# Do you review your Medicare supplement



## GreenSky

I've been helping people with their Medicare choices for over 25 year and am constantly surprised that many people buy a plan at age 65 and regardless of price just keep renewing.  Or they think all companies charge about the same so don't bother.

The company that might have a great price at age 65 could very well be $300 more expensive than other companies in a few years. Just because the company sells the most doesn't make it the best deal. And hearing "my agent looks out for me" is rarely correct.

Case in point.  I took a look at pricing in Iowa.  One company has about 60% of the business and at age 65 is $300 more expensive (Plan F, G or N) than others.  It gets even worse at age 75.  In Nevada one company writes over 50%.  I just quoted Plan F for a 74 year old man paying $173.  I can replace the coverage with the same plan but different company for about $135.  That's almost $600 he's wasting!  And of course going to Plan G saves even more.

How many billions of dollars are being wasted because either agents are too lazy to call their clients, or policyholders don't bother checking?  (It's even worse if you do it yourself).

So, when was the last time you checked pricing?  And if you do, how often?

Rick


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## Liberty

Rick...the rates depend on whether the person is on any meds, right?  Maybe that's why a lot of people don't try to change...they would have to go 
under "under writing" again in order to do it. 

We live in Texas and the last time we changed they wanted to take me right away.  Told them they would have to take my husband or I'd  keep looking around.  He was only on a tier 1 med for "essential tremor", which they know is not a serious condition - and that the people that have it live longer as the tremors keep strokes away.  After I told them that they got with under writing right away and came back saying ok.

Our ex business partner and his wife can't change he says as he's a diabetic and she has had a lot of physical issues.

What about just a Crestor prescription or something...guessing that automatically raises their rates, too.

Think the insurance companies are using the "cable model" to sometimes suck you in and then raise the prices in a couple years.

Love the Plan D though. Well Care rocks.


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## Don M.

Part of my retirement plan consists of several choices for Medicare/Drugs/vision/dental insurance....which the company allows $3K a year for.  We usually opt for a good Medicare Advantage plan....we've stayed with a Humana Medicare Advantage PPO for the past few years, and then a vision plan (EyeMed), which covers the bulk of the costs of a thorough eye exam and new glasses annually.  About the only thing I haven't found is a Dental plan which is worth a hoot....most of them cover little more than a couple of annual cleanings, and minor repairs.   Luckily, with these plans our annual "out of pocket" is quite modest.....Knock Wood....the company plan covers about 11 months of the premiums, so we just have December to pay for, and a half dozen small co-pays during the year.  This company Group Plan changes slightly, year to year, and the sign-up process begins in October, if we want to make any changes...so every Fall, I give the choices some good scrutiny, and "adjust", if necessary.
Looking at the costs of insurance, etc., for those without a group plan, I can easily see why health care costs are driving so many Seniors to the brink of bankruptcy.


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## Liberty

Don M. Sounds like you have a handle on it.  We'll stick with the Medigap supplement as long as we can.  Understand the feds are pushing the Advantage "managed care" model.  Not a fan of giving up personal medicare to the "managed provider".


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## GreenSky

Liberty said:


> Rick...the rates depend on whether the person is on any meds, right?  Maybe that's why a lot of people don't try to change...they would have to go
> under "under writing" again in order to do it.
> 
> We live in Texas and the last time we changed they wanted to take me right away.  Told them they would have to take my husband or I'd  keep looking around.  He was only on a tier 1 med for "essential tremor", which they know is not a serious condition - and that the people that have it live longer as the tremors keep strokes away.  After I told them that they got with under writing right away and came back saying ok.
> 
> Our ex business partner and his wife can't change he says as he's a diabetic and she has had a lot of physical issues.
> 
> What about just a Crestor prescription or something...guessing that automatically raises their rates, too.
> 
> Think the insurance companies are using the "cable model" to sometimes suck you in and then raise the prices in a couple years.
> 
> Love the Plan D though. Well Care rocks.



Many people believe that they won't be eligible for a new underwritten plan due to medication.  Even insulin is ok subject to other issues such as HBP, nephropathy, etc.  Just because you take medication does not mean a person is not eligible to save money.  And there is no reason that if one person is uninsurable with a new company the spouse shouldn't save money.  I have many clients with 2 different companies.  (I just saved one person $120 a month but unfortunately the spouse can't change.  Oh well, only $120 instead of double that).

Here's what rarely matters:  Cholesterol, HBP, Thyroid, etc.  COPD is a problem with most but not all companies.  Pacemakers are almost never an issue.

My point is just because "you" think you can't change doesn't necessarily mean you are correct.  Once we hit Medicare age most of us have a few issues.  You don't need to be even close to perfect health to save money.  It takes 1/2 an hour to gather information and take an application.  What's the worst that can happen?  You keep what you have.

I strongly suggest everyone review their supplement with an independent insurance agent representing many companies.  If you are accepted into a new company there are no pre-existing issues and as we all know, Med Supps have no network.  All companies are identical in what they cover since all plans are standardized.

Rick


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## GreenSky

Don M. said:


> Looking at the costs of insurance, etc., for those without a group plan, I can easily see why health care costs are driving so many Seniors to the brink of bankruptcy.



For most people Medicare is $135 and a supplement/part d adds about $200 (or less).  Aside from considering a cancer plan for the expenses not directly related to medical most seniors aren't going bankrupt for $335 a month with virtually no other costs for treatment.  The people that are going bankrupt are those covered by Obamacrap where the taxpayers are paying the bill.  Once on Medicare people are generally ok.

Rick


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## Liberty

Rick, are you saying if someone is even on a single cholesterol med...look how many are nowdays - some of them even have total "normal" cholesterol ranges, that it is a major factor? My ex business partner has diabetes, a almost dead thyroid and is on a statin...that I know.


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## GreenSky

Liberty said:


> Rick, are you saying if someone is even on a single cholesterol med...look how many are nowdays - some of them even have total "normal" cholesterol ranges, that it is a major factor? My ex business partner has diabetes, a almost dead thyroid and is on a statin...that I know.


 I'm saying just the opposite.  Thyroid issues, diabetes and certainly statins normally have little or no affect.  The price with most companies doesn't change either.  You either get a policy or you don't.

My point is if you don't try you won't know.  And you MUST use an independent agent who specializes and represents many companies.  I can even get coverage for someone with COPD without oxygen.  Most agents don't have the experience or frankly the intelligence to do a good job.

Rick


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## Liberty

Cool...didn't know that about either being accepted or not.  Funny thing...the doc judy put my husband on 10 mg of Crestor after several years of basically the same variances of blood panels, and even though his total cholesterol is 160- said he was "tired of watching the numbers bounce around".  When we went to CVS to get the scrib filled, the total cost was "zero".  How bout that- go figure. Are you registered in Texas?


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## GreenSky

Liberty said:


> Cool...didn't know that about either being accepted or not.  Funny thing...the doc judy put my husband on 10 mg of Crestor after several years of basically the same variances of blood panels, and even though his total cholesterol is 160- said he was "tired of watching the numbers bounce around".  When we went to CVS to get the scrib filled, the total cost was "zero".  How bout that- go figure. Are you registered in Texas?



I do have an insurance license for TX along with about 12-15 other states.  But regardless I'm happy to help everyone save money.  I hate to subsidize insurance companies with high premiums.

BTW, I just read an article pointing out that statins are basically worthless.  I've had this feeling for years.  But then again, I'm not a doctor.

Rick


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## Liberty

Yep, that's what I was thinking about Statins. Course it depends on who wrote the article...if its peer review. Think pressure is being put on the docs to scribe them so if something happens they don't get left out on a technicality.  Do have a female friend that says Crestor has worked for her, though.

We pay (for the both of us) a total of $287.50 for plan "G"s...have Well Care for plan D for another 20 bucks total. Please send me a PM if you think we could do better...lol.  Thanks a bunch for the input. I'm sure its a big help to those new Medicare folks here on the forum.  That's nic to help them out.


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## GreenSky

Liberty said:


> Yep, that's what I was thinking about Statins. Course it depends on who wrote the article...if its peer review. Think pressure is being put on the docs to scribe them so if something happens they don't get left out on a technicality.  Do have a female friend that says Crestor has worked for her, though.
> 
> We pay (for the both of us) a total of $287.50 for plan "G"s...have Well Care for plan D for another 20 bucks total. Please send me a PM if you think we could do better...lol.  Thanks a bunch for the input. I'm sure its a big help to those new Medicare folks here on the forum.  That's nic to help them out.



Again, I'm not a doctor but here's one article and by searching it's easy to find others about statins:  https://www.express.co.uk/life-styl...s-heart-professor-no-heart-deaths-risk-effect

My personal feeling is they cause much more harm than good in people that haven't had heart problems.

Rick


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## Ken N Tx

Rick (@GreenSky ) has saved us $100+a month!!! If you feel you are paying too much for you insurance,contact him..


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## Butterfly

I review my Advantage plan every year as soon as I get the information about changes for the next year.  The only thing that changed this year is that the premium went down to $15 per month.


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## Liberty

Brenda...we had Mutual of Omaha some years ago and all they did was "up the premiums" year after year.  We got out and went with another company and saved almost $200 bucks a month!


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## GreenSky

BrendaAnderson said:


> You can take the different benefits of health insurance and also taking the humana medicare supplement plans from the health exchange company.



I don't know of a "health exchange company" but to promote humana is just wrong.  All companies provide the same benefit for the same plan.

Rick


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## debodun

I have the "traditional" Medicare Plan A and B. However, I do not have dental or vision coverage.  My prescriptions are picked up by the insurance I had when I was working (United Healthcare Silversaver). I only have 2 prescriptions (for hypertension) and there is a very small co-pay. What bothers me is that now that I have Medicare, I am paying more for doctor office visits and proceedures than when I was working. I believe this is due to my not having reached the deductible limit for Medicare and the supplemental insurance feels Medicare should be paying. This week I received a bill for the colonoscopy I had done in May indicating that I may be billed $500 for it!


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## Trade

What we need to do us expand Medicare to everybody and make the coverage 100% instead of 80%. And kick all these private health insurance profiteers to the curb.


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## Ken N Tx

Liberty said:


> Brenda...we had Mutual of Omaha some years ago and all they did was "up the premiums" year after year.  We got out and went with another company and saved almost $200 bucks a month!


Ditto!! @GreenSky save my wife $100+ a month..


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## Liberty

Think they should be wearing masks, Ken...lol.

They are one of only two that have the state partnership long term care policies in Texas now.  The other company goes up every year, too.
It is what it is, huh!  Explains why we don't have a policy!


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## GreenSky

debodun said:


> I have the "traditional" Medicare Plan A and B. However, I do not have dental or vision coverage.  My prescriptions are picked up by the insurance I had when I was working (United Healthcare Silversaver). I only have 2 prescriptions (for hypertension) and there is a very small co-pay. What bothers me is that now that I have Medicare, I am paying more for doctor office visits and proceedures than when I was working. I believe this is due to my not having reached the deductible limit for Medicare and the supplemental insurance feels Medicare should be paying. This week I received a bill for the colonoscopy I had done in May indicating that I may be billed $500 for it!



The Medicare deductible for 2019 (Part B) is $185.  Just because you _may_ be billed $500 doesn't mean you will. Wait until Medicare and your group plan pay their share.

Your other option is to spend a couple hundred (or less) for a true Medicare supplement and drug plan. This would limit your costs to the Part B deductible plus up to but no more than $20 for an office visit. Neither should cause much financial difficulty for most people. However, I rarely recommend anyone leave a group plan.

Rick


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## GreenSky

Trade said:


> What we need to do us expand Medicare to everybody and make the coverage 100% instead of 80%. And kick all these private health insurance profiteers to the curb.



We've gone back and forth with this before but it won't be Medicare for all, it will be MEDICAID for all.  That way we all equally have terrible access to care.

The real profiteers in health care are doctors and hospitals.  Perhaps if they work for free costs will be reduced.

Rick


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## Liberty

Rick, I want to thank you so much for the information you gave me on the phone today.  To everyone on this forum...heartily recommend you contact Rick for a "second opinion" on your medicare health care related choices.  He's a fountain of knowledge and this forum is lucky to have him in its arena!

Thanks again, Rick.  So much appreciate it!


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## GreenSky

Liberty said:


> Rick, I want to thank you so much for the information you gave me on the phone today.  To everyone on this forum...heartily recommend you contact Rick for a "second opinion" on your medicare health care related choices.  He's a fountain of knowledge and this forum is lucky to have him in its arena!
> 
> Thanks again, Rick.  So much appreciate it!



I appreciate the nice comments and your agent did exactly the right thing.  You are with a low cost company with very stable rates.

Your check is in the mail!

Rick


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## Liberty

Rick, certainly hope you can help others in this forum make informed decisions about their medicare related care, both with premiums and potential "out of pocket " expenses that might be incurred with specific  low cost plans.  Sometimes you get what you pay for other times you don't.
The last thing retirees need to do is be overcharged and/ or under insured medically.  Knowledge is golden.


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## Ken N Tx

Liberty said:


> Rick, I want to thank you so much for the information you gave me on the phone today.  To everyone on this forum...heartily recommend you contact Rick for a "second opinion" on your medicare health care related choices.  He's a fountain of knowledge and this forum is lucky to have him in its arena!
> 
> Thanks again, Rick.  So much appreciate it!



Ditto


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## Trade

GreenSky said:


> We've gone back and forth with this before but it won't be Medicare for all, it will be MEDICAID for all.  That way we all equally have terrible access to care.



Sure Dude, because that's exactly what has happened in Austria, Belgium, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Luxembough, Netherlands, Norway, Portugal, Russia, Serbia, Spain, Switzerland, United Kingdom, Australia, New Zealand, Canada, Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Mexico, Peru, Hong Kong, India, Israel, Japn, China, Taiwan. Belgium, Greece. Right?


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## Butterfly

BrendaAnderson said:


> You can take the different benefits of health insurance and also taking the humana medicare supplement plans from the health exchange company.


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## Liberty

Butterfly...wondering; does anyone realize when you click on this link it brings up a big Mutual Of Omaha ad?!


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## GreenSky

Trade said:


> Sure Dude, because that's exactly what has happened in Austria, Belgium, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Luxembough, Netherlands, Norway, Portugal, Russia, Serbia, Spain, Switzerland, United Kingdom, Australia, New Zealand, Canada, Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Mexico, Peru, Hong Kong, India, Israel, Japn, China, Taiwan. Belgium, Greece. Right?


You missed Venezuela.  You are aware that many of these countries are going bankrupt and/or cutting services?  Denmark, Finland, etc. are going back to private insurance because they can't afford that much socialism.  The UK has a terrible lack of doctors and nurses.  Russia?

And please don't call me "Dude."  It's a put down and not worthy of you.  You might want to apologize.

Rick


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## Olivia

Rick, wouldn't you have a bias against universal health care (medicare/medicaid for all) considering what you do for a living?

And, by the way, I have family in Austria that has universal health care and from all reports that they are being served and cared for very well. The only thing is my cousin went to Hungary to get tooth implants. Cheaper there. Only private dentists in Austria, from what I understand.


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## GreenSky

Olivia said:


> Rick, wouldn't you have a bias against universal health care (medicare/medicaid for all) considering what you do for a living?



That would be a reasonable assumption but I'm quite consistent in my beliefs about all socialist programs.  While I make a good living helping people with their Medicare choices I firmly believe it is unconstitutional.  I see no authority for the federal government to provide medical care for anyone.  But it is here and I do my best to help people make the right choice for them.

As far as healthcare being cheaper elsewhere once you factor in higher taxes and wait times the differential is not as great.  BTW, I'm not opposed to the taxpayers providing catastrophic benefits which would reduce the cost of insurance (despite my Constitutional feelings).

The cool thing is (despite one person attacking me) we can have different opinions and still be friends.

Rick


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## Trade

Olivia said:


> Rick, wouldn't you have a bias against universal health care (medicare/medicaid for all) considering what you do for a living?
> 
> And, by the way, I have family in Austria that has universal health care and from all reports that they are being served and cared for very well. The only thing is my cousin went to Hungary to get tooth implants. Cheaper there. Only private dentists in Austria, from what I understand.



We have several members that live in countries with universal health care. Canada, Australia, and the United Kingdom that I know of. It would be interesting to hear their take on it. And if any of them would like to trade systems with us. I doubt many would.


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## Butterfly

Somehow my earlier post got all goofed up.  It looks like it came up blank.  Must have pushed a wrong button or something.

I meant to post that many people I know here have had a lot of trouble with everything Humana.  AND I don't trust (and wouldn't buy) anything AARP sells.  Just my opinion.


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## GreenSky

Butterfly said:


> Somehow my earlier post got all goofed up.  It looks like it came up blank.  Must have pushed a wrong button or something.
> 
> I meant to post that many people I know here have had a lot of trouble with everything Humana.  AND I don't trust (and wouldn't buy) anything AARP sells.  Just my opinion.



I'm certainly not a fan of AARP's political stance.  They backed Obamacare and then asked and received an exemption because "it's too expensive".  However, unlike MA plans where each company can have different networks and copays, all Medicare supplements of the same letter are identical.  So I use AARP (UHC) when they are the least expensive supplement for my customers.

Companies are not evil although there are some that go out of their way to increase rates dramatically (like Mutual of Omaha).

Rick


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## Liberty

Well, I have a friend in Canada right now that is suffering - needing an abdominal hernia operation that her doctor has cleared her to get, but she told me she has no idea how long she will have to wait... when she can get it because its "not life threatening".  No matter that she gets sick as a dog sometimes when she eats.  Have heard that same thing about standing in line and waiting from other "universal" health care countries.  Guess you just get used to whatever health care you have, when you have it!

Told her if that happened here in the US, there would be picketers lined up all around the White House...lol.


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## GreenSky

Liberty said:


> Well, I have a friend in Canada right now that is suffering - needing an abdominal hernia operation that her doctor has cleared her to get, but she told me she has no idea how long she will have to wait... when she can get it because its "not life threatening".  No matter that she gets sick as a dog sometimes when she eats.  Have heard that same thing about standing in line and waiting from other "universal" health care countries.  Guess you just get used to whatever health care you have, when you have it!
> 
> Told her if that happened here in the US, there would be picketers lined up all around the White House...lol.



But it's "free."

I was diagnosed with an "incisional hernia" which caused almost no pain. But it would not get better. My surgery was scheduled almost immediately. I needed a hip replacement but pain was pretty well controlled with medication. I had the OPTION of surgery. I wonder if any government would love to pay for something not absolutely necessary.

We used to have the best system here until the government decided they know more than we do about our own health.  Hence, Obamacare was born.   Now everyone has high prices (without taxpayer assistance), higher out of pocket costs, and more difficulty finding doctors.  But at least my 31 year old son can get a "free" breast pump.

Rick


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## Liberty

Rick...its not free.  Here's what one site says:

https://pocketsense.com/government-grants-people-klinefelters-12182418.html
Canada's health care system is often mistakenly thought of as "free." In fact, Canadians pay for health care through taxes, low monthly or yearly premiums, and in some cases, out-of-pocket payments for non-insured services. Under the Canada Health Care Act of 1986, Canadians have universal access to health care, irrespective of income, employment, status, age or state of health. The administration of most services is provided provincially however, and differs from province to province.


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## Trade

It's interesting how all the "experts" on how awful the universal health care sysytems of other countries are happen to live here in the US. While I have yet to hear an actual resident of those countries say that they think the US system is better than theirs. As I said earlier, I would like to hear from some of the forum members that are actual residents of countries with universal health care.


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## Liberty

Actually I think you tend to get used to what you've had.  I've had conversations with others in different countries and lets face it they don't live in the US, we do, so they aren't normally qualified to compare the two systems personally.  Also think you get used to the system you've grown up with or lived with all your life so it is what it is.  What I do hear is the drug costs can be an issue sometimes with them.
Ironic since Canada does ship cheaper drugs into the USA.  

We had a business and had dealers in Canada.  They often came across the border to get things "cheaper" and said the cost of living in 
the US was less expensive overall than Canada.  They used to sometimes complain when the dollar exchange wasn't in their favor - like we were supposed to charge them in their own money and not the USD for goods we manufactured for them?!  I don't think so.


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## Trade

Liberty said:


> I've had conversations with others in different countries and lets face it they don't live in the US, we do, so they aren't normally qualified to compare the two systems personally.



Applying that same logic disqualifys anyone living in the US from comparing the two systems also.


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## Liberty

Am not comparing them.  Am repeating what I have directly heard from those living in the countries, a couple of which are very good 
friends I've known for years.  One is a "dualie" (that is a person who carries dual citizenship for 2 countries), she tends to get her yearly exams and medical issues taken care of here in the US.


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## GreenSky

Liberty said:


> Actually I think you tend to get used to what you've had.  I've had conversations with others in different countries and lets face it they don't live in the US, we do, so they aren't normally qualified to compare the two systems personally.  Also think you get used to the system you've grown up with or lived with all your life so it is what it is.  What I do hear is the drug costs can be an issue sometimes with them.
> Ironic since Canada does ship cheaper drugs into the USA.



Most people discuss their "feelings" about which system is better.  Statistics show that wait times for non-emergency services are much higher elsewhere.  Many times people just die waiting - again this is fact not opinion.

Drug prices are suppressed by the Canadian government. If USpharm companies don't comply Canada won't honor their patents. This causes consumers to pay more for medication here to make up the difference. (And I'm NOT defending big pharma - they are ripping people off). But I'm waiting for all the medical breakthroughs from Canada vs USA.

Yes, many people need help but it's not my responsibility to pay for everyone else. ANYTHING THAT REQUIRES THE LABOR OF OTHERS IS NOT A BASIC HUMAN RIGHT. Healthcare is a service, not a right.

(BTW, it's so much nicer on this forum now that I put one jerk on ignore.  He should really be removed for his attacks).

Rick


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## StarSong

GreenSky said:


> But it's "free."
> 
> I was diagnosed with an "incisional hernia" which caused almost no pain. But it would not get better. My surgery was scheduled almost immediately. I needed a hip replacement but pain was pretty well controlled with medication. I had the OPTION of surgery. I wonder if any government would love to pay for something not absolutely necessary.
> 
> *We used to have the best system here until the government decided they know more than we do about our own health.*  Hence, Obamacare was born.   Now everyone has high prices (without taxpayer assistance), higher out of pocket costs, and more difficulty finding doctors.  But at least my 31 year old son can get a "free" breast pump.
> 
> Rick



Maybe _for you_ we had the best system, but not for those of us who weren't covered by an employer or government program. As a small business owner my (crappy) coverage was over $2500 per month for my husband and me - two people with no pre-existing or health conditions.

If Obamacare was so dreadful why didn't the president, Senate and House overturn it when the Republicans had majorities in all three places? I'll tell you why: because the previous system SUCKED far worse than Obamacare.

If our government hadn't become so ridiculously partisan and stubborn, Obamacare could have been refined as time went on, but instead of doing what a government is supposed to do, both sides dug in. That's really why we're where we are.

BTW, many foreign doctors don't pay the extraordinarily high tuition bills that US schools charge, nor do they receive extraordinarily high remuneration. Our system is broken on a lot of levels. A doctor I knew long ago once pointed at his medical degree and said to me, "Do you know what that is? It's a license to steal." I never forgot his words.

Get treated in a hospital and some doc that you didn't request and couldn't pick out of a lineup, supposedly pokes his head in your room, and you get charged $500 for his time - and have to pay out of pocket because he's out of network? Gimme a break.

I'm with Kaiser and can't imagine changing plans.


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## Trade

Liberty said:


> Am not comparing them.  Am repeating what I have directly heard from those living in the countries, a couple of which are very good
> friends I've known for years.  One is a "dualie" (that is a person who carries dual citizenship for 2 countries), she tends to get her yearly exams and medical issues taken care of here in the US.



I keep hearing the exact opposite from people living in those countries. In addition all the hard empirical data such as cost per capita, death rates, life expectancy, etc. is overwhelmingly in favor of the coutiries that have universal health care. No other country in the world expends anywhere near 17% of their GNP on healthcare. No other country in the world has anywhere near the rate of personal bankruptcies due to medical bills. The US system is failing tens of millions of it's citizens. And for 10's of millions of others like myself, who are not being failed, are tired of seeing so many of our fellow citizens being failed due to the out rageous and unconscionable greed of our Healthcare Industrial System.


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## Trade

StarSong said:


> Get treated in a hospital and some doc that you didn't request and couldn't pick out of a lineup, supposedly pokes his head in your room, and you get charged $500 for his time - and have to pay out of pocket because he's out of network? Gimme a break.



I know exactly what you are talking about. When my wife got admitted to the hospital last February we waited in the ER for several hours for "the doctor" to do whatever he or she had to do for her to be admitted. During that whole time I never saw this doctor. The only person I saw was a nurse. And then only a handful of times for a minute or two. Yet later when I looked at the bills from that admision, which my insurance paid almost all of, no less that four, count em four doctors had submitted bills for the time she was in the ER area. And they all got paid. For what?

And then during the time she was in the hospital the same thing. Although she only was seen by one doctor that I know of, and then only rarely, about six others came out of the woodwork from God knows where to submit bills. And they got paid too.


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## GreenSky

The reason the republicans didn't overturn in the 2 years they had the majority is because McCain hated Trump so much he was willing to screw the entire country by voting to keep it.  Then he died.  He wasn't covered by Obamacare.  Plus the republicans have no "nads."

I was am still self employed. The insurance my wife and I had more than doubled in the years since Obamacare was passed. Our out of pocket went from $3,000 to $16,000. And I call BS on $2,500 for crappy health insurance. You either didn't shop the coverage or used an idiot for a broker.

Kaiser is an HMO.  Many of us actually would like to have choices in providers.  But if it works for you then great.  As far as out of network, try to see a non Kaiser doctor.

Rick


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## StarSong

Not going to argue politics with you, Rick.  You and I obviously have very opinions of our government.  

Try to see doctors out-of-network with any insurance provider. Don't forget your checkbook when doing so. The difference with Kaiser is that these docs don't wander into your hospital room and surprise you with a bill later. 

I'm very happy with Kaiser coverage, thanks. They're non-profit, have excellent doctors, nurses and hospitals, and are highly rated by Medicare. They _are_ my choice of provider.


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## Butterfly

Liberty said:


> Well, I have a friend in Canada right now that is suffering - needing an abdominal hernia operation that her doctor has cleared her to get, but she told me she has no idea how long she will have to wait... when she can get it because its "not life threatening".  No matter that she gets sick as a dog sometimes when she eats.  Have heard that same thing about standing in line and waiting from other "universal" health care countries.  Guess you just get used to whatever health care you have, when you have it!
> 
> Told her if that happened here in the US, there would be picketers lined up all around the White House...lol.



A lot of people don't realize that we DO have to wait here for surgeries for non life threatening conditions.  When I had my hips replaced (and they were so bad I could not walk) I waited several months to get on the schedule.  You have to wait for a spot on the surgeon's calendar, and you also have to wait for an open slot in a suitable operating room.

I wanted the surgeries done by the surgeon I had selected, and he's very busy.  He's very busy because he's the best in this area for hips and knees.  I was willing to wait -- I suppose I might have been able to get it done earlier if I had been willing to have it done by whoever had the earliest time, but I wasn't.  Maybe it wouldn't have mattered, because there are a finite number of operating rooms for orthopedic surgeries.  And of course with a non life threatening procedure you are always going to be bumped if there's an emergency which takes precedence.

I guess it's like everything else -- you take a number and wait your turn.


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## Liberty

Well, scratching my head over the "in network" and "out of network" doctors.  As far as I know, with a medicare "supplement" you can go to any doctor you want to ...assuming they take medicare patients of course.  We tend toward specialists...like we have a cardiologist who is basically our primary doc - as he does the intensive blood work and testing.  I'm not understanding what an "out of network" doctor would be, maybe someone else here can explain, unless its a term pertaining specifically to certain "advantage plans"?


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## GreenSky

Liberty said:


> Well, scratching my head over the "in network" and "out of network" doctors.  As far as I know, with a medicare "supplement" you can go to any doctor you want to ...assuming they take medicare patients of course.  We tend toward specialists...like we have a cardiologist who is basically our primary doc - as he does the intensive blood work and testing.  I'm not understanding what an "out of network" doctor would be, maybe someone else here can explain, unless its a term pertaining specifically to certain "advantage plans"?



You are correct.  With Original Medicare you can see any doctor that accepts it.  So I guess you could say Medicare is a network plan in that respect, although the network is huge.  A PPO will allow you to see doctors who are in network and at a (much) higher price those who will accept payment but not the PPO's limiting charges - hence out of network.

HMO plans have limited networks and with a few exceptions require approval to see specialists. Most contract with medical groups. A few (like Kaiser) are "staff models" meaning they are both the insurance company and the medical group. Many people love Kaiser because everything is under one roof. If you don't like Dr. Kaiser you can see a different Dr. Kaiser. And just to clarify, Kaiser is NOT non-profit, they are not for profit. There is a difference. With not for profit there is no way to know how much money they make.

I know many people who love HMO plans and have probably enrolled over 1,000 people over the years.  Fortunately (for the time being) we have a choice in how we receive our healthcare.  It should be up to the patient to make the decision that they prefer.  You and I have chosen Medicare and a Supplement.  Others like a Medicare Advantage Plan, either PPO or HMO.  And I'm good with all of this.  Nobody should be forced into a "cookie cutter" plan.

Rick


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## GreenSky

Butterfly said:


> A lot of people don't realize that we DO have to wait here for surgeries for non life threatening conditions.  When I had my hips replaced (and they were so bad I could not walk) I waited several months to get on the schedule.  You have to wait for a spot on the surgeon's calendar, and you also have to wait for an open slot in a suitable operating room.
> 
> I guess it's like everything else -- you take a number and wait your turn.



I too had hip replacement surgery.  Two hips - two surgeries.  Fortunately I did not have to wait long - maybe 7-10 days.  Can you imagine waiting 6 months to a year for approval?  Or never getting approval?

So many in Europe just take medication and use a cane because they can't get care.

We're lucky to live in America.

Rick


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## Liberty

Ok, thanks Rick for clearing that up.  Was wondering, as to the best of my knowledge, have not been billed any extra for anything that I know of.  Here in this area Kelsey-Seybold is a non profit that sounds like what you are talking about with Kaiser.  With them though I don't think you can choose docs.  May be wrong on that.  

Do realize premiums are probably the main consideration for choosing one plan or another.  We travel sometimes and didn't want to have any issue outside the state if something happened.  Last year, went into an ER to get some steriod pills for a serious case of poison ivy, and when the doc and the PA and whoever else saw me, took my temp and gave me the pills there was no charge...the check out lady said "you have Medicare an a Supplement".


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## Butterfly

GreenSky said:


> I too had hip replacement surgery.  Two hips - two surgeries.  Fortunately I did not have to wait long - maybe 7-10 days.  Can you imagine waiting 6 months to a year for approval?  Or never getting approval?
> 
> So many in Europe just take medication and use a cane because they can't get care.
> 
> We're lucky to live in America.
> 
> Rick



I got approval right away.  The wait was about the doctor's backlog and  the wait for the operating room.  This area has a great number of older people, and joint replacements are a very common thing.  I'm not complaining -- I understand it would probably be worse elsewhere.  I was just expressing that we do sometimes have to wait here, also, though certainly not as long as some places do.

I am extremely happy with the results of my hip replacements and of the care I received.


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## mathjak107

Kaiser has an excellent reputation in advantage plans ...they are the only advantage plan I would ever consider .... advantage plans are never a problem until they are a problem ....Kaiser seems to be one of the few I would ever use ...I will only use good ole not for profit government Medicare and a supplement  since Kaiser is not in my state ...which shows the problem right there ....

I had enough of for profit insurers being my gate keeper to my health in my lifetime ...the decisions you can get made about your care can be very different when a for profit insurer in an advantage plan has the final say so on your course of treatment vs not for profit Medicare.

In theory they are supposed to pay for the things medicare covers but that is a very grey area ... when it comes down to procedures and course of action you can’t prove what Medicare would have paid for in your exact situation since you don’t have Medicare to prove what they would have allowed in your case and the insurers know this and have you over a barrel... they can aye or nay treatment plans solely from a cost standpoint...they did this to a friend of mine .

They had pituitary gland cancer ... the for profit  advantage plan refused  to pay for both halves to be removed even though the other half was in poor shape ...her surgeons argued this is always allowed by Medicare .they always pay to have both sides done ...but since she has an advantage plan and not government Medicare there is no way to show Medicare would have approved both sides ...so now she needs to wait until the other half has cancer ....just ridiculous......so this is where those cheaper advantage plans can come back and bite you hard


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## Trade

mathjak107 said:


> I had enough of for profit insurers being my gate keeper to my health in my lifetime ...the decisions you can get made about your care can be very different when a for profit insurer in an advantage plan has the final say so on your course of treatment vs not for profit Medicare.



Amen to that! I wouldn't touch a Medicare Advantage Plan with a 10 foot pole. I have Traditional Medicare as my primary and the BCBS PPO plan that I had when I was working as secondary. I'm covered in all 50 states. And since my BCBS secondary is a group plan I'm not hanging out there all on my lonesome at the mercy of some private insurance company. It's expensive, but I have access to medical care that is almost as good as what I would have as a Canadian for free. That's pretty good for someone living in the Land Of The Free and Home Of The Brave.


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## GreenSky

mathjak107 said:


> Kaiser has an excellent reputation in advantage plans ...they are the only advantage plan I would ever consider .... advantage plans are never a problem until they are a problem ....Kaiser seems to be one of the few I would ever use ...I will only use good ole not for profit government Medicare and a supplement  since Kaiser is not in my state ...which shows the problem right there ....
> 
> I had enough of for profit insurers being my gate keeper to my health in my lifetime ...the decisions you can get made about your care can be very different when a for profit insurer in an advantage plan has the final say so on your course of treatment vs not for profit Medicare.
> 
> In theory they are supposed to pay for the things medicare covers but that is a very grey area ... when it comes down to procedures and course of action you can’t prove what Medicare would have paid for in your exact situation since you don’t have Medicare to prove what they would have allowed in your case and the insurers know this and have you over a barrel... they can aye or nay treatment plans solely from a cost standpoint...they did this to a friend of mine .
> 
> They had pituitary gland cancer ... the for profit  advantage plan refused  to pay for both halves to be removed even though the other half was in poor shape ...her surgeons argued this is always allowed by Medicare .they always pay to have both sides done ...but since she has an advantage plan and not government Medicare there is no way to show Medicare would have approved both sides ...so now she needs to wait until the other half has cancer ....just ridiculous......so this is where those cheaper advantage plans can come back and bite you hard



Kaiser is one of very few plans that are both the insurance company and the medical group.  They do indeed have a good reputation and many people I know are happy with them (in California).  But every advantage plan - as you wrote - are not a problem until they are a problem.

Friend of a friend had stomach cancer while a Kaiser member.  They would do the surgery the traditional way by "gutting" him to remove the cancer.  He could have gone to the City of Hope nearby who would do it using a laparoscopic procedure with only a few small punctures.  But he had Kaiser.  

Again, not knocking Kaiser or any other HMO specifically but if you want the best options nothing beats Original Medicare and a supplement.

Rick


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## Liberty

GreenSky...is your friend ok?  That is so sad to have to suffer more when it could have been avoided.  The way I understand it, when joining, you sign over or give your traditional medicare rights to the "managed care provider" who is then empowered to  decide if, when and how a treatment will be done and sometimes if it was under medicare it could and would be under different treatment guidelines. Right? Yikes!


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## GreenSky

Liberty said:


> GreenSky...is your friend ok?  That is so sad to have to suffer more when it could have been avoided.  The way I understand it, when joining, you sign over or give your traditional medicare rights to the "managed care provider" who is then empowered to  decide if, when and how a treatment will be done and sometimes if it was under medicare it could and would be under different treatment guidelines. Right? Yikes!



Your understanding is correct.  You still are a Medicare beneficiary but your medical is handled 100% by the HMO.  I never want anyone to feel that Medicare Advantage is an "evil" option.  It is what it is.  You are allowing a medical group to make all your healthcare decisions.  And it is NOT important if the HMO is for profit or not for profit.  They all must spend less than they take in like any business.

All HMO plans must cover at least what Medicare will cover.  However they can determine the treatment and cost to the member.  Many HMO companies have been and are still merging.  And some have purchased large medical groups.  Personally I want my doctor and the insurance company to be separate.

My doctor came from an HMO background and still primarily sees HMO patients.  She believes in making all the decisions for me.  I want to be free to decide my medical fate and see whomever I choose.  I've had a nice conversation with her and suggested recommendations are fine.  I'll ask for a referral if I decide I want one.

I had hernia surgery two weeks ago.  I did not opt for the surgeon my doctor had call me.  (Yes, rather than asking she made the decision).  I was able to choose one of the very few in Las Vegas, an area known for really terrible medical care, that uses a robotic procedure.  13 days after I played 18 holes of golf.  I made the right choice.

As far as the man with stomach cancer, he is a friend of a friend so I don't know his fate.

Rick


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## mathjak107

never forget with an advantage plan your gate keeper for healthcare is a for profit insurer  vs non profit gov't medicare ...there can be a big difference in your treatment path between the two and what they approve ... advantage plan insurers know they are in the drivers seat since while they are expected to approve the same things medicare does , you don't have  gov't medicare to even know what they would do in your case ...so they got ya .


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## Ken N Tx

mathjak107 said:


> never forget with an advantage plan your gate keeper for healthcare is a for profit insurer  vs non profit gov't medicare ...there can be a big difference in your treatment path between the two and what they approve ... advantage plan insurers know they are in the drivers seat since while they are expected to approve the same things medicare does , you don't have  gov't medicare to even know what they would do in your case ...so they got ya .


Ditto...I would never sign away my Medicare!!!


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## mathjak107

like i say , with advantage plans nothing is ever a problem -until it's a problem . some are lucky and never hit problems , others wish they never  gave  up not taking medicare and a supplement. personally i would never go advantage plan as long as i could afford it .. we use medicare and a high deductible f-plan .


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## Liberty

mathjak107 said:


> like i say , with advantage plans nothing is ever a problem -until it's a problem . some are lucky and never hit problems , others wish they never  gave  up not taking medicare and a supplement. personally i would never go advantage plan as long as i could afford it .. we use medicare and a high deductible f-plan .


So agree, mathjak...we have plan "G".  Thinking if you went on an advantage plan and then wanted to get out of it - would probably be hard to get out.


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## mathjak107

it could be hard , but  not here in ny ... we pay more for everything but we can switch with no medical underwriting . but only at enrollment time . get sick in between and you are stuck


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## terry123

GreenSky said:


> I do have an insurance license for TX along with about 12-15 other states.  But regardless I'm happy to help everyone save money.  I hate to subsidize insurance companies with high premiums.
> 
> BTW, I just read an article pointing out that statins are basically worthless.  I've had this feeling for years.  But then again, I'm not a doctor.
> 
> Rick


Rick, are you licensed in Florida?


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## GreenSky

terry123 said:


> Rick, are you licensed in Florida?


Yes for many years.  I can't remember why but I still have a valid license there.

Rick


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## Liberty

GreenSky...have heard that Florida and various states charge higher prices for medicare supplements.  Is that true?  I'm guessing they are state regulated or priced?


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## mathjak107

Liberty said:


> GreenSky...have heard that Florida and various states charge higher prices for medicare supplements.  Is that true?  I'm guessing they are state regulated or priced?


All states and locations are different....some like New York is community based and we are not charged by age ...we can also switch plans with no medical underwriting.. but we pay more then age based states where you are increased over time by age ..as an example an f-plan can be about 330 a month .....we pay 92 a month for a high deductible f-plan ....we have a 2200 deductible but since we only have about 300 a year in deductibles on the supplement we save a lot ...they also pay the 40 a month for my gym through silver sneakers so we pay very little


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## GreenSky

Liberty said:


> GreenSky...have heard that Florida and various states charge higher prices for medicare supplements.  Is that true?  I'm guessing they are state regulated or priced?



The reply above is correct.  Every state is different.  Prices in NY are indeed high because they have the same rate regardless of age and there are no medical questions.  If you want low rates move to Oklahoma!

Florida is indeed expensive because so many of us have moved there (I chose Nevada instead).  However it is always worth shopping coverage.  The company that was well priced at age 65 might be a complete rip-off by age 70.  It takes about 3 minutes to check.

Rick


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## Liberty

GreenSky said:


> The reply above is correct.  Every state is different.  Prices in NY are indeed high because they have the same rate regardless of age and there are no medical questions.  If you want low rates move to Oklahoma!
> 
> Florida is indeed expensive because so many of us have moved there (I chose Nevada instead).  However it is always worth shopping coverage.  The company that was well priced at age 65 might be a complete rip-off by age 70.  It takes about 3 minutes to check.
> 
> Rick


Very good advice.  Another thing to think about if you are moving to another state.  Are the variances large or just a few bucks a month?
Also, have heard that you are either accepted or not by the companies...rates are the same no matter what the health condition range might be...that there aren't varying rates within the "acceptance factor"?


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## GreenSky

Liberty said:


> Very good advice.  Another thing to think about if you are moving to another state.  Are the variances large or just a few bucks a month?
> Also, have heard that you are either accepted or not by the companies...rates are the same no matter what the health condition range might be...that there aren't varying rates within the "acceptance factor"?


Moving may not affect the rate.  Many companies keep you with the rate you pay in the former state.  I had a client in CA that moved to TX.  Her rate should have dropped 20% but she was kept at the higher CA rate.  (It would have worked the other way also if she moved from a lower rate state to a higher rate state).  If she was healthy I could have moved her.

Some companies notably United Healthcare (via AARP) have the ability to issue at a higher rate if health conditions are poor but that kind of thing is the exception rather than the rule.  Most companies either accept or don't.

Rick


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