skip Medicare B and D?

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Chuckles960
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skip Medicare B and D?

Post by Chuckles960 »

I apologize if this has been addressed before. We haven't retired yet and are covered through employment so this is all hypothetical. I have two potential issues with paying for Parts B and D:

(a) We might move abroad for extended periods, but want to keep open the option to return
(b) We are fortunate enough to owe the maximum IRMAA once we retire and have to take RMD.

So my question is, is it ever appropriate to stop paying for Parts B and D? I am aware that once we stop, it effectively has to be for ever. Is there any realistic non-Medicare coverage that can be purchased on an as-needed basis whenever in the US? (I am afraid the answer is no, given our ages at the time, but thought I would ask anyway.)

PS I know we could self-insure, but that's a bridge too far...
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GerryL
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Re: skip Medicare B and D?

Post by GerryL »

Chuckles960 wrote: Mon May 17, 2021 3:14 pm I apologize if this has been addressed before. We haven't retired yet and are covered through employment so this is all hypothetical. I have two potential issues with paying for Parts B and D:

(a) We might move abroad for extended periods, but want to keep open the option to return
(b) We are fortunate enough to owe the maximum IRMAA once we retire and have to take RMD.

So my question is, is it ever appropriate to stop paying for Parts B and D? I am aware that once we stop, it effectively has to be for ever. Is there any realistic non-Medicare coverage that can be purchased on an as-needed basis whenever in the US? (I am afraid the answer is no, given our ages at the time, but thought I would ask anyway.)

PS I know we could self-insure, but that's a bridge too far...
Where are you getting the idea that disenrolling from Part B is a forever decision? All I am seeing is that if you want to re-enroll at a later date, you can't do it online. You have to do it in person. And of course, you would likely be penalized for the gap with higher premiums, on top of the IRMAA increase.
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Chuckles960
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Re: skip Medicare B and D?

Post by Chuckles960 »

GerryL wrote: Mon May 17, 2021 5:31 pm Where are you getting the idea that disenrolling from Part B is a forever decision? All I am seeing is that if you want to re-enroll at a later date, you can't do it online. You have to do it in person. And of course, you would likely be penalized for the gap with higher premiums, on top of the IRMAA increase.
That is what I meant by "effectively has to be forever". Once it is dropped as not worth keeping, it is likely to be even less cost-effective to re-enroll some years later. But you're right, it depends on the details.
afan
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Re: skip Medicare B and D?

Post by afan »

If you owe the maximum in IRMAA you should easily afford the premiums. Maybe explain the problem?
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Chuckles960
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Re: skip Medicare B and D?

Post by Chuckles960 »

afan wrote: Mon May 17, 2021 5:52 pm If you owe the maximum in IRMAA you should easily afford the premiums. Maybe explain the problem?
There are undoubtedly many things that you and I can afford, but nonetheless do not buy because they are not worthwhile.

In this case, I was asking if there is a way to spend less. Part B (in particular) seems remarkably expensive with max IRMAA, and much more so when we are not in the US and don't get any benefit.

I hope that explains the problem.
UpperNwGuy
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Re: skip Medicare B and D?

Post by UpperNwGuy »

Whether you live in the US or abroad, you would be wise to sign up for Medicare Parts A, B, and D. I have several friends who live abroad who make an annual trip to the US to visit friends and family. While they are in the US, they take care of many of their annual medical examinations using their Medicare benefits.
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Wricha
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Re: skip Medicare B and D?

Post by Wricha »

In the same situation with IRMAA. I have drop Medicare part D, it’s just not worth from my personal health perspective.
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Wricha
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Re: skip Medicare B and D?

Post by Wricha »

afan wrote: Mon May 17, 2021 5:52 pm If you owe the maximum in IRMAA you should easily afford the premiums. Maybe explain the problem?
More than likely a person who is paying the maximum IRMAA, also paid much more for Medicare during their work career than the average person. These folks were looking forward to a benefit when they retired only to find out that benefit has become a new tax. Why? Because the can afford it. That argument tends to rub people the wrong way.
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susa
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Re: skip Medicare B and D?

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Chuckles960
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Re: skip Medicare B and D?

Post by Chuckles960 »

susa wrote: Mon May 17, 2021 7:29 pm Maybe this helps

https://www.medicareinteractive.org/get ... ted-states
Thanks for the relevant link.

For no-IRMAA Medicare recipients, the advice is good. But for max IRMAA, at what point is it worthwhile to walk away? Catastrophic costs are in any case somewhat covered by Part A. The web site does not address that.
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Re: skip Medicare B and D?

Post by TropikThunder »

UpperNwGuy wrote: Mon May 17, 2021 6:10 pm Whether you live in the US or abroad, you would be wise to sign up for Medicare Parts A, B, and D. I have several friends who live abroad who make an annual trip to the US to visit friends and family. While they are in the US, they take care of many of their annual medical examinations using their Medicare benefits.
If they live most places in Europe, they could probably get equivalent (if not better) care locally for less than the B and D premiums. Southeast Asia or Central America, I’m not sure.
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Stinky
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Re: skip Medicare B and D?

Post by Stinky »

Chuckles960 wrote: Tue May 18, 2021 12:21 am But for max IRMAA, at what point is it worthwhile to walk away? Catastrophic costs are in any case somewhat covered by Part A. The web site does not address that.
Even for those paying maximum IRMAA, your Part B premiums plus IRMAA is expected to cover just 85% of your costs. See the link below.

So Part B is “money-good” for everyone, at least on average. And it’s more money-good as your IRMAA cost goes down.

https://secure.ssa.gov/apps10/poms.nsf/lnx/0601101031
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Chuckles960
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Re: skip Medicare B and D?

Post by Chuckles960 »

Stinky wrote: Tue May 18, 2021 10:00 am
Chuckles960 wrote: Tue May 18, 2021 12:21 am But for max IRMAA, at what point is it worthwhile to walk away? Catastrophic costs are in any case somewhat covered by Part A. The web site does not address that.
Even for those paying maximum IRMAA, your Part B premiums plus IRMAA is expected to cover just 85% of your costs. See the link below.

So Part B is “money-good” for everyone, at least on average. And it’s more money-good as your IRMAA cost goes down.

https://secure.ssa.gov/apps10/poms.nsf/lnx/0601101031
Yes, interesting and relevant link. But the number changes if you live abroad part-time.
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nisiprius
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Re: skip Medicare B and D?

Post by nisiprius »

Within the last ten years I had a hospital stay.

The total bill was about $50,000.
Medicare part A covered about $30,000.
Medicare part B covered about $16,000.
(Private) Medicare supplemental ("Medigap") covered about $4,000.

Without part B and Medigap, I would have paid $20,000 out of pocket. Maybe.

Let me be clear, when I say Medicare part B "covered" $16,000 I mean that doctors billed that amount, but accepted about a fifth of that sum from Medicare.

As a practical matter, if I had not had Medicare part B I believe that I would have received twenty separate bills totaling $20,000. I suppose I would have had to try negotiating each one down and if I had succeeded I suppose I might have gotten it down to $5,000 total. But so far I have never tried to personally negotiate a doctor's bill down and I'm not very good at that kind of thing.
Last edited by nisiprius on Tue May 18, 2021 12:05 pm, edited 4 times in total.
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Stinky
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Re: skip Medicare B and D?

Post by Stinky »

Chuckles960 wrote: Tue May 18, 2021 10:33 am
Stinky wrote: Tue May 18, 2021 10:00 am
Chuckles960 wrote: Tue May 18, 2021 12:21 am But for max IRMAA, at what point is it worthwhile to walk away? Catastrophic costs are in any case somewhat covered by Part A. The web site does not address that.
Even for those paying maximum IRMAA, your Part B premiums plus IRMAA is expected to cover just 85% of your costs. See the link below.

So Part B is “money-good” for everyone, at least on average. And it’s more money-good as your IRMAA cost goes down.

https://secure.ssa.gov/apps10/poms.nsf/lnx/0601101031
Yes, interesting and relevant link. But the number changes if you live abroad part-time.
Another question - do you expect to be in the top IRMAA tier for the rest of your life? That could influence your thoughts.

For me, I’d take the catastrophic protection of having Part B, even if I were top-tier IRMAA forever (and I’m not). But you’ve got to figure out your foreign living thing to see if it’s the best choice for you.
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Chuckles960
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Re: skip Medicare B and D?

Post by Chuckles960 »

Stinky wrote: Tue May 18, 2021 11:00 amAnother question - do you expect to be in the top IRMAA tier for the rest of your life? That could influence your thoughts.
Well, It's tough to make predictions, especially about...you know...but of course my intent is to be in the top IRMAA tier all my life. RMD factors keep going down (the percentage keeps going up), the approximate effect being to keep payouts constant, or even (if I am lucky in my investing) increasing. But [expletive removed by admin LadyGeek] happens.
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Re: skip Medicare B and D?

Post by nisiprius »

Here's a question. A treatment with snake antivenin costs about $100,000 and would usually be given in an ER, I think. I know wondering about this is not a silly question because in Tucson in 2019 in the Gilbert Ray campground, a neighboring camper got bitten and taken to the hospital. She was a visitor from Germany and I have no idea what happened with the bills. I've wondered about that.

Now if it had been use, it would have been a Medicare situation. I'm thinking if the antivenin were given in an ER it would not be covered by part A.
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Chuckles960
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Re: skip Medicare B and D?

Post by Chuckles960 »

nisiprius wrote: Tue May 18, 2021 12:11 pm Here's a question. A treatment with snake antivenin costs about $100,000 and would usually be given in an ER, I think. I know that's not a silly question because in Tucson in 2019 in the Gilbert Ray campground, a neighboring camper got bitten and taken to the hospital. Visitors from Germany and I have no idea what happened with the bills.

But I'm thinking if the antivenin were given in an ER it would not be covered by part A?
Yes, that's Part B.

And your broader point is that insurance/Medicare is particularly useful as protection against freak events. So its not a matter of whether I save money on the average, but whether I have peace of mind about unpredictable expenses.

But...but...it won't give me peace of mind about being bitten by a snake when in Mexico...neither Parts A nor B help there.

So my original question was not about having no coverage at all. I was asking whether there was any available and cost-effective non-Medicare coverage for the periods when we were back in the US.
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Stinky
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Re: skip Medicare B and D?

Post by Stinky »

Stinky wrote: Tue May 18, 2021 11:00 am
Chuckles960 wrote: Tue May 18, 2021 10:33 am
Stinky wrote: Tue May 18, 2021 10:00 am
Chuckles960 wrote: Tue May 18, 2021 12:21 am But for max IRMAA, at what point is it worthwhile to walk away? Catastrophic costs are in any case somewhat covered by Part A. The web site does not address that.
Even for those paying maximum IRMAA, your Part B premiums plus IRMAA is expected to cover just 85% of your costs. See the link below.

So Part B is “money-good” for everyone, at least on average. And it’s more money-good as your IRMAA cost goes down.

https://secure.ssa.gov/apps10/poms.nsf/lnx/0601101031
Yes, interesting and relevant link. But the number changes if you live abroad part-time.
Another question - do you expect to be in the top IRMAA tier for the rest of your life? That could influence your thoughts.

For me, I’d take the catastrophic protection of having Part B, even if I were top-tier IRMAA forever (and I’m not). But you’ve got to figure out your foreign living thing to see if it’s the best choice for you.
One final personal story.

On a Sunday afternoon a few weeks ago, I had a medical situation arise that required an immediate CT scan, so I was directed to go to the emergency room. The CT scan indicated that I needed to have a surgical procedure that could be done in the ER. That was completed, and I went home after three hours. All is well.

The explanation of benefits showed the submitted charges by the hospital were over $11,000. I was responsible for only my ER copay under my Medicare advantage plan.

I don’t believe Medicare Part A covers ER visits.

I don’t know what I would have had to pay if I did not have Medicare part B coverage. And I have no desire to find out.

As you say, (life) happens.
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kramer
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Re: skip Medicare B and D?

Post by kramer »

I am a retired American living abroad for almost 15 years now, aged mid-50's. I definitely plan to get Part B and I probably will get Part D. For Part D, you can usually choose plans that cost little money, I think.

I want the option of going back to America for health care (and the option of going back to live there), and I normally visit a couple of times per year, anyway. Nowadays when I return to the US for my visits, I have to buy travel health insurance, something I wouldn't have to do if I had Medicare A and B. Also, that sort of travel insurance gets more difficult to obtain for older folks (or it will have preexisting conditions exclusion clause).

I also agree with the post above, that without Part B it's almost as if you don't really have Medicare coverage, they are too deeply integrated.

One thing to keep in mind is that Part B cost is much less than the average benefit paid out, I think they charge 25% of the actual program cost. I know that IRMAA may change those dynamics for you.

One way I have mentally dealt with this is just mentally subtracting the amount from what will be my Social Security check (plus I have an HSA account that I will want to drain). In today's dollars, I am figuring that my Part B and Part D cost in 10 years will cost around $250/month and will grow somewhat in real terms throughout my life.
calwatch
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Re: skip Medicare B and D?

Post by calwatch »

You do have super cheap Part B Medicare Advantage plans which exist, that actually refund half or more of the standard premium and include Part D. If you just need catastrophic coverage and don't particularly care about the best quality service, that might be an option (provided you have a residence or mailbox address in one of those areas).

There is a concern with retirees from my local government, who (if they started before 2013 at least) get 100% medical coverage after 25 years. They can either keep their Blue Cross indemnity plan beyond 65 or go on Medicare and a Medicare Supplement plan. The agency will pay for Medicare premium but only to the standard level and not IRMAA. Many public safety workers that qualify for the safety pension stay on Blue Cross and don't join Medicare due to IRMAA combined with a high pension. The issue is that this Blue Cross plan has a $1,000,000 per person lifetime limit, and recently a retirement board member reported out that 16 people had hit this limit (out of about 5,000 on this plan). While one could switch over to Medicare + the retiree medicare supplement plan later, you would pay a hefty Part B penalty - although given that the penalty is on the base rate and not IRMAA it might make sense to do so, barring a coma or some other disease generating six figures of care costs (due to the open enrollment period timing).
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Re: skip Medicare B and D?

Post by andypanda »

"The issue is that this Blue Cross plan has a $1,000,000 per person lifetime limit, and recently a retirement board member reported out that 16 people had hit this limit (out of about 5,000 on this plan)."

A million doesn't last very long these days. Never did really is you had a spinal cord injury, heart surgery, brain cancer, etc.

Two guys I've known for almost 50 years both had bad cases of Covid-19. One spent 7 weeks in the hospital and one spent 6 weeks and both of them spent all but a week of their stay in intensive care. Their initial bills - not what Medicare or insurance will end up paying - were a little over one million dollars and 2.1 million. The one with the higher bill had his funeral scheduled three times in six weeks by his wife based on medical advice. That was months ago and he is still on oxygen, but his weight is still down although it is back up from 160 to over 200 pounds. We went fishing for a few hours last week, so there's hope.
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Re: skip Medicare B and D?

Post by Shallowpockets »

OP. Looks like you plan on being back in the US now and again. And most likely, at the end of your days also. You are also IRMAA income.
I don’t see the big deal on paying the Medicare and going about your life without the hassle you could create in trying to finagle some better deal.
Get an MA plan and be done with it. Get the MA plan that has no additional cost beyond the required.
Otherwise everything time you get in the US you will have doubts, worries about coverage.
Gee whiz! IRMAA, you can afford it. Aren’t you already saving money by being and ex pat?
Amazing how rich BHs can create their own problems like this. For what? This is what you have aspired to. Financial independence. You arrived there. Now enjoy it.
cbeck
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Re: skip Medicare B and D?

Post by cbeck »

When you move abroad, you should disenroll from and stop paying premiums for your Medicare Advantage Plan or stand-alone prescription drug plan (Part D). You are not eligible for these plans because you live outside the plan service area, and your coverage must end if you live outside of the United States. It is your responsibility to notify your plan that you are moving.

https://www.medicareinteractive.org/get ... ive-abroad

US expats are not eligible for MedAdvantage and Part D. If you falsify your address in order to apply for it you will be committing fraud. In addition, if you were to return to live in the US you would have Special Enrollment Period of 60 days during which you could sign up for MedAdvantage and/or Part D without penalty and without underwriting. So, an expat, who can't use these programs while abroad, gets no advantage from paying premiums for them.

The same is not true of Part B. There is a steep and permanent increase in premiums if you discontinue Part B and later re-enroll.

As an expat I maintain Part B against the possibility that I might someday return to the US, although that is not my current intention.
FactualFran
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Re: skip Medicare B and D?

Post by FactualFran »

Chuckles960 wrote: Mon May 17, 2021 6:05 pm In this case, I was asking if there is a way to spend less. Part B (in particular) seems remarkably expensive with max IRMAA, and much more so when we are not in the US and don't get any benefit.
The Medicare Part B premium for 2021 with the max IRMAA is at most 1.6% of the modified adjusted gross income for a "we" who file a join income tax return. To some that is not remarkably expensive in terms of percent of income. For those who pay less than max IRMAA, the percent is higher.
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Chuckles960
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Re: skip Medicare B and D?

Post by Chuckles960 »

FactualFran wrote: Tue May 18, 2021 9:11 pm The Medicare Part B premium for 2021 with the max IRMAA is at most 1.6% of the modified adjusted gross income for a "we" who file a join income tax return. To some that is not remarkably expensive in terms of percent of income. For those who pay less than max IRMAA, the percent is higher.
I realize that I was wrong. We are in the 2nd-highest tier of IRMAA, which happens to be only about ten dollars per person per month below the highest tier so I wasn't making a distinction. I should have been more precise.

More generally though, when I buy (say) a car, I don't do it on the basis of what the price is as a percentage of income, but on the basis of the dollar amount and whether that is the best option. My original question was, are there viable alternatives to Medicare B/D in our situation? I'm guessing the lack of an answer is an answer. Oh well, thanks everybody!
InMyDreams
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Re: skip Medicare B and D?

Post by InMyDreams »

You're buying insurance. And health insurance is weird - unlikely most other types of insurance, it is likely that an insured person will use health insurance in their lifetime.

If while living overseas you need serious health treatment, would you obtain that in your new living situation, or want to return to the US? What if it's a coronary bypass? Cancer treatment? What if you want to be near family while receiving treatment? If part of your answer is - that won't happen to me - uh, I've had patients who thought the same thing.

As you probably already know, not picking up MCare part B has a lifetime penalty if/when you do enroll. And if I'm reading Medicare for Dummies correctly, you can only enroll in it outside of your Initial Enrollment Period during specific time periods (January-March). A lot of those big health conditions are not going to wait for you to get signed up.

I buy insurance to cover the costs that I can't afford to self-insure for. If you think you have a way to cover the exposure (e.g., using the health system in your foreign living place), then it sounds like you have a plan.

BTW - I thought Medicare for Dummies had a weblink for a coalition of expats seeking to sway Congress. Darned if I can find it now. Maybe it was the link already given.
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Re: skip Medicare B and D?

Post by biscuits »

This isn't exactly what you asked, but in case it's helpful: While Medicare doesn't cover out-of-country medical expenses, many supplemental plans offer a lifetime limit $50,000 benefit for out-of-country coverage, paying 80% of the cost per event. Our supplemental plans only cover international trips of 60 days or shorter duration--that seems to be standard.

My husband had a medical emergency in Canada that left him with $10,000 of bills and his supplemental, USAA, paid $8,000 very quickly.
Duzz78
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Re: skip Medicare B and D?

Post by Duzz78 »

Check this article out
https://www.cnbc.com/2019/08/08/retirin ... plans.html

This may give you a gimmer of hope.

It all comes down to managing your taxes. Note you have the options of moving abroad for extended periods. You will pay IRMMAs and income tax on your RDMs. You choose these options. You could have chosen jobs that did not pay as much through the years so you did not have these issues and options now. Yes, it was an option for you. But your upbringing, passions, wants all said contrary. There is a group of people who have paid into Medicare all their working career. They will never receive its benefits. They died before age 65. Their family will not get a refund.
afan
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Re: skip Medicare B and D?

Post by afan »

Just to put some numbers on the IRMAA, which many people assume is an important retirement planning consideration:

For a married couple, the minimum income to reach the top tier of IRMAA is $750,000. This results in a monthly premium of $491.60. That is $5,899.20 per person annually. For the couple, the cost is $11,798.40. Most couples with 750k in income can so easily afford 12k per year that is is hardly worth worrying about. If the couple knew they were never coming back to the US, then the coverage would be worthless and they may as well cancel it. If they expect to be making regular visits, then the cost/benefit of Medicare at that price is overwhelmingly in favor of buying the coverage.

The next lower tier costs $475.20 per person per month. $11,404.80 per year for the couple. So one can try desperately to stay below the top tier to save $393.60 per year. At an income of just below 750k.

One hits the 2nd tier at $330,001 of income. Way below 750 but still a level that makes $11,404.80 for the coverage Medicare provides a screaming buy.

For a family in the top tier of Medicare premiums, there are far more important financial issues to address than less than 12k per year in Medicare premiums.
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onthecusp
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Re: skip Medicare B and D?

Post by onthecusp »

Looking at my wife's options as she is signing up for Medicare soon. Going with A&B and supplement G; so for Part D coverage we still have a decision. Her few meds are cheap and the general advice seems to be either forgo Part D (not going this route) or get the cheapest part D plan available for catastrophic coverage.

In this second case, is there much difference between cheap(er) plans? There is certainly a whole bunch of tier options, and specific drugs to speculate on. How would I think about such a comparison?
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GerryL
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Re: skip Medicare B and D?

Post by GerryL »

onthecusp wrote: Sat May 29, 2021 2:50 pm Looking at my wife's options as she is signing up for Medicare soon. Going with A&B and supplement G; so for Part D coverage we still have a decision. Her few meds are cheap and the general advice seems to be either forgo Part D (not going this route) or get the cheapest part D plan available for catastrophic coverage.

In this second case, is there much difference between cheap(er) plans? There is certainly a whole bunch of tier options, and specific drugs to speculate on. How would I think about such a comparison?
Have you used the tool on the Medicare site for picking a Part D plan? Just put in current meds and a few other preferences and the tool will compare the options, with pricing, available to you -- right now. It can change year to year, so you need to re-do this exercise each year at open enrollment. If your wife eventually needs a different med, or if the plan you are in changes, you find a different plan for the next year. You are only committing to a year at a time.

I was in the "lowest cost" plan for two years, paying $15/mo premium and $0 for four maintenance from the online pharmacy option. Last fall I switched to my new "lowest cost" plan. Still pay $0 for meds but the premium has been cut in half.
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onthecusp
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Re: skip Medicare B and D?

Post by onthecusp »

Yes I've done that process. It seems pretty straight forward to me until I started pondering the value of coverage for occasional prescriptions. Antibiotics, vaccinations, pain meds, etc. I don't know what will be prescribed. As a family we've had the odd procedures over the years with some very expensive drugs for a few weeks.

I realize that the difference between $10/month plan and $900/month plan will pay for a lot of occasional prescriptions, but I was wondering if there was any way to have a clue as to which plans might be more generous other than "you get what you pay for."

If it is not enough to justify the effort of comparison, I'll just go with the cheapest given the known prescriptions, but if paying 10% more a month gives better catastrophic coverage I might be willing to go for it.

In edit: What is your experience with occasional prescriptions on the low cost plans?
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GerryL
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Re: skip Medicare B and D?

Post by GerryL »

onthecusp wrote: Sat May 29, 2021 4:15 pm Yes I've done that process. It seems pretty straight forward to me until I started pondering the value of coverage for occasional prescriptions. Antibiotics, vaccinations, pain meds, etc. I don't know what will be prescribed. As a family we've had the odd procedures over the years with some very expensive drugs for a few weeks.

I realize that the difference between $10/month plan and $900/month plan will pay for a lot of occasional prescriptions, but I was wondering if there was any way to have a clue as to which plans might be more generous other than "you get what you pay for."

If it is not enough to justify the effort of comparison, I'll just go with the cheapest given the known prescriptions, but if paying 10% more a month gives better catastrophic coverage I might be willing to go for it.

In edit: What is your experience with occasional prescriptions on the low cost plans?
In my limited personal experience, the cost has been shockingly low. Of course, that is because I am getting generics. I have, so far, never regretted opting for a low-cost plan.
DetroitRick
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Re: skip Medicare B and D?

Post by DetroitRick »

onthecusp wrote: Sat May 29, 2021 4:15 pm In edit: What is your experience with occasional prescriptions on the low cost plans?
My experience (4 months into my first year on Medicare) with a low cost plan has been fine. But I did a fair bit of research to make sure the formulary and the pharmacy network (preferred and standard) were good for me up front, and would likely also be satisfactory in the near future. The price range in my market (monthly premiums) for 2021 was only $6.90 to $109.30 anyway, nothing higher (your area could be far different). The plan I finally took was $23. But I have an average number of prescriptions (all maintenance stuff, seldom changes, so generally predictable) and that $23 plan was the second cheapest available anyway in terms of total cost (premium + deductible + copay). I relied on the Medicare.gov site to enter prescriptions to get the components of that total cost, and verify that nearby pharmacies were covered. This was a very fast shopping process, once I understood what I was doing, actually. Shopping for next year should be a really simple process for me. Anyway, this cheaper plan has proven pretty decent for me.

There were a total of 29 Plan D available to me, and I eliminated 9 because they didn't cover one or two common medications that weren't particularly expensive or fancy, and that I needed. I sort of used those as a surrogate to figure whose formularies were more limited. I got my choices down to two plans, then downloaded both formularies, and checked coverage based on a few other drugs wife and I have taken in past years. Finally I did a few random checks from my decent pre-Medicare policy to see if drugs were in my new formulary. I also looked at reviews, hoping that coverage limitations in prescription areas I wasn't familiar with would be mentioned by others.

This seemed "good enough" to help me make a safe choice. Plus, I know I can change yearly during open enrollment as needed. But the tough part for those needing occasional prescriptions lies in evaluating formulary breadth for unknowable near-future needs (for those of us without pharmacy degrees). Still, in the end I was reasonably comfortable. In using my new plan, no issues or surprises so far.

When I broached this subject while speaking to a friend's Medicare insurance agent last year - formulary breadth - I got a pretty blank look. Which is why I did this semi-deep dive myself.
DetroitRick
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Joined: Wed Mar 23, 2016 9:28 am
Location: SE Michigan

Re: skip Medicare B and D?

Post by DetroitRick »

onthecusp wrote: Sat May 29, 2021 4:15 pm In edit: What is your experience with occasional prescriptions on the low cost plans?
My experience (4 months into my first year on Medicare) with a low cost plan has been fine. But I did a fair bit of research to make sure the formulary and the pharmacy network (preferred and standard) were good for me up front, and would likely also be satisfactory in the near future. The price range in my market (monthly premiums) for 2021 was only $6.90 to $109.30 anyway, nothing higher (your area could be far different). The plan I finally took was $23. But I have an average number of prescriptions (all maintenance stuff, seldom changes, so generally predictable) and that $23 plan was the second cheapest available anyway in terms of total cost (premium + deductible + copay). I relied on the Medicare.gov site to enter prescriptions to get the components of that total cost, and verify that nearby pharmacies were covered. This was a very fast shopping process, once I understood what I was doing, actually. Shopping for next year should be a really simple process for me. Anyway, this cheaper plan has proven pretty decent for me.

There were a total of 29 Plan D available to me, and I eliminated 9 because they didn't cover one or two common medications that weren't particularly expensive or fancy, and that I needed. I sort of used those as a surrogate to figure whose formularies were more limited. I got my choices down to two plans, then downloaded both formularies, and checked coverage based on a few other drugs wife and I have taken in past years. Finally I did a few random checks from my decent pre-Medicare policy to see if drugs were in my new formulary. I also looked at reviews, hoping that coverage limitations in prescription areas I wasn't familiar with would be mentioned by others.

This seemed "good enough" to help me make a safe choice. Plus, I know I can change yearly during open enrollment as needed. But the tough part for those needing occasional prescriptions lies in evaluating formulary breadth for unknowable near-future needs (for those of us without pharmacy degrees). Still, in the end I was reasonably comfortable. In using my new plan, no issues or surprises so far.

When I broached this subject while speaking to a friend's Medicare insurance agent last year - formulary breadth - I got a pretty blank look. Which is why I did this semi-deep dive myself.
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onthecusp
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Re: skip Medicare B and D?

Post by onthecusp »

Thanks GerryL and DetroitRick. I can see why most people pull up short of the deep dive into the formulary. I might do it for the two or three cheapest "total cost" plans based on known Rx just to get a feel for it.

To some extent it is fine if I get hit once or twice with an odd big bill if I'm saving month to month on the premium. Just how insurance works.
Duzz78
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Re: skip Medicare B and D?

Post by Duzz78 »

Onthecups, my understanding that for most plans Tier and Tier 2 drugs are zero costs on most plans. On every plan, the plan provider is required to have at least one maintenance drug in each category at zero cost. Many maintenance drugs cost zero on most plans. But some plans do charge for tier 2 drugs. Most plans charge for Tier 3 and above.

Here is one way you can use to compare specific drugs to speculate upon. Just go to GoodRx. Use a drug that you get occasionally or a specific pain med. The go to Medicare.gov and put that drug(s) into the Part D plan search. Compare the cost at GoodRx to that on a few Part D plans. On GoodRx, after choosing a specific drug, you then can set the price for your location.

If yo use a regular pharmacy, your pharmacist can provide insight into which plan provider, not a specific plan, are worth to be on, have been around for years, etc.

This should be able to help you make a more informed choice.

Note: GoodRx is a free program for anyone to use. You may have even received a free card in the mail. I have. Eligibly for Medicare soon myself. GoodRx is one way to cover drugs that are not on your plan formulary or may even give you a lower price for a drug on your formulary. You have an options. Most people just don't think outside their perimeters. You may have seen their advertising on TV.

You should recheck your Part D plan every year during open enrollment. Your current Part D plan formulary can change every year. Your drugs may change also. Plan providers will change the premium each year. When handling my mom's drug for seven years, I changed her drug plan every year. I did not considered antibotics or other occasional drugs. They were usually covered under the plan I choose. I was able to get her prescription B Vitamin, which was never on any formulary, at a lower price through GoodRx.
Last edited by Duzz78 on Sun May 30, 2021 9:44 pm, edited 1 time in total.
InMyDreams
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Re: skip Medicare B and D?

Post by InMyDreams »

Duzz78 wrote: Sun May 30, 2021 9:36 pm Note: GoodRx is a free program for anyone to use. You may have even received a free card in the mail. I have. Eligibly for Medicare soon myself. GoodRx is one way to cover drugs that are not on your plan formulary or may even give you a lower price for a drug on your formulary. You have an options. Most people just don't think outside their perimeters. You may have seen their advertising on TV.
There's also Canada pharmacies.

I think even on GoodRx there may be some "coupons" that can't be used by MCare recipients.

Again, it's a crazy, convoluted system.
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