At the urging of a nephew, whose Mom suffers from AD just as my DW did, I went back today and looked at what we had paid for BC/BS Medigap insurance for my DW over the last four years, and compared this against the amounts that the policy had actually paid out on her behalf. Surprising result -- $6653 paid in, only $1080 paid out. Even for my own case, where I was hospitalized in 1996 for expensive heart bypass surgery, it turns out that over the same four year period I had paid in $6823 and received back in benefits only $3646. I realize that the purpose of medical insurance is to protect us from being wiped out financially by possibly huge expenses associated with treatment of catastrophic illnesses or conditions, but maybe we ought to rethink the need for that in the case of an ADLO who is already terminally ill with AD. Would it be logical, or even merciful, to pursue surgery or aggressive treatment for conditions that might, in fact, otherwise allow our ADLOs to experience a more merciful death than what is in store for them later at the hands of AD? At what point does it become counterproductive, not just economically but also morally or ethically, to continue pursuing aggressive treatments and surgeries? Based on my analysis, I recommended to my nephew that he discontinue the Medigap coverage. Comments?
Well, in my husband's case when he qualified for Medicare at the age of 52 and was already deep into EOAD, I made the decision to purchase a Medicare Advantage plan for him. It only cost us $69.00 a month and since the doctors he was already seeing accepted that plan it was a good fit for us. It covered everything and I never paid for anything other than a copay for 15 months to pay for his hospital bed and the air mattress and any copays when he could still go out to doctor's appointments. I have heard people say to avoid this type of plan like the plague, but in this situation maybe it is a good thing.
I have chosen a Medicare Advantage plan for myself an it's working well. Co-pays for Dr.s visits are much less than the standard 80/20 split of regular Mediocare. DH has regul;ar Medicare combined with a Medicaid Waiver Plan--we have only very, very low co-pays for meds. and the Medicare and Part D premiums are covered. A Medigap Plan is not the same. It pays, in addition to Medicare, covering a portion of costs Medicare doesn't pay. Premiums can be pretty hefty (IMHO), when matched against actual benefit collected. Gourdchipper could have banked his premiums, paid the part Medicare didn't cover and still had money in the bank in both his wife's case and his own. I agree with his advice to his nephew.
I'm using an Advantage plan too. I've been on it for three years and just moved my husband over to it as well. Advantage plans can be a lot less expensive. I've bought the most expensive kind, but it covers podiatry and BOTH of us have bad foot problems that need care.
At the time I went into the Advantage plan I asked what happens at the back end, where the catastrophic care is. The answer was that there was no difference at that end. The difference was in the front. I pay co-pays for doctor's visits, and $50 to go to emergency, which has happened twice so far. This year I checked such things as the nursing home coverage and what happens if you go in for a long hospital stay. The coverage was identical between my husband's old Medigap and the Advantage plan I had chosen. The difference was that if you looked at what I would have paid this year for the Medigap and Plan D I was saving $50 a month on the Advantage Plan. And I know that the customer service at our current company will be better.
Oh, one more thing. The Advantage plan like the Medigap plans will cover Hospice. I'm not sure how much of Hospice you need to cover yourself if you drop all Insurance other than Medicare. I'd check that one out before I did it. Frankly, all of us are going to need Hospice.
Both my wife and I have opted for Medicare Advantage plans. We started out with Medicare and after the first year switched to an advantage plan. While they both have pluses and minus' the advantage plan is working out well for us both. Even though she has had AD since we have been on Medicare the advantage plan still seems to be our best choice. One word of caution, investigate annually all changes to the plan you are in because other new plans may be a better fit to your condition. Sometimes the more expensive is just that. It all depends on what parts of it you need. I know they are sometimes confusing but you have time on your side (3mos) to investigate so take your time and compare plans.
I chose not to purchase a Med Adv plan because I was told you couldn't choose a dr--had to go w/network and if I later wanted to go to the Med Supplement plan, they could refuse to accept pre-existing (dementia) conditions. Guess that part has probably changed.
some plans do require their dr others do not you must investigate each one separately. i dont know about preexisting conditions probably depends on the plan
The Advantage Plan I had and the one I switched to have had no issue with pre-existing condition and mine is about as pre-existing as you can get. The co-pay for a non-participaing Dr. is the same as for a specialist--far less than 20% of an appointment. The main reason I switched is customer service and aditional coverage the first didn't include. Definitely worth shopping around.