# Getting a Little Nervous..Health Ins.



## Helena

I will be going on Medicare next month. So my SS will be a little more than $100 less a month. Don't know how that will work on the old budget..but that's another question. So..after having very good health insurance with husbands job for many years..now he is on disabiltiy and they are paying for his insurance but my payments would be $450 a month to continue my plan..and with a little more than $100 a week disablity don't see continuing my insurance on his plan now. So looking into supplemental insurance and think I have found one than PA is looking pretty good with very low cost including prescription. Guess I'm a little nervous because I have been so very spoiled with the unions health coverage for many years. So...how did you all work it out.??:drum:


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## Nevada

You know that on the main board page the title of this thread has been truncated by the vBulletin software to "Getting a Little..." 










Maybe you are, but it's none of my business anyway. I just thought it was an interesting thread title for the retirement forum. Some members are going to wonder what goes on around here.

As for your healthcare insurance, look for a Medicare Advantage plan in your area at medicare.gov. You might find an HMO plan that meets your needs without the expense of supplemental insurance.


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## thesedays

If your household income is that low, you may be eligible for Medicaid. It doesn't hurt to ask.


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## Nevada

thesedays said:


> If your household income is that low, you may be eligible for Medicaid. It doesn't hurt to ask.


Yes, she certainly might. Here is an Obamacare calculator to get an idea.

http://www.washingtonpost.com/wp-srv/special/politics/what-health-bill-means-for-you/#

As it stands today, Social Security income does not count towards income in calculating Obamacare, but that may change. Figure it with & without SS to get a feel for what that will do to you.


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## fordy

Helena said:


> I will be going on Medicare next month. So my SS will be a little more than $100 less a month. Don't know how that will work on the old budget..but that's another question. So..after having very good health insurance with husbands job for many years..now he is on disabiltiy and they are paying for his insurance but my payments would be $450 a month to continue my plan..and with a little more than $100 a week disablity don't see continuing my insurance on his plan now. So looking into supplemental insurance and think I have found one than PA is looking pretty good with very low cost including prescription. Guess I'm a little nervous because I have been so very spoiled with the unions health coverage for many years. So...how did you all work it out.??:drum:


 
.................There are several plans to choose from besides an Advantage plan , A , B , C , D........F , G ! They are all a little different . Of the lettered plans , PLAN F , is the BEST ! You will have to take out a supplemental Policy , ~ 150 a month , and a drug plan ~30 a month ! BUT , Plan F pays the full 20% as long as medicare pays the 80% . And , once you sign up for plan F they cannot cancel your coverage , BUT , IF you opt out for say 6 months and reapply , they can make you take a physical to re establish coverage ! , fordy


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## Helena

went today and signed up for the Gessinger Hospital plan in PA. Basically, I don't use my medicare..I have a $3000 deductable with them giving me $1500 credit first to use and the second $1500 of the $3000 is out pocket then once it hits $3000 they pay all. I realize that the hospital is taking the medicare monthly payment towards the $1500 credit to me...but..OK..Then took the AARP prescription plan for $37.00 a month which means my prescriptions are either $3or $5or highest $40 at any pharmacy for 30 days or through the mail at same price for 90 days supply. Any hospital or doctor will take this plan except one in our local area. So for me..this is fine. I can change it during certain months if I want too later. Of course, I have no dental or optician care. but..can work with that. I have no monthly premimum except the AARP prescription money. So for me I think will work just fine. If any of you live in PA please check into this plan.You can live in any county or city in PA..


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## Micheal

Helena, glad to see you signed up for something that will work for you......
Healthcare (medicare plus other coverage) once you turn 65 is not one of the easier things a retiree has to decide on. 
I know here in NY each and every plan offered has to be approved on the county level making it all the more difficult to find a suitable coverage only because what may be offered in one county may not be in the adjacent county...... So commenting on healthcare just in another NY county let alone another state is near impossible.


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## RDuke

I,for one, am tired of being confused by the myriad of insurance plans. I will be signing up for Medicare in just under 12 months and have tried to educate myself on the various plans that are available. I've compared costs vs coverages and etc. I have spoken with an insurance professional to get further guidance and I keep running into the same wall; Obamacare is to kick in at the first of next year, if some or all of it isn't repealed by congress, and coverages and costs are very much up in the air as of now. Everything I try to absorb now may be worthless information no longer applicable in 12 months.
I try not to stick my head in the sand but I'm afraid that, for now, by best approach is to just wait and see.
Do others feel this way? Can anyone here suggest an approach toward planning the next 12 months?


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## Wolf mom

If you're confused by the different plans - use an insurance agent - _they're paid for by the government so have no personal interest having you buy a more expensive plan. _


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## Nevada

RDuke said:


> Do others feel this way? Can anyone here suggest an approach toward planning the next 12 months?


I'm in about the same situation as you are. I'm planning on using a Medicare Advantage provider so I can have an HMO with small copays. As it happens, the same company I want to go with also offers an HMO through Obamacare. The insurance will basically be the same for me.


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## Wolf mom

Nevada, 
I have an Advantage plan and my co-pays for specialists are up to $50.00 a visit. Primary Doc is $25.00 a visit. 

HMO's are _not_ the same as Advantage plans.


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## fordy

...................My AARP HMO has NO Copay for my primary care doc , specialists are $45 or so . I go every 3 months for a complete Blood workup due to Type 2 diabetes and it costs me nada . , fordy


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## Nevada

Wolf mom said:


> Nevada,
> I have an Advantage plan and my co-pays for specialists are up to $50.00 a visit. Primary Doc is $25.00 a visit.
> 
> HMO's are _not_ the same as Advantage plans.


That's true, not all advantage plans are HMOs. What makes it an Advantage plan is being administrated by a private insurance company instead of by Medicare. Advantage plans can be an HMO, a PPO, or even a traditional insurance plan.

But Medicare Advantage plans are much more competitive here in Las Vegas. Alma's HMO was like this:

Primary Visit: No copay
Specialist Visit: $35
Xray Clinic Visit: $5
Lab: $5

With copays like you are paying there isn't a lot of advantage over straight Medicare.


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## Wolf mom

So true, Nevada. This is what you get when insurance companies can't cross state lines like auto insurance.

I'm just thankful I'm pretty healthy - so far. But, by then, we'll have single payer insurance so this'll be a moot point.


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## Nevada

Wolf mom said:


> So true, Nevada. This is what you get when insurance companies can't cross state lines like auto insurance.


Just so you know, auto insurance is also regulated by states. They can't operate across state lines without state approval either.

But that's not altogether a bad thing. States regulate insurance companies that operate in their states to protect customers. States have that right. If congress passes a law that allows insurance companies to operate across state lines, the law will almost certainly be an infringement of states rights to regulate insurance companies who operate in their states. Not only is that probably unconstitutional, but it isn't a good idea either. Do we really want more federal regulation?


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## Wolf mom

Yup, state rights. And because of state regulations many people have fewer and fewer choices as health insurance companies are pulling out of some states. That's one reason rates are so high - little competition.

No, I don't want more federal regulations, and we don't need the states to "look out for us" (an old argument intimating we can't look out for ourselves) any more than they do for the auto insurance industry.

How can you say it's an infringement on states rights or unconstitutional when it's not for the auto industry? I don' understand....


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## farmrbrown

Just a note of fact.
There are currently no laws that prevent auto, health, or any other kind of insurance to be "sold across state lines". 
This is a myth, perpetuated by those with a vested interest (insurance companies) and the vast, ignorant public.
All that is necessary to sell an insurance policy in any state, is to get a license to do so.
The problem is, that a company has to abide by the insurance regulations on coverage, etc. in that state.
Think of it like a driver's license.
One license, and you can legally drive in all 50 states.
BUT, just because you have a Texas driver's license doesn't mean you can go 75 mph thru Rhode Island, you have to obey the rules of that state when you drive thru it.

They can make the *licensing* accepted in all 50 states, but that in no way means that an insurance company will automatically want to go there.
(Think about a Texan in Rhode Island again, lol)


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## Nevada

Wolf mom said:


> No, I don't want more federal regulations, and we don't need the states to "look out for us"


The insurance industry wouldn't work without regulation. The incentive for the insurance company is to maximize profits by putting money collected as premiums into risky investments. Regulation curbs that, and required the insurance companies to keep a certain amount of money on hand to cover claims. Without regulation, why would an insurance company do that.

Whenever an industry's interests are dissimilar from the public's interests regulation is required to avoid disasters. The mortgage crisis of 2007 is a perfect example of the way things can go wrong with too little regulation.


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## Wolf mom

Nevada said:


> The incentive for the insurance company is to maximize profits by putting money collected as premiums into risky investments. Regulation curbs that.


Too funny, Nevada (although I agree with a lot of what you've written). One of the largest buyers of bundled mortgages was insurance companies.....and we know how that industry is thriving today.

farmrbrown, the key to what you wrote is the statement that the health insurance companies have to abide by state regulations, and that is what I supported my prior post: "because of state regulations, people have fewer and fewer choices as health insurance companies are pulling out of some states"


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## KeepingItAtHome

We don't carry traditional health coverage. We have chosen to use a co-op of sorts. It's called Samaritan Ministries (it is specifically Christian). When we have a major medical expense we pay for it out of pocket (or put it on credit, or make arrangements for payments) because we pay cash we get a discount (as much as 90% for my gallbladder surgery) We then submit the bills to the corporate office and receive checks to pay it back. Each month we send out our share (currently $350 for our family of 9) directly to the family in need. 
Things I really love about this set up
* No CEO fat cat getting rich because of my need to have coverage
* my money goes directly to a family, I know the problem they had, I send a little card with a note of encouragement. Receiving these cards is really nice. 
* I always have the option of sending more to help a family out. 
* I don't have to get approval or a referral to get the treatment I deem necessary. <giant plus in my book!

Things I don't like
* it can take 3-4m to get reimbursed
* prescriptions are not covered
* minor office visits are not covered. This is really just for major medical conditions. We've used it twice, both of them were out patient surgeries I needed. 
* sometimes the bills are prorated, there isn't enough members to cover all the needs. This means that a percentage of the need won't be covered, usually it's 10-20%

I know there are several other health care co-ops out there. Each with their coverage rules.


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## Nevada

Wolf mom said:


> Too funny, Nevada (although I agree with a lot of what you've written). One of the largest buyers of bundled mortgages was insurance companies.....and we know how that industry is thriving today.


What you say is true, but it's just another example of regulation gone wrong. Those insurance companies invested in AAA-rated securities, rated by licensed rating agencies. It was fraud to be sure, but the insurance companies didn't know that because they relied in the opinions of rating agencies.


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## fordy

KeepingItAtHome said:


> We don't carry traditional health coverage. We have chosen to use a co-op of sorts. It's called Samaritan Ministries (it is specifically Christian). When we have a major medical expense we pay for it out of pocket (or put it on credit, or make arrangements for payments) because we pay cash we get a discount (as much as 90% for my gallbladder surgery) We then submit the bills to the corporate office and receive checks to pay it back. Each month we send out our share (currently $350 for our family of 9) directly to the family in need.
> Things I really love about this set up
> * No CEO fat cat getting rich because of my need to have coverage
> * my money goes directly to a family, I know the problem they had, I send a little card with a note of encouragement. Receiving these cards is really nice.
> * I always have the option of sending more to help a family out.
> * I don't have to get approval or a referral to get the treatment I deem necessary. <giant plus in my book!
> 
> Things I don't like
> * it can take 3-4m to get reimbursed
> * prescriptions are not covered
> * minor office visits are not covered. This is really just for major medical conditions. We've used it twice, both of them were out patient surgeries I needed.
> * sometimes the bills are prorated, there isn't enough members to cover all the needs. This means that a percentage of the need won't be covered, usually it's 10-20%
> 
> I know there are several other health care co-ops out there. Each with their coverage rules.


................When was the last time this operation submitted their accounting system , asset accounts , investment accounts , minutes of board meetings , etc . to a Complete Audit and then mailed the results to ALL participants ? If , it takes 4 months for them to pay the bills of their customers , they are taking advantage of those customers ! , fordy


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## KeepingItAtHome

fordy said:


> ................When was the last time this operation submitted their accounting system , asset accounts , investment accounts , minutes of board meetings , etc . to a Complete Audit and then mailed the results to ALL participants ? If , it takes 4 months for them to pay the bills of their customers , they are taking advantage of those customers ! , fordy


No it can sometimes take 4 months because of waiting for bills from all the medical entities, the process of dividing the shares, and then waiting for a variety of people to send in a check. 

There are no investment accounts, they don't get the money, my check is made out to Mr & Mrs Smith who had gallbladder surgery. I send about $100 a year to the corporate office for paperwork etc. 

Minutes go out quarterly, members vote yearly on board members.


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## upnorthlady

I second the idea of an Advantage plan. I have a Humana Advantage plan that costs me $91 a month. It covers just about everything. Doctor visits are $10. Specialists are $30. Surgeries and hospitals are paid. I get one dental visit and cleaning a year with no charge. I get one vision screening a year with no charge. I use a mail in pharmacy and as long as drugs are in tier 1 or 2, there is no charge. I know that finding an insurance plan can be very confusing. I used an insurance agent and was glad I did. They sift through all the details and lay it all out for you.


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## Wolf mom

I do have an Advantage Plan and you saw my costs in my former post. Guess I'll have to go back to my insurance agent and see if he can get me a cheaper one in Arizona - although with Obamacare, next year many benefits of an Advantage plan will be cut. 

My golden years sure are getting tarnished!


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## Nevada

Wolf mom said:


> I do have an Advantage Plan and you saw my costs in my former post. Guess I'll have to go back to my insurance agent and see if he can get me a cheaper one in Arizona - although with Obamacare, next year many benefits of an Advantage plan will be cut.
> 
> My golden years sure are getting tarnished!


You don't really need to ask your insurance agent. You can search for Medicare providers in your area at medicare.gov.


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## fordy

Wolf mom said:


> I do have an Advantage Plan and you saw my costs in my former post. Guess I'll have to go back to my insurance agent and see if he can get me a cheaper one in Arizona - although with Obamacare, next year many benefits of an Advantage plan will be cut.
> 
> My golden years sure are getting tarnished!


............My AARP plan costs me $0 , but , it has the largest number of members in my county ! Currently , over 100,000 last I checked . IF , my RV park were 1000 feet further west I'd be in a different county and ineligible to join the AARP plan I'm in now ! , fordy


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## ycanchu2

KeepingItAtHome said:


> We don't carry traditional health coverage. We have chosen to use a co-op of sorts. It's called Samaritan Ministries (it is specifically Christian). When we have a major medical expense we pay for it out of pocket (or put it on credit, or make arrangements for payments) because we pay cash we get a discount (as much as 90% for my gallbladder surgery) We then submit the bills to the corporate office and receive checks to pay it back. Each month we send out our share (currently $350 for our family of 9) directly to the family in need.
> Things I really love about this set up
> * No CEO fat cat getting rich because of my need to have coverage
> * my money goes directly to a family, I know the problem they had, I send a little card with a note of encouragement. Receiving these cards is really nice.
> * I always have the option of sending more to help a family out.
> * I don't have to get approval or a referral to get the treatment I deem necessary. <giant plus in my book!
> 
> Things I don't like
> * it can take 3-4m to get reimbursed
> * prescriptions are not covered
> * minor office visits are not covered. This is really just for major medical conditions. We've used it twice, both of them were out patient surgeries I needed.
> * sometimes the bills are prorated, there isn't enough members to cover all the needs. This means that a percentage of the need won't be covered, usually it's 10-20%
> 
> I know there are several other health care co-ops out there. Each with their coverage rules.


 Have you heard of Christian Healthcare Ministries? I have thought about going that route.


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## frogmammy

fordy said:


> ...................My AARP HMO has NO Copay for my primary care doc , specialists are $45 or so . I go every 3 months for a complete Blood workup due to Type 2 diabetes and it costs me nada . , fordy


Last time I saw my doctor, she asked what I was there for (diabetic). Said, for my thrice yearly checkup, but frankly, I'd rather be having a root canal.

Before I left, she told me that they prefer I come every four months, BUT I could come every six months if I preferred. I preferred. Yay!

Anyway, you might ask if you can go less, if you desire to.

Mon


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## Nancy

We have Samaritan Ministries also. Love that we have fellow believers covering our medical needs and not the government. Since we aren't covered for the prescriptions or doctor visits, we keep a savings account to help with those expenses. When I turned 65 this summer we stayed with Samaritan. If I took some supplemental B plan out it would cost more than I get in SS. DH is 64 so it is really cheaper to do Samaritan for both of us. DH has had several surgeries since we've been with Samaritan and it's been covered 100% minus our first $300. out of pocket. No 80-20 split like we had with our conventional insurance. And we've always gotten a hefty discount for being self pay.


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