Anyone have any Medicare Advice?

[misty8723]

Last Monday I was told my position at work was being eliminated and my last day is April 2. This was not unexpected, I hung in there more years than I thought I would, and I'm not unhappy. I'm 70 and thinking about retirement for a long time, so now I get to leave with 10 weeks severance and supinsurance for the rest of the month of April.

Hubby and I already have Part A, but need to sign up for Part B and the supplements. I've been researching (for a long time actually), but it seems I can't sign up for Part B until I get a certain form from my employer, which they won't send to me until I'm officially no longer employed. I would really like Medicare to start on May 1 so I can avoid COBRA while I'm waiting, but it's not looking good. I have an appointment with SHIIP on Thursday, but I've already talked to her and she was not certain I could get it to start on May 1.

But....I'm just looking for some general information from anybody who already has it. I'm thinking we will probably go with Part G supplement, but it seems there's a huge range in cost based on which insurance company you get it from (with no difference in benefits). I'd like to get it from a reputable company, but I don't want to pay a fortune if I can avoid it. You can't even get a quote unless you call them. It seems a few years ago there was a site you could go to compare all of them in one place, but I can't find one now. Anybody know of one? Anybody got a good deal on their supplement?

Part C has some attractive parts like dental and vision, but some limitations. I need to research this a little more.

Any advice will be appreciated

 

[denice]

I just turned 65 and signed up for Part A only because I still have employer coverage. The form verifies that you had a qualifying group plan for the six months prior to retiring. You need to get it to avoid paying a punitive penalty for putting off signing up for Part B. I haven't researched the plans but I do medical billing for ambulance service. The Medicare Advantage plans aren't good for emergency bills, they are more geared towards preventative care. People with Advantage plans always get stuck with a higher copay for emergency care. The best combination I have seen for emergency bills is Traditional Medicare and the AARP supplement. Emergency bills are 100% covered by that combination. The AARP supplement is actually a United Healthcare company. I do not know how much it costs. One thing you do need to be aware of though, if Medicare disallows a bill then the supplement also will. We run into that a lot with ambulance bills that are deemed Medically Not Necessary, the dreaded MNN. If that happens to you you have the right to appeal but there is a time limit on appealing. Don't mess with trying to get your own medical records, just appeal and Medicare will then get the records.

 

[artiemom]

I had an Advantage plan for a few years. I found that I was paying out a ton in co-payments. It depends on your medical history. If you had several doctors, and have on going appointments, expect a co-payment. Also on medical procedures.

I changed it a year ago to: Regular Medicare and a Supplement. So far, it has worked out well. I do not have any referrals, can go to any hospital.. Yes, It is expensive, but I was paying out pretty much the same amount with co-payments on the Advantage plan.

Waiting and wondering how my hospital bill will be taken care of... but that is Medicare, from what I understand--all inpatient...

With a supplement, you have to find a prescriptions coverage plan...

The Advantage, is all All-in-One... instead of Medicare..

The way it was explained to me, is that you really do not make out to your advantage, with any plans.. I was advised to stay with original Medicare, get a supplement, and a prescription plan.

But, this is for me... you may be very different... so an Advantage Plan may work out for you...

I like the option of not having an HMO. I prefer, since I have access to so many hospitals, that I have a choice of where to go and who to see, without referrals..

Good Luck..

 

[susanm9006]

You definitely need something to go with your Medicare. Part D is for prescription drug coverage and needs to be purchased in the market place plus you should have either an Advantage plan or a supplement. Medicare plus Part B in itself is good coverage however it doesn’t have annual maximum out of pocket limits so if you have multiple Illnesses or hospitalizations it can be a financial disaster.

I have an Advantage plan which includes Part D drug coverage and it only costs $56 a month. It has maximum out of pocket limits so and $20-$40 copays for some things. In order to purchase an Advantage plan you must also carry part B, so I spend $148 a month on part B plus the $56 for the Advantage plan.

You can also go the Supplement route. They tend to be a bit more complicated and you may also need to purchase your Part D separately. Some brokers will do comparisons for you and the Advantage plans usually have great marketing materials.

 

[misty8723]

I just turned 65 and signed up for Part A only because I still have employer coverage. The form verifies that you had a qualifying group plan for the six months prior to retiring. You need to get it to avoid paying a punitive penalty for putting off signing up for Part B. I haven't researched the plans but I do medical billing for ambulance service. The Medicare Advantage plans aren't good for emergency bills, they are more geared towards preventative care. People with Advantage plans always get stuck with a higher copay for emergency care. The best combination I have seen for emergency bills is Traditional Medicare and the AARP supplement. Emergency bills are 100% covered by that combination. The AARP supplement is actually a United Healthcare company. I do not know how much it costs. One thing you do need to be aware of though, if Medicare disallows a bill then the supplement also will. We run into that a lot with ambulance bills that are deemed Medically Not Necessary, the dreaded MNN. If that happens to you you have the right to appeal but there is a time limit on appealing. Don't mess with trying to get your own medical records, just appeal and Medicare will then get the records.

I appreciate your input, it's very helpful. I know I need the form, but can't get it from my employer until I'm officially off the payroll. The only reason that's an issue is that I really wanted to see if I could get Part B started by May 1 to avoid either a coverage gap or having to buy Cobra. I'll have to see what the SHIIP rep has to say. I had a feeling based on what I've read that the Advantage Plans would not be a good option. I just like the fact that they have dental and vision, but I guess I'll see how much they cost to buy separately. It's very good to know AARP with United Healthcare is a good option. UHC is what I have through my employer and they've always been very good.
As far as ambulance, in this Town we have a subscription with EMS that would cover ambulance fees. We pay a nominal amount every year, so hopefully that won't be an issue should be every need one.

I had an Advantage plan for a few years. I found that I was paying out a ton in co-payments. It depends on your medical history. If you had several doctors, and have on going appointments, expect a co-payment. Also on medical procedures.

I changed it a year ago to: Regular Medicare and a Supplement. So far, it has worked out well. I do not have any referrals, can go to any hospital.. Yes, It is expensive, but I was paying out pretty much the same amount with co-payments on the Advantage plan.

Waiting and wondering how my hospital bill will be taken care of... but that is Medicare, from what I understand--all inpatient...

With a supplement, you have to find a prescriptions coverage plan...

The Advantage, is all All-in-One... instead of Medicare..

The way it was explained to me, is that you really do not make out to your advantage, with any plans.. I was advised to stay with original Medicare, get a supplement, and a prescription plan.

But, this is for me... you may be very different... so an Advantage Plan may work out for you...

I like the option of not having an HMO. I prefer, since I have access to so many hospitals, that I have a choice of where to go and who to see, without referrals..

Good Luck..

Thank you for the input about the Advantage Plans. I had a feeling they wouldn't be very good. A couple years ago when my husband needed an appointment with a gastroenterologist, we told them we had United Healthcare and they said they didn't take it. They thought based on his age that it was Medicare, and they did take my United Healthcare through my employer. So...I'm guessing stay with the supplements. Which supplement did you get? I thought F at first since I still qualify, but the SHIIP rep said we have to look at the cost benefits because G might be cheaper overall.

You definitely need something to go with your Medicare. Part D is for prescription drug coverage and needs to be purchased in the market place plus you should have either an Advantage plan or a supplement. Medicare plus Part B in itself is good coverage however it doesn’t have annual maximum out of pocket limits so if you have multiple Illnesses or hospitalizations it can be a financial disaster.

I have an Advantage plan which includes Part D drug coverage and it only costs $56 a month. It has maximum out of pocket limits so and $20-$40 copays for some things. In order to purchase an Advantage plan you must also carry part B, so I spend $148 a month on part B plus the $56 for the Advantage plan.

You can also go the Supplement route. They tend to be a bit more complicated and you may also need to purchase your Part D separately. Some brokers will do comparisons for you and the Advantage plans usually have great marketing materials.

Yes, I know I need something...the big question is what. I've pretty much ruled out the Advantage Plans, so it will be Part B which we have to have and medigap supplements. I've got one drug which is very expensive, but I think I found a Part D that isn't too bad. And a Part F or G I guess. I don't have a lot of medical issues except diabetes, but my husband has a bunch. I've heard we might be able to get a family discount if we both take the same plan(s). I know it's going to be expensive - which is why I want to make the best decision I can.

 

[artiemom]

I have Blue Cross. Not the best one, but the other one. I think it is Sapphire. The prescription plans can get you. They have a deductible and are pretty much the same, covering the same things as Medicare. And the tiers are similar. They get you one way or another

Sorry I cannot go by A,B, C....etc.
I find it simpler my way.

I have Cigna as my prescription plan. You have to decide which pharmacy you want or the mail order option.
I prefer Rite Aid. I do not care for CVS. They are too big for their britches. Had some bad experiences with them

Not many prescription plan allow Rite Aid.

Yes, you do need guidance on this. And need to decide how much you can afford on both plans.

Dental and eyeglasses are usually extra options.

I should add: there was a typo/autocorrect error on my original post.

I prefer NOT to have an HMO. I have a PPO.
I have doctors at 2 different hospitals and would get bogged down with referrals. Easy to mess up, if you have many appointments.

 

[DreamerRose]

I disagree with everyone about Medicare Advantage, and I think you should talk to several of the insurers about their Advantage plans (it's Part C). My policy has no (zero) premiums. Office visits are free, and I pay a $25 copay for specialists. Ambulance is free, as we are also subsidized by the city. Advantage is also HMO-based, so if your HMO doesn't include dentists, dental is not covered. Vision is covered if you go to an opthamologist in your HMO, but glasses are not. Catastrophic costs are covered well. I had two surgeries a few years ago that cost $250,000 each. I paid less that $1,500 for each of them. All of my prescription drugs are free, whether I use their on-line pharmacy (my preference) or a drugstore.

Don't wait to talk to the insurance companies. Do that now, and they will tell you what you need to do for coverage. All of the Medicare supplementary plans are the same; the only difference between the companies is the cost.

 

[fionasmom]

I ended up going to a broker who could discuss various plans with me. It was a big help. I have regular Medicare, Anthem F supplement, Silver Script for meds, no vision or dental. There is a small vision/dental on the Anthem Plan but my optometrist and dentist don't accept it and I won't change. Of course, ophthalmology of any type is covered by Medicare. My dentist advised me, based on my dental history, not to take dental insurance.

I did not take an advantage plan because I decided to call my drs to ask what insurances they accepted along with Medicare and several did not accept advantage plans. One office manager told me that doctors make less money with those plans. For my own medical reasons, I did not want to change doctors and I don't want to be part of any network that uses referrals.

Having said all that, my husband has no medical worries at all and chose SCAN. He needed to have a very tricky elbow and hand surgery so was referred to an orthopedist in that network. I do have to say that the surgery was a complete success, he is back to normal, and there is not even a visible scar. The office was easy to deal with and there were no problems with the billing.

Some of this might depend on your own health history and how attached you are to present doctors, if you need any specialized care of any kind. A lot of people do take those AARP plans; I can't speak to them as we are not AARP members.

 

[denice]

There are so many plans and new ones coming up all of the time. It is a nightmare when it comes to billing. Even those areas that do not balance bill for ambulance service, insurance is still billed. Medicare actually requires that patients be balance billed but the one exception is balance billing for ambulance service when the patient lives in district. The rationale being that the patient pays taxes, part of which goes to the fire department so they have in essence already paid their copays.

The average Medicare copay for an ambulance run is around $90.00. The average for Advantage plans is $250 to $300. After doing medical billing for almost 10 years I have already decided to stick with traditional Medicare.

A lot of people also don't realize that when they go into Hospice they automatically go back to traditional Medicare. None of the Advantage plans will work with Hospice, only traditional Medicare.

 

[lizzie]

My husband and myself both have the Aetna Medicare Premier Plus and have been very happy with it.It costs us nothing per month.We have $5 doctor co pays,I think specialists are $45 and the emergency room is $90.We made an appointment when he retired with an insurance agent here in town ( we worked together at WalMart when he was in high school) and went right in when I retired.So far no complaints.

 

[DreamerRose]

I have Humana Medicare Advantage, and I forgot to say that although the ambulance to the hospital is free, there is a $100 copay for the Emergency Department. But still, overall, I think the Advantage plans are the best way to go.

I looked at separate dental plans, and the quote was a $100 monthly premium, and the max annual payout was capped at $1,000. What a deal!

 

[artiemom]

I sincerely think it is up to the individual. It depends on medical needs, income, and what they feel most comfortable with..

Yes, I suggest an appointment with an independent 'broker'.. I know the government in every state provides some sort of person to help you negotiate through the plans and explain the red tape. It is free..

I would contact the local senior center. They may have someone there to help you out..

I was advised to take a look at how many office visits per year I have, where I go for medical care, and an estimate on how much I spend on medications per year.. This way, I would have an idea of which plan may be more suitable for me.. And how much you can afford per month on health insurance.

I also heard that Advantage plans are good for healthier people; since the premiums are usually lower, and out of pocket expenses (deductibles) are usually higher..
But it seems like a crap shoot..

It is a very individual decision...
Remember, you can change your plans every year through open enrollment.. That is what I did. I had an Advantage plan.. which seemed more costly in deductibles, as I was seeing more doctors.. So I switched to one which is higher in premiums, but no co-payments for office visits, and no referrals.. I had several things checked out, which I had been having symptoms for.. It has worked out well.. so far...
I will find out about the hospitalization part---medicare.. as soon as I get my bills...

I think next thing I will change will be a better prescription plan.. in the future.. right now, I am ok with what I have...

 

[Winchester]

I officially retired from work back in January 2020. In December 2019, I went to our local Social Security to sign up for SS. I also called Medicare to get things started. Rick and I went to an insurance agent to whom we were referred by close friends. She was able to help us figure out the best Part F and also a good drug plan. The Part F insurance company we were going to use had a few questions, so she called me, she called them, and we had a conference call to settle things. Same with my drug plan and, again, a conference call settled everything.

I pay $17 monthly for my drug plan, but then I pay nothing for meds. Then again, I'm taking basic meds that are Tier 1, nothing exotic.

We had it figured out, so that when I retired in January, 2020, I had my first pension payment direct deposited into my bank account in February (I had paid into my pension account from my first paycheck with the County; and for the 20 years I worked there, and the County matched my payments, so my pension, while not overly sizeable, is really nice). My Medicare started at the beginning of February, so there was no lag period between work insurance and Medicare. My Social Security kicked in in March and they take out taxes. It all worked out beautifully. But I really think the reason it worked out so well is because of our insurance agent. She is wonderful and she really knows her stuff. She helped us chose our Part F plans, so we went with a company that was cheaper than others, but still provided good service.

FWIW, in my area, AARP had one of the most expensive plans in the whole book! We are not impressed with AARP at all.

 

[denice]

I know nothing about how much the AARP supplement is cost wise. I only know it from the billing side. Medicare forwards to AARP after they pay and AARP pays quickly. No muss no fuss. No phone calls no 'lost claims'. Traditional Medicare is actually the same way. Most correct claims go through quickly and are paid quickly. Once we get the claim out we are done, we just wait for the payment which comes quickly. Some of these companies are really bad. It takes months of calls and filing appeals to get payment and the payment is less then what traditional Medicare pays. They have to use Medicare allowable rates but they shift some of that to patient responsibility.

 

[susanm9006]

AARP’s plan for coverage equivalent to mine is one of the most expensive in my area as well.

 

[DreamerRose]

FYI - AARP doesn't actually have a plan. It just recommends United Healthcare, which issues the policy. United Healthcare likes to throw around the AARP label a lot, but they aren't really connected.

 

[denice]

We do bill AARP but it is underwritten and processed by United.

 

[misty8723]

Thank you everyone. I've actually been researching Medicare off and on for years. I chose to defer it when I was first eligible for it because I had health insurance through my employer with an HSA. I've taken more than one class at the senior center and spoke with the SHIIP representative who helped me decide to defer it. In 2018 I took a class at the senior center on how to maximize social secuity and learned I could file on my husband's social security and get half. I did that and was automatically enrolled in Part A, at which time I had to stop contributions to the HSA. Last year I turned 70 and applied for social security on my own record, so I'm getting more now. We are both having taxes taken out, but now that I'm about to be unemployed, we need to re-evaluate how much we need to have taken out.

I've been researching online and also reading a Medicare for Dummies book. One thing that's brought out in the book is that if you go with the Advantage Plan when you first enroll and later decide to switch to original it will cost you more. I am relatively healthy, but I do have diabetes, and my husband has health issues. I realize we can get our own plans, but I've heard there may be discounts if we both are on the same plans.

Based on our birthdays, we are still eligible for Part F, but the SHIIP rep told me that it may be most cost effecftive to go with Part G, which is similar but doesn't cover Part B deductible. What irritates me is you can't see how much these plans cost without calling each of the insurance companies.

Individual dental plans are ridiculous. My dentist charges $125 for the basic cleaning, but if you need any other services like fillings, it could get costly. Vision plans - we both wear glasses, I'm diabetic and he's pre-diabetic. I'm planning on switching to an ophthmologist after my upcoming exam, I don't know what Medicare covers with ophthmologists. Two years ago I had cataract surgery. My optomitrist, who I love, retired.I'm going to someone else in that practice because I couldn't get one with the ophthmologist in April.

We have an appointment on Thursday with the SHIIP rep. I'd rather hear what she has to say than call the insurance companies who have an agenda.I contacted one supposed broker over the internet, filled out a form, and they are calling me two or three times a day. I don't answer. They keep calling. They are not looking to help me if they're that persistent. I think the SHIIP Rep can help me sort this all out.

I've looked at Part D and found one that I think might work for me. I have one diabetes medicine that's very expensive, and this one claims it would cost me $0. I find that a little hard to believe, but I'll see what SHIIP has to say.

Again, thanks, all of your posts is helping me clarify what is right for us and hopefully I'll be prepared with intelligent questions on Thursday.