Medigap insurance

[VeeEnn]

Pretty much…but only a problem if you require significant medical intervention, for the most part. That’s not a given, of course…even in the last 6 months of life. Personally I was planning on spending next to nothing on medical care and putting my hopes on a carbon monoxide leak the night before my “x” birthday (I keep shifting the age back). Fortunately, husband had the gumption/risk aversion to suggest a supplemental plan.

[bjurasz]

Wow. The more I learn about Medicare the more confused I get, and I think that is intentional on the part of the insurance industry. But hey, we’re exceptional here, right? Who would want the universal health care system of the rest of the industrialized world anyway…

(Sitting in a hotel right now, 3 miles from a hospital where FIL has been for close to two weeks now after being induced into a coma. 70 years old, on Medicare, and I know none of the financial details).

[UpNorthJoe]

intercst, I was of the impression that if one doesn’t sign up for a Medigap plan when turning 65, and then wants to enroll in a Medigap plan in the following years, the insurer can require a test for any pre existing conditions, and can deny the membership request. Is this true ? That was the main reason I signed up for a Part G high deductible, get in while healthy.

With Part D, if one doesn’t sign up for a plan at 65, they will be charged a premium based on the # of years they have waited after 65. Not a big deal, actually found a $0 plan to sign onto.

[steve203]

@UpNorthJoe

if one doesn’t sign up for a Medigap plan when turning 65, and then wants to enroll in a Medigap plan in the following years, the insurer can require a test for any pre existing conditions, and can deny the membership request. Is this true ?

Apparently so. I didn’t pick up a gap plan until I was 70. Fortunately, I have no pre-existing conditions, so was accepted.

@UpNorthJoe

With Part D, if one doesn’t sign up for a plan at 65, they will be charged a premium based on the # of years they have waited after 65. Not a big deal, actually found a $0 plan to sign onto.

Yes, there is a penalty for not paying your tithe to the insurance industry as soon as you turn 65. I did some math, and the penalty came out about the same as the premium. The first plan I was on had a cost. A few years ago, a zero premium plan showed up, iirc, “Wellcare”, or something like that, so I switched. I don’t care what the deductible and copay are, because I am a med-free zone. If I ever do require any meds, I can switch to a more beneficial plan.

Steve

[rainphakir]

@intercst

The average total Medicare Part B payments per treated beneficiary rose by 12.0% between 2016 to 2019, from $14,487 to $16,227. }}

So 20% of that is about $3,000 – and your last year of life typically has the highest medical expenses.

The linked post are the numbers, the arithmetic, calculations of the average Medicare Part B, during the last 6 months of life.

The study apparently does NOT consider the illness… Only the Part B costs.

In 2019, the AVERAGE total Medicare Part B payments per treated beneficiary was $16,227.

16227*0.2= 3245.

If one assumes that there are several related large costs… Does this imply that there are many more very small numbers?
(In the same way that high income and billionaire wealth skews the average wealth)?

The median might be instructive?
The Maximum and Minimum might also be instructive?

Medicare n MediGap are insurance. People buy insurance for the "unexpected ".
@intercst commented above that he had MediGap “just in case”.

Are crises in which “outpatient” care is appropriate, more or less likely in the final 6 mm months of life?

My take away from the topic is “get a MediGap plan just in case”.

VN writes:

@VeeEnn

These costs she itemised were for outpatient (plan B) procedures…even if they took place within a hospital setting.

@VeeEnn

Hospital facilities are frequently used for outpatient procedures that don’t require admission…even if you’re hanging around all day for one reason or another

In other words, the health care industry is shifting from designating inpatient status to designating outpatient status… A designation that results in MORE income to the hospital, Drs, etc.

In the past, the health care industry got paid more for inpatient, more cases were designated “inpatient”.
Now, Medicare is limiting the fraud of that fountain of wealth, and the industry is turning to gouging individuals.

ralph

[intercst]

@VeeEnn

The reason for a hospital admission isn’t to make it cheaper for a Medicare beneficiary…but because it’s medically necessary.

Not at all. A for-profit hospital will fill an empty bed if they can generate a reason to do so. It’s all about the “billing opportunity”. Both the for-profit hospitals and the for-profit insurers team up to squeeze as much as they can out of Medicare. And in the case of thieves like United Healthcare, they may own both the hospital and the insurer.

It’s like Tag-Team Wrestling.

intercst

[intercst]

@rainphakir

@intercst

The average total Medicare Part B payments per treated beneficiary rose by 12.0% between 2016 to 2019, from $14,487 to $16,227. }}

So 20% of that is about $3,000 – and your last year of life typically has the highest medical expenses.

The linked post are the numbers, the arithmetic, calculations of the average Medicare Part B, during the last 6 months of life.

The study apparently does NOT consider the illness… Only the Part B costs.

Vanguard has a good document that illustrates the arithmetic at the 95th percentile of the cost distribution (i.e., Top 5% worst case). Check out the chart on page 6, Figure 2.

personal1.vanguard.com

ISGPLHC_072021.pdf

2.35 MB

For a high risk, 65-yr-old woman, at the 95% percentile of the cost distribution, the difference between having Medigap and going bare with just Medicare is $6,300/yr. Like I said, “the cost of a cruise”.

Part B is the thing that generates cost for you. Your piece of a $1 MM hospital bill under Part A is capped at $1,676. It’s lost in the round-off if you get a serious illness. A lot of people don’t understand that – even in this thread. {{ LOL }}

I bought a high deductible Plan G Medigap not because I was worried about the cost of the Medicare co-pays, but because I knew that if I had symptoms of a heart attack or stroke, I’d be evaluating the need to go to the Emergency Room against the financial risk of getting rogered by the health care system. At least if I knew my co-pay was limited to the High Deductible Plan G deductible of $2,870 for 2025, I’d be more likely to seek aid. But that’s just me. Your behavior may differ.

intercst

[ptheland]

This is all getting interesting to me. While I’ve started paying a bit more attention to Medicare over the last couple of years, I’m down to about a year before I hit 65 and will qualify. So it’s time to get serious.

What is confusing me is the Medigap options. From what I can tell, I have two options: part G and part N. G covers more, but costs more. N is cheaper, and better suited to those who are relatively healthy or on a tighter budget.

It also seems that if you sign up for either one when you start Medicare, there’s no underwriting. You are guaranteed to be able to buy a policy. But if you wait, there is underwriting and you could pay more or even be denied.

Does that sound right so far?

—Peter

[intercst]

@ptheland

It also seems that if you sign up for either one when you start Medicare, there’s no underwriting. You are guaranteed to be able to buy a policy. But if you wait, there is underwriting and you could pay more or even be denied.

Depends on the State. Connecticut, New York, Maine, and Massachusetts let you buy a Medigap policy at any time without Medical Underwriting or a higher premium.

intercst

[ptheland]

@intercst

You only pay 20% on Part B expenses. Your piece of a $1 MM hospital bill is capped at the $1,676 Medicare Part A deductible for 2025. That’s a small fraction of 1%, not 20%.

Let’s revisit this statement. I’m not sure it’s right.

Here’s what Medicare says:

Part A Deductible
$1,632 ($1,676 in 2025) for each time you’re admitted to the hospital per benefit period, before Original Medicare starts to pay. There’s no limit to the number of benefit periods you can have.

Inpatient stays (copayments)
Days 1-60: $0 after you pay your Part A deductible
Days 61-90: $408 each day ($419 in 2025)
Days 91-150: $816 each day while using your 60 lifetime reserve days ($838 in 2025)
After day 150: You pay all costs

What does Medicare cost?

If I’m reading that right, that cap is per hospital admission, not per year. If you are admitted twice in a year (with a long enough gap between them), you pay the deductible twice.

Then if the hospital stay is longer than 60 days, you start paying even more.

Those potential costs would provide a good incentive to buy a Medigap policy (assuming such a policy would cover these costs).

[ptheland]

Of course, this is going to vary by state, but in CA where I am, it looks like I can get a Medigap Plan G-high deductible for about $40-$80 a month (gotta go through a full application to get an exact figure, which I can’t do yet as my enrollment window has not yet opened). For all reasonably probable care, I’d have a max out of pocket of $2800 for the supplemental plan plus another $240 for Part B.

The main risks are very long lifetime hospital stays (after about 1 1/2 years spent in hospitals lifetime, you lose coverage) and foreign travel (which actually has civilized copayments and a reasonable lifetime max).

Every other policy in CA costs more and covers less. Why would anyone choose anything else? (Unless, of course, those two risks I mentioned are really important to you - perhaps you have a chronic condition that lands you in the hospital on a regular basis. Or you do a LOT of foreign travel - in which case you can revisit your travel plans if you use up too much of your lifetime max there.)

I also found a Drug plan (Part D) that’s only a few dollars a month and would cover my current maintenance meds for just over $20 a year for all of them.

Lots more details to dig into, but that gives me a good start.

Still gotta look at vision and dental.

–Peter

[Leap1]

@intercst

Not if she had you thinking you were going to pay 20% of a $1 million hospital bill.

Read Vee’s comment above this. You do not know that it is Part A.

[Leap1]

@intercst

Yes. That’s a major, for-profit hospital scam under Medicare.

@intercst

Not at all. A for-profit hospital will fill an empty bed

No no no

In patient can kill you. Out you go as fast as possible.

People who are ill that stay in hospitals get pneumonia. It kills them. The elderly with broken hips survive much longer now because three days later they are out of the hospital. It used to be over two weeks. It was killing the elderly.

You really want someone with open heart surgery to stay in hospital till they get pneumonia.

Now if you want a more efficient system get rid of private insurers. It will cut major costs out. But healthcare will remain expensive.

Now will some doctors fail to diagnosis? Yes.

[intercst]

@ptheland

@intercst

You only pay 20% on Part B expenses. Your piece of a $1 MM hospital bill is capped at the $1,676 Medicare Part A deductible for 2025. That’s a small fraction of 1%, not 20%.

Let’s revisit this statement. I’m not sure it’s right.

It’s $1,676 for the first 60 days in the hospital. I’m assuming any senior citizen spending more than 60-days isn’t coming out alive, so I’m really not worried about Day 61 onwards.

intercst

[WendyBG]

@ptheland

Still gotta look at vision and dental.

Traditional Medicare does not cover vision and dental. That requires separate insurance, if desired.

Wendy

[jerryab2]

@WendyBG

Traditional Medicare does not cover vision and dental.

I have seen 1-3 TV ads about “real” dental insurance. No idea if or how it works. Claims to be “real” insurance, but (IMO) that gets into the real $$$ fast.

[ptheland]

@WendyBG

Traditional Medicare does not cover vision and dental.

Yep. That’s why I’ve got to look into them.

Frankly, I haven’t had coverage for either of these for over 25 years. It’s quite likely that will continue, but I do plan to look at what is available for folks on Medicare.

–Peter

[123spot]

Thanks so much everyone for the good discussion. I think I’ve learned a lot- I applied for the least expensive ($125/month, Humana) part G supplemental I could find ( thanks intercest especially ) and received my acceptance today.

I’m still surprised to find out that it only covers Part B; my advisor had told me that,with the supplemental, my max out-of-pocket annually would be $250. From the thread, however, do I understand correctly that there is also a separate Part A annual deductible of ~$1600 ? Thx. Spot

[intercst]

@123spot

I’m still surprised to find out that it only covers Part B; my advisor had told me that,with the supplemental, my max out-of-pocket annually would be $250. From the thread, however, do I understand correctly that there is also a separate Part A annual deductible of ~$1600 ? Thx. Spot

No. High Deductible Plan G covers Both Part A and Part B 100%, after you pay the $2,870 annual deductible for 2025, plus your annual premium.

intercst

[flyerboys]

This thread illustrates the utter unspeakable absurdity of USA healthcare law and practice. How in hell can this allow for market chastening consumer choice? It cannot, as its purpose is to obfuscate the robbery taking place.

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