snowbound Asked December 2010

Do you need a Medicare Advantage Plan if you are in the nursing home or will Medicare pick up hospitaliations, etc.?

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EXPERT Carol Bradley Bursack Dec 2010
For General Information: Medicare A, plus B, plus any other supplemental plan will pay most of the the costs, depending on which plan you choose.

Medicare Part A is for hospitalizations (generally no charge), B is for the doctors and such (there is a charge), but they both have co-pays. Go to Medicare.gov to compare plans. With Parts A and B, plus the "best" supplemental (without Advantage), which is Plan F, takes care of most bills and co-pays.
Each Advantage plan is different, so this is all general information. Some people like their Advantage plans, but these are private plans supplemented by the government. This should be (please check) open enrollment time, which means you can change plans. Please go to www.Medicare.gov for the information you need.
Take care,
Carol
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Easy way to remember:

Medicare A = hospitalizations. This is the only part that is totally supported by your tax dollars and does not have monthly premiums to pay.
Medicare B = Physician's services - monthly premiums of about $115
Medicare C = "choice" - your Aadvantage Plans that combine parts A & B. Choice plans are like HMOs, sold by private insurance companies.
Medigap = supplemental plans sold by various commercial insurers that help pick up the copays and deductibles. Monthly premiums vary.
Medicare D = "drugs" - monthly premiums vary, depending on which level plan you buy
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@Dragonflower that's the most concise explanation of Medicare I've ever seen! Congrats!
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Medicare Advantage Plans can drop coverage in any county or state; or drastically change "rules", such as benefits, co-pays, providers & networks, & fees, and deductibles, each year.

An attraction is that some have 'free drug coverage bundled in, A down side is the entire plan uncertainty. Often seniors don't keep up with or or not aware of the yearly change.

In contrast: Medicare Supplements are required by law to offer continual coverage every year, ( it cannot drop you, your state or county, and cannot alter the Plan benefits. They do not offer a bundled drug Plan. The cost for a supplement is usually higher, & one needs to find a part D stand alone drug plan.

Enrollment in a Medicare Supplement is guaranteed issue REGARDLESS of health, if applied for when turning 65 or after dropping employer "creditable" coverage. Supplements cover the (in general) 20% of costs that Medicare does not.

An simplified example (for illustration purposes) a $100,000 Medical bill would leave you with a $20,000 responsibility.

A very cost efficient supplement is Plan HDF (High deductible Plan F),it over time is reasonably expected to save thousands of dollars for seniors, and savings might about double for married couples. It pays after the Medicare Deductible. The Medicare deductibles for 2015 are not yet set but there is some expectations of what they will be. Currently, in 2014 the deductibles are as follows:

Part A deductible: $1,216

Part B deductible: $147

The Medicare deductibles for 2015 are expected to be as follows

Part A deductible: $1,248

Part B deductible: $147

.., and a Plan deductible of about $1, 200

BUT the approximate Medicare Supplement plan HDF (F plans offer extensive benefits including foreign travel), premium for a non smoker male age 65, (in Georgia) is only about $50.00 a month, saving about $100-$150 a month in premium, x 12.

In other words you avoid paying more to cover a small loss, which normally is not incurred each year. (Something like your collision or homeowner deductible), and your savings in monthly premium is used towards your deductible if the need arises.

I have a HDF plan in case you wonder.

{Many Supplement companies do not offer the HDF plan, compare premium costs and you can imagine the reason}.
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Ritashelper Oct 2014
Do you really need a supplement. My mom has Blue Cross supplement that costs $205 a month. She recently had a trip to hospital in ambulance. No overnight stay but BC only paid about $340 after medicare paid. Mom did not owe anything. But she would have been better off paying the $340 as apposed the 205 a month! She's been paying BC premiums for years and the never have to pay much over and above what Medicare already covers.
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jblum777 Oct 2014
If you want your Mom to have the flexibility of seeing any doctor she chooses and be covered under original Medicare then she should have a Medicare Supplement to cover the costs that Medicare does not pay. The example that you provided does not speak to her potential financial liability under original Medicare. The biggest potential out of pocket cost lies in the Part B coverage of Medicare where you are responsible for 20% of the costs. In the example provided above, if your mom needed surgery and the surgeon charges are approved by Medicare to be $100,000, then you will owe the surgeon $20,000.

With the Medicare Supplement Plan F, you pay your monthly premium and then the supplement covers 100% of the Medicare approved amounts for the care that she may need. At $205/month this is $2,460 a year - a very reasonable amount to give you and your mom the peace of mind that you won't have any large medical bills.
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Rita and jblum

We want to be concerned with major expense,not the minor, therefore the annual savings of about $2,000 a year for a HDF vs. a F, will go a long way towards covering the deductible of about $2,160 of a HDF plan

They have already figured most people pay much more for the F plan than it covers for typical claims of $400 to $800 a year across the demographic.

The best time to get the HDF is at turning 65 or if an MED ADV plan drops coverage , or you move out of plan area

Those who do not keep up with Med ADV changes can be caught short. And the seniors children may not grasp this. Look at the Max OOP (Out of Pocket), for Med Adv it may be as high as $6,500 ,vs The plan HDF of $2,160.

Only a few companies and agent will offer HDF (agents produce much less income . vs F)

I am a HDF 'customer' and I offer them to clients, It makes sense.
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