Wednesday, September 14, 2016

Medicare Question (Since This Isn't Clear From Medicare's Website)

Working on budget for next year.  Samaritan Ministries will cost $220 per month for my wife.  I will be eligible for Medicare by then, next February or March.  I can pay another $220 to be "covered" by Samaritan Ministries as well.  It sounds like Medicare Parts A and B are sufficient that I probably don't need the additional coverage of Samaritan Ministries.  Comments?

There is something called a Medicare Medical Savings Account that is similar to an HSA.  I can't find any income limitations on it.  Are there likely enough uncovered Part A and Part B expenses to justify this?

It appears that under Part B you pay 20% of the costs after meeting the $166 deductible.  What have your experiences been?  Is that 20% pretty large if you aren't going to the doctor regularly?


  1. As I'm a vet, I'm covered by the VA; but I have some friends who tell me that it's getting very difficult to find a doctor who accepts Medicare, esp. for new patients. You should check with your current MD and ask his advice.

    Here's a NYT article that may be helpful, though it's a bit dated:

  2. You will be sorry....
    Drugs are expensive even with Medicare Part D.
    Part B costs about $120/ Month

    I would recommend a Part D and Advantage (PPO)

    As an example check out Blue Cross of Idaho.

  3. I pay for B supplement. It can, I think, save you a whole lot of money if you have an expensive problem. Also, B supplemental has a gotcha. If you don't sign up when eligible, you become subject to medical underwriting if you want to sign up later. I don't know all the ramifications, but that was one reason I signed up for it up front.

    Part D is different - you can choose a different plan every year, and there is real competition - at least here in Arizona.

  4. Eric: I find the net effect of Medicare Advantage plans confusing. With just Part B what do I pay for?

  5. What I did when I got disabled was do the regular sign up for Medicare Parts A (that's automatic I think, and covers hospitalization) and B (doctor's visits, flu vaccines, but not other medicines as a rule), then got a "Medigap" insurance plan that covers additional stuff. There are a set number of types of Medigap plans, you just have to find one that best fits your needs and an underwriter for it (USAA didn't, or didn't do the sort of plan I wanted, back then). Mine currently costs $172/month.

    Medicare Part D is competitive as noted by StormCcahser, you'll find yourself reevaluating your plan each year, gaming it with the drugs you know and suspect you'll be taking in the next year (the Medicare web site is pretty neat for doing this, and makes enrollment and changes almost trivial once you decide), avoiding ones that don't give good service (a while ago Express Scripts was beyond horrible, and I'm still going out of my way to avoid them, even putting myself into the hands of CVS/Caremark this year (!), which nonetheless doesn't suck as much as Express Scripts did back then), etc.

    Or you can go the HMO route, or rather it's modern government version, Medicare Part C AKA Advantage which replaces A and B, and generally D. Problems with this include:

    It's the HMO model: the company gets a set amount of money for each patient from the government, and then....

    In terms of money you really want to use healthcare providers inside their network; if you weren't close to Boise that would be an insurmountable problem, and it still might be.

    Obama hates them with a passion for some unknown reason, despite their often giving superior integrated care to sickly urban city dwellers, including of course lots of blacks. So they've been targeted since he entered office, and Obamacare included provisions against them. Don't know where that is or is going, but it's another important detail to consider.

    As noted by others, seriously consider these options, for there are nasty penalties if you don't sign up as soon as you're eligible.

  6. I stayed away from Advantage because it was too much like an HMO - limited networks.

    Part B supplemental, it covers the copays (20% IIRC) that Medicare Part B doesn't pay.

    Part D is very important insurance, though. Without it, you pay all of your prescription costs (unless you are on advantage). With it, you have true insurance. It is not very expensive. It does have the "donut hole" - after a certain level of expenses, the coverage level drops way down until you hit a higher level, and then it gets very good.

    Drugs have recently gotten really expensive. I get my most expensive ones from the VA, while I use non-VA doctors for most of my care (for quality and ease of access).

    However, as someone else has posted, it is getting harder to find primary care doctors that take Medicare, but there are still a lot who do. Remember "if you like your doctor, you can keep your doctor?" Well, Obamacare took a big chunk of money from Medicare, and the result is that primary care doctors are not paid nearly enough. I lost my primary care doctor as a result, and now (same clinic, different doctor), I rarely see an MD at all, just a nurse practitioner. If it gets much worse, I'll switch my primary care to the VA - an option I don't think you have.

    There are Medicare consultants and I think they are free - mine is. They may have a conflict of interest, but they do know the ropes.

  7. Amusingly, yesterday I went to my doctor's office for something that would be normally handled by a nurse practitioner with a consult to the doctor (needed more antibiotics for a sinus infection), and I saw the doctor instead.

    Probably because it was 2:50 pm on a Friday and he didn't have much else to do, and all in all it was better that I saw him in this one case (needed to generally sync up, and harsh experience shows I need 30 days of antibiotics, and everyone is understandably hesitant to write such a script, including the nurse practitioner I saw at the "convenient care" clinic initially ... which I had to go to because that day my doctor's office was down a nurse practitioner themselves :-).

    Not quite the same ethos as when my father handled the business affairs for several doctors and groups of doctors, including the pediatrician who'd become his primary hunting partner at the same time I started hunting, but at least for now the system in my little corner of SW Missouri is getting the job done, these just drop in clinics that fill a niche between your doctor's office and the emergency room are a really good thing, relieving both of the latter from a lot of pressure. And I've not heard of anyone having problems finding a good doctor who'll take Medicare Part B, although most of them are now working for The Man.

    But the location might also have something to do with it, it's a traditionally very low cost of living area, and I suspect the Medicare payment system isn't precisely calibrated enough to squeeze them as hard as Obama et. al. wants them to.