Medicare Insurance

November 07, 2017  •  Leave a Comment

THIS IS A VERY ROUGH DRAFT OF A BLOG I'M WORKING ON.  BUT, I'M GETTING SOME QUESTIONS SO PUTTING IT OUT TO THOSE INTERESTED and willing to slog through a rough draft. 

After retiring as a Montessori teacher I became a full-time traveler in my 17' Casita camper with a 6' x 13' living space. I travel with my cat all over the country. I have no house or apartment.  I am a 66 year old woman who went from healthy one day to an emergency room the next with serious embolisms in my lungs and spleen and in extreme danger of a heart attack or major stroke.  After 2 emergency rooms, ambulance transportation to a hospital and a whole lot of expensive tests I transferred to my brother's backyard in KY for further diagnosis and evaluation. That has led to me to being seen at Mayo Clinic in Arizona for treatment of a rare blood cancer.  I must have a health plan that will allow me to have covered care anywhere in the United States at a moment's notice. 

Because I have no home and the IRS wants people to have an address I have my "domicile" in South Dakota. Everything I own is in my car, my camper and a 5' x 10' storage unit in KY.   I chose SD because they have no state tax and registering and licensing my camper and car is quite cheap in comparison to other states.  Being over 65 my health insurance is less expensive than in some states.  My figures listed here are not national figures but South Dakota figures.  Yours will differ.  

So this blog is coming from my experience and my knowledge which my not be accurate and may be different for other people. 

First and foremost.....there will come a time in your future when you will likely need expensive health care.  And, any health care is expensive some just more so that others.  At some point in your life you may need heart surgery, joint replacement, cancer treatment, and on and on.  Not many reach their mid-60s to 90s without needing specialized medical care. 

When I first joined Medicare I chose an Advantage PPO Plan.  Everything I read made me believe I would be covered no matter where I traveled. I was a happy camper!  But,  I was WRONG! I found out that there were areas in the United States that may not cover me at all if they are outside of the PPO area!!  What a shock!!!  When I left KY to become a full-time camper I had to change insurance as my PPO plan was not offered out of KY.  

I contacted Kyle at RVInsurance and he filled me in on the weaknesses of Advantage Plans.  So, I started looking at Medicare + Medigap + Prescription plans.  I said to myself, "I'm healthy.  I can change plans every year.  Why not get a high deductible plan and save money now?".  Seemed like a good idea.  Then someone else said that this was NOT the time to penny-pinch.  It will likely cost you down the road.  Wow...was she right.  If I had gone with the high deductible Medigap plan:

1.  I couldn't have been seen at Mayo without a lot of out of pocket money, if at all. 

2. The lower premiums would never have made up for what I would have spent annually on higher deductibles and overages.  And I will continue to have high annual medical expenses so this loss of savings would have been ongoing every year. 

3. Some Medigap plans, including Plan G, may not have been available to me at a premium I could afford if I had not chosen it within the first year of Medicare coverage. 

If I had continued on my PPO plan: :

1. If I was on ANY Advantage Plan I would not have been accepted as a patient at Mayo Clinic.  I want to be able to chose where I go and not have the insurance companies make that decision for me.   

2.  Insurance companies can and do drop their Advantage Plans.  Physicians and hospitals can change whether they accept a current Advantage Plan. 

3. During my travels I could have found myself in areas that would have not accepted my insurance. 

Medicare and Medigap plans: 

The chart at the end of this blog is for those who stay on Original Medicare and purchase a Medigap Plan. 

NOTE!  Plan F has no deductible. It will not accept new people beginning in 2020 and it's being replaced with Plan G.  The people on Plan G can stay on it but new people cannot purchase it. I wonder if their premiums will go up as fewer and fewer people are on that plan.

It is my understanding that within 6 months of signing up for Medicare you can change plans.  After that, if you can change, it may be at a much higher premium due to late sign-up and pre-existing conditions. For many, it may be out of each financially after that first 6 months. 

With my many bills Plan G has paid for everything except the small deductible.  I have Mutual of Omaha aka Omaha Insurance and have been very satisfied. Check Medicare.gov for reviews and go compare premiums.  Any of the Medigap plans though are exactly the same in coverage and only the premiums should differ.  I would suggest though going with a solid, well-known, financially stable insurance company. 

Again, I am not an expert in the field.  I tried to do my homework and found it all very confusing.  I can say, that for me, I believe I have the one and only plan that could have worked for my situation.  

MY COSTS 

Note: I need to add what I pay for Original Medicare. It is deducted from my Social Security.  Got locked out for 24 hours when I forgot my password. 

Plan G Premiums for me in South Dakota is $94/month in 2017. On November 1 it is going up to $99. They can do price increases twice a year.  

Prescription Plan - $17/month for Humana/Walmart Prescription Plan. That will go to $20.40 in 2018.  As with most prescription plans there are tiers and deductibles that I don't understand. Most of my drugs are generic and I pay $4.  I have one non-generic drug that I had to pay over $400 the first time to reach a new tier and now pay about $77.  Prescription costs, if non-generic, can be very high.  You can go to Medicare.gov and then to prescription plans and enter your medications and it will tell you your annual cost for every single Medicare Prescription Plan offered.  A wonderful tool!

Once you are on a Medigap plan, including  Plan G,  you are on it forever and cannot be charged more for medical conditions.  NOTE to SELF....are increases based at all on increased age compare to a younger person just signing up). 

HOWEVER and this is a biggie......

1.  If you have already signed up for Medicare you can change your plan within 6 months  to any other plan and only be charged the same as if you had signed up for it originally. You should not pay a higher premium due to existing conditions or the change.  I ran into an issue that I moved within the 6 months.  They originally said I couldn't get Plan G because of the move.  I held firm that ai was changing due to the 6 month choice NOT because of my move. Get the facts so you can stand up for yourself.  

2. After that six months there will be additional premium increases for the late change AND for pre-existing conditions. I understand those difference in premiums can be substantial amounts.  I believe after that  first 6 months your choice of Medigap plans if reduced and does not include Plan G.  

Links I have found helpful.

https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/switching-plans/switch-medigap-.html

https://www.consumerreports.org/cro/news/2014/10/medigap-vs-medicare-advantage-consumer-reports/index.htm

https://www.medicare.gov/supplement-other-insurance/medigap/medigap-and-medicare-advantage/medigap-and-medicare-advantage-plans.html

When I switched form PPO to Medigap these guys really were a huge help and easy to work with.  They helped me with the issue of the 6 month change vs I was moving.  Plan G was only available when they argued for the 6 months change rather than the move. 

https://www.senior65.com/

Good article and company even if you are not an RVer. 

For those who are not 65 but are travelers. 

http://www.rverinsurance.com/health-insurance-2018/  

For those on or soon to be on MEDICARE. 

http://www.rverinsurance.com/medicare-for-rvers/

NOTE THAT PLAN F AND G ARE THE ONLY PLANS THAT COVER EXCESS CHARGES!  EXCESS CHARGES CAN BE HUGE AMOUNTS!!!!  Do some research to find out what they can include. Mayo is all about excess charges.  Some doctors will have an extra surgeon join them during surgery. You may not even know that person was there and was never asked if it was okay.  If his bill is not covered by medicare then you pay it!  I think some surgeons are doing this in what could be considered a scam. 

 


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