My Turn to Start Figuring Out Medicare

[jcam222]

High detuctables and out of pocket. Have not found one plan that will cover Dutasteride / tamsulosin. Its about $1000 a month.

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Have you looked at any of the Advantage plans with an actual low monthly premium? I found those to be far better. The med cost for those two drugs makes no sense to me. Are there options other than Humana in your area? I will say those deductibles will be hard to beat but many plans allow PCP and Dr visits with low cost from day one without meeting deductibles. I think you may be taking the all in one dutasteride / tamsulosin pill? If so it stupid expensive everywhere. If you take the two separately it's dirt cheap. Through cost plus 90 supply of TAM is $8 and DUTA $12.

 

[sandyut]

High detuctables and out of pocket. Have not found one plan that will cover Dutasteride / tamsulosin. Its about $1000 a month.

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Those look like good options to me. Bear in mind, the cost for procedures and general benefits will be far better than ACA coverage. My wife's hip replacement was a $250 copay. Her meds are all free, I cant even think of anything else she paid out of pocket for.

Not sure what would run up your costs to the MOOP, but our experience is that would be near impossible.

Check your drug costs on their site and on Cost Plus drug. Obviously I have no clue what you take, but ~$900 a year sounds high.

 

[dward51]

I am curious as to what doesn't look good on the advantage plans? I've only been on mine a few months but so far so good.....

The plans vary depending on where you live (the service area). So the same plan with the same coverage may be more in one state/area than another.

To me it was all simpler back before the passed Obamacare. But I've never had to shop the open market either.

 

[BrianGSDTexoma]

Have you looked at any of the Advantage plans with an actual low monthly premium? I found those to be far better. The med cost for those two drugs makes no sense to me. Are there options other than Humana in your area? I will say those deductibles will be hard to beat but many plans allow PCP and Dr visits with low cost from day one without meeting deductibles. I think you may be taking the all in one dutasteride / tamsulosin pill? If so it stupid expensive everywhere. If you take the two separately it's dirt cheap. Through cost plus 90 supply of TAM is $8 and DUTA $12.

I just taking the tamsulosin. I did try the dutasteride as tamsulosin makes me dizzy but tamsulosin works better. I done looking until I meet with broker.

 

[jcam222]

I just taking the tamsulosin. I did try the dutasteride as tamsulosin makes me dizzy but tamsulosin works better. I done looking until I meet with broker.

Just keep in mind then that you can get the Tamsulosin cheap from Cost Plus if you have too.

 

[Chasdev]

Humana:
For what its worth?
Back when I was working.
The Local union dropped HUMANA!
The advantage plan is very weak !
Yeah ? You get perks, some unnecessarily needed?
what happens when you need the serious healthcare?
Hope you got a huge bank roll to payout !?
BIG QUESTION!?
When you need serious care?
Medi-gap pays for it !
When my Mom passed @ age 96, she was covered.
Had a 2nd stroke and had many expenses, all covered.

Humana publishes all out of pocket costs and the worst case is under $10K a year.
That sounds like a high number but that's for BIG stuff like brain surgery or massive car crash injuries and/or prolonged hospital stays.
I've already saved more than that by kicking standard medicare to the curb, so I'm already ahead of the game.
Our total out of pocket for my wife's cancer treatments is under $5000.
The billed costs would have been $150,000+.
Talk to a Humana rep and ask them ANYTHING, ask 100 questions, they have answers to all scenerio's and will even tell you answers to questions you did not think of.
We requested hard copy of all policy particular's and they mailed us a folder with every micron of coverage and out of pocket potential costs.
We looked at this issue very carefully before ditching conventional medicare and it's so much better than the other options out there it's just no contest.
IF it's available in your area run, do not walk, to sign up.

 

[sandyut]

To me it was all simpler back before the passed Obamacare. But I've never had to shop the open market either.

ACA doesnt hold a candle to Advantage plans. Been on ACA for 5 years, wife on advantage same amount. It cost me WAY more for everything. Kills me to see how great her coverage is compared to mine...and I pay 4X as much.

 

[BrianGSDTexoma]

ACA doesnt hold a candle to Advantage plans. Been on ACA for 5 years, wife on advantage same amount. It cost me WAY more for everything. Kills me to see how great her coverage is compared to mine...and I pay 4X as much.

I just going to happy next year when my ACA goes away and dont have to worry about my income anymore! Can finally dig into that IRA.

 

[jcam222]

I just going to happy next year when my ACA goes away and dont have to worry about my income anymore! Can finally dig into that IRA.

Income still has bearing on your Medicare premium if you have over $109K in income. They will calculate your premium on your AGI from 3 years ago as well. If it was too high then and lower now there is an appeal form to fill out. I had to appeal two years because it was going no off my salary when fully employed. Pretty easy process though.

 

[dward51]

Income still has bearing on your Medicare premium if you have over $109K in income. They will calculate your premium on your AGI from 3 years ago as well. If it was too high then and lower now there is an appeal form to fill out. I had to appeal two years because it was going no off my salary when fully employed. Pretty easy process though.

Yep, it's $109k for single, and $218k for married filing joint. If you go over those income levels, you part B and part D costs will increase. They will take it out of your social security payment automatically - they just send you a letter saying it's happening and then it does.

Keep in mind this is your adjusted gross income, not actual income. For some folks that does not matter, but others have "above the line" deductions to offset some of that income from which the AGI is calculated.

 

[BrianGSDTexoma]

Just keep in mind then that you can get the Tamsulosin cheap from Cost Plus if you have too.

I looked and only around $6. I double checked and I selected the combo on tamsulosin. Changed it and came way down to about $110.

Income still has bearing on your Medicare premium if you have over $109K in income.

I under $30,000 right now. Next year plan on about $55,000 so no problems with that.

 

[jcam222]

I looked and only around $6. I double checked and I selected the combo on tamsulosin. Changed it and came way down to about $110.


I under $30,000 right now. Next year plan on about $55,000 so no problems with that.

Sounds good, I assume $110 for the a nual cost?.Just keep in mind they go by your annual AGI from 3 years ago initially. For me that was significant as I had two full years of very robust income that hit me on that last year and this. They were going to charge me an additional $450 a month penalty on my Medicare premium! Appeal was easy though. Finally being able to tap into that retirement money is going to be nice for you!

 

[Dive Bar Casanova]

Medicare and my supplement PPO insurance picked up the tab:

Never smoked nor vaped and still got lung cancer.
Robot entered under my rib cage, cut one full lobe, sealed the lung and removed the cancerous lobe.
No rib cutting or separating.
60 day recovery.
Surgery was delayed until last week.
Man o man I’m I in a world of hurt. Nurse wife taking care of me. She’s a hero.

 

[Gonna Smoke]

That's tough. Hoping for a speedy recovery...

 

[BrianGSDTexoma]

Just got back from doctor. He also said to stay away from Advantage plans. Guessing its our plans here that not good. He also changed my diabetes med to Synjardy. Still not showing to be covered under any of the D plans. Couple more weeks to see broker.

 

[mike243]

I will be 65 in November but wife is still working for a hospital group and I wont have to start anything other than A and my wifes insurance will be the primary so A wont have to pay anything that we are aware of, this is per her HR rep at work. She just had shoulder surgery and cost was 0

 

[Dive Bar Casanova]

During my 6 month fight with colon cancer I met other fighting it too.
Those with Medicare supplemental insurance got Avastin Chemo.
Those without got radiation, old school chemo and a lifetime stinky colostomy bag.

 

[Fueling Around]

During my 6 month fight with colon cancer I met other fighting it too.
Those with Medicare supplemental insurance got Avastin Chemo.
Those without got radiation, old school chemo and a lifetime stinky colostomy bag.

You've beenn dealt a couple of bad hands. Hoping for your recovery.

 

[Fueling Around]

I will be 65 in November but wife is still working for a hospital group and I wont have to start anything other than A and my wifes insurance will be the primary so A wont have to pay anything that we are aware of, this is per her HR rep at work. She just had shoulder surgery and cost was 0

Yes, as long as you have private insurance coverage Medicare Part A is all that is needed at age 65.
This holds true for which ever is older and which ever has the private insurance coverage.
My wife is 2 years older than me and her HR rep (also a hospital) was completely inept and incompetent. They cost us about $10k after she turned 65 and 2 years later with a forced retirement.
When does your wife turn 65?

 

[SmokeRing0909]

My wife is a Medicare specialist by trade. I’m not certain what state you are located in. She’s only licensed in Alabama. I would strongly suggest finding a Medicare specialist local to you. They know all about everything you’re dealing with and assist you with everything at no charge to you