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paulz
Member
# Posted: 23 Nov 2020 19:59
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Hey, any of you old farts got Medicare? Thinking about one of the advantage plans.

ICC
Member
# Posted: 23 Nov 2020 20:43 - Edited by: ICC
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Yes, I have been called an old fart before, and yes I do have a Medicare Advantage plan.

My employer paid for the insurance premiums before I became eligible for Medicare. My employer was my ranch corporation, so myself, more or less. I had coverage with a big NM HMO.

When I switched to Medicare I got basically the same coverage I had before with the same HMO's Advantage plan. The premium comes directly out of my S/S at pretty much the same rate as before.

toyota_mdt_tech
Member
# Posted: 23 Nov 2020 20:56
Reply 


Wife turned 65 early this year, but still working. She did sign up for medicare by law, but employer is still covering her medical. She wanted to retire June 2021, and may just go till end of next year. She is looking into plans now, but doesn't have to purchase or sign up during open enrollment. But she is actively shopping now. She will do an advantage plan also. Its so much, so many providers, so much information, its just hard to absorb. I'm only 60 so a few years to go, but it will go by fast.

Nobadays
Member
# Posted: 23 Nov 2020 21:15
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We went with Medicare and a supplemental G plan. Really lowered our health insurance costs. I am sure there is a period of time that insurance companies cannot penalize you for pre existing conditions... miss that window and they will do their best to deny, or limit coverage for those conditions.

frankpaige
Member
# Posted: 23 Nov 2020 21:26
Reply 


Go to a broker. They can show several plans and let you choose which might be best. They don't cost you any $$, ( the broker). You know your situation best, location, doctors. I am happy with our plan. Good Luck.

paulz
Member
# Posted: 23 Nov 2020 21:59 - Edited by: paulz
Reply 


Quoting: toyota_mdt_tech
Its so much, so many providers, so much information, its just hard to absorb.


Got that right. I'm overwhelmed. As I understand it, there is supplemental coverage, as Nobadays has, and there's advantage plans. With either you pay an insurance company, not the government. Some health care providers don't take advantage plans, all take the supplemental. There are various supplemental plans, F, G etc..

Beyond that, I'm lost. I'm seeing TV commercials about every 2 minutes, somebody is making money off this. Why the big push this year all of a sudden? I'm afraid to call or contact anyone for fear of endless spam.

Is the benefit mainly co-payment coverage, drugs, or potential hospital bills? Or some of each?

Thanks guys.

Nobadays
Member
# Posted: 23 Nov 2020 22:22
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Yep.... really complicated and CV confusing.... oh the spammers will find you anyway... some way THEY know you are turning 65.... mail, calls by the bucket load!

The F plan is not available anymore..if you turn 65 after January 1st, 2020. The G plan is the same except it does not cover the Part B deductible... this year ~$200.00.

I was told to shop for price. The state representative at our local senior center told me all supplemental plans MUST cover the same things... they can cover more (our plan covers a lot of preventive care testing that is above and beyond the requirements) but must all cover the minimums set by the government.

I do know my SIL waited past the magic dates to enroll and she not only has been penalized by having pre existing conditions excluded but also will pay more for life.

gcrank1
Member
# Posted: 23 Nov 2020 23:08
Reply 


We both have had Medicare for a few years after decades of paying Huge for an employer Cadillac plan that was great coverage but every so many years they changed carriers (the 'group') so we had to switch to the new group doctors. Hate That!
With Medicare you can go anywhere that takes Medicare patients, basically about everywhere in the country.
Let me try to weed out the fluff and give you an idea:
Medicare has some limits and exclusions so you buy a Supplement to pick up the diff, no big deal, not a big premium.
And you buy a Drug Coverage Plan, again, not a big deal or expense.
So, 3 'plans', but the Medicare is auto pay out of your ss, and the Sup and Drug can be auto-pay out of your checking acct, so no management required; easy-peasy.
You can change the Sup or Drug to another provider if dissatisfied.
The Advantage Plans incorporate all that into 'the plan', which sounds attractive at first because it is pretty much like what you are used to with a private plan, but, you have to go to their group doctors and each has a bit different tweak to try to sort out.
I suggest that when you become eligible for Medicare you do it, get a Sup and Drug plan and try it for a year. You aint married to it and will be able to change. Within that year you will understand how it works SO much better and, if like us, the costs will be so good compared to private plans that it is like getting a raise. Of course if your employer has been paying it all you will have costs but they are not huge.
We have been so satisfied that we are continuing (I had well over $100,000 in med costs last year with a quad-bypass and maybe $150 in co-pays).
Btw, look into the AARP membership that allows you to utilize their United Heathcare and Drug plans; been Way Good for us!
I agree that the agents who specialize in this stuff for free can help you navigate it. If you do an interview see if they say what I just did, ask questions and if they dont mention AARP and United Healthcare ask why not. Or just call AARP for the info.

ICC
Member
# Posted: 23 Nov 2020 23:50
Reply 


And the Canadians who are reading this are thinking... WTF.

hunt_camper
Member
# Posted: 24 Nov 2020 05:57
Reply 


Quoting: ICC
And the Canadians who are reading this are thinking... WTF.




paulz
Member
# Posted: 24 Nov 2020 08:50
Reply 


Quoting: gcrank1
You can change the Sup or Drug to another provider if dissatisfied.
The Advantage Plans incorporate all that into 'the plan', which sounds attractive at first because it is pretty much like what you are used to with a private plan


Thanks, gcrank1, that helps. When you say the Advantage incorporates all that, it's just the two, Sup and Drug that are incorporated, right, you still pay the Medicare separately?

Quoting: Nobadays
penalized by having pre existing conditions excluded but also will pay more for life.


Speaking of which, I am considering this for my wife, not me, I'm 63. She's in her 50s but has been on Medicare most of her life due to permanent disability (traumatic brain injury). I suppose that might be a problem. Her meds aren't that bad, under $50 a month, it's mostly the co-pays and chance of extended hospitalization that concerns me.

Nobadays
Member
# Posted: 24 Nov 2020 09:34
Reply 


This comes from EHealth: "Medicare Supplement insurance plans are sold by private health insurance companies which usually are allowed to use medical underwriting when evaluating insurance applications. One period in which insurers cannot use medical underwriting when considering your application is during your Medicare Supplement Open Enrollment Period. This period lasts for six months and begins on first day of month in which you’re both 65 or older and enrolled in Medicare Part B. During your Medicare Supplement Open Enrollment Period, an insurance company can’t refuse to sell you a policy based on your pre-existing condition and it can’t charge you more than someone without health problems. After your Open Enrollment Period ends, you may be subject to medical underwriting."

I don't know if you can change plans each year during open enrollment period... and not be subject to pre existing conditions restrict/ waiting periods or if it is a one time deal when you first sign up.

I think my SIL waited until after the open enrollment period to sign up for Medicare A and B and D supplements. I did some reading and not clear if all penalties are for life.... but they are significant. Here is a site that explains it pretty well... like all things Medicare (read government involved) it's confusing!

HERE

I think the main thing is to get signed up as soon as you can... for all... A,B, a drug plan and a supplement... you have a couple of years.

gcrank1
Member
# Posted: 24 Nov 2020 11:00 - Edited by: gcrank1
Reply 


In the Advantage plans the Medicare portion is part of the plan also, you have one premium for all. Iirc the gov pays them your Medicare premium which is deducted from your Social Security check and you pay any other fees as 'premium. Some plans advertise a -0- dollar premium; ie, you pay nothing! That means the deducted Medicare premium has covered it all. Hard to believe.....
Like I said, our reduced cost of health care was like getting a nice raise, money we could then use for consumer goods/services. Since some 85% (or more) of this economy is based upon consumer spending that was a win-win.
The downside is the 'reimbursement payments' (doctor bills) are at such a low rate that the hospitals, clinics and doctors cant make a living on it. So the fees for services to those on private insurance are jacked up to make up the diff. Yeah, those on private insurance are subsidizing those of us on 'Medicare'. In our case it was to the tune of 1/3 of our fixed income for over a decade. That would have bought a lovely cabin.....
But amortizing all those heavy cost years and the past few much lower cost years against my recent CABG surgery I am WAY ahead; we would have been bankrupt otherwise (or I would have been dead).

paulz
Member
# Posted: 24 Nov 2020 11:16
Reply 


Ah OK. Man I can't believe the TV commercials on Advantage plans! Seriously sick of Joe Namath. No adverts for Supplemental, the insurance companies must make more dough for the Advantage. Maybe getting guaranteed payment from the government is a plus for them.

Anyway, I have two calls to make today, one to my wife's doctor to see if they take Advantage, and one to a broker.

My wife had two online (Zoom) Dr. visits recently, half an hour each at most. $600 each.

Nobadays
Member
# Posted: 24 Nov 2020 12:01
Reply 


Since your wife is in her 50's and her disability is how she is on government insurance.... is she on Medicare or Medicaid? Very different. Checking the SSI site they do allow Medicare after 24 months of disability. I did read however supplemental insurers are not required to provide that coverage for folks under 65... some states however require them to offer it.

You are in a tough spot.... good luck sifting through the BS and finding coverage that will ease your financial burden. The US medical system is the best in the world some would argue, but accessing that care without ending up broke is the major flaw.

paulz
Member
# Posted: 24 Nov 2020 14:09
Reply 


Thanks. She has Medicare A and B now.

Weill I have left a message with her doctor (no one ever answers the phone even though 3 receptionists are sitting there when I go in..) to see if he accepts Advantage. I called the local HICAP (the Health Insurance Counseling & Advocacy Program), got a message machine in garbled English saying they have no appointments available before the deadline.

Called AAA, our auto and home insurance, they don't do it, said try United Health Care.

On the bright side, just did a brake job on the truck. Much more rewarding.

paulz
Member
# Posted: 25 Nov 2020 11:52
Reply 


Some progress.. Wife's Doc says United Healthcare. Been poking around their site. The Sup plan (G) says you must be 65, but call, and is around $100-$150 a month.

Four Advantage plans, two under AARP. She could join only have to be 50. Plans are $0-29, 49, 69 and 89 a month depending on what you get. I didn't see anything about hospitalizations, is that covered under Max out of pocket?

Again any advice appreciated. Gotta get through this.

https://www.uhc.com/medicare/medicare-supplement-plans

paulz
Member
# Posted: 28 Nov 2020 09:04
Reply 


I have applied (for my wife) with United Health Care. Did it online, sounds like they take all your info and go check you out. We'll see.

gcrank1
Member
# Posted: 28 Nov 2020 10:06
Reply 


I think those kind of questions are best answered by the company.
I do Know, fer sure an certain, that for me with Medicare, the UHC sup and the Rx plan that I have paid only a few hundred dollars for a $60K+ kidney stone surgery and last Dec. open heart. We just re-uped the other day for the same thing. We have kept what we started with, no (NO) regrets or problems.

paulz
Member
# Posted: 28 Nov 2020 10:18
Reply 


I signed up for the least expensive plan, and as you suggested will see how it goes. Something is better than nothing and can always upgrade. We've been married 30 years and relied on just Medicare (for her only). She's had many issues and surgeries and isn't getting any younger so this is probably a good time.

As I've mentioned, the advertising has been crazy this year, never noticed it in the past. At least it got me off the stump but I'll be glad when Dec 7 rolls around.

gcrank1
Member
# Posted: 28 Nov 2020 12:59
Reply 


Ive always wondered why they picked Pearl Harbor Day as the end of the 'open enrollment'?

BobW
Member
# Posted: 28 Nov 2020 13:49
Reply 


I made a mistake and did not get drug coverage from a private company when I signed up for Medicare and now and forever pay a penalty each month for not being covered.
Medicare only covers 80% and my wife and I carry a Medigap which costs more than Medicare as well as Medicare. We go to any provider which takes Medicare and get drugs from our choice of stores.
Each drug plan has a formulary which can change each year and states which drugs are covered and co pays for each.
Changes can be made, but after the initial enrollment period when you first become eligible, only during a yearly window.

toyota_mdt_tech
Member
# Posted: 28 Nov 2020 20:16
Reply 


Quoting: BobW
I made a mistake and did not get drug coverage from a private company when I signed up for Medicare and now and forever pay a penalty each month for not being covered.


Bob, penalty for the year or is this for life? You have peaked my interest. (wife is 65 now and retiring next year, so we are working on this now for her)

Nobadays
Member
# Posted: 29 Nov 2020 09:07
Reply 


Right off Medicare.gov:

Part D late enrollment penalty
The late enrollment penalty is an amount that's permanently added to your Medicare drug coverage (Part D) premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Medicare drug coverage or other creditable prescription drug coverage . You’ll generally have to pay the penalty for as long as you have Medicare drug coverage.

How much is the Part D penalty?
The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($32.74 in 2020, $33.06 in 2021) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

So this translates to about 33 cents per month you were not covered when you could have been.... so if you miss only one open enrollment period about $3.30 extra for life. If you don't sign up for a few years this penalty could be significant. This is what my SIL did, waited about 3 years after eligibility.

My wife, who is on 3 different prescriptions pays $13/mo then just a few dollars for each prescription when she refills. I'm on 1 prescription, that I could actually buy OTC, and pay $21/mo but my script costs me only $2 each time when the OTC would be ~$40 for the same amount. So $23/mo as opposed to ~$40/mon. Mainly on the Part D as I suspect as I age there will be other medications, plus, no penalty to pay.

Hope that helps.

paulz
Member
# Posted: 1 Dec 2020 08:48
Reply 


Got an email from United Healthcare yesterday, wife's app was accepted, coverage starts January 1. It's the bottom basement coverage, $26 a month, but we'll see how it does and possibly upgrade.

Thanks again for all the advice, I'm sure I would have given up otherwise.

paulz
Member
# Posted: 9 Dec 2020 09:04 - Edited by: paulz
Reply 


Welp, we got Late Enrollment Penalty letter yesterday. Got a couple weeks to prove otherwise. My wife has been getting some kind of discount on her meds at Costco, need to go over there and see what it is. The good news is they say it was only for a year, so under $5 a month penalty.

1. They spring this on you after they approve you and send your new card.

2. For some reason it has to be a monthly charge instead of a one time payment.

Not sure why we're getting penalized for paying out of pocket for meds. I guess they have their reasons..

toyota_mdt_tech
Member
# Posted: 9 Dec 2020 15:19 - Edited by: toyota_mdt_tech
Reply 


Wife is all signed up, retires next summer, she did the medicare right before 65 sign up, and she signed up and paid for first month even though it doesn't start till June. She got her part D also.
She is covered via her work now.
She got an advantage plan.
I have never seen so much solicitation mail in my life, worse than election year for the medicare.

Nobadays
Member
# Posted: 9 Dec 2020 17:41
Reply 


Quoting: toyota_mdt_tech
I have never seen so much solicitation mail in my life, worse than election year for the medicare


And it doesn't stop! This year before and during open enrollment we both got inundate with mail, emails and phone calls wanting us to switch providers. We are covered and happy with what we have, if not I would go shopping, don't need companies hounding us. If I understand it correctly, you only have the one period of 6 months after you turn 65 where you are 100% guaranteed coverage and preexisting conditions cannot prevent you from getting coverage. My guess is companies hound us to change providers every year hoping they can get you to jump at a seemingly lower price but then spring the...."oh we can't cover you for that because it is a preexisting condition. " So what you were covered for, now you're not.

paulz
Member
# Posted: 11 Jan 2021 14:27
Reply 


Quoting: gcrank1
Btw, look into the AARP membership that allows you to utilize their United Heathcare and Drug plans;


Geez, can a day go by without something from United Healthcare in the mail?

Today we got something about a $100 per quarter OTC products credit, free! Catalog of stuff came with it. Sounds good, ever heard of it? No catch?

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