Dreading the fact I must now enroll in Medicare

[Marq1]

I have dreaded the day that I would need to sit down and figure out how all this Medicare stuff works. My entire group was let go from GM recently, thanks for most impersonal manner possible.

I have tried to read up on how all the plans work but honestly do not fully comprehend, it must be a government thing to sow confusion, I simply cant wrap my head around all the options and wish it to go away.

The issue I struggle with is at 67, have never had a illness, I have never taken any medications for anything. My yearly health check ups keep my doctor amused that nothing has come up in the past 20 years that I have been seeing him. I realize that the past is no guarantee of the future but based on my current need of not needing anything am I wrong for just saying standard Medicare is sufficient (since nothing will be used) and just go with it to get the decision over with?

[blortchplop]

[Unnecessary comment removed by admin LadyGeek] can you be more explicit about what options you're comparing? What is "just standard Medicare"? What else might you sign up for beyond that?

... am I wrong for just saying standard Medicare is sufficient (since nothing will be used) and just go with it to get the decision over with?

I'm happy to hear of your good health. Please don't take it for granted. As someone who depends on an incredibly expensive medication that must be taken daily in order to function normally, I recommend some kind of prescription coverage. It's insane what the [(removed) -admin LadyGeek] are allowed to charge. I ran into coverage issues at one point and ended up googling whether the UN and ICC classify charging unfathomably high prices for essential medication a crime against humanity.

I wish I was joking.

[Bosslady]

I have dreaded the day that I would need to sit down and figure out how all this Medicare stuff works. My entire group was let go from GM recently, thanks for most impersonal manner possible.

I have tried to read up on how all the plans work but honestly do not fully comprehend, it must be a government thing to sow confusion, I simply cant wrap my head around all the options and wish it to go away.

The issue I struggle with is at 67, have never had a illness, I have never taken any medications for anything. My yearly health check ups keep my doctor amused that nothing has come up in the past 20 years that I have been seeing him. I realize that the past is no guarantee of the future but based on my current need of not needing anything am I wrong for just saying standard Medicare is sufficient (since nothing will be used) and just go with it to get the decision over with?

Conventional wisdom is that you should have some type of supplemental plan as Medicare by itself does not have an out of pocket maximum. So if you get a serious illness you could be out a lot of money to cover the 20% MC doesn’t. A supplemental plan would cover the 20% not covered by MC.
You should contact your local State Health Insurance Assistance Program- SHIP
https://www.shiphelp.org/
Medicare is a complicated program. These people should be the experts.
Also look for a broker in your area. Boomer Benefits is one that seems very reputable and popular

Check into whether you are in a guaranteed issue state for supplemental plans. Some states are but they can differ as to what qualifies for guaranteed issue.

Sorry to hear about your layoff and that the employers were jerks.

[billfromct]

I think since you are over age 65.5 & applying for Medicare, you need to document that you had “credible insurance” (I think it’s form CMS-L564, Request for Employment Information) which you would get from your employer.

This is to prevent people from not applying for Medicare if healthy & not paying the monthly Medicare fee, until they have medical issues.

When I left my job in my late 60s, about 6 years ago, I had to get this form from Corporate HR which was in a different city/state 1,000 miles away. I had to mail my request, in writing (they wouldn’t accept an email request) & Corporate HR had to send me a signed original Form CMS-L564.

I would think if you have local HR office at your place of employment, it will be a lot easier.

Just a heads up if the same rules are in effect if applying Medicare when you are over age 65 & 1/2.

Maybe if someone has gone through this process recently, they can provide better, up to date information.

bill

[Skyway]

Marq1,
You should never have just original medicare. By itself there is no out of pocket max, which makes it very risky.
There are much better options out there than just original medicare.
Look at what medicare advantage plans are available in your area and you will likely find zero premium plans.
With no additional premium you will have out of pocket maximums as well as additional benefits that may be helpful.
You will need to make sure the network is acceptable to you. You may even find plans that give back part or all of the part B premium.
These would possibly make sense for you if you dont think you will use many services. Compared to original medicare you will have an out of pocket max as well as less cost since you wont be paying the full part B premium.
Remember with medicare advantage you can change plans w/o underwriting every year as your needs change.
The other option is to add a supplement plan to your original medicare. This way will cost more due to a premium for the supplement as well as a part D plan. You will have to decide if this additional cost is worth it for you. (Its not for me)

[Yooper]

The issue I struggle with is at 67, have never had a illness, I have never taken any medications for anything. My yearly health check ups keep my doctor amused that nothing has come up in the past 20 years that I have been seeing him. I realize that the past is no guarantee of the future but based on my current need of not needing anything am I wrong for just saying standard Medicare is sufficient (since nothing will be used) and just go with it to get the decision over with?

I wouldn't pass on the prescription drug part of it. My father was exactly the same as you (only time he'd been in the hospital was the day he was born). That changed when he hit 76. The long and short of it is that due to the penalty for not signing up for prescription drug side of things (if he signed up now the monthly cost would be through the roof), he cannot afford a particular medication that would be MUCH more convenient to take so he's stuck with taking a less expensive version and making regular trips to the hospital for blood draws to ensure it's working correctly.

[Vinny_in_NJ]

Enrolling in Medicare is not that bad assuming you did a little homework. The worst part of it if you choose traditional Medicare + Supplement is what may happen if the Supplement plan closes the book on your plan and you can't pass medical underwriting to change plans. But none of us can predict the future.

So far, I find traditional Medicare + Supplement+ Part D a little better (less costly) than my employer's plan but I've only been on it for 6 months. Part D has been a little more expensive drug wise than when I had my employer's plan but overall being on Medicare seems to be OK.

[ReadyOrNot]

You must have got some sort of layoff package. Many others were laid off and have similar questions. Either GM HR or your union should have information about medical benefits after layoff. Do you get some transition plan? You must have COBRA rights. Your union or the layoff HR contact would tell you.

What do similar laid-off employees do? Did you use an HMO while at GM? If you liked it, you may be able to continue under a similar Medicare Advantage plan with just the Medicare Part B payment.
Or your union may have a union part B supplement plan for laid-off or retirees. They would tell you how to sign up.
If you were using an HMO before, the HMO has an interest in helping you continue under their Medicare Advantage plan and would tell you how.

[mrmass]

Marq1,

Remember with medicare advantage you can change plans w/o underwriting every year as your needs change.

I thought this was state dependent...

[22twain]

When my wife and I started Medicare at the normal age or 65, we found the book "Medicare for Dummies" to be very helpful. Don't be put off by the title. Make sure you get the latest edition, because it's revised regularly for changes in Medicare laws/regulations.

The big choice is between (a) "traditional Medicare" including a supplement plan ('Medigap") and a part D prescription drug plan, and (b) Medicare Advantage.

Medicare Advantage attracts many people because of the low (even zero) monthly premium. Traditional Medicare has a significant cost for the premiums. This year I've paid $174.70 for Part B (withheld from my Social Security benefit), $176.93 for a supplement (Plan G from UHC/AARP), and $0.50 for part D, for a total of $352.13 per month. For doctors' office visits I paid a total of $240 for the year (the annual part B deductible), and about the same amount out of pocket for two generic drugs under my part D plan. So a total of $4700 per year. My wife pays somewhat more because she's older. We're 70 and 75, basically healthy but things are creeping in on us. I have a condition that for now just requires "active monitoring" and a cheap generic drug, but when/if it starts growing, the bills will mount up.

We would probably have paid none of this under Medicare Advantage. However, that would have come at the price of a limited network of providers, which we considered to be a significant drawback because we live in a small town in flyover country. We want to have to flexibility of going to one of the regional "big cities" (we're not even talking NY, LA, etc. which are several hours away by air) if necessary. Also, your doctors' (and your) decisions about treatment can be subject to pre-approval under an Advantage plan. We have a colleague whose mother has been denied coverage for potential treatment at one of our regional "big city" facilities because her plan deemed the local (cheaper) facility "good enough".

Another potential "gotcha" with Medicare Advantage is that insurance companies negotiate agreements with providers and hospital chains, for coverage and reimbursement rates. During the past few years, we've seen negotiations for renewing some of those agreements stretch out long enough that the agreements temporarily lapsed, meaning that some patients lost their Medicare Advantage coverage for a few months. One of these difficulties was with my supplement plan's company and our local hospital chain. This did not affect my supplement plan's coverage (only Medicare Advantage). If I had been on an Advantage plan, this could have been a major headache for me.

These drawbacks for Advantage may be less of an issue in the big burbs where there is more choice in providers. Out here in the boonies, they matter more. Fortunately, we can afford to pay for a good traditional Medicare setup, so we do.

Note that if you sign up for traditional Medicare when you're first eligible, you do not undergo medical underwriting (and potential denial of enrollment in a supplement plan, or higher premiums). If you start with Medicare Advantage and later want to switch to traditional Medicare, you have to undergo underwriting for a supplement plan. (If you go the other way, traditional to Advantage, no underwriting is required IIRC.)

[grok87]

Marq1,

Remember with medicare advantage you can change plans w/o underwriting every year as your needs change.

I thought this was state dependent...

agree.
don't trust advice from strangers on the internet!

also the problem with the medicare advantage plans is that if you have a serious illness you may not be able to see the doctor you want if they are not in your network.
cheers,
grok

[PeninsulaPerson]

I have dreaded the day that I would need to sit down and figure out how all this Medicare stuff works ...

... am I wrong for just saying standard Medicare is sufficient (since nothing will be used) and just go with it to get the decision over with?

It's actually pretty easy to figure out if you're not aiming for some unattainable level of financial perfection. Talk to a good local SHIP/SHINE person. Maybe a local insurance broker. There aren't that many moving parts.

"Nothing will be used ..." - what a laugh! The odds are that you are quite wrong about that. Celebrate your good health up to now and go with the odds.

Um, yup - just get over it. The parental Big Corp is out of your picture. Gotta' start paddling your own boat.

(My best friend's parents had no issues until their late 70s when they had issues. Lots of issues. One long hospital stay, from an infection. Thanks to their classic Medicare coverage, they never paid one dime. Medicare is a blessing. Some decisions to make but still a blessing.)

(Maybe your doctor is shining you on. Mine tend to do a lot of tests and make suggestions. One found a benign/not cancer/symptomless situation from something a little off in in my blood work. Something that could be corrected easily now while I was still young enough to survive the surgery - which might have not have been as survivable at 85, for example. I am not on Medicare yet but I also had "perfect health" before that totally out of the blue diagnosis that I did not want to hear. I am grateful that my doctor was looking WAY beyond the past and this very second. Given your age, your doctor seems too jovial to me!)

[capran]

We found a free, not selling anything group called SHIBA in Washington state that helped understand options and made it very clear. We, too, were blessed with perfect health in our youth. I used to only go in every 5 years for a physical, but just before medicare age figured I'd better get a regular doctor.

[LikeNumbers]

First, sorry to hear about the lay off.

I felt the same way about Medicare , overly complicated. Once your really sit down and look a a few plans you will quickly figure it all out.

There are typically several options dependent upon where you live.
Like you I only see the Dr. for yearly checkups and take no prescription drugs. As such, I cannot comment from experience on the
Part D drug plans provided by various plans.

I decided on a Presbyterian Medicare Advantage Plan HMO as they have several facilities in the area.
The premium monthly cost = $Zero. Max Out Of Pocket/year $4250, very reasonable co-pays about $20,
includes 2x basic dental visits/cleanings and 1x eye exam per year; however, it is seemingly impossible to get an eye appointment, so I simply pay a local provider about $125 for a full exam. I buy my glasses at Costco.

ALSO - the Advantage Plan takes care of all billing interactions with Medicare - a headache I prefer to avoid.

Of course, you still have to pay your PartB premiums which will be $185/month each in 2025. These are automatically deducted from your Social Security if you have SocSec.

The HMO still pays for out of area emergencies, we can also call for a video consult if necessary, and in larger cities they may be a Presbyterian Urgent care.

[TheGreyingDuke]

Medicare Advantage attracts many people because of the low (even zero) monthly premium. Traditional Medicare has a significant cost for the premiums. This year I've paid $174.70 for Part B (withheld from my Social Security benefit), $176.93 for a supplement (Plan G from UHC/AARP), and $0.50 for part D, for a total of $352.13 per month. For doctors' office visits I paid a total of $240 for the year (the annual part B deductible), and about the same amount out of pocket for two generic drugs under my part D plan. So a total of $4700 per year. My wife pays somewhat more because she's older.

We would probably have paid none of this under Medicare Advantage. dicare, you have to undergo underwriting for a supplement plan. (If you go the other way, traditional to Advantage, no underwriting is required IIRC.)

The Part B payment is still charged on Medicare Advantage plans and may or may not include a prescription drug plan. For may Advantage plans there is an additional premium beyond the standard Part B premium

Back to the OP:
Under your reasoning, since my house has not burned down the past 50 years, no reason to carry fire insurance. Admittedly, even though we call it "health insurance" it has begun to look like a pre-payment for health care costs. It then turns to a question as to whether or not an insurance mechanism is the best way to fund this. After all, if you have a heart attack and need intensive cardiac care it is the dollars collected the past 10-20 years by everyone that built and staffed that facility. It is too late to have it built only after your immediate need arises. But that is a topic verboten here.

[SevenBridgesRoad]

Medicare Advantage has served us well in two different parts of the country, a smaller city isolated from a metro area and now in a very large metro area. About half of US seniors choose MA plans. In both markets we found a plan with zero premium (other than the one standard Medicare premium everyone pays no matter what plan) and large networks of physicians, included drug plan, dental, eye, and other benefits such as paid-for gym membership. Our current United Health plan has a nationwide network of doctors and hospitals at no additional cost.

Check out YouTube for many short and informative videos on Medicare choices. And spend some time at Medicare.gov.

[TN_Boy]

Marq1,

Remember with medicare advantage you can change plans w/o underwriting every year as your needs change.

I thought this was state dependent...

I believe that Medicare *Advantage* plans never require underwriting.

Medicare *supplement* (Medigap) plans do not require underwriting if you pick one when you first enroll in medicare. After that, if you change supplement plans you will have to worry about underwriting in *most* states.

There are lots of good resources available on Medicare, both on the web, and books, like Medicare for Dummies. (I have this latter book).

For what it is worth, when I sign up for Medicare I will go with a supplemental plan and drug plan versus a Medicare Advantage plan. The latter is less expensive if you have few medical problems. The supplement plan is probably cheaper if you start having more $$ problems, and you don't have to worry about being in the Advantage plan network.

[Ret2018]

I thought this was state dependent...

agree.
don't trust advice from strangers on the internet!

also the problem with the medicare advantage plans is that if you have a serious illness you may not be able to see the doctor you want if they are not in your network.
cheers,
grok

While I agree with your assessment about the disadvantages of Medicare "Advantage" your statement regarding state specific Medicare Advantage is incorrect. Medicare beneficiaries can change Medicare Advantage plans without underwriting every year during the open enrollment period.

There are state specific conditions for Medicare supplement plans. This is the additional insurance purchased in conjunction with original/traditional/fee for service Medicare to cover deductibles and Part B 20% co-pays.

[InMyDreams]

OP, there are no-premium/low-premium Part D plans. If you don't take any prescriptions, that might be a good choice to "keep your foot in the door" and avoid a future penalty for not enrolling in Part D when you were eligible.

Agree with others, your local SHIP office may be able to assist you.
https://money.usnews.com/money/retireme ... d-problems

but they tend to be busy this time of year.

[mrgeeze]

I was underwhelmed enrolling with Medicare.

Given that I was mostly healthy, it ended up costing us (me and wife) almost $600 more per month when you factor Medicare, supplemental, and drug together.

I liked Obamacare much better.

[Broken Man 1999]

I have dreaded the day that I would need to sit down and figure out how all this Medicare stuff works. My entire group was let go from GM recently, thanks for most impersonal manner possible.

I have tried to read up on how all the plans work but honestly do not fully comprehend, it must be a government thing to sow confusion, I simply cant wrap my head around all the options and wish it to go away.

The issue I struggle with is at 67, have never had a illness, I have never taken any medications for anything. My yearly health check ups keep my doctor amused that nothing has come up in the past 20 years that I have been seeing him. I realize that the past is no guarantee of the future but based on my current need of not needing anything am I wrong for just saying standard Medicare is sufficient (since nothing will be used) and just go with it to get the decision over with?

Did you qualify for any retiree benefits through your company?

IF so, do you have choices?

Additional info will help us make good suggestions.

Broken Man 1999

[preach]

I have dreaded the day that I would need to sit down and figure out how all this Medicare stuff works. My entire group was let go from GM recently, thanks for most impersonal manner possible.

I have tried to read up on how all the plans work but honestly do not fully comprehend, it must be a government thing to sow confusion, I simply cant wrap my head around all the options and wish it to go away.

The issue I struggle with is at 67, have never had a illness, I have never taken any medications for anything. My yearly health check ups keep my doctor amused that nothing has come up in the past 20 years that I have been seeing him. I realize that the past is no guarantee of the future but based on my current need of not needing anything am I wrong for just saying standard Medicare is sufficient (since nothing will be used) and just go with it to get the decision over with?

Like some others have stated you need to get a copy of form CMS-L564 for creditable coverage. However, we need more information too. Are you eligible for any type of retiree healthcare coverage either from GM directly or through your union? If so, do they provide Medicare plans? If they provide medicare advantage plans, this is considered a group plan (EGWP) and those are usually much better than individual medicare advantage plans you can enroll in on your own.

If not, no worries. Most people here, including myself, usually advocate in favor of choosing original medicare combined with a supplement plan such as Plan G or N. Those 2 are the most popular ones across the country.

I didn't fully understand medicare myself until I got involved in handling my parents coverage several years ago. I'm glad I did because it at least helped educate me on how the system works and then I could better explain things for my parents and others who have questions. I fully realize it can be overwhelming to someone who has never dealt with it before but I think you need to use a different mindset instead. Rather, everyone who is medicare eligible should be glad for all of these different choices that are available because there is no one single option to fit all peoples' lifestyles. You get a lot of different choices to suit your life and what works for you.

One last thing to mention - original Medicare as a system actually works pretty damn well in covering all sorts of medical procedures and keeping those costs down considerably. I have seen doctors/hospital/nursing home bills north of $500k and my parents out of pocket costs were zero. Medicare itself knocked that cost down a lot and then their supplement plan picked up everything else.

[grok87]

agree.
don't trust advice from strangers on the internet!

also the problem with the medicare advantage plans is that if you have a serious illness you may not be able to see the doctor you want if they are not in your network.
cheers,
grok

While I agree with your assessment about the disadvantages of Medicare "Advantage" your statement regarding state specific Medicare Advantage is incorrect. Medicare beneficiaries can change Medicare Advantage plans without underwriting every year during the open enrollment period.

There are state specific conditions for Medicare supplement plans. This is the additional insurance purchased in conjunction with original/traditional/fee for service Medicare to cover deductibles and Part B 20% co-pays.

I accept your correction.

Without being pedantic, the original statement was "Remember with medicare advantage you can change plans w/o underwriting every year as your needs change. " And i guess i was concerned that some might interpret that as meaning you can switch back from Medicare advantage to standard medicare+Medigap. My understanding is that you can switch back to medicare but medigap may be subject to underwriting.

cheers,
grok

[Broken Man 1999]

I have dreaded the day that I would need to sit down and figure out how all this Medicare stuff works. My entire group was let go from GM recently, thanks for most impersonal manner possible.

I have tried to read up on how all the plans work but honestly do not fully comprehend, it must be a government thing to sow confusion, I simply cant wrap my head around all the options and wish it to go away.

The issue I struggle with is at 67, have never had a illness, I have never taken any medications for anything. My yearly health check ups keep my doctor amused that nothing has come up in the past 20 years that I have been seeing him. I realize that the past is no guarantee of the future but based on my current need of not needing anything am I wrong for just saying standard Medicare is sufficient (since nothing will be used) and just go with it to get the decision over with?

Did you qualify for any retiree benefits through your company?

IF so, do you have choices?

Additional info will help us make good suggestions.

Broken Man 1999

[mrb09]

You must have got some sort of layoff package. Many others were laid off and have similar questions. Either GM HR or your union should have information about medical benefits after layoff. Do you get some transition plan? You must have COBRA rights. Your union or the layoff HR contact would tell you.

What do similar laid-off employees do? Did you use an HMO while at GM? If you liked it, you may be able to continue under a similar Medicare Advantage plan with just the Medicare Part B payment.
Or your union may have a union part B supplement plan for laid-off or retirees. They would tell you how to sign up.
If you were using an HMO before, the HMO has an interest in helping you continue under their Medicare Advantage plan and would tell you how.

Warning on COBRA, if you’re over 65, COBRA isn’t a “creditable” plan for delayed Medicare enrollment.

[mhadden1]

I have dreaded the day that I would need to sit down and figure out how all this Medicare stuff works ...

... am I wrong for just saying standard Medicare is sufficient (since nothing will be used) and just go with it to get the decision over with?

It's actually pretty easy to figure out if you're not aiming for some unattainable level of financial perfection. Talk to a good local SHIP/SHINE person. Maybe a local insurance broker. There aren't that many moving parts.

"Nothing will be used ..." - what a laugh! The odds are that you are quite wrong about that.

For most people, it probably takes some work to figure out how to hit the bullseye of the sweet spot of optimal coverage. But, for people I know, there are a number of choices that are pretty good, not bad, can't complain.

As far as the need for insurance - what could happen? A stroke out of the blue? A car accident?

[Skyway]

grok87,
My original statement “Remember with Medicare advantage you can change plans every year as your needs change w/o underwriting “ was correct in the context of advantage plans of which I was discussing. Remember this person was asking about original Medicare alone which also would not provide future assurance of a supplement being accessible.
The other point of my post was to point out that there are advantage plans that have a negative premium (give back plans) which is cheaper than plain original medicare as well as provide the protection of an out of pocket max.

[grok87]

grok87,
My original statement “Remember with Medicare advantage you can change plans every year as your needs change w/o underwriting “ was correct in the context of advantage plans of which I was discussing. Remember this person was asking about original Medicare alone which also would not provide future assurance of a supplement being accessible.
The other point of my post was to point out that there are advantage plans that have a negative premium (give back plans) which is cheaper than plain original medicare as well as provide the protection of an out of pocket max.

thanks

[Northern Flicker]

Marq1,

Remember with medicare advantage you can change plans w/o underwriting every year as your needs change.

I thought this was state dependent...

You can change between Advantage plans at any open enrollment without underwriting. After having been on an Advantage plan for 12 months, you lose guaranteed issue rights for Medigap, if you still had them when you enrolled in the Advantage plan, unless you are in a state where there are additional guarantees.

If selecting Advantage at initial enrollment, you still can switch to original Medicare plus Medigap in the first 12 months without needing to clear underwriting for Medigap.

[GaryA505]

I have dreaded the day that I would need to sit down and figure out how all this Medicare stuff works. My entire group was let go from GM recently, thanks for most impersonal manner possible.

I have tried to read up on how all the plans work but honestly do not fully comprehend, it must be a government thing to sow confusion, I simply cant wrap my head around all the options and wish it to go away.

The issue I struggle with is at 67, have never had a illness, I have never taken any medications for anything. My yearly health check ups keep my doctor amused that nothing has come up in the past 20 years that I have been seeing him. I realize that the past is no guarantee of the future but based on my current need of not needing anything am I wrong for just saying standard Medicare is sufficient (since nothing will be used) and just go with it to get the decision over with?

You have to do your homework. There is a lot of misinformation about this so you will have to be careful to get the facts. Even some of the stuff posted in this thread is misleading or incorrect.

Sorry, there's no easy way. You just have to research it.

[MathWizard]

Your state should have a SHIP (State sponsored Health Insurance
assistance Program) . They will help you with the
options.

Typically, if the former employer does not provide an option for continuing group health care , the decision is between

1)
Medicare A and B
and usually a private Medigap plan , usually G or N which
have the most coverage, but are the most expensive
and probably some Medicare part D (drugs) plan.
Walmart's Humana part D plans are usually cheapest, but
may not cover all you need.

2) Medicare part C ( aka Medicare Advantage) which are
private plans, typically quite cheap and some have drug
and dental coverage.
These are more like HMOs.
There are changes coming, as they have been quite expensive
for the government. Also, some places may accept
Medicare part A&B but not sone Medicare Advantage plans.

I know that the Mayo Clinic in Rochester Minn. sent out a letter
about not accepting some Medicare Advantage plans:
https://www.medpagetoday.com/special-re ... ves/101320

Check everything with your state's SHIP .

Do you have COBRA health insurance coverage for the few months until you get signed up for Medicare?

[GaryA505]

A couple of things:
I believe as of today, Mayo Clinic and MD Anderson Cancer do not accept any Medicare Advantage plans. Someone can correct me if you have better info. If you have a serious condition and the best doctors for it are there, you probably don't want to be on Medicare Advantage.
If you decide to go with original Medicare, don't overlook Plan G High Deductible. It works well for some people, others not so much. Most insurance brokers will try to scare you away from it because their commission on it is so low.

[friendlydave]

You need to open an account on Medicare.gov. You can research information, and comparison shop for Supplement Plans and Part D plans there. I found that Medicare for Dummies, latest edition was a great resource, and I was fortunate to find a good medicare broker that worked with me to get the proper coverage ( In my case Part A, B, Part D private plan, and Part G private supplement).

You need to decide whether you want an advantage plan or not. Just remember, brokers make more money selling an Advantage Plan than they do selling private Supplement and Part D coverage.

[GaryA505]

You need to open an account on Medicare.gov. You can research information, and comparison shop for Supplement Plans and Part D plans there. I found that Medicare for Dummies, latest edition was a great resource, and I was fortunate to find a good medicare broker that worked with me to get the proper coverage ( In my case Part A, B, Part D private plan, and Part G private supplement).

You need to decide whether you want an advantage plan or not. Just remember, brokers make more money selling an Advantage Plan than they do selling private Supplement and Part D coverage.

And commission is based on the price, so guess which Medicare Advantage or Medicare Supplements they are going to recommend as "the best fit for you".

[Northern Flicker]

A couple of things:
I believe as of today, Mayo Clinic and MD Anderson Cancer do not accept any Medicare Advantage plans. Someone can correct me if you have better info.

I believe that Mayo Clinic may be in network with some UHC Advantage plans. Moreover, some Advantage plans cover out-of-network care.

There are a fair number of Advantage providers I would have nothing to do with, some that would be acceptable to me, but to which I'd still prefer original Medicare with Medigap, and a few very good ones with which I would be fully comfortable. There are 2 (if not 3) of the latter where I live. In two of the cases, the insurer is an insurance foundation associated with a large care organization. That creates a scenario where they are incentivized financially to deliver care, not to withhold it. The third is transitioning to that, but the dust hasn't settled yet.

The concierge practice phenomenon is increasingly throwing a wrench into the original medicare model.

[GAAP]

Lots of useful information to make things clear: https://www.youtube.com/@Theretirementnerds.

A thread here with a lot of information: viewtopic.php?t=434922.

[CrossOverGuy]

I've been helping a friend who's moving to another state who had an opportunity to switch from Medicare Advantage to a Medigap and Part D prescription plan; she might not pass underwriting without such a guaranteed issue opportunity like this -- moving to another states make her eligible for a limited time to get Medigap without the insurance company asking and possibly denying for her answers to medical questions. She said her MA plan denied and/or didn't pay much for her prescription plans, plus with other medical co-pay she was out of pocket about $10,000 for the year. Since she's going with a high deductible G plan, her costs will be the approx. $44/month premium and $2,870 maximum out of pocket. Her Part D prescription is $0, with the new $2,000 maximum out of pocket for all such plans. Plus, for her Medigap and Part D, she's paying less than Medicare Advantage, which was about $52/month (although there are many that charge $0/month, too). By signing up for at least a cheap (or $0) Part D plan, one is safe from any life-long Part D penalties. Plus Medigap allows one to use any doctor in the U.S. (and the popular plans have a foreign travel benefit, too) that accepts Medicare (most do), rather than be more limited in MA and have to put the insurance company in charge of approving, delaying or denying care. Medigap Plans (regular) G and N are the most popular for folks who were eligible to sign up after 2020 as they are more comprehensive coverage, but the trade-off is the premiums are most expensive per month.

A very good book is by the lady who runs Boomer Benefits -"10 Costly Medicare Mistakes You Can't Afford to Make" - Danielle Kunkle Roberts - very clear and informative and not very expensive.

[GaryA505]

A couple of things:
I believe as of today, Mayo Clinic and MD Anderson Cancer do not accept any Medicare Advantage plans. Someone can correct me if you have better info.

I believe that Mayo Clinic may be in network with some UHC Advantage plans. Moreover, some Advantage plans cover out-of-network care.

There are a fair number of Advantage providers I would have nothing to do with, some that would be acceptable to me, but to which I'd still prefer original Medicare with Medigap, and a few very good ones with which I would be fully comfortable. There are 2 (if not 3) of the latter where I live. In two of the cases, the insurer is an insurance foundation associated with a large care organization. That creates a scenario where they are incentivized financially to deliver care, not to withhold it. The third is transitioning to that, but the dust hasn't settled yet.

The concierge practice phenomenon is increasingly throwing a wrench into the original medicare model.

Apparently Mayo Clinic does not accept noncontracted Medicare Advantage (MA) Plans.
https://www.mayoclinic.org/billing-insu ... urance/faq

It appears that Mayo have a list of contracted MA plans that varies by clinic location. Here is there list of contracted plans for Mayo Arizona:
file:///C:/Users/Administrator/Downloads/commercial-insurance-plan-contracts-arizona.pdf

As an aside, UHC is out-of-network for my provider which is really odd. My doctor advised me to switch last year. Due to being dropped by the MA provider I selected after UHC, I am now eligible to switch to original Medicare with certain Medicare Supplement plans in my state without underwriting.

[Big Dog]

Does GM offer retiree medical, aka, a company supplement to Medicare, for those 65+? (If so, HR will have the forms.)

Otherwise, if no company support, you can obtain some free, unbiased help from your state SHIP.

https://www.shiphelp.org

[Northern Flicker]

She said her MA plan denied and/or didn't pay much for her prescription plans, plus with other medical co-pay she was out of pocket about $10,000 for the year.

I am not doubting that a Medigap plan is her best option, but for clarity, I presume that a significant part of $10K out of pocket was the drug costs that also could be incurred with a standalone part D plan?

[Northern Flicker]

Apparently Mayo Clinic does not accept non-contracted Medicare Advantage (MA) Plans.

How I would word that is that they don't bill out of network plans. You are responsible for paying the bill and submitting claims yourself. Accepting a plan just means accepting the contractually mandated rate.

[CrossOverGuy]

Northern Flicker wrote

I am not doubting that a Medigap plan is her best option, but for clarity, I presume that a significant part of $10K out of pocket was the drug costs that also could be incurred with a standalone part D plan?

I don't have her breakdown of costs, but a Medigap HD-G and Part D will limit her to $2870 and $2,000, respectively, in a worse case scenario year, that sum of plans of $4,870 being about half she was responsible for with her MA plan.

[nisiprius]

Don't stress too much about it. The basic-basic part, enrolling in parts A and B, is pretty easy, especially if you are already enrolled in Social Security. Once that's done you've got decent insurance against the really big-ticket items: hospital stays. And 80% coverage of doctors' bills. In my opinion, no, you should not stop there.

I believe the complexity is intentional, to make you feel helpless so you will accept help from friendly companies offering to help you navigate the maze. Do not accept THEIR "help" in navigating the maze. Do this instead:

Do a web search on
[name of your state] SHIP Medicare. It's usually called SHIP, some states call it something different. Or go to https:www.shiphelp.org

This will connect you to nonprofit trained volunteers.

There are two basic ways to go about it. People argue intensely about which way is better. But it's mostly a question of figuring out the value of the varying levels of coverage to you, and choosing among plans that try to dazzle you with low-end sweeteners (like paying for eyeglasses, but only up to moderate costs and only every so many years and only through specific providers...)

Path 1: "Traditional Medicare" is, in my opinion, less complicated but you have to deal with several pieces.

Parts A & B: easily signed up for online, and no choices to make, there just "is" Part A and there "is" Part B and they cover what they cover.

Medigap or "Supplemental," which is private insurance, with mandated benefits, that covers part B co-pays. Part B covers doctors' bills but it only covers 80%. You have to pay the remaining 20% which can range from small nuisance to minor problem, but probably won't bankrupt you. You "should" have it. It's not too complicated. One thing about it is that the insurer does not have much discretion on what they cover, so you don't need to worry too much about denying claims. Medicare makes all the claims decisions. If Medicare approves it, they pay 80% and Medigap pays the other 20%, period.

Part D, "Prescription drugs." It's insanely complicated, you need it, the premiums can be very low and the low-premium plans are OK. The big thing they do is provide "catastrophic" coverages of the kinds of drugs that run into five- or six-figure costs. So you need it for that coverage, even if you can easily afford the retail-price-without-insurance of the drugs you use now.

Path 2: "Medicare advantage." These are completely private plans. The only thing "Medicare" about them is that what they cover is subject to regulations to make sure meet minimum standards for coverage. Instead of paying medical providers, under Medicare Advantage the government pays the insurers, meaning your premium is heavily subsidized. Medicare Advantage plans often are HMOs with the typical HMO characteristics. You are limited to the insurer's "network" of doctors, and usually to a geographic area. With provisions to cover emergency care when you're out of the network area.

I believe they are more complicated because there is so much variation in plans... what is covered, what the co-pays are, and what shiny bells and whistles (ooh! free membership at a fitness center) they have.

But they are all-in-one packages, so there's that.

[GaryA505]

Apparently Mayo Clinic does not accept non-contracted Medicare Advantage (MA) Plans.

How I would word that is that they don't bill out of network plans. You are responsible for paying the bill and submitting claims yourself. Accepting a plan just means accepting the contractually mandated rate.

That's the terminology they use on their web site. Contracted vs non-contracted. Maybe a "non-contracted" Medicare Advantage plan would pay the out-of-network rates.

[Chardo]

Most people celebrate the day they finally reach Medicare.

[GaryA505]

I don't have her breakdown of costs, but a Medigap HD-G and Part D will limit her to $2870 and $2,000, respectively, in a worse case scenario year, that sum of plans of $4,870 being about half she was responsible for with her MA plan.

That reminds me that this is the part that a lot of people get wrong. The HD-G deductible works like a maximum out-of-pocket, as you stated, not like a typical deductible. If we look at worst case and sum the Part A deductible ($1632) , HD-G Part B deductible ($2870), and Part D deductible ($2000), it's still less than the maximum out-of-pocket of most Medicare Advantage (MA) plans. And you don't have to worry about networks and pre-approvals from the MA company.

[Northern Flicker]

How I would word that is that they don't bill out of network plans. You are responsible for paying the bill and submitting claims yourself. Accepting a plan just means accepting the contractually mandated rate.

That's the terminology they use on their web site. Contracted vs non-contracted. Maybe a "non-contracted" Medicare Advantage plan would pay the out-of-network rates.

Correct. An MA plan with out-of-network care benefits would pay the full (out-of-network) cost but subject to deductibles, max out-of-pocket cost, or in some cases, max out-of-network benefit.

[gotoparks]

My aunt who was never sick when she was younger only has Medicare and pays out of pocket for what it doesn't pay for. Over the past five years, she has had major health problems and can't afford her bills so I've been helping her so she won't go to collections or not be able to go to her doctors because she owes so much. I didn't read all the responses but getting additional insurance besides Medicare if you can afford it would be a good move.

[Mayacallie]

The insurance brokers are less than useless now. When I signed up for Medicare 4 years ago, I received good service from a broker, who happened to be the father of my PCP. The current brokers are incentivized by certain companies- especially United Healthcare and AARP. Best to call the companies directly after doing the comparison on the Medicare site. My wife wanted Anthem, which is what I have, and couldn’t even have a broker give her a comparison. They wouldn’t even return calls after we voiced our preference.
We ended up calling BCBS directly and signed up effortlessly.

[Ret2018]

My aunt who was never sick when she was younger only has Medicare and pays out of pocket for what it doesn't pay for. Over the past five years, she has had major health problems and can't afford her bills so I've been helping her so she won't go to collections or not be able to go to her doctors because she owes so much. I didn't read all the responses but getting additional insurance besides Medicare if you can afford it would be a good move.

Depending on her income and assets, your aunt may be eligible for either Medicaid, or for Medicaid Qualified Medicare Benificiary (QMB), in which Medicaid pays the Medicare deductibles, Part B co-pays, and Part B premiums. Both of these are state administered programs.