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No. of Recommendations: 2
I suggest just contacting Medicare for the straight scoop.
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No. of Recommendations: 2
I think you are asking the right questions but I know nothing about NY programs. I do use Medicare supplemental insurance for the reasons you mention. Medicare Advantage saves you premiums and works fine when you are healthy. But the high co-pays and limitations on in network facilities and doctors can be costly at the worst possible time.

I see the Medicare supplemental premium as peace of mind insurance.
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No. of Recommendations: 2
I suggest just contacting Medicare for the straight scoop.
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No. of Recommendations: 3
"I suggest just contacting Medicare for the straight scoop. "

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There are times when I read instructions for various Medicare applications,
instructions to complete IRS forms, Social Security documents that I really
wish Gutenberg had never invented the printing press.

Howie52
Cave dwellers had the right idea.
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No. of Recommendations: 0
Thanks everyone who chimed in.

I went with gov't Medicare A&B, found a reasonable Part D for drugs and went through the AARP for Part G. I prefer being as covered as I can. Hopefully, I will never need to use it, but isn't that the point of insurance? Taking care of things when they go wrong?

I appreciate the comments.

SD
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I confess that several years back I had Part D, but I found the premium was more than the meds I was on -- generics -- so I halted it.

I know now if I restarted I would pay X amount per month (!) penalty, on top of the premium, since I stopped, but, so far, thankfully all my meds have been of the generic $9.99/3 months variety.

Vermonter
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No. of Recommendations: 2
I confess that several years back I had Part D, but I found the premium was more than the meds I was on -- generics -- so I halted it.

Thank goodness you are relatively healthy and can be treated with low cost generics.

In this era, I would say being self insured for meds is a risky maneuver. Yes, you can save money by not insuring, but the end result could be far different.

Good luck!!
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"I confess that several years back I had Part D, but I found the premium was more than the meds I was on -- generics -- so I halted it.

Thank goodness you are relatively healthy and can be treated with low cost generics.

In this era, I would say being self insured for meds is a risky maneuver. Yes, you can save money by not insuring, but the end result could be far different.

Good luck!!"

*******************************************************************************************

I recognize that many of the most expensive medications I take are items that did not
exist as medications ten years ago. And most of these are not taken to "resolve" a medical
condition. They merely treat a condition to avoid "life-threatening" symptoms from developing
tomorrow.
Life threatening conditions will eventually happen.
Other medications are even more expensive - and treat things like cancer and such.

Used to be fatal - now you can have treatment for a cost.

The question of what you are willing to pay for treatments is now compounded by not
only what are you willing to pay for insurance - but also what taxes are the rest of the
population willing to pay for both their own insurance and their "future" insurance plus
your insurance.

Howie52
And we all need to thank each other for doing our/your/their part.

Thanks
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No. of Recommendations: 1
SD wrote I prefer being as covered as I can.

In my view insurance is to cover expenses you can not easily cover yourself. That is one reason for having a deductible on say my auto insurance. If I have to have one accident every 3 years to cover the difference with an auto deductible, for me it is not worth it. Having that frequency of claims first would raise my rates and eventually get me canceled.

I happen to live in a state that allows me to change my medicare supplemental plans. (Not all do!). So since I am in good health and rarely go to a doctor other than my annual physicals (PCP, Dermatologist & eyes), I do save money with a co-pay system. My mother in-law has had dozens of medical appointments in the last year. She saves money with a no co-pay supplemental.
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I know now if I restarted I would pay X amount per month (!) penalty, on top of the premium, since I stopped, but, so far, thankfully all my meds have been of the generic $9.99/3 months variety.

Vermonter


Lately I have been getting my sawbones to give me a scrip which I use to shop around (GoodRX.com) and the prices do vary. I have Aetna as my medicare thing, but I will be changing at the end of the year. Sometimes the Aetna (They own CVS drugs or vice versa.) price is high. I just paid $99 for 30 Myrbetriq (Who comes up with those names?) tablets, 25 mg. That was lower than $300 at Von's drugs. (Von's = Safeway.)

CNC
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No. of Recommendations: 1
GWPotter: In my view insurance is to cover expenses you can not easily cover yourself. That is one reason for having a deductible on say my auto insurance. If I have to have one accident every 3 years to cover the difference with an auto deductible, for me it is not worth it. Having that frequency of claims first would raise my rates and eventually get me canceled.

Auto insurance is a horse of a different color. I carry $1000 deductible on my car and the mandatory liability coverage. I was hit from the back earlier this year (The other driver ran away.) Used my $1000 deductible. The insurance paid $10,000. Could I afford a $10,000 bill every five years? Yes, but I'd rather pay my monthly bill from the insurance company.

CNC
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No. of Recommendations: 5
SD
Strongly suggest you go online and download the booklet "Medicare and You". User friendly and comprehensive in explaining the fundamentals of Medicare and its various parts and choices...and you have LOTs of choices.

Brief overview:

Part A, hospitalization, is provided without a premium but with a $1,408 Deductible (2020) per admission diagnosis (not per year)

Part B, outpatient and Dr. Bills. Premium (for most except very low and very high household income) of $144.60/month, taken automatically from your Social Security or you pay if not receiving SS. A $198 deductible per calendar year and then a 20% copay on Medicare allowable charges

Medicare Supplement (or Medigap) is private insurance with standard coverages for plans A through N, that cover some-to-all of what Medicare allows but does not cover. Premiums run from $20 or so for A plans up through $150 - $250 for the F plan (the most comprehensive), although this will vary by your location and how the premium is determined by age. All these private plans are 'guraranteed issue' meaning they have to take you on initial enrollment, but may deny coverage if you delay enrollment. These rules vary by state.

Part D plans for drug coverage. Like part B, you can elect not to enroll, but later enrollment will carry a penalty. Plans vary from basic coverage for around $20/month up to expensive for plans that cover most or all drug costs. Varies widely by state.

Medicare Advantage (MA) Plans are the alternative to Medicare + Supplement + Part D. VERY IMPORTANT: when you choose an MA plan, Medicare is no longer the insurer...the plan is. You must follow the plan's rules for coverage. MA plans can be divided into 4 types: Group HMO, Point of Service (sometimes called Community) HMO, PPO and Fee For Service.

Group HMO: Kaiser Permanente is the standard here, although there are others. It owns the hospitals, clinics and most oupatient services. Monthly enrollment premium includes Part A, Part B and Part D coverages that are part of the plan and usually much less expensive than standard Medicare + coverages would be. But you must choose a primary care provider (physician) within the plan and almost all referrals must go through them, you must live in the plan's catchment area and cannot elect coverage outside the plan, unless you pay for it. (except emergency coverage which the plan covers)

Point of Service (POS) HMO. This HMO model requires a primary care provider for each enrollee but allows enrollees to go out of the plan to seek specialty care, although the plan may place restrictions on this. Typically, the out of plan deductible is higher than in-service visit deductibles

Preferred Provider Organizations or PPO. This is a group of contracted medical offices, hospitals and outpatient services in a broad network. The primary difference with the PPO is it does not require the enrollee have a primary care provider through which all specialist referrals must be made. There is a potential major problem with this, as any treatment or surgery involving a provider not enrolled in the PPO will bill directly for their services to you as the PPO will not pay for it. So its up to you to make sure all providers who see/treat you are part of the plan.

Private Fee-For-Service. These I understand are declining in number, The attraction is most do not charge a monthly premium and you can go to any Dr. you wish who accepts their payment. The bad news is you don't know how much the insurer will pay and anything they don't, you will pay. My advice: stay away if these are offered in your area.

A great resource is your states Senior Health Insurance Program (SHIP) or Senior (or Statewide) Health Insurance Benefits Advisors program. This is a consumer-driven program offered to you for free, funded by Medicare. I'd say this should be a mandatory visit for all those first comming into Medicare.

BruceM
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No. of Recommendations: 3
Part D plans for drug coverage. Like part B, you can elect not to enroll, but later enrollment will carry a penalty. Plans vary from basic coverage for around $20/month up to expensive for plans that cover most or all drug costs. Varies widely by state.

I've been paying out-of-pocket for medications for years. I started getting notices from Medicare this past year to sign up for Part D. I didn't think I was eligible yet, but...

I signed up for a cheap plan, based on the drugs I take. Costs me $13/month and is saving me about $3000 per year on the drugs I currently take. Most of my drugs have no co-pay.

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When my mom got a prescription for a new drug, she found out it was something her insurance plan (Humana) didn't cover. Her "co-pay" was something like $96. When I checked on goodrx.com, I found out the pharmacy at Fry's Foods would charge less than $50 if she used the GoodRX "coupon". So she's been getting it there.
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