Saturday, January 16, 2016

Health Insurance

Right now, I have health insurance under the long-term disability plan of my last employer.  This expires about a year from now, and when it does, I need to find insurance for my wife and me.  I will be eligible for Medicare in another six months or so, but Medicare really only covers catastrophic problems.  Medicare supplement insurance seems to be absurdly expensive considering what Medicare covers.   A strong case for recognizing group marriage so that we can become dependents of someone with group health insurance!

The m ore I think about this, the more it makes sense to go on to one of the Christian health sharing ministries along with Medicare for me.  Anything really major (including any pre-existing issues with my heart or stroke history) will be big enough for Medicare and everything?   Should be pretty minor.  The cost of coverage through Samaritan Ministries is only a bit higher than what we pay now.


StormCchaser said...

I don't think you have good information on Medicare.

We have it, and it is quite good insurance, and certainly not just catastrophic coverage.

There are two kinds:


Medicare Part A is hospitalization - maybe that's all you looked at.

Medicare Part B is for physicians, etc.

Medicare Part D is for medicines (George W Bush administration's addition).



You get Medicare Part C - "Medicare Advantage" - which is sort of HMO/PPO for Medicare, and includes all 3 coverages of the other parts.

NONE have pre-existing condition limits, IF you sign up when you are first eligible (roughly).


We use A,B and D for more flexibility. We have Blue Cross supplemental (about $150/month per person). We each have our own Part D provider - Part D comes from private companies. Changing to a different supplemental would subject us to pre-existing conditions, but getting it originally did not - as we both have them as do many retirees. You can change the Part D provider every year with no limits, and it is often worth doing so.

In our area, Mayo Clinic Family Medicine will take no new patients on Medicare, and Mayo will in general not deal with Medicare Advantage. We are both pre-existing patients and did not get Medicare Advantage, so we get all our care from Mayo.

There are various subtleties and traps in Medicare, so you want to read up on it or use a consultant. But... in our experience so far, Medicare is very good.

Our monthly costs look like (per person):
Part A: ~$100
Part B Supp: ~$150
Part D: ~$30

So, for 2 of us, about $600/yr for pretty much top tier Medicare insurance.

There is a danger that in the future, too many providers will not accept Medicare.

But that danger exists for all options, and since Medicare is so big, the vast majority of providers do accept it, even though it doesn't pay them as much as they would like.

As a note... I stayed employed until I was Medicare eligible due to pre-existing conditions. Had I quit, I would have had 18 months of COBRA, and then no insurance. I used 18 months of COBRA twice during my career - 18 month consulting stints between jobs.

I am no fan of Obamacare for sure, but Republicans left us vulnerable to it by not solving the pre-existing conditions problem. It could have been solved at far less cost and enormously less disruption than Obamacare, but Obamacare would never have sold without its claim to "insure the uninsurables."

Also... if your wife will not be eligible for Medicare, you will still need to find insurance for her. Obamacare solves that problem, but with extremely high deductibles in many cases.

Good luck! I think things are a lot better than you think.

Clayton Cramer said...

Thanks. Most of what I know about Medicare is from my mother. What's theed for a supplemental plan?

Clayton Cramer said...

I agree. Failure to fix pre-existing conditions exclusions was a major mistake. Insurers owned most Republicans until Democrats gave them a better bribe.

hga said...

StormCchaser's overview was excellent, but I'll note that supplemental plans are most often called Medigap, there are a wide variety of types with coverage and costs all over the place, I currently pay about $172/month. And the overall Part A, B and D coverage is good (don't go for HMO style Part C plans, especially as Obama and company hate them, despite their providing good integrative care for lots of minorities in cities), as long as you can find good doctors, which I've been able to do in my low cost of living corner of SW Missouri.

StormCchaser said...

I don't remember the details, but basically, the supplemental pays a lot of the Medicare deductibles. If you don't, it may not be. But... if you don't get it during the right time period, then you face pre-existing conditions requirements when you do try to buy it. This stuff requires some researching. Medicare supplemental is also called Medigap. It is also tightly regulated. I don't know if my Part B makes economic sense right now, but due to pre-existing, I didn't want to be excluded if I didn't sign up.


Note that, like other insurance, Medicare pays based on its own schedule.

If you go to a provider who "accepts Medicare assignment," it means Medicare pays them directly, and they can only bill for the Medicare amount. If you go to a provider who does not, they can bill 15% over, and you pay the difference unless your supplemental does - on top of the Part B 20% deductible, and Medicare pays you and then you pay the provider. Mayo Clinic fits into that latter category, which is annoying to me. Also, in that latter category, they have less incentive to make sure a procedure is covered, because they are billing you, not the government. That has cost me some money.

Like I say complex, and please don't take my observations here as the final word.

StormCchaser said...

I just noticed that my cost posting above had an error. It is $600/mo, not $600/yr. BIG difference.