Be sure you are clear on how Medicare works. I've seen some misinformation posted at DU recently

[NewHendoLib]

Everyone gets part A (which is typically at no charge - hospital insurance), part B (Medical insurance) which you have to pay for. Part B has lots of coverage gaps. There are 2 options to satisfy the coverage gap - supplemental or medigap insurance, which you pay for and covers those things part B doesn't - and part C Advantage plans, which are the ones that are heavily advertised and tend to be controversial (some love them, some don't), and you also have to pay for. Part D covers medicines. There are a LOT of options for supplemental, advantage and drug plans and it is well worth doing comparisons to find those that work for you.

This is the place to go to get accurate information - https://www.medicare.gov/

[Marcus IM]

1. As of now, Part D coverage was more expensive than the prescriptions I take. Much more. n/t

[NewHendoLib]

2. You can get a very low monthly fee and use Good RX. Taking a part D plan is mandatory

I have a plan that is 5.00 per month - all of my scripts are 10.00 or less with the Good RX card for 90 day supply.

[Farmer-Rick]

30. I don't take part D

I have another plan that covers meds and I don't need it.

But I have to take and pay for part B. Though I will never use it.

[Ms. Toad]

11. Mine is $0 next year. It has been $8-$10/month for the last 2 years.

We buy most of our drugs off the plan, because they are cheaper from Costco without any insurance subsidy than with.

It is critical to enroll in a plan at the first opportunity, however, since most people need subsidies at some point - because there is a very steep surcharge that is imposed (forever) if you wait to enroll.

[Deuxcents]

3. Just had my phone appointment today

I’m retired and as of 2024, the only benefits my company will offer retirees is an Advantage plan. I have Original Medicare and want to keep it so I’ve been educating myself on all the Plans, Parts and questions I’ve had. I’ve never been on the “open market” and it was confusing but the site you gave is very informative. Shop around and compare..best advice that was given to me.

[NewHendoLib]

4. Exactly - I had a call with a medicare consultant and they walked me through all of the options

It is well worth taking the time to really understand it. Once you get through it, it ends up making sense - I've had my same supplemental for 3 years, but changed my pharma plan each year as coverage for medicines varies.

[Deuxcents]

5. I changed my Part D today, too

I was paying a monthly payment and never met my deductible..it’s 500$ plus. So as of the first of the year, my monthly payment is 0$ but the deductible is set so can’t get out of that. This whole enrollment period was an eye opener for me as I’ve been fortunate to have had employer benefits up until now.

[Ms. Toad]

12. I evaluate every single part D plan annually.

That's somewhere betwen 12 and 24 plans.

My Excel spreadsheet includes the costco member price. We buy the cheapest plan overall (premium + drugs bought through insurance + drugs bought from Costco).

[Skittles]

26. that right there tells you it's a scam

when they're forcing you on it - that's just plain wrong

[dflprincess]

6. Supplement or "Medigap" policies are not considered Part C coverage.

They are part of what a person may sign up for if they choose traditional Part A & B Medicare, along with a Part D drug policy.

Part C refers strictly to Medicare Advantage plans and is private insurance. It shouldn't even be allowed to use "Medicare" in its title as it's really false advertising.

Definitions of Medicare here:

https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare

What is interesting is the term "Part C" is not used anywhere at the link.

[NewHendoLib]

8. I am going to edit my OP to reflect this - I've seen an array of descriptions on the web, but you are correct

[dflprincess]

9. I've worked in the biz so I have an "advantage". (sorry, I couldn't resist)

I always thought I'd retire at 70 but I currently have employer insurance that covers more, has no deductible, and costs me less per month than just Medicare B alone will (not even including supplement costs) and I just don't trust the Advantage plans sooner or later their premiums will go through the roof.

[NewHendoLib]

10. I appreciate your input - thanks.

My wife and I both found Blue Cross Blue Shield supplementals at around 100 monthly - we are quite pleased with them. I retired in my mid 50s but was covered by retiree health until I turned 65 (a few years ago) - have to say my wife and I are very pleased with Medicare. As a retiree (from big Pharma), I was paying about 400 monthly for both my wife and I combined. Now we are at about 250 monthly. The only issue is dental...good thing we both have good teeth!

[PoindexterOglethorpe]

14. Not all Advantage Plans have premiums.

I have one, and pay nothing extra. No, I've never been refused treatment of any kind. I've had significant hospital and ER bills covered in their entirety.

Clearly something is wrong here, only I can't figure out what. Do I need the sarcasm thingy?

[NewHendoLib]

18. the world is far more than just you - there are a range of experiences

check this article

https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

but if it works for you - great!

[PoindexterOglethorpe]

20. Well, gosh. Apparently I'm the only person who hasn't had a problem with an Advantage Plan.

I do not have a minimal out of pocket cost I have to pay before my Advantage Plan kicks in. How weird is that?

Meanwhile, here on DU people are constantly starting threads about how truly terrible all Advantage Plans are. They aren't all terrible. So I wish people here would stop saying that.

[unweird]

27. Advantage plans are all terrible

They privatize Medicare, inserting a profit center into the middle of it where is there no benefit to the provider or recipient. Granted in your case you may have not noticed it but on a macro level they do not provide benefit to the masses but to the private business operating it.

[Lonestarblue]

32. Advantage plans are all about maximizing insurance company profits.

Advantage plans have been replacing original Medicare at a rapid pace because the insurance companies want to gain a majority of retirees and offer lower premiums to prevent them from signing up for real Medicare. Once they have a significant majority of retirees, they will push to eliminate original Medicare and privatize all coverage, at which point truly maximizing profits will kick in and the days of using lower premiums to attract users will end. It’s just an extension of our dysfunctional for-profit healthcare system, while original Medicare is more like universal care enjoyed by those in European countries without having to jump through insurance company hoops.

The difference between original Medicare and Advantage plans is that with original Medicare you and your doctor decide what treatment you need and get. With Advantage plans, an insurance company flunky decides what medical care you need and will get, and sometimes that might be the extra care you need to continue living. For example, they are notorious for forcing patients to go through lower-cost cancer treatments that doctors know do not work for specific cancers. If you’re lucky, you might finally get the one that does work before you die.

[IbogaProject]

41. There are two types of MA

There are ones that are paid by former employers, and there are the ones people sign up for. They are both degradations, but the retiree ones get extra money from the former employers.

[brush]

7. You're right. Thanks for this. Those commercials and the phone calls....

saying you can get additional benefits for if you have Medicare A and B and offer to sign you up for an advantage plan for Part C or D can be deceptive.

I listened through the pitch once then finally asked if it would reduce my SS benefit amount. The pitchman had to admit it would.

[unc70]

13. Why would it reduce your SS benefit amount?

Do you mean because any monthly premium would be deducted from your benefits? Many of the Advantage plans are $0 monthly premium. Is there something I am missing? I have been on MA plans for ten years. Never encountered the problems reported. Can't believe that my local plans in NC would be that much better.

[PoindexterOglethorpe]

16. Thank you.

I am so heartily sick of the trashing of Advantage Plans here. I've had one for, oh, dear lord it's now been 10 years! How did I get so old? Never any problems. Never any denial of benefits. As I've posted before, I had a heart attack three years ago, and of the $70,000 plus hospital bill, I paid (not sure exactly) around $700. Not bad. More recently, I fell and broke an arm and the ER visit cost me a whopping $25.00. I would love to see someone post similar stories, only they're simply on traditional Medicare, and reveal what their out of pocket costs are.

[Ms. Toad]

19. I have posted my costs. Repeatedly. They are lower than yours.

My total bill for your heart attack (assuming it was in 2022) would have been $233 (the deductible for the year).

If the ER visit was the first care for the year in the 2023 it would have cost me $226 (the deductible for the year). Then all of the rest of my care for the year (doctor's visits, MRIs, CT scans, hospitalizations, etc.) would have been $0.

What happens when you get a rare disease and you need to travel out-of-state to one of a handful of centers that treat it? Would it be covered? Would you have to apply for treatment out-of-state? Out of network? Mine is 100% covered, and I don't have to ask pemission first. I don't have to have pre-approval for expensive genetic tests on my tumor (that aren't typically covered by MA), for MRIs, for expensive chemo administered in the hospital.

While you have been lucky so far, the reality over time is that people on Medicare Advantage plans are denied coverage at a higher rate than Medicare. Even if the denials are ultimately reversed, you have lost time and energy fighting them. I have sarcoma - a rare cancer which is best treated in Texas. I can just go - no need to ask permission, no network, no pre-approval required. This cancer is extremely aggressive - it doubled in size in 2 weeks. If I had been forced to wait for permission for an MRI, to wait for permission for treatment, etc. - or been denied and had to appeal - the cancer would likely have metastasized, and I would fighting for my life. This is not hypothetical - people in my support group with MA plans are experiencing this. Their choice is to risk having enormous expenses out of pocket when the insurance company doesn't act fast enough, or to wait and risk their lives.

[PoindexterOglethorpe]

21. Okay, so from what you say I paid more for my heart attack

than you would have, but significantly less for the ER visit.

Yes, I realize how lucky I am to be phenomenally healthy, and hope to continue that way.

[Ms. Toad]

24. Not quite, since payment structures are not at all similar.

In 2022, I paid a total of $233 for all medical care. In 2023 I pay a total of $226 for all covered medical care. In 2024 it will be a total of $240.

You didn't provide information about any other medical expenses in the year, so I had to treat the two events you specifically mentioned as if you heart attack was the only 2022 expense, and your ER visit was your only 2023 expense. I'm guessing you had at least office visits following each of the two you mentioned - for which you had a co-pay. I pay nothing once I hit the deductible. If you had even a couple of office visits before the ER visit, the cost on my plan for the ER (or the heart attack, for that matter) would have been $0.

So the per-event cost is really meaningless under my plan, since my first medical encounter of the year is likely to require the entire deductible ($233 in 2022, $226 in 2023, and $240 in 2024). I have no costs for the rest of the year after I pay the deductible. On the other hand, you continue to have costs for each and every medical encounter. So to be a fair comparison, you'd need to add in your share of every other medical encounter for the entire year.

The problem with MA plans is that as we age, it is far more likely that our medical luck will not hold. When yours gives out, you may find yourself incurring enough expenses that you are required to pay the annual maximum each and every year. This year plans are allowed to set your maximum annual cost at $8,850. The highest my father (who has been on essentially the same plan I'm on for 27 years) have had to pay for all medical care for the year is $233. Next year it will be $240.

[IthinkThereforeIAM]

29. Very similar to my MA plan...

... I received my year to date Rx statement from Aetna this week, opened it, totals are: Plan paid:$513.47; you (I) paid:$29.64. I have one Rx that I pay $7.41 out of pocket for. And I am diabetes type 2, just take metformin and watch my bg and what I eat or don't eat.

Also, I have had gall bladder surgery, tailbone flap surgery (laid up for 6 months with daily nurse visits to my home), again a minor tailbone surgery when I hit a bump in the golf cart and inflamed the tailbone area again... facial cyst removal by plastic surgeon...my costs? $40 co-pay at my clinic/PPO of choice that I have been going to for 4 decades. And none of my co-pays or percentages for the surgical procedures were outrageous.

And my physicals are twice yearly, I go in for a CT scan to check on my lungs and lymph nodes later this month. The one I had 6 months ago was only a $40 co pay...

For now, I am pretty much care free as to my MA coverage. I never signed up for the Part D under Dumya out of self righteousness (ha) so I have Part C, pay in an extra $40 a month for my premium, deducted from my SS, I have been retired for 20 years.

I wish everyone had it this easy as to health insurance. And some nice nuns that run my clinic and hospital.

[NewHendoLib]

17. check this article. if you are happy, great - but it can be highly variable

https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

[brush]

31. The advantage plans reduce monthly payments. I have Caremore...

Last edited Sat Nov 4, 2023, 02:51 AM - Edit history (1)

part of Anthem as my part C option. If I got rid of it and just settled for A and B, my monthly benefit would go up some as the advantage cost is taken out of SS benefits.

The advantage plans are worth it as they save on prescription costs, hospitalization, some doctor visits, and the 20% A and B don't pay.

Verify on Medicare's web site though.

[brush]

36. Medicare A and B only pay 80%, advantage plans come in there...

and pay much of the other 20%, there is a small cost out of you monthly SS benefit, but as we all know, hospitalization alone can quickly mount into the thousands of dollars.

It's best to verify this on Medicare's web site.

[Ms. Toad]

15. The one thing that is not clear from medicare.gov

Is that (in most states) you have a one-time opportunity to opt in to Medigap plans to satisfy the coverage gap.

Under federal law, insurance companies are only obligated to offer Medigap plans to everyone who applies during their initial (or in some instances special) enrollment period. Outside of that window, unless a state law alters the rights of the insurance companies, they can reject you entirely.

If they choose to offer you a Medigap plan (outside of that guaranteed issue window) they are allowed to set your premium based on your health (subject to the state law altering the rights of the insurance company).

I'm only aware of Illinois altering these two rights of the insurance company - in Illinois there must be at least one Medicare Advantage plan which can be converted to a Medigap plan with a community rated premium.

Most people are not aware of this one-time opportunity to guarantee access to Medigap at the lowest rates, partly because the Medicare.gov site makes it seem like they have an opportunity to change the first couple of months every year.

A good secondary resource is the state SHIP office. Just search {your state name} SHIP and that should bring you to your state's office.

[leftstreet]

22. Thanks for adding this

Good grief you've become very well informed!

Kicking this page so members can come back and pick your brain as needed

[Ms. Toad]

25. I spent about 200 hours in a crash course on Medicare,

when I was unexpectedly retired shortly after my 65th birthday - and fairly quickly realized I was making the decision not just for the next year, but essentially for the rest of my life, because of the structure that punishes people who don't opt into original Medicare.

You can't go wrong with choosing original Medicare if you have to make a quick decision - you can alway hop back out into Medicare Advantage if you decide to go that way. Unfortunately if you start with Medicare Advantage (which I assumed until my crash course that I would) you are pretty permantly opting out of a Medigap plan.

[Desert grandma]

33. I learned this valuable information too.

Thank you Ms. Toad for sharing this very valuable information.

As you indicated, many people do not realize that Medigap or Supplemental insurance in addition to requiring your application must go through underwriting if you do not choose it when it is first available, is also rated by 3 designations..:
Age Attained...Can increase yearly on your birthday or because of increased cost of medical care due to inflation in your area.
Issue Age...Is priced for the age you take it out (65 in my case) and will ONLY increase due to medical inflation in your area.
Community rating....Rates all policies on the average of all participants in the area.

I have read that Age attained rating is the most common because initially it can seem to be the least expensive, and some participants have found it very hard financially to keep in later years.
We have Age Issued and our policy has not increased more than $10 in the ten years we have had it. In addition our plan G will pay for any "premium" that a provider might charge Medicare beneficiaries. The Mayo Clinic for example has a 15 % premium it charges Medicare patients.We too pay only the Part B deductible and every other expense is covered totally. There are no provider networks or pre-authorizations for medical procedures either. We have been very happy with it.

[Yonnie3]

43. For six months I weighed the options before my 65th

"You can't go wrong with choosing original Medicare"

A bit of history first:

While I was having ongoing treatments for cancer my employer switched plans and all my providers went off network. I decided to absorb the extra costs and not have a delay in treatments while I found new providers. With that fresh in my memory I began to study Advantage plans.

All of the Advantage plans available to me then had restrictions on who you could see and required prior approval of some procedures and treatments. Representatives would not directly respond to my queries about the stability of their network provider list. They did admit it could change. They just kept dangling the carrots of various extras like dental and vision.

I opted for the standard government Medicare, added a supplemental policy and never looked back.

In 2021 I had a serious health problem and spent 6 days in the ICU and a few months later a surgery that required 2 more days in the ICU. I also had lots of imaging. My expenditures were $0.00 excluding Rx. I haven't totaled the cost of these stays and the surgery plus imaging but it is was a lot. With the arguments and delays I had earlier with private insurance, I'm so glad they weren't involved.

What would an Advantage plan have paid , allowed to be done and how timely would have been my treatment? I don't know and can't know. It is the certainty of the government Medicare option that guided my decision.

Please spare me the anecdotes about a specific instance with a specific Advantage plan, that is not my point here.

[MissB]

38. So, do I have this right?

Background: Dh is nearly retired (couple more weeks) and I will continue working for up to another decade. I carry the health insurance through my employer.

When he hits 65, we still have to sign up for a Medigap plan, even though he’s covered by my insurance until I retire (I’m younger than him)? And if we don’t sign him up for one at that point, he can be denied for one?

[Ms. Toad]

39. That is one of the exceptions.

The window around 65 is when most people sign up, but if you are covered under work insurance (yours, or your spouses) you can wait until that work insurance ends when a special enrollment window opens. He can't be denied during that window, and he can't be charged a surcharge for our health. Pay attention to timing though - the part B enrollment window is shorter than the one around his 65th birthday.

He should still sign up for part A (hospitalization) at 65. (As long as he is eligible for part A at no premium there is no penalty for late enrollment - but it is free for most and can supplement the hospital coverage he gets through you)

We were in the same situation - my spouse was on my insurance until she hit 70. It is somewhat more challenging to figure out how to sign up, since all of the literature and directions (and even some of the Medicare people I talked with) are geared toward the window around your 65th birthday. There was a special form that had to be completed to be able to apply to sign up outside the standard window, and no one could direct me to where it was. I don't remember how I eventually found it, but once I did, I bookmarked it so I didn't lose it again.

That said, you might have hubby explore signing up at 65. We would have saved money doing the that. The difference between single and family premiums at work was just about the same as she is paying now for Medicare + Medigap, and the coverage under Medicare is far superior, unless hubby takes expensive medications - work insurance is generally superior to Medicare for anyone who will fall into the donut hole.

And, as long as I'm on the subject, both of you should explore buying your meds outside of your insurance plan. One of the surprising things I discovered was that my insurance was price gouging me on many drugs. In many instances, the Costco member prices, or GoodRx, cost less than paying my copay. It never occurred to me that using insurance would increase the price of many drugs. We're saving $1000 or so a year by just using Costco for around half of our meds.

[MissB]

40. All very good advice!

I really appreciate the detail.

I do have excellent health insurance - union job - but I’ll check the cost of his meds next time I'm at Costco. Two of his are covered 100% (no copay) and the other one runs about $7 every two months. But still, cost comparison would be good, and frankly pharmacies are struggling right now. Costco is so big that it seems more likely to maintain services.

I’ll start looking into the cost for Part A for him. We have a couple of years still, but I’m happy to pay for additional coverage. My cost for health insurance is under $150/mo for my family (still have both kids on), so spending some coin for Part A if necessary is fine.

Walking away eventually from employer covered insurance is the scariest part of getting old so far. Knowing what our options are is helpful. Thank you again for your wealth of knowledge.

[Tree Lady]

23. All I know is the more they try to push me

to a advantage plan the more I think something has t be wrong with it or someone is making a lot of money off of it.

I get notices all the time, especially during open enrollment with a ton of pressure sales.

I am doing fine on my regular medicare with supplement, only thing I wish I had was dental but most coverages don't cver the big stuff anyway.

[Desert grandma]

34. Try enrolling in an individual dental plan

We have Spirit Dental which uses the Ameritas network. We are also enrolled in MetLife comprehensive through the VA because my husbands get a lot if his care there. We also have the Delta dental coverage which I kept from my last job.It only covers $1500 max annually which is why we have additional policies. The other 2 cover $3500 annually. As we have gotten older, my husband and I have had more dental issues. I had 2 dental implants done today, which will probably be fully covered. I will get the crowns on them next year in Jan or Feb, when the maximums will be highest again.

Many require a 12 month waiting period for the implants and such. But it varies. Met Life has an individual "Take Along" plan and Delta Dental had a great plan in our area that had NO waiting periods for any services.Unfortunately they no longer offer it without waiting plans. Both were reasonable in cost. Spirit dental is reasonable too.

[misanthrope]

35. While your decision isn't based on hard evidence, I can't fault it

Last edited Sat Nov 4, 2023, 11:37 PM - Edit history (1)

My mind moves in the same direction. I have been on Medicare for nearly 20 years now, the result of disability due to a rare disease. Without it, I would have no insurance for treatments and drugs that run over $150,000 a year.

The aggressiveness I perceive in Medicare Advantage phone calls along with the ever-increasing wealth of TV ads tell me that the private sector senses piles of money to be made, like sharks smelling blood in the water. If insurance companies are behaving like this, it isn't to the advantage of consumers and private citizens.

Cynical? Of course. I'm not blind to what private insurance companies have done to the American health care system.

[Demovictory9]

28. Can you cover all the B "gaps" from government paid plans?

[hlthe2b]

37. ++

[Danascot]

42. AARP is a good source for Medicare information

https://www.aarp.org/health/medicare-insurance/medicare-made-easy/

[brooklynite]

44. The big issue appears to be anti-capitalism...

The smoking gun in these threads is that Medicare Advantage plans are (dramatic pause)....for-profit. Never mind that the doctor you're visiting is also for-profit, and well as pretty much every other good or service people partake of.