Question about surgery before Medicare eligibility

[curious34442]

I am 63, soon 64, may need some shoulder surgery. I have health coverage which is 80/20 and pretty good through my previous employer. I will have Medicare when I turn 65 of course. Would it be better financially, cost wise, to have surgery before Medicare kicks in or after? I think I could hold off on the surgery if necessary. Thanks for any insight on this.

 

[Mrs. Robinson]

Do you plan on having a supplemental policy? If not,I can`t really answer your question. But if you plan on having one,it will likely be 100% covered. At least my BIL`s shoulder surgery was,as well as my husband`s recent knee replacement surgery.

 

[Butterfly]

I waited to have my hips replaced until after I had Medicare Advantage coverage. My out-of-pocket cost was a fraction of what I would have paid with my 80/20 insurance. I couldn't afford to have it done with the 80/20 coverage.

 

[GreenSky]

I am 63, soon 64, may need some shoulder surgery. I have health coverage which is 80/20 and pretty good through my previous employer. I will have Medicare when I turn 65 of course. Would it be better financially, cost wise, to have surgery before Medicare kicks in or after? I think I could hold off on the surgery if necessary. Thanks for any insight on this.

From a financial standpoint your monthly premium for Medicare, a supplement and a drug plan would be around $250 for most people in most states. Aside from paying your deductible ($198 for 2020) you will likely not incur any additional costs for Medicare covered services. I'm guessing you have Cobra so continuing your current insurance must be quite a bit higher in cost and paying 20% for medical treatment until you reach the maximum out of pocket must be more.

But, if the out of pocket is reasonable and you're in pain, why wait? It's the same type of question I ask people who choose between a Medicare supplement and advantage plan. What's your health worth? In your case, it's "what's you pain worth?"

Rick

 

[curious34442]

Thanks everyone for the information. I will try to put this off till Medicare kicks in. Never thought I would be wishing myself older! Have a very Happy and Healthy New Year.

 

[Butterfly]

This was the same choice I was pretty much forced to make based on finances. If the surgery had been for something life threatening, of course I would have made a different decision, but hip replacement is an elective procedure, and despite the pain of my (seriously) degenerating hips, I was able to make it through with gritted teeth and the use of canes and help from friends.

Besides the actual cost the out-of-pocket for the surgeries (which I had 30 days apart), had I had them before I retired, I am certain my employer would not have paid me for my recovery time. With the hit of the out-of-pocket and the loss of income, I would have been in deep doo-doo.

Many people think that 80/20 coverage is great, but it really isn't when you're looking at really pricey procedures.

 

[GreenSky]

Many people think that 80/20 coverage is great, but it really isn't when you're looking at really pricey procedures.

It's not the percentage you pay, it's the maximum out of pocket. Prior to Obamacare, an 80/20 from an employer typically would have about $2,500 in out of pocket costs. My son had a plan where he paid the 1st $1,500 and then benefits were at 100%.

The only plan I know of where the 20% continues forever (despite what Obama told us) is Medicare.

Rick

 

[Pepper]

My father wasn't feeling well and didn't tell anyone as he was waiting to be 65. Well, it was cancer, and he died. There is a consolation here--the type of cancer he had would have killed him anyway. Nothing would have alleviated or helped it. So, at least his dying was a few months less.

 

[Butterfly]

It's not the percentage you pay, it's the maximum out of pocket. Prior to Obamacare, an 80/20 from an employer typically would have about $2,500 in out of pocket costs. My son had a plan where he paid the 1st $1,500 and then benefits were at 100%.

The only plan I know of where the 20% continues forever (despite what Obama told us) is Medicare.

Rick

Mine was not from my employer, who didn't offer insurance. It was a private policy, and all I could afford.

 

[StarSong]

My father wasn't feeling well and didn't tell anyone as he was waiting to be 65. Well, it was cancer, and he died. There is a consolation here--the type of cancer he had would have killed him anyway. Nothing would have alleviated or helped it. So, at least his dying was a few months less.

I'm so sorry about this, Pepper. My sister-in-law was in poor health mostly as a result of poorly managing her diabetes. Likewise, she was waiting to turn 65 to address it. As happened with your dad and untold numbers of people, she died less than 6 months before turning 65.

@curious34442, I'd advise you take @GreenSky's advice to heart. He's our resident insurance expert and won't steer you wrong.

 

[Linda]

I'm so sorry about this, Pepper. My sister-in-law was in poor health mostly as a result of poorly managing her diabetes. Likewise, she was waiting to turn 65 to address it. As happened with your dad and untold numbers of people, she died less than 6 months before turning 65.

@curious34442, I'd advise you take @GreenSky's advice to heart. He's our resident insurance expert and won't steer you wrong.

Same with my mom who died about 3 weeks after she turned 65.