Medicare insurance & supplemental plans

Wendy said:

If you sign up with VA, even if you don't use them, they count as a drug plan and if you later add a drug plan, there's no penalty.

Wendy

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That's really good info, Wendy.  Thanks!  Tom has gotten his non-generic prescriptions from the VA for years.  His generics are cheaper through WalMart.  Good to know the late sign-up penalty, if ever necessary, would not apply to him.

Margi

[quote author=Terry A. Brewer]I must have refrigerators on my mind.[/quote]

Great recovery Terry, I didn't think of that one, and it's especially timely  ;D

.... if you don't sign for a drug plan when you are first  eligible they penalize you with higher monthly rates if you decide to join in the future.

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Aye, I've been conscious of that.

We have Humana Medicare Advantage and our drugs come from their mail order pharmacy, RightSource.  We can have them ship our meds anywhere at no cost.  Generics are no charge, others have costs varying from a few dollars to a lot for some name brands, especially if you don't specify the generic equivalent.  Fortunately, all of ours are available in generic form so our out of pocket drug costs have been 0 so far.

I also have Human/Walmart drug Coverage part D, and like Ned get my prescriptions filled through Right Source, a mail order.  My policy also states that I can have a prescription filled at any pharmacy in the event of an emergency.

Marsha~

Yes, with Humana you can use any pharmacy but then there is a small co-pay for generics, which are free from Right Source.  It's less than $10 usually.

Adding to the mix; After more research (aka procrastination), I eventually opted for Blue Shield supplemental coverage (plan F) and Blue Shield prescription drug coverage (Premium plan). A few highlights of the plans I chose:

- No deductibles or copays for Part A and Part B.

- No donut hole.
- BS has a deal with CVS to supply 3 months for the price of 2; This brings the copays on my expensive non-generics to the point of eliminating the need for annual trips to Los Algodones.
- One medication not available south of the border, and not affordable under my prior plan, is now affordable.

Meanwhile, I save approx $600/month in premiums, phew!

Sounds like you found a plan that matches your needs perfectly.

Tom said:

- No deductibles or copays for Part A and Part B.
- No donut hole.
- BS has a deal with CVS to supply 3 months for the price of 2; This brings the copays on my expensive non-generics to the point of eliminating the need for annual trips to Los Algodones.
- One medication not available south of the border, and not affordable under my prior plan, is now affordable.
Meanwhile, I save approx $600/month in premiums, phew!

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Congratulations.  Now you can start looking for that new motorhome. 

Seriously, $600 a month.  That, and the other improvements must result in an annual reduction in your health insurance expense of close to $10,000 a year.   

Doesn't it make you wonder how that is possible?  Is BS losing money on this deal, or did you just cut out $10,000 in net profits from the other guys?  For me, this is  indicative of a system so completely out of whack it's mind boggling. 

Are there lessons learned here for our Boys in DC? 

Now you can start looking for that new motorhome.

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LOL, no plans for a new motofhome.

Doesn't it make you wonder how that is possible?  Is BS losing money on this deal....

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Two things make this possible:

- The Medicare premium for basic (part A & B) coverage is affordable, and Medicare holds providers' charges down.
- Blue Shield is a not-for-profit company, and their supplemental coverage covers only what Medicare doesn't.

Did you just cut out $10,000 in net profits from the other guys?

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Yes and no; Providers also get squeezed, which is why so many don't accept Medicare.

Tom said:

Yes and no; Providers also get squeezed, which is why so many don't accept Medicare.

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Tom, I am retired from a 40 year career in the insurance and risk management field.  I worked for the largest insurance broker in the world.  I retired from a Fortune 100 company where I served as the Director of the Risk Management Department. 

Trust me when I say this. 

The only people getting squeezed are the insureds. 

The amount of Fraud Waste and Abuse in the insurance industry is beyond comprehension. 

Understood Gary and, in the end, we all pay. I don't have your knowledge/experience of the fraud & abuse, and all I can do is relate a simple example, one of many. During a period I was without insurance, I visited one specialist doctor who' s office visit charge was $300; When he learned I had no insurance, he told his office gal to "charge him the Medicare rate" ($100), athough I was far from Medicare age. I have no idea if he made money out of my visit, but presumably Medicare 'squeezes' him with their allowed charges.

One of the problems with Medical Insurance, as well illustrated by above comment here, has been, and still is the various laws that prohibit standardization of policies and coverages among different states.

As an employer I provide a group medical policy available for my employees based upon what I have been able to find amoung different providers over the years. I try to provide the best benefits, within the the best costs, that have been available and my employees seem to be happy with the plans that have been available to them over the years. I still don't know how or what I can provide, if anything, under the new "Obamacare" mandates. My accounting firm still has not decided if it would be most appropriate for me to just pay a penalty to save the premium cost (with perhaps another adjustment to my employees compensation).

For myself, as a result of advise from my business accountants and consulting with insurance company reps,, for years I have had two personal coverages. For almost 40 years I have had a Medical Savings Account. I have been very happy with this since the value balance has continued to increase with proper management so that it actually has generated income from the savings account investment far over the medical costs needed. It is not yet clear but it seems that under "Obamacare" I may be penalized for having a Medical Savings Account, although my secondary policy may avoid this. My accountants are not yet sure about this.

Upon advice from experts I also have a second policy coverage as an emergency backup from Humana that is very cost effective. With my situation including the Medical Savings Account, the Humana Gold Plan that I carry as a backup for emergency has zero premium. The zero premium is based upon my medical record and the fact that my savings account is my primary coverage. I don't know if this is available in other states for other conditions.

So to date, my medical insurance costs have been nil for years and although I am well over 80 years of age, I actually earn a little income profit from my system rather than having a policy cost.

I don't know if this system would be useful for anyone else but it has been valuable for me for years. I also don't know if it would be allowed in other states, other than Colorado. But it has been useful for me and  the only problem, if it is a problem, has been one of minor red tape. For example my last incident needing medical care happened in Riverton Wyoming where I went to the local hospital for minor repair to injury to my hand. The hand was cleaned, stitches applied and bandage applied. I tried to pay the hospital and doctor in cash after only a couple hours in the hospital for care and my payment was refused. I was informed that the Hospital does not take cash payment and I would receive a statement in the mail.  I did receive the statement almost two months later, which I primptly paid by mailing a check. It would have been more convenient to just have paid before I left the Hospital.

I rarely need medical care except for my annual checkup. Even my personal doctor did not take cash payment on the spot for a number of years at checkup untill a few years ago when I gave an ultimatum. Either take my money when offered or I would not pay. That got results.

garyb1st said:

Tom, I am retired from a 40 year career in the insurance and risk management field.  I worked for the largest insurance broker in the world.  I retired from a Fortune 100 company where I served as the Director of the Risk Management Department. 

Trust me when I say this. 

The only people getting squeezed are the insureds. 

The amount of Fraud Waste and Abuse in the insurance industry is beyond comprehension.

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And, I now believe that this FW&A is "rampant" across most, if not all, forms of "insurance"... health, auto, flood, life, annuity, liability and whatever else that might be available.  There's a reliable indicator, based on the old adage, "where's there's smoke, there's fire"... "where there is rampant advertising, there is FW&A".  If there is a sound product offered by a reliable company, a little bit of advertising  gets results... usually... after that, if the product is really sound and if the company is really reliable, then "word of mouth" advertising is more than sufficient to prosper.  People love to tell others about their "good" experiences and, especially, about their "bad" experiences.  No amount of advertising can change that... IMHO.

OTOH, Rancher Will has the absolute best health plan available... "Don't get sick"!  If you can get one of those plans, you've got it made.

We probably have some of the best doctors/health care providers on the planet and they will do their best to take care of you... for the most part... but, IMHO, we have, by far, the most expensive health care funding systems on the planet and, it's not because the doctors/nurses/providers are paid too much...

Hope everyone is having a great summer...

I am really worried if romney and paul get in.  They are wanting to do away with medicare and make SS private, they just can't stand alone, it functions the way it is because new money is coming in all the time.  I am very concerned about this, and also I don't understand people voting for folks that are going to get rid of things we need.  Just when we  are going to need it it may not be there.  the best laid plans, sigh.

But I don't know what Obamacare will do either, it all worries me, jeez.

I am really worried if romney and paul get in.  They are wanting to do away with medicare and make SS private, they just can't stand alone, it functions the way it is because new money is coming in all the time.  I am very concerned about this, and also I don't understand people voting for folks that are going to get rid of things we need.  Just when we  are going to need it it may not be there.  the best laid plans, sigh.

But I don't know what Obamacare will do either, it all worries me, jeez.

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Unfortunately, it appears easier to repeat misinformation than to research the facts.

Let's not allow this discussion to turn political. Admittedly, the future of healthcare will be dictated by politicians and, having lived in the UK for 32 years, I fully understand the good and the bad of government-run healthcare. But that's not the subject of this discussion.

Providers getting squeezed on federal and state programs is without question. My primary care doc gets $17 for a basic office visit for a Medicaid patient. He believes in treating these folks as they are really in need but at the same time he can only accept so many from a business standpoint.

My wife works for a hospital and the more you learn about Medicare the worse it gets. Hers is a for profit corporation, they routinely keep older patients admitted when Medicare ends, some have nowhere to go, no family or sensible options. If they are too sick for rehab, assisted living or nursing home the hospital eats it in many cases. Of course that is looking at it at the patient level, they make it up in other ways. They showed a 2.8 percent profit last fiscal year, for which we are thankful.

[quote author=Tom]... I eventually opted for .... Blue Shield prescription drug coverage (Premium plan)...

- No donut hole.
- BS has a deal with CVS to supply 3 months for the price of 2; This brings the copays on my expensive non-generics to the point of eliminating the need for annual trips to Los Algodones.
- One medication not available south of the border, and not affordable under my prior plan, is now affordable.
[/quote]

Well rats, after all the prior research and procrastination, Blue Shield will not offer their premium prescription plan in 2013. A quick scan and recap of the alternatives suggest that Humana might be my next best choice.

Within a day or two of receiving Blue Shield's letter, I received the annual US DHHS 'Medicare & You' book; The BS decision was so recent that their discontinued plan is still shown in the DHHS book.

Anyone else receive the Blue Shield letter?

I suspect there are going to be a lot such letters as the provisions of "Obamacare" begin to take effect and change the medical insurance landscape. Or, if Obamacare is rescinded, there will be another round of changes as some to-be-determined alternate scheme is put in place.

Either way, it is going to be "interesting times"!

Aye Gary, that thought went through my mind as I was re-reviewing the plans offered by other companies.