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Thread: Medicare Advantage vs Medigap

  1. #11
    Senior Member Oddity's Avatar
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    Quote Originally Posted by funklab View Post
    Doesn?t traditional part A cover 100% of hospital costs?
    Depends on length of stay and state insurance regulations. For short stays, yes. There is always a deductible (2019 ~$1,500 per "spell of illness"/admittance for a condition. Admissions for multiple issues means multiple $1,500 deductibles. Once for each diagnosis code being treated, per admission, essentially.) Long stays get up around $300-$400 per day co-pay. More in some states. It's not a flat 20% co-pay for Part A like it is for part B, but even some out patient part B services (chemo, radiation, outpatient surgeries, etc) still can be HUGE bills. My Dad racked up nearly $50k in Medicare copays over just a couple years recently.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  2. #12
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    Quote Originally Posted by Oddity View Post
    Depends on length of stay and state insurance regulations. For short stays, yes. There is always a deductible (2019 ~$1,500 per "spell of illness"/admittance for a condition. Admissions for multiple issues means multiple $1,500 deductibles. Once for each diagnosis code being treated, per admission, essentially.) Long stays get up around $300-$400 per day co-pay. More in some states. It's not a flat 20% co-pay for Part A like it is for part B, but even some out patient part B services (chemo, radiation, outpatient surgeries, etc) still can be HUGE bills. My Dad racked up nearly $50k in Medicare copays over just a couple years recently.
    Wow.

  3. #13
    Senior Member Oddity's Avatar
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    Quote Originally Posted by Tetracyclone View Post
    Wow.
    Yeah. That's why 'stop loss' risk management was so important to me. There is a lot of confusion as to what a "spell of illness" exactly means (that's the language used in the Medicare claims processing manual) and it's not perfectly consistent claim to claim, as far as I understand. E.g. I've heard from some folks who've had multiple admissions for what was adjudicated as a "single spell of illness" who've only paid the $1,500 once, and another who had a single admission for multiple illnesses get charge it twice. It's about as clear as mud to me.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  4. #14
    I enrolled in my Medigap policy during a special window of time that has closed, and over the years my premiums go up and up. So, I used to call around for something more reasonable (I was barely using my pricey Medigap policy), and the only alternatives offered me were Medicare Advantage. I was getting close to signing up, but called around to a couple more agents just in case. The last guy I reached, it was late Friday afternoon, closing time.

    He was talking to me about the Medicare Advantage plan I was considering, and at one point he dropped the sales speak. His voice changed. "Spitz, don't do this." Then he laid out the reasons why I, with a progressive condition, could get caught behind the eight ball. Losing my choice of providers and facilities. Being constrained by formularies if I needed newer treatments. Most likely losing coverage when away from my primary address, which is a concern in our lifestyle. He went on for a few minutes. It was a very sobering. I wish now I could recall more exact details.


    Meanwhile though my Medigap provider will keep trying to buck me off. Who knows what will happen? Go Bernie.

  5. #15
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    I talked with Medicare today about a bill I received in the mail. The bill was about a claim from 2 1/2 years ago. My beef, 2 1/2 years and I was just now getting this surprise bill about a claim denied 2 yrs 5 months after it was originally submitted. .
    I was advised to talk to SHIP (don't know what that stands for). This is a medicare affiliated office with many local locations. After I receive protest form (in about 15 days), I will call and visit them.
    I need help writing the protest (hand function).
    Supposedly Medicare gurus work there and they also can advise which supplement policies are best for me or you.
    Ph # for SHIP 800-243-5463 Call for a location near you.
    Attack life, it's going to kill you anyway
    Steve Mcqueen (Mr Cool)

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