"? About health Insurance

Discussion in 'The Okie Corral' started by boatman1, Aug 14, 2018.

  1. boatman1

    boatman1

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    me and my wife are starting to look at health insurance options in retirement which means we will be paying much larger premiums than we currently pay and I admit that I am a dummy in this area.

    My question is this: the plan has a term called out of pocket maximum for example $14,000. If I have a heart attack, cancer, etc that costs $100,000 to treat each year, does the out of pocket maximum mean that the most me and my wife will have to pay is the $14,000 or is there some exception for catastrophic health care problems. In other words does the term out of pocket maximum not really mean what it sounds like???

    Thanks
     
  2. SWFlGuy

    SWFlGuy Lifetime NRA member

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    Yes. Out of pocket max is just that.
     

  3. n2g

    n2g

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    Just be sure the doctors and medical facilities you use take that insurance. For example, I'm on Medicare and have a Medicare C plan through my former employer that provides additional coverage. I have to be sure any providers I use accept Medicare (except in a life-threatening emergency situation). If they don't, I have no coverage there at all.

    My husband was on Medicare and also had an individual "Medicare supplement" policy that provided additional coverage. He just had to make sure the providers accepted Medicare, or neither insurance would pay anything. Not all doctors and providers accept Medicare but many do.

    I think it's the same way with lots of other medical insurance. Be sure the providers you use accept your insurance.

    There might be a few odd-ball exclusions to the out-of-pocket maximums (check your policy for exclusions), but by and large the out-of-pocket max usually means what it says, in my experience anyway.
     
  4. SleeperSS

    SleeperSS

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    They make getting supplemental insurance too complicated. Assuming you're eligible for Medicare, you might look at plan "F". The different plans that are offered by different companies are all the same...just different prices. I pay $200 per month for plan F. It covers everything Medicare doesn't. No deductibles, no co-pays, no office visit charges....nothing. I've never recieved a bill for services...just statements saying it was paid.
     
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  5. mmcbeat

    mmcbeat

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    My wife and I are on a so called *advantage* plan now. No premium but co-pays and deductibles. We are going to look at an F Plan next year. Pretty sure the premium would be less expensive, especially as we get older and need more health care.
     
  6. SleeperSS

    SleeperSS

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    They are going to discontinue Plan F in 2020 I believe. Those that already have it by then can keep it.
     
  7. Detectorist

    Detectorist

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    Look first for Medicare Advantage plans. Surprisingly, availability and coverege depends on the county you live in.
     
  8. Z71bill

    Z71bill

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    That $14,000 max is PER YEAR.

    My plan has a max out of pocket of $14,300. I pay $1,400 a month / wife & I.

    I can't recall the exact numbers - but I can get close -

    If I wanted to reduce the max out of pocket down to $5,000 - my premium went up by about $600 a month.

    So my choice was -

    Pay $1,400 a month or $16,800 per year for sure and maybe an additional $14,300 out of pocket for a total of $31,100.

    Or pay $2,000 a month or $24,000 per year for sure and maybe an additional $5,000 out of pocket for a total of $29,000.

    I took the lower premium and out of pocket - $7,200 in hand is worth more that $2,100 in the bush.
     
  9. boatman1

    boatman1

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  10. boatman1

    boatman1

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    We are not yet old enough for Medicare. This would be private insurance.
     
  11. jim goose

    jim goose "The Goose"

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    I am a medicare broker.

    You have two choices.

    1. Stay on original medicare, go to any medicare provider in the country without referral. Buy a Plan G supplement, F is over priced by about 20-40 per month for reasons I will spare you an explanation. THen look up your drugs on medicare.gov because they are dozens of Part D plans and the costs can vary a lot. Do this annually.

    If you have pre existing conditions, or are really sick, I reccomend people stay with original medicare.

    2. Medicare advantage. Private plans from companies who have contracts with medicare. Lower monthly cost, but can spend more than supplement if you get sick. Usually have to use network and get referrals. The bread and butter for the health insurance industry right now.

    Cheap people are attracted to this, but you give up some choices and may never get a supplement again if you go back to original medicare, so choose wisely.
     
  12. aplcr0331

    aplcr0331

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    Does the state you are in, or retiring in, have a plan on the exchange/marketplace?

    For instance, in Washington State you can check here: https://www.healthcare.gov/screener/ to see if you qualify.

    Retiring and losing healthcare from your job qualifies you for a plan and a special enrollment period as well so you could get insurance right away. Depends on your income if you get a subsidy however (400% of poverty level for your county).