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Again, my retirement-incentive health insurance STOPS when Medicare STARTS. So for me, that's effective 12/1/23 -- not quite 2 months from now.
Most people pay $164 because their income 2 years previous was $97,000 or less (mine was, too, much of my working life!). If your income was above $97,000, you pay more. They use your PAST income to determine how much you will pay -- not your CURRENT income. It appears to be 2 years behind? (EG the 2023 rate based on my 2021 income, the 2024 rate based on my 2022 income, etc. -- I THINK.) There IS a method of appealing for life changes, and I think RETIREMENT counts, so I will appeal if my 2024 premium ends up being based on my 2022 income, which was an anomaly.
I lived in the Bay Area in California for 11 years (1982 to 1993) and had Kaiser insurance for most of that time. I found it totally fine. I'd grown up in the enlisted ranks of the military so HMO-style medicine was totally normal to me.
Alas, I did not realize that (^^^ bolded). I knew there was a premium charge for Medicare but I didn't realize that there was also a charge for the "gap" that Medicare doesn't cover (i.e. Medigap!) and for prescription drug coverage. As I wrote upthread, I wasn't planning to retire for many more years so would have just stayed on my employer's health insurance until then -- so I never had to look into Medicare!! Now, of course, I do.
Have you looked for an HD-G plan? High deductible? If you don't have any big health issues it may be better. We're only paying $28 for me and $30 for my husband.
Because I’m curious I went to the Medicare website and all I could find about being guaranteed to switch to a medigap plan after being on a advantage plan is that you can only do that for the first 12 months after you initially go on Medicare. So for many of us that ship has sailed.
That's interesting. I'm going to email that agent I talked to the other day and ask her about that because she stated that we can try it and switch back if we want to. I got the impression that this is a recent change. I will email her but I won't expect to hear back until Monday.
Pathrunner, it’s possible that I missed it and will be interested in what you find out. When I read that brokers get paid quite a lot when they put someone on an advantage plan it makes me very suspicious.
When I read that brokers get paid quite a lot when they put someone on an advantage plan it makes me very suspicious.
From what I recall our benefit broker telling me, Advantage plan commissions are regulated so they run from a low of about $450 to a high of about $750 (state dependent) for initial enrollments.
Supplement's commissions are not regulated in that way and are set by the insurance company which averages only about $125.
So in theory, commissions can drive some to push Advantage plans even when they may not be the best option for the consumer, although that would be a violation of the producer's licensing.
As mentioned way upthread, I started Plan G in 2016 at $124/mo California price. It goes up about $20/yr. My current rate is $228/mo. It goes up every September. In 7 years a $100 jump is not outrageous.
I'm sure actuaries are using a program to evaluate health conditions and usage, and probably do adjust each person's rate accordingly. I'm just guessing at that, but it makes sense.
Medigap rates are not adjusted for each individual's current health status and usage each year.
Once you have your policy, the premium may be adjusted annually based upon your age and sex, depending on the pricing methodology used by the insurance company.
To further expound, if one individual had no medical expenses last year and another individual developed cancer and had $1 million of medical expenses last year, they will both have the same subsequent premium increase. The individual with cancer will not see a big spike in their premium because of their medical condition.
As mentioned way upthread, I started Plan G in 2016 at $124/mo California price. It goes up about $20/yr. My current rate is $228/mo. It goes up every September. In 7 years a $100 jump is not outrageous.
I'm sure actuaries are using a program to evaluate health conditions and usage, and probably do adjust each person's rate accordingly. I'm just guessing at that, but it makes sense.
You might want to consider looking at other Medigap insurers, since California has a Birthday Rule that allows you to switch to another Medigap plan (of equal or lower benefits) around your birthday each year without underwriting.
It is much easier to understand why a specialist might not be considered “in network” by every insurance system
But the idea that an ER which admits patients to a hospital it is based in that is “out of network” is just a financial decision made to reside profits—
It is likely a shell corp owned by the hospital Linder a different name
Might even be leased out to another entity for flat fee or % of overhead even though both are owned by same ultimate corporation——
That is what market-based medicine brings you in America
FWIW,
the separation of the emergency department from the “hospital’s network” could be in itself a result of mind-boggling amount of uninsured or undocumented who use it as their de-facto healthcare providers as EDs are legally required to take them all.
So it is the networks loss leader of sorts.
Sounds like we need to look at how to remedy that for patients as well as insurance companies and healthcare system.
Why healthcare should be for profit? Nobody wants cancer or surgeries…
I would cancel all so called non-profits “charities” - we have literally millions of them getting money and not paying taxes.
Their CEO’s salaries in multi millions
Divert all of it to healthcare?
As it stands now - the Medicare Supplement is just another tax on people - some of them?most of them - are lower if not completely low income.
No wonder that the citizens who paid that Medicare tax all their lives have to resort to using some bogus disadvantage plans to avoid monthly fees…while their taxpayers money go to line up the pockets of the insurers..
Sometimes the choice is not truly theirs and yes… it is a gamble
Last edited by L00k4ward; 10-07-2023 at 04:42 AM..
That's my understanding from my conversation with the agent. As long as it's before 12 months are up.
Thanks...I am also going to call them and get further info. What I don't understand is, I had regular Medicare with my Fed BC/BS. Got 'talked into' rolling the BC into the advantage plan. I am paying co-pays now that I didn't pay when I just had the Fed BC/BS as 'back up,' as in $40 for my PT (shoulder issue) when last year, before advantage, I had no co-pay for a different issue. I'm not sure what the 'advantage' is to the Advantage plan.
I consider myself reasonably intelligent but when I start talking about this stuff, I am confused. I thought I was doing the right thing, switching.
Edit: I pay my Medicare premiums and I still pay for my BC/BS coverage monthly out of my fed retirement, which ain't alot.
You might want to consider looking at other Medigap insurers, since California has a Birthday Rule that allows you to switch to another Medigap plan (of equal or lower benefits) around your birthday each year without underwriting.
Thanks, I already mentioned upthread that I'm not willing to switch. I'm in the middle of a bunch of treatments and I just don't want the hassle of switching everything over with each doctor. If next year things have calmed down, I'll consider switching. I will admit that I don't trust companies and rising costs. Or coverage. For example, if I switch to the company I mentioned upthread, why is it so much less expensive and would I really get the same level of benefits? Even though they say they will, will they really?
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