Educate me on Medicare

[Evans, Marv]

When I was working, my insurance covered me & my wife. When I retired, I went onto my wife's insurance, which she had to activate since she was on mine before. When she changed to a different district that didn't offer free coverage for family members, I went onto Medicare. There wasn't any penalty since I was covered under a private plan up to that point. I've been with Kaiser for decades, and chose it when I went onto Medicare and signed up for the Advantage plan. Medicare premium is something like $153/mo. and an additional $20/mo. for that Advantage add on. These are taken out of my social security monthly. So for me, I haven't noticed any difference in coverage, except for one thing.

When I had commercial coverage, I was always getting tested for several things every three to six months (at least it seemed that way). Now it's a routine visit once a year. However I can email my doc, and he schedules whatever he thinks I need based on my description (same doc for 22+ years) or an appointment he schedules usually within a couple of days. Copays are more but not excessive (I paid a $160 copay for a CT scan several months ago). Labs are more - maybe $40-$60. However it seems like they aren't as concerned about me in general as they used to be. I'm supposing it's because they get lower payments from Medicare. I did comment to a nurse one time it seemed like I'd been kicked to the curb since going on Medicare. She answered that observation might deserve some merit.

[schwarz633]

Originally Posted by 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.

According to this, that's not true if the employer has less than 20 employees:

https://www.fool.com/retirement/2017/05/25/do-i-need-to-enroll-in-medicare-if-im-still-workin.aspx

But then these say that you qualify for a SEP is you're covered under a group policy, no mention of the 20 employees:

https://www.ehealthmedicare.com/apply-for-medicare/when/late-enrollment-penalties/

https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html

All of these links seem to use the words "some people", "usually", "may", and "should" quite liberally. I'll be talking with the UHC agent in few days, maybe I'll gain some clarity on the subject.

[Zeke]

You can apply early and you should. It takes some time for the whole thing to be complete up and running for you. Get it in place as soon as you decide so your coverage starts the day you're eligible.

There are some good books on Medicare. I bought one a few years ago called "Medicare Demystified" written by a doctor. There are others as well. Lots, in fact.

[vinny c]

I've been on Kaiser Advantage for 9 years. Hip replacement 3 years ago cost $560 (2 days in hospital). Covered home visits for PT and several follow up appointments.
Getting other side done tomorrow. Should be home same day. We'll see. Trying to get things done around the house. Did take 911 out for Italian tune-up. Won't be getting into a sport seat for 2 months or so.

Vince

[JavaBrewer]

My Mom is 82 and paying $600/month for supplemental insurance on top of the $150 for Medicare. Dad signed up for some bogus policies but I want to make sure I'm not cancelling something that she might need in the future.

IMO this stuff is in constant flux and may need to be reevaluated more often than not.

[Crowbob]

I thought Medicare was for old people.

...DOH!

[Joe Bob]

If you retire at 62 and start S/S payments....do you still have to wait until 65 for Medicare or can you get it then as well?

[Crowbob]

I believe you have to wait unless you're on (or get on) disability.

[Tobra]

Originally Posted by 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.

I am not so sure about this.

I have patients that are still working and have medicare benefits. Medicare is always primary, employer's plan is secondary.

[Zeke]

Originally Posted by Joe Bob

If you retire at 62 and start S/S payments....do you still have to wait until 65 for Medicare or can you get it then as well?

Yes.

[Joe Bob]

Yes, which way u old phart?

[ossiblue]

Originally Posted by Joe Bob

Yes, which way u old phart?

65 to start Medicare.

[Baz]

Bumping this thread.....

Was told that Blue Cross Blue Shield is a strong player in my state and other states in the south.

As has been mentioned.....some of these company's do not extend away from major metropolitan areas. Supposedly, BCBS does more than Humana.

I'm still a little ways out from enrollment so have time to research.

[hcoles]

Originally Posted by Zeke

Yes.

I don't think so. I haven't heard anyone getting Medicare before 65. SS can be started at any age from 62 to 70. The amount you get goes up 8% per year that you wait until 70. Medicare you get when you are 65, I think you get penalized if you don't sign up. Please provide link if I'm wrong on this.

[Zeke]

Originally Posted by hcoles

I don't think so. I haven't heard anyone getting Medicare before 65. SS can be started at any age from 62 to 70. The amount you get goes up 8% per year that you wait until 70. Medicare you get when you are 65, I think you get penalized if you don't sign up. Please provide link if I'm wrong on this.

My answer was ambiguous. I was answering the way you believe it to be. 65, not before.

[ossiblue]

Originally Posted by hcoles

I don't think so. I haven't heard anyone getting Medicare before 65. SS can be started at any age from 62 to 70. The amount you get goes up 8% per year that you wait until 70. Medicare you get when you are 65, I think you get penalized if you don't sign up. Please provide link if I'm wrong on this.

This is correct^^.

Medicare has two parts, A and B. Failure to sign up for part A will lead to an annual penalty for the duration of your life. There are some cases where you may delay signing up for part B without penalty, such as if your employer or spouse has you covered on a group policy, but usually you must sign up for part B at the same time as part A to avoid any penalties.

https://www.ehealthmedicare.com/medicare-enrollment-articles/medicare-enrollment/

[hcoles]

Be advised that there are two general ways to go with medicare .....

Regular Medicare - you select your doctor(s) and go the appointments/etc. If the doctor takes Medicare you are generally good to go - just go to the appointment and walk out when finished. In addition most people also buy a supplemental plan that "covers" what Medicare doesn't cover. For example we have AARP Plan F which is via United Health Care. Usually these sup. plans don't cover dental - but there could be exceptions. Typically you also get a supplemental prescription plan. We have Silverscript. So you end up with three bills per month so to speak: Medicare, medicare supplement and prescription supplement. In addition you pay for co-payments and deductibles.

A Medicare Advantage Plan - These sorts of plans have become more popular recently. They are "all-in-one" type plans. The prescriptions (drug) cost and medical appointments/etc. are all covered under one plan and you select from a specific set of doctors that are likely paid a salary. Many advantage plans include e.g. dental. These are sort of like a Kaiser type of plan - in fact I think Kaiser offers advantage plans for those over 65.

With the advantage plans the government gives the plan the money they allocated for you as if you were on regular Medicare. The government pays this money out weather you are sick or not. This is why some of the original advantage plans were free or very close to it. In a sense the government signs you over to a private company to cover all your medical costs.

The business incentive is completely different comparing the two approaches:

1 - Regular Medicare - your doctor or hospital increases profits by doing stuff (procedures/etc.) to you (like your doctor does now, before you are on Medicare) E.g. the hospital charges $47 for a box of Kleenex and Medicare pays $7 which is the agreed price they pay for a $1 box of Kleenex served in your hospital. I think most of you know the drill on how this goes.

2 - Advantage Plan Medicare - they increase their profits by not doing stuff to you.

I've read that if you select an advantage plan and want to switch back to regular Medicare the process can be difficult. Going the other way is not. The government doesn't want to be responsible for you. I don't know what happens if your advantage plan goes broke.

I hope what I've said is correct - maybe others can post to correct me and/or educate us more.

[Danimal16]

Originally Posted by John Rogers

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

I cannot speak for disabled-retired military.

BUUTTTT, if you are retired military, you must have medicare a and b to remain eligible for TriCare. https://www.tricare.mil/medicare

[sammyg2]

Educate me on Medicare

Based just on what I saw with my parent's experiences, Medicare is when you pretend to get medical care and the gubmint pretends to pay for it.

[Steve F]

What to do if you stay employed and under the company plan?


Thanks