Here comes Medicare

[AZjeff]

The time is coming, I turn 65 in April and don't work and wife is going to retire in July at full retirement age. We've been trying to educate ourselves about the options with little success and much confusion so decided to go to a 2 hour seminar by a local "Medicare specialist". His background was in Medicare billing for a number of care facilities in northern Arizona before going on his own as a broker and saw the financial problems people had both by not understanding what they had and not having the right thing for them. We were surprised that he advises the best choice for the most coverage with the least hassle is original Medicare A & B & some level of D along with supplement G from the company that best meets your situation . The qualifier is it does cost more that Advantage plans but his take is Medicare is accepted almost universally across the US and with G your max out of pocket yearly is $233. He's up front saying if you can afford it in his opinion it's the best choice for the best coverage with the least hassle. If you travel he's even more in favor of original Medicare.

I'm not looking for advice but am curious of what the experience of those already using Medicare or an Advantage plan has been both good and bad. I never understood why it was such a big deal for my parents every year about meds and changing D plans, now I do.

TIA for your replies.

 

[JohnnyG]

I agree with him on the G supplement. Only thing is it's not offered in all states or to all income levels, so you just have to see what's available. Having said that, I ended up with a supplemental "F" plan. It's a bit pricey, like $140.00 per month, but there is never any additional charge or co-pay for anything. Doctor visits, stent placement, knee replacement, nothing out of pocket except the premiums. Fortunately my retirement benefits reimburse me for the premiums, so it works for me. There also might be an H plan that you don't hear about.
Supplemental "D" plans are plentiful. I chose Humana, but they are about $70.00 per month, and I don't feel I'm getting my money's worth on that one.
As far as a part "C" supplement, plenty of hassels and people sure do take ADVANTAGE of it. A friend of ours seems to get a new pair of glasses every month or two. Had teeth pulled (covered) whereas a regular dentist would have likely saved them for a price.
Most doctors seem to take those plan supplements around here now, and you can tell by the number of commercials on TV, that they are BEGGING for new members.

Dy-NO-MITE!!

 

[ARCOgraphite]

Az, I hope you signed up for Part A during the 3 month window around your birthday.

 

[CKN]

The time is coming, I turn 65 in April and don't work and wife is going to retire in July at full retirement age. We've been trying to educate ourselves about the options with little success and much confusion so decided to go to a 2 hour seminar by a local "Medicare specialist". His background was in Medicare billing for a number of care facilities in northern Arizona before going on his own as a broker and saw the financial problems people had both by not understanding what they had and not having the right thing for them. We were surprised that he advises the best choice for the most coverage with the least hassle is original Medicare A & B & some level of D along with supplement G from the company that best meets your situation . The qualifier is it does cost more that Advantage plans but his take is Medicare is accepted almost universally across the US and with G your max out of pocket yearly is $233. He's up front saying if you can afford it in his opinion it's the best choice for the best coverage with the least hassle. If you travel he's even more in favor of original Medicare.

I'm not looking for advice but am curious of what the experience of those already using Medicare or an Advantage plan has been both good and bad. I never understood why it was such a big deal for my parents every year about meds and changing D plans, now I do.

TIA for your replies.

That coverage is exactly what I signed up for after talking with someone who has been advising clients for 20 years. But yes-since it's the Cadillac of options and it costs considerably more. The upside is that for most issues you do not need pre approval from original medicare.

 

[DwightFrye]

The only thing I will add is before choosing any supplemental plans, check with your doctor(s) to see if they will accept it.
I didn't want to change doctors because there are only two small clinics in my town and one of them didn't accept any of the popular plans. The next doctors that did were 35 miles away.

I didn't want to change my dentist either, he is awesome and I have been seeing him for more than 20 years. But he only accepts PPO plans which are quite a bit more expensive. So I pay the higher premiums.

In any case, my yearly premiums whether taken out of my SS checks or paid directly to the provider are much higher than the deductions from my paychecks when I had an employer provided plan, and higher even when you factor in the percentage that my employer contributed. And I pay higher co-pays and deductibles when I do have doctor and dentist visits and need prescriptions filled.

 

[levi]

The time is coming, I turn 65 in April and don't work and wife is going to retire in July at full retirement age. We've been trying to educate ourselves about the options with little success and much confusion so decided to go to a 2 hour seminar by a local "Medicare specialist". His background was in Medicare billing for a number of care facilities in northern Arizona before going on his own as a broker and saw the financial problems people had both by not understanding what they had and not having the right thing for them. We were surprised that he advises the best choice for the most coverage with the least hassle is original Medicare A & B & some level of D along with supplement G from the company that best meets your situation . The qualifier is it does cost more that Advantage plans but his take is Medicare is accepted almost universally across the US and with G your max out of pocket yearly is $233. He's up front saying if you can afford it in his opinion it's the best choice for the best coverage with the least hassle. If you travel he's even more in favor of original Medicare.

I'm not looking for advice but am curious of what the experience of those already using Medicare or an Advantage plan has been both good and bad. I never understood why it was such a big deal for my parents every year about meds and changing D plans, now I do.

TIA for your replies.

Wife and I recently went through this process. Over a few months we talked to at least 3 different "specialists", "advisors".

Just know any advisor that can sign you up for a particular plan basically can only do so with companies with which they have an agreement. They really aren't going to recommend someone from whom they won't get paid. Of course most have an agreement with multiple companies. But that does not guarantee the very best match for you.

The field of choices is (to me) incredibly complex. Many times a choice can be dictated by meds you are trying to get covered more than anything else. The process ain't easy. And like your parents, every year you'll want to review your options to see if something more affordable has popped up that will benefit you.

Two points - use an advisor. Talking to them about your needs and situation will educate you more than you may think. They may make your head spin talking about options, plans. etc. Get used to it. Talk to more than one advisor. There was never any charge or cost from them. They get paid if they sign you up with someone, and it does NOT raise your premium.

Secondly, I would avoid an Advantage Plan. JMO. Yes, they can be incredibly inexpensive. And you may yet decide that is best option for you. But before you pull the trigger, go online and search for people who have been on it. Some like it just fine, but a whole bunch hate it. And it is possible to get locked into one and not be able to change.

Best wishes on your journey.

 

[AZjeff]

Everything mentioned so far tracks with what he said in his seminar. We're going to go listen to someone else to see if the advice is any different.

I've already signed up and of course wife did a year ago. We're used to a pretty high level BCBS plan and can afford A,B,G so are leaning that way. One very interesting thing learned was initial enrollment is guaranteed on any plan but after 6 months if you change plans or go from Medicare to Advantage etc you're subject to medical underwriting and can be denied so it's important to try to make the best choice.

C&F supplements are no longer available BTW and H isn't even on the list. We're in a low population county so the available plans & companies is pretty limited. We really don't have many doctors but good advice to check with them.

They certainly didn't make this easy to do thank you very much .Gov

 

[BlueOvalFitter]

I agree with him on the G supplement. Only thing is it's not offered in all states or to all income levels, so you just have to see what's available. Having said that, I ended up with a supplemental "F" plan. It's a bit pricey, like $140.00 per month, but there is never any additional charge or co-pay for anything. Doctor visits, stent placement, knee replacement, nothing out of pocket except the premiums. Fortunately my retirement benefits reimburse me for the premiums, so it works for me. There also might be an H plan that you don't hear about.
Supplemental "D" plans are plentiful. I chose Humana, but they are about $70.00 per month, and I don't feel I'm getting my money's worth on that one.
As far as a part "C" supplement, plenty of hassels and people sure do take ADVANTAGE of it. A friend of ours seems to get a new pair of glasses every month or two. Had teeth pulled (covered) whereas a regular dentist would have likely saved them for a price.
Most doctors seem to take those plan supplements around here now, and you can tell by the number of commercials on TV, that they are BEGGING for new members.

Dy-NO-MITE!!

I was put on SSDI at age 49. I too am on a BCBS TYPE F plan. But my monthly rate is 3.5X the rate you're paying at $140. I'm not happy about it but I have saved probably AT LEAST $150K of out of pocket expenses for the 20% Medicare doesn't pay for all of the operations I have had.
TYPE F is not available anymore. Those that had it before it was taken away can keep it-AKA-Grandfathered in.

 

[CKN]

Wife and I recently went through this process. Over a few months we talked to at least 3 different "specialists", "advisors".

Just know any advisor that can sign you up for a particular plan basically can only do so with companies with which they have an agreement. They really aren't going to recommend someone from whom they won't get paid. Of course most have an agreement with multiple companies. But that does not guarantee the very best match for you.

The field of choices is (to me) incredibly complex. Many times a choice can be dictated by meds you are trying to get covered more than anything else. The process ain't easy. And like your parents, every year you'll want to review your options to see if something more affordable has popped up that will benefit you.

Two points - use an advisor. Talking to them about your needs and situation will educate you more than you may think. They may make your head spin talking about options, plans. etc. Get used to it. Talk to more than one advisor. There was never any charge or cost from them. They get paid if they sign you up with someone, and it does NOT raise your premium.

Secondly, I would avoid an Advantage Plan. JMO. Yes, they can be incredibly inexpensive. And you may yet decide that is best option for you. But before you pull the trigger, go online and search for people who have been on it. Some like it just fine, but a whole bunch hate it. And it is possible to get locked into one and not be able to change.

Best wishes on your journey.

My advisor outright told me he doesn't make as much money on the original Medicare plan and the "G" supplemental. He said he makes much more on the " Advantage inclusive ones" but wanted to do what was best for me. Again-20 years experience. This is one of those times when no matter how intelligent one thinks they are-you need someone who looks at these things as their full time job. They are VERY confusing. I had my (young) guy who handles my car insurance who wanted to sell me some Medicare. I very politely told him no thank you and explained why.

 

[CKN]

I was put on SSDI at age 49. I too am on a BCBS TYPE F plan. But my monthly rate is 3.5X the rate you're paying at $140. I'm not happy about it but I have saved probably AT LEAST $150K of out of pocket expenses for the 20% Medicare doesn't pay for all of the operations I have had.
TYPE F is not available anymore. Those that had it before it was taken away can keep it-AKA-Grandfathered in.

Yes-if it wasn't for the government medical program you would be not be able to get insurance-OR it would be cost prohibitive for you to do so.

 

[wag123]

It depends on where you live. If you live in a larger metro area with many doctors and several good medical facilities, part C can make sense. If you live in a rural area with few doctors and few medical facilities, your broker is right, you are better off with A, B, D, and medigap.
There are now a few part C plans available in some areas that will cover you within their network when you travel. That is the plan that I went with.

 

[jstert]

i can’t directly reply as my medicare supplement is tricare for life, courtesy of 25 years of military reserve service. if i had to buy a supplement i would likely choose a medicare advantage ppo plan as most offer decent urgent care anywhere, even when abroad. otherwise medicare pays nothing upon leaving the usa.

one thing i stupidly missed was the intial, medicare-paid, comprehensive, base-line, health examination that must be done within a limited time window upon first enrolling in medicare. after this window closes medicare pays only for specific complaint related care or an annual verbal counseling (latter is pretty much worthless imho). getting some expert advice on medicare is useful, the self-learning curve is steep.

 

[AZjeff]

one thing i stupidly missed was the intial, medicare-paid, comprehensive, base-line, health examination that must be done within a limited time window upon first enrolling in medicare.

Is this a military thing? My wife signed up last year before her 65th and was issued a genuine Medicare card and was enrolled with no exam.

 

[jstert]

Is this a military thing? My wife signed up last year before her 65th and was issued a genuine Medicare card and was enrolled with no exam.

not military-related and no exam is required for medicare enrollment. the initial medicare-paid exam is a once in a lifetime opportunity to establish a baseline snapshot of one’s health at 65yo that may be useful going forward. kinda like one free, initial, used oil analysis from the car manufacturer. i wasn’t paying attention to all the small print of medicare when i enrolled because i’m in good health, so missing it is not a life-changing mistake on my part, but it would have been a nice freebie.

 

[Wolf359]

Is this a military thing? My wife signed up last year before her 65th and was issued a genuine Medicare card and was enrolled with no exam.

Seems like it's a regular thing.

Are annual physicals covered by Medicare?

Medicare mainly covers medical treatment and appointments, but coverage sometimes includes preventive tests. Here, find out about Medicare and annual physicals.

www.medicalnewstoday.com

Why Medicare Does Not Cover the Annual Physical Exam

While Medicare does not cover annual physical exams, it does cover a single initial preventive physical examination, followed by annual wellness visits.

blog.prevounce.com

 

[MHartfield]

I'm using Humana and A&B, and I don't pay anything extra except for a colonoscopy ($50) and 1/3 of the shingles shot ($75). One of the local HMOs here in SoCal does a seminar every November where the various insurance companies talk about their changes for the next year. I'd keep an eye out for these. I'm a CPA with a business background, so I'm familiar with medical insurance. The few independent Medicare salesmen & women that I've talked to have been very square.

AZJeff:
What insurance company did you end up with? I'm moving to Bullhead City shortly snd may need to change, although Humana has been very good here in SoCal.

 

[AZjeff]

AZJeff:
What insurance company did you end up with? I'm moving to Bullhead City shortly snd may need to change, although Humana has been very good here in SoCal.

We don't have to finalize for a couple of months and have a Zoom with the broker tomorrow. We were looking tonight and there isn't $5/month difference in the supplemental G from the companies we looked at.

 

[SeaJay]

The wife and I were lucky, an essentially free Medicare supplemental policy including 100% prescription costs on generics when she retired.

For those having to pay the full freight for a Medicare supplemental policy it is an expensive option. The main advantage is that it attaches excess over Medicare for any procedures covered by Medicare. Advantage plans while often far less expensive, require procedures and visits to be in their network of providers to obtain full coverage. More restrictive but less out of pocket costs. YMMV.

 

[wag123]

Advantage plans while often far less expensive, require procedures and visits to be in their network of providers to obtain full coverage.ss out of pocket costs.

Yes, but, the employer's health insurance that I was on for 30+ years also required the use of their provider network. Most employer health insurance coverage is this way.
The one important thing that I wanted was a PPO, not an HMO, policy. I went through the HMO thing with our health insurance policy over 20 years ago and I didn't want to get into that trap again. A PPO lets you go directly to any doctor or specialist within their network without having a referral from your primary care doctor. The part C PPO plan that I chose was less than half the monthly cost of combined A+B+minimal D+minimal medigap plans, has zero deductible or copay for most services or tier 1&2 drugs, and includes dental and eye coverages.

 

[Yah-Tah-Hey]

The time is coming, I turn 65 in April and don't work and wife is going to retire in July at full retirement age. We've been trying to educate ourselves about the options with little success and much confusion so decided to go to a 2 hour seminar by a local "Medicare specialist". His background was in Medicare billing for a number of care facilities in northern Arizona before going on his own as a broker and saw the financial problems people had both by not understanding what they had and not having the right thing for them. We were surprised that he advises the best choice for the most coverage with the least hassle is original Medicare A & B & some level of D along with supplement G from the company that best meets your situation . The qualifier is it does cost more that Advantage plans but his take is Medicare is accepted almost universally across the US and with G your max out of pocket yearly is $233. He's up front saying if you can afford it in his opinion it's the best choice for the best coverage with the least hassle. If you travel he's even more in favor of original Medicare.

I'm not looking for advice but am curious of what the experience of those already using Medicare or an Advantage plan has been both good and bad. I never understood why it was such a big deal for my parents every year about meds and changing D plans, now I do.

TIA for your replies.

That is exactly what we have. Our local hospital does not accept Medicare advantage plans so the only choice we have is finding the right broker and what Part B gap coverage we need. I have the G plan, but wife kept the F plan in line with her health. I think many, many individuals who switch to the advantage plans due to all the misleading media hype are going to regret their choice. There is no free lunch guys.