Medicare Part B

Hello all,
I turn 65 in May of 2015 and I was once given advice to get the N or F plan when I sign up for Part B on this forum, but I can't find it. I still have incontinence (100-200 ml/day after 8 months) and only a half mast erection on the ED front.
I may consider the AUS or sling or collagen injections and/or Trimix or the penile implant in the future so I may have some expensive surgeries coming up.

I did receive a 8 month PSA of <0.008 this month but I still could need radiation in the future if the PSA goes up.
With all these possibilities, does anyone have any advice on which plan to get and the specifics of how to
find out if your urologist is covered in your plan, etc?
I am just starting this process and am not really sure how to begin?
Thanks for your advice,
Jess

Here is a page that discusses Plan F Medigap. That is the one that has been suggested to be the best for my situation, but I'm not due for medicare for a couple of years.

The rationale was that although it has a somewhat higher premium, it covers most of the holes in traditional Part A / Part B. I did some estimates based on current planned Doctor visits, and probabilities, and F did come out the winner.

boomerbenefits.com/medicare-supplemental-insurance/medicare-supplement-plans/medicare-plan-f/

There are at least two ways to find out what plans are available in your geography:
1) go to medicare.gov; click on "find a medicare and drug plan". You will be asked for your zip code and age, etc. The system will then pull up all medicare supplement plans in you rarea. (Plan F is the most comprehensive one). The plans will be listed by company and then will say, Plan A, Plan N, Plan F, etc. For a drug plan you can input all of your drugs and the system will tell you the premium and annual cost for each plan. You then pick which is best for you.
There are no networks in medicare supplement plans (unlike medicare advantage plans). You just need to make sure your doctor takes original medicare. Also, all Plan F plans offer the same benefits, even though the premiums vary. The most expensive plan doesn't give you any more than the least expensive plan (but always go with a company you have heard of.)

2) a simpler way is to contact your local SHIP office (Senior Health Insurance Information Program) and make an appointment. They will do all of the above in #1 for you. You will leave the appointment with lots of information with which to make a decision. There is no charge for this service.

I found plan G to be best, since the only thing not covered was Plart B deductible of $147 and premiums are lower than Plan F.
Bob

Plan G does not cover the Plan B deductible. If you can get a plan G for more than $147 less than a Plan F, it is better. But that all depends on your residence.

First stop -- go here to compare all Medigap, Medicare Advantage, and Medicare Pharmacy plans available in your area:
/www.medicare.gov/find-a-plan/questions/home.aspx

I mentioned this in another thread, but it is appropriate here also. In addition to looking at Medigap plans, I suggest you also look carefully at Medicare Advantage plans offered by private insurers. These plans vary widely in costs and it what is covered. Plans also vary widely from one state to another. For example in my state, Massachusetts, there is no such thing as Medagap Plan F, Plan G, etc. although there is something similar.

In my case I'm on a Blue Cross Medicare Advantage plan that includes drug coverage and minimal co-pays with an annual out-of-pocket maximum of $3,400 per year. I'd only ever hit the out-of-pocket maximum if I had a hospitalization or major out-patient treatment. Over the past couple of years the only out-of-pocket costs for me and my wife -- other than the plan's monthly premiums -- have totaled only $100 - $200 per year for doctor appointment co-pays. It is a PPO plan under which we we can go to out-of-network doctors at no additional cost.

Now if weigh the cost of the monthly premium against the cost of a Medigap plan, the plan I am on is much cheaper. For the past few years I've been on the "plus" plan which cost $124 per month each for me and my wife. For 2015 we are switching to the "value" plan at $49 each per month. Ironically the value plan has a lower out-of-pocket maximum then the more expensive plus plan should either of us need out-of-network treatment. If we went the Medicare plus Medicare Supplement Plan route, we would each need to pay at least a couple of hundred per month to cover the Supplement Plan plus a separate Pharmaceutical plan and would end up with much greater certain annual cost and no greater benefit other than the relatively small risk of both needing services every year that pushed us into out-of-pocket maximum range.

Again, caution is the watchword with these plans -- you read to really read the details of what is covered and what might bring additional out-of-pocket costs. Also you need to check to see if your doctors accept a given plan. Beware especially, so-called "free" plans because these are typically loaded down with copays and may be refused by many doctors. But that said, at least in my state, I have a choice of several plans that are much less expensive than Medigap and offer excellent value.

LupronJim said...
Here's the thread I started a few weeks ago

If you go with Medicare Advatage it is generally free or very inexpensive depending on your zip code, and includes Parts A, B & D. However as you have claims you are on the hook for 20%.

So Plan F and Part D costs about $2,200 annually and the break even point is whether your expected claims total $11,000 or more since 20% of $11,000 worth of claims is about equal to the $2,200 or so Plan F premium and Plan D delta over Medicare Advantage (free or very inexpensive).

I can't speak for all Medicare Advantage plans, and I'm not shilling for these in particular, but I really need to clarify what seems to be a misunderstanding of what these plans are. There may be some really bad Advantage plans that would leave you on the hook for 20%, but if so I can't imagine why anyone would buy one because if you took basic Medicare with no supplement plan you would be on the hook for the same 20% -- hence what advantage would such an "advantage" plan offer?

So by means of example I'll quote the key costs vs benefits of my $49 per month Medicare Advantage Plan:
-Primary care copay $20
-Specialist copay $40
-"Your annual in-network maximum out-of-pocket amount is $3,400" (the same applies to out-of-network)
-"Our plan does not allow providers to 'balance bill' you."
Inpatient Hospital Care "You pay $200...for each day in a hospital for the first five days...then you pay nothing from day 6 onward."
-No copayment for most diagnostics, e.g., PSA test, cardiovascular testing, colonoscopy, diabetes screening, etc.
-Emergency care - $65 copayment
-Hearing services - $20 co-pay for Primary Care doc, or $40 for specialist
-x-Rays - $20 copay
-CT scans, MRI, PET scans - $150 copay

So even if worst case you had treatments in any give year that called for the higher copays: a hospitalization and/or some CT, MRI scans, emergency room, etc. you would still be capped at a maximum out-of-pocket cost of $3,400.

If I compare costs in my state I can weigh this maximum annual risk of $3,400 against the certainty of paying at least $3,000 in annual premiums for a Medigap Supplement plan plus another $300 or so for a Pharmacy plan. Compared to this certain annual expense for insurance, I instead have an Advantage plan that costs me $588 per year in premiums (which includes drugs with copays such as $8 for a 90 day supply of common generics) plus co-pays that typically run less than $200 per year for me and a maximum out-of-pocket risk of $3,400.

As I noted in my previous post, these plans vary widely from state-to-state and you do need to compare the details of costs and coverages carefully. But in my case I'm faced with a maximum, but unlikely, risk of paying $3,400 in any given year vs. the absolute certainty of paying $3,300 every year just in insurance premiums, whether I use the services or not ($169-233 per month for a Medigap plan plus another $25 or so per month for a prescription plan).

Not sure you'll see this with the accidental "Ignore" but thanks for clarifying my mis conception.

I knew basic Medicare pays 80% and just mis-spoke.

Glad you clarified so I go not inadvertently steer anybody the wrong way.

There is still a break even point of expected claims, it's just quite a bit more than the $11,000 I suggested since the % is not 20% but something quite a bit smaller once you factor in what beyond 80% Medicare Advantage pays.

My spouse Karen has Medicare Advantage, so it just depends on how many claims one is expecting the subsequent year which works out best.

Kinf of off topic but what worked best for her was Medicare Advantage for free plus an AFLAC type hospital indemnity policy from another insurance company and a cancer policy that refunds premiums after 10 years if she does not contract cancer.

I tried to email a copy but his email is not open.

LupronJim.

Thanks, guys, for all your help!
I appreciate it.
Jess