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Can we talk Medicare for a minute?

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Can we talk Medicare for a minute?

Old 12-11-19, 09:34 AM
  #26  
TakingMyTime
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Ultimate resolution to my original post

Sorry to dredge up this old post but I just wanted to let all the members who participated in this thread know that I have made it through to the other side of the Medicare "Adventure" and lived to talk about it.

This year I am signed up for Medicare A&B with supplemental group F and part D coverage with United Healthcare. The signup process wasn't as involved as I thought it was going to be (I tend to overthink certain things to death). The information I received in this thread is greatly appreciated and went a long way in helping me determine what the best path would be for me. I will confess that I did not do any in depth comparison of premium costs for this first year. I was more concerned in confirming my participation and putting things in place. I will now use my time in vetting other carriers and compare premiums in order to make next year's selection more cost effective.

Thank you for all your help,
TMT
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Old 12-11-19, 10:31 AM
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Originally Posted by Hondo Gravel View Post
1200 a month no wonder why Texas is getting California transplants. Iíll fess up coverage is 700 a month but as many surgeries I have had it has paid for itself. But 1200! That is expensive.
My employer pays the bulk of my insurance, but the total cost is about $1,800/month.

It will be a few years before I need to sign up for medicare, but reading this thread makes me wonder if the US is unique in designing so complex a plan to provide health care for seniors. Gives one a bit of trepidation.
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Old 12-11-19, 11:02 AM
  #28  
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Originally Posted by jon c. View Post
My employer pays the bulk of my insurance, but the total cost is about $1,800/month.

It will be a few years before I need to sign up for medicare, but reading this thread makes me wonder if the US is unique in designing so complex a plan to provide health care for seniors. Gives one a bit of trepidation.
I was at almost 1400 by the time October rolled around. I enrolled in Blue Shield F extra at about 140 a month with Envision prescription at 13 a month , so with Medicare at 135 a month my all in is less than 300 a month. No more copay at the Dr. office , $1 copay for thyroid meds . My niece in Canada is retired and canít believe how the US is getting ripped off. She pays $800 a year and her husband , also retired , pays the same. They love it and are glad they donít have to put up with what we have here!
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Old 12-11-19, 11:07 AM
  #29  
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I’m retired Federal and able to carry health insurance from employment for my wife and me into retirement. But at a larger cost. I’m still working part time with a private sector company. I checked Medicare Part B for supplemental coverage and the monthly cost for both is $600. That’s because of my part time employment raised me above a threshold where I pay extra. I planed on quitting work but I’m required to submit income tax records for proof of income. It has to be the last complete tax year so I’m stuck at a minimum of waiting almost 1.5 years from when I quit.
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Old 12-11-19, 12:20 PM
  #30  
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I quit my full-time plus fringe job in 2018. Paid for 16 months of COBRA at $2300 per month for family of three.
I now have a part time/semi-retired job and am making much less money so I qualify for government subsidies for Obamacare in 2020 - $215 per month for essentially the same plan.
I'm still 4+ years away from Medicare.
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Old 12-11-19, 12:44 PM
  #31  
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Originally Posted by linberl View Post
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.
you may want to check exactly what you have. With Advantage Plans the cost are not set and often times people get sick and have very high out-of-pocket expenses due to medications therapy Etc.

Secondly if you switch from a supplement to an Advantage HMO you can switch back anytime to the original supplement during the first year. What oftentimes stops people from switching back is they want to switch back when they have a significant medical event and see how exorbitant their costs are going to be but then they don't qualify. Good luck.
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Old 12-11-19, 12:52 PM
  #32  
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Originally Posted by TakingMyTime View Post
Sorry to dredge up this old post but I just wanted to let all the members who participated in this thread know that I have made it through to the other side of the Medicare "Adventure" and lived to talk about it.

This year I am signed up for Medicare A&B with supplemental group F and part D coverage with United Healthcare. The signup process wasn't as involved as I thought it was going to be (I tend to overthink certain things to death). The information I received in this thread is greatly appreciated and went a long way in helping me determine what the best path would be for me. I will confess that I did not do any in depth comparison of premium costs for this first year. I was more concerned in confirming my participation and putting things in place. I will now use my time in vetting other carriers and compare premiums in order to make next year's selection more cost effective.

Thank you for all your help,
TMT
1. I'm glad you got covered and nice job getting a Supplement. It will be the more affordable option long term.

There are a couple of very significant things which may cause you to want to move faster than slower. Plan F is the Cadillac plan but Medicare changed their rules and new enrollees are not going to be able to enroll in Plan F after January 1st. What this means is everybody in plan F rates are going to go up significantly as those who are in it age and get sicker. If you have some medical event that won't allow you to switch to other carriers you may be stuck in a very high priced plan for the rest of your life.

2. You are still in your initial enrollment and can still enroll in any plan and have guaranteed acceptance. After the next three months you will have to qualify to change plans. You will want to enroll and at least the Plan G if not a plan and to keep your long-term costs low.

3. I would recommend getting an independent agent who offers several companies plans and can give you the best price for a given plan. If you don't know one I can give you the name of a great agent who covers California.

4. DON'T GO BACK TO WHOEVER SOLD YOU THE F. They were looking out for themselves rather than you. AND GET OUT OF THE PLAN F. Really. The monthly premiums are about to rise significantly.
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Last edited by stevel610; 12-11-19 at 12:55 PM.
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Old 12-11-19, 01:45 PM
  #33  
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Originally Posted by stevel610 View Post
you may want to check exactly what you have. With Advantage Plans the cost are not set and often times people get sick and have very high out-of-pocket expenses due to medications therapy Etc.

Secondly if you switch from a supplement to an Advantage HMO you can switch back anytime to the original supplement during the first year. What oftentimes stops people from switching back is they want to switch back when they have a significant medical event and see how exorbitant their costs are going to be but then they don't qualify. Good luck.
Every plan has a maximum annual out of pocket cost - mine is under $5k. The costs are very clearly set, co-pays are enumerated, not a percentage. It could not be clearer. I had kidney stone surgery and it cost me $250 total. The cost of medications are clearly spelled out and one can always shop around for cheaper prices, you can get the prescription from the doctor, you don't have to fill through the HMO care provider. In fact, I have done that where one drug is on a pharmacy $4 generic list so it was cheaper than through my provider. Your information on Advantage plans clearly does not match up with the plans I have investigated or used (Kaiser, Stanford, Canopy, United, Blue Shield).
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Old 12-11-19, 02:01 PM
  #34  
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Originally Posted by linberl View Post
Every plan has a maximum annual out of pocket cost - mine is under $5k. The costs are very clearly set, co-pays are enumerated, not a percentage. It could not be clearer. I had kidney stone surgery and it cost me $250 total. The cost of medications are clearly spelled out and one can always shop around for cheaper prices, you can get the prescription from the doctor, you don't have to fill through the HMO care provider. In fact, I have done that where one drug is on a pharmacy $4 generic list so it was cheaper than through my provider. Your information on Advantage plans clearly does not match up with the plans I have investigated or used (Kaiser, Stanford, Canopy, United, Blue Shield).
Glad you have had a good experience. I was just passing on information from clients and agents I know who deal with a larger sample. Again, I hope it keeps working well for you!
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Old 12-11-19, 02:11 PM
  #35  
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I've been no Medicare since turning 65 and I am now 72. I have a supplemental plan, plan G. The supplemental plan costs me $128 per month. I'm full covered. I had a knee replacement in 2017, under Medicare and a supplemental plan F. Zero cost to me for the entire procedure. . On my plan G I think I have to pay a deductible of $200 a year. So, Medicare costs every month $100? and $128 for private supplemental and the $200 /year deductible. Not bad for living in a country that I believe ranked 39th overall in health care. But oops, got to stay away from the politics.
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Old 12-11-19, 02:18 PM
  #36  
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Originally Posted by stevel610 View Post
1. I'm glad you got covered and nice job getting a Supplement. It will be the more affordable option long term.

There are a couple of very significant things which may cause you to want to move faster than slower. Plan F is the Cadillac plan but Medicare changed their rules and new enrollees are not going to be able to enroll in Plan F after January 1st. What this means is everybody in plan F rates are going to go up significantly as those who are in it age and get sicker. If you have some medical event that won't allow you to switch to other carriers you may be stuck in a very high priced plan for the rest of your life.

2. You are still in your initial enrollment and can still enroll in any plan and have guaranteed acceptance. After the next three months you will have to qualify to change plans. You will want to enroll and at least the Plan G if not a plan and to keep your long-term costs low.

3. I would recommend getting an independent agent who offers several companies plans and can give you the best price for a given plan. If you don't know one I can give you the name of a great agent who covers California.

4. DON'T GO BACK TO WHOEVER SOLD YOU THE F. They were looking out for themselves rather than you. AND GET OUT OF THE PLAN F. Really. The monthly premiums are about to rise significantly.
I will take this all under consideration. It does give me 1 or 2 things to think about. For the record, no one sold it to me, I chose the plan on my own. In the past I have had high deductible policies (non medicare) and I guess I could say I've been twice bitten. I usually opt for the most coverage that fits my pocketbook. But again, you did give me some food for thought and I will be taking another look at what I have over the next couple of days.
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Old 12-11-19, 02:27 PM
  #37  
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Originally Posted by stevel610 View Post
Glad you have had a good experience. I was just passing on information from clients and agents I know who deal with a larger sample. Again, I hope it keeps working well for you!
Yeah, I understand, I'd just suggest being careful about generalized statements like "Advantage plans don't have set costs" because most of them do. In fact Advantage plans have more specific costs (co-pays enumerated) as many Supplement plans pay out a percentage of the remaining amount due after Medicare B pays out. But all plans, of either type, are required to enumerate their annual out of pocket limit. You can easily compare plans by logging in to medicare.gov.
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Old 12-11-19, 02:28 PM
  #38  
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Originally Posted by TakingMyTime View Post
I will take this all under consideration. It does give me 1 or 2 things to think about. For the record, no one sold it to me, I chose the plan on my own. In the past I have had high deductible policies (non medicare) and I guess I could say I've been twice bitten. I usually opt for the most coverage that fits my pocketbook. But again, you did give me some food for thought and I will be taking another look at what I have over the next couple of days.
Plan G would be your next best bet. It is the same as Plan F, you just need to pay the $183 deductable rather than having the insurance company pay it. Paying that $183 yourself usually lowers the annual premium $400-$600 dollars. Plan G will be the new "go to" plan once the new year starts.

Plan N Is the same as G except you pay up to $20 for an office visit or $50 for an ER visit. It usually saves $300-$500 in annual premium from Plan G.

Good luck!
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Old 12-13-19, 08:35 AM
  #39  
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Everyone's situation may be different. If you are over 65 and covered by a good plan from your spouse there is little need to buy Medicare Part B or the Supplement or Part D Rx plans. The group spousal plan pays first so there is likely little Medicare might pay if sick and likely not worth the premiums. You should sign up for Medicare Part A at age 65. There is no cost to you.

Once the group plan eligibility ceases, one has a short time to sign up all Medicare Plans Then its important to sign up prompty as there is a special provision allowing transfer with no medical evidence and no extra premiums to adjust for selection against the plans.

Some are covered by both a group plan and Medicare plans although see small advantage in doing so.

I was in this situation until June of this year. perhaps this will help others in a similar situation.
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Old 12-14-19, 04:26 PM
  #40  
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My wife is turning 65 this month and needs to enroll in medicare. I'm 60, still working and my wife is covered under my qualifying group health plan. We went online to sign her up this weekend and it seemed like a simple matter to decline Part B for her - until I saw this line in the "Declining Part B Coverage" of the "Medicare" Booklet I downloaded from the SSA site:

"You canít enroll using a special enrollment period if your employment or the employer-provided group health plan coverage ends during your initial enrollment period."

If you have not been through the process, if you delay part B because you are covered under a group plan, when that plan ends, you get a special enrollment period to sign up for Part B without penalty. My wife's initial enrollment period ends in March. So, if she signs up now (December) and declines Part B, AND lets say that in February (still during her initial enrollment period) something happens to me or my company and my insurance coverage ends, she does not get a special enrollment period? Which means she may have to pay a penalty for not choosing Part B for the rest of her life. Am I reading this right? If so, it makes no sense. I don't expect to lose my coverage between now and March, but why take a chance?

I'm going to call the contact number on Monday to see if I am interpreting this correctly. If I am, we will just wait until March to sign her up. But these little gotcha's can drive one crazy.
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Old 12-14-19, 04:36 PM
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Originally Posted by woodway View Post
My wife is turning 65 this month and needs to enroll in medicare. I'm 60, still working and my wife is covered under my qualifying group health plan. We went online to sign her up this weekend and it seemed like a simple matter to decline Part B for her - until I saw this line in the "Declining Part B Coverage" of the "Medicare" Booklet I downloaded from the SSA site:

"You can’t enroll using a special enrollment period if your employment or the employer-provided group health plan coverage ends during your initial enrollment period."

If you have not been through the process, if you delay part B because you are covered under a group plan, when that plan ends, you get a special enrollment period to sign up for Part B without penalty. My wife's initial enrollment period ends in March. So, if she signs up now (December) and declines Part B, AND lets say that in February (still during her initial enrollment period) something happens to me or my company and my insurance coverage ends, she does not get a special enrollment period? Which means she may have to pay a penalty for not choosing Part B for the rest of her life. Am I reading this right? If so, it makes no sense. I don't expect to lose my coverage between now and March, but why take a chance?

I'm going to call the contact number on Monday to see if I am interpreting this correctly. If I am, we will just wait until March to sign her up. But these little gotcha's can drive one crazy.
She can enroll at any point up to the end of the 3rd month after her birthday month, or change supplements/drug plans at any point during that time.

You need to be sure that your work coverage is considered "credible coverage". As well, you need to be sure your prescription plan is considered "credible coverage" or she will have a lifelong penalty each month as well (10% per year). Talk to your HR department. They should have a form you will need to prove credible coverage for both you and her.
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Old 12-15-19, 10:30 AM
  #42  
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Originally Posted by stevel610 View Post
She can enroll at any point up to the end of the 3rd month after her birthday month, or change supplements/drug plans at any point during that time.

You need to be sure that your work coverage is considered "credible coverage". As well, you need to be sure your prescription plan is considered "credible coverage" or she will have a lifelong penalty each month as well (10% per year). Talk to your HR department. They should have a form you will need to prove credible coverage for both you and her.
Yes, already got the info that my coverage is creditable. My concern is more with the wording in the SSA medicare document that seems to imply if she signs up for Part A only and then I lose my coverage during her initial enrollment period, she is not eligible for a special enrollment period for Part B. Need to call and find out what's up with that.
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Old 12-15-19, 11:14 AM
  #43  
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My wife and I had advantage for several years, were very satisfied with it. We moved, advantage not allowed in the new county. Had to get new
a supplement plan, double the cost! Wife has used it with pretty good results.
We also needed new drug plan, we used it once, saved $0.59! Almost $800 a year and we saved $0.59!
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Old 12-18-19, 08:11 PM
  #44  
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Originally Posted by woodway View Post
Yes, already got the info that my coverage is creditable. My concern is more with the wording in the SSA medicare document that seems to imply if she signs up for Part A only and then I lose my coverage during her initial enrollment period, she is not eligible for a special enrollment period for Part B. Need to call and find out what's up with that.
Just for clarification, the "Special enrollment period" it is referring to is if she has coverage from your employer past her "initial enrollment period" (3 months before her birthday, her birthday month, 3 months following her birthday). Should your coverage terminate, she would then have an 8 month "special enrollment period" in which she could enroll in Part A, Part B, a Part C Advantage Plan or Part D Drug plan without having to go through underwriting. IOW being guaranteed acceptance.

If your coverage was terminated within her 7 month initial enrollment period (3 months before her birthday, her birthday month, 3 months following her birthday) she would not qualify for the 8 month "special enrollment period". She would need to sign up for Part A, Part B and Part D or a Part C Advantage Plan which included Prescription Drug coverage by the end of the 3rd month following her birthday month.

Brokers in your state will have the best information on plans and pricing. If you want to connect with one let me know and I can have a colleague licensed in your state contact you. People are often surprised a given Supplement Plan pricing can vary by several hundred dollars a month for an identical plan from a different company.
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Old 12-19-19, 09:51 AM
  #45  
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This question is purely academic. The reason I'm asking is that I asked this question of my doctor the other day, including the nurse, and they had not heard that you can do this...

I know you can change from a traditional plan to an Advantage plan (during enrollment periods). But I had also read somewhere that you can change from an Advantage plan to a Traditional plan but that your going to have to get a checkup and/or some kind of document from you doctor stating your level of health. The way I read it was that this kind of transfer of plans is possible but you'll need to jump through a lot of hoops..
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Old 12-19-19, 10:10 AM
  #46  
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Originally Posted by TakingMyTime View Post
This question is purely academic. The reason I'm asking is that I asked this question of my doctor the other day, including the nurse, and they had not heard that you can do this...

I know you can change from a traditional plan to an Advantage plan (during enrollment periods). But I had also read somewhere that you can change from an Advantage plan to a Traditional plan but that your going to have to get a checkup and/or some kind of document from you doctor stating your level of health. The way I read it was that this kind of transfer of plans is possible but you'll need to jump through a lot of hoops..
Yes, the documentation is called underwriting. What happens are a lot of people take an Advantage plan because they generally have a low monthly cost. They also have a maximum out of pocket for the customer, often $6500-$7000 in my area.

Someone gets sick and they start getting bills they wouldn't have with a Supplement (aka Medigap). They want to switch but can't because an insurance company won't take them because they just had a major event. If this happens towards the end of the year (Nov/Dec) they get hit with more bills in January as their fiscal year begins again. It's not unusual for people with an $1800 a month income to have $8000 worth of medical Bill's.

I deal with a lot of lower income folks who take the Advantage Plans due to the low initial monthly cost and then get stuck once they have a major event. It can be a very sad situation.
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Old 12-19-19, 10:40 AM
  #47  
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Originally Posted by stevel610 View Post
I deal with a lot of lower income folks who take the Advantage Plans due to the low initial monthly cost and then get stuck once they have a major event. It can be a very sad situation.
Although I feel that the wife and I have a comfortable cushion and partial income to make it through our "Golden Years". I have felt the pain of making a healthcare decision that ended up not being as wise as I had first thought. My wife and I (65 & 57) are in what I would consider good health. We rarely need to see a doctor, and when we do all the results come back confirming my belief that we are in good health. Using this logic, last year I decided that by going with a high deductible policy through my wife's work, we should be able to reduce our overall healthcare costs. Well, after an accident and a couple of unforeseen illnesses, my logic was put to the test, and the bills kept coming in until we hit our deductible.

Throughout my life I have always considered being covered by good insurance to be a necessity, not a luxury. This goes for almost everything including car, house, umbrella policy etc. My father was an attorney and did insurance defense. No only have I hear his stories while we sat down for dinner, I've always followed his lead that good overage is just that... good coverage.
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