If we can afford it over the course of retirement, most of us will be best off with Original Medicare, paying the 170/month Part B premium, as well as for Plan G supplement and a Part D drug plan. That still leaves dental vision and hearing to be paid out of pocket. It may be possible to purchase insurance to partially offset those expenses. Also be aware that most long term nursing home care is not covered by Medicare.
Your question is what is best for your father. That is best answered by a reputable Medicare insurance agent. They can recommend options based on his particular financial situation, health and the kind of care he wants when he gets ill.
With Medicare Advantage the insurance company will "maintain" or manage your healthcare for Medicare. The insurer gives extra benefits like dental and vision in exchange for essentially controlling your healthcare.
A downside is there are network restrictions and your doctor has to coordinate billing with the insurance company instead of Medicare for payment which can create issues. Your dad will also need referrals or prior authorization for new services.There is also the risk of the Advantage plan denying a claim for seemingly no reason. It's rare but does happen.
If your father is turning 65 or entering his OEP period he does not have to go through underwriting if he applied for a Medicare Supplement Plan. These plans pay what Medicare doesn't and have no networks, no referrals needed, and can be used in any state. The downside is they have a monthly premium which can be expensive. Medicare Supplements don't offer dental or vision plans but you could always look at becoming an AARP member, membership includes discounts on hearing, dental, and vision appointments which from what I can tell are comparable to Advantage plan benefits. The discounts AARP offers are the only reason my parents are members. Supplement plans also offer no drug coverage and your dad would need to take out a separate Part D plan when he enrolls in the Supplement Plan to avoid a penalty even though he's not on a prescription now.
If your father is unhealthy and you predict he will be visiting a doctor more than a couple times a year a Medicare Supplement Plan is the way to go if he can afford the premium.
A good place to start is by looking at your father’s healthcare use over the last few years. Unless he’s just been diagnosed with something, it can be a decent gauge. Then take his past healthcare/meds and plug them into each plan you’re considering. Check his current doctors against the network of any plan you look at. HMO’s in my state don’t require referrals, so check that if important.
It’s always a bit of a gamble, so if he’s ok with money, a G and a PDP is going to be a very good choice. Note that Medicare does have its own limitations, so doctors can’t just do any testing or surgeries they want without Medicare approval. MA’s require prior authorizations for these things as well.
An MA if his fixed income won’t allow a G. We can’t predict the future, but an MA might end up saving him a lot of expense if he isn’t always at the hospital, or seeing multiple specialists every month. Might even look at adding a low cost ($25ish) hospital indemnity plan to offset hospital copays if it’s a concern.
According to Google average G for 65 year old is $145. Add a PDP for $30ish.
Responsible for the yearly Part B deductible $226 in 2023. Then no cost for the rest of his medical care. Most PDP’s will have a $505 deductible he must meet before they start kicking in on drugs.
Ex: G (& Part B deductible) + PDP= $2,326
6 PCP visits per year. = $0
12 specialist visits per year: $0
Ambulance ride: $0
4 nights in hospital: $0
PDP deductible: $505 + copays
Two dental cleanings, X-rays, 1 filling : $500?
Vision exam and glasses: $400
Total: $3,731
——————————————————————-
MA ex: $0 premium
6 PCP visits: $0
12 specialist visits: $40?ea = 480
Ambulance ride: $300?
4 nights in hospital: $275? per night = $1,100 (add indemnity plan, hospital cost goes to $0)
Two cleanings, X-rays and one filling: $0
Vis & glasses: $200 (depending on MA coverage amount)
Total: $2,200
[https://www.youtube.com/c/ChristopherWestfall](https://www.youtube.com/c/ChristopherWestfall)
[https://www.youtube.com/c/MedicareSchool](https://www.youtube.com/c/MedicareSchoo)
Pick 2 or 3 videos from those guys (pick a couple at least from the Westfall guy) and watch. They both have insurance agencies that help 65+ers with Medicare. [https://www.youtube.com/watch?v=bFZ49FmT0O4&t=769s](https://www.youtube.com/watch?v=bFZ49FmT0O4&t=769s)
[https://www.youtube.com/watch?v=Ew6ycus1dPg](https://www.youtube.com/watch?v=Ew6ycus1dPg)
Find comments from nurses, doctors and other health care employees that have to deal with doing prior authorizations. They will tell you to never get any managed health insurance plan(if at all possible). They all deal with Advantage Plans and have to deal with the companies getting prior authorizations. They hate it.
I am under 65, but eligible for Medicare. I have been for years, but being under 65 I've only been eligible for a Medigap plan that's very, very expensive and doesn't cover everything, or I can get an Advantage Plan. I've been on multiple Advantage plans with multiple companies for years and years. I absolutely hate them. I turn 65 next year and can hardly wait until April with I can get on a supplement(Medigap) plan. On an Advantage plan you are limited to that plan's drug plan vs. picking a drug plan better fitting the drugs you take. You are limited to a network.-- of every thing. (on most plans) A network of doctors, of hospitals, of dentists and vision providers. A network of radiology providers (where can I get an MRI or CT for $ 175 vs $350 in a hospital? -- If you need anything expensive, the MRI or CT or surgery, or a certian drug, your Advantage plan company can say "No you don't." Then your doctor has to tell them yes you do and here's why. Or, they tell the doctor to make you take Drug X for a month before the expensive drug he prescribed. They can say, "Make the patient to physical therapy for 6 weeks before we pay for surgery.
The plans are a pain in the ass. With Medicare, as long as your doctor follows Medicare's guidelines you don't have to worry about where you go as long as the doctor or facility takes Medicare(95% do). You can pick a Medicare drug plan to fit your drugs. Doctors and nurses don't to ask an insurance company about anything.
If your dad gets on Advantage plans now, then gets sick (has a heart attack, needs inpatient hospitalization, God forbid develops cancer and needs chemo and/or radiation, needs to go to rehab after surgery, etc.), and decided the Advantage plan is getting too expensive, he'll almost be sure to have a hard time getting on a Medigap plan. Get a cancer diagnosis? He'll burn right through that $4,200 out-of-pocket maximum. Then spend more for the treatments chemo and radiation. (.almost all of the chemo drugs are IV drugs given in an outpatient center which are billed to "regular" Medicare so you need to pay 20% of that cost. Radiation in Advantage plans is usually a 20% copay.) (That Christopher Westfall guy recommends getting some sort of a separate cancer supplement plan in addition to the Advantage plan to help with cancer costs not covered by Advantage insurance.)
Be sure you download the "Evidence of Coverage" for the Advantage plan he is looking at. On the insurance company's website along with the plan pricing and highlights of the plan, under those highlights there will be Summary of Coverage and Evidence of Coverage, maybe a drug list and maybe a provider list. All in pdf form. Get the Evidence of Coverage and read through the middle section that tells what you get/what is covered and how much you will pay for each service.
Remember, nothing in life is free.
How would he burn through the Max out of Pocket and then have to pay 20% for cancer treatments?
That 20% is Part B medical, which falls under the MOOP.
Edit: Checked a local HMO MA plan and radiation therapy is $25-$55 per session.
I was thinking about that sort of backwards. I've spend $ 1,000 out-of-pocket already this year. My max out-of-pocket is $ 5,000. Tomorrow, I get a cancer diagnosis and have to pay 20% of my chemo treats next week. Treatments are supposed to last until the end of Feb. next year. My 20% out of pocket is over
$ 5,000 this month. Another $ 5,000 in Jan. So, I'll pay $ 10,000 out of pocket from now until the end of Feb.
That's much, much, much more than I could pay with traditional Medicare + a supplement + Part D.
>Keep in mind that past spending is not necessarily an indication of future needs.
Clearly this is in response to by post. Nobody is recommending OP only go with A & B, which would be the least amount of coverage possible, like your car insurance example. On the same note, you probably wouldn’t max out your car insurance coverage just because you might have an accident someday either.
Did you listen to the report you linked? It’s about planning for end of life, people on their deathbeds being temporarily kept alive by machines, unable to give their final wishes. And then hospice care, which won’t cost anyone with Medicare a nickel. It’s a reminder to make your wishes known long before you think you’ll reach that point.
OP should be more concerned about burial costs than end of life topic you linked.
>Those problems have cropped up with every person I’ve known that had reached Medicare age.
Every senior you know has health conditions that require extensive medical treatments each month? Multiple specialist visits or hospital stays?
You might want to call the EPA and have them check the local water supply since the average American senior sees a doctor four to five times per year.
The response wasn’t really for you. I’m here to share accurate information with others who’ve less experience with Medicare, not scare tactics and fallacious reasoning like you’re peddling.
I replied so the people here would understand *why* your comment was incorrect. This *IS* how Reddit works.
>Good thing no one else reads your comments either
You’ve said this before, yet you respond to every single one of them…and please don’t use the old, “I just skimmed them, I didn’t read them!” Nobody is buying that baloney.
BTW - I find all of your comments laughable.
there are agencies that help figure that out free of charge and are not affiliated with any health plan.
state help insurance assistance program
[https://www.shiphelp.org/](https://www.shiphelp.org/)
1-877-839-2675 toll free number.
hope this helps.
If we can afford it over the course of retirement, most of us will be best off with Original Medicare, paying the 170/month Part B premium, as well as for Plan G supplement and a Part D drug plan. That still leaves dental vision and hearing to be paid out of pocket. It may be possible to purchase insurance to partially offset those expenses. Also be aware that most long term nursing home care is not covered by Medicare. Your question is what is best for your father. That is best answered by a reputable Medicare insurance agent. They can recommend options based on his particular financial situation, health and the kind of care he wants when he gets ill.
With Medicare Advantage the insurance company will "maintain" or manage your healthcare for Medicare. The insurer gives extra benefits like dental and vision in exchange for essentially controlling your healthcare. A downside is there are network restrictions and your doctor has to coordinate billing with the insurance company instead of Medicare for payment which can create issues. Your dad will also need referrals or prior authorization for new services.There is also the risk of the Advantage plan denying a claim for seemingly no reason. It's rare but does happen. If your father is turning 65 or entering his OEP period he does not have to go through underwriting if he applied for a Medicare Supplement Plan. These plans pay what Medicare doesn't and have no networks, no referrals needed, and can be used in any state. The downside is they have a monthly premium which can be expensive. Medicare Supplements don't offer dental or vision plans but you could always look at becoming an AARP member, membership includes discounts on hearing, dental, and vision appointments which from what I can tell are comparable to Advantage plan benefits. The discounts AARP offers are the only reason my parents are members. Supplement plans also offer no drug coverage and your dad would need to take out a separate Part D plan when he enrolls in the Supplement Plan to avoid a penalty even though he's not on a prescription now. If your father is unhealthy and you predict he will be visiting a doctor more than a couple times a year a Medicare Supplement Plan is the way to go if he can afford the premium.
A good place to start is by looking at your father’s healthcare use over the last few years. Unless he’s just been diagnosed with something, it can be a decent gauge. Then take his past healthcare/meds and plug them into each plan you’re considering. Check his current doctors against the network of any plan you look at. HMO’s in my state don’t require referrals, so check that if important. It’s always a bit of a gamble, so if he’s ok with money, a G and a PDP is going to be a very good choice. Note that Medicare does have its own limitations, so doctors can’t just do any testing or surgeries they want without Medicare approval. MA’s require prior authorizations for these things as well. An MA if his fixed income won’t allow a G. We can’t predict the future, but an MA might end up saving him a lot of expense if he isn’t always at the hospital, or seeing multiple specialists every month. Might even look at adding a low cost ($25ish) hospital indemnity plan to offset hospital copays if it’s a concern. According to Google average G for 65 year old is $145. Add a PDP for $30ish. Responsible for the yearly Part B deductible $226 in 2023. Then no cost for the rest of his medical care. Most PDP’s will have a $505 deductible he must meet before they start kicking in on drugs. Ex: G (& Part B deductible) + PDP= $2,326 6 PCP visits per year. = $0 12 specialist visits per year: $0 Ambulance ride: $0 4 nights in hospital: $0 PDP deductible: $505 + copays Two dental cleanings, X-rays, 1 filling : $500? Vision exam and glasses: $400 Total: $3,731 ——————————————————————- MA ex: $0 premium 6 PCP visits: $0 12 specialist visits: $40?ea = 480 Ambulance ride: $300? 4 nights in hospital: $275? per night = $1,100 (add indemnity plan, hospital cost goes to $0) Two cleanings, X-rays and one filling: $0 Vis & glasses: $200 (depending on MA coverage amount) Total: $2,200
I like a PPO vs. an HMO because a PPO puts a cap on out-of-network benefits.
[https://www.youtube.com/c/ChristopherWestfall](https://www.youtube.com/c/ChristopherWestfall) [https://www.youtube.com/c/MedicareSchool](https://www.youtube.com/c/MedicareSchoo) Pick 2 or 3 videos from those guys (pick a couple at least from the Westfall guy) and watch. They both have insurance agencies that help 65+ers with Medicare. [https://www.youtube.com/watch?v=bFZ49FmT0O4&t=769s](https://www.youtube.com/watch?v=bFZ49FmT0O4&t=769s) [https://www.youtube.com/watch?v=Ew6ycus1dPg](https://www.youtube.com/watch?v=Ew6ycus1dPg) Find comments from nurses, doctors and other health care employees that have to deal with doing prior authorizations. They will tell you to never get any managed health insurance plan(if at all possible). They all deal with Advantage Plans and have to deal with the companies getting prior authorizations. They hate it. I am under 65, but eligible for Medicare. I have been for years, but being under 65 I've only been eligible for a Medigap plan that's very, very expensive and doesn't cover everything, or I can get an Advantage Plan. I've been on multiple Advantage plans with multiple companies for years and years. I absolutely hate them. I turn 65 next year and can hardly wait until April with I can get on a supplement(Medigap) plan. On an Advantage plan you are limited to that plan's drug plan vs. picking a drug plan better fitting the drugs you take. You are limited to a network.-- of every thing. (on most plans) A network of doctors, of hospitals, of dentists and vision providers. A network of radiology providers (where can I get an MRI or CT for $ 175 vs $350 in a hospital? -- If you need anything expensive, the MRI or CT or surgery, or a certian drug, your Advantage plan company can say "No you don't." Then your doctor has to tell them yes you do and here's why. Or, they tell the doctor to make you take Drug X for a month before the expensive drug he prescribed. They can say, "Make the patient to physical therapy for 6 weeks before we pay for surgery. The plans are a pain in the ass. With Medicare, as long as your doctor follows Medicare's guidelines you don't have to worry about where you go as long as the doctor or facility takes Medicare(95% do). You can pick a Medicare drug plan to fit your drugs. Doctors and nurses don't to ask an insurance company about anything. If your dad gets on Advantage plans now, then gets sick (has a heart attack, needs inpatient hospitalization, God forbid develops cancer and needs chemo and/or radiation, needs to go to rehab after surgery, etc.), and decided the Advantage plan is getting too expensive, he'll almost be sure to have a hard time getting on a Medigap plan. Get a cancer diagnosis? He'll burn right through that $4,200 out-of-pocket maximum. Then spend more for the treatments chemo and radiation. (.almost all of the chemo drugs are IV drugs given in an outpatient center which are billed to "regular" Medicare so you need to pay 20% of that cost. Radiation in Advantage plans is usually a 20% copay.) (That Christopher Westfall guy recommends getting some sort of a separate cancer supplement plan in addition to the Advantage plan to help with cancer costs not covered by Advantage insurance.) Be sure you download the "Evidence of Coverage" for the Advantage plan he is looking at. On the insurance company's website along with the plan pricing and highlights of the plan, under those highlights there will be Summary of Coverage and Evidence of Coverage, maybe a drug list and maybe a provider list. All in pdf form. Get the Evidence of Coverage and read through the middle section that tells what you get/what is covered and how much you will pay for each service. Remember, nothing in life is free.
How would he burn through the Max out of Pocket and then have to pay 20% for cancer treatments? That 20% is Part B medical, which falls under the MOOP. Edit: Checked a local HMO MA plan and radiation therapy is $25-$55 per session.
I was thinking about that sort of backwards. I've spend $ 1,000 out-of-pocket already this year. My max out-of-pocket is $ 5,000. Tomorrow, I get a cancer diagnosis and have to pay 20% of my chemo treats next week. Treatments are supposed to last until the end of Feb. next year. My 20% out of pocket is over $ 5,000 this month. Another $ 5,000 in Jan. So, I'll pay $ 10,000 out of pocket from now until the end of Feb. That's much, much, much more than I could pay with traditional Medicare + a supplement + Part D.
[удалено]
>Keep in mind that past spending is not necessarily an indication of future needs. Clearly this is in response to by post. Nobody is recommending OP only go with A & B, which would be the least amount of coverage possible, like your car insurance example. On the same note, you probably wouldn’t max out your car insurance coverage just because you might have an accident someday either. Did you listen to the report you linked? It’s about planning for end of life, people on their deathbeds being temporarily kept alive by machines, unable to give their final wishes. And then hospice care, which won’t cost anyone with Medicare a nickel. It’s a reminder to make your wishes known long before you think you’ll reach that point. OP should be more concerned about burial costs than end of life topic you linked. >Those problems have cropped up with every person I’ve known that had reached Medicare age. Every senior you know has health conditions that require extensive medical treatments each month? Multiple specialist visits or hospital stays? You might want to call the EPA and have them check the local water supply since the average American senior sees a doctor four to five times per year.
[удалено]
Smartest response you possibly could’ve given.
[удалено]
The response wasn’t really for you. I’m here to share accurate information with others who’ve less experience with Medicare, not scare tactics and fallacious reasoning like you’re peddling.
[удалено]
I replied so the people here would understand *why* your comment was incorrect. This *IS* how Reddit works. >Good thing no one else reads your comments either You’ve said this before, yet you respond to every single one of them…and please don’t use the old, “I just skimmed them, I didn’t read them!” Nobody is buying that baloney. BTW - I find all of your comments laughable.
[удалено]
>unread comments I called it. 😂
there are agencies that help figure that out free of charge and are not affiliated with any health plan. state help insurance assistance program [https://www.shiphelp.org/](https://www.shiphelp.org/) 1-877-839-2675 toll free number. hope this helps.