How health insurance works? (HSA, plan, hospital, doctor)

[abhisheks77]

Hello,

I am confused about how health insurance works in US and trying to understand. I am in US since 10+ years and if I check SSA website, it shows me I am eligible for Part A and Part B. That indicates that me and my spouse should be eligible to get my health expenses covered after age of 65.
Now I am reading that Part A and Part B are not sufficient. It lacks at two places --
- Vision, Dental and Hearing will not be covered.
- Only 80% expenses are covered. Rest 20%, we will have to bear.
- After certain period/expense (like hospital stay over 60 days), cost will increase on our pocket.

We can buy Medigap policy which will help to cover above gaps. It can be bought when we are few months away from 65. Please correct me if I am understanding it correct so far.

Now my confusion is, do I need to buy any health insurance plan starting now, which would trigger at my post-retirement?
If I buy it/something post retirement, am I expected to buy with my saved money or SSA payment?
Is that a monthly expense which I would need to do at that time?

Please help to understand.

Thanks

[GWoodle]

You are on the right track. Prices for 2024

Part A is free with a 10 year work history. A spouse can be carried if the other partner is married 10 years & has the work history. Someone may pay $505/month premium

There are limits to Part A (Hospital)
Hospital stay 0-60 days zero
Hospital stay 61+90 days $408/day
Hospital stay 91-150 days $816/day

At skilled nursing facility $204/day

Most Medigap plans will fill gap left by Part A

For Part B pay $174.10/month premium. The doctor charges, Medicare allows, then pays 80% of that amount. You pay the 20%

This is where a Medigap insurance plan begins. Depends on the Plan you select. All Plans have a letter that covers each item to some %.

Then you get a Part D Prescription plan. Pay an insurance company premium to cover medication expense. In Part D there can be 4 prices for a medication depending what Phase you are in. Medicare keeps track of the retail cost of the items you purchase. What you pay depends on what type it is & how the Plan covers the medication.

Vision, dental & hearing covered separately. Some Plans & some Advantage plans bundle these services.

You can't pre-buy a policy now. There is a 7 month window where you apply for Medicare, Social Security, & your insurance plan at that time. You get 3 months before/after your birthday month.

[abhisheks77]

Originally Posted by GWoodle

You are on the right track. Prices for 2024

Part A is free with a 10 year work history. A spouse can be carried if the other partner is married 10 years & has the work history. Someone may pay $505/month premium

There are limits to Part A (Hospital)
Hospital stay 0-60 days zero
Hospital stay 61+90 days $408/day
Hospital stay 91-150 days $816/day

At skilled nursing facility $204/day

Most Medigap plans will fill gap left by Part A

For Part B pay $174.10/month premium. The doctor charges, Medicare allows, then pays 80% of that amount. You pay the 20%

This is where a Medigap insurance plan begins. Depends on the Plan you select. All Plans have a letter that covers each item to some %.

Then you get a Part D Prescription plan. Pay an insurance company premium to cover medication expense. In Part D there can be 4 prices for a medication depending what Phase you are in. Medicare keeps track of the retail cost of the items you purchase. What you pay depends on what type it is & how the Plan covers the medication.

Vision, dental & hearing covered separately. Some Plans & some Advantage plans bundle these services.

You can't pre-buy a policy now. There is a 7 month window where you apply for Medicare, Social Security, & your insurance plan at that time. You get 3 months before/after your birthday month.

I was confused, as I was comparing it with insurance pan in South Asian countries. There most of the places, people start paying monthly or yearly into health insurance, and it will continue till retirement age. Then paying to insurance company will stop and health insurance will trigger. It will continue depend on it was bought for next 20 years of 30 years and what monthly/yearly premium was paid. In US, it looks different.

I am at 46 right now. So, I will not be enrolling/buying now and I will start buying monthly insurance (for Medigap and Part D prescription) near my 65?
I don't know, what will be amount to pay at 65, but if I assume it is few hundred or say $400/month to be paid for Medigap and Part D prescription, will it need to be continued forever?

[ihatetodust]

I assume you have (private) monthly insurance now?

You will cancel that at 65 when you sign up for Medicare, and yes continued forever. $400 is not a bad estimate today but in 20 years it will go up

[abhisheks77]

Originally Posted by ihatetodust

I assume you have (private) monthly insurance now?


You will cancel that at 65 when you sign up for Medicare, and yes continued forever.

Yes, I am paying around $400 per paycheck through my employer to Aetna. But it will cover me as far as I am employed. If I change job, will do same deduction with that employer, till I don't get retire.

[southernlady5464]

Medicare/Medigap/Medicare Advantage policies are individual. You have one, your spouse has one. There is no way to be a family. I wish there was but there isn’t.

[skeddy]

when you're eligible, Medicare covers 80% as you stated. What you'll need is a supplemental policy to cover the remaining 20% too.

[GWoodle]

Originally Posted by abhisheks77

I was confused, as I was comparing it with insurance pan in South Asian countries. There most of the places, people start paying monthly or yearly into health insurance, and it will continue till retirement age. Then paying to insurance company will stop and health insurance will trigger. It will continue depend on it was bought for next 20 years of 30 years and what monthly/yearly premium was paid. In US, it looks different.

I am at 46 right now. So, I will not be enrolling/buying now and I will start buying monthly insurance (for Medigap and Part D prescription) near my 65?
I don't know, what will be amount to pay at 65, but if I assume it is few hundred or say $400/month to be paid for Medigap and Part D prescription, will it need to be continued forever?

The US plan won't compare to any other country.

You are 46 now. Your employer may be paying most of your coverage. You may be paying the rest. There may be a choice in the level you get. Pay more in premium for more coverage. Pay a little less for less coverage. A lot depends on your health & at what level of risk you accept. With your company plan also depends how healthy your fellow workers are. With more illness over time comes more cost. It is up to the company to decide how much of the cost is to you. Since you are 46 now you may have 20 years to work & stay on a similar plan.

Nobody knows how Medicare will change in 20 years. You can guess over 20 years numbers may be 2x the 2024 figures. This is why you need to save money now to provide for your future. You probably have a 401K plan to provide for your retirement. You may have a HSA to provide for your health care needs. You need to fund these accounts over the next 20 years as much as you can.