Medicare, IRMAA and the like

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josephny
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Medicare, IRMAA and the like

Post by josephny »

I know only what a little online searching has been able to explain, so please feel free to treat me as completely ignorant on this subject.

I am 57, wife is 65. We are and hopefully will continue to be in one of the higher tax brackets.

We live in New York and have 3 young-adult kids (under 26) and have a private health insurance plan from United Healthcare Oxford through my business that costs me over $41,000/yr just in premiums (then there's the deductibles, co-pay, non-covered, etc.). I (on behalf on my family) can opt-out if I so choose.

I believe that my wife having turned 65 is eligible for Medicaire. (That's pretty much the extent of my understanding.)

I have a very (very) basic understanding that there are supplemental plans available (Parts A (hospital), B (stuff), C (something else), D (prescriptions), etc.).

I also have an even more basic understanding that IRMAA is a surcharge/fee/tax one pays on parts B and D for people in certain tax brackets.

How would we go about figuring out if we are better off (financially) keeping the current insurance policy, and until when (i.e., our youngest will turn 26 in 8 years, coincidentally, when I turn 65).

Thank you.
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bhwabeck3533
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Re: Medicaire, IRMAA and the like

Post by bhwabeck3533 »

josephny wrote: Thu Jul 04, 2024 5:34 am How would we go about figuring out if we are better off (financially) keeping the current insurance policy, and until when (i.e., our youngest will turn 26 in 8 years, coincidentally, when I turn 65).
A starting point would be to provide your estimated AGI for 2024 (assume you file MFJ).
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josephny
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Re: Medicaire, IRMAA and the like

Post by josephny »

bhwabeck3533 wrote: Thu Jul 04, 2024 6:55 am
josephny wrote: Thu Jul 04, 2024 5:34 am How would we go about figuring out if we are better off (financially) keeping the current insurance policy, and until when (i.e., our youngest will turn 26 in 8 years, coincidentally, when I turn 65).
A starting point would be to provide your estimated AGI for 2024 (assume you file MFJ).
Between $300,000 and $500,000 (impossible to know more precisely at this time), MFJ.
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Re: Medicaire, IRMAA and the like

Post by jebmke »

josephny wrote: Thu Jul 04, 2024 7:02 am
bhwabeck3533 wrote: Thu Jul 04, 2024 6:55 am
josephny wrote: Thu Jul 04, 2024 5:34 am How would we go about figuring out if we are better off (financially) keeping the current insurance policy, and until when (i.e., our youngest will turn 26 in 8 years, coincidentally, when I turn 65).
A starting point would be to provide your estimated AGI for 2024 (assume you file MFJ).
Between $300,000 and $500,000 (impossible to know more precisely at this time), MFJ.
IRMAA is based on a two year look-back so the surcharge for your wife if she enrolls now is based on your AGI from two years ago.
When you discover that you are riding a dead horse, the best strategy is to dismount.
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Re: Medicaire, IRMAA and the like

Post by Jack FFR1846 »

Look at the actual MAGI numbers, not tax brackets. Here's a reference from SSA: https://www.ssa.gov/forms/ssa-44.pdf

IRMAA monthly added premium starting at $206k MAGI is from about $80 to over $750k, about an extra $500 total EXTRA on B and D.

Medicare looks at your MAGI from 2 years ago. If your new income is less (like if you or your spouse retires), you can fill out a form asking for a recalculation of your premium. I did this last year as I retired half way through the year. I submitted this in person when I applied for part B. Nothing happened and phone calls showed that nothing happened. I went in again in person and they keyed in something and said that someone in that office needed to do the approval. 2 weeks later it was approved.

It's been said that you can only appeal one year. But I appealed a second year, handing the form in person. Then a few phone calls. Then a snail mail form and 2 weeks later, I was approved for a second year re-calculation and so I have technically never paid IRMAA. You can also be lowered to a lesser bracket of IRMAA. But it's all dependent on income and if you're still bringing in the big bucks, you won't have a reason to not pay the added premium.

Look at deductibles and co-pays. And Medicare has something called the doughnut hole. When (and if) your medication cost (what Medicare pays plus your copay) exceeds a limit, your co-pay goes up. This is mainly on tier 3 meds which most have TV ads with fat people dancing around. So you may have your first 90 day supply of a med being $750. Next one, if you are past deductible, it's $48. Then you get in the doughnut hole and it's $2100. If you research, you can find alternates at lower cost. Places to look include Amazon Pharmacy, using a separate pharmacy where you do NOT give them any insurance information then use a GoodRx or singlecare card, sometimes alternate pharmacies that are not preferred and Canadian pharmacies.

As an example, if I use my normal preferred (supposedly attached to my part D plan), one med is $49. If I go to another "in network" but not preferred pharmacy, it's $39. I use yet another pharmacy with the GoodRx card and it's $12. This is a tier 2 med.

I have a tier 3 and with Medicare, 90 days because of the deductible is $715. I buy from a Canadian pharmacy and total with shipping is $250.

Supposedly next year, there's going to be a $2000 out of pocket limit. If that happens, it'll be much cheaper to stick inside of the Medicare system and just run up the med cost, then like most private insurance, pay zero out of pocket.
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CAsage
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Re: Medicaire, IRMAA and the like

Post by CAsage »

Most insurers presume that if you are 65, you are definitely on Medicare and reduce their coverage commensurately. Get the Medicare for Dummies book and read up... Have you priced the policy to keep just you and the kids on it? The short summary is Part A is hospital, Part B is Doctors, Part C is HMO instead of Part B (and many people choose it because it's cheaper with limitations), Part D is drugs. There are permanent penalties (higher future prices) if you don't sign up for Medicare Part D when eligible... My suggestion would be to contact 1~2 insurance brokers and they can walk you through various medicare options for your wife. IRMAA surcharges are totally a thing, but nowhere near your current premiums.
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Topic Author
josephny
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Re: Medicaire, IRMAA and the like

Post by josephny »

Thank you all very much.

Unfortunatley, a good portion of the comments have gone way over my head.

Here is what I think I've learned:

Supplemental (A, B, C, and D) are important/useful/helpful/financially-wise;

IRMAA will be an additional cost to me;

I need to get a quote for the current plan without my wife to evaluate whether the savings realized by going with medicare plus supplemental plus IRMAA is substantial enough to deal with the complexities and shortcomings of Medicate+A/B/C/D.

Am I on the right track?
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josephny
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Re: Medicaire, IRMAA and the like

Post by josephny »

Is there a penalty is she does not sign up for Medicare?
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Re: Medicaire, IRMAA and the like

Post by jebmke »

josephny wrote: Thu Jul 04, 2024 7:35 am Thank you all very much.

Unfortunatley, a good portion of the comments have gone way over my head.

Here is what I think I've learned:

Supplemental (A, B, C, and D) are important/useful/helpful/financially-wise;

IRMAA will be an additional cost to me;

I need to get a quote for the current plan without my wife to evaluate whether the savings realized by going with medicare plus supplemental plus IRMAA is substantial enough to deal with the complexities and shortcomings of Medicate+A/B/C/D.

Am I on the right track?
I started by looking at resources on the Medicare site medicare.gov. They were helpful. I then selected a supplemental plan based on looking at various alternatives in my area (Medicare Advantage is not available so I didn't face the choice of Traditional Medicare vs. Medicare Advantage). Then I selected a Part D prescription plan. When I though I knew what I wanted I set up an appointment with a local SHIP counselor to review my interpretation and determine if I had missed something. Then I finalized and made my selection.

Reports of the availability and helpfulness of a SHIP resource vary by location but if one is available, I'd at least give them a look.

https://www.shiphelp.org/
When you discover that you are riding a dead horse, the best strategy is to dismount.
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Re: Medicaire, IRMAA and the like

Post by Jack FFR1846 »

josephny wrote: Thu Jul 04, 2024 7:38 am Is there a penalty is she does not sign up for Medicare?
Yes

She should at a minimum sign up for part A.

To sign up for B, and the rest, without penalty, she would need a company letter saying she was on a qualified plan. I do not know, if she's covered under your insurance if she's not working, how that works. Others will chime in. But part A....do it now. It costs nothing and keeps penalties away.
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SuzBanyan
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Re: Medicaire, IRMAA and the like

Post by SuzBanyan »

josephny wrote: Thu Jul 04, 2024 7:35 am Thank you all very much.

Unfortunatley, a good portion of the comments have gone way over my head.

Here is what I think I've learned:

Supplemental (A, B, C, and D) are important/useful/helpful/financially-wise;

IRMAA will be an additional cost to me;

I need to get a quote for the current plan without my wife to evaluate whether the savings realized by going with medicare plus supplemental plus IRMAA is substantial enough to deal with the complexities and shortcomings of Medicate+A/B/C/D.

Am I on the right track?
The first question to ask your employer is if your wife can stay on the employer plan after she turns 65. Some employers it is yes; some it is no.

If she cannot stay on you plan, then she will have to go on Medicare.

If you have a choice about whether she stays on your employer plan or not, you will need to dig into the numbers to see which option is best.

When you first are faced with Medicare options, if feels like a foreign language. The good news is by the time you hit 65, you’ll be fluent.
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Re: Medicaire, IRMAA and the like

Post by stlrick »

I would say you are not on the right track. Medicare is unreasonably complicated and you are nowhere close to understanding it. No one enrolls in A, B, C and D and none of them are "supplememental." A (hospitals) is free, B (doctors and others) is subject to IRMAA, D (prescriptions) is subject to IRMAA. C is a replacement for A, B and D - it is one or the other. A,B,and D are "traditional medicare" and C is an "advantage plan." You are going to have to pick up a book or something to understand the advantages and disadvantages of that distinction, which is fundamental to your costs and quality of care. Moreover, traditional medicare will only cover 80% of major costs, so that is where you now add a fourth coverage, a supplemental plan. That's right - traditional medicare is up to 4 items - A, B, D and a supplement plan. C, D and the supplement plan are from insurance companies, A and B are from the government. Finally, there are penalties and restrictions if you do not do this when it is required or if you want to change a plan.

If you respond to a TV ad about Medicare enrollment, you are almost assured that you are talking to a salesperson for insurance companies. Contact your state SHIP (State Health Insurance Program) for help instead. Before you use them, you need to educate yourself more. Read a book.

By the way, IRMAA is itself as consumer unfriendly as the rest of Medicare. It involves a two-year look back. The IRMAA charge to you for 2025 Medicare premiums will be based on your 2023 MAGI (modified adjusted gross income). IRMAA brackets go up each year, so knowing which bracket your 2024 income will put you in when charges are applied in 2026 can be no more than an estimation, and the brackets are a cliff - one dollar over and you will pay $1000+ per person more over the year.
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Re: Medicaire, IRMAA and the like

Post by cas »

josephny wrote: Thu Jul 04, 2024 7:35 am
Supplemental (A, B, C, and D) are important/useful/helpful/financially-wise;
Medicare A, B,C and D aren't supplemental, they *are* Medicare.

Medicare "supplement" is private insurance that covers potentially considerable costs (20% co-insurance + deductibles) not covered by the "traditional" configuration of Medicare (A + B + D).

I have heard the Medicare for Dummies book recommended many times on this forum. (Don't take the name personally. Lots of very smart people recommend it.) Also the medicare.gov website, as jebmke said.
IRMAA will be an additional cost to me;
I mention this because it seems to lower some people's blood pressure considerably:

IRMAA is not applicable to Medicare A (hospital). If your wife has enough Social Security credits via her own or your work records, Medicare A is free. That is what the Medicare deductions on her/your paystub for all those years were funding.

IRMAA applies to Medicare B and D, which is funded via premiums and taxes. *Everyone*, no matter their income, currently gets at least a 20% subsidy. The vast majority of people get a 75% subsidy on the premiums because their Medicare-age income is low enough. However, the subsidy is phased out (at specific income thresholds) as income goes up. That is IRMAA. (I mention this because it seems to lower some people's blood pressure considerably when they think of it as a reduction in subsidy rather than an additional cost. It is true that IRMAA appears as an additional line item on the social security statement, so it is kind of one of those optical illusion things that flip between two different images ... reduction of subsidy/additional cost.)
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Re: Medicaire, IRMAA and the like

Post by stlrick »

I don't believe it has been mentioned that Advantage Plans (Medicare Part C) are subject to IRMAA. If your income falls into the IRMAA brackets, there is no avoiding it.
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josephny
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Re: Medicaire, IRMAA and the like

Post by josephny »

I have an email into the person who sold me the Oxford insurance plan at mybenefitadvisor.com asking about whether my wife can still be covered and if there is anything United Healthcare will require or have to do about her turning 65.

Given the complexity, I would (at least for now) prefer to leave the current coverage in place, if UHC will allow and there will be no penalties.

I don't know what else to do, because putting in the time now to become educated about Medicare (which is clearly very complicated) is not an option.
stlrick
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Re: Medicaire, IRMAA and the like

Post by stlrick »

josephny wrote: Thu Jul 04, 2024 9:14 am I have an email into the person who sold me the Oxford insurance plan at mybenefitadvisor.com asking about whether my wife can still be covered and if there is anything United Healthcare will require or have to do about her turning 65.

Given the complexity, I would (at least for now) prefer to leave the current coverage in place, if UHC will allow and there will be no penalties.

I don't know what else to do, because putting in the time now to become educated about Medicare (which is clearly very complicated) is not an option.
I cannot give you good details about this issue, but the current health coverage for your wife must meet very specific requirements if she is to avoid a lifetime penalty for not enrolling in Medicare at age 65. I doubt that UHC would have any problem about continuing her coverage as a dependent on your policy, but that is not the issue. I would not depend on them to give you accurate information about whether her coverage with you avoids potential Medicare penalties. A mistake here would be very costly.
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Re: Medicaire, IRMAA and the like

Post by jebmke »

stlrick wrote: Thu Jul 04, 2024 9:45 am
josephny wrote: Thu Jul 04, 2024 9:14 am I have an email into the person who sold me the Oxford insurance plan at mybenefitadvisor.com asking about whether my wife can still be covered and if there is anything United Healthcare will require or have to do about her turning 65.

Given the complexity, I would (at least for now) prefer to leave the current coverage in place, if UHC will allow and there will be no penalties.

I don't know what else to do, because putting in the time now to become educated about Medicare (which is clearly very complicated) is not an option.
I cannot give you good details about this issue, but the current health coverage for your wife must meet very specific requirements if she is to avoid a lifetime penalty for not enrolling in Medicare at age 65. I doubt that UHC would have any problem about continuing her coverage as a dependent on your policy, but that is not the issue. I would not depend on them to give you accurate information about whether her coverage with you avoids potential Medicare penalties. A mistake here would be very costly.
I wouldn't either. At a minimum I would research this specific issue if not able to do a deep dive on Medicare in general.

Some friends of mine didn't understand the penalties associated with delaying Part D and opted not to pay for it. 15 years later when it appeared they really needed it they were priced out of the market by penalties.
When you discover that you are riding a dead horse, the best strategy is to dismount.
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Re: Medicaire, IRMAA and the like

Post by SuzBanyan »

stlrick wrote: Thu Jul 04, 2024 9:45 am
josephny wrote: Thu Jul 04, 2024 9:14 am I have an email into the person who sold me the Oxford insurance plan at mybenefitadvisor.com asking about whether my wife can still be covered and if there is anything United Healthcare will require or have to do about her turning 65.

Given the complexity, I would (at least for now) prefer to leave the current coverage in place, if UHC will allow and there will be no penalties.

I don't know what else to do, because putting in the time now to become educated about Medicare (which is clearly very complicated) is not an option.
I cannot give you good details about this issue, but the current health coverage for your wife must meet very specific requirements if she is to avoid a lifetime penalty for not enrolling in Medicare at age 65. I doubt that UHC would have any problem about continuing her coverage as a dependent on your policy, but that is not the issue. I would not depend on them to give you accurate information about whether her coverage with you avoids potential Medicare penalties. A mistake here would be very costly.
I didn’t realize until the latest post that the OP likely has his own business. Unless there are 20 or more employees, continuing on the employer insurance plan is unlikely to be an option under applicable law. And if the plan is through the ACA, then spouse cannot remain on the policy after age 65.

Still, contacting the insurance broker the OP used before is a good first option. The broker may be able to steer OPs spouse to an acceptable option and may be able to at least educate OP and spouse about the available options.

Also, this should be done ASAP. The OP stated in a thread from April, 2024 that his spouse was 65. If she turned 65 in April, she has until July 31, 2024 to sign up without penalty.
stlrick
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Re: Medicaire, IRMAA and the like

Post by stlrick »

SuzBanyan wrote: Thu Jul 04, 2024 9:55 am
stlrick wrote: Thu Jul 04, 2024 9:45 am
josephny wrote: Thu Jul 04, 2024 9:14 am I have an email into the person who sold me the Oxford insurance plan at mybenefitadvisor.com asking about whether my wife can still be covered and if there is anything United Healthcare will require or have to do about her turning 65.

Given the complexity, I would (at least for now) prefer to leave the current coverage in place, if UHC will allow and there will be no penalties.

I don't know what else to do, because putting in the time now to become educated about Medicare (which is clearly very complicated) is not an option.
I cannot give you good details about this issue, but the current health coverage for your wife must meet very specific requirements if she is to avoid a lifetime penalty for not enrolling in Medicare at age 65. I doubt that UHC would have any problem about continuing her coverage as a dependent on your policy, but that is not the issue. I would not depend on them to give you accurate information about whether her coverage with you avoids potential Medicare penalties. A mistake here would be very costly.
I didn’t realize until the latest post that the OP likely has his own business. Unless there are 20 or more employees, continuing on the employer insurance plan is unlikely to be an option under applicable law. And if the plan is through the ACA, then spouse cannot remain on the policy after age 65.

Still, contacting the insurance broker the OP used before is a good first option. The broker may be able to steer OPs spouse to an acceptable option and may be able to at least educate OP and spouse about the available options.

Also, this should be done ASAP. The OP stated in a thread from April, 2024 that his spouse was 65. If she turned 65 in April, she has until July 31, 2024 to sign up without penalty.
Just to reiterate here because of the potential urgency and costs - some of the rules about coverage that allow for a no penalty delay in Medicare are arbitrary and make no sense to the uninitiated - such as the rule that the employer group includes at least 20 employees. Also, UHC is under no obligation to make certain that you do what is best for you. There are no rules that prevent them from selling you a policy that would eventually result in large Medicare penalties. Someone there may be willing and able to inform you about this, but there are no safeguards. Finally, if your wife must enroll in Medicare, the Advantage Plan versus traditional is a big decision that you need to be informed about, as is the decision about choosing an insurer for Part D and an insurer for a supplement plan. The ability to change your mind later on for specific items can also depend upon what state you live in. If she must enroll in Medicare now, you have to get some solid information now. In addition to financial penalties for not enrolling at the right time, you can end up having to deal with medical underwriting for some of the coverage you might want.
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Re: Medicaire, IRMAA and the like

Post by tibbitts »

I'm not an expert but agree with the suggestions for the OP to regard this as extremely urgent.
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BolderBoy
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Re: Medicaire, IRMAA and the like

Post by BolderBoy »

stlrick wrote: Thu Jul 04, 2024 8:05 am I would say you are not on the right track. Medicare is unreasonably complicated and you are nowhere close to understanding it. No one enrolls in A, B, C and D and none of them are "supplememental." A (hospitals) is free, B (doctors and others) is subject to IRMAA, D (prescriptions) is subject to IRMAA. C is a replacement for A, B and D - it is one or the other. A,B,and D are "traditional medicare" and C is an "advantage plan." You are going to have to pick up a book or something to understand the advantages and disadvantages of that distinction, which is fundamental to your costs and quality of care. Moreover, traditional medicare will only cover 80% of major costs, so that is where you now add a fourth coverage, a supplemental plan. That's right - traditional medicare is up to 4 items - A, B, D and a supplement plan. C, D and the supplement plan are from insurance companies, A and B are from the government. Finally, there are penalties and restrictions if you do not do this when it is required or if you want to change a plan.

If you respond to a TV ad about Medicare enrollment, you are almost assured that you are talking to a salesperson for insurance companies. Contact your state SHIP (State Health Insurance Program) for help instead. Before you use them, you need to educate yourself more. Read a book.

By the way, IRMAA is itself as consumer unfriendly as the rest of Medicare. It involves a two-year look back. The IRMAA charge to you for 2025 Medicare premiums will be based on your 2023 MAGI (modified adjusted gross income). IRMAA brackets go up each year, so knowing which bracket your 2024 income will put you in when charges are applied in 2026 can be no more than an estimation, and the brackets are a cliff - one dollar over and you will pay $1000+ per person more over the year.
I think this is a good summation and accurately describes my understanding of Medicare for the last 9 years I've been on it.
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Leesbro63
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Re: Medicaire, IRMAA and the like

Post by Leesbro63 »

stlrick wrote: Thu Jul 04, 2024 10:28 am Just to reiterate here because of the potential urgency and costs - some of the rules about coverage that allow for a no penalty delay in Medicare are arbitrary and make no sense to the uninitiated - such as the rule that the employer group includes at least 20 employees.
I am in a very small employer group with 3 employees. It's not clear that our Blue Cross/Shield affiliate insurer will allow me to stay on the group plan when I turn 65 early next year. But assuming they do, are you saying that Medicare will penalize me when I go on it (Medicare) at a later date? I was hoping to stay on the employer plan for a year or two or three, but not if there's a Medicare penalty.
Last edited by Leesbro63 on Thu Jul 04, 2024 10:49 am, edited 1 time in total.
jebmke
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Re: Medicaire, IRMAA and the like

Post by jebmke »

BolderBoy wrote: Thu Jul 04, 2024 10:46 am
stlrick wrote: Thu Jul 04, 2024 8:05 am I would say you are not on the right track. Medicare is unreasonably complicated and you are nowhere close to understanding it. No one enrolls in A, B, C and D and none of them are "supplememental." A (hospitals) is free, B (doctors and others) is subject to IRMAA, D (prescriptions) is subject to IRMAA. C is a replacement for A, B and D - it is one or the other. A,B,and D are "traditional medicare" and C is an "advantage plan." You are going to have to pick up a book or something to understand the advantages and disadvantages of that distinction, which is fundamental to your costs and quality of care. Moreover, traditional medicare will only cover 80% of major costs, so that is where you now add a fourth coverage, a supplemental plan. That's right - traditional medicare is up to 4 items - A, B, D and a supplement plan. C, D and the supplement plan are from insurance companies, A and B are from the government. Finally, there are penalties and restrictions if you do not do this when it is required or if you want to change a plan.

If you respond to a TV ad about Medicare enrollment, you are almost assured that you are talking to a salesperson for insurance companies. Contact your state SHIP (State Health Insurance Program) for help instead. Before you use them, you need to educate yourself more. Read a book.

By the way, IRMAA is itself as consumer unfriendly as the rest of Medicare. It involves a two-year look back. The IRMAA charge to you for 2025 Medicare premiums will be based on your 2023 MAGI (modified adjusted gross income). IRMAA brackets go up each year, so knowing which bracket your 2024 income will put you in when charges are applied in 2026 can be no more than an estimation, and the brackets are a cliff - one dollar over and you will pay $1000+ per person more over the year.
I think this is a good summation and accurately describes my understanding of Medicare for the last 9 years I've been on it.
I would add that researching and understanding Part D is as close to a mystical experience as you're likely to find while still alive.

The only time you really know if you made the right choice is in retrospect, alas.
When you discover that you are riding a dead horse, the best strategy is to dismount.
SuzBanyan
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Re: Medicaire, IRMAA and the like

Post by SuzBanyan »

Leesbro63 wrote: Thu Jul 04, 2024 10:48 am
stlrick wrote: Thu Jul 04, 2024 10:28 am Just to reiterate here because of the potential urgency and costs - some of the rules about coverage that allow for a no penalty delay in Medicare are arbitrary and make no sense to the uninitiated - such as the rule that the employer group includes at least 20 employees.
I am in a very small employer group with 3 employees. It's not clear that our Blue Cross/Shield affiliate insurer will allow me to stay on the group plan when I turn 65 early next year. But assuming they do, are you saying that Medicare will penalize me when I go on it (Medicare) at a later date? I was hoping to stay on the employer plan for a year or two or three, but not if there's a Medicare penalty.
If you are on an employer plan, then there is no penalty for not migrating to Medicare until after that coverage ends. However, my understanding is that for employers with fewer than 20 employees, there is no option to stay on the employer plan. The small business I worked for when my spouse turned 65 had to transition him to Medicare, but still reimbursed me for the premiums for Medicare Part B, Medicare Part D and a Medigap policy. Even with these 3 policies, Medicare was less expensive than his age 64 costs on the employer plan.
donall
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Re: Medicaire, IRMAA and the like

Post by donall »

This link from UHC does a good explanation about your situation :
https://www.uhc.com/news-articles/medic ... loyer-plan

The Medicare website can also be helpful:
https://www.medicare.gov/basics/get-sta ... ng-past-65
stlrick
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Re: Medicaire, IRMAA and the like

Post by stlrick »

Leesbro63 wrote: Thu Jul 04, 2024 10:48 am
stlrick wrote: Thu Jul 04, 2024 10:28 am Just to reiterate here because of the potential urgency and costs - some of the rules about coverage that allow for a no penalty delay in Medicare are arbitrary and make no sense to the uninitiated - such as the rule that the employer group includes at least 20 employees.
I am in a very small employer group with 3 employees. It's not clear that our Blue Cross/Shield affiliate insurer will allow me to stay on the group plan when I turn 65 early next year. But assuming they do, are you saying that Medicare will penalize me when I go on it (Medicare) at a later date? I was hoping to stay on the employer plan for a year or two or three, but not if there's a Medicare penalty.
I am not a Medicare consultant and I stayed on a group plan with 10,000 employees so I have no specific experience with this situation. My understanding is that this coverage does not qualify you for delaying Medicare without a lifetime penalty for each year of delay after 65. Don't take my word for it, but you certainly must look into it carefully.
Dregob
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Re: Medicaire, IRMAA and the like

Post by Dregob »

josephny wrote: Thu Jul 04, 2024 5:34 am I know only what a little online searching has been able to explain, so please feel free to treat me as completely ignorant on this subject.

I am 57, wife is 65. We are and hopefully will continue to be in one of the higher tax brackets.

We live in New York and have 3 young-adult kids (under 26) and have a private health insurance plan from United Healthcare Oxford through my business that costs me over $41,000/yr just in premiums (then there's the deductibles, co-pay, non-covered, etc.). I (on behalf on my family) can opt-out if I so choose.

I believe that my wife having turned 65 is eligible for Medicaire. (That's pretty much the extent of my understanding.)

I have a very (very) basic understanding that there are supplemental plans available (Parts A (hospital), B (stuff), C (something else), D (prescriptions), etc.).

I also have an even more basic understanding that IRMAA is a surcharge/fee/tax one pays on parts B and D for people in certain tax brackets.

How would we go about figuring out if we are better off (financially) keeping the current insurance policy, and until when (i.e., our youngest will turn 26 in 8 years, coincidentally, when I turn 65).

Thank you.
We are and hopefully will continue to be in one of the higher tax brackets. This.

I wonder why we don't see this statement more often!
Leesbro63
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Re: Medicaire, IRMAA and the like

Post by Leesbro63 »

donall wrote: Thu Jul 04, 2024 11:00 am This link from UHC does a good explanation about your situation :
https://www.uhc.com/news-articles/medic ... loyer-plan

The Medicare website can also be helpful:
https://www.medicare.gov/basics/get-sta ... ng-past-65
Thanks for the links, but neither site addresses the "I have employer coverage, but the group is less than 100 people" issue.
Dregob
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Re: Medicaire, IRMAA and the like

Post by Dregob »

Jack FFR1846 wrote: Thu Jul 04, 2024 7:57 am
josephny wrote: Thu Jul 04, 2024 7:38 am Is there a penalty is she does not sign up for Medicare?
Yes

She should at a minimum sign up for part A.

To sign up for B, and the rest, without penalty, she would need a company letter saying she was on a qualified plan. I do not know, if she's covered under your insurance if she's not working, how that works. Others will chime in. But part A....do it now. It costs nothing and keeps penalties away.
Examples of coverage that is not creditable for Medicare Part B include:

TRICARE
Veterans Benefits
COBRA
CHAMPVA
Retiree plans
Individual Marketplace plan
Leesbro63
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Re: Medicaire, IRMAA and the like

Post by Leesbro63 »

SuzBanyan wrote: Thu Jul 04, 2024 10:55 am
Leesbro63 wrote: Thu Jul 04, 2024 10:48 am
stlrick wrote: Thu Jul 04, 2024 10:28 am Just to reiterate here because of the potential urgency and costs - some of the rules about coverage that allow for a no penalty delay in Medicare are arbitrary and make no sense to the uninitiated - such as the rule that the employer group includes at least 20 employees.
I am in a very small employer group with 3 employees. It's not clear that our Blue Cross/Shield affiliate insurer will allow me to stay on the group plan when I turn 65 early next year. But assuming they do, are you saying that Medicare will penalize me when I go on it (Medicare) at a later date? I was hoping to stay on the employer plan for a year or two or three, but not if there's a Medicare penalty.
If you are on an employer plan, then there is no penalty for not migrating to Medicare until after that coverage ends. However, my understanding is that for employers with fewer than 20 employees, there is no option to stay on the employer plan. The small business I worked for when my spouse turned 65 had to transition him to Medicare, but still reimbursed me for the premiums for Medicare Part B, Medicare Part D and a Medigap policy. Even with these 3 policies, Medicare was less expensive than his age 64 costs on the employer plan.
This is good info. Thank you. I will assume that I have to go on Medicare and will put the wheels in motion about 6 months before I turn 65.
mrb09
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Re: Medicaire, IRMAA and the like

Post by mrb09 »

Here’s an example, it won’t directly apply to the OP’s case, just an example of our experience.

My wife is over 65 and I’m a year under. She’s taken social security since she was 62

While I was working, we were both on my work insurance plan, which was a qualifying plan to defer Medicare parts A, B and D, which she did defer (she avoided part A so we can do a family HSA)

Two months before my retirement, she signed up for parts Medicare parts A, B and D. She had to submit evidence of a qualifying plan for the years she wasn’t enrolled, my company gave me that through our HR department. We kept her on my work insurance plan, with Medicare as a secondary provider.

A month before retirement, she signed up for a medigap plan for part B and a supplemental plan for part D, starting at my retirement date. Medicare would then be her primary provider, with the medigap plan as supplemental.

When I retired, I went on COBRA. I could have kept my wife on the COBRA insurance, but COBRA isn’t a qualifying plan to defer Medicare, so she needed to pay for Medicare anyway. And the medigap plan was quite a bit cheaper than the COBRA premiums.

The Medicare deductions for social security were nominal the first month, then IRMAA kicked in and they deducted the amount of the pro-rated first month plus the monthly surcharge. I appealed IRMAA with a retirement as a “live changing event”, waited a few months (with the surcharges each month), and then they refunded the surcharges and the Medicare deductions are back to nominal.
stlrick
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Re: Medicaire, IRMAA and the like

Post by stlrick »

Leesbro63 wrote: Thu Jul 04, 2024 11:13 am
donall wrote: Thu Jul 04, 2024 11:00 am This link from UHC does a good explanation about your situation :
https://www.uhc.com/news-articles/medic ... loyer-plan

The Medicare website can also be helpful:
https://www.medicare.gov/basics/get-sta ... ng-past-65
Thanks for the links, but neither site addresses the "I have employer coverage, but the group is less than 100 people" issue.
The number is 20 employees, not 100. But it is not a perfect criterion. "Usually" group coverage from an employer with 20 or more employees is considered "creditable coverage." I believe the other criterion is that all employees are eligible for the coverage. I don't know if this means that 20 or more are eligible or if it means that all are eligible.
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ResearchMed
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Re: Medicaire, IRMAA and the like

Post by ResearchMed »

Given the possible/likely urgency, please note the first link from
donall wrote: Thu Jul 04, 2024 11:00 am This link from UHC does a good explanation about your situation :
https://www.uhc.com/news-articles/medic ... loyer-plan

The Medicare website can also be helpful:
https://www.medicare.gov/basics/get-sta ... ng-past-65

That includes the following:

"How to avoid late enrollment penalties for Part B or Part D
Make sure you have creditable coverage and can delay enrollment.
Make sure your current prescription drug coverage is considered creditable by Medicare (it’s as good as or better than Medicare Part D).
Get written proof of your creditable prescription drug coverage.
"

OP: You'll want to make SURE that your current plan includes CREDITABLE coverage. You need to have a letter to that effect, and then *keep* that letter, although you'll be able to get another one upon termination. But having an early copy of that should help a lot with any claim about having had creditable coverage.



If they could have made the Medicare system more confusing... i'm not sure how. :annoyed
[Well, yes, I'm sure creative Bogleheads could come up with quite a variety of worse arrangements, but the current one is certainly confusing enough that BHs should spend their time elsewhere! :wink: ]

First, get a copy of the "Medicare & You 2024" booklet.
The online version can be found at
https://www.medicare.gov/Pubs/pdf/10050 ... nd-you.pdf

However, I suggest getting the free paper copy, which is MUCH easier to browse through:
Call: 1-800-MEDICARE (1-800-633-4227) to have a *free* copy sent to you.
You'll probably want to do a quick browse through it and then keep it on hand for reference. If it's the first time you are dealing with Medicare, that handbook is not really a good/simple intro.

We just started Medicare, very belatedly, on Monday (1st of the month). "Belatedly" because DH was still eligible for Employee Healthcare plan no matter how old, and I was also covered.
The transition to Medicare was not at all as difficult as we expected, nor did ti take the weeks and weeks as we had been warned, such as, "get as many Rx's filled before, so you don't need to get meds until after the Medicare situation has finally been completed".
And on June 30th, when we tried to give Pharmacist our new Medicare Rx Benefits Plan number, he said they already had it, that "the system automatically updated it". Nice surprise.

Make sure you understand that "Medicare Advantage" (which is the "combo plan" that includes the underlying parts) is DIFFERENT than "Medicare Medigap/supplement", which is *regular* Medicare PLUS the Medigap Supplemental policy.
Depending in part upon state of residence, ==>> once one has started on either Medicare Advantage OR a Medicare with Supplement plan, it may be difficult or impossible to change (I think there is a one-year window at the start?? Please check!).
IF one can switch between plans in your state, then there is less need to make *sure* that you get "the right plan" at the start. (And the rules among plans allowing one to switch... yup, those rules can be quite different from state to state. Crazy system!)

Medicare Advantage plans tend to be less expensive, but can have significant gatekeepers and restrictions in terms of what is covered or what hurdles one must hop over.
Original Medicare with Medigap/supplement may cost more, but has very few restrictions: IF Medicare covers something, then the supplement WILL cover the 20% not covered by Medicare. There may be other benefits.

Some large employers have their own Retiree Healthcare Plan that functions as the "add on" to regular Medicare, even though it isn't officially a "Medigap" plan.
This may be unlikely if OP is the Employer and has few employees (?), but it's important to understand the difference. (This ended up being the most confusing to us, regardless of whether it should have been...)

RM
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Kingghoti
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Re: Medicaire, IRMAA and the like

Post by Kingghoti »

FYI

As long as the dependent spouse over 65 can remain on the group policy, and the group, according to TEFRA rules, has >20 employees (on average) enrolled or waived,

… and here is the key: if the group plan pays “Working Aged” Actively at Work employees’ and their dependents’ claims as primary, with Pt A Medicare secondary, then this should count as credible group coverage and the requirement to timely enroll in part B is tolled until a Special Enrollment Period (SEP) starting when group coverage ends and extending a few months, maybe as much as six months, but do make sure!

Part D has the same SEP provision so long as the group RX coverage is deemed credible in terms of coverage scope.

My wife and I (employee) deferred B and D until retirement at 71.

Best!
nonnie
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Re: Medicaire, IRMAA and the like

Post by nonnie »

jebmke wrote: Thu Jul 04, 2024 10:49 am
I would add that researching and understanding Part D is as close to a mystical experience as you're likely to find while still alive.

The only time you really know if you made the right choice is in retrospect, alas.
What a wonderful response! I still remember how I felt when I started researching Medicare at 64 or so. It seemed so needlessly complex and difficult and I thought I'd never understand it. Once I did, I was glad to find out that Parts A and B aren't that difficult once the decision about Medicare Advantage or not is made. For me it's Plan G for Medigap, choose insurer with cheapest price.

I currently have the $.40/month WellCare plan with "only" 6 meds (at 81, perspective is everything :D ). I get 2 generic at Wellcare/Express Scripts for no cost, one Tier 4 at a Canadian pharmacy, a Tier 3 at Amazon, another Tier 3 at Cost Plus Drugs and the 6th, I play bingo between Amazon and Cost Plus Drugs.

It shouldn't be this hard! I'm starting to consider having that written on my tombstone.
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Artsdoctor
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Re: Medicaire, IRMAA and the like

Post by Artsdoctor »

josephny wrote: Thu Jul 04, 2024 9:14 am I have an email into the person who sold me the Oxford insurance plan at mybenefitadvisor.com asking about whether my wife can still be covered and if there is anything United Healthcare will require or have to do about her turning 65.

Given the complexity, I would (at least for now) prefer to leave the current coverage in place, if UHC will allow and there will be no penalties.

I don't know what else to do, because putting in the time now to become educated about Medicare (which is clearly very complicated) is not an option.
This might be an indicator that you have an individual policy or that the policy is a small group plan. So the first step I'd suggest is being able to answer if you're in a small group plan through your employer is the question: does the employer have more than 20 employees?

If you're in a small group plan with under 20 employees, the small group plan would generally be secondary to Medicare (meaning, medical bills will be sent to Medicare before the private plan). Many small group plans will say "no way, Medicare is first) and refuse to pay until after Medicare has paid their share.

If you're in a large group plan, your wife could generally stay on your plan as long as you're working.

If you have a personal family plan, then your wife is obligated to enroll in Medicare when she turns 65.

It may be that your wife is obligated to enroll in Medicare so weighing the pros and cons of whether or not to enroll becomes moot.
tallguy3891
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Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

CAsage wrote: Thu Jul 04, 2024 7:23 am Most insurers presume that if you are 65, you are definitely on Medicare and reduce their coverage commensurately. Get the Medicare for Dummies book and read up... Have you priced the policy to keep just you and the kids on it? The short summary is Part A is hospital, Part B is Doctors, Part C is HMO instead of Part B (and many people choose it because it's cheaper with limitations), Part D is drugs. There are permanent penalties (higher future prices) if you don't sign up for Medicare Part D when eligible... My suggestion would be to contact 1~2 insurance brokers and they can walk you through various medicare options for your wife. IRMAA surcharges are totally a thing, but nowhere near your current premiums.
Also, Part C (Medicare Advantage) does have PPO plans in addition to HMO plans. It could vary by location. We have a number of them here.
Topic Author
josephny
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Re: Medicaire, IRMAA and the like

Post by josephny »

I had no idea Medicare was so complicated.

Now I'm really anxious about us incurring penalties or fines for not signing up in time (it's almost 6 months since she turned 65).

Our current plan is indeed through a business I own, with only myself and my partner (so, our families are the only participants).

I don't know if that means we have "a personal family plan" and I don't understand if these penalties are only assessed if and when she goes on Medicare, and if the penalty increases the longer she waits, etc.

Our current plan is pretty good, as far as health insurance in this country goes, and if the she can stay on the current plan AND the premium differences (which so far appear to be indecipherable or unknowable given the complexities and choices) are not great, I'd certainly keep the insurance we have in place.

My thinking is that when the last of the kids turn 26 (in 8 years), we would reevaluate this. This thinking would change if (1) health care miraculously gets inexpensive and great for young people, (2) the kids get good coverage elsewhere such as their work, or (3) the difference in cost between having a private plan and medicare becomes great.

In the meantime, I will wait for the broker to respond. Neither of us have the energy needed to become educated and informed about Medicare.

BTW, the plan we now have is the Oxford Health, EPO Non-gated, Freedom Network.
Duzz78
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Re: Medicaire, IRMAA and the like

Post by Duzz78 »

josephny wrote: Thu Jul 04, 2024 9:37 pm I had no idea Medicare was so complicated.

Now I'm really anxious about us incurring penalties or fines for not signing up in time (it's almost 6 months since she turned 65).
You had up by 3 months after she turned 65 to sign up without any penalties incurring. You are now past the timeframe. Your goal is to minimize this amount now.

Our current plan is indeed through a business I own, with only myself and my partner (so, our families are the only participants).

I don't know if that means we have "a personal family plan" and I don't understand if these penalties are only assessed if and when she goes on Medicare, and if the penalty increases the longer she waits, etc.
They increase the longer she waits.

https://www.medicare.gov/basics/costs/m ... -penalties


Our current plan is pretty good, as far as health insurance in this country goes, and if the she can stay on the current plan AND the premium differences (which so far appear to be indecipherable or unknowable given the complexities and choices) are not great, I'd certainly keep the insurance we have in place.

Medicare is only concerned about one aspect of your wife's current insurance plan. That is, if her insurance plan is "Medicare creditable". "Medicare creditable" means the employees' insurance policy that includes drug coverage is as good as what Medicare provides. This is the crucial point. If it is, then she can continue on it without paying any penalties for Part B & D when she does apply for Part B in the future. If it is not, then if she continues on it, when she does apply for Medicare Part B, then she will incur Part B & Part D penalties that will last as long she is on Medicare Part B & D.

Hopefully, Oxford Health can tell you this information. Companies with less than 20 employee are not required to offer any coverage to employees ages 65+. Chances are slim that it is simple because small companies cannot afford coverage for age 65+ for those additional number of years of employment They know employees can get coverage through Medicare.. This plan most likely does not have this consideration built into it. But, for the premium, it just might be a diamond in the rough.

Vey important that you verify this plan is "Medicare creditable". Oxford Health may tell you over the phone it is creditable. You need to verify and triple check. You need them to put this in writing and signed by someone of importance in the company. There may be specific forms that Medicare requires and that are sent in to them. These are government documents, so don't take this lightly. If your plan is not "Medicare creditable", then those penalties have started accruing.

There are strict rules for when you can enroll in Medicare. There are different enrollment periods for different circumstances. This is what you need to figure out: Does your wife need to enroll in Part A, B & D now? What forms does she need to fill out and send with her application to Medicare? Has she even signed up for Part A yet? If your insurance is "Medicare creditable', what forms does she need to fill out and send to them so that when she applies for Part B later on, without incurring any penalties? Who needs to sign those forms? These are government documents, so don't take this lightly. Are you comfortable in signing them as company representative based on verbal from OXford Health? Ei: Form CMS-L564.

If not "Medicare creditable", then when is she eligible to enroll in Medicare Part B and Part D? How will the penalty be calculated? Important that you call Social Security at 1-800-772-1213. Calling between 8-10 am and 4-7 pm Wednesday through Friday are suppose to be slower times.


My thinking is that when the last of the kids turn 26 (in 8 years), we would reevaluate this. This thinking would change if (1) health care miraculously gets inexpensive and great for young people, (2) the kids get good coverage elsewhere such as their work, or (3) the difference in cost between having a private plan and medicare becomes great.

No. Medicare is dramatically different from the insurance you are used to. You already heard of IRMAAs, penalties for Part B & D. Part A B & D are independent of each other with their own deductibles, premiums, co-pays and co-insurance costs. You pay a premium for each part. Both the government and private insurance companies provide coverage. It not just one insurance plan. It is 3 plans by different companies.

You can also purchase a supplemental plan (Medigap) which will help pay most of your out-of-pockets costs for part A & B. In terms you will understand, this plan would reimburse you for all the money you paid to providers from the time you met your deductible up to your out-of-pocket max. Plus any copays not applied to your limits. It even pays your Part A deductibles. Note, again only for Part A & B costs. Does not include prescriptions drug costs. Plan G will pay for every Medicare approved cost except for the Part B deductible, currently $240. Plan N does the same except does not cover the Part B deductible, excess charges and part of foreign emergency travel costs. Strongly recommend you purchase.
https://www.medicare.gov/health-drug-pl ... n-benefits


In the meantime, I will wait for the broker to respond. Neither of us have the energy needed to become educated and informed about Medicare.
BTW, the plan we now have is the Oxford Health, EPO Non-gated, Freedom Network.
Some forms or information for your assistance:
https://www.cms.gov/Medicare/CMS-Forms/ ... com/forms/
tallguy3891
Posts: 828
Joined: Sat Jul 03, 2021 10:47 am

Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

Duzz78 wrote: Fri Jul 05, 2024 1:45 am
josephny wrote: Thu Jul 04, 2024 9:37 pm I had no idea Medicare was so complicated.

Now I'm really anxious about us incurring penalties or fines for not signing up in time (it's almost 6 months since she turned 65).
You had up by 3 months after she turned 65 to sign up without any penalties incurring. You are now past the timeframe. Your goal is to minimize this amount now.

Our current plan is indeed through a business I own, with only myself and my partner (so, our families are the only participants).

I don't know if that means we have "a personal family plan" and I don't understand if these penalties are only assessed if and when she goes on Medicare, and if the penalty increases the longer she waits, etc.
They increase the longer she waits.

https://www.medicare.gov/basics/costs/m ... -penalties


Our current plan is pretty good, as far as health insurance in this country goes, and if the she can stay on the current plan AND the premium differences (which so far appear to be indecipherable or unknowable given the complexities and choices) are not great, I'd certainly keep the insurance we have in place.

Medicare is only concerned about one aspect of your wife's current insurance plan. That is, if her insurance plan is "Medicare creditable". "Medicare creditable" means the employees' insurance policy that includes drug coverage is as good as what Medicare provides. This is the crucial point. If it is, then she can continue on it without paying any penalties for Part B & D when she does apply for Part B in the future. If it is not, then if she continues on it, when she does apply for Medicare Part B, then she will incur Part B & Part D penalties that will last as long she is on Medicare Part B & D.

Hopefully, Oxford Health can tell you this information. Companies with less than 20 employee are not required to offer any coverage to employees ages 65+. Chances are slim that it is simple because small companies cannot afford coverage for age 65+ for those additional number of years of employment They know employees can get coverage through Medicare.. This plan most likely does not have this consideration built into it. But, for the premium, it just might be a diamond in the rough.

Vey important that you verify this plan is "Medicare creditable". Oxford Health may tell you over the phone it is creditable. You need to verify and triple check. You need them to put this in writing and signed by someone of importance in the company. There may be specific forms that Medicare requires and that are sent in to them. These are government documents, so don't take this lightly. If your plan is not "Medicare creditable", then those penalties have started accruing.

There are strict rules for when you can enroll in Medicare. There are different enrollment periods for different circumstances. This is what you need to figure out: Does your wife need to enroll in Part A, B & D now? What forms does she need to fill out and send with her application to Medicare? Has she even signed up for Part A yet? If your insurance is "Medicare creditable', what forms does she need to fill out and send to them so that when she applies for Part B later on, without incurring any penalties? Who needs to sign those forms? These are government documents, so don't take this lightly. Are you comfortable in signing them as company representative based on verbal from OXford Health? Ei: Form CMS-L564.

If not "Medicare creditable", then when is she eligible to enroll in Medicare Part B and Part D? How will the penalty be calculated? Important that you call Social Security at 1-800-772-1213. Calling between 8-10 am and 4-7 pm Wednesday through Friday are suppose to be slower times.


My thinking is that when the last of the kids turn 26 (in 8 years), we would reevaluate this. This thinking would change if (1) health care miraculously gets inexpensive and great for young people, (2) the kids get good coverage elsewhere such as their work, or (3) the difference in cost between having a private plan and medicare becomes great.

No. Medicare is dramatically different from the insurance you are used to. You already heard of IRMAAs, penalties for Part B & D. Part A B & D are independent of each other with their own deductibles, premiums, co-pays and co-insurance costs. You pay a premium for each part. Both the government and private insurance companies provide coverage. It not just one insurance plan. It is 3 plans by different companies.

You can also purchase a supplemental plan (Medigap) which will help pay most of your out-of-pockets costs for part A & B. In terms you will understand, this plan would reimburse you for all the money you paid to providers from the time you met your deductible up to your out-of-pocket max. Plus any copays not applied to your limits. It even pays your Part A deductibles. Note, again only for Part A & B costs. Does not include prescriptions drug costs. Plan G will pay for every Medicare approved cost except for the Part B deductible, currently $240. Plan N does the same except does not cover the Part B deductible, excess charges and part of foreign emergency travel costs. Strongly recommend you purchase.
https://www.medicare.gov/health-drug-pl ... n-benefits


In the meantime, I will wait for the broker to respond. Neither of us have the energy needed to become educated and informed about Medicare.
BTW, the plan we now have is the Oxford Health, EPO Non-gated, Freedom Network.
Some forms or information for your assistance:
https://www.cms.gov/Medicare/CMS-Forms/ ... com/forms/
Duzz78 wrote: Fri Jul 05, 2024 1:45 am
josephny wrote: Thu Jul 04, 2024 9:37 pm I had no idea Medicare was so complicated.

Now I'm really anxious about us incurring penalties or fines for not signing up in time (it's almost 6 months since she turned 65).
You had up by 3 months after she turned 65 to sign up without any penalties incurring. You are now past the timeframe. Your goal is to minimize this amount now.

Our current plan is indeed through a business I own, with only myself and my partner (so, our families are the only participants).

I don't know if that means we have "a personal family plan" and I don't understand if these penalties are only assessed if and when she goes on Medicare, and if the penalty increases the longer she waits, etc.
They increase the longer she waits.

https://www.medicare.gov/basics/costs/m ... -penalties


Our current plan is pretty good, as far as health insurance in this country goes, and if the she can stay on the current plan AND the premium differences (which so far appear to be indecipherable or unknowable given the complexities and choices) are not great, I'd certainly keep the insurance we have in place.

Medicare is only concerned about one aspect of your wife's current insurance plan. That is, if her insurance plan is "Medicare creditable". "Medicare creditable" means the employees' insurance policy that includes drug coverage is as good as what Medicare provides. This is the crucial point. If it is, then she can continue on it without paying any penalties for Part B & D when she does apply for Part B in the future. If it is not, then if she continues on it, when she does apply for Medicare Part B, then she will incur Part B & Part D penalties that will last as long she is on Medicare Part B & D.

Hopefully, Oxford Health can tell you this information. Companies with less than 20 employee are not required to offer any coverage to employees ages 65+. Chances are slim that it is simple because small companies cannot afford coverage for age 65+ for those additional number of years of employment They know employees can get coverage through Medicare.. This plan most likely does not have this consideration built into it. But, for the premium, it just might be a diamond in the rough.

Vey important that you verify this plan is "Medicare creditable". Oxford Health may tell you over the phone it is creditable. You need to verify and triple check. You need them to put this in writing and signed by someone of importance in the company. There may be specific forms that Medicare requires and that are sent in to them. These are government documents, so don't take this lightly. If your plan is not "Medicare creditable", then those penalties have started accruing.

There are strict rules for when you can enroll in Medicare. There are different enrollment periods for different circumstances. This is what you need to figure out: Does your wife need to enroll in Part A, B & D now? What forms does she need to fill out and send with her application to Medicare? Has she even signed up for Part A yet? If your insurance is "Medicare creditable', what forms does she need to fill out and send to them so that when she applies for Part B later on, without incurring any penalties? Who needs to sign those forms? These are government documents, so don't take this lightly. Are you comfortable in signing them as company representative based on verbal from OXford Health? Ei: Form CMS-L564.

If not "Medicare creditable", then when is she eligible to enroll in Medicare Part B and Part D? How will the penalty be calculated? Important that you call Social Security at 1-800-772-1213. Calling between 8-10 am and 4-7 pm Wednesday through Friday are suppose to be slower times.


My thinking is that when the last of the kids turn 26 (in 8 years), we would reevaluate this. This thinking would change if (1) health care miraculously gets inexpensive and great for young people, (2) the kids get good coverage elsewhere such as their work, or (3) the difference in cost between having a private plan and medicare becomes great.

No. Medicare is dramatically different from the insurance you are used to. You already heard of IRMAAs, penalties for Part B & D. Part A B & D are independent of each other with their own deductibles, premiums, co-pays and co-insurance costs. You pay a premium for each part. Both the government and private insurance companies provide coverage. It not just one insurance plan. It is 3 plans by different companies.

You can also purchase a supplemental plan (Medigap) which will help pay most of your out-of-pockets costs for part A & B. In terms you will understand, this plan would reimburse you for all the money you paid to providers from the time you met your deductible up to your out-of-pocket max. Plus any copays not applied to your limits. It even pays your Part A deductibles. Note, again only for Part A & B costs. Does not include prescriptions drug costs. Plan G will pay for every Medicare approved cost except for the Part B deductible, currently $240. Plan N does the same except does not cover the Part B deductible, excess charges and part of foreign emergency travel costs. Strongly recommend you purchase.
https://www.medicare.gov/health-drug-pl ... n-benefits


In the meantime, I will wait for the broker to respond. Neither of us have the energy needed to become educated and informed about Medicare.
BTW, the plan we now have is the Oxford Health, EPO Non-gated, Freedom Network.
Some forms or information for your assistance:
https://www.cms.gov/Medicare/CMS-Forms/ ... com/forms/
The Part B penalty does not apply until one has 12 months of having turned it down, so the first answer is not entirely accurate. Depending on what period someone refused Part B and when their birthday was factors in the calculation. The 12 months of not having Part B when first eligible for Part B begins the month after the end of the Initial Enrollment Period (IEP). So, if the person turned 65 in January 2024, their IEP ends April 2024. The 12 month window begins May 2024 and ends April 2025. The fact that the person missed their original enrollment (IEP) period does not necessarily mean they will have a penalty. It is the number of months truly without Part B which determines this. The OP needs to figure this timing asap if getting close to the number of months from the end of the IEP to the month enrollment will apply. A call to Social Security can help with this. Note: It used to be that if one signed up in the General Enrollment Period (GEP) of Jan-Mar each year, the Part B coverage was effective July 1st. This changed to where the person is now enrolled as of the month after signing up in the GEP, e.g., signs up in Jan 2025, is enrolled as of Feb 2025, etc. Remember, the IEP timeframe (3 months before the month of attaining age 65 to 3 months after the month attaining 65) can be different from the GEP (currently Jan-Mar of each year).

If I had so many questions about this and how it works with the health insurance type the OP currently has, I would personally go to Social Security and sit down with them and discuss all the details about the situation for the most accurate info.

PLEASE NOTE the corrections to my original post concerning the 12 month window for the Part B penalty. Verify with official source of Medicare.gov
Last edited by tallguy3891 on Sat Jul 06, 2024 9:48 am, edited 3 times in total.
stlrick
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Re: Medicaire, IRMAA and the like

Post by stlrick »

tallguy3891 wrote: Fri Jul 05, 2024 10:04 am The Part B penalty does not apply until one has 12 months of having turned it down, so the first answer is not entirely accurate. Depending on what month someone turned Part B down and when their birthday was factors in the calculation. For example, if the person turned 65 in January of 2024, and they can normally not sign up again until January 1, 2025, their Part B would be effective February 1, 2025 and the 10% penalty would apply because there was 12 months of non-coverage since turning down Part B. HOWEVER, if the person turned 65 in, say March of 2024 and signs up for Part B in January of 2025 during the General Enrollment Period, the Part B coverage is effective February 2025 and they have not had 12 months of not having Part B since turning it down, and there is no penalty. The fact that the person missed their original Enrollment period does not necessarily mean they will have a penalty. It is the number of months truly without Part B which determines this. The OP needs to figure this timing asap if getting close to the number of months from the month of birth to the sign up period next year. A call to Social Security can help with this. Note: It used to be that if one signed up in the General Enrollment Period (GEP) of Jan-Mar each year, the Part B coverage was effective July 1st. This changed to where the person is now enrolled as of the month after signing up in the GEP, e.g., signs up in Jan 2025, is enrolled as of Feb 2025, etc.

If I had so many questions about this and how it works with the health insurance type the OP currently has, I would personally go to Social Security and sit down with them and discuss all the details about the situation for the most accurate info.
The Part D penalty begins after 63 days without creditable coverage for prescriptions and increases 1% per month, including the months in the initial 63 day period. The penalty is calculated on the "national base beneficiary premium" regardless of the premium for the Plan D plan in which you enroll.
jebmke
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Re: Medicaire, IRMAA and the like

Post by jebmke »

stlrick wrote: Fri Jul 05, 2024 10:29 am The Part D penalty begins after 63 days without creditable coverage for prescriptions and increases 1% per month, including the months in the initial 63 day period. The penalty is calculated on the "national base beneficiary premium" regardless of the premium for the Plan D plan in which you enroll.
This is why I have always just gotten the cheapest plan available (this year it is effectively zero). Insurance insurance.

My friend who got priced out was under the mistaken assumption that you had to buy a Part D policy from the same company that carried the gap insurance. It wasn't until she turned 80 that this came out; by then it was too late.
When you discover that you are riding a dead horse, the best strategy is to dismount.
DebiT
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Re: Medicaire, IRMAA and the like

Post by DebiT »

I know this seems very complicated. I would like to propose a safe simple solution. Have your wife enroll in Medicare immediately. Do not pick a Medicare Advantage plan. In many states, once you do that, you may need underwriting tif you later want to enroll in “traditional Medicare”. Medicare Advantage plans are effectively “substitutes” for traditional Medicare, usually cheaper because you give away the almost infinite flexibility of traditional Medicare.

Have her enroll in traditional Medicare,and pick a supplemental plan (aka MediGap) of the Plan G variety. This too is the top of the line. You could always step down later, but often stepping up requires underwriting. This is bad if she has or develops a pre-existing condition. Now you’re almost finished. She is now enrolled in Medicare Part A (which covers hospitals) and Part B ,which covers everything else.

Is your wife on any prescription drugs? If no, pick the cheapest Part D (prescriptions) plan you can find. You have the opportunity to change these every year anyway, which is complicated if someone takes lots of drugs, or expensive drugs. If she already does, there are calculators online for your state which will help with this. There are penalties for waiting, so get this figured out fast.

In this way, you will have avoided , or I guess in her case, minimized existing penalties, and preserved flexibility for future decision making. It’s likely that once you learn a little more you’ll be happy with the Plan G supplemental plans anyway. Some states allows switching these infinitely, some in birthday months, some not all. If your state allows switching, sign her up today, and learn more later. If it doesn’t , then try to learn which company to pick quickly. Others here, or in a separate post, who live in your state can probably help you narrow that down in one day.

I hope this helps. By the way, the books recommended here are skimmable. You don't have to read every word. But in glancing at mine to recommend one, I was reminded of the people at www.BoomerBenefits.com. Please take a look at their website. It's possible they can answer all your questions, help her get enrolled and put this to rest, without costing you a dime.
Age 66, life turned upside down 3/2/19, thanking God for what I've learned from this group. AA 40/60 for now, possibly changing at age 70.
Jack FFR1846
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Re: Medicaire, IRMAA and the like

Post by Jack FFR1846 »

In short, she needs to sign up for part A TODAY.

This can be done online. It costs nothing and the longer she waits, the bigger her permanent penalty will be.

So long as her current health insurance meets the minimum criteria, there won't be added penalty. If it doesn't meet it, there will be.
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DebiT
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Re: Medicaire, IRMAA and the like

Post by DebiT »

Jack FFR1846 wrote: Fri Jul 05, 2024 11:48 am In short, she needs to sign up for part A TODAY.

This can be done online. It costs nothing and the longer she waits, the bigger her permanent penalty will be.

So long as her current health insurance meets the minimum criteria, there won't be added penalty. If it doesn't meet it, there will be.
Agreed. Which is why my recommendation, especially since I doubt cost is the main decision driver, is to simply go ahead and enroll completely
Age 66, life turned upside down 3/2/19, thanking God for what I've learned from this group. AA 40/60 for now, possibly changing at age 70.
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wwhan
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Re: Medicaire, IRMAA and the like

Post by wwhan »

If she was a Social Security online login account setup https://www.ssa.gov/, she can sign up for Medicare there.

She should sign up for Medicare A immediately.

When to sign up for Medicare: https://www.ssa.gov/medicare/plan/when-to-sign-up

Medicare overview Summary Booklet: https://www.ssa.gov/pubs/EN-05-10043.pdf

Traditional Medicare (A, B, D) covers the first 80%, the Medi-Gap Supplement covers the other 20% deductable. The Supplement G is the most inclusive, currently available for new enrolles. If signing up for part B, sign up for part D immediatly, since the penality increases quickly with time. The cheap Wellcare part D cost me $0.40/month premium.

Medicare Advantage (part C) is really a money maker for the insurance companies and has lots of limitations and is tied to your zip code. It is often chosen by people that do not want to pay the higher premiums of traditional Medicare OR people that want a one stop solution, like at Kaiser. More details here: https://www.medicare.gov/what-medicare- ... ge-choices

Details on Medicare Advantage: https://www.commonwealthfund.org/public ... icy-primer

"The government pays Medicare Advantage plans a set rate per person, per year (around $12,000 in 2019, not including Part D–related expenses) under what’s known as a risk-based contract" ... "Medicare Advantage costs the government more than traditional Medicare for covering the same beneficiary."

"What are the differences between traditional Medicare and Medicare Advantage?

Access to providers. People with traditional Medicare have access to any doctor or hospital that accepts Medicare, anywhere in the United States. That’s the vast majority of doctors and virtually all hospitals.

In contrast, Medicare Advantage enrollees can access providers only through more limited provider networks. All Medicare Advantage plans are required to have such networks for doctors, hospitals, and other providers."


Parts of Medicare: https://www.ssa.gov/medicare/plan/medicare-parts

The IRRMA is only affected by the modified adjusted income from 2 years before (MAGI of 2022 for premiums in 2024). If 2023 falls in a different MAGI income bracket, then the IRRMA amount readjusts to the 2023 income for year 2025. So IRRMA is not a permanent surcharge, but can change yearly.

Who do I contact – Social Security or Medicare: https://www.ssa.gov/pubs/EN-05-10500.pdf

Compare Medigap Supplement Plan Benefits: https://www.medicare.gov/health-drug-pl ... n-benefits

For Traditional Medigap supplement (such as option G) and part D drug plans, you can search here, Find Medicare health & drug plans: https://www.medicare.gov/plan-compare/# ... 24&lang=en
hvaclorax
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Re: Medicaire, IRMAA and the like

Post by hvaclorax »

cas wrote: Thu Jul 04, 2024 8:07 am
josephny wrote: Thu Jul 04, 2024 7:35 am
Supplemental (A, B, C, and D) are important/useful/helpful/financially-wise;
Medicare A, B,C and D aren't supplemental, they *are* Medicare.

Medicare "supplement" is private insurance that covers potentially considerable costs (20% co-insurance + deductibles) not covered by the "traditional" configuration of Medicare (A + B + D).

I have heard the Medicare for Dummies book recommended many times on this forum. (Don't take the name personally. Lots of very smart people recommend it.) Also the medicare.gov website, as jebmke said.
IRMAA will be an additional cost to me;
I mention this because it seems to lower some people's blood pressure considerably:

IRMAA is not applicable to Medicare A (hospital). If your wife has enough Social Security credits via her own or your work records, Medicare A is free. That is what the Medicare deductions on her/your paystub for all those years were funding.

IRMAA applies to Medicare B and D, which is funded via premiums and taxes. *Everyone*, no matter their income, currently gets at least a 20% subsidy. The vast majority of people get a 75% subsidy on the premiums because their Medicare-age income is low enough. However, the subsidy is phased out (at specific income thresholds) as income goes up. That is IRMAA. (I mention this because it seems to lower some people's blood pressure considerably when they think of it as a reduction in subsidy rather than an additional cost. It is true that IRMAA appears as an additional line item on the social security statement, so it is kind of one of those optical illusion things that flip between two different images ... reduction of subsidy/additional cost.)
Thanks for your reply and explanation of this topic. I can’t say anything more because you nailed it (for me personally). I hope others will understand this and understand.
tallguy3891
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Re: Medicaire, IRMAA and the like

Post by tallguy3891 »

stlrick wrote: Fri Jul 05, 2024 10:29 am
tallguy3891 wrote: Fri Jul 05, 2024 10:04 am The Part B penalty does not apply until one has 12 months of having turned it down, so the first answer is not entirely accurate. Depending on what month someone turned Part B down and when their birthday was factors in the calculation. For example, if the person turned 65 in January of 2024, and they can normally not sign up again until January 1, 2025, their Part B would be effective February 1, 2025 and the 10% penalty would apply because there was 12 months of non-coverage since turning down Part B. HOWEVER, if the person turned 65 in, say March of 2024 and signs up for Part B in January of 2025 during the General Enrollment Period, the Part B coverage is effective February 2025 and they have not had 12 months of not having Part B since turning it down, and there is no penalty. The fact that the person missed their original Enrollment period does not necessarily mean they will have a penalty. It is the number of months truly without Part B which determines this. The OP needs to figure this timing asap if getting close to the number of months from the month of birth to the sign up period next year. A call to Social Security can help with this. Note: It used to be that if one signed up in the General Enrollment Period (GEP) of Jan-Mar each year, the Part B coverage was effective July 1st. This changed to where the person is now enrolled as of the month after signing up in the GEP, e.g., signs up in Jan 2025, is enrolled as of Feb 2025, etc.

If I had so many questions about this and how it works with the health insurance type the OP currently has, I would personally go to Social Security and sit down with them and discuss all the details about the situation for the most accurate info.
The Part D penalty begins after 63 days without creditable coverage for prescriptions and increases 1% per month, including the months in the initial 63 day period. The penalty is calculated on the "national base beneficiary premium" regardless of the premium for the Plan D plan in which you enroll.
Please note my (tallguy3891) corrections to my original post previously about the 12 month period, etc. Almost completely rewritten. The info in the post by me attached to this post was corrected so do not go by my (tallguy3891) comments in that one. See my previous post for corrections and also below is the corrected version:
The Part B penalty does not apply until one has 12 months of having turned it down, so the first answer is not entirely accurate. Depending on what period someone refused Part B and when their birthday was factors in the calculation. The 12 months of not having Part B when first eligible for Part B begins the month after the end of the Initial Enrollment Period (IEP). So, if the person turned 65 in January 2024, their IEP ends April 2024. The 12 month window begins May 2024 and ends April 2025. The fact that the person missed their original enrollment (IEP) period does not necessarily mean they will have a penalty. It is the number of months truly without Part B which determines this. The OP needs to figure this timing asap if getting close to the number of months from the end of the IEP to the month enrollment will apply. A call to Social Security can help with this. Note: It used to be that if one signed up in the General Enrollment Period (GEP) of Jan-Mar each year, the Part B coverage was effective July 1st. This changed to where the person is now enrolled as of the month after signing up in the GEP, e.g., signs up in Jan 2025, is enrolled as of Feb 2025, etc. Remember, the IEP timeframe (3 months before the month of attaining age 65 to 3 months after the month attaining 65) can be different from the GEP (currently Jan-Mar of each year).

If I had so many questions about this and how it works with the health insurance type the OP currently has, I would personally go to Social Security and sit down with them and discuss all the details about the situation for the most accurate info.

PLEASE NOTE the corrections to my original post concerning the 12 month window for the Part B penalty. Verify with official source of Medicare.gov
Last edited by tallguy3891 on Sat Jul 06, 2024 9:47 am, edited 2 times in total.
HIinvestor
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Re: Medicaire, IRMAA and the like

Post by HIinvestor »

Just to add confusion—my husband worked fulltime until he was 70. He had us all on his family medical insurance plan. He did file for Medicare A at age 65, because it was “free.” He didn’t gave to get part B until 8 months after he retired. We turned in the paperwork but went down to Social Security because we didn’t get his card for medicare B. Took 2 visits to straighten it out.

Everything worked fine for us and no penalties.
Topic Author
josephny
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Re: Medicaire, IRMAA and the like

Post by josephny »

Here is the response from mybenefitadvisors.com:

"My wife just turned 65 and I wanted to find out what is required of us with respect to Medicare. HAVE HER GET ENROLLED IN PARTS A & B---POSSIBLY GET A SUPPLEMENT.

It is my understanding that if she does not sign up, there is a penalty. Can you confirm? MY RESEARCH SUGGESTS THAT THERE IS A PENALTY IF YOU WAIT 2 YEARS TO ENROLL.

And, she can sign up, at no cost, right? NO COST TO SIGN UP.

Will our current insurance carrier require a change in our coverage because of her enrollment in Medicare? THEY WONT REQUIRE ANYTHING, BUT YOU MAY WANT TO TERMINATE HER FROM THE GROUP PLAN. IF SHE CONTINUES TO USE THE OXFORD COVERAGE, HER CLAIMS CAN BE REDUCED BY THE AMOUNT MEDICARE WOULD PAY---OXFORD WILL NOT PAY AS PRIMARY

Can we be relieved of any obligation for supplemental Medicare coverage because of our current plan? I DO NOT KNOW THIS ANSWER PERHAPS KYLE DOES.

Lastly, and possibly most importantly, does it make sense to keep the current plan with her covered? Or does it make more sense for her to be on Medicare with all the best supplements plans? IT MIGHT BE COST EFFICIENT TO REMOVE HER FROM THE GROUP PLAN WHEN SHE IS FULLY ENROLLED. YOUR RATE WILL GO FROM A FAMILY RATE OF $3418.42 TO THE EMPLOYEE & CHILD RATE OF $2039.06---YOU WILL HAVE TO DETERMINE WHAT WILL WORK BEST FOR YOU."

I am following up with Kyle, someone there who knows more about Medicare.

My follow up with include what I believe are the most important things to me: (1) That my wife continue to have the same type of coverage (financial as well as which doctors and services are covered, etc.), (2) that we do not incur penalties (financial or otherwise) now or later, and (3) that the difference in cost isn't significant for us ($1,379/month minus whatever Medicare's additional policies would cost us -- I wouldn't dare use any more specific terms because I am 100% confused about supplementals, additional, advantages, parts A-Z, etc.).
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