Medicare Planning 102

Follow Up To Yesterday’s Email…

I received a WONDERFUL response from a friend about the Medicare post I sent out yesterday.  She allowed me to share the entirety of it with you.  Which you can find at the bottom of this email.

First though, I want to point out that Jae Oh, author of Maximize Your Medicare, and I have begun a podcast series called State By State Guide To Medicare.

We recorded Alabama and Alaska yesterday. All my podcast episodes can be found here. The interesting thing is,and fits in VERY well with what my friend shared with me yesterday, is that it can be incredibly hard to find CARE under Medicare Advantage (Part C) if you are in a more rural area.

For example, Alaska has NO Medicare Advantage plans available.  The only plans are Medicare Supplements. In fact, when you read the email I sent yesterday you can see the real world caution signs about Medicare Advantage policies. No docs in the local network, no local CARE.  I can’t stress enough the difference between insurance and care.  Just because you have insurance does not mean you have care.

Those of us on the free-market side of the health care debate have been arguing for decades that insurance and care are not synonymous.

So, if you’re in a rural area, you may not even have a choice between Medicare Advantage or Medicare Supplemental policies.

Now, be advised, Medigap, i.e., Medicare Supplemental policies, are not free!  There are monthly premiums and those premiums may be significant. Between your Part B, Part D and Medigap plans you could easily spend $300 a month on premiums. (I certainly hope you’re calculating that into your financial planning software!)

But, read on, and you may see what you may actually get for the coverage from a REAL PERSON who just went through all this over the past couple years.

This is a HUGE choice you’re making folks. I can not stress enough how important it is to seek professional guidance. If you want me to recommend someone to talk to, I’d just say reach out to Jae. Let him steer you straight.

However you proceed, do so with extreme caution because as you can see in the email below, we’re talking big bucks here. And you want to make sure you have the appropriate coverage.

Here you go. Such valuable information here. Feedback is always welcome.

Blessings,

Josh

Josh,

(Husband) had Medicare Part A and B, and a supplemental plan and a drug plan.  The supplemental was through (Insurance Company) and cost 200+/month.  It was a high end plan.

One month before his first heart attack he considered downgrading it but thankfully procrastinated  With that coverage, we incurred zero expense for that hospitalization and surgery, total cost of 100,000+.  Our big surprise on coverage concerned which part of Medicare covered what.

I had always heard that A was for inpatient stuff, B for outpatient.  But really A is for room and board as an inpatient.  Any test – lab, x-ray, cardiac imaging is a part B area and subject to the 20% copay which adds up in a hurry.  But, in his case, the 20% was fully covered by the supplemental plan.  Of course this is after they all play with the numbers and the hospital admits that they will take $500 for the test they originally charge $1200 for.

There were also quirks on the Part D, medication side.  (Hub) was on 1000 mg of Metformin 2x/day (diabetes drug).  He could get that for $1 if he got it in 500mg pills.  One time the doctor suggested he just take 1000mg pills to have less to swallow.  That prescription would cost $250.  Same med, same total strength.  Needless to say he stuck with the 500 mg pills.  In that case (Insurance Company), who he got his Part D from, had a deal, but only on 500mg tablets, not 1000 mg. tablets.  Crazy!  That plan cost less than $10/month.

As a provider the supplemental plans varied.  The biggest issue was the wait for everyone to send payment and trying to keep current as a recognized provider on everyone’s list.  When I worked in a private clinic each Physical Therapist had to fill out a pile of papers to become a recognized provider even though the clinic was the billing entity.  And THAT is part of the high cost of health care.  In fact I would suggest that we have created a monster and it is NOT all higher technology that is driving costs up.  Much of the cost is paper shuffling which has been made no better and seldom even faster with electronic billing.

To make health coverage look a bit easier to swallow, I think of it this way:  Few people leave this world without a major event that costs big bucks.  I am just making installment payments on my big event.

Real World Medicare Advice

Wow!!! Just wow… I received the email below from a nurse friend/client regarding her knowledge of Medicare, Medicare Part C and Medicare Supplements.  She sent a second email too, which I’ll send under different cover because it’s so informative it also needs your undivided attention.  (She did give me permission to share the email too – just FYI).

Any personal info has been changed of course.  Words that have been put into bold are from me, not her, just to add emphasis.

“I just read your email about Medicare.  Just to throw my two cents into the mix, I would urge caution in going with a Medicare Advantage (Part C) plan.  As a provider several years ago we saw many problems with people insured this way and a broad variety of coverage.  Two specifics that I remember were plans that limited access to a small number of providers.  That may be less of an issue in an urban area but around here(a small town) it could mean driving to a bigger city to have care fully covered.  The other issue involved moving from one state to another.  Sometimes there was quite a delay while the person figured how how there coverage worked across state lines. Sometimes they were charged out of network costs for moving.

And, in my opinion, in the field of medicine there can be a huge difference in competence amongst providers.  Insurance companies look only at licence but some doctors are better diagnosers, or have better communication skills all of which equals better care. 

If you are limited in the pool you can choose from that can be a problem.  I used to say, you can buy generic potato chips but if  you are buying a service (doctor, lawyer, carpenter) cost is not the prevailing factor to consider. Traditional Medicare is widely accepted and consistent from state to state.  True, it is not always understandable – but few health care plans are in all honesty.

I’m interested to hear what else you share about Medicare.  Maybe I should figure out how to get to those podcasts.”

Funny thing about this email, at least to me as a professional financial planner, is her comment that ‘better communication equals better care.”  Now, I don’t know how they do it in doctor school, or lawyer school etc.  but in financial planning school they do not teach communication skills at all.  It’s stupid, actually.
The world is littered with the failed careers of brilliant financial advisors who never learned how to relate to people.

Stay tuned for the follow up email to this as well.  I simply can not express my thanks for the lady who wrote this email to me(You know who you are!)  Just wonderful information to share.

Blessings,

Josh

P.S.

Anyone who wants to know how to get the podcast just go here.  You can listen directly from your browser even!

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