Health Insurance

[db-2]

JIm. .
I do know over the last 11 years we have not paid a penny to the hospital or clinic and that was with the wife having cancer other than that premium. The VA has been great to me and i would save $300/month but am still unwilling to go that way.

Maybe i am spending monies i would not have to with an advantage plan, but.

Why not. I do not know, am not willing to learn, do not trust certain people and their claims and people who i have talk to and tell me they are in the know have stated i will regret going advantage. I will pick my own doctor to start with. db

 

[BDub]

We have an advantage plan. We pay zero a month. The plan the year before ran us about $400 a month. We have only spent close to $400 for our year out of pocket. Plus the dental, eye and hearing benefits. It’s been a Godsend for us.

 

[Jim Simmers]

JIm. .
I do know over the last 11 years we have not paid a penny to the hospital or clinic and that was with the wife having cancer other than that premium. The VA has been great to me and i would save $300/month but am still unwilling to go that way.

Maybe i am spending monies i would not have to with an advantage plan, but.

Why not. I do not know, am not willing to learn, do not trust certain people and their claims and people who i have talk to and tell me they are in the know have stated i will regret going advantage. I will pick my own doctor to start with. db

You do you my friend!

 

[db-2]

thanks I feel okay now. db

 

[camper]

apparently you don't understand Bidenomics, have Camper explain to you how it works and how you are better off now than when Trump was in office.

Another day living rent free in your head. hahahah

 

[Obi-Wan]

Another day living rent free in your head. hahahah

Just giving you a chance to justify and back up your political beliefs and how we are all better off now than we were under Trump. It's time to put up or shut up, please explain Bidenomics and how it works for the average Joe in America.

 

[eyexer]

I am not of Medicare age. I have been an insurance agent for 23 years. I have been primarily an advantage plan agent for almost 18 years. Providers are dropping them at an alarming rate? Where at? Not in ND. Program has never been bigger and growing fast as we are close to the middle of the baby boomer generation. These plans grow by 2-3% every year at close to 52% of the Medicare population choosing an advantage plan. I am trained to be an expert in the field. Basically it’s all I do. The main reason why some Medicare providers might not like dealing with these plans is because they require pre authorization before a major procedure can be done. Doctors have to do that for the plan member. Providers have been over billing original for decades helping to break the Medicare program financially. 70% of all insurance fraud is from the doctors office in double billing or billing for services not rendered. Previously those claims would sit at CMS in pending status and it would be 6 months before the federal government would pay that claim without checking to see that the service was actually provided. The feds put a cap on how much profit a carrier can make. Most of all monies paid to part c carriers must be used to pay claims and provide benefits. Fact is, this year there are more plans to choose from than ever before. Plans don’t pop up if providers are dropping. Not sure where you are getting your information but you’re terribly wrong. They are here to stay.

I sold med supps in the early to mid 90’s. Have zero knowledge how it all works today. What’s all changed since then. They were pretty cut and dried back then

 

[Davey Crockett]

You guys that like to argue politics 7 days a week , give us a break on this topic. Go to another thread that you have already run off the rails and bash away all day long IDK . Just don't run this topic off the rails, some of us are trying to learn some important information here so scrammmmmm. GO AWAY ..

 

[Jim Simmers]

I sold med supps in the early to mid 90’s. Have zero knowledge how it all works today. What’s all changed since then. They were pretty cut and dried back then

Just that med sups are expensive and offer no other benefits. As you know, med sups only pay when original Medicare pays. Medicare does not have a max out of packet, does not cover observation, it also does not offer drug coverage, hearing, dental, vision, meal programs, rewards for being healthy, OTC items. There are so many benefits to an advantage plan over medsups. On a dollar for dollar comparison, it over 90% of the Medicare population would benefit from and advantage plan. Original Medicare Part B premium will be about $174.50 in 2024. Basically for that amount of money you are covering 80% almost forcing you to spend on average $200 per month to pick up that 20%. You still need a drug plan, average premium is $36 mo, Dental and vision plan for ave $56 mo, average cost for a hearing aid is $5000. In a nut shell you are only pre paying for your health services if you get sick. Advantage plans cover everything that original medicare covers and more. For a low premium, often a $0 premium you can have plans with $0 ded, as low as a $3700 MAx out of pocket, $0 co pays to see a PCP, up to $4000 in dental coverage per year, Hearing aids as low as $99 per year, average of $200 per year in vision coverage. The benifits are so much more and thousands less.

 

[Davey Crockett]

I have A&B plus blue cross.

No interest in risking what we have by going to the unknow for me.

I'm in the same boat as you db. A, B and blue cross for about 1K a month and scared to drop the insurance. These so called "golden years" are more complicated than I thought they would be. There is no rest , work most of the life trying to earn something then retire and spend the rest of your life trying to figure out how to keep it. I think it's only going to get worse until there is some major correction. Nurses make around $ 75,000 a year and they are striking , It costs big money to get them to come back to work so theres that, but I think the biggest part of the problem is there are a lot of able bodied people who don't want to work and they don't have insurance because they know they can't be turned down for medical care so I guess we pay thier share too. I'm not sure how we can change that .

 

[Retired-Guy]

Jim Simmers says it all in his last post. Thanks Jim!

 

[BDub]

With our advantage plan we have to stay in network. With Sanford. Or there are additional charges. But that is OK because we have gone to Sanford forever. We have no complaints with Sanford. I just got a check for over $1000 to help pay a dental bill. Without having to pay for monthly dental insurance. Jim Simmers is right on.

 

[Davey Crockett]

Thanks Jim for stepping up to the plate and sharing your knowledge .

 

[Jim Simmers]

Thanks for the kind words. I have been pretty much non existent on this page for a few years. Glad to be back and to contribute. There is no one fix for everything or any one and you definitely have to do what’s best for you. The first couple of posts on this thread alarmed me because there was no merit to them. Sorry to say. I love my profession. Medicare has been good for me and my family personally as an agent. But most importantly it’s the people that I have helped with their Medicare benefits that it has helped the most and that’s why I do what I do. I know it’s hard and confusing. It is for me as well, I just have been trained on where to go and what to do. Like catching a fish, I understand Medicare. I don’t know why but I do. I have seen the good and bad of it and the bad of it in most cases is still better than the good of other plans. The good of it is you save a ton of money, even in a bad year, you get a ton of benefits that you wouldn’t normally get or you might have to pay a large premium for them. AARP printed an article I think last September that shows why advantage plans are here to stay and it isn’t because it’s big money for insurance companies. They do make out well but like I said earlier their is a limit on what their profit is so they build a large member enrollment. Strength in numbers. Then you get all the benefits you need and it won’t break your bank. To not have an advantage plan you are surely insurance poor.
****Disclaimer***** I also sell medigap, Medicare supplements. So it’s not like I don’t know or understand how they work. I just believe that 99.9% would be better off on an advantage or even a cost plan if an advantage plan is not available in your area.
Again, thanks for the kind words.

 

[tikkalover]

Type this into whatever search engine you use- Medicare secondary insurance - it helps explain things.

I'm 62.5 years old and the question I have is, can or should you sign up for a supplemental insurance before you actually retire? Would it possibly be cheaper if you sign up early?

Like the earlier in life you sign up for life insurance the cheaper it is.

 

[eyexer]

Just that med sups are expensive and offer no other benefits. As you know, med sups only pay when original Medicare pays. Medicare does not have a max out of packet, does not cover observation, it also does not offer drug coverage, hearing, dental, vision, meal programs, rewards for being healthy, OTC items. There are so many benefits to an advantage plan over medsups. On a dollar for dollar comparison, it over 90% of the Medicare population would benefit from and advantage plan. Original Medicare Part B premium will be about $174.50 in 2024. Basically for that amount of money you are covering 80% almost forcing you to spend on average $200 per month to pick up that 20%. You still need a drug plan, average premium is $36 mo, Dental and vision plan for ave $56 mo, average cost for a hearing aid is $5000. In a nut shell you are only pre paying for your health services if you get sick. Advantage plans cover everything that original medicare covers and more. For a low premium, often a $0 premium you can have plans with $0 ded, as low as a $3700 MAx out of pocket, $0 co pays to see a PCP, up to $4000 in dental coverage per year, Hearing aids as low as $99 per year, average of $200 per year in vision coverage. The benifits are so much more and thousands less.

How can you have a $0 premium? Thankfully I won’t have to worry about all this when I hit Medicare age because my wife will have federal government health insurance forever

 

[Jim Simmers]

Type this into whatever search engine you use- Medicare secondary insurance - it helps explain things.

I'm 62.5 years old and the question I have is, can or should you sign up for a supplemental insurance before you actually retire? Would it possibly be cheaper if you sign up early?

Like the earlier in life you sign up for life insurance the cheaper it is.

No, supplements are age specific and increase as you age. Advantage plans vary in premium and are usually more cost effective. Premiums increase slower but usually stay the same for a few years at a time and doesn’t matter if you’re a kid on Medicare or 100 years old, premiums are the same. They have been known to take a decrease in years.

 

[Jim Simmers]

How can you have a $0 premium? Thankfully I won’t have to worry about all this when I hit Medicare age because my wife will have federal government health insurance forever

Insurance companies agree to accept what the federal government pays them and isn’t charging an additional premium. You might think that it’s too cheap, it can’t be any good. Normally you get what you pay for. But in the wonder world of advantage, some of the $0 premium plans have the most protection and best benefits. Strength in numbers.

 

[Davey Crockett]

How can you have a $0 premium? Thankfully I won’t have to worry about all this when I hit Medicare age because my wife will have federal government health insurance forever

That's what I thought too. Wife is retired Postal worker so we have fed BCBS. Unless there is something I'm missing here , the feds now require everyone on Medicare to have Medicare part B . I sure hope someone can correct me on this so I can get them to quit taking it out of my SS.

We are caught between a rock and a hard spot, If we keep our insurance we are still forced to pay an extra $ 350 a month for part B that we won't need and that extra $ 350 makes our health insurance unaffordable .

Then to top it off , there is something new rolling off the assembly line in 2024 , PSHB that contradicts what I just said.

1. 2024 open season.
2. If you are an annuitant as of January 1, 2025, and not currently participating in Medicare Part B, you ARE NOT required to enroll in Medicare Part B to continue your health insurance coverage in the new PSHB Program. Participation in Medicare Part B is voluntary; however, enrollment in Medicare Part B may reduce your overall costs for health care-related expenses and may provide greater value.
   1. Your covered spouse and eligible family members will also not be required to enroll in Medicare Part B even if they are age 65 or older; however, enrollment in Medicare Part B may reduce overall costs for health care-related expenses and may provide greater value.
   2. Note: If you are an annuitant as of January 1, 2025, and are already enrolled in Medicare Part B, you ARE required to remain enrolled in Medicare Part B to continue coverage under PSHB.

 

[eyexer]

Insurance companies agree to accept what the federal government pays them and isn’t charging an additional premium. You might think that it’s too cheap, it can’t be any good. Normally you get what you pay for. But in the wonder world of advantage, some of the $0 premium plans have the most protection and best benefits. Strength in numbers.

So what is the difference between sups and advantage in a nutshell?