Reader's Comments on Medicare

Some of the best material I find is from readers.  There is an old saying that if you want to find out something on the Internet, post an obviously wrong answer and people will educate you!  Maybe that's why I have this blog - to get educated!

A reader writes with some interesting comments on Medicare.  You could write a book on this subject and I am sure someone has!  Anyway, I thought his extensive comments deserved a wider audience.  Republished with permission:

I am a long time reader of your blog and found your recent writings on the Medicare game most interesting.

I am "similarly situated" age-wise and other factors as you relative to Medicare and thought you might be interested in some additional information.

In addition to the Medicare Advantage vs. Original Medicare with a Supplement and Part D drug plan decisions, many states throw in yet another wrinkle to further complicate the matter.

Some states allow different pricing schemes that can cause massive Medicare Supplement price increases just as you can least afford it. Specifically, some states allow Attained Age pricing, Issue Age pricing, and Community pricing.

With Attained Age pricing, the cost of your Medcare Supplement goes up each year based on your age in addition to any increases for inflation and higher costs.  I know of several people who started out paying around $50/month for their Supplement at 65, and now that they are in their late 70's, are paying $400/month or more.  And it will continue increase significantly each year that they live.

With Issue Age pricing, the price is based on your age when you first took out the policy, and will increase based only with inflation and general overall cost increases and NOT on your advancing age.  The difference being that had the people mentioned above who are now paying over $400/month and increasing each year, had chosen an Issue Age policy, they would be paying around $150/month now.  So massive back-end loading price increases as your resources decline with 401K withdrawals and the usual failure of Social Security payments to keep up with *real* increases in living costs.

Community Pricing is where everybody in the same state and class pay the same rate.

If you go the Medicare.gov website and go to the "find policies" page where you can enter your zipcode, you can play around and see what others have to pay and deal with by entering zipcodes from different states.  When I did this, I entered some random zipcodes for Georgia and Florida, and it appears that those states and many others are Issue Age only states, where state law only allows Issue Age policies that provide important and valuable protections to their residents.

Comment: Yay, Georgia!  I noticed this on the Medicare website, but didn't understand what it meant.

If you then enter a zipcode from say Indiana, you will see that that the vast majority of all policies available are Attained Age pricing. These policies start out around 110 to 120 per month and the only viable Issue Age policy starts around 145/month.  So minimally cheaper to suck you in, then by the time you've had some health issues, are well past your 7 month guaranteed issue period at 65, and cant change your plan, they bleed you dry with massive price increases.

From what I can see, the best way to go is an Issue Age Plan G Supplement with traditional Medicare Parts A and B and whatever Part D drug plan you chose.  The Part D is the least concerning because you can change that every year with no penalty and based on the benefit level you want and the premium you want to pay.

Comment: I was not aware of this with regard to part D. 

As to Medicare Advantage aka Part C, run the other way, fast.  Don't even consider them unless you want a screwing for the rest of your life.  They draw people in by offering low or even zero dollar monthly premiums depending on the state you live in, and with low or no deductibles and low max out of pockets, Then, once they have you past your guaranteed issue point, they jack premiums, deductibles, and max out of pocket through the roof.

The place I happened to retire from, like most companies now, offered a so-called retiree health plan using a Medicare Advantage plan from who else but United Healthcare.  In this plan, they set aside a certain number of thousands of dollars based on your years of service that could only be used to pay the premiums on their chosen plan. 

The plan starts out at about a $70 monthly premium and a no deductible max 2000 annual out of pocket.  Sounds like a good deal, right?  Until you talk to other victims of this plan and find out the monthly premiums double or triple in a just two or three years and keep going up from there, AND the max out of pocket also climbs by 30% or more EACH YEAR.

End result is you find yourself in your seventies, the fund from the place you retired from is all used up, and you are stuck paying 500 per month in premiums and climbing rapidly, and your max out of pocket per year is in the many thousands and rising fast.  And since you are long past your 7 month guaranteed issue period at age 65, if you do try to change, any company you try to change to does not have to accept you, and if they do accept you, they can charge whatever they want.

Comment: Medicare Advantage (Part C) sucks.  Some agents push it for the commissions. 

One last point, from what I understand, it does not really matter what insurance company you choose for your Supplement because other than to pay your premiums, you really won't have any contact with them.  When you get medical care, your doctor etc. bills Medicare for the full amount and whatever Medicare does not cover is billed by Medicare directly to your Supplement insurance company, so no forms to fill out. So a plan G from company X will pay out exactly the same as a Plan G from company Y.

Anyhow, just a few thoughts that came to mind after reading your most recent posts on Medicare and Social Security.  I look forward to reading in your blog about what you end up doing as far a Medicare and whatever supplement company you choose.

Thanks for the feedback!  I think I have finally figured this out.  Now, to pick a company for plan G and a company for plan D.  MoO has the low premiums for Plan G ($160), although "Wooodmen of the World" (About Schmidt) has even lower at $130.  I think Aetna has Plan D at $49 a month or so.

Oddly enough, UHC offers a plan G at $170 a month and a "deluxe" Plang G for over $400 a month.  I guess that gets you gold-plated service or something.  While UHC is popular with the AARP set, I read something online about UHC recently, can't remember what.

AARP started out selling burial insurance.  I wrote about them before.  Twice.  Still, it is cheap to join ($55 for five years) and you do get a insulated tote bag!

Medicare for All? - More Medicare Follies!

The learning curve is steep!

I spent an hour with a local insurance rep at a card table at Walmart.  She was very well informed and gave me some other important information:

1.  You can go to Medicare.gov and compare supplemental plans and drug plans from every company in your area (and there are many!).  The prices quoted, however, are estimates (usually $5-$10 higher than what I have been quoted) and you may have to go to the company website or an agent to get the actual monthly cost.  There are discounts, for example, for automatic debit from your checking account or from Social Security.

2.  You have to (or should) get your supplemental and drug plans signed up before your birth month of your 65th year.  While there is technically a 7-month "window" to sign up for Medicare (three months before your birth month, your birth month, and three months afterwords) you may end up paying more if you don't sign up during the first three month window.

3.  Some agents push "Medicare Advantage" as they get a higher commission.  However, not as many doctors and hospitals take that plan.  The Mayo clinic, for example, will take my Medicare Plan A&B plus supplement (traditional Medicare) but not Medicare Advantage.  Some advantage!  But now I know why some agents push that plan.

4.  Agents get a commission on supplemental plans, but it is only a few hundred dollars at best - a lot of work for not a lot of payback.  It doesn't appear to affect the costs too much, although I noticed that MoO (Mutual of Omaha) offers a discount for signing up through their site.  Interesting.

5. The "silver sneaker" plan gives you free gym membership at participating gyms.  UHC offers thsi, but so do other supplemental plans. 

6.  The cost of Medicare to the consumer can be much higher than for Obamacare (ACA).  Right now, I am paying $0 for Obamacare.  Last year, we paid about $220 a month - it varies with income.  Between the plan B coverage ($185) and the supplemental coverage ($170) and drug coverage ($50) we will be paying about $400 a month.  Not only that, but drugs that cost me a few dollars per prescription will now cost me tens of dollars per prescription.

Which brings us to our second point.  Medicare for All?  Guaranteed Annual Income?  The Left has some screwy ideas that would result in a cut of benefits for most Americans.  Medicare is more expensive and may cover less than traditional insurance plans or Obamacare.  Americans would pay more and get less.

Guaranteed annual income (touted as $1200 of free money) would be a pay cut to the millions of Americans who are getting paid $2000 or more, every month, in Social Security.

These ideas have great traction with the very young, but really make no sense, when you think them through.  I still can't believe that Democratic candidates were seriously discussing handing out $1200 to every American, every month, as though it was a serious proposal.

No wonder we lose elections!

UPDATE:  Want to save on prescription drug costs?  Have your doctor prescribe a 90-day supply.  In many cases, the cost of a 90-day supply is about the same as, or the same as, a 30-day supply.  Filling the prescription is the largest cost.  For example, Allopurinol is $18 a bottle, for 30 tablets or 90 tablets. Which do you choose?

I also searched for participating Silver Sneaker locations, and it seems that Planet Fitness is the only one in my area.  Not enough to sell me on a more expensive plan!

Stop Feeding The Beast!

Protesting Twitter by posting on Twitter is stupid.  Stop feeding the beast!

I look back on life these days and wonder at all the changes that have occurred, for better or worse - mostly worse in the last few years, it seems.  When I was a kid, we were going to be a "great society" and had landed on the moon!  America, we thought, was the greatest country in the world (and still is, despite efforts to make it great "again").

When I was a teenager in the 70s, I had a front-row seat to the nascent PC evolution - and revolution.  We were warriors, we felt, bringing computers to the average American.  And with this revolution of information technology, we would liberate the world and start a new age.  Yes, we were that naive.

Funny thing happened.  Microsoft - a small, obscure software company whose claim to fame was a BASIC compiler that turned out to be vaporware - landed a lucrative contract to create DOS, as the owner of the then-prevalent CP/M system, Gary Kildall, told IBM to take a hike.

So Bill Gates had this opportunity land in his lap (no less after telling IBM to talk to Kildall in the first place!).  So he hires a guy to make a reverse-engineered copy of CP/M and called it DOS, or IBM-DOS if it came bundled with an IBM-PC, or MS-DOS if you bought your own copy.

Computer sales took off, and each computer needed an operating system.  That lucky IBM contract turned into a gold mine, as Microsoft had the rights, in the contract, to sell to third parties.  No one expected the generic PC market to be so huge.  Microsoft got rich, IBM no longer makes personal computers.

A lot of people saw this happening and wanted in the deal - rags to riches seemingly overnight.  Tech Bros have created this myth of instant riches, which is not so much a myth, but something that is not as common as many would think.  In the 1990s, I used to fly out to Silicon Valley every month to get Patent business.  Back then Silicon Valley was silicon - hardware.  Not so much in manufacturing chips (A "fab" they call it) but in designing a chip and then sending the design overseas to be manufactured.

It was a wild West and some companies did well, others struggled.  Like a casino, you could win big or lose it all.  Usually the little guy investor lost it all, while the Billionaires made money no matter what.  Computers (hardware) became a commodity and software was where all the money was.  Silicon Valley became Software Valley.  But that was just the start of it.

With all these PCs sold and internet connectivity becoming a common thing by the 2000's (remember all those Mom and Pop ISC's?  Heady days!) people wanted something to do with their computes, besides drafting dull memos or visiting government websites.  Internet commerce and Social Media was born.  And there were a few winners - and a lot of losers.  Timing is everything, it seemed.

For example, Sears offered an online service call Prodigy.  They also had the worlds largest and best known retail catalog.  But rather than combine the two, they discontinued the catalog and concentrated on physical stores as mall anchors.  You know how that worked out.  But to be fair to Sears, the world wasn't ready for e-commerce just yet.  An obscure used book seller would occupy that space and become a Billionaire in the process.

AoL had some social media-like features, with discussion groups.  Of course, UseNet newsgroups had been around since the 1980s, but by the 1990s, they were being SPAMmed to death.  A guy named "Tom" started something called "MySpace" and was very successful - at first.  In echoes of Gary Kildall, he decided MySpace should be some sort of indie band platform and not a social media site.

So instead, a Harvard dropout creates a Social Media monster - almost by accident.  A page for sharing pictures of incoming Freshmen turns into a colossus online.  And that was just the start - several other Social Media sites have sprung up since them.  You know their names.....

In those heady early days, many still believed that the Internet would make our lives better and we proselytized about how the world of the future would solve all the petty problems we have by providing transparent communication and data across the planet.  Google, back then, had a company slogan - "Don't Be Evil!" which was a dig at Microsoft's monopoly practices.  It was also a dig at the new Silicon Valley private equity investors who were not interested in the greater goo, but rather lining their pockets, often at the expense of the public.

Go big or go home.  Move fast and break things.  It had less to do with technology than with Business.  For a brief time, the Patent Office even recognized "methods of doing business" as Patentable.  Then they realized they had opened Pandora's box.

The new Silicon Valley investors weren't interested in hardware or even software (not a lot a money in that!  Requires effort and expertise, too!).  Rather, they wanted to create business that did things like taxi services or food delivery or scooter rentals - which were already "things" - and monetize them such that a big percentage of the profits, worldwide, finds it way back to Silicon Valley.  The consumer and the delivery driver get squeezed on both ends, while the CEOs of these companies rake in the dough.

Google abolished its "Don't Be Evil" mantra.  Most other "tech" companies were no so foolish as to adopt one.

And yes, there are upsides to the Internet, still.  You can get a lot of your work done online or do your finances.  Online prices can be far less than brick-and-mortar, with a better selection as well.  The downside is, the local merchant goes bankrupt in the process.  You also have to deal with shady suppliers selling substandard junk (Looking at you, Temo, Wish, etc.).  But we are so connected this way, it would be hard, if not impossible, to go back to earlier days and old ways.

So, technology, once thought to be our savior, becomes the enemy.  Instead of sharing truth and valid information online, we see myths, superstitions, misinformation, and outright lies being spread.  We are manipulated, sometimes by foreign forces, other times by commercial interests.  People are divisive these days because they are taught so by the Internet.  And we are all influenced this way, whether or not we want to admit it.  Sure, you can blame the maga-set for their idiotic beliefs they absorb from Inforwars or Fox News.  But many on the Left have similar wacky beliefs that they think are their own, but are  absorbed from their own echo-chamber.   The whole "pronoun" thing, for example, was the height of Democratic silliness and drove many independent voters to the right.  Of course, it was the Internet that made people think that the only issue they were concerned about was Transgender rights.  Both sides are painted as extremist by the other.

But I digress.....

In the early days of the PC, there were a plethora of manufacturers and many people assembled their own computers from parts.  There were few Billionaires, other than the Microsoft gang, but that was about to change.  We are in a similar situation as we had in the late 1800s - with "Trusts" controlling large swaths of the economy and controlling the government as well.  If you wanted to buy any sort of things, from food to coal to oil or minerals, you had to do business with the Trusts, and they could set prices as they saw fit.

The "Trusts" of today are information or technology related (if you agree to call a taxi service or delivering pizzas, "technology").  You want to buy something?  You go online and check out Amazon - it is kind of hard not to shop there than it is.  It is like trying to avoid WalMart - you can, but expect to pay 50-100% more for basic commodities.  And the competitor you go to may end up being as "bad" as the one you left.  People are calling for a boycott of Target because they cancelled DEI initiatives.  Funny thing, but no one let out a peep when Walmart did the same thing back in November.  I guess people expected that of Walmart, so it's OK.

People have similar reservations about Facebook, Google, and Twitter.   All the big tech companies bowed down to Trump, paid a million bucks for his inauguration, and Facebook forked over $25 million to Trump to settle a clearly specious lawsuit.  Say, that's another clever way to avoid campaign finance laws or bribery charges!  Just have the politician you want to bribe sue you and then you go "Mea Culpa! I'll settle! Here's a suitcase of cash!" Pretty slick!

But I digress again.  And yes, I am feeling a little better on the Parkinson's meds.  I just take a little pill when I want to use my brain for something.  Works pretty well - so far.

But getting to the topic of this posting (finally) the problem isn't - as I see it - the Billionaires, but the ordinary people (you and me) who fork over tons of money, directly or indirectly, to said same Billionaires.  Every time you use Facebook, you put a little money in the pocket of Mark Zuckerberg, who in turn puts some in Trump's pocket.  Meanwhile, you are exposed to all sorts of propaganda, both political and commercial.  You can't protest Zuckerberg in a Facebook posting.

Similarly, you can't go on Twitter to denounce Musk, as each time you go on Twitter, you put a penny or two (or dimes or dollars) in his pocket.  You are creating "content" for him to sell (laden with advertisements) by posting there.  Even providing a link to a Twitter post generates money for Musk.  Advertiser pay based on the number of clicks as well as "engagement."  So when you post something along the lines of, "Check out this outrageous thing Musk said!" and provide a link, and a thousand people click on that link, well, Musk wins.

And yes, I appreciate the irony of saying this on Blogger which was bought by Google in 2003 when they still believed, "Don't be Evil!"   And yes, Google is a case-in-point, as they have gone from being a search engine to being the only search engine (in practice) and along the way have gotten their hands into a lot of other businesses, from smart phone O/S to video hosting, etc.  It is kind of hard not to use a Google product and that is sort of the point of my posting.  We are stuck with these services, which, although not as necessary to our survival as food and shelter, nevertheless form a part of our daily lives.

And while Google abandoned "Don't Be Evil" long ago, until recently, they were fairly benign. But then someone decided they needed more money.  Unskippable ads started appearing on YouTube - and then more and more of them.  Google searches turned into advertisements for products, with the "real" search results way down the page.  And now, in recent months, we have Google AI providing all the (wrong) answers to your search inquiries.

They made it so easy to get into their "space" but then did a rug-pull as did all the other "tech" companies.  Like a drug dealer, they offer the first sample for free to get you hooked.  And one you are hooked, they set the hook.  I must note, however, that the anology is flawed - I never met a real-life drug dealer who gave away free samples.   That was only on television with those stupid "Just Say No!" ads, not real life.

I am not sure what the ultimate answer is, of course.  I was never on Twitter and when I click on something that links to Twitter, I quickly exit out.  There is nothing so important in this world that needs to be hosted on Twitter only.  I mean, for Chrissakes, you can cut and paste the text of a tweet or even do a screen shot if you wanted to.  Linking is just lazy.

As for Amazon, that is a lot harder.  eBay used to be America's garage sale, before it became all about power-sellers.  And much of what is on eBay is stuff that is sold through Amazon and then arbitraged onto eBay.  Then there are the Wish/Temu type products that find their way onto eBay on occasion (and Amazon for that matter).  For a lot of stuff, I find going to the manufacturer's (or distributor's) website to be cheaper than both eBay and Amazon, with the service just as good if not better.

Boycotting Facebook is a lot easier, other than having to deal with Facebook idiots.  I was on Facebook early on, but only for a few months. Something seemed "off" about it and it was very addictive.  Better off to blog, instead!  Mark was never on it, period.  The problem is, a lot of other people think that "everyone has a Facebook page!" and thus limits their online presence to Facebook.  This is problematic with businesses.

And I understand why they do it.  You want to update your website, it takes time to craft the HTML coding, even with editing tools such as those used here on Blogger.  But Facebook?  Much easier.  You want to update your restaurant's schedule of events, you can do it with a few clicks.  Your customers get the information, along with a lot of right-wing and Nazi propaganda.

We visited a campground the other day and our friend Juan was pissed that the theme that night at the bar was "funny hats."  Juan has a ton of funny hats but didn't bring any as he was unaware of the event as it was only posted on Facebook.  He's on Facebook, too!  But he didn't think to check.  Similarly, the next night was "Cowboy night" and here I am with my Stetsons sitting in a box on the shelf in my closet back home.  If I had only known!

It gets worse.  If you cross the border, you may be asked by an ICE agent for your social media account information (and even access to your cell phone!).  "What's your Facebook page?" they ask, and "I'm not on Facebook" isn't an acceptable answer.  Everyone is on Facebook, right?

Like with the Trusts, the Tech Bros have managed to get us dependent on them completely.  Going cold turkey is difficult, if not impossible to do. But protesting Facebook with a Facebook posting, or protesting Musk on Twitter seems kind of dumb.  The only answer is to not feed the beast.  Don't create content for sites you don't like.  Don't let them make money from your clicks.  It is hard to do, as alternatives are either obscure or hard to come by.  Some people are claiming "BlueSky" will eclipse Twitter as users flee the latter.  Perhaps, but since Twitter still has a critical mass of people (even after Musk killed off the bots /s), a message on BlueSky isn't going to resonate as well.

But why is it so important to send out messages on Twitter or post your updates on Facebook?  Beats me - probably the same reason I feel compelled to blog.

More Medicare Follies - Parts A, B, C, D, G, L, K, & N

How old people navigate Social Security and Medicare is beyond me!

A friend of mine got a big television as a Christmas present and asked me to help install it.  I bought a really nice wall mount at Harbor Freight for $35.  Heavy as all get-out with a backing plate that easily spanned two studs!  It came with 4" lag screws, too.  That ain't going anywhere!  So an hour or so later, we have it bolted to the wall, the television installed and even the soundbar (which I found at a campground, Sony with a subwoofer, too!).  Then the fun began.

Upon power-up, the television needed to access the router.  Do you remember your router password?  No.  Once logged in, it had to update the operating system - that took 30 minutes.  Then another 30 to learn my way around an Amazon television and "install" apps like Netflix and YouTube (the only two not pre-installed!  Welcome to the Social Media wars!).  Remember your password for Netflix?  What about your Google password?   No and No.  Between password resets (particularly Google) where the recovery account was either a dead e-mail or an old phone number, plus all the updates, well, it was a couple of hours of sheer frustration.

How is anyone over the age of 50 able to do this?  They have to wait for the grandchildren to visit, I guess.

The same is true for Medicare - it is a daunting task to learn the lingo and the "windows" and the horrific consequences you face if  you don't get it right.

Three months before you turn 65 - and three months after - there is a seven month "window" to sign up.  I filled out the form online in November and hit "enter" in late December and got my card in mid-January, with an activation date of March 1st.  Coverage begins on the first day of the month of your 65th birthday.

I went with "traditional" medicare - Parts A (Hospital) and B (Medical).  Part C is what they call "Medicare Advantage" and from what everyone tells me, it is no advantage in some States, as it may not cover all the charges.  Basically, your medicare money goes to a private insurance company who then insures you in a traditional manner.  You may pay less (or nothing) in premiums, but if you get sick, you may pay more.  In some States, apparently, it is an advantage.  Just not Georgia.  At least that is the way it was explained to me.

In 2025, most people will pay $185 per month for Medicare Part B, and most people will pay no premium for Part A. However, some people may pay more for Part A, for example, if you have worked less than 40 quarters.  Usually, the premiums are deducted from your Social Security check or debited directly from your bank account.  I guess that is another reason to claim Social Security at age 65 instead of later.  Which I just did.

$185 a month sounds reasonable, particularly compared to the hundreds a month (as much as $1000) when I was on a traditional Blue Cross plan.  It seems reasonable compared to the "standard" premium of $1800 a month under Obamacare (ACA) which is subsidized by the government down to a few hundred, or in some cases, zero.  What is clear, however, is that $185 a month probably barely covers administration costs - the taxpayer picks up the rest in the form of the payroll tax.  And by the way, as we shall see, there are other coverage charges to consider,  Such as.....

Part D is drug coverage and you have to sign up for this during the "window" or pay a penalty later on - every month.  People think this is unfair, but those same people think it is unfair that you can't get collision coverage after you've already wrecked your car or fire insurance while your house is on fire.  You can't get something-for-nothing.  I have one friend who declined coverage as his medications were inexpensive.  They are now - that can change.  Another friend decided to use the VA hospital which is an hour away.  It was cheap, but a hassle.

If you decide, later in life, to get part D, there is a penalty formula calculated that is applied to every monthly payment from then on. It is only fair - you can't wait until you need a $1000-a-month prescription to seek coverage.  That's now how insurance is supposed to work, or at least that is how it used to be.

When you sign up for Medicare at 65, there is no medical exam and pre-existing conditions are not excluded.  They have to take you.  That changes once you are on the plan, with regard to add-ons, as we shall see. Part D plans are priced based on what drugs you are taking at the time you sign up.  So for me, a basic plan from Humana will run about $50 a month, with an annual prescription cost estimated at another $50 or so.  I have five prescriptions, most of which cost less than $20 each for a 90-day supply.  Is Part D a good value?  It would be if, later on, I end up needing a $1000-a-month prescription.  There are co-pays, of course, and some plans have zero co-pays if you use an online pharmacy as I like to do.

But supplemental plans are where it gets confusing.

During the signup window (Note, one agent told me, in the three months before your birth month only!), you can sign up for a supplemental plan (If you went with Medicare A&B and not C!), no questions asked, pre-existing conditions not an issue.  If you miss that window or decide to change plans later on, you can sign up in the fall, but if you are really sick, they may refuse to write you, or if they do, under standard underwriting terms.  It could get expensive, presuming they will cover you at all.  So it pays to sign up during the window.

So if I decide I don't like the plan I chose, I have to go through regular underwriting, where pre-existing conditions are considered.  Want to write me a plan?  No pre-existing conditions, other than diverticulosis, gout, a stroke, and Parkinson's disease.  Healthy as an Ox!  So you see, choosing the right plan is a once-in-lifetime choice, which for me, means a one-in-the-next-decade choice.  I am a realist.

Now, all you folks living in countries with National Health, have a good laugh at our expense and also take pity on us.  What other country has such a backward system where some people are covered and others are not and there is a complicated set of rules and deadlines and cut-off-your-balls with a rusty hacksaw if you don't?  Why is the government being generous on the one hand and stingy the next?  It is like some inheritance that you can only get if you agree to stay in the haunted house overnight, but before February 10th or you lose it all.

Private health insurance, Medicare, Medicaid, Obamacare, Employer-provided health insurance - or no insurance at all.  It is a patchwork mess at best.  And essentially, the wealthier you are, the better medical care you can get.  It is like the Dentistry business - no one opens a practice in Appalachia, where people need dental care. The smart move is to open a cosmetic dentistry practice near a wealthy city, where people can afford to pay a lot to look good.  Similarly, it doesn't pay to be a GP in a small town - better to be a specialist in a big city, where people have good insurance or wads of cash to spend.

It is a screwed-up system, but we are forced to play within its bounds - like the Squid Game, I guess.  And so long as you are winning, it seems like a good deal.  I see seniors all the time gloating how their gall bladder operation "cost them nothing!" - but at the same time treat their children or grandchildren as failures because they faced medical bankruptcy.  Why didn't they do the smart thing and wait until they were on Medicare to get sick?  Smug bastards!

But I digress....

What are supplemental plans and how much do THEY cost?  Which plan do you want?  There are several, and the government dictates the terms of each plan.  AARP/UHC for example, offers plans G, N, K, I, select G, and select N, to name a few.  Each lettered "plan" has the same basic required terms as the same lettered "plan" from another insurer.  So if you are comparing plan "G" from UHC with a plan "G" from Humana, the terms are going to be the same and the only difference is in the priciing.

Except.... They can't make this simple, can they?  Some insurers (AARP/UHC and I think Humana) offer "perks" like the "Silver Sneaker" perk, where you can get a free gym membership (at participating gyms only!).   There are also premium discounts if you have more than one person in your household getting a plan and if you sign up online - at least for some insurers.

AARP (United Health Care) Offers an alphabet of plans, including the following:

Plan G: $179.95 per month

Plan N: $160.25 per month

Plan K: $69.50 per month

Plan G has few co-pays and the (Gov't) standard $257 out-of-pocket limit, which seems ridiculous to me, having had $10,000 deductibles and out-of-pocket limits for decades now (I have been self-employed for 30 years).  It is a Cadillac plan, to be sure. Cradle to Grave!  Well, grave, anyway,

Plan N is not quite as generous, as you might expect, having $20 co-pays.  Plan K has a 10% copay and a $7220 out-of-pocket limit.  So, once again, we are tasked with deciding how sick we plan on getting and how much we think that will cost and how much we can afford.  It is a shitty system.

And remember kids, you have to make this decision NOW and are stuck with it for the rest of your life.  Since agents are on a commission (which may add $5 to $10 to monthly premiums) they tend to push plan G the most as the commissions are higher on the higher priced products.

There are a few major players in this game - UHC being the biggie, while Humana, Anthem Blue Cross, Aetna, and Mutual of Omaha are other significant players.  Not surprisingly, their premiums are all within the ballpark of one another - by a few dollars at least.

So why pick one over another?  In terms of "accepting insurance" this turns out to be a non-issue.  If the doctor or hospital accepts Medicare (which 99% do) they are bound to accept your supplemental policy.  In fact, it is transparent to them as they send the bill to Medicare, which pays 80% of the costs and then passes the remaining bill to your supplemental insurance provider who pays the other 20%.  No paperwork hassles for the provider.  This was a big issue for my Obamacare Ambetter plan, as some doctors refused to accept the insurance because of the low payouts and the hassles of submitting claims.  So, no worries there with regard to acceptance, with Medicare supplements.

So again, why choose one company over another?  The prices are all in line (within a few dollars of one another) and the coverage for each plan type is mandated by the government,   Just pick one at random - right?

Well, there is one other issue - and I discovered this after asking several agents pointed questions and searching online.  Premiums go up over time.  And they go up for everyone, uniformly, not based on your claims.  Some companies raise rates more than others, but getting hard data is difficult.  I read a lot of reviews online, but in this era of the dead Internet, well, reviews are spammed.

For example, I read one review - which was repeated all over the net, leading me to believe it was part of a bot campaign (act shocked) - that Mutual of Omaha or "MoO" raises rates more than others, particularly at the five-year mark.  I could not find hard data to back this up.

Most of the oldsters on the island are on the AARP/UHC plan, but some are on Cigna, Humana, Anthem Blue Cross, and I found one on MoO.  He was complaining that at age 79, his premiums are now up to $220 a month!  I kind of had to take him down a notch, reminding him I was paying over $1000 a month when I was in my 40's before the invention of Obamacare.  $220 a month?  I can fund that in loose change under my couch cushions.

So the idea that MoO raises rates more than others seems kind of specious to me.  They have a 4.5 star rating on NerdWallet, while UHC has a 5.0.  Anthem Blue Cross comes in at a sad 4.0.  I read something in the paper the other day about UHC and a guy named Luigi, but I can't remember, because that was several news cycles ago and I am supposed to be outraged about something else now.

On the other hand, if you add up the Part B ($185) plus the Plan G supplemental ($180) plus the Part D drug plan ($50) you end up with a monthly premium of $415 a month (for one person!) which is considerably more than I am paying now ($0) or last year ($200 for two people).   On the other hand, going to a cheaper plan doesn't save much, and dropping drug coverage could get expensive down the road.  Given my health issues, well, maybe I should spend the money.

While changing to another plan down the road is not really realistic, one can always drop add-on coverage and simply pay the 20% medicare doesn't cover.  For the very poor this is a real option as often hospitals are happy to get the 80% from Medicare and write-off the rest.

Again, these "survey" and rating sites are always suspect as they can be spammed by bots (A 5.0 rating?  Really?  No one complained, ever?).  A note of caution:  There are sites claiming to allow you to "compare" different plans - all you need to do is enter your e-mail address, phone number, and birth date!  If you do, your SPAM box will be full and your phone ringing off the hook.  All they are is a lead aggregator selling your info to various insurance agents and who knows who else.

Speaking of which, in the months leading up to your 65th birthday, you will get dozens of phone calls from overseas call centers, trying to sell you supplemental coverage.  You'll get flyers in the mail and even brochures and whatnot. A local agent sent an entire portfolio of information which was helpful.

Do you go with an agent or just apply online?  Good question.  Agents can answer all of your questions and if they are local, at least that is something.  But from what I can see, most companies offer a small discount (such as 5% with MoO) if you apply directly online as opposed to going through an agent.  Problem is, the shit is so confusing that you feel you need to talk to someone about it, and it seems kind of shady to say, "Thanks for an hour of your time, I'll just apply online!"

But that's all I  have learned so far, which leaves me with more questions than answers.  Sadly, even with insurance, the future is an uncertain thing.  Again, you Canadians and Brits can all have a laugh at our expense. Choosing Plans? Paying Premiums? Deciding how much illness you can afford?  Madness!

But it is the madness we are stuck with.  By the way, some of these supplemental plans pay for overseas coverage (20% co-insurance, $50,000 max) so that may come in handy if you decide to flee the country before they start construction of the crematoriums at Guantanamo Bay.