Insurance

100%

by AgentX86 - 2021-05-02 19:33:46

For individual plans covering 100% would be ridiculously (read: impossibly) expensive, particularly with the pre-existing conditions mandated by Obamacare.  My employer plan comes reasonably close.  I pay about $400/mo for two people.  Insurance policies are impossible to completely understand but I paid $1000 out of pocket for my CABG, only because of two ER visits (one before and one after).  The total bill was ~$250K, which the insurance paid about half.  My PM cost me $250.  The total was something like $100K and the insurance company paid $60K, IIRC.  Meds coverage illogical and undecipherable but end up (somehow) being very cheap.

Medicare with Medigap Plan-F (not available to people born after 1952?) pays everything else. Plan-G pays everything except the Part-B deductible (couple of hundred bucks, for people with incomes under a couple hundred grand). These don't include drugs, which are more complicated than my employer's impossible to understand plan and a *lot* more expensive.  But that's government for you.

There are also Medicare Advantage plans, which I don't completely understand either, except that private employers take over Medicare coverage and do a lot better job of it than the government ever could.  That's my summer's homework.  I'll be retired by the end of the year so I have to decode all this crap.

100%

by Sharron2 - 2021-05-03 04:58:52

Advantage plans are limited to doctors in a very specifc geographical area. If you travel, they are not for you. If you live in a rural area, there may only be one doctor that accepts their plans. If you can afford the part B you have much more control over who you get to see and choosing to see a specialist without a referral.

100%

by AgentX86 - 2021-05-03 10:59:55

Yes, I didn't tell the whole story.  There are probably a million pages of regulations about this stuff.  It's impossible to decipher.  I'm just going through all the crap now.  I know all of my doctors are in the plans I've researched (PPOs only, no HMOs).  The hospital I go to (major teaching hospital) is in-plan, for these Advantage plans too.  I'm trying to ofind the downside. 

You're right, Medigap plans are expensive. The commissions aren't negligable, which tells you something about the costs.  The first year commission for a Medigap with Part-D sale is $539, with $270 every year after (pretty much guaranteed income).  For an Advantage plan it's $81 and $41 (not so guaranteed).  That answers the question of why there are so many TV ads pushing these plans.

The premiums are strange but not terrible on their own, depending on the zip code (really strange).  The part that would get most of us here, would be Part-D (drugs).  Eliquis, alone, is $500/mo so would put one into the "donut hole".  I have two other similarly expensive drugs (for gout and glaucoma).  When the donut hole hits it would be quite a shock (~$1500/mo total).  I'd be paying the out-of pocket maximum very quickly.  It would still be expensive, considering that there are two of us.  The other issue is that Medigap is a now or never proposition.  Sure, in theory one can change plans but not likely with any of our medical conditions. It would be nearly impossible to move to a better plan.

Qestion for you, Sharron:  When you say "travel", are you talking international or within the US.  Long term or short term (emergency or elective)? Obviously we never know when we're going to have a problem and our chances are far higher than the general population.

Thanks for helping me piece this together.  The more information I have before talking to an agent, the better questions I can ask (not dissimilar to the care itself). I'll be consulting a professional (my previous employer kicks in some if I use their agents.  I'll do that in the next few weeks.  Considering the above commissions, one can see why they want to control the agents).

I never see a bill for anything related to healthcare !!

by IAN MC - 2021-05-03 15:02:59

....... that is because I am lucky and live in the UK . Here, like the U.S  , our government pays for roads, education, the police and the military but here it also pays for our healthcare.

I think your question will always be a  "dream" under the American healthcare system  ( or is it a healthcare "business " ? )

signed the fortunate

Ian

Healthcare costs

by Aberdeen - 2021-05-03 17:48:55

Like Ian I live in the U.K. and my two pacemakers and hospital stays last year did not cost me anything. 

We are very fortunate to have free healthcare. I am on medication and in Scotland that is free also.

vive la France

by Tulp - 2021-05-03 20:21:11

Living in Europe has it advantages.

Like Ian and Aberdeen, healthcare is nearly free here in France. I pay a very small pourcentage of my salary for a complimentary insurance provided by my employer (mandatory)

No idea what the cost was. We have a small contribution for the medication, perhaps 50 cents per box...

I'm so sorry to hear that USA patients have to struggle often.

agent

by Sharron2 - 2021-05-03 22:42:40

Investopedia has a good medicare comparison for standard medicare and advantage, the good, the bad and the ugly. I would review it if I were you. From what I understand traveling in the US and needing health care can be a problem with an advantage plan. My husband has standard medicare, Tricare for our secondary and a 3rd insurer from his corporate life. My brother inlaw chose to stay with standard medicare and chose a supplement. I am turning 65 this July and will join my husbands plans. We spend a few months in northern midwest to escape the Texas heat and need to be able to have easy access to medical care where ever we are. We also have new medical developments happening and want to be able to pick our doctors from all that are available. Good luck in digging through all that information. It is a challenge and it is a lot of money.

Investopedia

by AgentX86 - 2021-05-03 23:36:24

Thanks Sharron, good information.  I knew most of what I found there but there were some important pieces it filled in, though in places the phrasing was ambiguous.

EU/US:  There is a big difference between health care and health care insurance.  Our big problem is that the goverment insists on getting in the middle of everything, driving costs through the roof.  There is no way I want them making it even worse.  Every time they touch it, it gets worse.  I'm glad it works for you but there we don't need it any worse than it is now, and that's all anything the government would do, would do.

We have the best healthcare that money can buy.  The problem is that we also have the best government that money can buy.

Heath insurance

by Julros - 2021-05-04 00:22:12

The whole US system is no system at all. It a big jumble of what ever for-profit insurers think will bring in the most $$$ while bamboozling citizens. There is plenty of blame to spread around, but I would welcome taking the proift out of health care. 

Taking profit out....

by AgentX86 - 2021-05-04 15:11:38

That worked so well with the VA, and Social Security, why not socialize the entire economy? They are (too) many who want that too. The fact is that our country and government aren't European, for better or worse.

I never see any bills

by Giggi - 2021-05-09 08:58:45

I live in NH and am fortunate enough to have great coverage. I have traditional Medicare coverage which pays 80% of my medical and I have a another insurance for retired employees that pays the remainer of the 20%. My husband is the retired employee of a city and this is a retirement benefit however we pay premiums on a monthly basis for it along with paying our Medicare insurance takes a chunk out of our monthly budget.