How much does Medicare cost?

[AbsoluteZero]

Hi,
I am trying get an idea of monthly Medicare & supplemental plans cost when I retire in couple of years. I live in NJ. It will be great if you can please share your current actual cost. I will have no medical, dental, vison insurance from work when I retire!!

I appreciate your time. Thanks.

AbsoluteZero

[Bogle7]

Zero (sort of) for me. "The standard Part B premium for 2021 is $148.50" which Social Security deducts from my monthly benefit. https://www.ssa.gov/benefits/medicare/m ... miums.html
I have the cheapest Kaiser Medicare Advantage plan. It includes some dental and vision "insurance". And, free Silver Sneakers.
I am very satisfied with Kaiser. Gave them a good "test" with colon cancer 8 years ago.

[sherwink]

Go on a date with your IRMAA, you'll see what that costs. Likely you'll not be happy.

[arcticpineapplecorp.]

be careful of medicare advantage plans. there is low or no monthly premium, but you may be on the hook for costs not covered after the fact.

if you choose a medigap plan (Plan G is best) you pay a higher monthly premium but then you know the other 20% not covered by traditional medicare will be covered (above medicare deductible).

in that sense, it's pay now or pay later. If you're trying to cover unconstrained costs, part G will do that. If you want to gamble not knowing what your costs might be, advantage plans might be for you.

i would contact your SHIP office (usually through office of aging) and they will explain your options, costs, etc.

there's part D to consider as well. Usually monthly premium for that is cheap, but you still have to determine what meds you have, what they'll cover, what tiers your meds are, etc.

see more here and call for info (in NJ):
https://www.google.com/search?client=fi ... +office+NJ

[cheese_breath]

Don't forget if you're going with Traditional Mediate you'll also want medigap and Part D prescription plans.

[arcticpineapplecorp.]

if you are over 65 and didn't get part b because you had insurance through work, you'll need to verify certificate of creditable coverage to avoid a penalty on not getting part b at age 65 when you first became available.

https://www.cms.gov/medicare/prescripti ... ecoverage/

Also, when you first qualify/choose medicare you can enroll in Part G supplemental without underwriting.

If you choose advantage plan and later want to choose to Part G you will have to go through underwriting and might not qualify.

you can switch from part g to advantage with no underwriting, but not the other way around.

[phxjcc]

"Silver" plan is 224/month; drug is 17.20

"Bronze" plan is 170/month; drug is 17.20

Both are BCBS/Anthem
Drug is Humana.

Silver has no co pay, bronze does, ditto labs.

Here is the guy I use, don't know if he is blue sky'd for NJ.

http://medicarebabyboomer.com/

I will not, under any circumstances, go with Advantage.
My money, my choice.

[Bogle7]

be careful of medicare advantage plans. there is low or no monthly premium, but you may be on the hook for costs not covered after the fact.

I just don't understand this statement.
Eight years with Kaiser Medicare Advantage.
Total out of pocket costs (including 1 major surgery +chemo and 3 minor surgeries) are under $4000.

[arcticpineapplecorp.]

be careful of medicare advantage plans. there is low or no monthly premium, but you may be on the hook for costs not covered after the fact.

I just don't understand this statement.
Eight years with Kaiser Medicare Advantage.
Total out of pocket costs (including 1 major surgery and 3 minor) are under $4000.

the SHIP office said that multiple hospitalizations in a given year could leave the advantage holder on the hook for costs above what is covered, whereas Part G would be covered regardless.

also, the advantage plans are a type of HMO in which they will have you do certain treatments (less costly) before moving more aggressively which could be a problem considering the condition.

Finally, the advantage plans only work with in network. you might not have a problem finding a problem that works with your advantage plan, but where I live, I heard that could be a problem and transportation could be required to find an in network provider.

this is not me. it's right here:

Still, while many offer $0 premiums, the devil is in the details. You will find that most have unexpected out-of-pocket expenses when you get sick, and what they pay can differ depending upon your overall health. Here's a look at some of the disadvantages of Medicare Advantage Plans...

Sick participants may find that medical care costs skyrocket under a Medicare Advantage plan due to copayments and out-of-pocket expenses...

Prospective Medicare Advantage customers should research plans, copays, out-of-pocket costs, and eligible providers...

Disadvantages of Medicare Advantage Plans

In general, Medicare Advantage Plans do not offer the same level of choice as a Medicare plus Medigap combination. Most plans require you to go to their network of doctors and health providers. Since Medicare Advantage Plans can’t pick their customers (they must accept any Medicare-eligible participant), they discourage people who are sick by the way they structure their copays and deductibles.

Author Wendell Potter explains how many Medicare Advantage enrollees don’t find out about the limitations of their Medicare Advantage plans until they get sick...

More Disadvantages of Medicare Advantage Plans

Dr. Brent Schillinger, former president of the Pam Beach country Medical Society, has pointed out a host of potential problems he encountered with Medicare Advantage Plans as a physician. Here's how he describes them:

Care can actually end up costing more, to the patient and the federal budget, than it would under original Medicare, particularly if one suffers from a very serious medical problem.
Some private plans are not financially stable and may suddenly cease coverage. (This happened in Florida when a popular MA plan called Physicians United Plan was declared insolvent, and doctors canceled appointments.)
One may have difficulty getting emergency or urgent care due to rationing.
The plans only cover certain doctors, and often drop providers without cause, breaking the continuity of care.
Members have to follow plan rules to get covered care.
There are always restrictions when choosing doctors, hospitals, and other providers, which is another form of rationing that keeps profits up for the insurance company but limits patient choice.
It can be difficult to get care away from home.
The extra benefits offered can turn out to be less than promised.
Plans that include coverage for Part D prescription drug costs may ration certain high-cost medications.

source: https://www.investopedia.com/articles/p ... -plans.asp

more on pros/cons of advantage plans:
https://www.healthline.com/health/medic ... advantages
https://www.consumerreports.org/medicar ... 834167849/
https://www.medicarefaq.com/faqs/why-me ... s-are-bad/
https://www.healthcarefinancenews.com/n ... ntage-plan
https://www.ehealthmedicare.com/medicar ... tage-plan/
https://medicarewire.com/blog/why-medic ... s-are-bad/
https://www.retireguide.com/medicare/co ... pros-cons/
https://www.everydayhealth.com/medicare ... age-plans/

[JoeRetire]

be careful of medicare advantage plans. there is low or no monthly premium, but you may be on the hook for costs not covered after the fact.

I just don't understand this statement.
Eight years with Kaiser Medicare Advantage.
Total out of pocket costs (including 1 major surgery +chemo and 3 minor surgeries) are under $4000.

For most, Medicare Advantage plans are not a problem, and are usually cheaper, assuming the doctors/hospitals you want are in network.

If you are very sick, they may not be better. But every plan has a maximum out of pocket cost for the year.

[illumination]

For the "cost" of Medicare, we're not counting FICA portion that's been taken out of every paycheck for our entire life?

[bhsince87]

I've noticed that it's hard to get a good answer for this question.

I suspect a lot of people don't know exactly what it costs them.

[dbr]

As it happens we know pretty exactly what our costs have been. I have an efficient practice of expenses recordkeeping.

For a couple Medicare A + B + D and a very good Medigap plan probably comes in around $1000/mo. It is possible to run down much less than that with less costly Medigap coverage, using an Advantage Plan (though that was not a choice we would have made), and not running up some really expensive medications.

Between 2012 and 2020 we averaged $11,298/year for a couple all in for medical, dental, and drugs -- insurance, copays, not insured, grand total. In that list is some eyewear, some crowns, a root canal or five, Medicare and Medigap insurance, prescription and over the counter meds, etc. That amount experienced an average increase of $156/year or a rate if inflation of about 1.4%. We had no hospital stays or major medical incidents.

[quantAndHold]

It’s interesting how much fear mongering there is about Medicare Advantage plans, which I assume comes primarily from people who benefit financially from people not being in a Medicare Advantage plan.

Wife’s MA plan is with a major provider has a $0 premium (after the $159 or whatever it is Medicare premium), with $0 copays, and includes dental, vision, and a gym membership. It works absolutely fine. In ten years, she’s never been surprised by having to pay for something unexpected. Most of our friends are on the same plan, and some of them have had major health issues, also with no problems getting it paid for.

[retiredjg]

Hi,
I am trying get an idea of monthly Medicare & supplemental plans cost when I retire in couple of years. I live in NJ. It will be great if you can please share your current actual cost. I will have no medical, dental, vison insurance from work when I retire!!

I appreciate your time. Thanks.

AbsoluteZero

What you pay for original Medicare will depend on your income and which Parts of Medicare that you get. Part A (hospital costs) is free. Part B covers doctor bills and labs and such. Part D covers prescription costs.

I think Part C are the 'Advantage plans" but I'm not sure. "Advantage plans" are an alternative to original Medicare.

Getting back to what you pay...your income in 2021 will determine what you pay for Medicare Part B and D in 2023. There is always a lookback of 2 years. That is what IRMAA (google this) is all about. If you make a lot of money, you pay more for your Medicare coverage. If you make a smaller amount of money, you pay less for your Medicare coverage.

If you are working in 2021 and not working in 2023, you can get a waiver of the IRMAA costs that are based on years you were working.

I don't know anything about the cost of supplemental plans.

There is a lot of information published on the internet by the government about Medicare. You should take advantage of that.

I pay $148.50 a month (the base amount) for Medicare Part B. I have a supplemental plan from previous employment that covers prescriptions so I don't need part D.

[Zhuang]

As a healthcare professional, I would not recommend Medicare advantage plan. With a Medicare advantage plan your care is dictated by insurance company and often you have much higher co-pays if you are hospitalized or you need a skilled nursing facility. Look at the bigger picture and in a long run you have much better quality coverage with traditional Medicare and medigap insurance (Medicare supplemental insurance). The only reason you get Medicare advantage plan is that you cannot afford a traditional Medicare with a Medigap insurance or Your former employer pays the premium for Medicare advantage plan. Even that I still feel you’re better off with a traditional Medicare/ medigap insurance (such bcbs, AARP, Mutual of Omaha.. etc).

[dbr]

As mentioned above one may also have a retiree plan that serves for the supplement. That can be especially beneficial for retired federal employees, state or local employees, teachers, etc.

Some employers offer instead a Health Care Reimbursement Account to help pay insurance costs.

[Duckie]

I am trying get an idea of monthly Medicare & supplemental plans cost when I retire in couple of years. I live in NJ. It will be great if you can please share your current actual cost.

I live in California and have a Kaiser Medicare Advantage plan. My monthly Kaiser payment is $182 which is deducted from my pension. My medicare Part B is $148 which is deducted from my social security. That totals $330 per month. So far co-pays and prescriptions add up to about $200 per year. That totals around $4200 per year.

[ModifiedDuration]

If you go the Traditional Medicare route, your costs would probably be $0 for Part A (hospitalizations); $148.50 per month for Part B (doctors and outpatient services); a Part D plan (prescriptions), which would cost from $7 a month and up; and a Medicare Supplement policy (Medigap).

If you go the Medicare Advantage route, your costs would be $148.50 a month for Part B, plus a premium for the Medicare Advantage Plan (monthly premium of $0 and up), plus a Part D, if prescription coverage is not included in the Medicare Advantage Plan.

In addition you would have to pay IRMAA (Income-Related Monthly Adjustment Amount), under both Traditional Medicare and Medicare Advantage for Part B and for Part D (if you have it), if you have higher income.

Here is a Medicare Supplement pricing chart for New Jersey. The most popular plans that someone now turning 65 can get are G and N (some people on Bogleheads have the high-deductible G Plan, that a person now turning 65 can get):

https://www.state.nj.us/humanservices/d ... ale_65.pdf

Unfortunately, the chart does not show what pricing methodology each insurance company is using - attained age, community pricing, or issued age.

It’s not too early to start getting up to speed by reading something like Medicare For Dummies or Medicare Demystified.

The government publication Medicare And You is also a good place to start:

https://www.medicare.gov/Pubs/pdf/10050 ... nd-you.pdf

[MJS]

Single, Arizona. Not paying IRMAA ... yet.
2022:~~ $3900/yr
▪ Part B. Medicare.
= 475.50/qtr = $1,902/yr.
▪ Part D drug. Aetna: SilverScript SmartRx
= $7.50/mo = $90/yr. ?? +$3/mo Co-pay
▪ Medigap Plan G. Aetna
= $150.36/mo = $1804.32/yr.
▪ Suppl: dental
= $8.52/mo = 102.24/yr

[palaheel]

When DW and I signed up a few years ago, we got the same advice from multiple sources:

If you're in good health, Medicare Advantage is cheaper. If there are medical problems, traditional medicare is better. We went with traditional.

Medicare Advantage plans seem to be limited geographically.

One's first choice of a Part B plan does not have a qualification test, and we were advised to choose wisely and plan to never change it. Any change thereafter would require qualifying.

Plan G was the most comprehensive, and that's what we chose.

Part D can change every year; there are no qualifying tests.

[dbr]

One's first choice of a Part B plan does not have a qualification test, and we were advised to choose wisely and plan to never change it. Any change thereafter would require qualifying.

This is important. Expanding coverage for Medigap (not Part B) plans can be subject to medical underwriting.

[yules]

if you are over 65 and didn't get part b because you had insurance through work, you'll need to verify certificate of creditable coverage to avoid a penalty on not getting part b at age 65 when you first became available.

https://www.cms.gov/medicare/prescripti ... ecoverage/

Also, when you first qualify/choose medicare you can enroll in Part G supplemental without underwriting.

If you choose advantage plan and later want to choose to Part G you will have to go through underwriting and might not qualify.

you can switch from part g to advantage with no underwriting, but not the other way around.

No, no, the creditable coverage letter is not for part b. It’s for part d.

Yules

[Bogle7]

As a healthcare professional, I would not recommend Medicare Advantage plan. With a Medicare Advantage plan your care is dictated by insurance company…

Is Kaiser Permanente an insurance company?

[arcticpineapplecorp.]

if you are over 65 and didn't get part b because you had insurance through work, you'll need to verify certificate of creditable coverage to avoid a penalty on not getting part b at age 65 when you first became available.

https://www.cms.gov/medicare/prescripti ... ecoverage/

Also, when you first qualify/choose medicare you can enroll in Part G supplemental without underwriting.

If you choose advantage plan and later want to choose to Part G you will have to go through underwriting and might not qualify.

you can switch from part g to advantage with no underwriting, but not the other way around.

No, no, the creditable coverage letter is not for part b. It’s for part d.

Yules

yes, yes. from medicare:

Part B late enrollment penalty

If you didn't get Part B when you're first eligible, your monthly premium may go up 10% for each 12-month period you could've had Part B, but didn't sign up. In most cases, you'll have to pay this penalty each time you pay your premiums, for as long as you have Part B. And, the penalty increases the longer you go without Part B coverage.

Usually, you don't pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period. Read more about different situations that may affect when you decide to get Part B.
https://www.medicare.gov/your-medicare- ... nt-penalty

from aarp:

If you have other creditable coverage, you can delay Part B and postpone paying the premium. You can sign up later without penalty, as long as you do it within eight months after your other coverage ends. If you don’t qualify to delay Part B, you’ll need to enroll during your Initial Enrollment Period to avoid paying the penalty. You may refuse Part B without penalty if you have creditable coverage, but you have to do it before your coverage start date. Follow the directions on the back of your Medicare card if you want to refuse Part B.

source: https://www.aarpmedicareplans.com/medic ... nalty.html

[tetractys]

be careful of medicare advantage plans. there is low or no monthly premium, but you may be on the hook for costs not covered after the fact.

I just don't understand this statement.
Eight years with Kaiser Medicare Advantage.
Total out of pocket costs (including 1 major surgery +chemo and 3 minor surgeries) are under $4000.

I don’t understand this statement either. Especially with the Affordable Care Act sticking the way it has. I like $0 premiums, included plan D and Dental!

[pshonore]

be careful of medicare advantage plans. there is low or no monthly premium, but you may be on the hook for costs not covered after the fact.

I just don't understand this statement.
Eight years with Kaiser Medicare Advantage.
Total out of pocket costs (including 1 major surgery +chemo and 3 minor surgeries) are under $4000.

I don’t understand this statement either. Especially with the Affordable Care Act sticking the way it has. I like $0 premiums, included plan D and Dental!

I think the idea is if you have free dental and zero premiums, they are going to have to make that up somewhere else. In other words you get what you pay for. You may have increased copays, fewer doctors to choose from, higher contributions for hospital stays, higher deductibles, larger OOP, etc. I have an Advantage plan that I'm quite happy with but they may not work well for everyone.

[Mr.RegPark]

My Medicare premium ( also includes drug supplement) is $545.90. / month
Anthem Blue Cross supplement is $121.06/month
WellCare drug plan $16.40/ month
Not only did I pay higherMedicare premiums when working, but I now have the privilege to pay higher premiums again with means testing. My understanding is that most countries with single payer medical systems don’t have means testing like we do.

[LunarOpal]

My Medicare premium ( also includes drug supplement) is $545.90. / month
Anthem Blue Cross supplement is $121.06/month
WellCare drug plan $16.40/ month
Not only did I pay higherMedicare premiums when working, but I now have the privilege to pay higher premiums again with means testing. My understanding is that most countries with single payer medical systems don’t have means testing like we do.

When I lived in Germany, I paid ~7.5% of my salary for insurance, and my employer paid another ~7.5%. This is a form of means testing. (There is a cap at some point, I think; I was below it).

[yules]

if you are over 65 and didn't get part b because you had insurance through work, you'll need to verify certificate of creditable coverage to avoid a penalty on not getting part b at age 65 when you first became available.

https://www.cms.gov/medicare/prescripti ... ecoverage/

Also, when you first qualify/choose medicare you can enroll in Part G supplemental without underwriting.

If you choose advantage plan and later want to choose to Part G you will have to go through underwriting and might not qualify.

you can switch from part g to advantage with no underwriting, but not the other way around.

No, no, the creditable coverage letter is not for part b. It’s for part d.

Yules

yes, yes. from medicare:

Part B late enrollment penalty

If you didn't get Part B when you're first eligible, your monthly premium may go up 10% for each 12-month period you could've had Part B, but didn't sign up. In most cases, you'll have to pay this penalty each time you pay your premiums, for as long as you have Part B. And, the penalty increases the longer you go without Part B coverage.

Usually, you don't pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period. Read more about different situations that may affect when you decide to get Part B.
https://www.medicare.gov/your-medicare- ... nt-penalty

from aarp:

If you have other creditable coverage, you can delay Part B and postpone paying the premium. You can sign up later without penalty, as long as you do it within eight months after your other coverage ends. If you don’t qualify to delay Part B, you’ll need to enroll during your Initial Enrollment Period to avoid paying the penalty. You may refuse Part B without penalty if you have creditable coverage, but you have to do it before your coverage start date. Follow the directions on the back of your Medicare card if you want to refuse Part B.

source: https://www.aarpmedicareplans.com/medic ... nalty.html

Nope, nope. Go check the link you provided in the original post. As I said, the letter you referred to is for part d. This isn’t even a debate.

Yules

[tetractys]

be careful of medicare advantage plans. there is low or no monthly premium, but you may be on the hook for costs not covered after the fact.

I just don't understand this statement.
Eight years with Kaiser Medicare Advantage.
Total out of pocket costs (including 1 major surgery +chemo and 3 minor surgeries) are under $4000.

I don’t understand this statement either. Especially with the Affordable Care Act sticking the way it has. I like $0 premiums, included plan D and Dental!

I think the idea is if you have free dental and zero premiums, they are going to have to make that up somewhere else. In other words you get what you pay for. You may have increased copays, fewer doctors to choose from, higher contributions for hospital stays, higher deductibles, larger OOP, etc. I have an Advantage plan that I'm quite happy with but they may not work well for everyone.

Exactly. As said, different strokes for different folks.

[vested1]

I sometimes complain on these threads about the cost of our Medicare coverage, namely for prescriptions, but my wife and I both have HRA's (Health Reimbursement Accounts) from our former employers which add up to $11,200 a year for anything health related, so I really have no right to complain. The HRA's cover all premiums for Medicare and most of the other expenses, which exceed 16k every year and rising. One of the HRA's is set to be cancelled by my former Megacorp employer in 2023, so that will leave $7,000 reimbursement from my wife's HRA, for as long as they offer it. One of her drugs has a co-pay of over 6k, and it went up 10% last year despite being on the market for 22 years.

The best option, in my opinion is to go with Plan G for medical medigap insurance from the outset, which may be your only opportunity to do so. I wish I would have known about that when we signed up for Medigap. After the initial sign up period when you enter the Medicare system you are not allowed to change to Plan G without going through underwriting. In our case, my wife's condition would cause our costs to skyrocket, if she were even accepted by an insurance company, if she had to go through underwriting. That same arthritis drug without insurance is over 75k a year.

We both have parts A + B (hospitalization and medical), Part D (prescriptions), and Plan N (medigap medical). In order to have both HRA's we have to have medigap and/or Part D insurance through both of our former employer's coordinating companies, so that's one reason Medicare Advantage wouldn't work for us. At the very least we would lose $4,200 in reimbursement.

Contrary to a previous statement, negative comments on MA are not fear mongering. After looking into it and speaking with unbiased health counselors with different organizations who were not affiliated with any insurance company, we wouldn't use MA even if it didn't affect our HRA's. You never know when a more serious health issue will crop up, the only thing that's certain is that aging will make that event inevitable. Higher co-pays and lack of coverage, as well as having to get referrals for specialists, and in-network requirements were the first warning signs. The requirement to go through underwriting if you want or need to change from MA back to traditional Medicare was a bridge too far.

You have to ask yourself, why do insurance companies push MA so hard if it's costing them money to offer it? Where do you think their profit is coming from when they agree to zero premiums. Do they do it out of the goodness of their heart?

A prime example of the motive behind MA came from my former employer this year at open enrollment. They unveiled with great fanfare their own version, which "only" cost $80 a month per member (for now) and which had all the aforementioned pitfalls. Small print stated that signing up for their MA program would disqualify you from their HRA program. What a great deal! For them. They save $4,200 out of the gate per couple, plus $1,920 in premiums for a program they likely pay nothing for.

Kaiser MA may be the exception, at least it was for my brother and his wife before they decided to move without checking on the availability of continuing their Kaiser coverage in their new location. Oops, no Kaiser there, so at age 71 he had to enter the world where the rest of us live, with open enrollment looming every year, with ever changing coverage and options that need to be scrutinized before making your decision to stay with your current coverage (no action needed) or change to another which usually results in unknown gotchas.

Welcome to Medicare. I would gladly pay more for a less complicated solution to healthcare.

[andypanda]

"Welcome to Medicare. I would gladly pay more for a less complicated solution to healthcare."

I understand, we are locked into our health insurance for better or worse.

My wife and I pay for Medicare Part B and have some IRMAA added on every year (have I complained recently about paying IRMAA bump every month for Part D and we don't have Part D?)
We are both state government retirees with retirement system Anthem coverage that we lose forever if we switch to something else for any reason. Currently we are each paying $307/month for the Anthem coverage and that includes prescriptions, some dental and a bare minimum for vision and hearing. All in all it's good coverage, but I do wonder sometimes for about a minute what it would be like to have free or nearly free coverage.

I don't dwell on it because I realize I would have to go shopping every year.

[arcticpineapplecorp.]

Nope, nope. Go check the link you provided in the original post. As I said, the letter you referred to is for part d. This isn’t even a debate.

Yules

well this clearly is a debate but I'll let Medicare end the debate, medicare clearly says a penalty applies to delayed PART B if you don't enroll when eligible (65) unless you meet certain exceptions (like had creditable coverage/insurance through prior job, see below):

Between January 1-March 31 each year (General Enrollment Period)

You can sign up between January 1-March 31 each year. This is called the General Enrollment Period. Your coverage starts July 1. You might pay a monthly late enrollment penalty, if you don’t qualify for a Special Enrollment Period.

Get details about the late enrollment penalties.
Special Situations (Special Enrollment Period)

There are certain situations when you can sign up for Part B (and Premium-Part A) during a Special Enrollment Period without paying a late enrollment penalty. A Special Enrollment Period is only available for a limited time. If you don’t sign up during your Special Enrollment Period, you’ll have to wait for the next General Enrollment Period and you might have to pay a monthly late enrollment penalty.

Check my specific situation to find out when to sign up.
When coverage starts

Generally, coverage starts the month after you sign up.
Special situations include:

You have health insurance through a job and still working — You can sign up for Part A and Part B any time as long as:

You have group health plan coverage
.
You or your spouse (or a family member if you’re disabled) is working for the employer that provides your health coverage.

You also have 8 months to sign up after you or your spouse (or your family member if you’re disabled) stop working or you lose group health plan coverage (whichever happens first).

Your 8-month Special Enrollment Period starts when you stop working, even if you choose COBRA
or other coverage that’s not Medicare.

You’re a volunteer, serving in a foreign country — Contact Social Security for more details.

Certain situations for people with TRICARE — Contact TRICARE for more details.

Situations that don’t qualify for a Special Enrollment Period:

Your COBRA coverage or retiree coverage ends. If you miss your 8-month window when you stopped working, you’ll have to wait until the next General Enrollment Period to sign up.
You have or lose your Marketplace coverage.
You have End-Stage Renal Disease (ESRD). Learn more about Medicare coverage for ESRD.
https://www.medicare.gov/basics/get-sta ... rage-start

maybe it's a matter of semantics in that they're not specifically asking for proof of creditable coverage, but are you saying they just take your word that you had employment and insurance within 8 months of applying for part B? If so, when would they ever issue the penalty on part b except under an honor system of reporting?

You're providing to medicare the reason you didn't choose and pay for part b was because you had insurance through employment. It would seem to me, you've got to verify that or you pay a penalty for late enrollment of PART B.

[ModifiedDuration]

There is a late enrollment penalty for both Part B and for Part D, unless you fall under one of the exemptions, such as having creditable insurance.

The late enrollment penalty for Part B is 10% for each 12-month period that you delay enrolling in Part B when you were eligible to enroll.

The late enrollment penalty for Part D is 1% of the Part D national base beneficiary premium ($33.06 in 2021) for each month you went without prescription drug coverage, rounded to the nearest $0.10, when you were eligible to enroll.

[OldTimer]

OP:

Real experience.

If you go the Medicare Advantage route, your costs would be $148.50 a month for Part B, plus a premium for the Medicare Advantage Plan (monthly premium of $0 and up), plus a Part D, if prescription coverage is not included in the Medicare Advantage Plan.

In addition you would have to pay IRMAA (Income-Related Monthly Adjustment Amount), under both Traditional Medicare and Medicare Advantage for Part B and for Part D (if you have it), if you have higher income.

My plan is a Medicare Advantage plan (Colorado), The $148.50 is deducted from my monthly social security, I and my wife are on UHC Advantage and pay $0. Small co-pays of about $30 on doctor visits, I just had major surgery this year. Over $220,000 of bills, ended up paying about $1,000 total due to hospital stay.

Very happy with this plan.

[OldTimer]

OP:

I should have said that you really need to watch the IRMAA, it can surprise you.

[dbr]

OP:

I should have said that you really need to watch the IRMAA, it can surprise you.

It can.

The brackets are here: https://www.medicare.gov/your-medicare- ... 20these%3A

But one would imagine that people at those income levels would be able to afford the cost.

[tm3]

I've noticed that it's hard to get a good answer for this question.

I suspect a lot of people don't know exactly what it costs them.

I have not thoroughly read all the responses in this thread, but from what I've heard from in person conversations I can say that I certainly agree that most folks I have talked to don't know what they are paying. Many simply "went to an insurance agent and let him figure it all out."

Taking a stab at the OP's question, your cost is going to depend on what plan you choose and how much income you have.

[Shallowpockets]

Anyone paying an add on IRMAA really has no cause to complain. Come on people, an IRMAA add on is due to your much greater income.
Everyone wants every thing for free. If you go into IRMAA territory you can easily afford it.

[Boston Barry]

As a health care professional I would also urge people to not outsource their Medicare with an Advantage plan. I have seen many people hospitalized for an unexpected cause, unable to be discharged to a rehabilitation facility because their outsourced plan (=Advantage) does not have rehab benefits. They go instead to sit forevermore in a bed in a nursing facility at high personal cost. So be careful. It is akin to going for the cheap home insurance but not covering for the rarer, more costly events to your home.

[jabberwockOG]

It’s interesting how much fear mongering there is about Medicare Advantage plans, which I assume comes primarily from people who benefit financially from people not being in a Medicare Advantage plan.

Wife’s MA plan is with a major provider has a $0 premium (after the $159 or whatever it is Medicare premium), with $0 copays, and includes dental, vision, and a gym membership. It works absolutely fine. In ten years, she’s never been surprised by having to pay for something unexpected. Most of our friends are on the same plan, and some of them have had major health issues, also with no problems getting it paid for.

Medicare advantage plans may work fine if you live in a large city with lots of highly rated medical facilities and specialists available that may or may not be "in network" with your specific plan. We live in a smallish town and local in network options for facilities and specialists are limited.

If a person becomes seriously ill and wants to seek treatment at a non local world class facility or with a specific non local specialist, the majority of Advantage plans are not going to pay for it since their coverage is almost always limited to "in Network" only unless its a travel emergency. Many folks on Advantage plans are not aware of this limitation or what it can mean. If you become seriously ill and local options won't cut it, something like a Plan F or G supplement instead of an Advantage plan gives you the option to go to MD Anderson, Mayo, Cedars Sinai, Cleveland Clinic, etc., at no extra cost.

Bottom line is there is no free lunch - lower cost options for health insurance usually equates to less coverage and more risk for the consumer. At normal income levels Part B is $150/month and a Plan G will cost $120-160/month depending on location and gender. For an average couple expect $600 per month to cover after age 65 healthcare insurance premiums. Average dental will run $50-75 per person more per month (usually not worth it).

Be aware that Medicare supplement plans, like Plan G, are now also being sold with a "select" version that has lower cost premiums - the "select" version only pays for local in network facilities and docs. I would avoid these.

[JoMoney]

Anyone paying an add on IRMAA really has no cause to complain. Come on people, an IRMAA add on is due to your much greater income.
Everyone wants every thing for free. If you go into IRMAA territory you can easily afford it.

I hate taxes, but I have a hard time feeling any sympathy for people complaining about being at the top of the heap, if you don't like being there it's an easy fix to give money away (not so easy from the other end.) I have a little more sympathy for the IRMAA payers since they likely contributed heavily into medicare system while earning wages... Less sympathy about RMDs on IRA accounts, you got a tax benefit for the money going in - time to take the lumps coming out.

[tj]

Anyone paying an add on IRMAA really has no cause to complain. Come on people, an IRMAA add on is due to your much greater income.
Everyone wants every thing for free. If you go into IRMAA territory you can easily afford it.

I hate taxes, but I have a hard time feeling any sympathy for people complaining about being at the top of the heap, if you don't like being there it's an easy fix to give money away (not so easy from the other end.) I have a little more sympathy for the IRMAA payers since they likely contributed heavily into medicare system while earning wages... Less sympathy about RMDs on IRA accounts, you got a tax benefit for the money going in - time to take the lumps coming out.

The only part of Medicare that pays for out of wages is Part A.

[oxothuk]

Anyone paying an add on IRMAA really has no cause to complain. Come on people, an IRMAA add on is due to your much greater income.
Everyone wants every thing for free. If you go into IRMAA territory you can easily afford it.

The hatred of IRMAA comes from the fact that it is structured in discrete steps (where an extra $1 of income can cost you thousands) and the exact boundaries are not known until after regular income taxes have been filed. No other tax I know of works this way.

[tetractys]

Hi,
I am trying get an idea of monthly Medicare & supplemental plans cost when I retire in couple of years. I live in NJ. It will be great if you can please share your current actual cost. I will have no medical, dental, vison insurance from work when I retire!!

I appreciate your time. Thanks.

AbsoluteZero

IMHO best thing would be to call a few of the 1-800 free services with the databases to find you the best plan for your needs in your area. Plans are competitive and changing every enrollment period.

I’ve spotted a lot of erroneous info on this thread, and veiled political leanings, even from claimed doctors. Therefore it would better to get your info directly.

I’ve just gone through the same situation, retired, lost paid coverage, started Medicare, ended with good (in some ways better) coverage.

[Rudy Tooty]

be careful of medicare advantage plans. there is low or no monthly premium, but you may be on the hook for costs not covered after the fact.

I have medicare advantage. My maximum out of pocket is $1000. So I know that even if the very worst happens - I won't pay any more than $1000 in a single calendar year. Most services have $0 co-pay. Doctors, MRI's, x-rays, labs, inpatient hospitalization, urgent care, acupuncture, chiro, vision, hearing. All $0 co-pay. This is documented in the 'Evidence of Coverage' and the plan is bound by law to follow it. So not sure what "costs" you mean.

[JackoC]

Hi,
I am trying get an idea of monthly Medicare & supplemental plans cost when I retire in couple of years. I live in NJ. It will be great if you can please share your current actual cost. I will have no medical, dental, vison insurance from work when I retire!!

I'll start Medicare in 2022 in NJ. Part B basic rate will be $158.50/mo ($148 in many posts is 2021's), though if you are subject to IRMAA it can be a multiple of that depending which tier. The cheapest Part D plan I see is $7/mo (with possible IRMAA add on of $10's). The cheapest Plan G High Deductible (~2.4k) Medigap plan I see is $47, regular Plan G $141, not subject to IRMAA.

I'm going with the conventional wisdom of most professional advisors AFAIK that Medigap is the way to go if you can afford it. There isn't a strict efficient market 'get what you pay for' with Medicare Advantage because the profit making enterprises offering these plans don't necessarily have to get the 'free' items back from *you*, they have to have to get it back from some combination of you and the government. It's possible MA could be more advantageous but I don't think it would be for me vs. the restrictions. Such as narrow networks which might not have any providers outside NJ. Right now a big drawback of our private health insurance in NJ is no coverage outside narrow basically limited to NJ, living elsewhere even part year would be a problem. And there can be gaps in MA plans compared to Medigap if you look more closely. This is not contradicted by particular friends not having stumbled into them. And, you can only make your choice (in NJ, a handful of states are different) completely free from impact of your current/previous health problems during the initial enrollment period. If a few years down the line you're chronically sick and decide the MA plan's limitations aren't for you, the Medigap providers can then charge you more for those health problems or refuse your business.

I'll likely go with High Deductible G because ~$1.2k less premium v hitting the deductible at $2.4k every year if/when my health goes downhill is a game I can afford to lose if I'm wrong in my estimation I'll probably win it.

[JackoC]

Anyone paying an add on IRMAA really has no cause to complain. Come on people, an IRMAA add on is due to your much greater income.
Everyone wants every thing for free. If you go into IRMAA territory you can easily afford it.

The hatred of IRMAA comes from the fact that it is structured in discrete steps (where an extra $1 of income can cost you thousands) and the exact boundaries are not known until after regular income taxes have been filed. No other tax I know of works this way.

That's a quirky feature, true, and it's surely not an example of a highly transparent and efficient tax (if we don't get bogged down in arguing whether it is a tax, one might make a legalistic argument that it isn't, though I wouldn't buy it). But basically 'come on people you can afford it' is a political argument, and stylized according to political conceptions. People way below the IRMAA thresholds would not literally be unable to afford to pay more for Medicare. The thresholds and increases are an inherently political determination. But some political expressions are more acceptable than others, no human moderation can be free of bias in seeing some things as 'statements of simple fact' that others view as injecting politics, and vice versa.

[DetroitRick]

OP, you asked for specific cost experience. Here's mine for this year, my first year on Medicare (11 months in 2021). Context is important too, so I tried to add a bit.

Premiums:

standard $148.50/mo for Part B, no IRMAA, current estimate for 2022 is around $10 more (but yet to be announced)
Part D $23.00/mo, my 2022 program will be $36/mo
Supplement Plan G $121.98/mo. Will go to $128.08 on anniversary date in 2022.

Out of pocket:

Medical, just the $203 Part B deductible. Everything else in my unusually heavy-use year was covered.

Prescription. Out-of-pocket should come out to just over $1,000 including $445 deductible. Will be roughly the same as last year's ACA coverage out of pockets (just the way this worked out for me, not a general rule). Around $300 less than if I just used GoodRx (again, just for me and my RX's).

Dental. $207. Just routine exams and set of xrays. No insurance, just dental discount program. Would have otherwise been just over $400 at my dentist, which I prefer to keep above all else.

Vision. $74 for exam. $550 for glasses and frames.

The biggest variable in the future will be premium increases, my supplement in particular. Impossible to accurately predict, but I looked at most of the insurers' history as part of that decision process (hint, they almost never go down...).

Medicare Advantage programs in my area are a perfectly viable alternative as they are well-established and very broad. But, the relatively fixed out-of-pocket for my supplement especially suits my needs for the next few years. After that, I will re-evaluate. Easy to switch to or among MA programs in my state during open enrollment. Going the other way - MA to supplement down the road - requires medical underwriting here.

Supplement premiums vary substantially across geographic regions and, for attained age polices, by age. Beyond that, their (substantive) general rate hikes are hard to predict as well (just look at rate history to see that point). I narrowed my own choices to just G, G-HD and N. All were perfectly acceptable to me.

Obviously both MA and supplements have substantial market shares. For a reason - they meet people's needs in terms of premiums vs. out-of-pocket costs. Before deciding, a good exercise is to make sure you can cite the potential advantages and disadvantages of each - for you, in your area, now and as you age. There will be both advantages and disadvantages to either choice. No matter what those Joe Namath commercials imply.

The 4 best resources that I found in my research phase:
the book "Medicare For Dummies"
medicare.gov - general explanations and specific Part D and MA quotes
my state's (SERFF) insurance portal for supplement data (since we don't have a consumer-friendly state portal)
talking to people with experience (doctors, office staff, fellow Medicare recipients, insurance brokers, and so on). But caution here, as I got a lot of bad info too. Still, helpful to me overall.

Edited to clarify: All the above costs are for me only. Wife is not yet on Medicare. If she were, these costs would pretty much just double, with 3 exceptions. 1)her dental costs are higher, 2) her RX costs are currently minimal, 3)her supplement G premium with my current carrier would be about 12% less (their female vs. male rating).