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Medicare and Health Care


*This is a non-medical board. This site shall not be used to seek professional, medical or legal consultation.

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age person with End-Stage Renal Disease (ESRD). There are many different parts to Medicare; with all of these options, it can be confusing.

This forum will allow members to share their experience with medicare and seek advice* on certain medicare-related situations.

To read today's top news stories on federal employee pay, benefits, retirement, job rights and other workplace issues visit FederalDaily.com.

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fedwife  
#1 Posted : Monday, June 24, 2019 8:48:32 PM(UTC)

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If you have Medicare Part B with your Federal insurance, can you please tell me if the extra cost is still worth it to you when you have years where the premium is more than the copays would have been with your insurance? Thank you for any input on the extra cost. I need to make up my mind this week, and having a hard time with that part of it.
OUtside  
#2 Posted : Tuesday, June 25, 2019 3:11:10 PM(UTC)

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fedwife, you're asking the question that Checkbook tries to answer by analyzing a vast database of healthcare statistics and boiling the results down to how average people in situations would do in similar situations to yours on an FEHB plan by plan basis. In other words, whether they would have lost or saved money given assumed health experiences of low, average or high medical expenses overall and given the insurance plan (both with and without Part B). It also will give you your worst case scenario for out of pocket costs if you have a very bad year with very high out of pocket expenses.

If someone replies to your question saying they saved money having Part B and someone else replies they lost money with Part B, that's not going to be a better answer than Checkbook which has analyzed thousands of situations and summarized them in numerical form for you to review.

You are asking a very sensible question and deserve to understand the best answer Checkbook provides.
someoldguy  
#3 Posted : Tuesday, June 25, 2019 3:24:42 PM(UTC)
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I was curious about this so I visited checkbook-dot-org and could not find any ratings of medicare or medicare part B. Lots of ratings of medical providers but nothing specific to medicare.
DISCLAIMER: You read it on an open internet forum :)
OUtside  
#4 Posted : Tuesday, June 25, 2019 6:09:19 PM(UTC)

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Go to the web site below, charge the few bucks to your credit card for a subscription, log on and answer a few questions such as age, self or self plus one, and a couple others, then review the numbers as much as you wish.

If you want clarification of what you are seeing, post questions here and I will try to clarify.

If you want to understand just how they go about formulating their analysis, I think they have a chapter on that to read. I also think they have an entire chapter discussing Medicare and how it relates to FEHB.

https://www.checkbook.org/newhig2/hig.cfm

If you are still employed, your personnel office may have a subscription you can use gratis.

Edited by user Tuesday, June 25, 2019 6:11:54 PM(UTC)  | Reason: Not specified

fedwife  
#5 Posted : Tuesday, June 25, 2019 8:35:19 PM(UTC)

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Yes, it was helpful and showed me it would cost more out of pocket to get Part B, overall. You're right OUtside, it's a great website. Thank you for the suggestion.

I think what else is making it so hard to decide is the website also says to read the articles about the advantages to Part B that outweigh the cost for "most retirees". The penalty for life really makes it hard. I wonder why have it. If we should need it down the road, it might cost too much. It is a big part of my struggle, because it is expensive for us.
OUtside  
#6 Posted : Tuesday, June 25, 2019 9:28:57 PM(UTC)

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I haven't visited the site in awhile. Please specify the section or page where your reference to 'most retirees' is referred to.

The reason the penalty works like that is bc the premium is expensive enough so that without the penalty many people would just wait to enroll until they got sick enough for it to be cost effective to have it, then they would join.

Another thing to think about, if you decide not to have it and save $ by not paying the premium, consider putting at least some of that into a savings account in case, as you say, you need it down the road.

Note that using Checkbook, you can also consider which FEHB plans would be more or less costly both having Part B and not having it. Suppose you have Part B, some plans save you a lot of money vs other plans. Similarly, without Part B, some plans cost you a lot more money than other plans. Of course, you have to pay close attention to which plans we are talking about, read the brochure, compare to your current plan, etc, which takes extra effort. When you reach Medicare age, FEHB allows you a mini open season in order to change FEHB in the middle of the year, if you want to.

Another way to go is to take Part B and then select a Medicare Advantage plan and 'suspend' (do not cancel) your FEHB plan on a temporary basis. If budget is a problem, this can be a very cost effective way to go. You have to read Advantage brochures to make your selection. If you just turned 65, you're probably received mailing solicitations from Medicare Advantage plans. They are worth a look and I think Checkbook has a section on this topic though, as far as I know, doesn't provide estimates for these types of plans.

Edited by user Tuesday, June 25, 2019 9:31:11 PM(UTC)  | Reason: Not specified

fedwife  
#7 Posted : Wednesday, June 26, 2019 7:38:36 PM(UTC)

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That sentence was in the article "What Federal Annuitants Need to Know About the FEHB Program and Medicare, in the first paragraph after the list.

We had looked at the two plans that give assistance towards the cost, but the drug part wasn't good for my husband's medications. I thought about Medicare Advantage, but then someone told me she had to switch to regular Medicare to get her knee surgery because the doctor didn't take Medicare Advantage for the surgery. I know two people that have problems with the doughnut hole and their Medicare Advantage. But it could be something down the road, which is why not getting Medicare part b now is worrisome.

Saving the money for later is a good idea.
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Sante123 on 11/25/2019(UTC)
OUtside  
#8 Posted : Wednesday, June 26, 2019 9:47:16 PM(UTC)

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Thanks for the information. Yes, I see what you are referring to.

However, read the page entitled 'Should Federal Annuitants Enroll in Medicare after age 65?' I can't explain the difference, however, if the data tables support this other page, I think that is important, for one thing, those tables should reflect the generally economical co-pays with FEHB plans (as mentioned in this other page), which means you have to have a lot of co-pays waived with Part B in order exceed the Part B premium.

If you do not take Part B (or even if you do) make sure you understand how FEHB plan allowances are based on Medicare rates after age 65 for retirees. Those rates are generally low or even quite low, and protect the retiree from high out of pocket costs for services. For example, in the political debates recently with respect possibly Medicare for all, it was pointed out the Medicare rates for in patient hospital, Medicare Part A, are so low that if hospitals had to charge such rates to everyone, not just seniors, many hospitals would go out of business. There should a page in your FEHB brochure about Age 65+ without Medicare, or similar wording, which details this subject. It's a good idea to read and understand this page thoroughly.
OUtside  
#9 Posted : Tuesday, October 1, 2019 8:53:48 AM(UTC)

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Sorry for this late comment.

To the statement above ('I think what else is making it so hard to decide is the website also says to read the articles about the advantages to Part B that outweigh the cost for "most retirees"'), I think what they are saying here is, in their cost comparison tables, where there is a plan or plans where the estimates for out of pocket costs including premiums is less for combining Part B with the fehb plan, then if 'most retirees' enroll in those plans and Part B, then those retirees are likely to come out ahead of retirees who do not take Part B.

But if your fehb plan is not one of those plans, then the estimates for your plan in the cost comparison tables should show you not coming out ahead.

Granted, it's not an easy subject and I think Checkbook could have worded the point better. For example, if 'most retirees' do not enroll in the few plans where this better outcome occurs, then it is confusing to refer to 'most retirees,' as if they do without further clarification.

Edited by user Wednesday, October 2, 2019 8:43:25 PM(UTC)  | Reason: Not specified

PattyPies  
#10 Posted : Friday, October 11, 2019 9:58:31 PM(UTC)

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I have been retired since June 2013. When I retired I was only 62 so I kept my Blue Cross Blue Shield Federal Employee plan when I turn 65 I signed up for Medicare in the middle of all this when I retired I was also diagnosed with a progressive neurological disease where I am in a doctor's office or for tests more often at night but by having Medicare and my Blue Cross Blue Shield Federal Employees I pay no co-pays, no deductibles, basically no costs other than medication and I don't fall into the donut hole. To me it's safer because no matter what happens I know it won't have to come up with all this money. On the other hand if you just keep your Blue Cross without Medicare you going to have a lot of problems because you still have that high out-of-pocket amount to reach Etc
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GSBS on 10/12/2019(UTC)
PDXbiker  
#11 Posted : Saturday, October 19, 2019 12:17:54 AM(UTC)
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I have been with an FEHB HMO plan for the last 35 years. Upon retirement and age 65 I did not opt for part B. I would have received absolutely zero reductions in copays and deductibles whether I had B or not within my HMO network. All financial benefit would have gone to the HMO in dropping off more of its costs to Medicare B. With Medicare A plus FEHB plus my HMO plan I am pretty well fully covered. Only if I desired to go out of network would B be a benefit to me. I would also require B if I wanted to join a Medicare Advantage Plan. For those with Blue Cross plans, etc. Part B is essential. But in my particular case with an HMO Medicare B gained me nothing in dollar benefits.
old fed  
#12 Posted : Saturday, October 19, 2019 8:06:29 AM(UTC)
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Originally Posted by: PDXbiker Go to Quoted Post
I have been with an FEHB HMO plan for the last 35 years. Upon retirement and age 65 I did not opt for part B. I would have received absolutely zero reductions in copays and deductibles whether I had B or not within my HMO network. All financial benefit would have gone to the HMO in dropping off more of its costs to Medicare B. With Medicare A plus FEHB plus my HMO plan I am pretty well fully covered. Only if I desired to go out of network would B be a benefit to me. I would also require B if I wanted to join a Medicare Advantage Plan. For those with Blue Cross plans, etc. Part B is essential. But in my particular case with an HMO Medicare B gained me nothing in dollar benefits.


why do you say part b is essential for those with BCBS? i opted out of b because, for me, the premiums are too expensive and i get little in return. i realize it can be essential for others.

BCBS has an out of pocket max/year which, while not insignificant,is not burdensome for me. i realize others have different circumstances with which to deal.

and as you mention the part b enrollment benefits the insurance company, not me. if they reduced my BCBS premiums based on part b enrollment i might think about it. i realize they offer $800/yr (for 2020) towards part b premium but that still is not significant in relation to my costs. plus i think i have to go chase that. just lower my premium up front and don't make me work for that and then we can talk.
Sante123  
#13 Posted : Friday, November 22, 2019 11:46:24 AM(UTC)
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For everyone interested in the “Should I take Part B?” issue, please answer the following questions:
1) Do you expect to be healthier when you are 75 or 85 than you are (now) at 65?
2) If you expect to be less healthy as you get older, won’t that tend to increase the cost of your healthcare?
3) If you rely on Part A and an FEHB plan to pay those increasing costs, over time won’t that cause the premiums for your FEHB plan to rise faster than they would have if you (and most folks like you) had taken Part B?
4) If so, in 10 or 20 years could you find yourself in an FEHB plan whose premiums had grown unaffordable?
5) If so, could you then find yourself stuck with the choice of an expensive FEHB plan or Part B with premiums based on a 100% or 200% penalty?

I would argue that a prudent person would likely answer YES to ALL of the above questions. Plans that traditionally served retirees just fine without Part B, plans like SAMBA, ended up stuck with a cohort of older, sicker enrollees. The result was skyrocketing premiums and the steady increase in deductibles and copays. Ditto for many of the high option plans. And what about HMO’s? Well, they used to be the affordable choice among health plans. Now they are generally quite expensive. Why? Because they offered such a nice package of benefits that many folks didn’t see the need for Part B. Another reason was that many HMO’s offered no price concessions (like waiving deductibles, copays or coinsurance) if you chose Part B. So, the HMO’s got stuck paying for the bulk of the ever-rising healthcare expenses of their loyal, but increasingly elderly enrollees.

Now comes the kicker....If you ever expect later in retirement to need Part B for more than a few years, then you should just go ahead and choose Part B right away. Why? Because, NO MATTER WHEN YOU ENROLL LATE FOR PART B, it will take only about 5 years from that point forward for the accumulated premium penalty to eat up ALL the money you saved in the meantime. After which, on a total net cost basis, you will end up paying more for Part B than you would have if you had signed up when you first had the chance.
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Citrine  
#14 Posted : Friday, November 22, 2019 9:47:45 PM(UTC)
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FEHB premiums do not go up with age.

If a plan gets expensive, the annuitant can easily change plans during an open season.



Sante123  
#15 Posted : Saturday, November 23, 2019 12:17:59 AM(UTC)
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Originally Posted by: Citrine Go to Quoted Post
FEHB premiums do not go up with age.

If a plan gets expensive, the annuitant can easily change plans during an open season.





No one is saying FEHB premiums go up with age. However, they do go up faster in plans that are full of older retirees who have never chosen Part B. That is the danger for someone who chooses a “rich benefit” FEHB plan in order to avoid paying another premium.

An annuitant who has never taken Part B coverage wouldn’t switch to just any cheaper plan when his/her own plan gets too pricey. That person would be looking for another “rich benefit” plan that could provide full protection on its own, without Part B. The problem is that most such plans would likely be pricey as well. Of course, the person could throw in the towel and finally opt for Part B + a cheaper wrap-around plan. But then they would be confronted with the Part B penalty for having postponed their enrollment. The more years one waits, the bigger the penalty. That’s the gamble. It may pay off for some folks with good genes and even better luck, but the odds are against it.
freeageless  
#16 Posted : Saturday, November 23, 2019 7:29:41 AM(UTC)
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Originally Posted by: Sante123 Go to Quoted Post
For everyone interested in the “Should I take Part B?” issue, please answer the following questions:
1) Do you expect to be healthier when you are 75 or 85 than you are (now) at 65?
2) If you expect to be less healthy as you get older, won’t that tend to increase the cost of your healthcare?
3) If you rely on Part A and an FEHB plan to pay those increasing costs, over time won’t that cause the premiums for your FEHB plan to rise faster than they would have if you (and most folks like you) had taken Part B?
4) If so, in 10 or 20 years could you find yourself in an FEHB plan whose premiums had grown unaffordable?
5) If so, could you then find yourself stuck with the choice of an expensive FEHB plan or Part B with premiums based on a 100% or 200% penalty?

I would argue that a prudent person would likely answer YES to ALL of the above questions. Plans that traditionally served retirees just fine without Part B, plans like SAMBA, ended up stuck with a cohort of older, sicker enrollees. The result was skyrocketing premiums and the steady increase in deductibles and copays. Ditto for many of the high option plans. And what about HMO’s? Well, they used to be the affordable choice among health plans. Now they are generally quite expensive. Why? Because they offered such a nice package of benefits that many folks didn’t see the need for Part B. Another reason was that many HMO’s offered no price concessions (like waiving deductibles, copays or coinsurance) if you chose Part B. So, the HMO’s got stuck paying for the bulk of the ever-rising healthcare expenses of their loyal, but increasingly elderly enrollees.

Now comes the kicker....If you ever expect later in retirement to need Part B for more than a few years, then you should just go ahead and choose Part B right away. Why? Because, NO MATTER WHEN YOU ENROLL LATE FOR PART B, it will take only about 5 years from that point forward for the accumulated premium penalty to eat up ALL the money you saved in the meantime. After which, on a total net cost basis, you will end up paying more for Part B than you would have if you had signed up when you first had the chance.


Brilliant post! I am 77 years old. I have always had Medicare Parts A and B since I retired. For the past 5 or 6 years I have had GEHA standard. I have had several surgeries since I retired to include bypass surgery. I have never had to pay one penny out of pocket for those surgeries. Whatever Medicare doesn't pay in almost every case, GEHA has paid it. I don't trust doctors, and in some cases I have gotten 4, or 5 different opinions from different doctors regarding a surgery or procedure. In all cases Medicare covered the cost, and GEHA paid the balance.

In my humble, anyone who does not get Medicare Part B is being penny wise and pound foolish.

Edited by user Saturday, November 23, 2019 7:39:53 AM(UTC)  | Reason: Not specified

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GWPDA on 11/23/2019(UTC)
OUtside  
#17 Posted : Saturday, November 23, 2019 8:53:17 AM(UTC)

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Please define '“rich benefit” plan that could provide full protection on its own, without Part B'. I think a basic assumption of Checkbook's analysis is that anyone who thinks just because a plan's subscriber premium is high automatically has superior coverage might likely be able achieve savings by switching to a cheaper plan with adequate benefits.

In fact, if older retirees lacking Part B tend to do this, that would similarly increase the lower cost plan for all subscribers in that cheaper plan. suggesting cheaper plans might not be good buys anymore.

And yet they still seem to be available.

Note: I don't take a position for or against enrollment in Medicare Part B and believe everyone should make their best decision after learning as much as possible about the subject.
Sante123  
#18 Posted : Saturday, November 23, 2019 3:16:55 PM(UTC)
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Actually, “rich benefit plan” is a phrase that Walton Francis often uses to describe FEHP options that emphasize broader, more generous coverage. He does not say that expensive plans are always the most generous, but most in fact are. He does say, repeatedly, that all FEHB plans are good ones. But that does not mean that they are all equally good. If they were, we would all prefer the ones that had the lowest cost sharing, the largest networks, overseas coverage, and the cheapest prescriptions with an open formulary. But they aren’t, so we are expected to choose the cost/benefit package that is most important to us and our families. This year’s Guide says “ All plans are reputable, and all will pay the benefits they promise. Every plan, not just the ones with the lowest premiums, has gaps or loopholes of one kind or another. But the lower-premium national plans generally expose you to higher copayments and deductibles, so they may not save you as much money as you think.” One of the biggest loopholes concerns prescription coverage, an element of great concern to annuitants. Prescriptions account for between 25-30% of all FEHB claims costs, so more generous prescription coverage is very attractive to annuitants. In an attempt both to differentiate between plans and also to attract enrollees who wish to avoid Part B premiums, insurers have created plans that incorporate “cadillac” features like this, in exchange for a higher premium. Over time, attracting high cost annuitants tends to to increase the operating cost of such plans, which are usually, but not always, referred to as “high option.” With this in mind, Walton Francis himself has openly described plans like APWU High Option and BCBS Standard as not being good deals.

Note that when the Checkbook Guide discusses annuitants, it’s advice is usually predicated on the fact that lower cost plans are a better deal precisely because they coordinate wrap-around coverage with Medicare Part B, which removes one of the key differentiators between them and the high option plans. This year’s Guide says.....“Perhaps you are a retired couple with Medicare parts A and B. The great majority of such retirees select the Blue Cross Standard Option. But we rate the MBHP High Deductible Plan, the Aetna Direct plan, the FEP Blue Focus option, the Blue Cross Basic option, the CareFirst High Deductible plan, and the new Aetna Advantage plan as likely to save you $4,000 or even more. Why? Most of these plans, like Blue Cross Standard Option, allow you to pay nothing for hospital and physician charges when you have Medicare parts A and B. In some of them their prescription drug coverage is not quite as good, but their premiums are far lower. So, you start the year with major savings in hand. The Consumer-Driven plans have “Personal Care Accounts” that you can spend on dental costs and drugs that Medicare doesn’t cover to offset the cost of the Medicare premium, and Blue Cross Basic now offers a similar arrangement through a premium rebate. Our ratings even show that enrolling in Part B and several of these plans will reduce your overall cost.” If this is true, then it’s also true that overall costs will not be reduced with these “best buy plans” if you don’t have Part B. That’s the predicament facing an older annuitant who never signed up for Part B.

Outside, you asked about the impact of aged, non-Part B, annuitants who enroll in highly touted lower cost plans. You analogized that if my argument concerning the adverse impact on high option plans were true, then the same should be true for lower option plans. You seem to feel that the continued existence of affordable plans proves it is not. I disagree. Just a few years ago, the AWPU CDHP plan was the highest rated “best buy” in the Checkbook Guide listings. Now it isn’t and Walton Francis no longer mentions it. For decades, Northern California Kaiser was the paragon (and the actual originator) of the low-cost-yet-comprehensive HMO model. The problem with both? Adverse selection. Premiums rose at an above average pace and cost sharing became less generous. Other plans whose premiums are still fairly low have nevertheless greatly increased their catastrophic maximum targets in the last few years. This is a direct (and non-premium-related) financial disincentive to enroll for those who lack Part B coverage. Everywhere you look, the trend is to incentivize Part B participation. Partly this is because OPM insists on it, but it’s also because the alternative may well be descending a slippery slope into unaffordability.

Edited by user Saturday, November 23, 2019 3:20:56 PM(UTC)  | Reason: Not specified

OUtside  
#19 Posted : Monday, November 25, 2019 8:50:45 AM(UTC)

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You seem to be saying there still are lower cost plans but the trend is against them due to the factors you mention. That seems reasonable but I don't think Checkbook makes this clear either in the discussion sections on Medicare or the financial tables. Perhaps I missed it although I was looking for it because there was a brief exchange about Checkbook's discussions earlier in this thread.

One question I have is aren't the majority of subscribers in most plans active employees? Also, I think someone mentioned not too long ago in these pages that the percentage of fed retirees without Part B is, as I recall, around 20% or so. So, even with adverse selection, as you say, it could be modified at least somewhat by the smaller numbers involved.

Another question I have is based on a recent Mike Causey column where he said the number of subscribers changing plans during open season is in the single digits. It would seem that's not a lot of people being adversely selected and piling into low copay plans with reasonable catastrophic limits, especially when you consider we are talking about an elderly population a certain number of which might be moving on to where they don't need health insurance anymore anyway.

Perhaps Checkbook, forecasting this trend, as you say, could provide some multi-year tabular forecast along these lines because the current addition, where they conveniently allow a one click display of all plans both with and without Part B but only for the upcoming year, seems to suggest it is not so easy to grab any old plan and expect to save money on waived copays, etc vs the Part B premium in the next 12 months. And some, even when there is savings, it's not a lot.

Edited by user Monday, November 25, 2019 11:16:21 AM(UTC)  | Reason: Not specified

Sante123  
#20 Posted : Monday, November 25, 2019 11:38:42 AM(UTC)
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OUTside:

My prior comment actually focused on the odds being against non-Part B annuitants if they expect their initial cost advantage to last long term.

Regarding the plans themselves, I would say that the trend is against ANY plan that attracts a lot of high cost enrollees without also attracting plenty of low cost enrollees to offset them. The relative number of individuals involved is not the key factor. Folks above age 55 account for 56% of all healthcare costs nationwide even though they are only 29% of the population. The top 1% of healthcare spenders over 55 account for 12% of all costs. The top 5% of spenders over 55 account for 34%. The profile of FEHB enrollees may be different, but probably not by that much. So, getting stuck with even a relatively low percentage of the costliest enrollees can be very detrimental to a plan’s financial stability. Source: https://www.healthsystem...od-or-better-health_2016

With respect to annuitants, the primary buffer that reduces the adverse financial impact is having enrollees choose Parts A and B. A plan provider like GEHA hedges its bets by attracting both low-cost younger participants and folks with Parts A and B. Result: a nice low cost plan with price stability. Others like Aetna Direct game the system a bit by crafting a very nice Medicare-compatible plan that isn’t nearly as attractive to people who lack Part B, no matter how old they are. Result: a plan where the plan is on the hook for (at most) 20% of costs. It can then pass along the savings via the HRA..

The Checkbook Guide has a primary focus on what to choose right now, not over the long haul. It even counsels folks to move from plan to plan if necessary to get the best plan each year. But I think most people don’t do that, and don’t actually want that much instability in their healthcare choices. Peace of mind and familiarity with a trusted plan is worth a lot.

I’ve number crunched (a lot) in the last few weeks, focusing on certain plans favored by the Checkbook Guide. Oddly enough, those that came out on top were better deals over a variety of cost scenarios (none, low, average, high) BUT many ended up in pretty much the same place when “max cost to you” was factored in. HOW COME? Well, plans have jacked up their max payable targets. But you may think that if the high expense profile looks good for a plan, you are safe. Catastrophic max is what happens to the other guy, right? Well, the Checkbook Guide considers the area around $25,000 to be “high.” That is unrealistically low IMHO, especially in HCOL areas or markets dominated by a few healthcare mega corps. One other big wildcard is prescriptions. Plans don’t usually waive prescription copays and coinsurance when Parts A and B are primary. And some have relatively high Rx coinsurance. In plans like the top-rated MHBP HDHP, not only is prescription cost sharing not waived, but neither is the Rx deductible, which can be as much as $4.000. Let’s say you have a chronic condition like diabetes, where medications are really expensive. You could end up spending thousands more even after all your other costs had been capped. And remember, deductible costs are 100% of the plan allowance, not just some piddly copay. So, not only could you eventually run up quite a tab, but you could do so QUICKLY (meaning at a lower cost threshold) if you are unfortunate enough to have large, chronic and unavoidable prescription costs. The Checkbook Guide uses some kind of proprietary profile of weighted healthcare costs. That’s understandable. But it may, and I think does, give a misleading picture for those who have high Rx costs and/or those who live in HCOL areas dominated by large healthcare conglomerates.

Edited by user Monday, November 25, 2019 9:48:38 PM(UTC)  | Reason: Not specified

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