Some of the plans would be “bad” for you. But might be what meets others needs
NFR For Those on Medicare/Specifically Kaiser Plan…. Help appreciated!
- Thread starter Xoxo
- Start date
Non-fishing related
There is most definitely no 'one size fits all' in this topic.
In 2021 I had 6 hours in ER + medications for bacterial pneumonia that I contracted from cutting back hazel nut trees on the property, 2 specialist follow-ups for DVT plus 2 doppler imaging sessions, a CKD diagnosis with ongoing dietician counselling (now normal kidney function) + ongoing prescription + a shoulder injury caused by adhesions treated with 6 deep tissue massage sessions. With my commercial Med Advantage plan ( like @Old Man @ no charge beyond the Medicare deduction from my SS) my total out of pocket cost.... $271.
A good thing to know about a commercial Med Advantage plan (at least with my company), in-network providers are contractually prohibited from charging subscribers more for approved treatments than the plan's subscriber's copay and deductible for the Current Procedural Terminology (CPT) codes the provider reports to the insurance company. Medicare dictates what is approved.
One other thing... Mrs Brian is having repeated issues with VA Medical for surgeries. The VA docs are OK, and no out of pocket so far, but Thank Goodness for the "Mission Act" signed into law in 2018!!! If a government-run health plan in the US were to turn out to be anything like the VA bureaucracy.....
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Bob Carroll
Smolt
Like several others, I use an independent agent. This is the third year. I had done some research and looked at videos before that but the agent has been a huge help. I’m with United Healthcare Plan G. Gets reevaluated each year.
My wife uses the same guy for help with the WA State Healthfinder Exchange.
I'm a retired Teamster. Through them I was able to get plan F supplemental plan before the government took them away from new enrollees in addition to Medicare A&B. Separate part D drug plan.
Plan F pays all bills, no copays, I can choose my own Drs. So far the bill's they've paid have been far more than my annual premium.
I'm kind of a worry wart and need peace of mind against a catastrophic illness bankrupting me. The cost is not cheap but the law of averages says over time the benefits will outweigh the cost.
Plan F pays all bills, no copays, I can choose my own Drs. So far the bill's they've paid have been far more than my annual premium.
I'm kind of a worry wart and need peace of mind against a catastrophic illness bankrupting me. The cost is not cheap but the law of averages says over time the benefits will outweigh the cost.
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MT_Flyfisher
Life of the Party
With all of the comments made so far I’m surprised that no one has recommended going to the official government Medicare website (Medicare.gov) for help in selecting the best insurance plan(s) to meet your needs. In my opinion, that site is not only valuable, but indispensable when you’re trying to choose among the myriad of options that are available to you, whether they are medicare advantage plans, drug plans (part D), medicap plans, or whatever. See: https://www.medicare.gov/plan-compare/#/?lang=en&year=2022
You can set up your own account on the Medicare website (which I’d recommend) or you can look through all of the options available to you without doing that. Then you can enter all of the prescriptions you’re presently taking, if any, the pharmacies you prefer to use to get your drugs, and your zip code.
The results are detailed reports of every insurance plan that is available to you, including not not only all of the coverages from every plan, but just what your expected costs of every plan might be, not only the total annual cost, but month by month throughout the year (if you’re interested in that level of detail.) Furthermore, you can sort the results to see the lowest cost plans first, to the highest cost plan last, and it will also show what consumer rating each plan has.
You can talk to your friends for recommendations, seek out a professional advisor (or insurance salesman), stay with your current plan, or get no insurance if you wish. However, I can almost guarantee you that if you want to take the time and effort to go through all of the information on the Medicare website that you’ll either find a better plan(s) at a lower cost than the one (or ones) that you presently have, or you’ll find (independent of all of the above mentioned options, or Joe Namath‘s suggestion on TV to call the Medicare hotline!) that the plans that you’ve already chosen are the best ones available to you, and you’ll have the added confidence in knowing you’ve made the right choice.
p.s. My wife and I, and a number of my friends have switched insurance plans in past years a result of the insurance information on the Medicare.gov website, saving a considerable amount on our annual health care expenses, including insurance premiums and prescription drug costs.
You can set up your own account on the Medicare website (which I’d recommend) or you can look through all of the options available to you without doing that. Then you can enter all of the prescriptions you’re presently taking, if any, the pharmacies you prefer to use to get your drugs, and your zip code.
The results are detailed reports of every insurance plan that is available to you, including not not only all of the coverages from every plan, but just what your expected costs of every plan might be, not only the total annual cost, but month by month throughout the year (if you’re interested in that level of detail.) Furthermore, you can sort the results to see the lowest cost plans first, to the highest cost plan last, and it will also show what consumer rating each plan has.
You can talk to your friends for recommendations, seek out a professional advisor (or insurance salesman), stay with your current plan, or get no insurance if you wish. However, I can almost guarantee you that if you want to take the time and effort to go through all of the information on the Medicare website that you’ll either find a better plan(s) at a lower cost than the one (or ones) that you presently have, or you’ll find (independent of all of the above mentioned options, or Joe Namath‘s suggestion on TV to call the Medicare hotline!) that the plans that you’ve already chosen are the best ones available to you, and you’ll have the added confidence in knowing you’ve made the right choice.
p.s. My wife and I, and a number of my friends have switched insurance plans in past years a result of the insurance information on the Medicare.gov website, saving a considerable amount on our annual health care expenses, including insurance premiums and prescription drug costs.
I walked across the street to MedicareHelpNow and got the help i needed…i knew what I needed, what i could afford
I’ve been on Medicare 10 years. First Group Health, then Kaiser. Happy with my choice. I’ve included dental coverage, too.
A couple of observations. Plan choices are based on your county of residence. If you live in Whatcom County you have different plan options than if you lived in King. If you live in Island County KP is not offered.
One important area for me is out of area coverage for a medical need. KP plans cover me while in Mexico and Canada for emergency care. Does not include medical evac tho. Travel insurance for that. Not all Medicare plans include such care. Its a feature I hope I never need.
A couple of observations. Plan choices are based on your county of residence. If you live in Whatcom County you have different plan options than if you lived in King. If you live in Island County KP is not offered.
One important area for me is out of area coverage for a medical need. KP plans cover me while in Mexico and Canada for emergency care. Does not include medical evac tho. Travel insurance for that. Not all Medicare plans include such care. Its a feature I hope I never need.
I agree. We consulted as many on-line resources as possible, but the independent broker (who literally spent hours laying out the implications of selecting either a medigap or advantage plan (as well as the specific vendor offerings for each) was able to point out some crucial details we weren't able to spot on our own. A good broker is also able to provide service 'after the sale' since they 'speak the language' of the vendor community. They can also often provide useful advice on Medicare application timing for the transition from employer based insurance so you can avoid some potentially long-term cost impacts.
Having served on my employer's retirement board for decades I was amazed at how little preparation some employees put into post-retirement medical planning. Some, literally at the time of retirement, were shocked and angered that their employee medical coverage didn't just continue on for the rest of their life (this was particularly common among people who retired very early, and clearly didn't anticipate that much of their pension would be consumed by medical coverage if they retired before before the age of 65).
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Xoxo
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Thank you @MT_Flyfisher for this link! This is great because the Kaiser plans are on here so i can compare. Ha, I’ve taken MANY screen shots so that i can start taking notes before i call an independent agent and list my questions ahead of time. I’ve been scrolling through this site. It’s very helpful. I’m still overwhelmed even just trying to narrow down the Kaiser plan that will best fit our medical needs today AND for the future, but this is a great start for me to compare with our current PEBB Kaiser plan. Whew. I had NO idea when i started this what it entailed.
I thank you all so much. It’s not the first time forum members from the old site and now here have helped me with advice in making difficult decisions. Thank you! Thank you! Thank you! I will be busy next week for sure!
When I worked for a living at Boeing I had King Country Blue Shield. I switched one year to Group Health .Worst mistake I ever made. Got sick in the winter time and went to the Clinic in Everett. I was ushered into a office to wait for a doctor to see. I sat in that damn room for an hour. I said to hell with this shit and put on my coat and got ready to leave. A nurse came by and asked me where I was going and I told her I sat in that room for an hour waiting. She told me I had to wait and I couldn't leave. I said to her just watch me leave and I left The next year I went back to the first one I had.
That was the extent of my trial with GH.
That was the extent of my trial with GH.
Early in my career we had GH (now Kaiser, I believe). We left because of outrageously poor treatment. Severe misdiagnoses for common disorders. Perhaps they are better now.
Moving around for different provider networks isn't like changing car dealers or different brands. Losing access to a trusted and very competent medical provider team can be devastating.
I've been retired since 1999, in May. I've gone through Many health insurances in that time. It seems that every year they stop and you have to get a new one. I had Blue Shield for a year. When I moved to Butte they dropped me. Not all supplement Insurances are available on Montana. Humana was.
Policies might vary but if you're out of network I think that once it's no longer considered emergency care any additional care is billed as out of network.
If you like the provider and care you receive at Kaiser its great. One reason I didn't select GH-Kaiser is its limited Health Maintenance Organization HMO model requiring care Kaiser facility. The no cost, (so far) low-out-of-pocket Med Advantage HMO plan I have has in-network providers at Multicare, CHI-Franciscan, Swedish-Providence... that are closer to me with a wider selection of docs.
The reason Kaiser operates as it does is due to it being a capitated health care model. Doctors are paid a salary, all the operating costs are projected by averaging out the expected cost of medical services per 100,000 patients = in plan membership costs to patients.
The capitated health care plan is the most cost efficient health delivery system, and should be the model for a US single payor system. Won't happen due to agressive lobbying by the for profit hospital chains, and physcian lobbying that view salaries as a huge drop in pay, especially for the specialists.
Have two friends who are urologists. The private practice one makes well over 1M a year. The other, a Kaiser urologist, gets paid 350K a year.
The private practice doc can see patients quickly, the Kaiser doc patients wait weeks to see him. And that is the core issue in the Kaiser system -the long wait time for specialists, and the fact you can't go outside the system to see one without going through major hoops.
The capitated health care plan is the most cost efficient health delivery system, and should be the model for a US single payor system. Won't happen due to agressive lobbying by the for profit hospital chains, and physcian lobbying that view salaries as a huge drop in pay, especially for the specialists.
Have two friends who are urologists. The private practice one makes well over 1M a year. The other, a Kaiser urologist, gets paid 350K a year.
The private practice doc can see patients quickly, the Kaiser doc patients wait weeks to see him. And that is the core issue in the Kaiser system -the long wait time for specialists, and the fact you can't go outside the system to see one without going through major hoops.
Xoxo
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That’s not been my experience with Kaiser at all. In the past few months I have been seen by many Kaiser specialists which i was able to do easily through emailing my primary care physician.
This included a sport specialist, then a spine specialist, a physical therapist and also imaging for both Xrays and MRIs, including contrast MRIs. The communication from all of the specialists was great and my PT even called me at home to see how my progress was going. I did have to book about two months out to get a routine skin cancer checkup from the dermatologist but that was my fault i didn’t book sooner.
What’s also nice is i rarely have to wait in the waiting room for appointments.
My primary care doctor also referred me to an outside acupuncturist who contracts with Kaiser. (My plan for 12 visits per year, which i didn’t even know until she told me. Acupuncture is working for me!)
In addition because of my history of Guillain Barre i was able to get all of my Covid vaccines through Kaiser where there was Urgent Care.
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Richard Olmstead
Steelhead
I like the GH/Kaiser model in theory for the reasons outlined by SurfnFish, and in practice, because care and insurance are handled by the same organization. I loved my primary care physician, but in that system the PCP is the gatekeeper for any specialty care and I met resistance more than once when I wanted to see a specialist. That's part of how they keep costs down. If we were ever to grow up as a society and adopt a single-payer health care system, it should function like that. However, the fact is that the inequities in pay and specialized care, among other things, often results in better care elsewhere.
When I was diagnosed with cancer by a urologist at GH, I immediately started to study care and treatment options. I learned that successful surgery for this particular cancer (successful = both removing the cancer and having no negative side effects) was best achieved in hospitals and by surgeons who conduct hundreds of these operations per year. My urologist at GH was up front with me that he had done ca. 200 such operations in his career and does ca. 15-20 per year, and that the other urologist who does these surgeries at GH has a similar level of experience. After a couple rounds of requesting a second opinion from a specialist at UW Medicine (part of the Seattle Cancer Care Alliance), I was finally approved to see a urologist there who specialized in this particular surgery. He does ca. 200 of these surgeries per year. It was a no-brainer for me to wait for the next open-enrollment period and switch from GH to UW Medicine/Regence.
A few years later, I blew out my quadriceps tendon (while wading a river in Idaho) and required reconstructive surgery. I was once again happy to have my health care through UW Medicine, which has probably the best sports medicine clinic in the PNW.
When I was diagnosed with cancer by a urologist at GH, I immediately started to study care and treatment options. I learned that successful surgery for this particular cancer (successful = both removing the cancer and having no negative side effects) was best achieved in hospitals and by surgeons who conduct hundreds of these operations per year. My urologist at GH was up front with me that he had done ca. 200 such operations in his career and does ca. 15-20 per year, and that the other urologist who does these surgeries at GH has a similar level of experience. After a couple rounds of requesting a second opinion from a specialist at UW Medicine (part of the Seattle Cancer Care Alliance), I was finally approved to see a urologist there who specialized in this particular surgery. He does ca. 200 of these surgeries per year. It was a no-brainer for me to wait for the next open-enrollment period and switch from GH to UW Medicine/Regence.
A few years later, I blew out my quadriceps tendon (while wading a river in Idaho) and required reconstructive surgery. I was once again happy to have my health care through UW Medicine, which has probably the best sports medicine clinic in the PNW.
And much like real estate, health care comes down to location, locatoin, location....in some areas Kaiser, as well as other health plans, is strongly represented with plenty of doc's, in others not so much, and in some areas Kaiseris so thin on the ground they contract with 'outside' providers to provide treatemnt..
Hard to think of anywhere in the globe with more or better heatlh care providers than the Seattle region...world class. My daughters life was saved there by outstanding surgeons (12 hour surgery) when she was diagnosed with an extrememly rare tumor.
Hard to think of anywhere in the globe with more or better heatlh care providers than the Seattle region...world class. My daughters life was saved there by outstanding surgeons (12 hour surgery) when she was diagnosed with an extrememly rare tumor.
Xoxo
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Whoop Whoop! I’m making some headway! I got some good answers from Health Care Authority, Kaiser, PEBB and realized that i had some of the wrong forms which confused me so I’m getting the correct packets that is particular to our PEBB plan that is close to what we have. I have premium monthly cost amounts and I’m getting ready to sign up at medicare.gov . In one day i learned a lot from my earlier naïveté …. where i thought i walked into Kaiser Financial office filled out a few forms and voila, was signed up for Medicare and wrote them a check each month.
I’ll call the independent agent next week to cover extra questions.
That glass of water is going to be switched out for a glass of wine in about 90 minutes! I earned it.
Can’t stop wanting to thank you all!
I’ll call the independent agent next week to cover extra questions.
That glass of water is going to be switched out for a glass of wine in about 90 minutes! I earned it.
Can’t stop wanting to thank you all!
