mentioned Bankers Life and their Colonial Penn Supplement?

I'm weary of recommending MA plans because the future state of the Medicare Advantage program is uncertain. The governement doesnt like them and they're trying to do away with them. IF Medicare still offered their J plan I would certainly recommend that option. It's 100 percent coverage with a little coverage for home health care. I'm a big fan of the N plan because it's 100 percent coverage and your only out of pocket is 20 dollars if you go to the doctor, plus you part b deductible of 162.

Let me guess, you work for BLC??? Am I right? Also your definition of 100% coverage is interesting. If plan F is 100% coverage then how is the plan N also 100% coverage?

 

[Frank Stastny]

I have some questions about your statement regarding an F plan, why would that be your last choice? If this woman wants 100 percent coverage with no copays or deductibles than that would be a great plan for her. If she sees a doctor often, another good reason for her to select the plan. It's all about what best fits her situation.
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How come nobody has mentioned Bankers Life and their Colonial Penn Supplement?

I'm weary of recommending MA plans because the future state of the Medicare Advantage program is uncertain. The governement doesnt like them and they're trying to do away with them. IF Medicare still offered their J plan I would certainly recommend that option. It's 100 percent coverage with a little coverage for home health care. I'm a big fan of the N plan because it's 100 percent coverage and your only out of pocket is 20 dollars if you go to the doctor, plus you part b deductible of 162.

Plan F is, in a lot of parts of the country, is priced substantially above a Plan D. (I have seen a difference in premium in Missouri of $400 to $600 per year.) They both provide basically the same level of coverage for hospital and doctor expenses.

There are only two differences between the two policies. Plan F pays the Medicare Part B Deductible, $162, and Excess charges. If Plan D is $162 or more, less than Plan F then Plan D may be a better investment of their premium dollar. Another thing to take into consideration is when companies have premium increases Plan F will usually have the highest percent of increase.

Regarding Excess Charges, as a result of the changes made to Medicare in the mid 90's, today over 99% of doctors Accept Assignment. If doctors Accept Assignment then there will be no Excess Charges.

If you encounter a prospect where money is not a consideration then they may be willing to pay more than $162 a year extra to get the Medicare Part B Deductible paid by the insurance company.

How often your client sees a doctor really doesn't come into play with any of the Med Supp Plans except Plan N. All Medicare Plans except Plan N are going to pay all of their doctor bills once the Part B deductible has been met.

I would not recommend a Plan N to someone who is chronically ill and seeing several doctors on a regular basis. The copay could easily negate any savings they may experience by the reduced premium.

The copay is not necessarily $20 and I never present it that way to a prospect. I always identify it as an "up to $20 copay". Usually Medicare is not going to assign a value to the office call of $100. The copay is 20% of what Medicare approves up to a maximum of $20. Their copay could be only $10 or $15.

Plan N is exactly the same as Plan D with the exception of the "up to $20 copay". If you like Plan N then you should love Plan D.

Plan D has been my Plan of choice to recommend for the last seventeen years. Not once in that time has a client ever called me and said that they "got screwed" because they didn't have a Plan that covered Excess Charges. (I have clients in numerous states across the country.)