The plan is to live for a long time
April 30, 2013 6:29 AM Subscribe
It is time to sign my dad up for medicare (USA). He is very healthy and we come from long living stock. Which medicare plan is best for this situation? And even with the best plan, what are the pitfalls we need to look out for?
He is successfully self employed (what he earns is more than what he spends) and should be able to continue unless he gets very very sick. Currently, he pays for his own health insurance, that has a $5000 deductible, and has a Medical Flex Spending Account. He goes to the doctor once a year, the chiropractor once a month and has a massage every two weeks and takes no prescription drugs regularly but many vitamins. I am interested in help differentiating plans (especially BCBS v AARP/Humana), knowing what problems or situations are not covered (well), how can we continue with the medical flex spending account? Any changes since this question?
He is successfully self employed (what he earns is more than what he spends) and should be able to continue unless he gets very very sick. Currently, he pays for his own health insurance, that has a $5000 deductible, and has a Medical Flex Spending Account. He goes to the doctor once a year, the chiropractor once a month and has a massage every two weeks and takes no prescription drugs regularly but many vitamins. I am interested in help differentiating plans (especially BCBS v AARP/Humana), knowing what problems or situations are not covered (well), how can we continue with the medical flex spending account? Any changes since this question?
I just helped my grandmother do this, so between the research I did and knowing what I know from working in a psych hospital and from,other medical care friends, you probably don't want a Medicare Advantage replacement policy. Especially not Windsor, unless you absolutely have to have the other stuff they offer like meals and transportation. Here's why.
The government contracts out with these companies for these plans. Basically, they get a certain amount of money for each plan they sell and that is what they use to pay for services. In order for them to actually make money, they have to keep the money hey pay out down. Therefore they operate like any other private insurance...you have to go to their network doctors (which many of them are by geographic region, so going to the nearest big city may not be an option for you), you have to get pre approval for specialists visits, and they are free to deny coverage for services if they deem it not medically necessary. As of right now, regular Medicare from the government isn't that restrictive, so by choosing a Medicare Advantage plan you actually lose potential services. A serious illness and hospital stay may not be covered if they think you could have dealt with it at home.
Medigap policies, on the other hand, are a different animal altogether. They are simply secondary policies that pick up where Medicare leaves off. While different companies offer them, the plans are defined by the government (Plans a through f I believe) so Plan A has the exact same coverage no matter what company offers it. A medigap plan pays for the Medicare deductible and the 20% copay. So if you go to any Medicare facility, Medigap picks up the rest.
posted by MultiFaceted at 8:12 AM on April 30, 2013 [1 favorite]
The government contracts out with these companies for these plans. Basically, they get a certain amount of money for each plan they sell and that is what they use to pay for services. In order for them to actually make money, they have to keep the money hey pay out down. Therefore they operate like any other private insurance...you have to go to their network doctors (which many of them are by geographic region, so going to the nearest big city may not be an option for you), you have to get pre approval for specialists visits, and they are free to deny coverage for services if they deem it not medically necessary. As of right now, regular Medicare from the government isn't that restrictive, so by choosing a Medicare Advantage plan you actually lose potential services. A serious illness and hospital stay may not be covered if they think you could have dealt with it at home.
Medigap policies, on the other hand, are a different animal altogether. They are simply secondary policies that pick up where Medicare leaves off. While different companies offer them, the plans are defined by the government (Plans a through f I believe) so Plan A has the exact same coverage no matter what company offers it. A medigap plan pays for the Medicare deductible and the 20% copay. So if you go to any Medicare facility, Medigap picks up the rest.
posted by MultiFaceted at 8:12 AM on April 30, 2013 [1 favorite]
Just a tip - my dad took no prescriptions as well, so he decided not to sign up for a prescription plan. He got a hefty penalty once the Medicare folks noticed. Apparently you can't do that!
posted by cecic at 8:34 AM on April 30, 2013
posted by cecic at 8:34 AM on April 30, 2013
What MultiFaceted sez.
I've been on medicare with a medigap supplement (plan F, which is what most folks choose, I believe) for several years now. Couldn't be more satisfied. I deal with several health issues, and have yet to pay a cent out of pocket.
posted by drhydro at 10:30 AM on April 30, 2013 [1 favorite]
I've been on medicare with a medigap supplement (plan F, which is what most folks choose, I believe) for several years now. Couldn't be more satisfied. I deal with several health issues, and have yet to pay a cent out of pocket.
posted by drhydro at 10:30 AM on April 30, 2013 [1 favorite]
Can't speak to the financial end of it, but do want to echo the medical side of it. The older we get, the less "routine" medical procedures become. A hospital stay can quickly turn into weeks.
Other thing to consider: insurance is not to pay for things, but to protect assets. The more assets he has, the more insurance he needs. You don't insure for now, but for what might happen in the future.
posted by gjc at 5:54 PM on April 30, 2013 [1 favorite]
Other thing to consider: insurance is not to pay for things, but to protect assets. The more assets he has, the more insurance he needs. You don't insure for now, but for what might happen in the future.
posted by gjc at 5:54 PM on April 30, 2013 [1 favorite]
If you have a nice income and can afford a Medigap policy, by all means get one. If, however, you have a not-so-nice income, you may be eligible for "Extra Help" - meaning your monthly Medicare premium and deductible will be picked up by the state - even if you don't qualify for medical benefits per se from the state, food stamps, etc.
In either case, there's no reason that I can see to bother with a Medicare Advantage Plan. I had one a few years ago which paid for a pair of eyeglasses for me and that was nice - Medicare does not pay for eyeglasses or dental work. My friend, however, bought an Advantage plan because they paid for having her teeth cleaned twice a year - supposedly. She made an appointment, went in and had the cleaning done, then got a bill for $65 in the mail. She called the dentist and told them that her Advantage plan paid for tooth cleaning and the dental hygienist told her, "Oh no, Dear - we did a deep cleaning and your insurance only pays for a regular cleaning." So be aware - there's always a loophole.
The plan I was on changed to a different carrier, then that one left town at the end of 2012, and I checked into the different plans and damn if I can see any reason to have any of them; they don't pay one red cent more than Medicare itself pays, so why bother? Medicare Part D pays very well for prescriptions (patient is left with a minimal copayment) and believe me you don't want to be paying your own prescription prices. I didn't take any meds when I first went on Medicare, either - now I take nearly $1,000 a month's worth (drugs are insanely expensive), for which I pay about $100.
How I wish everyone in the country could be on Medicare. It breaks my heart to think of so many families - hard-working people with children, or without - who cannot afford to pay for a needed prescription, even while they're paying an ungodly month premium for "health" insurance - the whole situation is criminal, in my opinion.
posted by aryma at 10:42 PM on April 30, 2013
In either case, there's no reason that I can see to bother with a Medicare Advantage Plan. I had one a few years ago which paid for a pair of eyeglasses for me and that was nice - Medicare does not pay for eyeglasses or dental work. My friend, however, bought an Advantage plan because they paid for having her teeth cleaned twice a year - supposedly. She made an appointment, went in and had the cleaning done, then got a bill for $65 in the mail. She called the dentist and told them that her Advantage plan paid for tooth cleaning and the dental hygienist told her, "Oh no, Dear - we did a deep cleaning and your insurance only pays for a regular cleaning." So be aware - there's always a loophole.
The plan I was on changed to a different carrier, then that one left town at the end of 2012, and I checked into the different plans and damn if I can see any reason to have any of them; they don't pay one red cent more than Medicare itself pays, so why bother? Medicare Part D pays very well for prescriptions (patient is left with a minimal copayment) and believe me you don't want to be paying your own prescription prices. I didn't take any meds when I first went on Medicare, either - now I take nearly $1,000 a month's worth (drugs are insanely expensive), for which I pay about $100.
How I wish everyone in the country could be on Medicare. It breaks my heart to think of so many families - hard-working people with children, or without - who cannot afford to pay for a needed prescription, even while they're paying an ungodly month premium for "health" insurance - the whole situation is criminal, in my opinion.
posted by aryma at 10:42 PM on April 30, 2013
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My parents and my MIL both have BCBS and they both are very happy.
Now, you don't HAVE to sign up for an administrated Medicare program with a 3rd party insurer. If your doctor takes medicare payments directly from the government, then you may just want a Medigap plan to cover anything that isn't covered.
It's as complicated as any US Health Insurance. Here's some information from the Medicare Website.
Have your Dad read about his options and then he can decide how to proceed.
I will say that while your Dad is healthy today, as we age stuff starts to fall off. Old people going to the doctor once a week isn't a trope, it's reality.
I'm very lucky to have both of my parents, they're in their 70's and while they're as healthy as they can be, my mom had a knee replaced and my Dad developed diabetes.
So what will suit him at 65 won't necessarily be the best plan at 75, so this is an ongoing thing.
The good news is that he can pick something now, then change again during open enrollment.
posted by Ruthless Bunny at 6:38 AM on April 30, 2013