This is my last posting on Medicare, I promise!
A reader takes issue with my comment in the last posting that "Medicare Advantage Sucks!" And he has a point - in some States, it is not a bad plan. But in other States, it is expensive (in terms of co-pays and deductibles) and not many doctors or hospitals accept it. That is a real issue.
Medicare Advantage is a traditional health insurance plan, funded (at least in part) by Medicare dollars. As such, like any other health insurance plan, there ara "in-network" and "out-of-network" doctors, so you have to make sure your doctor and local hospital are "in-network" to get the best coverage. Out-of-network providers are covered, just not as well and there may be high deductibles.
The nightmare for me - when I was on my own health insurance policy - was the idea of going to the Emergency Room and being treated by a "visting physician" who was out-of-network. Suddenly, you have a bill in the thousands of dollars. You hear horror stories about this sort of thing all the time, as well as ambulance or especially air ambulance trips being only covered in part, leaving the patient with a huge bill.
Where I live, few providers accept Medicare Advantage. Like with my Dermatologist, who decided he no longer wanted to accept Obamacare, you are left with two choices. First, you can find another doctor who will accept your plan. Second, you can go to your old doctor and then submit the bill, along with the properly coded form, to your insurance company, for an out-of-network claim. In just 90 days, you'll get a decision on whether they will pay at all, and if they do pay, it will be a fraction of the overall cost.
In other parts of the country, Medicare Advantage works, as most providers accept it, although it may not pay as much of the cost as traditional Medicare - although the premiums might be lower or even zero to start out. Yes, health insurance and even Medicare (and Medicaid) vary State by State - another reason our system is whacked. Try explaining this to a Brit - that "National Health" has different rules in Scotland versus Wales versus England. Or in Canada, the plans being different in BC versus Quebec. Maybe they are, if so, it ain't "National" Health, is it?
So for our reader, who doesn't live in Georgia (I am guessing) Medicare Advantage works out well for him. My apologies! But even if your doctor and hospital accept the plan, there are other factors to consider. Like any private insurance plan (like my old Blue Cross plan I had for well over a decade) there are deductibles and co-pays to be made. Yes, in traditional Medicare, there is a deductible, but it is a paltry $256 or so for Plan B, and similarly small (or zero) for the supplemental or Medigap polices.
Co-pays with Medigap Plan G are also either very small or zero, as opposed to the $40 I am paying on Obamacare ($90 for Specialists). Not a lot of money in the greater scheme of things, but it is funny how you have to see your primary three times before referral to a specialist and three visits to the specialist to figure out what is wrong with you! BTW, in traditional Medicare, referral to a specialist is often not required.
And yes, you can opt for a "Plan G High Deductible" with a $7500 deductible. There are other plans as well, with lower premiums and less coverage (higher co-pays, higher deductibles) such as Plan K.
What it boils down to is three things:
1. What is the premium cost?
2. Does your doctor accept the insurance?
3. What are the co-pays, coverage limits, and out-of-pocket max (deductible)?
And you can't have all three. Traditional Medicare with Plan G is a Cadillac plan and everyone (here) accepts it, and it has low or zero co-pays and ridiculously tiny deductibles. The downside is, with a part D drug plan plus the underlying Medicare premium, we are looking at $500 a month for coverage, and it will go up as you age.
You get what you pay for, as they say. When I was younger and healthier (sort of) I had a cheap plan through Blue Cross that had a $10,000 deductible and various co-pays. The premiums started at about $500 a month and went up over time to over $1000 a month at the end, at which point Obamacare came on the scene.
And Obamacare spoiled us. The standard premium for my "Bronze" plan is on the order of $1800 per month. Thanks to your hard-earned tax dollars, however, this is subsidized down to a few hundred or even zero dollars a month. Don't quit your job! Those of us on Obamacare thank you for your service!
By the way, if you have employer-provided health insurance, that $1800 number should give you an idea of what it is actually costing the company. Your cost to your employer far exceeds the number on your paycheck!
Obamacare coverage was fairly decent - better than my private Blue Cross plan was. Like I said, we were spoiled. But the Traditional Medicare plan with Plan G? Gold-plated Cadillac, man! But at a cost, of course - $500 a month, just for me. The old me - young and healthy and trying to save for retirement - was willing to take risks like a $10,000 deductible. The new old me - who is actually old - doesn't want to take that risk. Getting sick and going to the doctor are no longer a "what if" kind of deal but what time is my appointment this week?
Of course, this raises the question as to whether doctors find problems with you once you are on Medicare because Medicare pays, or whether old people just get sick. I think it is a combination of the two. Doctors, like Lawyers, have to bill, bill, bill to justify their salaries. And subconsciously there is an imperative to find and fix problems if the client has the means to pay or good insurance. I am not taking a piss on doctors here, it is just human nature.
I mentioned before a dentist who wanted to do $10,000 worth of work on my mouth because she thought I had dental insurance. When I told her I didn't have dental insurance (who can afford that on their own dime?) suddenly these treatments were deemed unnecessary.
Or take my friend who had a diverticulitis attack. When I get them, they gave me prednisone and an antibiotic and was sent home. When my friend got it, she was hospitalized in a private room no less, as the hospital had empty beds and Medicare pays 80% even if my friend was indigent. There's always room at the Inn if you have cash or good insurance - too bad Mary and Joseph didn't know that!
But as you get older, maybe it is a smart idea to get a more inclusive plan. One reason I have been vacillating on this whole deal is that to be "stingy" it would make more sense to get a Plan K or at least a Plan G with high deductible and hope I don't get sick or go to the doctor very often.
Problem is, I am already sick and go to the doctor or specialist twice a month in the last few months. Fortunately, it has helped - as you can see, the Carbidopa-Levodopa has got my brain firing on all eight cylinders this afternoon - my typing speed is up to 100wpm!
So, I think I will go with Plan G. I still am awaiting surgery for my torn rotator cuff and need to see a neurologist over the missing and dead parts of my brain. The de-luxe plan makes sense if you have illnesses, which most old people tend to have.
But that is the fundamental trade-off. You can pay a little in premiums and then pay more for treatments, or pay a lot for premiums and less or nothing for treatments. And Part D for drugs works the same way. UHC has a $100 a month plan that would have zero co-pays for the five drugs I take. Aetna has a $50 a month plan that would have me pay $50 a year in co-pays. The latter is cheaper, provided that down the road, I don't need some esoteric and expensive drug. At least with Part D, you can jump ship if that happens.
There are layers of confusion for this whole mess. For the life of me, I don't understand how most oldsters figure this out, much less configure and install their new flat-screen teevee!
