Basic Medicare Questions...

[mikes425]

Hi. This will, I'm sure be a question that's been dealt with thousands of times here.
I'll turn 65 next month. I have literally not looked at what to do as far as anything to do with Medicare til this week. Yeah, call me irresponsible. Despite being pretty ignorant about it I need to make some choices pretty fast.

I'm self employed and have been on a Marketplace HMO (previously performer-union-PPO) I'm in excellent health and have minimal prescriptions and doctor expenses; basically an allergist, a primary care doc and a psych in order to maintain an anti-anxiety/depression med. My PCP suggested i see a healthcare advisor he and some mutual friends use for their medicare 'plans' and I met with him today. He essentially suggested a supplement plan (Advantage plan i guess) be it with Aetna or AARP/United HealthCare... But priority one was/is, that i go to the SS office asap to enroll in Medicare... in order to expedite getting the coverage to start April 1st - about a week or so from today.

I question what the real need is for anything beyond basic Part A/B Medicare. What IS the realistic downside in just rolling with basic medicare vs any supplemental plan. Is basic medicare - that is, as I understand it Parts A and B - generally sufficient for immediate purposes and if i wanted to say, add a 'supplement' later, can i just defer that decision til a later date? btw I'll not be taking SS til probably 67. I'm trying to wrap my head around the compelling necessity for an "advantage" or "supplement" plan... let alone weigh that vs a "Gap" option. The advisor suggested an Advantage plan as a wiser way to go that just signing up for basic Parts A/B... He spoke of being able to have more options similar to that of a PPO - in being able to get care if I traveled...and that basic medicare was generally less sufficient than say, an AARP/United Health advantage plan or Aetna - and made reference to some facilities and/or providers potentially not covering procedures/care if on basic Medicare --

Who REALLY needs an "advantage" or "supplement" plan - or, is it generally ok to just sign up for basic Part A/B. As it stands I have very few meds so... I don't see drug coverage being a big deal - i.e. whether i need Part D. Can I not just take the basic coverage right now...and decide down the road if i want to add a supplemental coverage option? Also, if a medical condition arose say, 10 years from now, is there any thing that would preclude me from just adding a supplemental coverage plan then? (pre-existing condition). Is it true that if I don't opt for an 'Advantage' plan at 65, i can't do get one later? The insurance advisor suggested i have to decide 'now' and if i don't - i don't necessarily get another chance. Sufficiently confused at this point. Thanks for any clarity.

[ivinsfan]

Good luck with that sign up...and you have a lot of questions why don't you Google a few Medicare threads on these forums, read up and then get back to us with a couple questions at a time.



Why didn't you ask the healthcare advisor a few of these questions? You can't do anything until you are actually on Medicare so do that signup tomorrow.

[Romer]

This book was recommended in a previous thread. If you have a Kindle, you can download it upon purchase, or at least in my area it is next day delivery

https://www.amazon.com/gp/product/15...?ie=UTF8&psc=1

Social Security provides the bulk of most retirees’ income and Medicare guarantees them affordable health insurance. But few people know what Medicare covers and what it doesn’t, what it costs, and when to sign up. Nor do they understand which parts of Medicare are provided by the government and how these work with private insurance plans—Medicare Advantage, drug insurance, and Medicare supplement insurance.

Do you understand Medicare’s parts A, B, C, D? Which Part D drug plan is right and how do you decide? Which is better, Medigap or Medicare Advantage? What do you do if Medicare denies payment for a procedure that your doctor says you need? How do you navigate the appeals process for denied claims? If you’re still working or have a retiree health plan, how do those benefits work with Medicare? Do you know about the annual enrollment period for Medicare, or about lifetime penalties for late enrollment, or any number of other key Medicare rules?

Health costs are the biggest unknown expense for older Americans, who are turning sixty-five at the rate of 10,000 a day. Understanding and navigating Medicare is the best way to save health care dollars and use them wisely. In Get What’s Yours for Medicare, retirement expert Philip Moeller explains how to understand all these important choices and make the right decisions for your health and wealth now—and for the future.

[skipro33]

Just in case you don't know, don't miss the sign up deadline or it'll cost you. And not just a one time catch up, but a lifetime penalty.
If you are drawing Social security, you'll be auto enrolled in Medicare.
https://www.medicare.gov/basics/cost...void-penalties

[Katsmeow]

Quote:

Originally Posted by mikes425 Who REALLY needs an "advantage" or "supplement" plan - or, is it generally ok to just sign up for basic Part A/B. As it stands I have very few meds so... I don't see drug coverage being a big deal - i.e. whether i need Part D. Can I not just take the basic coverage right now...and decide down the road if i want to add a supplemental coverage option? Also, if a medical condition arose say, 10 years from now, is there any thing that would preclude me from just adding a supplemental coverage plan then? (pre-existing condition). Is it true that if I don't opt for an 'Advantage' plan at 65, i can't do get one later? The insurance advisor suggested i have to decide 'now' and if i don't - i don't necessarily get another chance. Sufficiently confused at this point. Thanks for any clarity.

There is so much wrong in all of that it is hard to even know where to start. You need to do a lot of reading....

You can contrast Traditional Medicare with a supplement (gap insurance) to Medicare Advantage.

Traditional Medicare (Parts A/B) with a supplement has many advantages. The most important one to me is that I can see any doctor or hospital that accepts Medicare. If I decide to go to a surgeon several hours away (I recently did this for cataract surgery) Medicare doesn't care since he takes Medicare.

Medicare Advantage can be an HMO or a PPO. The big issue many people have with Medicare Advantage is that there is usually a network that you have to use. Some plans are PPOs that let you see any doctor that will accept the plan. However, not all doctors will accept being an out of network provider for Medicare Advantage. The other big issue with Medicare Advantage is that insurers are often paid a certain amount of money for "you" and make more money if they deny your claims.

No - do not even think of not taking a supplement. If you don't do it within your 6 month open enrollment period, you may not be able to buy one later as it will be medically underwritten. You can be denied a supplement plan later or can be offered one at much higher cost. Yes, there are people who only get Part A/B and don't get a supplement. They do this because they literally can't afford a supplement. For someone of any means the potential out of pocket cost for someone without a supplement is unlimited.

Here it is from the horse's mouth (Medicare)

https://www.medicare.gov/supplements...-i-buy-medigap


If you don't get at least a cheap Part D policy (prescription drug) policy now, you will later be charged a forever higher premium because you signed up late. Many Part D plans are very, very cheap and it makes no sense to delay as a result.

Here again it is from the horse's mouth:

https://www.medicare.gov/drug-covera...llment-penalty

I am a big fan of Traditional Medicare + supplement and Part D plan. I like having the choice of the most doctors and knowing that once my annual deductible is covered ($266 this year) that my medical costs are covered for the rest of the year (not including prescriptions). Each year for Part D you can change plans so if you get to a point where you need expensive meds you might change but getting a basic plan early on saves money in the long run.

The only people I really recommend Medicare Advantage to are those who literally can't afford the above. Better a Medicare Advantage plan than to take Medicare with no supplement.

As far you being healthy and having low medical needs. That's fine. But, you know, things change. I would have said a few months ago that I was really healthy, but I just found out that I have serious heart disease. I am glad I have good coverage.

I am not surprised that an advisor recommended by a doctor is pushing Medicare Advantage. That is fairly typical. Some people here have said they have had luck getting a more objective assessment of what they need from Boomer Benefits. I did not use them myself but others here seem to like them.

[mikes425]

I DO intend to study all info available. I’m sorry if i ask an overwhelming question. I am sure i have already mis-stated some terminology. I am talking a “ supplement” - not ‘Advantage’ plan. AARP / United…

It’s all moot til I sign up for A and B today .. Thanks for the leads.

[mikes425]

Quote:

Originally Posted by Katsmeow There is so much wrong in all of that it is hard to even know where to start. You need to do a lot of reading.... Traditional Medicare (Parts A/B) with a supplement has many advantages. The most important one to me is that I can see any doctor or hospital that accepts Medicare. If I decide to go to a surgeon several hours away (I recently did this for cataract surgery) Medicare doesn't care since he takes Medicare. No - do not even think of not taking a supplement. If you don't do it within your 6 month open enrollment period, you may not be able to buy one later as it will be medically underwritten. You can be denied a supplement plan later or can be offered one at much higher cost. Yes, there are people who only get Part A/B and don't get a supplement. They do this because they literally can't afford a supplement. For someone of any means the potential out of pocket cost for someone without a supplement is If you don't get at least a cheap Part D policy (prescription drug) policy now, you will later be charged a forever higher premium because you signed up late. Many Part D plans are very, very cheap and it makes no sense to delay [ I am a big fan of Traditional Medicare + supplement and Part D plan. I like having the choice of the most doctors and knowing that once my annual deductible is covered ($266 this year) that my medical costs are covered for the rest of the year (not including prescriptions). Each year for Part D you can change plans so if you get to a point where you need expensive meds you might change but getting a basic plan early on saves money in the long run.[/B][/B] The only people I really recommend Medicare Advantage to are those who literally can't afford the above. Better a Medicare Advantage plan than to take Medicare with no supplement. As far you being healthy and having low medical needs. That's fine. But, you know, things change. I would have said a few months ago that I was really healthy, but I just found out that I have serious heart disease. I am glad I have good coverage. I am not surprised that an advisor recommended by a doctor is pushing Medicare Advantage. That is fairly typical. Some people here have said they have had luck getting a more objective assessment of what they need from Boomer Benefits. I did not use them myself but others here seem to like them.

Thie plan you like IS essentially what the advisor was talking about. I may not be as confused as it seems. Very helpful post! Thank you. I will clarify with him that we are not talking abt an Advantage plan but rather a supplement + low cost Part D plan

[Sue J]

Try this Medicare Decision Tree.

https://mbaileygroup.com/blog/choosi...ntage-medigap/

The article is a few years old so some info may be dated but the steps will still be valid. Once I understood that first decision it all made a lot more sense. It explained that Medicare Advantage REPLACES Original Medicare A and B and usually D.

After being on regular pre-medicare employer insurance and then HealthCare.gov ACA insurance with huge deductibles, Medicare seems like the best, deluxe version of insurance we've ever had. We chose original Medicare A and B, with added Part D and a medigap supplement.

[athena53]

Quote:

Originally Posted by Katsmeow The only people I really recommend Medicare Advantage to are those who literally can't afford the above. Better a Medicare Advantage plan than to take Medicare with no supplement. As far you being healthy and having low medical needs. That's fine. But, you know, things change. I would have said a few months ago that I was really healthy, but I just found out that I have serious heart disease. I am glad I have good coverage.

I agree on both of the above. Medicare Advantage plans seem fine- until you develop a serious health issue. At that point, if you want to switch back to traditional Medicare A and B with a supplement, the supplement carrier is allowed to refuse coverage or may apply surcharges to your premium because you're higher risk.

In the 5 years since I started Medicare I've had to start annual breast MRIs after my sister developed breast cancer in 2018 (our mother and maternal grandmother died from it) and I've been diagnosed with "mitral valve regurgitation" (some of the blood going through my heart flows backwards rather than 100% forwards) which leaves me breathless on exertion. Not severe enough to need treatment but requires an annual echocardiogram and cardiologist consult.

Stuff Happens even when you do your best to have healthy habits.

[mikes425]

Quote:

Originally Posted by Sue J Try this Medicare Decision Tree. https://mbaileygroup.com/blog/choosi...ntage-medigap/ The article is a few years old so some info may be dated but the steps will still be valid. Once I understood that first decision it all made a lot more sense. It explained that Medicare Advantage REPLACES Original Medicare A and B and usually D. After being on regular pre-medicare employer insurance and then HealthCare.gov ACA insurance with huge deductibles, Medicare seems like the best, deluxe version of insurance we've ever had. We chose original Medicare A and B, with added Part D and a medigap supplement.

Thanks for this, and other replies here. Admittedly late to the game in a major way.. but it is what it is. I did go to my SSA office with all identification docs this AM and was told they are not accepting/processing in person applications, and i was assigned a "Phone Appointment" with someone on April 2nd. Theoretically she said if approved I can retroactively activate my coverage effective April 1st. This is confusing because I don't know how I can supply my identification documentation by phone (Birth Certificate/Identity Proof). I don't know if it will be a complication, but also, my current drivers license doesn't match my primary residence address but a prior address because I've kept my vehicles registered in another state (I live in a city that borders two states) at another property I rent. However I have all kinds of documentation in the form of utility bills tax returns, and so forth that prove my primary residence address. Just trying to cover all possible roadblocks but I don't know why my DL address would matter relative to what is showing on my current license... I would think all other documents would be enough to substantiate my primary address. I'm getting off my own 'main' topic but, it just occurred to me that I should be prepared for any potential hassles.

[CRLLS]

Quote:

Originally Posted by athena53 I agree on both of the above. Medicare Advantage plans seem fine- until you develop a serious health issue. At that point, if you want to switch back to traditional Medicare A and B with a supplement, the supplement carrier is allowed to refuse coverage or may apply surcharges to your premium because you're higher risk. In the 5 years since I started Medicare I've had to start annual breast MRIs after my sister developed breast cancer in 2018 (our mother and maternal grandmother died from it) and I've been diagnosed with "mitral valve regurgitation" (some of the blood going through my heart flows backwards rather than 100% forwards) which leaves me breathless on exertion. Not severe enough to need treatment but requires an annual echocardiogram and cardiologist consult. Stuff Happens even when you do your best to have healthy habits.

It is a fact that $hit happens when you get older. I have been healthy all of my life. Once I went on Medicare, my body reacted, and not in a favorable way. I have had 3 operations and many months of PT for a couple of issues in the last 5 years. I am fortunate to have traditional Medicare with AARP-UHC Plan G and a cheap drug plan. With them, I don't sweat any medical bills. I am fortunate to not be on any ongoing medicines. I still hate going to the doctors though.

If one can afford Medicare Parts A&B, a drug plan and a Medigap plan, I highly recommend it. Freedom of choice for providers and freedom from deciphering medical bills is what I had hoped for in my retirement healthcare life.

[REWahoo]

Quote:

Originally Posted by CRLLS It is a fact that $hit happens when you get older.

+1

When I hit 70 it hit back.

[Dash man]

Plan N is typically the lowest cost Medicare Supplement over your lifetime. Plan G is the most comprehensive coverage, but premiums will increase a little faster over time.
Apply for Parts A and B Medicare coverage today! It can take a few weeks to get your Medicare number, and you can’t purchase a Supplement until you have your Medicare number.

[ivinsfan]

Quote:

Originally Posted by mikes425 Thanks for this, and other replies here. Admittedly late to the game in a major way.. but it is what it is. I did go to my SSA office with all identification docs this AM and was told they are not accepting/processing in person applications, and i was assigned a "Phone Appointment" with someone on April 2nd. Theoretically she said if approved I can retroactively activate my coverage effective April 1st. This is confusing because I don't know how I can supply my identification documentation by phone (Birth Certificate/Identity Proof). I don't know if it will be a complication, but also, my current drivers license doesn't match my primary residence address but a prior address because I've kept my vehicles registered in another state (I live in a city that borders two states) at another property I rent. However I have all kinds of documentation in the form of utility bills tax returns, and so forth that prove my primary residence address. Just trying to cover all possible roadblocks but I don't know why my DL address would matter relative to what is showing on my current license... I would think all other documents would be enough to substantiate my primary address. I'm getting off my own 'main' topic but, it just occurred to me that I should be prepared for any potential hassles.

It doesn't matter what state you live in until you buy your supplemental. When I was wishing you good luck this is what I meant, it takes awhile. Have you actually gone to the SSA site and tried to signup for part A and B online. Many people do it that way. If you have no unusual circumstances that is the way to go. Do that without delay. Like right now.

[SheitlQueen]

I used Boomer Benefits when I signed up and found them very helpful. They have videos on youtube with good information. If you delay signing up for Part D you will have penalty for the rest of your life (unless you go with an Advantage plan where you may not need it). If you don't get a supplement plan initially you may have to undergo underwriting later on. And you are going to be responsible for the 20% Medicare doesn't pay and the Part A deductible. Don't base what you purchase on how healthy you are now. That will change in the future. I was healthy when I first went on Medicare and now I have had several problems crop up since. I'm glad I have the supplement. Part D, get the cheapest plan you can if you think you aren't going to be using it much. But again, that can change. I went with the best coverage I could, Plan G. Been very happy with it. Health care is not the place to cheap out. Research carefully and don't rush into buying something that is not the best choice.

[mikes425]

Quote:

Originally Posted by ivinsfan It doesn't matter what state you live in until you buy your supplemental. When I was wishing you good luck this is what I meant, it takes awhile. Have you actually gone to the SSA site and tried to signup for part A and B online. Many people do it that way. If you have no unusual circumstances that is the way to go. Do that without delay. Like right now.

Hi, yes, I did it online. Local SS office suddenly doesn't do "in person" applications. Worst case, this won't activate til May instead of April.

On the SS site's application, tho, there was no reference to "part A" - just "part B" (?)

[ivinsfan]

Quote:

Originally Posted by mikes425 Hi, yes, I did it online. Local SS office suddenly doesn't do "in person" applications. Worst case, this won't activate til May instead of April. On the SS site's application, tho, there was no reference to "part A" - just "part B" (?)

Part A is automatic....so you would get A and B Are you saying you have now gotten signed up for Part B... I'm having trouble understanding some of your posts...

[mikes425]

Quote:

Originally Posted by Dash man Plan N is typically the lowest cost Medicare Supplement over your lifetime. Plan G is the most comprehensive coverage, but premiums will increase a little faster over time. Apply for Parts A and B Medicare coverage today! It can take a few weeks to get your Medicare number, and you can’t purchase a Supplement until you have your Medicare number.

Done, online today. However, and as asked in another reply... when I did the signup (through SSA.gov where i already had an established account) - I saw no mention of "Part A" - just "Part B" ... FWIW also, I am choosing NOT to take Social Security benefits at 65, just Medicare. Did i 'miss something" as far as "Part A" -- or is that just automatically included when I submit my application?

[mikes425]

Quote:

Originally Posted by ivinsfan Part A is automatic....so you would get A and B Are you saying you have now gotten signed up for Part B... I'm having trouble understanding some of your posts...

Ok, so I'm saying, I just did the online application. In the questionnaire process, I saw nothing specifically referencing "Part A" - I only was given the option to select "sign up for Part B Medicare" and, NOT receive monthly retirement benefits (i.e., Social Security). ((and no, I do not want to receive monthly benefits since I am not taking Social Security yet)).

[ivinsfan]

Quote:

Originally Posted by mikes425 Done, online today. However, and as asked in another reply... when I did the signup (through SSA.gov where i already had an established account) - I saw no mention of "Part A" - just "Part B" ... FWIW also, I am choosing NOT to take Social Security benefits at 65, just Medicare. Did i 'miss something" as far as "Part A" -- or is that just automatically included when I submit my application?

It's included... now this week start looking for a broker you have reason to trust and get something going for your supplemental coverage. I believe



(but don't know for certain) a broker help you with the quickest possible supplement signup..plus since they are professionals they can do a better job of explaining the differences then this board...because of the time factor.