NFR For Those on Medicare/Specifically Kaiser Plan…. Help appreciated!

[Xoxo]

I hope this is okay to put this here, but if not it can be deleted.

I do not understand how i can be of Medicare age when i feel like I’m 32.

Right now I have a stack of Medicare packets that i have been procrastinating about for weeks and weeks. We’ve been happy with our PEBB Kaiser Permanente (which i wasn’t sure about when Group Health sold out to them). So we are able to at least narrow it down to what we want. But they have different levels of Medicare Plans and I’m not sure just going for the most expensive makes sense to start.

It’s all very daunting. I did take a webinar class from Kaiser recently and took notes about copays and deductibles and coverage. But there are so many variables to weigh.

For those of you who are on Medicare, how did you navigate through all this? Questions are like: What should i be thinking about with prescription drug coverage if our medication is not very expensive And we can always add better coverage if that changes during an open enrollment.

If you have any advice, ESPECIALLY if you are covered by Kaiser for Medicare, i would appreciate it.

 

[kerrys]

Jojo, I don’t have Kaiser and my needs are a little special when it comes to medical care and insurance. I used a consultant to narrow the field down. I’ll send you their name.

 

[Xoxo]

Thank you @kerrys !
My husband and i both worked in education and we are currently under a PEBB Kaiser plan. Kaiser has a PEBB Medicare Plan, along with i think three other plans. I’m unclear if i should go the PEBB way. What i learned is I i would have to choose the PEBB plan now or lose it forever. But i can always switch during open enrollment out of PEBB into one of the other plans if it’s not what we want. I thought i could just call up and say continue with exactly what we have and here’s my out of pocket expense. But i don’t think it’s like that.

 

[wetline dave]

I have Medicare parts A and B and then United Health Care through AARP for a supplemental. I have no co-pays and can have any doctor that excepts Medicare.

In the past nine years I have had some major expenses, 4 way bi-pass, dialysis 3 times a week to the tune of $4500 a pop. I have only been out the premiums.

The supplemental is key. Avoid Humana, they aren't what they seem and claim to be.

Dave

 

[Richard Olmstead]

I feel for you Jojo. I recently retired and had to go through this after having health care through my work (UW). I have a Ph.D. My wife is a retired social work case manager. This was one of the most incomprehensible and anxiety provoking things we have been through in a long time and we're still not sure if we made the right choice, although we did make the decision to sign up for a plan that enables us to keep your current providers. I had been with Group Health for many years, but a bout with cancer a few years back led me to switch to UW Medicine, so we decided on the Uniform Medical Plan with PEBB. It is a little more expensive, but very flexible. If you have been happy with GH/Kaiser, stick with them.

The process gave me a renewed appreciation for how effed up the health care insurance biz is in this country. Keeping people confused and anxious results in having people pay more, or doing what Kerrys did - hire a consultant. Wouldn't it be nice to have a system that didn't require a huge for-profit industry between you and your health care?

 

[SurfnFish]

My wife is way savvy on health plans, retired nurse manager with a masters in public health administration.
We checked them all out, as well as sat down with a plan broker who happened to be a friend.
The best F plan, the Medicare major supplemental, for us was the AARP United Health Care plan mentioned above. Each year we price it out against other plans and are still with it.
Rx plans, titled D Plans, can be highly variable. The best tool is to use the Medicare Plan D finder. Enter the drugs you use, and the plan finder will show what plan covers it and at what cost.
The bummer about retirement health care is the lack of dental, as even the best available open market dental plans cover little, and a single implant can cost 6K.

 

[SurfnFish]

IThe process gave me a renewed appreciation for how effed up the health care insurance biz is in this country. Keeping people confused and anxious results in having people pay more, or doing what Kerrys did - hire a consultant. Wouldn't it be nice to have a system that didn't require a huge for-profit industry between you and your health care?

Spent 25 years in health care before going into high tech. As Operatons Director for a medical school with large clinics and acute care hosptial , was a member of the Chargemaster committee. The Chargemaster captures the costs of each procedure, service, supply, prescription drug, and diagnostic test provided at the hospital, as well as any fees associated with services, such as equipment fees and room charges, and turns that into the basis for patient billing.
As a non-profit we compared our Chargemaster against that of a nearby for profit hospital. Their per line items ranged from 2x to 15x our charges across the board. The same surgery that was 20k in our hospital was 60K in theirs. Our daily all in room cost was $385, their was $740.
There are two things in America that should be operated as non profits = education and health care. Educated and healthy Americans maximize the potential of our country....the opposite does the opposite

 

[Brian Miller]

I retired at 64 after working for a health insurance company for 23 years. I worked there long enough to become vested in the defined bennies pension plan but it was frozen for about 10 years before I retired and only a 401K was offered to new employees. Mrs Brian is 3 years younger than I and the company provided health insurance at 50% of the cost of a standard employee plan for Mrs Brian and I until we each turned 65.
Even though I had worked in healthcare for 23 years when I was about to go on Medicare, I was confused (and biased), so I asked a recently retired fishing buddy who was a doctor and a founding partner of the my primary care clinic. He suggested a licensed insurance broker who works with several different health insurance companies and could get me (and 3 yrs later Mrs Brian) enrolled in a plan that works best for me-us. A broker is paid by commission from the company you select and enroll in, comes out to your house at no charge to you , gets to know you, asks you who your docs are, a little about your medical history, your plans for the future, insurance preferences... They know the plans, and can lay out plan options from multiple companies, explain the differences, and the costs. I don't know if our broker does Kaiser but PM me if you're interested in meeting with her.

 

[Old406Kid]

We have a very knowledgeable licensed independent agent that reviews the various supplemental plans every enrollment period and directs us accordingly. There is no additional charge and they can help you to avoid costly mistakes. Our agent is also there to go to bat if there's a coverage issue.
Last year I had Humana Plan G which is identical to Plan F with the addition of about a 250$ annual deductible. I racked up some huge bills and we didn't pay a nickel above the deductible.
This year the agent switched us to Asuris which has the same coverage for a lesser premium, kinda feel sorry for them as I have some even bigger expenses ahead.

 

[Old406Kid]

I retired at 64 after working for a health insurance company for 23 years. I worked there long enough to become vested in the defined bennies pension plan but was it was frozen for about 10 years before I retired and only a 401K was offered to new employees. Mrs Brian is 3 years younger than I and the company provided health insurance at 50% of the cost of an standard employee plan for Mrs Brian and I until we each turned 65.
Even though I had worked in healthcare for 23 years when I was about to go on Medicare, I was confused (and biased), so I asked a recently retired fishing buddy who was a doctor and a founding partner of the my primary care clinic. He suggested a licensed insurance broker who works with several different health insurance companies and could get me (and 3 yrs later Mrs Brian) enrolled in a plan that works best for me-us. A broker is paid by commission from the company you select and enroll in, comes out to your house at no charge to you , gets to know you, asks you who your docs are, a little about your medical history, your plans for the future, insurance preferences... They know the plans, and can lay out plan options from multiple companies, explain the differences, and the costs. I don't know if our broker does Kaiser but PM me if you're interested in meeting with her.

Much the same story in my comment above.

 

[RCF]

WOW! This is all I can say. Reading what @SurfnFish , @Richard Olmstead , @Brian Miller @wetline dave , and others have shared just shows how important the decisions we make with Medicare are so important. Thank you so very much for sharing!

We do not know what will happen in the future. But getting older also shows what the least expected can and in many cases will happen. Having choices on who to see is very important. If I had cancer I sure the hell would want to be able to go to the SCCA (Seattle Cancer Care Alliance) - rated in the top 10 in the nation and number 1 in the PNW.

When people in the 'medical/insurance field' have troubles making choices, heaven help the rest of us with when we do not have that knowledge.

In Seattle we are so fortunate to have some of the best, or in some cases the best, medical resources available in the nation. The UW, Fred Hutchinson, Seattle Children's remain independent yet have pooled their resources to provide the best for their patients. The research capabilities, when pooled and funded, provide so much more than if done independently.

With the consolidation of medical providers e.g. Swedish has merged with Providence and Group Health is now a part of Kaiser things are changing. To what is yet to be determined. My experiences with UW and Swedish have been off the charts incredible. Just wish I have not experienced them . But that is my life unfortunately .

IMHO - do not plan your medical needs with what you require now, but take them in account. Plan for unforeseen events in the future and have the flexibility to make your choices of treatment.

 

[krusty]

Just retired and have an advantage plan with United Health Care. Hope it works out well.

The big decision is whether to go with a Medigap supplemental or some sort of advantage plan...both have advantages (no pun intended) and disadvantages, and that depends on your specific needs, budget, retirement travel intentions, and location(s).

It's helaciously complicated, and if somebody can send you contact info for a good broker in your area (who'll certainly know the ins and outs for Kaiser as well as whatever is available in your county) I'd highly advise you to discuss the selection with such an expert. We utilized a widely respected broker in Spokane, and he helped us discover things we were unaware of despite extensive pre-retirement research.

If you contact the actual company (i.e. Kaiser or whatever) you're gonna get a sales pitch.

Finally, stay away from national on-line consultant brokers; they don't know your area's medical resources and coverage opportunities.

 

[Xoxo]

WOW! This is all I can say. Reading what @SurfnFish , @Richard Olmstead , @Brian Miller @wetline dave , and others have shared just shows how important the decisions we make with Medicare are so important. Thank you so very much for sharing!

When people in the 'medical/insurance field' have troubles making choices, heaven help the rest of us with when we do not have that knowledge.

@RCF , thank you for your help and Kerry too. I don’t feel stupid proceeding when i hear that it’s a daunting task even for health professionals like some of y’all. Y’all are wonderful! Thank you so much for your help.

I didn’t expect a lot of posts here and was coming here to tell the moderators that they can delete this thread if they want. It occured to me this morning that a Medicare thread might scare off any young fly fishers who come here and wonder why a Medicare thread is here.

If a Medicare thread is a downer for that reason…. @Billy , @Evan B , @Josh …. i have taken screen shots of this thread so I have some very good information to proceed.

Thank you. Thank you!!!!

 

[Xoxo]

And yes i do have a number (thank you again @kerrys ) for an independent agent @Brian Miller and @Old406Kid and will be contacting them. I didn’t know that folks did this where it didn’t cost me. I hope they can answer some questions about Kaiser.

 

[Evan B]

I see no reason to moderate this thread. We encourage a variety of discussion topics.

 

[Xoxo]

@Thank you @Evan B !

 

[Mossback]

This is a good thread. If you're fortunate to live long enough and get to Medicare, the more you know the better. The earlier you get educated about Medicare, the less steep your learning curve will be on a complicated system.

 

[Bucktrout]

We moved to Olympia in 2014. My wife was a Kaiser MD and when we got married back in 2012 I changed over to Kaiser. We had two residences and kept our Kaiser coverage using our Portland house to stay in the Kaiser Perm. NW area. We were very happy when Kaiser purchased Group Health and I have Medicare Advantage with Kaiser and pay extra for dental coverage. Did not do much research comparing costs because the Kaiser system is so well integrated to deliver quality care efficiently.

 

[Xoxo]

We moved to Olympia in 2014. My wife was a Kaiser MD and when we got married back in 2012 I changed over to Kaiser. We had two residences and kept our Kaiser coverage using our Portland house to stay in the Kaiser Perm. NW area. We were very happy when Kaiser purchased Group Health and I have Medicare Advantage with Kaiser and pay extra for dental coverage. Did not do much research comparing costs because the Kaiser system is so well integrated to deliver quality care efficiently.

Thank you @Bucktrout . I have been very happy with Kaiser too and wasn’t sure i would be when they purchased Group Health as i had been a member of Group Health since the time they bought out Sound Health. We ARE going to be signing up for dental coverage. When i asked the office manager at my dentist’s office about Medicare insurance and what she thought was best for patients she told me Kaiser (and i had not told them i had Kaiser as my medical insurance).

I’ve been so lucky all my life to always have medical insurance since i was a military brat and later worked in education where you just chose a plan and it was easy. Ha, my husband is so lucky to have me doing this. He doesn’t turn 65 until six weeks after i do so he has it easy! But i would be doing this anyway as I’m the researcher in the family. I always love having all my ducks in a row, with no stone unturned, about anything i do.

I really appreciate all of the help here as i move forward. I’m definitely going to start with calling the independent agent since i’ve only been in contact with a Kaiser Medicare contact. I had no idea that was available to me.

 

[Clean Willy]

WOW! This is all I can say. Reading what @SurfnFish , @Richard Olmstead , @Brian Miller @wetline dave , and others have shared just shows how important the decisions we make with Medicare are so important. Thank you so very much for sharing!

We do not know what will happen in the future. But getting older also shows what the least expected can and in many cases will happen. Having choices on who to see is very important. If I had cancer I sure the hell would want to be able to go to the SCCA (Seattle Cancer Care Alliance) - rated in the top 10 in the nation and number 1 in the PNW.

When people in the 'medical/insurance field' have troubles making choices, heaven help the rest of us with when we do not have that knowledge.

In Seattle we are so fortunate to have some of the best, or in some cases the best, medical resources available in the nation. The UW, Fred Hutchinson, Seattle Children's remain independent yet have pooled their resources to provide the best for their patients. The research capabilities, when pooled and funded, provide so much more than if done independently.

With the consolidation of medical providers e.g. Swedish has merged with Providence and Group Health is now a part of Kaiser things are changing. To what is yet to be determined. My experiences with UW and Swedish have been off the charts incredible. Just wish I have not experienced them . But that is my life unfortunately .

IMHO - do not plan your medical needs with what you require now, but take them in account. Plan for unforeseen events in the future and have the flexibility to make your choices of treatment.

All of this! After 65 years of literally perfect health, I found out the hard way that this was not to continue. Now aligned with SCCA and fortunate to have made the coverage choices (UHC Plan G) that will cover everything going forward.