Can we talk Medicare for a minute?
 

I'm not sure if I can keep my questions and explanations concise, but I will do my best. I'm also aware that any info given will still require my due diligence pertaining to my own personal situation. (How's that for a disclaimer, lol)

I will be turning 65 this December. I will be enrolling in Medicare but not SS. I need one more year to be fully vested in SS. I am currently covered with health insurance on my wife's policy at work. We are looking into what forms of supplemental Medicare insurance they may offer. My concern using my wife's insurance supplemental Medicare coverage (if any) is that we are not certain if she will still be working for another 4-5 years and that I would assume would mean changing the Supplemental provider.

Ok, that's my situation. Now for some questions.

1. Medicare Advantage: This appears to be a one stop shopping experience for people who wish to tie all their coverage's under 1 plan. At first glance this seems to be very efficient for the buyer. What do you think?

2. Medicare + separate supplemental add-ons. This way seems to be the way that most people choose. It would appear it gives you greater ease and flexibility when changing supplemental carriers as better deals arise.

I plan on calling a couple of providers (the usual big names i.e. United, Blue Cross etc) and speaking with them regarding these issues but I'm also interested in the procedure I should pursue. Do I first sign up for Medical and then start calling these providers or the other way around. I'm sure they'll be more than glad to sign me up, I was just concerned that my doing it that would put me more at their mercy and open to an aggressive sales pitch.

I am sort of in your position, past 65 but still working and eligible for employer-provided health insurance.

My person choice was to sign up for Medicare with Plan G. I detest HMOs, so I avoid Medicare [Dis]advantage like the plague that it is. If something serious happens, I want to choose my doctor, my hospital, my procedure, etc.

If money were tight and if I could get all of the providers and options I wanted through a Medicare Advantage plan, then I might think differently. Everyone's situation is unique, and there is no single one-size-fits-all jersey or helmet here.

I am 72. Depending on your health and location Medicare Advantage may be a good choice. Check the doctors in the network. This works like an HMO and you usually have to get referred to doctors from your primary doctor. These plans can change without much notice. Also if you choose this coverage changing to the Medicare with supplemental requires a exam and you may be rejected or the cost might be very high if your condition is serious.

For my wife, who has stage 4 cancer, Medicare plus supplemental insurance was a great choice. For her treatments we have zero out of pocket except for drug co-pays. She has Medicare with a Group F supplemental coverage. For me I have the same type of coverage but Group F high deductible insurance. Group F will not be offered in 2020 but if you have it before that time you can continue. Do NOT delay signing up for Part D drug coverage or you will pay a penalty. I did that because I don't take any drugs and now pay a 10% penalty for life.

This website can be very helpful. https://tonisays.com/

I wasn't aware that a Medicare Advantage program had provider specific terms. I have always had PPO insurance and appreciate the flexibility of such a policy. With that said, I think I can put the MA programs on the back burner for now.

I've been on a Medicare Advantage Plan for 2 years and it's a great choice for me. Like you I'm not drawing SS for now. I have all my normal physicians and specialists covered under my plan. There aren't any additional fees for me being on the plan as I just pay for the Medicare Parts A&B plan that I'd pay anyway. Prescriptions are at no cost (as long as they are in the lower Tier). I get $240 worth of over the counter items at no additional cost. It's REALLY easy for me. For me, there wasn't a lot of difference between my providers....Blue Cross, United Healthcare, Humana, etc. There are various options though within the providers so you can select the plan that best suits your needs.

I had to have a hip replacement last August and all I paid was a set fee per day for a hospital stay.

I don't know or need to know your income situation but you pay for different parts of Medicare depending on your Income level. I think they look back at your Federal Income filing two years ago. However if your situation changes to where your income from two years ago is much less you can file and get the amount you pay for Medicare reduced. I think the current threshold is $67,000 per year and below for minimum payments but I could be wrong there. Example-I was paid a severance when I retired and it greatly increased my income for that one year. I filed a form with SS that demonstrated my income for my current situation is much lower since I no longer work which keeps my monthly Medicare payments lower. I currently manage the annual income to optimize or keep the additional Medicare costs to the least amount they can be. Probably more that you want to know but thought I'd add that.

Good luck handling all the spam communications both email and phone regarding Medicare!!!

Something I have not seen mentioned is that if you have just Part A & Part B, there is no limit on out-of-pocket annual expenses.
As soon as you sign up for a Part C / "Advantage" plan, there is a cap on out-of-pocket annual expenses.

I have never had any chronic medical conditions. I have chosen to have an annual checkup (covered by Medicare) every fall so if a condition is discovered it will be during the open enrollment period and I can choose the proper supplement plan to help with the coming year. If they change the coverage and procedure, I'll change my strategy.

Marc

Next time you're at your doctors office, especially if you are in a larger doctor group or hospital network, ask the staff if they know of any consultants who advise on Medicare supplement insurance policies. My group has someone you can see (by appointment) who can lay it all out for you and find you the best coverage depending on who your primary care doctor is, specialty doctors you may see regularly, or for any special needs you have (physical therapy, respiratory treatments, pharmacy, sometimes dental, too). I'm a few years away from 65, but want to plan ahead so that there are no problems when I jump off the employment merry-go-round (gosh I'd love to leave right now, but I need the medical insurance I have at the moment).

IIRC, for 3 months before and 3 months after your 65th birthday, you can enroll in any Medicare Supllement plan and they have to accept you. After that, each insurance company can underwrite you as an individual.

The option of switching a supplement plan based on an annual checkup is state dependent. Seeing you are in Michigan I assume they allow this and the insurance company must take you. I know New York laws allow you to switch. But in North Carolina where I live, switching is not possible if your annual checkup showed any kind of serious medical condition(i.e. no insurance company will accept you). That is why I chose supplement plan G, which is the best plan at this point(Plan F is fading out in 2020 and those rates are going to go up as the number of Plan F folks gets smaller).

On the original question on Advantage plans, here is a link to a blog post from a person I trust, since I retired from IBM. I used his blog to make my decision.

ibm medicare options: IBM Medicare Via Benefits Extend Health Medicare Advantage Misery

I am looking into this. All I can remember is that they asked that they be notified whenever someone reaches the age to begin Medicare. I am not sure the reason why.

Great advice.

My wife and I have had Advantage HMO coverage for many years and like it. OTOH, we don't have any serious health issues. If you travel a lot, the PPO might be a better choice. HMO only works in your state. HMO is less expensive.

There are agents who will discuss your options, including from all providers of all plans in your area, for free. They are paid by the companies. Google "medicare health insurance brokers near me". We used one. Very simple, very informative.

Carbonfiberboy wrote --- "My wife and I have had Advantage HMO coverage for many years and like it. OTOH, we don't have any serious health issues.... "

Wife is low maintenance with her health care and does well with Advantage.

I'm high maintenance with cancer and go with F.

As a Veteran I find the 2 sides of the wall of VA & civilian Medicare are ignorant of each other..

freaking useless

Some background to issues that were brought up... my wife and I (64 and 56) are in what I consider very good health and we are fortunate enough to be able to purchase and afford additional coverage if it is deemed necessary. But, I know how fast someone's health can change and turn into something horrific. Throughout my life I have always ensured that I have insurance coverage for all the little gotcha's in life.

I like the concept of the Medicare Advantage program i.e. self-container with one point of contact and adequate coverage. What concerns me is what disadvantages might be hidden when you travel out of their coverage area. If that is even a concern (I'm not sure at this point).

Again, thanks to everyone who has contributed. My biggest issue here is just getting my head wrapped around this and getting comfortable with the choices and decisions. I have owned several small companies where I was the one making health insurance decisions for my employees and it was something that I always had an aversion to and was never able to get clear answers to what I thought were clear questions. I never liked being the HR person.

Just be sure you are comfortable with all the what-if's.

​​​​​​https://www.investopedia.com/article...tage-plans.asp

If you switch from Medicare Supplemental insurance to an HMO, you cannot switch back, ever.
Caps vary so you need to check your potential plans carefully, not just for any copays/drug costs, but for annual out of pocket and any precursor deductibles.
I've got Medicare Advantage, have had it for nearly 5 years. I've been quite happy knowing exactly what things will cost in advance, having reasonable
premiums that include a gym membership (which is $60/mo otherwise), and some basic dental coverage. The few times I've used it the care has been
quite excellent and appointments have been within one week. If you're not capable of advocating for your
needs, I would go with a supplemental plan rather than a HMO. Squeaky wheels gets the grease...
If you travel, by medical travel insurance.

I am with you 100% on Plan G, which many people do not even know about. For me, freedom, flexibility, and choice are paramount and cost is secondary. My wife and I are coming up on 4 years with Plan G, as well as a minimal Plan D. (If you do not sign up for any Plan D initially, you will have trouble adding it later. Even though my prescription drug costs have always been $0 and my wife's have run below $400/yr. for the past 25 years, I wanted to be able to get drug coverage if the need ever arises, because some of this stuff gets really expensive.)

I will be 65 in October , towards the end of the month. I am paying 1200 a month right now for health insurance here in California. I can't wait , my broker said I will have better coverage than I currently have for less than 300 a month with a supplemental policy. That is good news for sure. I will not tap SS until I reach full retirement age. I am making good money now , so no sense in getting it "early" . Joe joesvintageroadbikes.wordpress

That was precisely my situation almost 4 years ago. Medicare + Supplement G totals about $300/month each for my wife and me. My private insurance was just under the $1200/month (each) you are now paying.

You might want to talk with Navigate Medicare 1-844-438-6284. Selena is my contact. They were very helpful when starting out with no pressure at all. They provided the info and plan costs. Have checked on us a time or 2 to make sure we are still satisfied with the program.

I also have Silver Script for $84.00 per quarter for my prescriptions. Being a diabetic, I need a good program to cover the costs. It has saved me quite a bit so far this year

1200 a month :eek: no wonder why Texas is getting California transplants. I’ll fess up coverage is 700 a month but as many surgeries I have had it has paid for itself. But 1200! That is expensive.