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I get my Jardiance from a free plan called AARP Medicare Advantage Choice PPO. It costs me just $45/month for Jardiance.
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That's excellent.
All of this conversation appears to be about getting coverage for AS LITTLE AS POSSIBLE.
I took a very different road.
What I wanted the best coverage I could afford considering that (logically) my health care costs will get worse.
So, after researching it thoroughly, I signed up for "Column F" coverage before starting Medicare. (That was 5 years ago.)
Just like horse racing, I research stuff deeply.
PART 1: Column F - I pay ZERO
$211 monthly premium
$0 deductible
0% co-pay
No Network, no PPO, no HMO.
So, what I purchased was ZERO DEDUCTIBLE, ZERO CO-PAY coverage. This "supplement" (sold by AARP but fulfilled in NV by United Health Care) was $141 my first year and is now up to $211.
Specifically, this means that anything Medicare covers, this supplement pays 100% of the difference. IOW, my healthcare costs are covered 100% between Medicare & the supplement.
(Yes, I still pay the normal Medicare costs.)
(No, it does not include meds.)
I am diabetic - not horribly so - but still, it comes with costs.
In a typical year, I average 24 doctor visits.
Eye dr.
sleep doc
Dermo 4x
physiatrist (back pain)
podiatrist 5x
Family Physician 6x
etc.
(Fortunately, no cardiologist)
I pay zero for anything.
And Medicare pretty much covers everything.
The bad news is that Column F coverage is no longer taking enrollments. Although they cannot cancel me, the premiums will rise even more over the next few years.
The good news is that column G is even better.
PART 2: COLUMN G COVERAGE
Premium =$135
$168 = Deductible
$168 = Max Out-of-Pocket per year
No prescription coverage
Includes office visits.
No Network, no PPO, no HMO.
Beth (my wife) is 4 years younger than me. When I found out 2 years ago that they were going to phase out Column F this year, we switched her to Column G.
So, she pays $135 per month and, for the year, that $168 deductible represents 100% of everything she will pay!
Last year she had a full knee replacement. Cost was $102,000. She paid ZERO.
Not a single cent.
Two years ago she had a 2nd bariatric surgery. Cost was $60k+. She paid zero.
She has had 2 balloon sinuplasty surgeries - basically a roto-rooter for your sinus. $32,000 each. Paid zero.
We did have to pay $1,500 x 2 for her cataract surgeries, because she got the upgraded lenses - which Medicare doesn't cover.
Column G is the coverage that you want.
PART 3: The Harsh Realities
Here it comes.
We are aging and with that aging comes health issues.
Considering my weight, I have been extremely fortunate to maintain my health to the level I have.
(Example: My normal blood pressure (w/o meds) is 114/76, pulse 76 - about 2 points higher than I was at age 25 when I was breaking boards and bricks, and training 25 hours per week.)
But I do have health challenges as a result of the diabetes, such as eczema. (Which btw, I have all but reversed with mega doses of vitamin B12. A story for another day.)
The point is that my good health will not last forever, and either will yours.
I strongly suggest that you do not look for the cheap alternative, nor the one you need today. Instead, buy the one you will LIKELY NEED TOMORROW.
*** If you buy an HMO, doctors will make decisions about your treatment plan based upon THEIR PROFITABILITY. Bad idea.
*** If you buy a PPO, then you must see doctors & facilities within your network. Again, bad idea.
*** If you buy an Advantage Plan, that will be dirt cheap or even free. But, when... emphasis WHEN... your health begins to fail, you will not be able to upgrade your coverage to a better plan. Even a worse idea.
*** Medigap is the way. Sure, it costs more. But you will need it someday. And, if you don't, then you will have had a geriatric lifetime free of medical cost fears.
PART 4: UNDERSTANDING & GAMING THE SYSTEM
Yes, the system can be played.
So, a couple of things you should know...
1. When you first sign up for Medicare, which you do before your 65th birthday month, you can choose ANY PLAN and get it for the base rate without showing any evidence of insurability.
That simply means, they can't exclude you or raise your rates because of a health issue.
2. AFTER SIGNING UP, ALL THAT WILL CHANGE.
If you develop a health issue that comes with long-term costs, it is very unlikely that any company will take you if you decide to upgrade.
3. After the 1st year, there is an OPEN ENROLLMENT period towards the end of the year. Basically, the last 2 months - Nov & Dec.
During this period you can switch companies and plans
providing you are a good enough health risk.
Something you probably don't know: If you don't like your plan, you have about 45 days to switch back to your old company. IOW, Feb 14 is the drop dead date for the switch back. Not sure how they handle weekends.
Important: They have to take you back.
5. HERE COMES THE GAMING PART
Let's say that you have been on Medicare for at several years. Your coverage this year is an inexpensive supplement.
That was a great deal for you until you had a heart attack last year. You recovered but now you have two things: unpaid bills to the tune of (say) $200k and a heart condition.
(Could also be cancer or some other condition with a likelihood of returning. The kind of history which makes you a bad insurance risk.)
Or maybe (like me) you have diabetes.
So, now, you really wish you could switch to one of those cool, column G plans and have EVERYTHING covered.
You have applied and were rejected. And, if you are a bad risk, you WILL be rejected.
So, you are stuck for life, right?
WELL, THERE IS A WAY TO GAME THE SYSTEM but it will take some work.
Let's say that you want a column G plan. Pick a place on the map that DOES NOT have the
coverage you currently have and move there.
HUH?
Yes, I said MOVE THERE.
See, if YOUR CURRENT COVERAGE isn't offered in the place where you move, that means you have a short period of time to pick any other plan that is available and they have to take you!
Now, for the fine print.
a. Short period of time = 63 days.
b. You must be able to prove that you actually lived there for 3 months.
c. During this 63 days you are, effectively, back in the OPEN ENROLLMENT situation that you were in when you first signed up for Medicare.
d. Yes, I know. You want to live where you live now.
Fine. After living in the other place for 3 months (or more) you can MOVE BACK and, once again, you get a NEW OPEN ENROLLMENT period!
IOW, you can get the plan you want --- COLUMN G or whatever --- despite the fact that you are uninsurable.
They cannot refuse you.
e. There may be some other fine print - depending upon which state you live in - and whether or not the state insurance commissioner's office is more interested in helping consumers or companies - so read up.
Okay.
I'm done.
Understand that I am NOT the last word on this stuff.
Find yourself an agent that specializes in Medicare coverage who will spend the necessary hours to answer your questions.
What I did was a bunch of research back in the Obama Care days and then went asking for help from agents. The 3rd one gave me the answers that I already knew to be true and I committed to her for life.
I hope this helps someone. Burnsy, specifically, you.
(And my wonderful & longtime friend who is currently battling cancer.)
Regards to All,
Dave Schwartz
