Interesting story about how lack of the right Medicare insurance caused a large bill - She skipped Medicare Part B to save money. Now her family faces a massive bill : Shots - Health News : NPR
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I am trying to understand a situation where one would choose to not enroll in Medicare A & B, and instead opt for private insurance. I am years away from Medicare eligibility (fewer with each passing year!!), so am trying to understand this scenario.
I have friends who currently pay thousands each year to concierge doctors in addition to their employer-provided health insurance, and I donât know what will happen once they reach 65. Is it only the extremely wealthy who opt out of Medicare A&B and purchase private coverage? I cannot imagine a scenario where it would make sense to not enroll in A. I suppose once reaches a certain income threshold, the enrollee is paying almost the full cost of the Part B premium, but for anyone below the first IRMAA threshold, the govât is paying 75% of the cost of the Part B premium.
Also, electing to not participate means that one cannot take advantage of the negotiated reimbursements.
As I said at the start, I am not on Medicare so am looking to be educated.
Not sure I concur with your summation (not having teh ârightâ Medicare). She made the decision to have NO coverage for docs/labs/ambulances, i.e., self-insurance by NOT purchasing Part B, and her estate got hit with a large bill.
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But if the deceased had enrolled in Part B, her air ambulance company would only have been able to charge $10K and the patientâs share would have been $2K.
Or perhaps we are saying the same thing?
She did elect to self-insure, and decided to avoid accessing health care, until she couldnât avoid it.
My health insurance plan has a huge OON deductible, so I avoid seeing any OON providers, not only because the charges would not accumulate toward my sizable in-network deductible, but mostly b/c the lack of negotiated fees for OON providers results in charge two or multiple times higher than if I had received the same services in-network. In other words, I would be willing to pay what had been the negotiated fee out of pocket when my GYN or dermatologist participated on my plan, but once they stopped accepting any insurance, I couldnât stomach their charges.
Looping back to my earlier question, I am trying to figure out when one would not enroll in Medicare. The NPR articleâs example makes senseâwhen someone cannot afford the premiumsâbut I am wondering about the other extreme.
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If one cannot âaffordâ the Part B premiums, then that person should look into a Medicare Advantage plan, many of which have zero premium costs to the individual.
I have read some wealthy skip Parts B & D and just pay for a concierge plan out of pocket, but such folks are above my pay grade so not sure if they are true.
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Was just coming here to post this piece, @kiddie!
Arenât you young! 
AlrightâŠnot THAT many yearsâŠ
AhhâŠDidnât realize that Medicare Advantage plans eliminated Parts B & D premiums. I have only read that one needs to be careful when selecting a MA plan but havenât bothered to drill down to see if that is true and/or if it varies by state.
My parents had retiree coverage that picked up everything that Medicare B did not pay other than $500 for RX and $500 for med/surg. Am guessing there arenât many of those plans remaining.
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There used to be more retiree health insurance for big companies. My husbandâs company was one of those but decided for their salaried employees to give them a stipend to buy Medicare instead of the option to stay on the company health insurance.
This was common for the automakers and many large corporations. I do not know what the union retirees have as far as health insurance as thatâs negotiated and I have no idea what the most recent contract says.
It was also common for teachers to be a part of a large group, working and retired. My mil is a retired state worker and she is still on the state retirees health insurance. My mom was a state employee for another state but now they give stipends to purchase Medicare supplements or advantage plans.
Iâm sure the woman who opted out of plan B, thought she wouldnât go to the doctor, was convinced that she wouldnât seek medical help. But it goes to show you that best laid plans donât always work out that way. Now her estate has to pay the price.
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MA plans (technically, Part C) combine Parts A, B, & D, and may throw some vision, dental and hearing benies.
Or, more likely, figured sheâd just pay out of pocket for a doctors bill on occasion.
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It is my understanding if you chose Medicare Advantage you still pay the Part b premium, but some Advantage plans have no premium costs associated.
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Yes, whether a supplement or advantage plan is chosen, you still have to pay the Part B premium to the Govt. and then Medicare covers 80% of allowed charges. Advantage or supplement plans are chosen to cover the remaining 20% of the bill.
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I am not thumper, but can answer for my situation. We are federal govt retirees, and the govt pays 75% of our very good BCBS âprivateâ insurance payments each month (Itâs still not cheap). We also have a catastrophic limit to how much we would have to pay each year, and negotiated rates for various things. We will definitely take Medicare part A, bc itâs free. But we donât want to give up our great insurance, and Part B would be an added expense. Plus if we take part B, Medicare becomes primary, and our private insurance becomes secondary, which isnât ideal.
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Thanks for that explanation. Interesting to see different retiree plans.
My only experience to date has been my parentsâ coverage, which required them to enroll in Part B (and maybe D, but unsure of that), but then their Medicare Supplemental coverage was free, leaving them with a max of $1000 OOP per person per year.
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I donât think many of these exist. My school district USED to let folks 65 and over continue on the school employee plan as full pay folks. I know folks who didnât take part A or B and did this (I have no idea whyâŠit cost them a LOT of money to do so). Later these same folks decided to go on Medicare and and had a huge penalty for life.
The district no longer allows Medicare eligible former employees to buy the district insurance. SoâŠonce you are 65, that is no longer an option.
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I guess we are in the same insurance FEP BC/BS but I thought we were required to take Medicare part B when we turned 65? We already did this but I guess I am curious - looks like maybe we didnât need to?
This is interesting. When we purchased our house in early 2020, I took the maximum standard loan (is that FHA) I could get at 2.625%. I have fixed income investments in my 401k that are at a higher rate than 5.2%. The yield is currently between 7% and 8%. No tax at the moment, though at some point I will have to liquidate and pay taxes. Iâm trying to figure out how the SALT limitation plays into my calculations.
I was mentally linking the debt and the fixed income investment, but that is not an apples to apples comparison as the fixed income investment if pretax and to liquidate it, I would have to pay ordinary income tax on the whole investment. I do have a lesser amount in the same fixed income investment in a post-tax account. That would allow an apples to apples comparison.
You canât have private insurance in lieu of Medicare B. I donât think you could get private insurance once you are qualified for Medicare. The only way you could delay in signing up for Medicare B is if you were employed (at a company with more than 20 people) and have a company insurance.
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Hmmmmmm.
Iâm pretty sure you are not forced to sign up for Medicare B. Obviously if you donât sign up when itâs appropriate to and later choose to sign up, there will be a penalty.
Some employees are able to keep their employee coverage after retiring. I donât think these individuals are required to sign up for Medicare. Of course if they donât, and later change their mind and want to sign up, they will have to pay a penalty.