Medicare Choices

[TromboneAl]

Today, my to-do app told me to "Apply for Medicare" (three months until my 65th birthday). (Lena (DW) is 63.)

Is it me, or are there a lot of complicated choices that need to be made?

Given that we have a lot of money "in the bank," and we never use insurance to cut costs (only to eliminate catastrophic expenses), my initial assessment is that I should choose Medicare Parts A & B and add drug coverage (Part D).

There's only one Part C plan with drug coverage in our area, and that is a more expensive option.

Here's an example of the 21 drug plans available in my zip code:

If I were to select that plan, my total monthly premium would be

Plan A: $0
Plan B: $134
Plan D: $22.50
----------------
Total: $156.50

Is that correct?

Concerning the drug copay of $1-$4, is that only relevant after I've paid the $405 deductible? IOW, do I pay full price until I've paid $405, or do I pay $4 per purchase right from the start?

Thanks for the help!

Al

 

[Gotadimple]

Concerning the drug copay of $1-$4, is that only relevant after I've paid the $405 deductible? IOW, do I pay full price until I've paid $405, or do I pay $4 per purchase right from the start?

Thanks for the help!

Al

Al,
Yes you pay what the plan negotiated with the pharmacy benefit manager for the cost of the drug. That is not full price - what you would pay if you had no insurance at all. The co-pay doesn't come into play until you have spent $405. The Medicare site can show you what you will pay for a drug because they are the ones who are buying the drugs aka the pharmacy benefit manager.


As for your other question, I need more coffee before I consider the answer.


- Rita

 

[MichaelB]

Al, have you considered a MediGap plan to cover the 20% not covered by Medicare? You might find an F - Hi Deductible option in your area.

 

[DatumPoint5]

+1 to MichaelB's suggestion to consider MediGap Plan F-HD

 

[DatumPoint5]

Also, if you were to choose a "Plan C" it would be a Medicare Advantage choice. Once you go into an advantage plan, it is difficult if not impossible to "go back".

 

[TromboneAl]

Medicare.gov tells me "No Policies were found for your search criteria," so at least that cuts down on the complexity of the decision making.

 

[omni550]

Medicare.gov tells me "No Policies were found for your search criteria," so at least that cuts down on the complexity of the decision making.

Perhaps call a Medical supplemental insurance guy to confirm this^.

I've had great luck with Chris Westfall https://seniorsavingsnetwork.org

Chris found me a well-priced Plan G. He also saved my friends (who were already on Medicare) some serious money over what they'd been paying for their Medigap policies.

omni

 

[MichaelB]

Medicare.gov tells me "No Policies were found for your search criteria," so at least that cuts down on the complexity of the decision making.

Are you referring to MediGap or Medicare Advantage?

 

[MBSC]

Concerning the drug copay of $1-$4, is that only relevant after I've paid the $405 deductible? IOW, do I pay full price until I've paid $405, or do I pay $4 per purchase right from the start?

The co-pay doesn't come into play until you have spent $405.

From the plan documents.

Annual Deductible: $405.00
Deductible Drug Tier Exclusions: $0 Deductible on copay Tier(s) 1, 2;
$405 Deductible on co-insurance Tier(s) 3, 4, 5

Source: https://expressscripts.destinationrx.com/PlanCompare/Consumer/Type3/2018/Compare/PlanDetails

"The Saver plan offers...a $0 deductible on tier 1 and tier 2 generics. Copays are $1 for tier 1 generic medications and $4 for tier 2 generic medications when filled at one of more than 8,000 CVS pharmacies or more than 2,000 Kroger pharmacies nationwide. The copays for a 90-day supply of tier 1 or tier 2 generic medications are just $2 and $8, respectively, via home delivery by the Express Scripts Pharmacy."

Source: https://www.prnewswire.com/news-rel...are-part-d-saver-plan-for-2018-300528990.html

 

[TrvlBug]

Also, if you were to choose a "Plan C" it would be a Medicare Advantage choice. Once you go into an advantage plan, it is difficult if not impossible to "go back".

CA allows switching during your birthday month, for whatever reason with no underwriting. DH recently changed insurers due to cost.

 

[SumDay]

I'm fairly familiar with health insurance in my real life j*b, and I was totally and utterly confused when DH turned 65. I found a Farmer's agent who also specializes in health care insurance, both ACA and Medicare. No charge - he gets a cut from the companies he places us with.


We ended up with A & B (obviously) and Plan F and a Silver Scripts Part D. DH needs some things done so we went with the Cadillac Plan F, and at the end of the year we'll go do the High Deductible Plan F, @ $65 a month. Right now it's $200.


In retrospect, I feel like I made things way too complicated, but he's covered now, and that's all that matters.


Congrats on becoming eligible for Medicare!

 

[MBSC]

Also, if you were to choose a "Part C" it would be a Medicare Advantage choice. Once you go into an advantage plan, it is difficult if not impossible to "go back".

CA allows switching during your birthday month, for whatever reason with no underwriting. DH recently changed insurers due to cost.

The CA Birthday Rule allows a person with a Medicare Supplement to switch to another supplement of equal or lessor benefits. The rule does not apply when switching from Advantage to Supplement.

 

[Moemg]

Al,You need either a supplement or a medicare Advantage plan which includes part D . You may have no medical problems now but crap happens . I had the flu last year which ended up being a $61,500 medical bill( a hospital stay and three months of rehab ) . Luckily I had a supplement that paid for most of it .

 

[kaneohe]

Al,You need either a supplement or a medicare Advantage plan which includes part D . You may have no medical problems now but crap happens . I had the flu last year which ended up being a $61,500 medical bill( a hospital stay and three months of rehab ) . Luckily I had a supplement that paid for most of it .

+10
and 60K is nothing.......if you have a serious illness that requires continuing care, you could easily see 100-200K or more.

 

[Chuckanut]

Also, if you were to choose a "Plan C" it would be a Medicare Advantage choice. Once you go into an advantage plan, it is difficult if not impossible to "go back".

I was under the impression that during open enrollment one can switch to any of the Midicare gap plans or advantage plans one chooses. Well, at least until 2020 when Plan F won't be available to new people.

Or, am I mistaken?

 

[MichaelB]

I was under the impression that during open enrollment one can switch to any of the Midicare gap plans or advantage plans one chooses. Well, at least until 2020 when Plan F won't be available to new people.

Or, am I mistaken?

Guaranteed issue for Medicare supplemental plans only exists when one is first eligible for Medicare. After that, only if one's plan leaves the market. So, choose carefully.

 

[TrvlBug]

The CA Birthday Rule allows a person with a Medicare Supplement to switch to another supplement of equal or lessor benefits. The rule does not apply when switching from Advantage to Supplement.

Was not aware of that...received erroneous info. Thanks for posting the correction.

 

[Katsmeow]

Are you not planning on getting a supplement? To not get a supplement would seem to be a serious error. You need the supplement in case of catastrophic expenses. If you are getting traditional Medicare you will have a coPayment which has no maximum.

You need to look carefully at supplements and decide which one you want. This is something you need to get now as you may not be able to medically qualify for it in future if you need it.

 

[TromboneAl]

Are you referring to MediGap or Medicare Advantage?

Medigap.

 

[TromboneAl]

Are you not planning on getting a supplement? To not get a supplement would seem to be a serious error. You need the supplement in case of catastrophic expenses. If you are getting traditional Medicare you will have a coPayment which has no maximum.

You need to look carefully at supplements and decide which one you want. This is something you need to get now as you may not be able to medically qualify for it in future if you need it.

So, Supplement = Medigap?

Medicare.gov just told me that there aren't any Medigap plans available in my zip code. That must be wrong.

I'm still just learning about this stuff (started this morning), and I have Medicare for Dummies on hold at the library.

Any great resources on the web?

It's a mess. A lot of the problem comes from nomenclature.

For example, "Part A" should be called "Hospitalization." The letter system is arbitrary, and implies a progression that isn't true.

 

[MissMolly]

Have you checking with AARP?

 

[Katsmeow]

So, Supplement = Medigap?

Medicare.gov just told me that there aren't any Medigap plans available in my zip code. That must be wrong.

Yes. Medicare calls them a Medigap policy but most people I know call it a supplement. But that seems totally odd to say that there aren't any in your zip code. I would find that hard to be believe.

Normally I would say that the Medicare website is itself a good resource, but if that is what is telling you that there are Medigap policies for your zip code then....

 

[Moemg]

Medicare .gov is the best source on the web. I was a nurse for forty years and I had to read everything twice and then call my Mom who was 96 to explain it to me .

 

[REWahoo]

So, Supplement = Medigap?

Medicare.gov just told me that there aren't any Medigap plans available in my zip code. That must be wrong.

It has to be wrong.

I entered what I believe to be a zip code in your general area into the Medicare.gov site linked below and found numerous available Medigap policies.

https://www.medicare.gov/find-a-plan/questions/medigap-home.aspx

 

[Another Reader]

I'm in the same situation. My suggestion would be to look at Medigap plans that cover the same providers you use today or would use if you had a serious health problem.

One thing I cannot find an answer to is geographic limitation. I read somewhere that Medicare requires your PCP to be within 25 miles of your zip code.

This was a problem with my employer-provided PPO about 15 years ago. I had a long term PCP and the insurance company decided I did not. They tried to reassign me to a Spanish-speaking doctor in a low income neighborhood with the nearest hospital being the worst in the area. I had to show on a map that the PCP was less than 30 miles from my house and send them paperwork showing I had used the PCP for years.

If Medicare is going to deny access to the better doctors and hospitals because of zip code, I need to know before I sign up. A lot of my providers are outside of the 25 mile limit I recall reading somewhere. My residence address might have to change...