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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.

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Angel1955  
#1 Posted : Tuesday, January 31, 2012 1:41:07 AM(UTC)
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Time is getting short - and will have to make that decision - -was waiting for finalization of retirement pay - and go for Social Security (a little bit) and have the Medicare B paid from that instead of my retirement pay - - please tell me what is so wonderful about Medicare B - my co-pays for the year - after the hospital - still do not equal the yearly Medicare B amount - -

Fed1969  
#2 Posted : Tuesday, January 31, 2012 1:51:44 AM(UTC)
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Some will tell you know.  This is a good answer if you remain healthy the rest of your life.

I have Medicare B since I don't know if I will remain healthy the rest of my life.  I also have BCBS.
upandup  
#3 Posted : Tuesday, January 31, 2012 4:01:53 AM(UTC)
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Having Medicare Part B with a plan that waives copays gives you additional protection and provides you with very predictable yearly medical expenses. It also saves your FEHB plan money, which may help keep premiums lower over time.

OUtside  
#4 Posted : Wednesday, February 01, 2012 1:00:31 AM(UTC)
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Advantages of enrolling in Medicare Part B include the assurance of fehb co-pays waived for Part B-type services (by most fehb plans) as well as access to a large network of providers who accept Medicare patients. There is also the assurance of avoiding any penalty for late enrollment if circumstances change.

But this says little if anything whether the enrollment would likely be cost effective, which would require waived co-pays to exceed the cost of premiums paid.

Fehb co-pays are generally low. Medicare sets the rate, typically a low rate, for doctor and for in hospital care for fehb retirees age 65+ whether or not they are enrolled in Medicare.

These factors suggest it is not so easy to save more in fehb waived co-pays than to pay in in Part B premiums.

For example, let’s say a retiree is enrolled in BC Standard and Medicare Part A. Many Part B-type services, for example, surgery, would require a co-pay of 15%. PPO office visit primary care is $20 per visit, $30 for specialist, these might be in the vicinity of 15% also. Some care (such as preventive, immunizations, and accident) requires no co-pay.

If we generalize and say out of pocket expenses for Part B-type services would be around 15% of the total for the services, then the Part B premium of $1200 per year (higher if income is high) would cover about $8,000 of such care in a year (again, higher if income is high). This would be the break even point for these expenses, after which the retiree would continue to pay Part B-type co-pays for these expenses up to the plan catastrophic provision, in any given year or years.

Non Part B-type health expenses would include prescription drugs, in hospital stays (covered under Part A with no co-pay required), and dental care (both preventive and restorative, a small portion of which would be covered under the plan).

Non Part B expenses would not count toward the $8,000 threshold level but suggest that a year of high health care expenses for the retiree could easily reach $10,000 or more (and could be much higher, for example, for lengthy in hospital stays or for expensive prescriptions).

The point is, a lot of care could be received by the retiree for co-pays totaling $1200 per year for Part B-type services. Just one off-the-wall example, for each of 25 years beginning at age 65, if the retiree receives $10,000 in total care of which $8,000 is for Part B-type expenses, at age 90 he/she will have received $250,000 of total care, $200,000 for Part B-type care and $50,000 other care.

And according to this example, total co-pays for Part B-type services would still not exceed the $30,000 in Part B premiums he/she would have paid over the same period of time.

Disclaimer, I do not 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.

fedman53  
#5 Posted : Wednesday, February 01, 2012 1:17:44 AM(UTC)
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Good review OUtside. Another thing to consider, if you are under FEHB family coverage, the Part B premiums/coverage is for each eligible person. Both an eligible husband and wife would have to pay the Part B premiums ($2400 minimum)
OUtside  
#6 Posted : Wednesday, February 01, 2012 2:51:21 AM(UTC)
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Good point, fedman53; comparable numbers for self and spouse in same example:

Part B premiums, $2400 per year (higher if high income), $60,000 in 25 years.

Threshold care level for cost effectiveness, $16,000/yr.

Off the wall example for self and spouse over 25 years: if $20,000 total health care received each year of which $16,000 for Part B-type services, total cost of care received would be $500,000, $400,00 for Part B-type services, $100,000 for other services. Co-pays paid for Part B-type services would not exceed Part B premiums during the same period.

OUtside  
#7 Posted : Wednesday, February 01, 2012 4:16:29 AM(UTC)
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Correction, my last post should have said ‘…$400,000 for Part B-type services…’

Fed1969  
#8 Posted : Saturday, February 04, 2012 5:43:13 AM(UTC)
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Thanks for the information.  I still think part B makes sense for most.
martyb  
#9 Posted : Saturday, February 04, 2012 11:50:37 AM(UTC)
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Spouse & I will sign up for Medicare at 65, but will not be taking part B.
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Fed1969  
#10 Posted : Saturday, February 04, 2012 8:38:12 PM(UTC)
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martyb wrote:
Spouse & I will sign up for Medicare at 65, but will not be taking part B.

I know some healthy people in their mid 70s that only have part A and thus far things are working well for them.
martyb  
#11 Posted : Saturday, February 04, 2012 10:55:27 PM(UTC)
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Right....
martyb2012-02-05 07:20:15
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Not retiring yet  
#12 Posted : Monday, February 06, 2012 6:59:50 AM(UTC)
Not retiring yet

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Yes, but, if you can find ALL of Angels  posts,   you will learn she is a widow.  Therefore, the per person/family  does not/ or may not apply.  If she is still keeping her medical benefits, should she enroll in Medicare B?   or is that just another expense?   You have to really learn her whole story (such as needing medicines/ and already lost some time with medical issues), and that will give you a better picture. 
FSO(RET)  
#13 Posted : Monday, February 06, 2012 7:54:50 AM(UTC)
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I got it and then decided I didn't really need it, at least not now.  While I am rolling the dice somewhat it made sense for me to drop it.  All you do is fill out a form and talk to a service rep on the phone if you want to withdraw.  No visit to an office needed. 

shelter1  
#14 Posted : Monday, February 06, 2012 9:24:15 AM(UTC)
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I picked up Part B in July 2011. So far it has not paid off. I've gone to the doctor only two times. It would have been far cheaper to just cough up the $25.00 BCBS co-pays, but I caved in under the pressure
of all those "what ifs".

Overall, I am just grateful to be healthy and not need thousands of dollars of care. That's the only way to look at it, I guess.
OUtside  
#15 Posted : Tuesday, February 07, 2012 6:39:14 AM(UTC)
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It’s definitely possible to save more in waived fehb co-pays than to pay in Part B premiums, in which case, enrollment would be cost effective.

But this is not so easy to do. One reason is that fehb co-pays are generally low; shelter1’s post is an example of this with doctor visit co-pays of $25 per visit. An off the wall example is it would require 48 doctor visits at $25/visit to break even with the Part B premium of $1200 per annum (more if income is high). In the case of BC Standard, where primary care PPO doctor visit is $20, it would take 60 visits; specialist PPO, 40 visits.

The other reason is less visible. Medicare sets the rate for doctor services and in hospital care. This is usually low. When fehb co-pays are fixed such as for doctor visits, the co-pay is usually the same, but for other services, for example, surgery or hospital emergency room where doctor is not PPO, the co-pay could be a percentage (depending on the plan); in this case, the percentage is applied to the Medicare rate as used for the fehb allowance-- in other words, the percentage usually would be on a low rate and any difference between the plan allowance and the doctor’s charge would be constrained by the Medicare rules to not more than 15% of the rate (most fehb plans require subscriber to pay such difference out of pocket even having Part B).

shelter1 makes the point that he could have paid his fehb co-pays and come out ahead of the Part B premium. But the other interesting point would be, to get a perspective of the Medicare rate, could he have paid the entire amount of the Medicare rate for those visits and still come out ahead? Of course, fehb and Medicare would not permit this, but it should not surprise if it is so by a significant margin as the Medicare rate is usually low and only two visits were made during the period.

martyb  
#16 Posted : Tuesday, February 07, 2012 6:47:16 AM(UTC)
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Hey, just think about that scenario with Compass Rose for your FEHB provider.  My regular Dr. office visits are between $0 & $10 co-pays!   No doubt that amount will increase in time, but if I were 65 today, no way I'd be picking up & paying for Part B.  It might be a whole different picture when I get to 65 in another 11 years, but as it stands now, I'm suspending FEHB, going on TriCare and not buying into Medicare Part B.
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Fed1969  
#17 Posted : Tuesday, February 07, 2012 7:55:10 AM(UTC)
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TriCare is the way to go for those eligible.
upandup  
#18 Posted : Wednesday, February 08, 2012 12:59:22 AM(UTC)
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Fed1969 wrote:
TriCare is the way to go for those eligible.

It does, though, require Part B after reaching 65.
hustonj  
#19 Posted : Wednesday, February 08, 2012 1:55:32 AM(UTC)
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upandup wrote:
Fed1969 wrote:
TriCare is the way to go for those eligible.

It does, though, require Part B after reaching 65.
Or for those considered disabled by the SSA.
 
Because of that rule, my wife has had MediCare as her primary provider (and TriCare for Life as her secondary provider) since I retired from the military.  She was 45 at the time.
 
The "good news" aspect of this is that under the current rules (Congress is considering changing them, of course) once you start paying MediCare Part B premiums, you STOP paying TriCare premiums for that individual.
hustonj2012-02-08 10:05:25
DC2  
#20 Posted : Wednesday, February 08, 2012 5:00:25 AM(UTC)
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martyb wrote:
No doubt that amount will increase in time, but if I were 65 today, no way I'd be picking up & paying for Part B.  It might be a whole different picture when I get to 65 in another 11 years, but as it stands now, I'm suspending FEHB, going on TriCare and not buying into Medicare Part B.

That is the kicker--you have to sign up for Part B if you are on Tricare for Life.

"TRICARE For Life
TRICARE For Life (TFL) is TRICARE's Medicare-wraparound coverage available to all Medicare-eligible TRICARE beneficiaries, regardless of age or place of residence, provided they have Medicare Parts A and B.

While Medicare is your primary insurance, TRICARE acts as your secondary payer minimizing your out-of-pocket expenses. TRICARE benefits include covering Medicare's coinsurance and deductible."
TRICARE For Life
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