JONATHAN B SPARKS
Super Genius
- 231
Below is from a beneficiary's medicare.gov claims history.
Medicare-approved amount$193,386.20
Medicare paid$44,386.11
You may be billed See Claim
(I don't have the claim)
If Medicare approved $193K, why was only $44K paid? Can you help me understand this better please?
Is it correct that, suspending copays and deductibles and assuming the expense not paid by Medicare was entirely 20% coinsurance, this beneficiary's Medsup paid roughly $11K (20% of the amount Medicare didn't pay of the total paid (roughly 55K))?
I'm guestimating this beneficiary has paid a total of roughly $50K for Plan F over the past 20 years. She's had other medical expenses but, at most, her share of cost with Original Medicare would not have been more than $50K. So, had she invested instead of paying her Medsup premiums she'd be way ahead, especially if she'd had a zero premium MAPD plan with a low MOOP that proved adequate.
Assuming you're in good health when you enroll in Medicare, why not enroll in a MAPD plan and invest what you'd pay for a Medsup? You could "always" drop the MAPD plan (assuming you find it inadequate) and use your investments to cover the OM share of cost. ("Always" meaning: Move out of the network or wait for AEP.)
Risk management is hard, y'all. I could corner the market with a reliable crystal ball.
Medicare-approved amount$193,386.20
Medicare paid$44,386.11
You may be billed See Claim
(I don't have the claim)
If Medicare approved $193K, why was only $44K paid? Can you help me understand this better please?
Is it correct that, suspending copays and deductibles and assuming the expense not paid by Medicare was entirely 20% coinsurance, this beneficiary's Medsup paid roughly $11K (20% of the amount Medicare didn't pay of the total paid (roughly 55K))?
I'm guestimating this beneficiary has paid a total of roughly $50K for Plan F over the past 20 years. She's had other medical expenses but, at most, her share of cost with Original Medicare would not have been more than $50K. So, had she invested instead of paying her Medsup premiums she'd be way ahead, especially if she'd had a zero premium MAPD plan with a low MOOP that proved adequate.
Assuming you're in good health when you enroll in Medicare, why not enroll in a MAPD plan and invest what you'd pay for a Medsup? You could "always" drop the MAPD plan (assuming you find it inadequate) and use your investments to cover the OM share of cost. ("Always" meaning: Move out of the network or wait for AEP.)
Risk management is hard, y'all. I could corner the market with a reliable crystal ball.