Turning 65, Medicaire questions

[outlookcapital]

Ok, pretty well off guy here, on my still-working wife's medical plan right now, but I turn 65 in October and plan to drop off it and joining Medicare. I understand there are things I should do before I turn 65, however, and I am getting bombarded with calls, emails, seminars, et cetera. Is there a simple precis I can follow here from any of the learned posters. At this point, I want to keep my monthly payment low, a low co-pay and reasonable deductible don't bother me. I could probably use dental, if people think it's worth it, and I belong to a health club that recognizes silver sneakers. Advice? Do I really need to go to seminars and deal with sales people? I live in Seattle. Thanks.

[retiredjg]

Here's a start.

https://www.bogleheads.org/wiki/Medicare

[outlookcapital]

Is that a simple as it gets, in terms of advice? Or should I just talk to friends and their experiences? I just thought the voices on here might be more learned.

[Big Dog]

Here's a start.

https://www.bogleheads.org/wiki/Medicare

Hmm, that BH website is dated and unclear, IMO. For example, "Fee-for-Service" is confusing as that term includes both Original Medicare and some Medicare Advantage plans. Moreover, the 'wrap-around' coverage seems to get short shrift as 50% of folks 65-75 purchase a Supplement (aka wrap-around) plan, with a third taking MA. Supplements and MA plans are state-approved, so what is offered and priced in WA is different than CA. (I'm happy to share my experience from last year, but I'm in CA so not sure my story would help. fwiw: I chose Original Medicare, Plan G-Innovative which includes vision+Silver Sneakers.)

In any event, OP, contact your state SHIP for some free and unbiased advice. Nearly all the seminars that you would attend are sponsored by Medicare Advantage firms; mostly HMO-type plans so that will be the focus of their pitch.

You have time for research. But given COVID and lower staffing at many companies, better to start early to get your questions answered.

Another option is a local broker, which costs you nothing. But not all brokers offer all Supplement plans, so they are not necessarily unbiased.

Medicare.gov is the place to start, IMO.

https://www.insurance.wa.gov/shiba-events-calendar

https://www.medicare.gov/supplements-ot ... p-policies

[FIREchief]

I'm not there yet, but have started thinking about it. It seems that the biggest decision to be made is whether to use a Medicare Advantage plan or original Medicare with a Medigap supplement. As I understand it, if you go with a supplement you can keep it forever but will be subject to any rate increases by the insurance company. If you decide you don't like the supplement approach, you can revert to a Medicare Advantage plan during annual open enrollment without insurance underwriting. You can't go the other way (i.e. if you start with Medicare Advantage, you will need underwriting to change to a Medigap supplement). Although my state/county seems to have excellent Medicare Advantage plans, I'm leaning towards a Medigap Plan G high deductible plan when I turn 65 (coupled with the cheapest Plan D I can find - I believe that Plan D's can be changed at open enrollment if needs change). I don't mind the high deductible, but I don't want to deal with the in-network/out-of-network issues in a Medicare Advantage plan. I also have little interest in those "perks" (basic dental, vision, gym, free backpack, movie tickets, card on my Bday, etc. - I may be confusing some of those with AARP ). I also require assurance that I'll be able to continue to utilize at least one specialist and one certain hospital, so a Medigap Plan is likely the "safest." Good luck. Hopefully our experts will clarify if I've misstated any of this. As I said, I'm just starting to learn about this myself.

[FIREchief]

on my still-working wife's medical plan right now, but I turn 65 in October and plan to drop off it and joining Medicare.

If your wife will still be working, you may wish to investigate your options to stay on her plan and delay Medicare. In some/most cases, I believe that if your wife's plan allows it, you can later join Medicare without penalty. That said, if Medicare is cheaper or better, it may not be worth consideration. Also, although this is true for while your wife is actively employed, I don't think it applies to COBRA coverage.

[Big Dog]

If you decide you don't like the supplement approach, you can revert to a Medicare Advantage plan during annual open enrollment without insurance underwriting. You can't go the other way (i.e. if you start with Medicare Advantage, you will need underwriting to change to a Medigap supplement).

That is state-specific. For example, CA and OR have the birthday rule which means you can change Medigap/Supplement plans on or around your birthday without underwriting.

[retiredjg]

Is that a simple as it gets, in terms of advice? Or should I just talk to friends and their experiences? I just thought the voices on here might be more learned.

Sorry. I just thought the Wiki might answer a question or two and introduce you to some terms you have not yet encountered. It was not intended to be a real answer to your question, just a place to start.

As mentioned by another, your local SHIP office is one resource not to miss.

[FIREchief]

(deleted)

[Toons]

Give Mutual Of Omaha A call,,,
No I am not affiliated.
My spouse and I have the Supplemental G plan with them .
They all have to offer the same benefits.
We pay 213.60 combined monthly

As a sidenote ,we both use
Walmart Humana Value Plan for Medicare Prescription D Plan
13.20 for each of us monthly

[Sandwich]

.....
In any event, OP, contact your state SHIP for some free and unbiased advice. Nearly all the seminars that you would attend are sponsored by Medicare Advantage firms; mostly HMO-type plans so that will be the focus of their pitch.

You have time for research. But given COVID and lower staffing at many companies, better to start early to get your questions answered....

+ 1

Consider contacting your state SHIP office. In my area, a caller may leave phone message with a query on a "helpline" and / or send a message via the State's SHIP website and a call back will come from a SHIP volunteer in a few business days. (Volunteer presentations at senior and community centers have all been cut back due to COVID 19); however, SHIP volunteers are able to return assigned calls from their homes via government issued cell phones. They may be able to provide information that is particularly helpful in the county / area you live in.

Good luck.

[jebmke]

the local SHIP person was very helpful when I was getting ready to sign-up. I did some homework first and used the SHIP counselor to verify my conclusions.

[prudent]

boomerbenefits.com offers free webinars to help you get up to speed on Medicare. If you want them to help you shop for plans, they will, but the info on their site has been useful just to learn the basics. Went to a couple in-person info sessions locally but they were clearly biased. In fact, one of them at the local library was presented by an insurance broker who mumbled something at the start that at her office she represents a number of plans, but since this meeting was sponsored by XYZ Company, she's only going to talk about XYZ Company plans.

[Stinky]

I'm a big fan of Medicare Advantage. But, from other threads that have discussed Medicare, the attractiveness of MA is very location specific.

DW and I are both in MA, sponsored by our local Blue Cross. The Blue Cross plan covers basically all doctors and hospitals in the state. No premium for the MA plan. Drug plan is at no cost, and included in the MA package. I figure that each of us is saving $150 or so per month compared to being in traditional Medicare with a supplement and a drug plan. We also have the free Silver Sneakers, and minimal benefits for dental and vision ($100-$200 per year for each).

We love our MA. It feels just like the traditional employer-provided PPO health insurance.

Our situation may be unique. The biggest knock that I hear is the limitation on doctor panels and hospitals - but for us, that's not a concern. And, once you're in MA, you'll need to provide evidence of insurability to transition back to traditional Medicare with supplement and drug plan.

As I said above, the attractiveness of MA seems to be very location-specific. That being said, don't exclude MA plans from your search.

[dbr]

Just to be clear this is probably not a question about Medicare as in A, & B but rather about Medigap plans, the alternative Medicare Advantage Plans, best approach to drug plans (D, etc.) as well as dental and vision coverage. It is in these areas that sales pitches are being made, alternatives abound, and choices need to be made. Medicare.gov is a start and Medigap plans are somewhat straightforward because the terms are standardized.

After that I would be at a loss to discuss this with someone even though we are past Medicare age and have our set of plans. The one caveat I do know is to be sure to elect your supplementary plan during open enrollment at the beginning of Medicare elections and don't get stuck trying to buy something when underwriting will apply. This demands understanding things thoroughly soon.

[nisiprius]

1) Watch out, insurance is state-regulated and friendly advice from one state may not apply to another.

2) The Big Decision is "Traditional Medicare" versus "Medicare Advantage."

3) Traditional Medicare is relatively simple. First of all, Part A, the big-ticket hospital insurance, involves no choices and is "free." Usually, you would also opt for part B, which is 80% coverage of doctors and other providers outside hospital settings. It costs you a monthly premium. Since it doesn't pay 100%, often, you would opt to purchase a private insurance plan, variously called "Medicare Supplemental" or "Medigap" which (state-dependent!) often comes in an alphabet soup of options; however, the coverage in each option is standardize, so any Medicare Supplemental plan G covers the same things regardless of insurer. And, finally, you would usually opt for part D, which is prescription coverage and potentially important if you end up needed a very expensive drug.

Medicare has what could be called a national "network" of providers, which in my area basically includes "everybody." There is an online directory. Most providers "accept Medicare assignment" which is the key phrase that means they have agreed to accept whatever amount Medicare approves.

I use and like traditional Medicare with a supplemental plan. I have always been reasonably satisfied with the private HMOs I used at work, but I feel that things have gone more easily and smoothly under traditional Medicare than they used to with a private-insurer HMO.

A Medicare supplemental policy involves little discretion on the part of the insurer. It is Medicare, not the insurer, who decides whether to approve a claim. The insurer's job is only to pay the part of the bill that Medicare approves but does not itself pay. So far I have never needed to pick up the phone to talk to the Medicare supplement insurer.

4) "Medicare Advantage" looks and feels exactly like a private HMO plan, because that's what it is. The government's role is to subsidize the premium (and regulate what things must be covered). So you have a crazy smorgasbord of varying choices. You also have the issue that a Medicare Advantage plan usually has a limited local network of providers, and vary provisions about what happens if you need a doctor while you are traveling.

Medicare Advantage is pitched as cheaper, but I didn't find it to be hugely cheaper. A problem is that many of the costs are concealed e.g. in office co-pays, and that it is hard to make a proper dollar evaluation of the "size of the network."

Just as with any HMO, the claims-paying experience, time spent on the phone, etc. will vary depending on how nice your insurer is.

5) I didn't personally use a SHIP advisor, but I have heard good things from people who did. Like everything else, SHIP is different in every state and is called by different names in different states.

6) Before making any decisions, I spent some quality time making a list of every doctor that I could think of ever wanting to see, and checking them out to see if they "accepted Medicare assignment," and if they were "in network" for the Medicare Advantage plans I was looking at. It turned out that every doctor on the list did take Medicare assignment and also was in network for the Medicare Advantage plans I was looking at.

[Leif]

I read several books and went to a couple of seminars. On the decision of Medicare supplement vs. Medicare advantage, I simplified it to a choice between less cost (Advantage) and more flexibility (Supplement). More details depends on your medical condition, family history, travel plans, and available local insurance.

[jimishooch]

i'm 67 and still on my wife's employer plan which is creditable. signed up for Part A at 65 (which is free for me) and called it a day...will supplement when the time comes...

good luck

[GaryA505]

on my still-working wife's medical plan right now, but I turn 65 in October and plan to drop off it and joining Medicare.

If your wife will still be working, you may wish to investigate your options to stay on her plan and delay Medicare. In some/most cases, I believe that if your wife's plan allows it, you can later join Medicare without penalty. That said, if Medicare is cheaper or better, it may not be worth consideration. Also, although this is true for while your wife is actively employed, I don't think it applies to COBRA coverage.

Be careful about delaying signing up for Medicare B and D past 65. If you go that route, you need to retain proof of primary coverage up until the time you sign up for Part B, otherwise you can face some nasty penalties. The same goes for prescription coverage (Part D). If you delay, you need to retain proof of creditable drug coverage up until the time you apply. The burden is on you to produce the proof.

[FIREchief]

on my still-working wife's medical plan right now, but I turn 65 in October and plan to drop off it and joining Medicare.

If your wife will still be working, you may wish to investigate your options to stay on her plan and delay Medicare. In some/most cases, I believe that if your wife's plan allows it, you can later join Medicare without penalty. That said, if Medicare is cheaper or better, it may not be worth consideration. Also, although this is true for while your wife is actively employed, I don't think it applies to COBRA coverage.

Be careful about delaying signing up for Medicare B and D past 65. If you go that route, you need to retain proof of primary coverage up until the time you sign up for Part B, otherwise you can face some nasty penalties. The same goes for prescription coverage (Part D). If you delay, you need to retain proof of creditable drug coverage up until the time you apply. The burden is on you to produce the proof.

I merely suggested that the OP may wish to investigate this. I didn't recommend anything and, to your point, it's always important to fully understand the rules. That said, retaining proof of medical/drug coverage shouldn't be that big of a deal and possibly well worth it if the savings approach the monthly Part B/D premium costs.

[GaryA505]

on my still-working wife's medical plan right now, but I turn 65 in October and plan to drop off it and joining Medicare.

If your wife will still be working, you may wish to investigate your options to stay on her plan and delay Medicare. In some/most cases, I believe that if your wife's plan allows it, you can later join Medicare without penalty. That said, if Medicare is cheaper or better, it may not be worth consideration. Also, although this is true for while your wife is actively employed, I don't think it applies to COBRA coverage.

Be careful about delaying signing up for Medicare B and D past 65. If you go that route, you need to retain proof of primary coverage up until the time you sign up for Part B, otherwise you can face some nasty penalties. The same goes for prescription coverage (Part D). If you delay, you need to retain proof of creditable drug coverage up until the time you apply. The burden is on you to produce the proof.

I merely suggested that the OP may wish to investigate this. I didn't recommend anything and, to your point, it's always important to fully understand the rules. That said, retaining proof of medical/drug coverage shouldn't be that big of a deal and possibly well worth it if the savings approach the monthly Part B/D premium costs.

Correct. In my case my employer was clueless (as was the insurance company) as to how to provide the proof, even though one of them was probably required to by law. When I called the insurance company they didn't even know what creditable coverage was. After going round and round with them I gave up and signed up for Part B and then Part D (via Medicare Advantage). So, even though I keep the company coverage because I need it for my family, I also pay for Part B even though I never use it.

[FIREchief]

6) Before making any decisions, I spent some quality time making a list of every doctor that I could think of ever wanting to see, and checking them out to see if they "accepted Medicare assignment," and if they were "in network" for the Medicare Advantage plans I was looking at. It turned out that every doctor on the list did take Medicare assignment and also was in network for the Medicare Advantage plans I was looking at.

This is where I get stuck. I simply have no idea what specialists DW and I may wish to see someday. For most foreseeable health situations, it's likely close to one size fits all in terms of quality of care. That said, there are certainly exceptions, and I have no idea what Medicare Advantage plans will look like in the future. I guess the same is true of traditional Medicare, but I'm less concerned there. Personally, if I can "afford" to go with a Medicare Supplement at 65, that's likely what I'll do just to be on the safe side. Hopefully, it won't at all be about money at that point.

[Watty]

and I am getting bombarded with calls....

Whenever I get an unsolicited call I do not answer or I tell them to put me on their "do not call list" and hang up. Years ago I put our phone numbers on the national do not call list. It is widely ignored by scammers but it is against the law to call me with a sales call. Any company that is willing to break the law to try to sell me something is not a company I would want to deal with.


I would recommend the book Medicare for Dummies despite the title. Someone posted that a new edition was due this fall so you should be careful that some things may have changed since the last edition was printed.

[BigJohn]

I turn 64 this year so just starting to read these discussions. If I understood correctly from another thread I have a significant worry about Medicare Advantage plans that is either pertinent here or can be debunked which will be useful as well.

Since they are state regulated, MA plans are not transportable if you move to another state. My understanding is that if you move you’ll need to qualify for a MA plan in your new state. This qualification does not apply when you first make your choice and the Obamacare restrictions for accepting preexisting conditions does not apply later. So, if you’ve developed a significant health issue you might not be able to get a MA plan In your new state to accept you. In separate discussion I think I understood that once you start MA you cannot revert to Medicare and a Supplement. If both of these are true, is it possible to be unable to get medical insurance under these circumstances?

[dbr]

FWIW be careful about supplemental insurance in the form of employer retiree health insurance. While you may not get messed up with the qualified plan thing those plans can disappear at almost no notice. My employer did that but we were wary enough not to go there in the first place.* On the other hand if that plan is Federal Employee Health Benefits for Federal retirees before or after Medicare age that can be a pretty good option.

They terminated retiree health insurance both for those over 65 on Medicare and those under 65 not yet on Medicare.

[rivercrosser]

I turned 65 this past February. Went with a plan G supplement and part D with local CVS. Hadn't been to doctor for years. Thought I was doing everything right. Don't smoke or drink. Get plenty of exercise. Two weeks ago this past Sunday I ended up in ER with a kidney stone. Then last Thursday had a heart attack. Ended up in hospital overnight. They put in a stent. All I should end up owing is the $198.00 deductible on the supplement. Couple drugs are $0.00 but the Brilinta is going to cost me $435 deductible and $43.00 a month after that. So far I'm glad I went with the traditional medicare. Didn't have to worry about copays, perfered networks or anything. Show your cards once pay your up front deductible and your done for the year.

[FrugalInvestor]

You may want to read through this (previous) discussion....

viewtopic.php?f=2&t=285507&hilit=medicare

[capran]

SHIBA is a non profit, non sales organization that can help in the decision making and know the local offerings. I attended one meeting in Spokane and found it very helpful. Depending on your plan, unless it's an all inclusive one, you need a Plan D. We have delta dental offered through our state retirement plan. Costs about 45 a month. Just had a crown today and the crown would have been 1,000 instead of just under 500.

[RetiredArtist]

If you decide you don't like the supplement approach, you can revert to a Medicare Advantage plan during annual open enrollment without insurance underwriting. You can't go the other way (i.e. if you start with Medicare Advantage, you will need underwriting to change to a Medigap supplement).

That is state-specific. For example, CA and OR have the birthday rule which means you can change Medigap/Supplement plans on or around your birthday without underwriting.

If you live in CA & choose Original Medicare, and later want to use the birthday rule to switch your Medigap provider, I believe that you can only change to a less comprehensive plan.
After a visit to SHIP, I decided on Original Medicare, & used an independent agent to help me choose my Medigap and RX plans. He answered all my questions, & it did not cost me extra. If you live in SF Bay Area, I can message his contact info.
Fun fact: all Medigap Plan G's (for example) are mandated to provide the exact same coverage. So look for the cheapest Plan G. Prices vary by zip code. Watch out for agents who only represent one provider. SHIP recommended community rated pricing over age rated pricing, but no company offered age rated pricing in my city. Go figure. There is no standardization with RX Plans. The best you can do is look up coverage for drugs you currently take.
It helps to read the Wiki, or a Dummies book, or some such.

[FIREchief]

FWIW be careful about supplemental insurance in the form of employer retiree health insurance. While you may not get messed up with the qualified plan thing those plans can disappear at almost no notice. My employer did that but we were wary enough not to go there in the first place.* On the other hand if that plan is Federal Employee Health Benefits for Federal retirees before or after Medicare age that can be a pretty good option.

They terminated retiree health insurance both for those over 65 on Medicare and those under 65 not yet on Medicare.

Good advice. My former Megacorp offered me retiree insurance until 65 and then their own flavor Medicare supplement. The supplement looked like a bad joke. High deductible, expensive and no guarantees of continuation. Pretty much at their mercy, unlike a "real" medigap plan where the terms are tightly controlled. Fortunately, we were able to obtain better coverage elsewhere and put Megacorp (further) in the rear view mirror.

[Wannaretireearly]

If you decide you don't like the supplement approach, you can revert to a Medicare Advantage plan during annual open enrollment without insurance underwriting. You can't go the other way (i.e. if you start with Medicare Advantage, you will need underwriting to change to a Medigap supplement).

That is state-specific. For example, CA and OR have the birthday rule which means you can change Medigap/Supplement plans on or around your birthday without underwriting.

If you live in CA & choose Original Medicare, and later want to use the birthday rule to switch your Medigap provider, I believe that you can only change to a less comprehensive plan.
After a visit to SHIP, I decided on Original Medicare, & used an independent agent to help me choose my Medigap and RX plans. He answered all my questions, & it did not cost me extra. If you live in SF Bay Area, I can message his contact info.
Fun fact: all Medigap Plan G's (for example) are mandated to provide the exact same coverage. So look for the cheapest Plan G. Prices vary by zip code. Watch out for agents who only represent one provider. SHIP recommended community rated pricing over age rated pricing, but no company offered age rated pricing in my city. Go figure. There is no standardization with RX Plans. The best you can do is look up coverage for drugs you currently take.
It helps to read the Wiki, or a Dummies book, or some such.

Thanks. Very useful for Californians

[Big Dog]

If you decide you don't like the supplement approach, you can revert to a Medicare Advantage plan during annual open enrollment without insurance underwriting. You can't go the other way (i.e. if you start with Medicare Advantage, you will need underwriting to change to a Medigap supplement).

That is state-specific. For example, CA and OR have the birthday rule which means you can change Medigap/Supplement plans on or around your birthday without underwriting.

If you live in CA & choose Original Medicare, and later want to use the birthday rule to switch your Medigap provider, I believe that you can only change to a less comprehensive plan.
After a visit to SHIP, I decided on Original Medicare, & used an independent agent to help me choose my Medigap and RX plans. He answered all my questions, & it did not cost me extra. If you live in SF Bay Area, I can message his contact info.
Fun fact: all Medigap Plan G's (for example) are mandated to provide the exact same coverage. So look for the cheapest Plan G. Prices vary by zip code. Watch out for agents who only represent one provider. SHIP recommended community rated pricing over age rated pricing, but no company offered age rated pricing in my city. Go figure. There is no standardization with RX Plans. The best you can do is look up coverage for drugs you currently take.
It helps to read the Wiki, or a Dummies book, or some such.

Not true, with the birthday rule you can change to any similar Plan (say, G to G) or to a plan with lesser benefits (G to N). With the birthday rule, age-rated or community-rated matters not as you can change any year, so Californians should choose the cheapest letter plan. (fwiw: I ended up not using a broker since the supposedly top guy in my county only had relationships with the higher cost carriers; which I guess is no surprise since it results in higher commissions.)

Yes, by law, all Plans with the same letter (F, G, N...) must offer the exact same benefit levels. However, some providers, (e.g., Anthem, Blue Shield) are offering what's called F or G-Innovative, i.e., enhanced with additional benefits such as vision, hearing....(Blue Shield Innovative is cheapest in my SoCal zip code.)

The other thing about CA is that all supplement rates are online. (Just posting as other states might have something similar, so search online or ask your SHIP.)

https://interactive.web.insurance.ca.go ... f?p=111:30

[Opalmanta]

I think one thing you need to plan for is the IRMAA surcharges in premiums for Part B and D. Those surcharges may make it well worth your while to stay on your wife's workplace plan for some time. Had we understood the IRMAA charges better, we certainly would have made some portfolio changes both in our taxable account as well as being more aggressive in ROTH conversions.

[RetiredArtist]

Big Dog, we said the same thing about the birthday rule for Medigap plans in CA. You can only switch to the same or lesser plan. So you can't choose a lower benefit Medigap plan when you are a chipper 65, and switch to a plan with more benefits if/when your medical needs increase.
With the RX plan, if you must start taking a costly drug, every January you are allowed to switch to a more comprehensive plan.

[Eagle33]

I turned 65 this past February. Went with a plan G supplement and part D with local CVS. Hadn't been to doctor for years. Thought I was doing everything right. Don't smoke or drink. Get plenty of exercise. Two weeks ago this past Sunday I ended up in ER with a kidney stone. Then last Thursday had a heart attack. Ended up in hospital overnight. They put in a stent. All I should end up owing is the $198.0 ... upplement. Couple drugs are $0.00 but the Brilinta is going to cost me $435 deductible and $43.00 a month after that. So far I'm glad I went with the traditional medicare. Didn't have to worry about copays, perfered networks or anything. Show your cards once pay your up front deductible and your done for the year.

Actually the $198.00 is the Part B deductible, not the supplement plan.

[FIREchief]

If you decide you don't like the supplement approach, you can revert to a Medicare Advantage plan during annual open enrollment without insurance underwriting. You can't go the other way (i.e. if you start with Medicare Advantage, you will need underwriting to change to a Medigap supplement).

That is state-specific. For example, CA and OR have the birthday rule which means you can change Medigap/Supplement plans on or around your birthday without underwriting.

Are you sure we're talking about the same thing? I suggested that you can't switch from a Medicare Advantage plan to Medigap Supplement without underwriting. Your later posts seem to suggest that you're only talking about changes among Medigap Supplements, not what I was talking about.

(I deleted my earlier response)

[rivercrosser]

I turned 65 this past February. Went with a plan G supplement and part D with local CVS. Hadn't been to doctor for years. Thought I was doing everything right. Don't smoke or drink. Get plenty of exercise. Two weeks ago this past Sunday I ended up in ER with a kidney stone. Then last Thursday had a heart attack. Ended up in hospital overnight. They put in a stent. All I should end up owing is the $198.0 ... upplement. Couple drugs are $0.00 but the Brilinta is going to cost me $435 deductible and $43.00 a month after that. So far I'm glad I went with the traditional medicare. Didn't have to worry about copays, perfered networks or anything. Show your cards once pay your up front deductible and your done for the year.

Actually the $198.00 is the Part B deductible, not the supplement plan.

Yeah I worded that wrong.

[Bir48die]

1) Watch out, insurance is state-regulated and friendly advice from one state may not apply to another.

2) The Big Decision is "Traditional Medicare" versus "Medicare Advantage."

3) Traditional Medicare is relatively simple. First of all, Part A, the big-ticket hospital insurance, involves no choices and is "free." Usually, you would also opt for part B, which is 80% coverage of doctors and other providers outside hospital settings. It costs you a monthly premium. Since it doesn't pay 100%, often, you would opt to purchase a private insurance plan, variously called "Medicare Supplemental" or "Medigap" which (state-dependent!) often comes in an alphabet soup of options; however, the coverage in each option is standardize, so any Medicare Supplemental plan G covers the same things regardless of insurer. And, finally, you would usually opt for part D, which is prescription coverage and potentially important if you end up needed a very expensive drug.

Medicare has what could be called a national "network" of providers, which in my area basically includes "everybody." There is an online directory. Most providers "accept Medicare assignment" which is the key phrase that means they have agreed to accept whatever amount Medicare approves.

I use and like traditional Medicare with a supplemental plan. I have always been reasonably satisfied with the private HMOs I used at work, but I feel that things have gone more easily and smoothly under traditional Medicare than they used to with a private-insurer HMO.

A Medicare supplemental policy involves little discretion on the part of the insurer. It is Medicare, not the insurer, who decides whether to approve a claim. The insurer's job is only to pay the part of the bill that Medicare approves but does not itself pay. So far I have never needed to pick up the phone to talk to the Medicare supplement insurer.

4) "Medicare Advantage" looks and feels exactly like a private HMO plan, because that's what it is. The government's role is to subsidize the premium (and regulate what things must be covered). So you have a crazy smorgasbord of varying choices. You also have the issue that a Medicare Advantage plan usually has a limited local network of providers, and vary provisions about what happens if you need a doctor while you are traveling.

Medicare Advantage is pitched as cheaper, but I didn't find it to be hugely cheaper. A problem is that many of the costs are concealed e.g. in office co-pays, and that it is hard to make a proper dollar evaluation of the "size of the network."

Just as with any HMO, the claims-paying experience, time spent on the phone, etc. will vary depending on how nice your insurer is.

5) I didn't personally use a SHIP advisor, but I have heard good things from people who did. Like everything else, SHIP is different in every state and is called by different names in different states.

6) Before making any decisions, I spent some quality time making a list of every doctor that I could think of ever wanting to see, and checking them out to see if they "accepted Medicare assignment," and if they were "in network" for the Medicare Advantage plans I was looking at. It turned out that every doctor on the list did take Medicare assignment and also was in network for the Medicare Advantage plans I was looking at.

Our state has several PPO Medicare Advantage plans of which I will sign up for when I start my coverage in August. I will be paying about $185/mth with Plan B and Advantage. Currently paying $960/mth with $3,500 deductible. So you might say I'm going to be saving a bit of money.

[Big Dog]

If you decide you don't like the supplement approach, you can revert to a Medicare Advantage plan during annual open enrollment without insurance underwriting. You can't go the other way (i.e. if you start with Medicare Advantage, you will need underwriting to change to a Medigap supplement).

That is state-specific. For example, CA and OR have the birthday rule which means you can change Medigap/Supplement plans on or around your birthday without underwriting.

Are you sure we're talking about the same thing? I suggested that you can't switch from a Medicare Advantage plan to Medigap Supplement without underwriting. Your later posts seem to suggest that you're only talking about changes among Medigap Supplements, not what I was talking about.

(I deleted my earlier response)

My critical reading fail. You are correct, the Birthday rule only applied to Medigap plans.

[22twain]

on my still-working wife's medical plan right now, but I turn 65 in October and plan to drop off it and joining Medicare.

So you can sign up during the three calendar months preceding October, i.e. July, August, September, to take effect in October. Don't dawdle too long, especially if you go the traditional Medicare route and have to sign up for a Medigap supplement and a part D drug plan separately. It's apparently easiest if you already have an online account with Social Security, even if you aren't actually collecting SS yet. (Are you?) In that case you can apply for Medicare parts A and B online.

I didn't have an online SS account and couldn't create one online because my credit reports are frozen, so I had to go to the local SS office with sufficient identification. I first attempted to walk in just before Thanksgiving, with my birthday coming up in January. I had to make an appointment to return a week later and meet with an agent who specializes in Medicare signups. That went off without a hitch; she created my online SS account and set my Medicare application in motion. Then I had to wait until I got my Medicare card before I could sign up for a Medigap supplement and a part D drug plan. I did those online the week before Christmas. Then I chewed my nails a bit before the acknowledgements and the plan identification cards arrived during the week after Christmas. That was a bit too close for comfort.

Also, make sure your wife's employer plan drops you off at the right time. I was on my former employer's "early retiree" coverage with Blue Cross, which was supposed to end when I became eligible for Medicare. However, it didn't actually end when it was supposed to. My first Medicare Summary Notice (which described my first claims for the year) looked OK. Then I was surprised to receive a summary of claims from Blue Cross, followed by a corrected MSN from Medicare which showed the Blue Cross coverage as primary. After I talked to my former employer's HR department about this, Blue Cross eventually dropped me, but Medicare still listed them as primary coverage!

So my medical providers sent claims to Medicare, which returned them saying, "no, send them to Blue Cross first." They then sent the claims to Blue Cross, which said, "no, he's not one of ours." They then sent the bills to me.

I had to file an appeal with Medicare to get them to update their database. It did get sorted out by the end of the year, but it was pretty aggravating in the meantime, including a notice from a collection agency.

[OnTrack]

...
SHIP recommended community rated pricing over age rated pricing, but no company offered age rated pricing in my city. Go figure.
...

When you say "age rated," you should probably be more specific. There is attained-age rated and issue-age rated (as well as community rated).

[3feetpete]

A couple of things to consider if you decide to go with Medicare plus supplemental.

Choose the plan that makes the most sense for you and then the lowest cost provider for that plan. Don't worry about customer satisfaction ratings of the supplement company. The truth is that you will never deal with the supplemental insurance company. All bills go to Medicare and then Medicare tells the insurance company how much to pay. End of story.

Consider a high deductable plan. Medicare pays 80% of the bill with a fairly low deductible. So the supplemental insurance only covers the last 20%. In my case the high deductible was $1,000 per year lower in premiums than the no deductible. So I would have to have $5,000 in medical expenses before I spent that $1,000 savings. (20% of $5,000 = $1,000). I only go to the doctors a couple of times a year.

For prescripions go to the medicare website. They have a tool to help you find the best Part D plan for you. Enter your medications and the tool will find all the providers in your area and put them in order by total cost for you. Do this annually in November or early December. If you have any medications that you suspect are driving the cost up. Try seeing what you can get them for with a coupon on GoodRx.

[FIREchief]

If you have any medications that you suspect are driving the cost up. Try seeing what you can get them for with a coupon on GoodRx.

This is good advice for anybody, with any insurance, who routinely purchases Rx. DW and I have employer prescription drug coverage, but all our medications are cheaper just using a GoodRx-based plan. Ours is through a major grocery retailer who has partnered with GoodRx to make the prescriptions even cheaper.

[vested1]

We've been on A, B, D, and N (D and N are supplemental) for almost 3 years. We moved to a location that offers MA and at open enrollment we almost went with MA because of the zero premium. After reading about it and speaking with a former employer's non-biased Medicare advisory service we decided to stay with what we had.

If there is any confusion about it, you always have to pay for part B with any plan, even MA, as well as paying the annual deductible for part B.

https://q1medicare.com/q1group/Medicare ... ory_id=111

Part B is $144.60/mo and the part B deductible is $198/yr for 2020 unless you are on IRMAA (over various thresholds for earned income).

We found that the restrictions on doctors, specialists, and hospitals, as well as the much higher deductibles would make our yearly health care expenses rise with MA. That is mainly because of my wife's various health issues and one of the drugs she takes, which has a ridiculous cost and copay. We also didn't like the uncertainty of getting affordable Medicare coverage if one of us got worse or developed an additional ailment which would jack up the cost for copays and specialists.

I suppose that if a couple or individual is relatively healthy MA might make sense, but if you develop a health issue sometime in the future and have to switch back to supplemental insurance, the underwriting required could result in a huge yearly hit for healthcare costs. As it is our premiums and out of pocket costs are over 12k a year. We have AARP UHC Part N for about $180 a month combined and two different Part D plans, hers with Humana ($35) and me with Wellcare ($13). We still have office visit copays as well.

Her MA prescription coverage wouldn't have been as good, and our annual copay of about $5,800 for a single drug would have risen significantly, which was the main determining factor. Before she turned 65 that drug had a copay of $10 every 90 days, but the manufacturer was sued by a competitor for unfair competition, which forced them to drop Medicare aged clients from their discount program which had no income restrictions. I would suggest to the OP or anyone looking at options to input the specific drugs needed to see what the copay is for each provider before making a decision. Sometimes a higher premium is worth it.

[Jack FFR1846]

I just watched several hours of well made videos from Fidelity called "Understanding Medicare". I found it extremely informative. It's broken into 8 sections. If you can't find it, perhaps call Fidelity. I received an email as part of my workplace 401k which is at Fidelity.

There are both options and Musts that you really need to know to avoid permanent penalties.

[FrugalInvestor]

If you have any medications that you suspect are driving the cost up. Try seeing what you can get them for with a coupon on GoodRx.

This is good advice for anybody, with any insurance, who routinely purchases Rx. DW and I have employer prescription drug coverage, but all our medications are cheaper just using a GoodRx-based plan. Ours is through a major grocery retailer who has partnered with GoodRx to make the prescriptions even cheaper.

With the understanding that you'll likely never hit your deductible. If you would, then it may not not be a good strategy.

[FIREchief]

We also didn't like the uncertainty of getting affordable Medicare coverage if one of us got worse or developed an additional ailment which would jack up the cost for copays and specialists.

This is exactly my concern. I don't know what the future holds, and what specialists I might need to see.

I suppose that if a couple or individual is relatively healthy MA might make sense, but if you develop a health issue sometime in the future and have to switch back to supplemental insurance, the underwriting required could result in a huge yearly hit for healthcare costs.

I'm not certain switching back is always an option, even at a huge yearly cost increase. I think a lot of Medigap providers just stick with their new enrollees and have no interest in accepting others who have gone through an underwriting process with unfavorable results.

[FIREchief]

If you have any medications that you suspect are driving the cost up. Try seeing what you can get them for with a coupon on GoodRx.

This is good advice for anybody, with any insurance, who routinely purchases Rx. DW and I have employer prescription drug coverage, but all our medications are cheaper just using a GoodRx-based plan. Ours is through a major grocery retailer who has partnered with GoodRx to make the prescriptions even cheaper.

With the understanding that you'll likely never hit your deductible. If you would, then it may not not be a good strategy.

I'm not sure what "strategy" you're referring to. I'm not suggesting that somebody skip part D. Is that what you thought?

[FrugalInvestor]

If you have any medications that you suspect are driving the cost up. Try seeing what you can get them for with a coupon on GoodRx.

This is good advice for anybody, with any insurance, who routinely purchases Rx. DW and I have employer prescription drug coverage, but all our medications are cheaper just using a GoodRx-based plan. Ours is through a major grocery retailer who has partnered with GoodRx to make the prescriptions even cheaper.

With the understanding that you'll likely never hit your deductible. If you would, then it may not not be a good strategy.

I'm not sure what "strategy" you're referring to. I'm not suggesting that somebody skip part D. Is that what you thought?

No. If you're paying out of pocket then those purchases are not being applied to your deductible so you'll never hit it and the insurance company will never start paying. Especially for those taking expensive maintenance meds paying out of pocket may not be a good choice.

[FIREchief]

If you have any medications that you suspect are driving the cost up. Try seeing what you can get them for with a coupon on GoodRx.

This is good advice for anybody, with any insurance, who routinely purchases Rx. DW and I have employer prescription drug coverage, but all our medications are cheaper just using a GoodRx-based plan. Ours is through a major grocery retailer who has partnered with GoodRx to make the prescriptions even cheaper.

With the understanding that you'll likely never hit your deductible. If you would, then it may not not be a good strategy.

I'm not sure what "strategy" you're referring to. I'm not suggesting that somebody skip part D. Is that what you thought?

No. If you're paying out of pocket then those purchases are not being applied to your deductible so you'll never hit it and the insurance company will never start paying. Especially for those taking expensive maintenance meds paying out of pocket may not be a good choice.

Okay, that makes sense. My suggestion was more directed towards those taking lower cost medications who routinely never approach their deductibles. To your point, in 2018 I had a situation where I knew I would exceed not only my deductible, but my max out of pocket, for the year, so I paid for more expensive prescriptions through my prescription plan than I could have gotten elsewhere with some coupons, etc. I think this is part of the "game." My main point remains, those who routinely purchase Rx's should look into GoodRx and compare using their insurance with just paying out of pocket.

CVS actually has a form to use to submit out of pocket expenses to be credited towards your CVS administered prescription plan deductible, but after looking into it I concluded that it was designed to simply not work. It required all kinds of info that pharmacies/doctors don't normally include with drug prescriptions (think along the lines of the filling pharmacist's first pet's name, city of birth, etc.... ).