$220,000 medical expenses after retirement?

[question everything]

These are the numbers that come. Used to be $250,000 and I think that this is for a couple.

But I am not sure how they calculate. Say there are based on 20 years of retirement. This is translated into $11,000 a year. With both our Medicare and private insurance at about $450 a month, even though Medicare is deducted from our SS payments - that's about $5,300 a year. Adding long term insurance of about $3000, that $8,300 a year. So that leaves about $2500 for other medical expenses including some expensive medication that my spouse has to pay while in the donut hole.

This makes sense to me. But I admit that when I first hear $220,000 medical expenses - this scares me. I suppose there can be hospital expenses that will not be covered. Holding my fingers crossed.

[elleng]

1. Fingers crossed here too,

sounds high to me, but I, just me, have good 'supplemental,' that is, maintaining Federal Employees Health Benefits plan as a retiree/annuitant. Even so, paying a fair amount out of pocket right now for dental work.

[No Vested Interest]

2. Is the "donut hole" not eliminated with the ACA? nt

[question everything]

5. Not entirely. Medicare pays half of the brand name

but you still have to pay for your half and some of the brand name, like the asthma symbicort are expensive. Still, ever since we started with Medicare, several brand names got the generic equivalent so we are paying less.

[No Vested Interest]

7. I understand that you have to pay half the cost of branded meds,

(as do I), but that's not part of the donut hole, as I understand it.
You pay half of branded meds all year round - Jan. 1- Dec. 31, not when you reach certain payment amount.

Not trying to be "trying"; just clarifying.

[question everything]

8. Seems like it varies with the insurance plan

with ours, we pay $90 for a 3 months supply (mail order) of brand name, while the insurance pays the rest - $650 for Symbicort, for example.

But once the total costs of medications paid by us and the insurance reaches $2850, we are in the donut hole. Medicare pays half of brand name while we pay most of the generics. The insurance still pays some, not sure how this amount is determined.

To stay with the example of Symicrot which last year, was "only" $670 (it is $740 this year), while in the donut hole we paid $327, the insurance paid $17, and medicare paid $344.

[sinkingfeeling]

3. Don't forget your co-pays.

[question everything]

6. Yes, I know. I include it

for us it is $15.00 for office visit and no deductible.

I visit the insurance web site to see what has been charged and paid and, again, crossing my fingers, we only have to pay the office visits. Everything else, lab, EKGs, etc. are between the provider and the insurance.

And in my last visit of the website, from last week, I saw that a clinic submitted charges for blood analysis that was never done. I talked to the nurse and to the billing dept. and they promised to take care of it. Will see.

Having had individual insurance for almost 10 years before Medicare, I've gotten used to check these things.

[No Vested Interest]

4. Long term care insurance is sort of an extra, IMO.

It's really a crapshoot, as we all know.

If one is single, no children or close relatives, I suppose long term care insurance is more of a necessity.
You buy it on a cafeteria-plan. The more you pay beforehand, the more you'll receive when and if you reuire it.
I understand there are waiting periods and other qualifications before the insurer will pay.

When at 59 spouse and I were offered the opportunity to buy long term care insurance, we couldn't/didn't see the need and declined. Three of our parents had died suddenly, none past 70, and we hadn't had to deal with nursing facilities.
When my mother required nursing care, it was paid for with the receipts from the sale of her house, among other sources, including SS and a small pension, and a few other financial assets.
That took her through about 9 yrs of assisted living in dementia care.

When spouse needed what turned out to be six yrs in nursing care, proceeds from his IRA were able to take care of the expenses. All those expenses were tax deductible from our income taxes, under the medical deduction.

So I will be self-insured as well when/if long term care is necessary, i.e., using the same formula as used for my spouse.

[SheilaT]

9. I find those numbers to be astonishingly high.

Maybe because I have almost zero medical expenses. I take one prescription drug. When I was working the copay was ten bucks a month. Now that I'm on Medicare and have an Advantage plan, it's four dollars. I have a zero copay for routine office visits. Thirty bucks for a specialist, sixty-five for emergency room visit.

I think those average numbers are arrived at (and they are outside what you pay to Medicare in the first place) by averaging everything, every retired person's costs. In reality, some of us will have almost no out of pocket expenses. Others will have a lot. Many of us will have a lot more as we get older and presumably sicker.

You might want to guess where you'll fall along the continuum and plan accordingly.