Medicare and medical expense costs.

[barbarabini]

Does anyone have experience with Medicare coverage and out of pocket costs?

My in laws spend about 15,000 a year. Is this average? Its been like this for the last four years. So far, 60,000 in total. It seems high but maybe this is what everyone pays. They have A, B and supplemental and some type of drug plan.

I am not sure where to start with it and my in-laws are reluctant to shop around (if its even possible). But, with their dwindling savings, I don't see how they can sustain this for another 4 years.

PS - no cancer only the regular elderly issues, diabetes, ect.

Anyone with any experience?

 

[Tinknalli]

Medicare A has a deductible of $1132/spell of illness. I believe the spell of illness begins on the day of inpatient admission and ends 60 days after discharge. The Part B yearly deductible was $135 last I looked. In addition many services that Medicare covers are subject to coinsurance in which the patient is responsible for 20% of what Medicare allows. The are many types of supplemental policies, some cover everything after Medicare and some cover very little.

In addition, Medicare does not cover routine care. Other than your welcome to Medicare routine exam, they really only cover office visits if you are sick. Example: they will cover a pelvic and breast exam every 2 years but they will not pay for the routine office visit that one needs to get the exams.

The other thing as that providers are not required to accept Medicare and as long as they inform their patients the patient can be responsible for the entire amount of the bill.

Hope that helps!

 

[seasheller]

Supplemental insurance after 65 varies so much by state, and in Wisconsin even by county. DH and I both pay $129.00 a month for Medica supplement which covers everything we may need for doctor visits, etc. I also pay $14.80 a month for Walmart/Humana prescription drug plan, DH is covered through the VA. Not sure of the exact amount ($96.40?) is also deducted from our social securiy checks each month to cover Part B of Medicare. Is the $15,000 you quoted just for premiums?? That sounds awfully high (625.00 per person per month).

 

[dnbent]

My parents were paying close to $300 per month EACH for the supplemental insurance a number of years ago. It paid everything (except drugs) that medicare did not pay. I was able to convince them to change to a different plan which was about $100 per person per month. This plan has paid everything medicare does not pay.

This was a very touchy subject with my father but I just point blank asked him what they were paying and if he cared if I checked into other "good" alternatives for them. He didn't say no and was very happy when I came back with the numbers that I found for them.

Good Luck.

 

[Cheshire Figment]

I carry Blue Cross/Blue Shield from my former employer in addition to Medicare A and B. BC/BS picks up all of the Medicare copays and deductibles. All I have to pay for is a maximum of $10 for 90 day generics or maximum $70 for 90 days non-generics.

A few years ago I had a hip replacement and ended up in the hospital for 11 days, as well as three weeks in a rehab center, and my out-of-pocket was zero.

 

[AmandaRG]

From what my dad has said, he pays maybe $300 total between what Medicare comes out of his SS check, and his supplemental. He pretty much pays nothing out of pocket, so you might want to check into it if they don't mind!

 

[barbarabini]

Yes, I think it is the supplemental that is really making this expensive.
The premiums for both of them amount to 7000 a year ( slighty under 600 a month.) I think that is where the savings is.

 

[rapmarks]

Medicare costs about one hundred a month per person, but if you have higher income it goes up 60 a month per each income level per person. supplemental costs between 100 and 300 a month. there are deductibles in Medicare, but sometimes the supplemental covers them. perscriptions can vary. i pay quite a bit, but my aunt pays over 800 a month for perscriptions because her part D has the "donut hole". I think $15,000 a year sounds very high, something is wrong. Medicare does allow a yearly physical now as part of the Obama health changes. it always allowed yearly pelvic exam, but Pap test only every two years. My costs went down significantly when i went on Medicare and supplemental.

 

[Marionnette]

My parents pay close to $600/month for their supplemental plan. It's a plan that is no longer offered but they've been grandfathered into it. It covers just about everything that Medicare doesn't. Unfortunately, neither one of them is in good health and they really need this plan. OOP expenses for this year would have been outrageous had it not been for their insurance. As much as it I hate to see them spend so much of their retirement dollars on healthcare, I'm comforted by the knowledge that they are not choosing between heat or diabetes medicine. Thankfully, they can afford both.

 

[RitaE]

It's hard for me to estimate because my Mom has a Medicare supplemental plan through the pension she receives from my Dad's old employer. The deduct her payment for that from the pension check and I can't remember how much it is. She's lucky to have it because you don't see many retirement packages with healthcare for the employee these days, much less the employee's spouse.

She pays co-pays on her prescriptions .... ranging from (I think) $10 for a 90 day supply of the generic stuff (cholesterol meds etc) to some more expensive name brand drugs she takes. She also has a Doctor's office co-pay - $25 I think.

I know when she had to have some out patient tests at the hospital (colonoscopy etc) I had to write the check for some higher co-pays, I think it was about $150.

 

[Sadie22]

My parents pay close to $600/month for their supplemental plan. It's a plan that is no longer offered but they've been grandfathered into it. It covers just about everything that Medicare doesn't. Unfortunately, neither one of them is in good health and they really need this plan. OOP expenses for this year would have been outrageous had it not been for their insurance. As much as it I hate to see them spend so much of their retirement dollars on healthcare, I'm comforted by the knowledge that they are not choosing between heat or diabetes medicine. Thankfully, they can afford both.

When she died in her 90s, Mom's monthly supplemental insurance was over $300, and her Medicare Part D prescription plan had an additional premium cost on top of that plus copays for each drug. Just one hospitalization per year and she came out way ahead on what she would have paid without this coverage. I am so glad she had the insurance. As her advocate, I also did not have to file any claims for reimbursement and the like with her plan.

$7,500 per person per year may or may not be too high. It is worth it to review and see if less can be spent, especially in the area of prescriptions.

Before Medicare Part D prescription coverage, and when my father was alive, the doctor would write prescriptions for 30 days' worth at a time with automatic monthly refills. For maintenance medications, it may be more cost effective to ask the physician to write for 90 days' worth at a time because under many plans the overall copay will be lower. It is also important to stay within the insurance formulary whenever possible, and to request formulary exceptions when a less expensive drug will not meet the patient's needs. With so many prescription plans, it is up to the patient or the patient's advocate to request what is most cost effective for the patient. A physician cannot possibly know all this.

Mom was in assisted living for several years. Special bubble-packed prescription dispensing cards were required. One pharmacy said they would not fill prescriptions for 90 days for two copays instead of three. The facility changed to using another pharmacy which would do that and saved money for many of the residents.

 

[Straitlover]

During annual enrollment (going on right now), you can go on the Medicare website and enter in all their meds and it will list all the supplement and prescription plans and the annual estimated costs.

My mother is undergoing cancer treatment right now, and she pays nowhere near the amount you listed. Her supplement is $179/mo, and her part D plan (AARP) is around $34/month. Her supplement covers all her medical co-pays; she just has to pay her prescription co-pays. Now, there is one chemo drug that if they switch her to at some point, it'll cost her around $7,000 additional per year, but hopefully we will be able to get help w/ that from a couple of organizations.

 

[Judyat]

If you go to medicare.gov and click on compare plans and put in your zip code it will show you a variety of plans to look at and let you compare them.

 

[sherreis]

In addition to all the Medicare discussion:

1) tell your parents to ask their doctors for the cheapest medications that will work for them. So many providers just write what they want because they have no idea what kind of prescription coverage the patient has. It's up to the patient to ask.

2) some medications can be split. The doctor can order a 90 day supply (especially if it is a medication they can get filled at Walmart for $10) and then split them. Not all medications can be split due to special coatings, extended release.

3) whenever they need blood work, they should ask their providers "is this necessary right now?" Example -today, a patient's primary care doc sent her for bloodwork and she told me about the tests that were being ordered. A specialist just sent her for the same bloodwork about 2 weeks ago. No reason to do it again so soon for these blood tests.

I am a nurse Case Manager and these are things that I teach my patients all the time to save them money with their copays.