Educate me on Medicare

[Hugh R]

I'll be applying for it in four months. I've looked at Medicare.gov and Humana.com and sort of get the jist of it. I understand there are penalties for applying outside the seven month window when you turn 65.

Any good or bad supplemental plan experiences, tricks you wish you knew before, etc.

Thanks,

[Tobra]

You can have regular medicare, or sign up for a "medicare advantage" plan, that essentially subcontracts your medicare benefits to a third party managed care plan, often an HMO style program. Regular medicare is an 80/20 plan, covers 80% of allowed charges, managed care plan will be different, may exclude certain stuff, or have a limited panel of providers. These will also tend to have more limited formularies for prescriptions, or may limit who you have to go to for durable medical equipment.

The supplement is to pick up that 20%. The supplemental plan will depend in large extent to whether you have signed up for regular medicare or one of the managed care plans. Supplement plan generally will parallel benefits of medicare, but that is not always the case. Better have your business manager go over it with you.

Oh yeah, a supplemental plan that is primarily in California may not have anybody in Pennsylvania that is on their list of providers.

[hcoles]

I've been warned re. going with an "advantage" plan. You are basically signing all your benefits over to an HMO. We have a "supplement" plan through AARP called Plan F. We have yet to understand how it picks up the 20%/etc. - only been on Medicare for about 1 year. We also got a supplement plan for prescriptions - that plan is called Silverscript.

[wdfifteen]

All I can add that never came up in my research was the premiums for part B are based on your income and AND your tax filing status. Be careful filing as as married filing separately, it puts you in the highest premium level - $400+ per month vs $135.
The first year I was on Medicare we filed as MFS because of my wife’s business. The $4000 extra I paid for Medicare was more than she saved on her taxes by filing that way.

[wdfifteen]

Originally Posted by hcoles

I've been warned re. going with an "advantage" plan. You are basically signing all your benefits over to an HMO. We have a "supplement" plan through AARP called Plan F. We have yet to understand how it picks up the 20%/etc. - only been on Medicare for about 1 year. We also got a supplement plan for prescriptions - that plan is called Silverscript.

Sounds like the same setup I have. I’m happy with it.

[ossiblue]

Tobra has summed it up pretty well, but just a few other details.

The sign up deadline is for Medicare, Part B, which is optional but, IMO, really essential. That is the part for doctor's care, visits, etc. That Part B requires you to pay a premium each month, currently $140 for the lowest rate. That premium will be larger depending on your retirement income and filing status.

In addition to that premium, you may need a supplemental policy as Tobra mentioned to pick up the 20% that isn't covered by the Medicare B option. This is where the private companies come into play, offering different policies/coverage for different amounts, for that supplemental coverage only. Typically, you pay a separate premium as payment for their coverage. Their coverage only kicks in to cover expenses not covered by the Medicare B coverage, and the amount you pay, in addition to their monthly premium, is based on their co-pays and deductibles for you. This type of supplemental policy does not cover drugs, that's Part D, and requires a separate policy.

Medicare Advantage Plans cover both supplemental coverage and drugs. Many are HMO, have restrictions, and receive your Part B premium as partial or total payment for the plan. For example, I have Kaiser Medicare Advantage, pay no money beyond my monthly (actually quarterly) payment to SSS, and I have complete coverage for hospital, doctors, and drugs. Used to have an Anthem Advantage plan that had similar coverage for doctors and drugs, but was a PPO set up and, originally cost an additional $40/mo. That rose to over $160/mo. within two years so I switched to the Kaiser Plan.

Simply put:

Medicare Part A only=You pay nothing but it is only for hospitalization, basically. Everyone who qualifies receives this benefit, free.

Medicare Part B=you pay a monthly premium to SSS for doctor visits, etc. but it only covers 80% of the charges.

Medicare B w/supplemental plan=You pay SSS premium, plus a premium a private company for coverage of your 20% obligation, plus co-pays and deductibles out of pocket. You need another policy to cover drug costs with the additional premium, but some plans offer it as part of their premium costs.

Medicare Advantage plan=You pay monthly SSS premium and Advantage plan typically accepts that amount for their supplemental coverage for your 20% obligation. Includes a drug plan as well at no additional cost, typically.

[tabs]

A plus N is what you get from the govt 80/20 to pick up the 20 you have choices. Plan C is a no cost HMO that has prescriptions. Humana, United, blue cross. OR. Plan D a monthly cost prescription plan. Plan G ipo a monthly cost about 130 for me that has prescriptions. Plan F Ipo is a bit more expensive & has prescriptions.

Depending on your medical needs is where you fall. If you need a lot plan F. G if moderate. If you are pretty healthy C. Think of it as a flow chart.

A friend who is 80 and has lots of problems has plan F, his wife who has some problems has plan C.

[ossiblue]

Originally Posted by tabs

A plus N is what you get from the govt 80/20 to pick up the 20 you have choices. Plan C is a no cost HMO that has prescriptions. Humana, United, blue cross. OR. Plan D a monthly cost prescription plan. Plan G ipo a monthly cost about 130 for me that has prescriptions. Plan F Ipo is a bit more expensive & has prescriptions.

Depending on your medical needs is where you fall. If you need a lot plan F. G if moderate. If you are pretty healthy C. Think of it as a flow chart.

A friend who is 80 and has lots of problems has plan F, his wife who has some problems has plan C.

This^^(bold) is the most important criterion, IMO.

[Baz]

Subscribed......I'll be 65 next June!

[John Rogers]

Are you retired military or disabled-retired military? If so Tricare for life.

[Hugh R]

Thanks guys, lots to decipher in the next four months. No tricare for me.

[vash]

can you hire a firm to help fill out paperwork?

i'm nowhere near agewise..but this still freaks me out a bit.

[greglepore]

If you're still splitting times time between two locales an Advantage plan may be difficult, as many are hmo/ppo tied to a locale. You can get out of network tx but not usually for a long time.

Other than that, I'd seriously check out an Advantage plan-often its a pretty good deal compared to traditional Medicare plus a supplement, but yes, there is a lot to digest. And the target moves every year with the open enrollment period. There are consultants, both private and paid for by the industry, that can help.

[tabs]

It is a bit daunting. In nv the state has a consulting service to show you the ropes...then you compare different companies plans. They are all about the same as mandated by law.

If you are healthy I can already tell you you are going with plan C HMO. It is no extra cost than the 140 a month you are already paying out of your SS check. The determinant is your moving around? It picks up the 20%, offers prescriptions. They have a list of providers that accept that plan.

[jcommin]

I'm about 23 months away but I have listened to others and most use a consultant. I'm probably going to start interviewing them over the summer. I hope to have a plan in place by next year.

[RKDinOKC]

With my Mom we got her what you are calling an Advantage plan. Basically she was signed up with an insurance that paid for everything, 100% and took what she would have received as medicare as payment. She only gave her insurance card and NOT Medicare. Any care went thru her primary physician. He was the gatekeeper and sent her to all other specialist, services, health care needs.

Her care was the same as when she was using Medicare - with Supplemental insurance to cover what medicare did not. The care was the same, and she did not have to spend the extra money to cover that 20%. And drugs were only $4 each no matter what it was. Saved her to cost of paying for the supplemental insurance.

Had a advisor that helped us shop her current maladies and prescriptions around to get an Advantage plan that would take her.

Have two brothers that went to the VA for their health care after retirement and am sorry to say, I would not wish that on anyone.

[greglepore]

Go read the letters to the ed in todays WSJ. Seems the docs don’t like advantage plans, perhaps because its government funded private insurance, maybe the worst of all worlds


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[schwarz633]

Not to derail this thread, but I am turning 65 in a month and plan on working another 4 years until my wife turns 65, as she is covered under my employer provided coverage. My first thought was to ignore all the Medicare mailings I've been getting, but after doing a little research I see that's it's not that simple.

My current health insurance is provided by XX Corp with XX Corp paying 100% of the premium. It's a UHC high deductible policy with XX Corp funding an HSA account in the full amount of the deductible. XX Corp is an S corporation with fewer than 20 employees and I am a 50% owner.

From what I'm reading I would be penalized 10% for twice the number of years that I delay enrolling in Part A, and 10% for each year that I delay Part B, forever. Enrolling in Medicare also appears to make me ineligible to contribute to an HSA account, not sure if that applies to the employer contributions as well. None of this makes any sense to me.

Any words of wisdom?

[93nav]

schwarz633,

I thought that if you were covered under a private plan there would be no penalty for delaying signing up to Medicare. Others may know better.

[JackDidley]

Originally Posted by greglepore

If you're still splitting times time between two locales an Advantage plan may be difficult, as many are hmo/ppo tied to a locale. You can get out of network tx but not usually for a long time.

Other than that, I'd seriously check out an Advantage plan-often its a pretty good deal compared to traditional Medicare plus a supplement, but yes, there is a lot to digest. And the target moves every year with the open enrollment period. There are consultants, both private and paid for by the industry, that can help.

Costs seem to depend on what state you live in.I joined AARP just to get an advantage plan offered through AARP. It is an HMO but that is not a problem for me as my care providers are pretty much in network. Have a look at the AARP thing, it worked for me.