On Mon, 5 Apr 2021 23:26:16 -0700 (PDT), DerbyDad03
wrote:

On Monday, April 5, 2021 at 11:45:21 PM UTC-4, wrote:
On Mon, 5 Apr 2021 22:33:48 -0400, "John Grossbohlin"
wrote:

wrote in message ...

On Fri, 2 Apr 2021 22:45:43 -0400, "John Grossbohlin"
wrote:

As long as inflation stays moderate we will probably be OK. With all the
deductions for insurance, savings, retirement plan, and commuting costs
going away I'm ahead for now. I'll have to reassess every year... I
haven't
figured out how to predict the future so I cannot do it now!

Well, insurance is still there. That can be expensive. My drugs,
alone, are a fortune. List is around $1K/mo. They're relatively cheap
now because of rebate cards but that all goes away with Medicare. The
drug plans (Part-D) aren't all that great. I still have a lot to
figure out about Medicare. It's almost like it was designed by
politicians.

The insurance situation certainly varies across people. For someone who is
healthy and doesn't take maintenance meds a free basic Managed Medicare plan
that includes pharmacy can suffice for a long time. Later on if the health
situation changes the plan can be changed during open enrollment. For
someone with chronic health problems who takes multiple maintenance drugs it
can get real expensive for sure.
I have a couple (three?) of drugs that are $1000 to $1500 for 90days.
Now, I have discount cards that pay much of the cost that my insurance
doesn't cover. For one, the cost is $1500/90 days, my co-pay is $120,
and it costs me $30 out of pocket. With Medicare all of that goes
away. Medicare Part-D helps until the donut-hole, which for me is
about March. Then it's going to cost about $5K for the next quarter.
My choices get real, fast.

Have you looked into the Managed Medicare plans? Some give you the
opportunity to have premiums rebated through various programs.

I'm certainly not interested in an HMO. Not a chance. I am
considering a PPO Advantage plan but, again, that only works if I
never plan on moving. I'm in my employer's PPO now but while I'm
working I would take that wherever they would move me.

The problem with Medicare is that the decision is pretty much a one
time thing. Sure you "can change at any time" but the fine print says
"underwriting may be necessary". IOW, forget it.

Why do you feel that a blanket CYA statement that uses the word "may"
is actually a "forget it" clause?

It may (or not) require underwriting. "Forget it" means that there is
no way to get underwritten if you have any health issues. Insurance
companies aren't in the business to lose money.

Lots of contracts have verbiage that protects one party or the other against
that one-off case that just doesn't fit the norm. All it does is give them an out
under certain, usually limited, circumstances.

No, it gives them a choice of writing a policy, or not. Their choice.

Have you actually been told - by someone official - that you can't make changes
over the years? Any stats as to what percentage of change requests end up being
denied by an underwriter?

I know others in similar circumstances. I know the payouts that my
current insurance has made. The other insurance companies know it
too.

I know people that use Medicare plan brokers who hold seminars before every
open enrollment period - for their existing clients - presenting the options available
for the upcoming year. Why would they do that if everyone is simply going to be
told "forget it"?

Advantage and Medigap are very different. Advantage plans are "managed
healthcare" options with features and costs pretty much decided by the
insurance companies. The insurance company gets a chunk of money from
the Feds and manages your healthcare with that money. You may pay
additional, or not. That's primarily what the brokers sift through.
Which of the _many_ plans is best for you. You are limited to doctors
and facilities and med costs vary. The brokers go through your list
of doctors, meds, and excess costs and figure out which is best for
you.

Medigap is a whole different kettle. There are only a dozen Medigap
plans (labeled A through N with some holes and options). All plans
(pools, really) with the same letter are exactly the same. The only
difference between insurers is the price. One price for everyone in
the plan/pool. Once in the pool, you can't be denied coverage IN THAT
pool and everyone pays the same price. In theory, you can change
plans during the enrolment period but it is subject to underwriting.
You're entering a new pool of insured so if your history is worse than
that of the rest of the pool, you aren't getting in. The better
plans, of course, have the least risk so are more choosy. Going to a
lesser plan probably isn't an issue but a better one is more difficult
because those wanting to upgrade tend to be those needing better
coverage. The better plans cover everything, for any doctor/hospital
that takes any Medicare patients. I know several people who travel to
the best specialists in the country for surgery, for instance. They
can't be denied coverage.

Drugs aren't covered under Medigap so a Medicare Part-D policy is
needed. This is where the "donut hole" comes in. Part-D only pays up
to a cap, then you're on your own until you've paid your annual
maximum for healthcare for the year. In the meantime, you're on your
own, paying out of pocket for everything. Manufacturer's discount
cards aren't allowed so for that one drug, I'd be out that $500/mo.
I'm on three with similar costs. These aren't exotic drugs, either.
Many are in this situation.

This is only the basics. The minutiae is far more complicated. It's
almost like the US government put it all together. THAT'S why plan
brokers are needed. ...just as enrolled agents, accountants, and tax
lawyers are needed.