Medicare Question - did you ever hit the limit?

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kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

Munir wrote: Mon Aug 30, 2021 12:51 pm I understand that the monthly premiums of plan G are lower than that of Plan F but the annual deductible is covered under plan F but not by plan G. Speaking strictly in $ terms, which is less expensive as total cost?
Currently for our zipcode, plan G is cheaper than plan F even after accounting for the deductible. Who knows what the future holds.
DetroitRick
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Re: Medicare Question - did you ever hit the limit?

Post by DetroitRick »

Approach this Dr. Belk clown, that some people here have started spouting, with great caution. I've seen his stuff regarding Medicare supplement policies and Part D coverage. Overall, he cherry picks facts, exaggerates for effect, and has no understanding at all of risk management. There is a reason his main audience is ONLY via YouTube and self-published books.

First, he makes a perfectly valid point that Medicare Supplements are priced to profit their issuers. Of course that is true, but so is all insurance. While the Medical Loss Ratios for Supplements are clearly worse than normal health insurance (particularly since ACA regulations became effective), they do reflect significant claims experience too. Some supplement insurers in my market tread the minimum 65% loss ratio, a few others are show experience in the low 90'% range. Most are in between. Sure, I think they are generally too expensive too. But I don't get to pick the premium price. And they do pay out a significant level of claims. What matters for the individual is the risk they are comfortable carrying, not the profit the insurer can make. I guess my homeowners insurance is a scam too, I've never made a claim and paid lots of premiums. We all have different needs for risk coverage. I would never allow this guy to determine mine.

As far as insurers simply "scaring" customers into thinking that they have a massive medical cost risk, a point that Belk regurgitates frequently, I've certainly never had that happen. But, maybe some agents do exaggerate need to those who don't know better. Regardless, it's easy to get a basic feel for what Medicare might leave me on the hook for. Then I can refine that understanding by reviewing Medicare ESN's from myself, family and friends. That's where my understanding of this insurable risk comes from. So I can easily figure out what potential shared costs are really out there. Which is part of what OP was asking. Some may choose to take the risk, others won't. I won't. Just like I "could" afford skipping home insurance and having my house burn down, I'd really prefer no to. It's just a question of which risks you want to absorb and which you don't. The premium levels Belk quotes against potential benefits may be true for (edited) a few higher premium states, or a few higher-priced insurers, but they are not even close to what I see in my state (which tends to have an "average" geographic rating premium). So again, I find him to grossly exaggerate cost and understate benefit.

On Part D, he makes the perfectly valid point that late enrollment penalty is not huge. He's right. On the other hand, this Part D is pretty cheap insurance in the first place, particularly in the face of some areas of massive RX costs in the U.S. Having coverage when you need it is valuable and it is tough for the elderly to predict future prescription needs. Goodrx has some great deals, and some lousy deals. I don't have many prescriptions, and none are the "advertise on tv" expensive type, but my Part D premium + out of pocket would be about $300 per year higher if I skipped D for GoodRx. Your results could be different. But again, there is value in having coverage when you need it. Either way, it's worth running your numbers and considering what the future might bring.

I wouldn't change a thing because of Dr. Belk's approach, or ever listen to him again. But that's me.
Last edited by DetroitRick on Mon Aug 30, 2021 5:33 pm, edited 2 times in total.
DetroitRick
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Re: Medicare Question - did you ever hit the limit?

Post by DetroitRick »

susa wrote: Mon Aug 30, 2021 8:36 am
Watch Dr David Belk videos on YT
For most of us, his information is pure nonsense. I've detailed why I say this below in more detail. I would waste no time on the guy.
bradinsky
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Re: Medicare Question - did you ever hit the limit?

Post by bradinsky »

Munir wrote: Mon Aug 30, 2021 12:51 pm I understand that the monthly premiums of plan G are lower than that of Plan F but the annual deductible is covered under plan F but not by plan G. Speaking strictly in $ terms, which is less expensive as total cost?
As of 12/31/19 Plan F is NOT available to new enrollees.
bradinsky
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Re: Medicare Question - did you ever hit the limit?

Post by bradinsky »

Munir wrote: Mon Aug 30, 2021 12:51 pm I understand that the monthly premiums of plan G are lower than that of Plan F but the annual deductible is covered under plan F but not by plan G. Speaking strictly in $ terms, which is less expensive as total cost?
For DW & I, plan G premiums & deductibles included, we save over 25% not using plan F. For us, it’s a no brainer.
tj
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Re: Medicare Question - did you ever hit the limit?

Post by tj »

DetroitRick wrote: Mon Aug 30, 2021 2:23 pm

As far as insurers simply "scaring" customers into thinking that they have a massive medical cost risk, a point that Belk regurgitates frequently, I've certainly never had that happen. But, maybe some agents do exaggerate need to those who don't know better. Regardless, it's easy to get a basic feel for what Medicare might leave me on the hook for. Then I can refine that understanding by reviewing Medicare ESN's from myself, family and friends. That's where my understanding of this insurable risk comes from. So I can easily figure out what potential shared costs are really out there. Which is part of what OP was asking. Some may choose to take the risk, others won't. I won't. Just like I "could" afford skipping home insurance and having my house burn down, I'd really prefer no to. It's just a question of which risks you want to absorb and which you don't. The premium levels Belk quotes against potential benefits may be true for California, and some other higher premium states, but they are not even close to my area either. So again, I find him to grossly exaggerate cost and understate benefit.
California is NOT a high premium state. And the ability to switch every year without underwriting makes it even more affordable if for some reason you make a bad choice.
DetroitRick
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Re: Medicare Question - did you ever hit the limit?

Post by DetroitRick »

tj wrote: Mon Aug 30, 2021 3:47 pm California is NOT a high premium state. And the ability to switch every year without underwriting makes it even more affordable if for some reason you make a bad choice.
You are right, they are not high there. I'm glad you corrected me. He was claiming an unusually high average premium cost in the video I watched, and I wrongly assumed that's where he was sourcing his premium numbers, as that's where he is in practice (i.e., in one of his videos he pegs average premiums as being in "$200 - $350" per month range). I now see he was not doing this based on CA. Looking at just one major insurer's geographic rate tables, their rate adjustments for California are about the same as my area - more expensive than some states, lower than others. But overall they seem middle of the pack, at least for that issuer. With the ability to switch every year, I'd take those California rates over mine in a heartbeat. Anyway, I can't say where he came up with that range - unless he was skewing towards older policy holders, certain other states, or something else entirely.
Chuckles960
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Re: Medicare Question - did you ever hit the limit?

Post by Chuckles960 »

bradinsky wrote: Mon Aug 30, 2021 2:47 pm As of 12/31/19 Plan F is NOT available to new enrollees.
You've posted this twice in this thread, but it is not exactly correct. It is still available to new enrollees who were eligible for Medicare before 12/19. Not everyone is required to enroll in Medicare and in a Medigap plan as soon as they become eligible, e.g. if one is employed.

Of course "available" does not mean "worthwhile".
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Munir
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Re: Medicare Question - did you ever hit the limit?

Post by Munir »

bradinsky wrote: Mon Aug 30, 2021 2:47 pm
Munir wrote: Mon Aug 30, 2021 12:51 pm I understand that the monthly premiums of plan G are lower than that of Plan F but the annual deductible is covered under plan F but not by plan G. Speaking strictly in $ terms, which is less expensive as total cost?
As of 12/31/19 Plan F is NOT available to new enrollees.
As I mentioned in my earlier post, I have had Plan F for nearly 20 years. I am investigating a shift to plan G and I have received the necessary information from the respondents. Thank you.
TheGiantess
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Re: Medicare Question - did you ever hit the limit?

Post by TheGiantess »

I'm no expert but my mother is 89 and has had two major hospital visits in the past 10 months. She has original Medicare and Plan F. She has not paid anything so far for her medical care. Her first stay was in October 2020 -- week in the hospital, acute rehab for 2 weeks and then home health PT and OT and a bather for 3 months. Bill's are over $100,000 and her Plan F covers everything that Medicare does not. Between them all including Part D she pays about $400/month in premiums. If I can afford it when I am Medicare age and if it stays the same, I would choose original Medicare for sure. Many medical people told us that because she had original Medicare she was accepted into acute rehab and got a lot more home health than many Medicare Advantage enrollees. It is just one example but convinced me.
TG
bradinsky
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Re: Medicare Question - did you ever hit the limit?

Post by bradinsky »

Chuckles960 wrote: Mon Aug 30, 2021 4:29 pm
bradinsky wrote: Mon Aug 30, 2021 2:47 pm As of 12/31/19 Plan F is NOT available to new enrollees.
You've posted this twice in this thread, but it is not exactly correct. It is still available to new enrollees who were eligible for Medicare before 12/19. Not everyone is required to enroll in Medicare and in a Medigap plan as soon as they become eligible, e.g. if one is employed.

Of course "available" does not mean "worthwhile".
I stand corrected. Sorry! Eligible on or before 1/1/2020. Thank you!
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GerryL
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Re: Medicare Question - did you ever hit the limit?

Post by GerryL »

B. If you have Plan G HD, did you ever hit the plan deductible of $2370? If so, at what age for the first time?
I have been on a high-deductible Medigap plan for 6 years now. Initially F-HD. Switched to G-HD last year. (In Oregon we are allowed to switch plans laterally or down in the month of our birthday.)

Some years I go through the Medicare deductible. Have never made much of a dent in the plan deductible. This year I expect to have more expenses but doubt I will even approach the $2370. So far the difference in premiums between non-HD and HD have more than covered my out-of-pocket. But I know I can afford the full deductible if it comes to that.

When I made the decision to go with the HD plan, I looked back at my healthcare usage over several years to remind myself that every year is not like last year.
Topic Author
kd2008
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Re: Medicare Question - did you ever hit the limit?

Post by kd2008 »

GerryL wrote: Mon Aug 30, 2021 6:26 pm
B. If you have Plan G HD, did you ever hit the plan deductible of $2370? If so, at what age for the first time?
I have been on a high-deductible Medigap plan for 6 years now. Initially F-HD. Switched to G-HD last year. (In Oregon we are allowed to switch plans laterally or down in the month of our birthday.)

Some years I go through the Medicare deductible. Have never made much of a dent in the plan deductible. This year I expect to have more expenses but doubt I will even approach the $2370. So far the difference in premiums between non-HD and HD have more than covered my out-of-pocket. But I know I can afford the full deductible if it comes to that.

When I made the decision to go with the HD plan, I looked back at my healthcare usage over several years to remind myself that every year is not like last year.
Thank you for sharing your experience. Very valuable.
hvaclorax
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Re: Medicare Question - did you ever hit the limit?

Post by hvaclorax »

OP,
For those who say Medicare and it’s supplemental coverage is the best coverage ( for the price of premium and associated fees). I would point out that the provider by law takes a reduction in fee of approximately 50%. At least that was the case as recently as six years ago. Not really a complaint as now I’m a beneficiary of the current system.
HVAC
Big Dog
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Re: Medicare Question - did you ever hit the limit?

Post by Big Dog »

kd2008 wrote: Mon Aug 30, 2021 2:02 pm
Munir wrote: Mon Aug 30, 2021 12:51 pm I understand that the monthly premiums of plan G are lower than that of Plan F but the annual deductible is covered under plan F but not by plan G. Speaking strictly in $ terms, which is less expensive as total cost?
Currently for our zipcode, plan G is cheaper than plan F even after accounting for the deductible. Who knows what the future holds.
same as our zip code Plan G from the same insurer is ~$400/yr cheaper in premium which is 2x the deductible.
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susa
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Re: Medicare Question - did you ever hit the limit?

Post by susa »

pshonore wrote: When I was on traditional Medicare (Plan G) , I hit the deductible every year. A single doctor's visit usually comes close to covering it. Now on Medicare Advantage, I have no deductible but a $10 copay for every visit.
But you do pay something for that "..Medicare Advantage, I have no deductible but a $10 copay.." every month ?

On basic Medicare (A+B) with Plan G HD, it is 65/month in our state so 148.50 (B) + 65.00 (G).
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