| | | One key item that I don't know how many might be aware of is that after the initial year where you can switch from an Advantage plan back to original Medicare if you try to do so let's say in year two, when you try to buy a Supplemental plan, they have the right to do medical underwriting on you and charge more or reject you outright. At that point you are stuck unless you want to be on the hook for up to 20% of your medical costs. There are some obscure ways around this, like moving, and some states will still allow a purchase without underwriting, but you really have to be aware of the rules. The articles talks about medigap plans costing more, but doesn't really say you can be rejected outright. One other 'gotcha' to be aware of is that medigap plans will cover the cost of cancer drugs given in a doctor's office, while an Advantage plan can make you pay 20% until you hit your out of pocket max.
That said, my wife and I went with a Humana Advantage plan because in the suburbs of Chicago where we live, our favorite medical group, in addition to thousands of other docs were included, and our out of pocket max is $2600, most tests have a $25 copay, and it costs $20 to see a specialist. The plan also includes a yearly 2k max allowance for dental work, $300 for glasses, an allowance for hearing aids, and membership at a very nice gym. The way I figured it purchasing a good supplemental like Plan G, along with Part D coverage would cost as much yearly as the max out of pocket for this plan. The key here is the max out of pocket, if you choose a plan with a much higher dollar figure (and there are plenty) it becomes less of a deal, along with if you are very ill or have expensive chronic conditions.
So, all that said, all this stuff is still WAY too complex for many seniors, and really should not be. Even simple stuff, like scheduling a 'physical' can be a gotcha, as Medicare doesn't cover a yearly physical, but does cover a yearly 'wellness' exam. It's ridiculous.
I am thankful that we are fortunate enough to have zero deductible coverage. My wife was having some pretty severe back pain that she thought was radiating to her chest last week, so I took her to the ER. It was not a heart attack, but so far (and more charges are hitting her plan daily) the bill is approaching 16k. As you know I have been interested in the healthcare system for a long time now, so I scrutinize the billing codes. Some are astounding. I'll take the liberty to include the charge for a saline drip they gave her. Apparently they 'bill by the hour', so the first hour was billed at $1228, and then additional time after that was billed at another 1k! I checked on Amazon, you can buy two bags for under 8 bucks, so the hospital probably paid under 2 bucks for the bag. She had a CT scan that was billed at 4k, along with an additional 1k for the RadioIogist to read it, in addition to a bunch of other tests and bloodwork. I realize the ER has overhead, but this system is gonna collapse at this rate. I also realize that Medicare will pay this bill at a small fraction of what actually was billed, so they charge private insurance and the uninsured even more.
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