Medicare: Just Starting Down The Rabbit Hole

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
Topic Author
BillyV001
Posts: 23
Joined: Fri Dec 14, 2018 4:50 pm

Medicare: Just Starting Down The Rabbit Hole

Post by BillyV001 » Mon Nov 25, 2019 10:41 pm

Good Evening,

I will be Medicare eligible early next year so I've started my readings and talking to friends. I am in excellent health and take no prescribed meds. I'll see my PCP a few times/yr... typically nothing serious. I'll visit the emergency room once every few years when I fall off my bike. At some point in next few years, I'll probably have a knee replaced.

My understanding so far, is that, to avoid higher premiums for the rest of your life, you must sign up for Parts A and B during the initial enrollment period when you turn 65. Also, that you have to be enrolled in these before you can enroll in additional coverage (eg a Medicare Advantage plan). Then I read where "Many Medicare-eligibles choose add'l coverage and enroll in ...a Part C plan (that combine A &B)..".

If a Part C plan = A + B, why do you need to sign up for A & B? So you're paying a premium for A+B AND Part C (even tho C appears to, at least some extent, overlap A+B)?

Why?

Best,
Bill

retiredflyboy
Posts: 204
Joined: Sun Dec 02, 2018 10:02 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by retiredflyboy » Mon Nov 25, 2019 11:48 pm

You are dead on when it comes to making sure you sign up for Medicare part A &B when eligible to avoid laps in coverage and also higher fees for being late. Also true for Part D prescription drug plan. There are a few exceptions to the above rule, but this should be your default position and since you did not mention other credible coverage this need to sign up at 65 or best a couple months before is key. You are also correct that you sign up for part A ( likely free) and then part B which as you know has a monthly premium. You will also want a medigap or supplement plan to cover the other 20% that original Medicare does not cover. Medigap plans are private insurance that conform to Medicare standards and for a premium pick up the gap in coverage. Where the Medicare part C or Medicare advantage plan comes in is when instead of original Medicare A and B plus medigap you opt for a Medicare advantage plan. This is a private insurance company contracted with Medicare to provide your Medicare coverage. It combines the part A and B plus medigap as well as the part D into one plan but you still pay your part B premium. Some Medicare advantage or part c plans also include dental and vision coverage etc. I think your default position should be to sign up for original Medicare A, B, and D in plenty of time to have it in effect when you turn 65 along with a medigap plan which may already be reading about. The alphabet of plans..... which for most people will come down to plan G or HDG ( high deductible g). Make this your plan...... part A, B and D with a medigap G or HDG and only do something else if overwhelming convinced otherwise. Check thoroughly into all medigap part G and HDG plans and pick the cheapest plan with a stable price history of increases. Also on the part D plans go to Medicare.gov and put any drugs you are taking into the part D program and it will generate the cheapest plans to pick from. Do this every year because it changes. Also stay with companies rated 3 star or better and last I checked 3.5 stars was the highest. Since you currently don’t take any meds go with cheapest premium and decent ratings along with their preferred pharmacy coverage so it is near you.
Facts are stubborn things. Everything works until it doesn’t.

retiredflyboy
Posts: 204
Joined: Sun Dec 02, 2018 10:02 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by retiredflyboy » Tue Nov 26, 2019 12:09 am

I should have added to make sure you sign up for medigap coverage on time during your guarantee sign up period. After the 6 month window you can be turned down or have premium increased because of existing health issues. So to
really emphasize, be early/on time and make your default original Medicare part A, B and part D with a medigap G or HDG plan. Use Medicare.gove for Part D plan and pay attention to preferred pharmacy and star ratings if 3 or better. Good luck! Medicare Advantage or part C just rolls all the above into one plan but still Medicare so you make your Medicare part B premium. Medicare C will have networks and generally more restrictions or hoops to jump through in exchange for what may be cheaper coverage.
Facts are stubborn things. Everything works until it doesn’t.

Shallowpockets
Posts: 1425
Joined: Fri Nov 20, 2015 10:26 am

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Shallowpockets » Tue Nov 26, 2019 7:35 am

Medicare for dummies, the book. Your questions will be answered. Sounds like you are at square one.

User avatar
Cyclesafe
Posts: 972
Joined: Wed Dec 31, 2014 1:03 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Cyclesafe » Tue Nov 26, 2019 7:53 am

It truly seems daunting at first, but eventually you will figure it out. First step is whether you with go with Medicare Advantage or standard Medicare with a supplemental plan. This depends on what is offered in your area and whether you have a desire to stay with your current doctors, who, BTW are also getting older and may retire while you still need care. Ask other old people in your community what they like about their plan.
"Plans are useless; planning is indispensable.” - Dwight Eisenhower

User avatar
Watty
Posts: 17644
Joined: Wed Oct 10, 2007 3:55 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Watty » Tue Nov 26, 2019 8:17 am

Shallowpockets wrote:
Tue Nov 26, 2019 7:35 am
Medicare for dummies, the book. Your questions will be answered. Sounds like you are at square one.
+1 on the "Medicare for Dummies" book.

If you get it at a library or a used copy be sure that it is the most recent edition since the rules may have changed some.

pennywise
Posts: 701
Joined: Sat May 31, 2014 6:22 am

Re: Medicare: Just Starting Down The Rabbit Hole

Post by pennywise » Tue Nov 26, 2019 8:23 am

It is daunting! We've just been through the process for my husband who is also very healthy, takes no meds etc.

OP, since you too are a 'young' elderly person in great health and taking no prescription meds, consider your Medicare choices in future terms, not just for what you need or don't need now. In reality everyone is one diagnosis away from being in a very different medical expense outlook than what is true today. That's especially true as one enters the later decades of life when inevitably there will be health declines. Initial options both at Medicare age and during your first open enrollment have unique benefits such as not having to qualify medically. Don't squander your opportunities.

Get drug coverage. I did not know anything about the permanent penalty for not registering immediately. I learned about that during this open enrollment when we finally signed my 96 YO MIL up for a Medicare advantage plan. She is in assisted living with dementia but had adamantly refused to get anything other than Medicare coverage A and B. We didn't realize she could get coverage under an advantage plan till talking to an agent this enrollment cycle. It's still worth it to have her covered for what will now be end of life potential expenses, but it was a good reminder not to delay on that.

-Use the online Medicare site at www.medicare.gov to compare plans, get basic information etc. It's very helpful and not difficult to understand.

Good luck!

User avatar
nisiprius
Advisory Board
Posts: 39470
Joined: Thu Jul 26, 2007 9:33 am
Location: The terrestrial, globular, planetary hunk of matter, flattened at the poles, is my abode.--O. Henry

Re: Medicare: Just Starting Down The Rabbit Hole

Post by nisiprius » Tue Nov 26, 2019 8:32 am

You need to sign up for parts A and B.

At that point you are on "traditional Medicare," which covers a lot. It covers a lot of your medical dollar costs. The list of things it doesn't cover is annoyingly long, but their financial impact is relatively small.

You can now go in two directions to round out your coverage, which you should do.

The "traditional Medicare" direction involves buying a part D plan to cover prescriptions, and a "Medicare Supplement" plan to cover the 20% co-pay on part B. It's relatively simple. The biggest problem is choosing among the alphabet soup of supplement plans. At this point, you are relying on the government for your main medical costs and private insurers for the rest.

The "Medicare Advantage" direction, aka "part C," now being heavily promoted, is a privatized option. Instead of the government handling your medical insurance, they pay sorta-kinda what it would have cost them to do that, and hand it over to an insurance company. So the government isn't handling your medical care payments directly, but it is paying a hefty subsidy so that the premium you pay to the insurer is only a small fraction of what it would otherwise have been.

Medicare Advantage is a more complicated decision because you are just buying a private insurance plan, one whose premiums are heavily subsidized by the government, but insurers can ring in all the complicated and varying options they can do, e.g. on non-Medicare HMO plans. They involve complicated tradeoffs--restricted "doctor networks" in exchange for covering more things, but more nuisance-level out-of-pockets costs for small co-pays on things.

Notice that even when you are on a "zero premium" Medicare Advantage plan, you still need to pay your Medicare Part B premium, so it isn't "free" as in only paying co-pays and deductibles, you're still paying over $100/month in premiums, you just aren't paying them to the insurance company.
Last edited by nisiprius on Tue Nov 26, 2019 8:36 am, edited 4 times in total.
Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness; Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.

Monster99
Posts: 231
Joined: Tue Aug 29, 2017 10:28 am

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Monster99 » Tue Nov 26, 2019 8:33 am

DW turned 65 in November - You have 3 months before, the month you turn 65 and 3 months after. We started August 30 and she had her card on October 15. Medicare.gov has planning guides where you put in drugs, your doctors and area code to help select the plans in your area. Good luck!

User avatar
Mullins
Posts: 101
Joined: Wed May 08, 2019 4:38 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Mullins » Tue Nov 26, 2019 8:36 am

BillyV001 wrote:
Mon Nov 25, 2019 10:41 pm
If a Part C plan = A + B, why do you need to sign up for A & B? So you're paying a premium for A+B AND Part C (even tho C appears to, at least some extent, overlap A+B)?

Why?
"Part C" is only what they refer to Medicare Advantage Plans as, it's not actually a part of Medicare. Those plans are offered by insurance companies such as Aetna, Humana and others. They cover everything medicare covers but they usually offer something more. It could be dental, vision, gym membership, for example, and/or certainly an annual cap on out of pocket expenses. They're different than medigap (aka supplemental) plans, which are also offered by insurance companies.

That all aside, the thing is, a person can't get Advantage plans unless they're eligible for medicare; those insurance companies get reimbursed by medicare; and even with you having one of those plans you'll still have to pay your medicare premium for part B, and so that's why you have to sign up for medicare first to get an Advantage plan.

I recommend reading "Medicare for Dummies" as I found it helpful. Basically, you'll look at your probable medical needs, review the plans offered in your area which you'll find a complete list on the medicare.gov site, compare them and see what works for you.

kaneohe
Posts: 5956
Joined: Mon Sep 22, 2008 12:38 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by kaneohe » Tue Nov 26, 2019 9:28 am

Perhaps mentioned previously some miscellaneous things to know:
If you get a medicare supplement, you can go to any doctor that accepts medicare assignment (agrees to their fees). That means you can go to a specialist w/o a referral or see doctors nationwide. If you get a Medicare Advantage plan, you must see a doctor in their network which may limit who you can see geographically and probably have to get a referral from your primary doctor to see a specialist. Even if your doctor is in network when you enroll, that can change over time .

Medicare supplement plans have standardized features denoted by their plan letters like F, G, N,etc. All plans w/ the same letter are basically the same so you can compare on price. Medicare Advantage plans are not standardized so you need to look carefully at the details
of the plan to compare which may be more difficult than comparing standardized plans.

You can change Medicare Advantage plans every yr during open enrollment. You can theoretically change Supplement plans at any time but only if you pass underwriting................they look at your medical history and they decide if they want you.

Lots to learn but you will eventually will get comfortable with all of this.............

rivercrosser
Posts: 61
Joined: Thu Oct 31, 2019 3:48 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by rivercrosser » Tue Nov 26, 2019 10:26 am

I'm going on medicare on February so I'm in the same boat. Your going to notice that some brokers, mailings, TV ads etc. are really pushing the advantage plans. I have to admit they are tempting, but for me it's going to be a "G" plan with a basic part "D" (I don't take any drugs right now).

User avatar
Summit111
Posts: 309
Joined: Sun Mar 17, 2013 6:32 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Summit111 » Tue Nov 26, 2019 7:58 pm

IRMAA....Learn what that means and prepare for it....

Summit
“Got my mind on my money, and my money on my mind!” Snoop Dog

User avatar
JoeRetire
Posts: 3942
Joined: Tue Jan 16, 2018 2:44 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by JoeRetire » Tue Nov 26, 2019 8:15 pm

pennywise wrote:
Tue Nov 26, 2019 8:23 am
OP, since you too are a 'young' elderly person in great health and taking no prescription meds, consider your Medicare choices in future terms, not just for what you need or don't need now.
I disagree. You can change your plan every year.

Choose what you need now. Choose again next year, the year after that, etc.
Don't be a lemming.

User avatar
JoeRetire
Posts: 3942
Joined: Tue Jan 16, 2018 2:44 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by JoeRetire » Tue Nov 26, 2019 8:19 pm

nisiprius wrote:
Tue Nov 26, 2019 8:32 am
Medicare Advantage is a more complicated decision because you are just buying a private insurance plan, one whose premiums are heavily subsidized by the government, but insurers can ring in all the complicated and varying options they can do, e.g. on non-Medicare HMO plans. They involve complicated tradeoffs--restricted "doctor networks" in exchange for covering more things, but more nuisance-level out-of-pockets costs for small co-pays on things.
If you had an HMO or PPO before reaching Medicare age, a Medicare Advantage plan will look very familiar.

I started Medicare this year. I haven't found it any more complicated, nor restrictive than the ACA plan I had last year.
Same plan provider, same doctors, same network, same drug plan, tiny co-pay changes.

The only thing I found that was difficult was the transition from "Me + Wife both on ACA plan" to "Me on Medicare, Wife on ACA plan". The Healthcare.gov rep on the phone messed up the transition. It popped my wife into the Medicaid queue. That took me weeks to unwind, but I finally got it done. Hopefully next year, the transition to "Me + Wife on Medicare" will be simpler.
Don't be a lemming.

drawpoker
Posts: 2787
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: Medicare: Just Starting Down The Rabbit Hole

Post by drawpoker » Tue Nov 26, 2019 9:10 pm

JoeRetire wrote:
Tue Nov 26, 2019 8:15 pm
pennywise wrote:
Tue Nov 26, 2019 8:23 am
OP, since you too are a 'young' elderly person in great health and taking no prescription meds, consider your Medicare choices in future terms, not just for what you need or don't need now.
I disagree. You can change your plan every year.

Choose what you need now. Choose again next year, the year after that, etc.
To clarify: You can change your plan every year only refers to Part D and M.A. plans. Because there is no medical underwriting involved in either.

What pennywise is referring to - and it is very important - in most states it is difficult, or impossible, to switch supplement plans once you are outside of open enrollment and your health is poor. Or, switch from M.A. to a supplement.
Ergo, he is correct in advising that choices should be made in future terms, not just the here and now of it.

Unless the OP is in NY, CT, MA or one of the other very few states with special Medicare rules - he will kick himself in the rear later. IF he can easily afford Plan G or N now, but signs up for M.A. instead, thinking that is smart to do because he is in excellent health.
As many on this board can attest to - all that can change almost overnight.

radiowave
Posts: 2272
Joined: Thu Apr 30, 2015 5:01 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by radiowave » Tue Nov 26, 2019 9:39 pm

What happens if you are still working full time with health care benefits at 65 and older?
Bogleheads Wiki: https://www.bogleheads.org/wiki/Main_Page

User avatar
JoeRetire
Posts: 3942
Joined: Tue Jan 16, 2018 2:44 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by JoeRetire » Tue Nov 26, 2019 9:40 pm

drawpoker wrote:
Tue Nov 26, 2019 9:10 pm
JoeRetire wrote:
Tue Nov 26, 2019 8:15 pm
pennywise wrote:
Tue Nov 26, 2019 8:23 am
OP, since you too are a 'young' elderly person in great health and taking no prescription meds, consider your Medicare choices in future terms, not just for what you need or don't need now.
I disagree. You can change your plan every year.

Choose what you need now. Choose again next year, the year after that, etc.
To clarify: You can change your plan every year only refers to Part D and M.A. plans. Because there is no medical underwriting involved in either.

What pennywise is referring to - and it is very important - in most states it is difficult, or impossible, to switch supplement plans once you are outside of open enrollment and your health is poor. Or, switch from M.A. to a supplement.
Ergo, he is correct in advising that choices should be made in future terms, not just the here and now of it.

Unless the OP is in NY, CT, MA or one of the other very few states with special Medicare rules - he will kick himself in the rear later. IF he can easily afford Plan G or N now, but signs up for M.A. instead, thinking that is smart to do because he is in excellent health.
As many on this board can attest to - all that can change almost overnight.
https://www.elderlawanswers.com/enterin ... lans-12268

"Once you choose a plan, you can leave a plan only at certain times of the year. You can switch once during the open enrollment period that runs from October 15 through December 7 every year. In addition, you can switch Medicare Advantage plans or switch from a Medicare Advantage plan to original Medicare between January 1 and March 31 of each year. However, you can't switch from original Medicare to a Medicare Advantage plan during this time. You also can't switch prescription drug plans or join, switch, or drop a Medicare Medical Savings Account Plan during this period. If you switch to original Medicare during this period, you'll have until March 31 to also join a Medicare prescription drug plan to add drug coverage. "
Don't be a lemming.

drawpoker
Posts: 2787
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: Medicare: Just Starting Down The Rabbit Hole

Post by drawpoker » Tue Nov 26, 2019 9:57 pm

I don;t see your point. The link addresses "Entering and Leaving" Medicare Advantage plans.

Not "Entering and Leaving" Medicare supplement plans.

If you read thru, you will note switching back to Medigap is not always possible after the first year. There is only a one-time opportunity to do that, at the end of the first year. If you go beyond a year, you are out of luck. Stuck.

Quoted from the link you provided:

"One risk of switching from original Medicare to a Medicare Advantage plan is that when you leave you may not be eligible for the same Medigap policy you had before you shifted to Medicare Advantage.

When you return to regular Medicare, you have the right to go back to the same Medigap policy you had before you joined the Medicare Advantage plan, if the same insurance company you had before still sells it. If the policy is no longer available, you have a guaranteed right to buy a Medigap policy designated A, B, C, F, K or L that is sold in your state by any insurance company as long as you had Medicare Advantage for less than a year. In these circumstances the insurers cannot refuse you coverage as long as you apply for the Medigap policy no later than 63 days after coverage from your Medicare Advantage plan terminates. The insurance company is required to by law to sell or offer you a Medigap policy even if you have health problems (called "pre-existing conditions"). If you had Medicaid (sic) Advantage for a year or more or wait longer than 63 days, you can apply but you aren’t guaranteed of acceptance."

So, a suggestion of "Choose again next year, the year after that, etc. " is not in the cards. Not at all.

pennywise
Posts: 701
Joined: Sat May 31, 2014 6:22 am

Re: Medicare: Just Starting Down The Rabbit Hole

Post by pennywise » Tue Nov 26, 2019 10:13 pm

JoeRetire wrote:
Tue Nov 26, 2019 8:15 pm
pennywise wrote:
Tue Nov 26, 2019 8:23 am
OP, since you too are a 'young' elderly person in great health and taking no prescription meds, consider your Medicare choices in future terms, not just for what you need or don't need now.
I disagree. You can change your plan every year.

Choose what you need now. Choose again next year, the year after that, etc.
Yes one can certainly change plans but for Medicare supplement plans, as opposed to Medicare advantage plans, there is only the original enrollment period that is truly open, ie no medical underwriting takes place.

After that depending on your health status it might be more challenging or expensive to obtain a different supplement plan. That was what I referred to in my advice.

pennywise
Posts: 701
Joined: Sat May 31, 2014 6:22 am

Re: Medicare: Just Starting Down The Rabbit Hole

Post by pennywise » Tue Nov 26, 2019 10:22 pm

radiowave wrote:
Tue Nov 26, 2019 9:39 pm
What happens if you are still working full time with health care benefits at 65 and older?
You are exempt from the requirement to start Medicare benefits if you are working and covered by health benefits through your employer, or if you receive medical benefits via a spouse with such coverage.

Thus when my husband turned 65 he was still employed and our company required he start Part A (no cost to him) while still getting full health care benefits as an employee.

When he retired at 65 YO and 3 months, he went onto my health care coverage plan since I was still working.

When he was 65 YO and 10 months, I retired and he started his Medicare Part B. As it happened that was July 1 so we waited till open enrollment in October to sign up for a supplement plan and drug coverage. The supplement plan takes affect December 1 since he is within the six month window for open enrollment anyway.

rick0
Posts: 69
Joined: Thu Jan 31, 2013 10:54 pm
Location: WA

Re: Medicare: Just Starting Down The Rabbit Hole

Post by rick0 » Tue Nov 26, 2019 10:25 pm

Shallowpockets wrote:
Tue Nov 26, 2019 7:35 am
Medicare for dummies, the book. Your questions will be answered. Sounds like you are at square one.
+1 .. well worth the $15!

drawpoker
Posts: 2787
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: Medicare: Just Starting Down The Rabbit Hole

Post by drawpoker » Wed Nov 27, 2019 3:12 pm

pennywise wrote:
Tue Nov 26, 2019 10:22 pm

Thus when my husband turned 65 he was still employed and our company required he start Part A (no cost to him) while still getting full health care benefits as an employee.

When he retired at 65 YO and 3 months, he went onto my health care coverage plan since I was still working.

When he was 65 YO and 10 months, I retired and he started his Medicare Part B. As it happened that was July 1 so we waited till open enrollment in October to sign up for a supplement plan and drug coverage. The supplement plan takes affect December 1 since he is within the six month window for open enrollment anyway.
If I am understanding your post correctly (?) your husband switched from being a dependent on your employer's health plan to Original Medicare as of July 1. But, he did not take out a supplement plan effec. as of July 1? He delayed, and his supplemental Medicare coverage doesn't become effective until December 1

It strikes me as gambling a bit? What if something major happened during that 5 month period, serious surgery, hospitalization, heart attack, etc. He could be on the hook for the 20% of Part B charges, possibly a total going into the high five figures , making that 20% nothing to sneer at :shock:

pennywise
Posts: 701
Joined: Sat May 31, 2014 6:22 am

Re: Medicare: Just Starting Down The Rabbit Hole

Post by pennywise » Thu Nov 28, 2019 8:10 am

drawpoker wrote:
Wed Nov 27, 2019 3:12 pm

If I am understanding your post correctly (?) your husband switched from being a dependent on your employer's health plan to Original Medicare as of July 1. But, he did not take out a supplement plan effec. as of July 1? He delayed, and his supplemental Medicare coverage doesn't become effective until December 1

It strikes me as gambling a bit? What if something major happened during that 5 month period, serious surgery, hospitalization, heart attack, etc. He could be on the hook for the 20% of Part B charges, possibly a total going into the high five figures , making that 20% nothing to sneer at :shock:
You are correct, it was a foolish act of procrastination that hopefully will not result in any financial hits-we still have 2 days to go! :oops:

No excuse other than at the time we were experiencing a host of life changes including retiring, selling a house, moving and reorganizing our entire financial lives from dual working couple to dual retired couple. Even feebler excuse-he's extraordinarily healthy and we could have handled a high five figure cost if necessary.

That said, don't be like us. Get your insurance squared away so you aren't at risk! :

Topic Author
BillyV001
Posts: 23
Joined: Fri Dec 14, 2018 4:50 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by BillyV001 » Thu Nov 28, 2019 9:54 am

Thank you all for taking time to read and respond. Very good info that I'll consider.

First thing I did was get a copy of the "Dummies" book. Thanks for that recommendation. The book is incredibly information dense but the good thing is that large sections of the book cover situations that I (and I'm sure lots of you) just don't need to consider; so can get thru it fairly quickly.

Reading the book and your responses, talking to friends and looking at other sources of info gets you to thinking about what's really important now and going forward. One example is travel; didn't do a ton of that in working years but now have that time and will have to consider that impact on health care needs.

Been taking lots of notes. My plan going forward is to finish the book and try to rank my options in importance to me. Hopefully, the "answer" will simply fall out of the spreadsheet! I think at that point the hard work is done. Then all I have to do is pick a plan..hah!

Again, I appreciate the help.
Best, Bill

User avatar
susa
Posts: 552
Joined: Sat Oct 06, 2007 4:30 pm
Contact:

Re: Medicare: Just Starting Down The Rabbit Hole

Post by susa » Thu Nov 28, 2019 10:33 am

JoeRetire wrote: The only thing I found that was difficult was the transition from "Me + Wife both on ACA plan" to "Me on Medicare, Wife on ACA plan". The Healthcare.gov rep on the phone messed up the transition. It popped my wife into the Medicaid queue.
If you don't mind, can you share if you now know Why this happened? Was it simply a coding error/human or was something unusual?

It's been explained in other threads here and similar forums that since you or spouse independently applies for Medicare, that phone call to healhcare.gov is just a Notification "Hey, would you please drop me off ACA & subsidy effective 1st day of ___".

Perhaps that is not so simple.

User avatar
JoeRetire
Posts: 3942
Joined: Tue Jan 16, 2018 2:44 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by JoeRetire » Thu Nov 28, 2019 10:52 am

susa wrote:
Thu Nov 28, 2019 10:33 am
JoeRetire wrote: The only thing I found that was difficult was the transition from "Me + Wife both on ACA plan" to "Me on Medicare, Wife on ACA plan". The Healthcare.gov rep on the phone messed up the transition. It popped my wife into the Medicaid queue.
If you don't mind, can you share if you now know Why this happened? Was it simply a coding error/human or was something unusual?

It's been explained in other threads here and similar forums that since you or spouse independently applies for Medicare, that phone call to healhcare.gov is just a Notification "Hey, would you please drop me off ACA & subsidy effective 1st day of ___".

Perhaps that is not so simple.
I thought it would be that simple.
- When I called Healthcare.gov's help line, the gentleman on the other end of the phone started out saying something along the lines of "Sorry. Since your 65th birthday is in November, you'll have to call after November 1st." I called in October.
- Then he told me to hold for a few minutes while he spoke with his supervisor.
- He came back and said that he could process my change today and asked me a series of questions. There were many questions (obviously he was following the same questions that the online form asks) and some involved where my wife worked and her income. She had retired back in April, then got a minimal income part-time job in September. I am retired with no income.
- Apparently, that put our reported income level below the "Medicaid" line for our state at which point he said something like "Oh, I'm sorry. That puts your wife into the Medicaid queue. I don't think I can help you any longer. Let me put my supervisor on."
- I then waited and spoke with the supervisor. He confirmed that my answers popped us into the Federal queue at which point Healthcare.gov couldn't help us unless and until we were declined by our state's Medicaid. I asked if he could cancel the transaction so that I could investigate. He said no.

Perhaps I said the wrong magic words. Perhaps the original person on the call was incompetent and should have just told me to wait until November. Perhaps the supervisor was just covering up for some mistake. (shrug)

Either way, I had to wait until the state's Medicaid office went through their formal review process for weeks and eventually rejected us since we have too much in savings, 401ks, IRAs, etc. (something I could have told them on the phone immediately). I finally got the rejection letter, called them to confirm the rejection, called the Healthcare.gov folks, called the insurance provider.

I believe it's finally resolved, although we haven't yet received my wife's new insurance card with her account number.
Last edited by JoeRetire on Thu Nov 28, 2019 10:54 am, edited 2 times in total.
Don't be a lemming.

fru-gal
Posts: 1189
Joined: Wed Jan 02, 2019 9:48 pm
Location: New England

Re: Medicare: Just Starting Down The Rabbit Hole

Post by fru-gal » Thu Nov 28, 2019 10:53 am

I haven't had time to read all the replies, so this is just my 2 cents.

I signed up for A, B, and AARP Plan D as soon as I was eligible, and AARP Medigap. I still have those plans years later.

I would never sign up for a Medicare Advantage Plan, because that lets an insurance company run the ship. I had enough of that $#@% when I was covered by employer insurance pre-Medicare - disallowed imaging, procedures, meds.

Now if I need imaging, the doctor can just go ahead and order it, no waiting for approval. Medicare has covered 80% of it and Medigap automatically covers the remaining 20%. Ditto with hospitalization. I can see any doctor who accepts Medicare and in the maybe ten years I have had it, about two doctors did not. As far as I know all the specialists in my area which is saturated with major hospitals accept Medicare.

I have Plan F Medigap, so I don't have to keep track of copays or deductibles, there are none. Plan F is closed or soon will be closed to new enrollees, but there is another Plan (G?) that seems to be the same except for some initial charges of some sort.

I have needed approval for some expensive meds on AARP Plan D, and so far they have all been approved within a day. Big contrast with the pre-medicare plan controlled by my previous employer which did not approve expensive meds.

Murgatroyd
Posts: 292
Joined: Sun Jan 21, 2018 8:23 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Murgatroyd » Thu Nov 28, 2019 12:08 pm

fru-gal wrote:
Thu Nov 28, 2019 10:53 am
I haven't had time to read all the replies, so this is just my 2 cents.

I signed up for A, B, and AARP Plan D as soon as I was eligible, and AARP Medigap. I still have those plans years later.

I would never sign up for a Medicare Advantage Plan, because that lets an insurance company run the ship. I had enough of that $#@% when I was covered by employer insurance pre-Medicare - disallowed imaging, procedures, meds.

Now if I need imaging, the doctor can just go ahead and order it, no waiting for approval. Medicare has covered 80% of it and Medigap automatically covers the remaining 20%. Ditto with hospitalization. I can see any doctor who accepts Medicare and in the maybe ten years I have had it, about two doctors did not. As far as I know all the specialists in my area which is saturated with major hospitals accept Medicare.

I have Plan F Medigap, so I don't have to keep track of copays or deductibles, there are none. Plan F is closed or soon will be closed to new enrollees, but there is another Plan (G?) that seems to be the same except for some initial charges of some sort.

I have needed approval for some expensive meds on AARP Plan D, and so far they have all been approved within a day. Big contrast with the pre-medicare plan controlled by my previous employer which did not approve expensive meds.
Thank you for this crisp description supporting Medigap over Advantage plans. This will change our decision process.

drawpoker
Posts: 2787
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: Medicare: Just Starting Down The Rabbit Hole

Post by drawpoker » Thu Nov 28, 2019 3:07 pm

fru-gal wrote:
Thu Nov 28, 2019 10:53 am

......employer insurance pre-Medicare - disallowed imaging, procedures, meds......Now if I need imaging, the doctor can just go ahead and order it, no waiting for approval. Medicare has covered 80% of it and Medigap automatically covers the remaining 20%.......
I also bought Plan F. But, must point out something here. It is all not quite as rosy as all that. Way ahead of M.A. managed care for sure. But not perfect.

No matter which supplement Plan is bought, Medicare's own rules are in place, and they must be followed. Otherwise, if Medicare doesn't cover it, neither does the Medigap.
You mention imaging. With imaging, for ex, they will not cover a PET Scan more frequently than every 90 days. This may sound reasonable. To anyone not familiar with chemo and immunotherapy treatment for certain cancers. (PET scans are far superior to CAT scans, as they drastically reduce the risk of pseudoprogression phenomenon being seen)

My advice for anyone weighing the decision of Medigap versus Medicare Advantage: No matter how healthy you are now (or think you are) ask yourself - What if I get cancer, which type insurance would I rather have?

Ruger
Posts: 296
Joined: Fri Jun 09, 2017 9:44 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Ruger » Thu Nov 28, 2019 3:40 pm

I just went on Medicare in July and it wasn't as complex as I thought. I highly recommend using Boomer Benefits. They have lots of educational videos on You tube, and they will shop plans in your area and let you know the best deals. The best thing I like is that if you have any problems with Medicare payments, you can call them and they will work to resolve them for free.

Lalamimi
Posts: 122
Joined: Mon Jun 24, 2019 4:22 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Lalamimi » Thu Nov 28, 2019 5:13 pm

You do not mention an important piece of information - are you currently covered by Employer insurance, either your spouse's or yours? If yes, you only need to sign up for Part A when you turn 65. And if you are contributing to an HSA, you then no longer will be able to make contributions. If you are not covered, then you do have the window of 6 months as mentioned above, but if you are dropping any current insurance, you only have 63 days to get a Plan D coverage. Is confusing. I used Boomer Benefits last November and they suggested the same Plan G that my DH had enrolled in 6 months earlier, and the same Plan D. He confirmed all Plan Gs are the same, it just depends on how much you want to pay. Some want the major name carriers and end up paying too much for it. We are now in Open Enrollment for the first time and have changed to a cheaper Plan D using medicare.gov.

User avatar
Eagle33
Posts: 266
Joined: Wed Aug 30, 2017 3:20 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Eagle33 » Thu Nov 28, 2019 5:44 pm

Go to SHIP and click on SHIP Locator button and pick your state. I found my state had an excellent introductory guide explaining Medicare. And other Medicare information that is specific to ones own state.
Rocket science is not “rocket science” to a rocket scientist, just as personal finance is not “rocket science” to a Boglehead.

Grasshopper
Posts: 1009
Joined: Sat Oct 09, 2010 3:52 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Grasshopper » Thu Nov 28, 2019 6:16 pm

OP you mentioned travel not all Medigap plans offer some covered expenses while out of the country.

Calli114
Posts: 170
Joined: Tue May 16, 2017 12:54 am

Re: Medicare: Just Starting Down The Rabbit Hole

Post by Calli114 » Thu Nov 28, 2019 6:24 pm

fru-gal wrote:
Thu Nov 28, 2019 10:53 am
I haven't had time to read all the replies, so this is just my 2 cents.

I signed up for A, B, and AARP Plan D as soon as I was eligible, and AARP Medigap. I still have those plans years later.

I would never sign up for a Medicare Advantage Plan, because that lets an insurance company run the ship. I had enough of that $#@% when I was covered by employer insurance pre-Medicare - disallowed imaging, procedures, meds.

Now if I need imaging, the doctor can just go ahead and order it, no waiting for approval. Medicare has covered 80% of it and Medigap automatically covers the remaining 20%. Ditto with hospitalization. I can see any doctor who accepts Medicare and in the maybe ten years I have had it, about two doctors did not. As far as I know all the specialists in my area which is saturated with major hospitals accept Medicare.

I have Plan F Medigap, so I don't have to keep track of copays or deductibles, there are none. Plan F is closed or soon will be closed to new enrollees, but there is another Plan (G?) that seems to be the same except for some initial charges of some sort.

I have needed approval for some expensive meds on AARP Plan D, and so far they have all been approved within a day. Big contrast with the pre-medicare plan controlled by my previous employer which did not approve expensive meds.
I don't have to worry about this for a few years, but also don't some MCare Advantage plans have lifetime dollar limits?

drawpoker
Posts: 2787
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: Medicare: Just Starting Down The Rabbit Hole

Post by drawpoker » Thu Nov 28, 2019 8:55 pm

Ruger wrote:
Thu Nov 28, 2019 3:40 pm
........highly recommend using Boomer Benefits...........they will shop plans in your area and let you know the best deals. The best thing I like is that if you have any problems with Medicare payments, you can call them and they will work to resolve them for free.
For free? Really? How generous of them!

I see 2 problems with them. Big ones.

One, they may not give out a complete listing of all companies offering plans in the area. They are only going to show the ones where they stand to get the commission. For ex, Everence Assoc. offers some very good deals on Medigap policies in some states because they are issue-age rated, not attained age rated. But you will never hear about them from Boomer Benefits because Everence does not enter into cooperative arrangements with indep. brokers to pay sales commissions. Everence sells only though their own network of field representatives.

Second, BB's offer of lifetime help with any Medicare payment problems is really just a sales gimmick. Of questionable value. When it comes right down to it, the doctor (or other medical provider) who ordered the disputed service/exam/test/whatever/is the only one who is going to help the beneficiary quickly and efficiently navigate any problems that arise with the claim.

In fact, if you have a Medicare denial, or partial, asking for B. B. to handle it for you is just adding another layer of unneeded complexity. Because of HIPAA and other laws, you will likely waste time signing a stack of consent forms for your medical records, lab results, etc., to be shared with third-party Boomers.

Have you ever actually had a problem with Medicare paying a claim, and contacted Boomers to request their "help"?

rivercrosser
Posts: 61
Joined: Thu Oct 31, 2019 3:48 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by rivercrosser » Thu Nov 28, 2019 9:13 pm

I would love to know if the brokers get more of a commission from some companies. Couple of them I talked to seemed to be pushing one company over an other even though it was a little higher premium than another for the same plan G.

drawpoker
Posts: 2787
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: Medicare: Just Starting Down The Rabbit Hole

Post by drawpoker » Thu Nov 28, 2019 9:31 pm

You betcha. From this link, "Commissions for selling Medigap plans vary from carrier to carrier."

Check it out:

https://seniormarketadvisors.com/blog/m ... mmissions/

neilpilot
Posts: 2856
Joined: Fri Dec 04, 2015 1:46 pm
Location: Memphis area

Re: Medicare: Just Starting Down The Rabbit Hole

Post by neilpilot » Thu Nov 28, 2019 9:40 pm

rivercrosser wrote:
Thu Nov 28, 2019 9:13 pm
I would love to know if the brokers get more of a commission from some companies. Couple of them I talked to seemed to be pushing one company over an other even though it was a little higher premium than another for the same plan G.
I assume that you know that brokers will typically not offer every plan available in your market. I picked a Plan G that was not offered thru my broker, because they charged lower premiums. I think that because the underwriter avoided paying brokerage fees they were able to keep their premium lower.

TheDDC
Posts: 503
Joined: Mon Jan 08, 2018 11:11 am

Re: Medicare: Just Starting Down The Rabbit Hole

Post by TheDDC » Thu Nov 28, 2019 9:46 pm

How easy is it to switch from Plan F to Plan G? Asking for mom. The premiums seem like they are getting out of control fast, and the coverage pool is getting smaller.

-TheDDC
Refreshingly, a double barrel shotgun blast of truth...

OnTrack
Posts: 536
Joined: Wed Jan 20, 2016 11:16 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by OnTrack » Thu Nov 28, 2019 9:54 pm

Calli114 wrote:
Thu Nov 28, 2019 6:24 pm
I don't have to worry about this for a few years, but also don't some MCare Advantage plans have lifetime dollar limits?
I don't know, but when I was looking into a Kaiser MA (part C) plan I was told by the Kaiser representative that they don't have lifetime limits ( you should of course independently verify that if you are interested in Kaiser). Note that even original Medicare with supplements have limits, for example (1) how many days in the hospital (somewhat complicated formula I won't go into here) and (2) $50,000 lifetime limit on foreign emergency coverage by the medigap plans that have that coverage (not all do). If you travel, you might consider separate medical travel insurance (plenty of separate threads on this topic).

Also, if you are going onto Medicare at age 65 I recommend you sign up for parts A and B as early as allowed. (3 months before the month you turn 65 unless your birthday is the first day of the month, in which case you can sign up on month earlier since your coverage can start a month before the month you turn 65). It took about 2 months after I signed up before I received my Medicare card although I was able to find out my Medicare number online a few days before the card arrived in the mail. My understanding is that you need the Medicare number before you can enroll in part c or part d + medigap. So if you sign up 3 months ahead and it takes 2 months to get the card, you then have one month left to get the part c or part d + medigap in place. Of course you can be doing research on plans while you are waiting for your card.
Last edited by OnTrack on Thu Nov 28, 2019 9:59 pm, edited 1 time in total.

rivercrosser
Posts: 61
Joined: Thu Oct 31, 2019 3:48 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by rivercrosser » Thu Nov 28, 2019 9:56 pm

neilpilot wrote:
Thu Nov 28, 2019 9:40 pm
rivercrosser wrote:
Thu Nov 28, 2019 9:13 pm
I would love to know if the brokers get more of a commission from some companies. Couple of them I talked to seemed to be pushing one company over an other even though it was a little higher premium than another for the same plan G.
I assume that you know that brokers will typically not offer every plan available in your market. I picked a Plan G that was not offered thru my broker, because they charged lower premiums. I think that because the underwriter avoided paying brokerage fees they were able to keep their premium lower.
Brokers offered both companies I priced. One they favored was a 150.00 something more a year, so not a lot. I was figuring in any available household, prepay, etc. discounts they offered also.

rivercrosser
Posts: 61
Joined: Thu Oct 31, 2019 3:48 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by rivercrosser » Thu Nov 28, 2019 10:11 pm

TheDDC wrote:
Thu Nov 28, 2019 9:46 pm
How easy is it to switch from Plan F to Plan G? Asking for mom. The premiums seem like they are getting out of control fast, and the coverage pool is getting smaller.

-TheDDC
Depends on state you live in for one thing. Some you can. I saw what my 87 year old mother inlaw is paying for her F plan earlier today. When I got home I priced a G plan vr the F for her age. Big difference. Missouri here. I think she would have to go thru underwriting to change. She has cancer. Doesn't make sense to me if your going down from a F to a G but I guess they can keep her hooked on the higher premium F plan that way. She hasn't paid a penny for the high dollar hormone shots etc. she's been on for quite awhile now.

OnTrack
Posts: 536
Joined: Wed Jan 20, 2016 11:16 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by OnTrack » Thu Nov 28, 2019 10:22 pm

JoeRetire wrote:
Thu Nov 28, 2019 10:52 am
susa wrote:
Thu Nov 28, 2019 10:33 am
JoeRetire wrote: The only thing I found that was difficult was the transition from "Me + Wife both on ACA plan" to "Me on Medicare, Wife on ACA plan". The Healthcare.gov rep on the phone messed up the transition. It popped my wife into the Medicaid queue.
If you don't mind, can you share if you now know Why this happened? Was it simply a coding error/human or was something unusual?

It's been explained in other threads here and similar forums that since you or spouse independently applies for Medicare, that phone call to healhcare.gov is just a Notification "Hey, would you please drop me off ACA & subsidy effective 1st day of ___".

Perhaps that is not so simple.
I thought it would be that simple.
- When I called Healthcare.gov's help line ...
I believe it's finally resolved, although we haven't yet received my wife's new insurance card with her account number.
Switching from "Me + Spouse both on ACA plan" to "Me on Medicare, Spouse on ACA plan" was a big problem for me also. I was told to call the state exchange (my state has its own exchange) early in the month before I turn 65 and tell them I need to drop off ACA effective the end of that month because I am going onto Medicare the next month, but to leave my spouse on ACA. For some unknown reason both my spouse and I were dropped from ACA even before I turned 65. So that was a double mistake (1) my spouse should not have been dropped at all and (2) I was dropped 1 month too soon. It has taken many phone calls with both the exchange and the insurance company to get it straightened out (and I'm not sure it is straightened out yet).

I would think this would be a common event; I don't understand why it seems to be such a problem. One piece of advice for those initially signing up for an ACA plan with a spouse. Make the younger spouse the "subscriber" or primary person on the account. It seems to be easier to transition the older spouse to Medicare if it is set up that way.

User avatar
JoeRetire
Posts: 3942
Joined: Tue Jan 16, 2018 2:44 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by JoeRetire » Thu Nov 28, 2019 10:41 pm

drawpoker wrote:
Thu Nov 28, 2019 3:07 pm
My advice for anyone weighing the decision of Medigap versus Medicare Advantage: No matter how healthy you are now (or think you are) ask yourself - What if I get cancer, which type insurance would I rather have?
I had cancer less than 2 years ago. At the time I had an ACA-compliant insurance plan purchased on the marketplace. It was a very good plan, and in spite of a year numerous tests and scans and $28k-per-infusion treatments, I paid virtually nothing out of pocket other than $25 co-pays for some of the visits. I had to get a referral from my primary care physician to my oncologist.

My cancer is gone (at least for now) and I am now 65. I now have a Medicare Advantage plan. It is from the same insurance provider, covers all the same physicians I had, the same hospitals, the same medications. The co-pay is lower. The deducible is a bit higher. I had to get a referral from my primary care physician to my oncologist.

Everything is virtually the same. If I get cancer (again), I'm not worried. Your mileage may vary.
Don't be a lemming.

drawpoker
Posts: 2787
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: Medicare: Just Starting Down The Rabbit Hole

Post by drawpoker » Thu Nov 28, 2019 10:48 pm

rivercrosser wrote:
Thu Nov 28, 2019 10:11 pm
......I priced a G plan vr the F for her age. Big difference. Missouri here. I think she would have to go thru underwriting to change. She has cancer. Doesn't make sense to me if your going down from a F to a G but I guess they can keep her hooked on the higher premium F plan that way.........
That's not quite it. You are looking at it from the point of view of the consumer - not the insurance company. I can assure you - the "higher premium F plan" premiums are not nearly covering the actual cost of her medical claims.

The only difference (to the insurer) when going from F to G is that the $185 (going to $198 next year) deductible isn't coming out of their pocket anymore. It is coming out of customer's pocket. So what? Around 200 bucks? Pocket change, meaningless to Mega insurance company. They still have to pay out big $$$ for sick people like your M.I.L.

I wouldn't waste my time even asking my insurer if I could switch from F to G. They would be leaping for joy to say "No, you can't" ! Because they would be thinking (hoping, praying) that I was asking because I could no longer afford my F premiums.
"Aha, finally we will get rid of her, she can't afford Plan F anymore, probably will be shopping for N, or HD-G, maybe even M.A. Good riddance...."
Likely any inquiry from you on behalf of your cancer-stricken M.I.L. would get similar results.

And why would they like to be permanently shut of me? Oh, um, maybe something to do with they have shelled out over $36,000 this year in claims. With another month to go (and another treatment in Dec.) the total for the year will exceed $40,000.
And how much $$$ are they getting from me for the year? Only $2,820.

See how it works.......

User avatar
JoeRetire
Posts: 3942
Joined: Tue Jan 16, 2018 2:44 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by JoeRetire » Thu Nov 28, 2019 10:48 pm

OnTrack wrote:
Thu Nov 28, 2019 10:22 pm
For some unknown reason both my spouse and I were dropped from ACA even before I turned 65. So that was a double mistake (1) my spouse should not have been dropped at all.
When I finally straightened things out, the insurance company told me that my wife would indeed a new plan, since the old plan that had both of us on it had me as the subscriber. She needed a new plan with her as the subscriber.

Maybe that's what happened in your case as well.
Don't be a lemming.

rivercrosser
Posts: 61
Joined: Thu Oct 31, 2019 3:48 pm

Re: Medicare: Just Starting Down The Rabbit Hole

Post by rivercrosser » Thu Nov 28, 2019 11:30 pm

drawpoker wrote:
Thu Nov 28, 2019 10:48 pm
rivercrosser wrote:
Thu Nov 28, 2019 10:11 pm
......I priced a G plan vr the F for her age. Big difference. Missouri here. I think she would have to go thru underwriting to change. She has cancer. Doesn't make sense to me if your going down from a F to a G but I guess they can keep her hooked on the higher premium F plan that way.........
That's not quite it. You are looking at it from the point of view of the consumer - not the insurance company. I can assure you - the "higher premium F plan" premiums are not nearly covering the actual cost of her medical claims.

The only difference (to the insurer) when going from F to G is that the $185 (going to $198 next year) deductible isn't coming out of their pocket anymore. It is coming out of customer's pocket. So what? Around 200 bucks? Pocket change, meaningless to Mega insurance company. They still have to pay out big $$$ for sick people like your M.I.L.

I wouldn't waste my time even asking my insurer if I could switch from F to G. They would be leaping for joy to say "No, you can't" ! Because they would be thinking (hoping, praying) that I was asking because I could no longer afford my F premiums.
"Aha, finally we will get rid of her, she can't afford Plan F anymore, probably will be shopping for N, or HD-G, maybe even M.A. Good riddance...."
Likely any inquiry from you on behalf of your cancer-stricken M.I.L. would get similar results.

And why would they like to be permanently shut of me? Oh, um, maybe something to do with they have shelled out over $36,000 this year in claims. With another month to go (and another treatment in Dec.) the total for the year will exceed $40,000.
And how much $$$ are they getting from me for the year? Only $2,820.

See how it works.......
I know how it works and theirs no way she's giving up her F plan (she can afford whatever she wants) but why not let someone that's less fortunate save a few bucks a month by stepping down to a G plan.

drawpoker
Posts: 2787
Joined: Mon May 19, 2014 6:33 pm
Location: Delmarva

Re: Medicare: Just Starting Down The Rabbit Hole

Post by drawpoker » Thu Nov 28, 2019 11:32 pm

OnTrack wrote:
Thu Nov 28, 2019 10:22 pm
.......For some unknown reason both my spouse and I were dropped from ACA even before I turned 65. So that was a double mistake (1) my spouse should not have been dropped at all and (2) I was dropped 1 month too soon. It has taken many phone calls with both the exchange and the insurance company to get it straightened out (and I'm not sure it is straightened out yet)...... I don't understand why it seems to be such a problem.............
Why? It's the gumbmint, that's why. Murphy's Law of Governing, Anything That Can Be Screwed Up, Will Be.

Many years ago when my state adopted Medicaid expansion (removing all means-testing for the under-65) the state exchange (ACA) put me on Medicaid. Of course my regular insurance was dropped effec. last day of month. It didn't amount to much savings as I was turning 65 in a little over 3 months anyway.

Oh boy, that's when I got lost in the shuffle, chaos reigned. Apparently the state Medicaid computers weren't speaking with the federal Medicare computers because next thing I know, I get a letter from SSA saying "The state of Maryland will be paying your Part B premium beginning...your social security benefit payment is now blah, blah. " Then comes the "purple letter" from CMS, "Congratulations, you automatically qualify for Extra Help beginning ...blah blah".

They had wrongly assumed that I was a dual-eligible :shock: Phone calls, followed up by letters, telling them I was not eligible, was over the limit on assets/resources, etc. were ignored for nearly five (5) months. Telling them to look it up in the computer the date I signed up for Medicare Part A, Part B, Part D, and a Medigap did no good. They weren't listening as everything I was telling them was contrary to what they had been told what happens when people on Medicaid turn 65 (or otherwise become Medicare-eligible)

When the idiots finally realized their mistake - it represented five months of Part B premium payments I was not entitled to. But, they must have realized the error was their own stupidity, as I was only required to pay back 2 months. :D

LookinAround
Posts: 69
Joined: Tue Mar 27, 2018 5:41 am
Location: Chicagoland

Re: Medicare: Just Starting Down The Rabbit Hole

Post by LookinAround » Thu Nov 28, 2019 11:38 pm

rivercrosser wrote:
Thu Nov 28, 2019 10:11 pm
TheDDC wrote:
Thu Nov 28, 2019 9:46 pm
How easy is it to switch from Plan F to Plan G? Asking for mom. The premiums seem like they are getting out of control fast, and the coverage pool is getting smaller.

-TheDDC
Depends on state you live in for one thing. Some you can. I saw what my 87 year old mother inlaw is paying for her F plan earlier today. When I got home I priced a G plan vr the F for her age. Big difference. Missouri here. I think she would have to go thru underwriting to change. She has cancer. Doesn't make sense to me if your going down from a F to a G but I guess they can keep her hooked on the higher premium F plan that way. She hasn't paid a penny for the high dollar hormone shots etc. she's been on for quite awhile now.
Yes, it depends on your state (a small number don't allow carriers to required medical underwriting to switch plans) but it can also vary by insurance carrier.

I'm in Illinois. I have Plan F with UHC. If I switch to Plan G with UHC they require medical underwriting. But if I switch to Plan G with BCBS they don't! This is one case where it can be helpful to call broker(s) as it's one stop to know how the same plans from different companies vary in underwriting requirements.

p.s. Based on comparing todays Plan G rates for BCBS vs UHC, BCBS will go up faster then UHC from year-to-year. Not much at first, but more so at 70+. But that's not surprising as BCBS (at least at the moment) doesn't require underwriting so they have sick people who couldn't get onto other plans

Post Reply