Medicare for the clueless

To reply to several statements.
OP. I thought Medicare is free - Part A the hospital part is free. The room and board is free. Most every thing else is not. That is why there is a Part B and Part D, and Medigap, and Part C (Medicare Advantage).

OP. So I can drop Part B. You now have a link. Should you decide that while you live in the United States, you might like to see a physician for an illness that doesn't require hospitalization, you have to be able to pay them. That's Part B and Medigap.

You have already signed up, but what isn't clear is if you re-sign up whether or not the 10% premium penalty applies. That is a 10% premium increase for each 12 month period where you did not pay a premium. If the premium is $135 today and you enroll 24 months after your eligibility, then, I'll let you do the math.

OP. Part D. There is a penalty for delaying enrollment. There is a donut hole which over time will get smaller (assuming nothing else is changed by Congress). This is a big 0 in the middle of the period of time when the are paying for your drugs. Some people never hit the donut hole, and some Part C carriers cover the donut hole so there is no period when you are without drug coverage. It is not a scam, it is the way Congress set up the plan.

Like Part B, it is optional, and like Part B if you never will need drugs then you can go bare. However, the United States is one of the most expensive countries to live in if you need prescription drugs to manage your health.

Gayl. Check with your insurance agent or Human Resources department about what happens when you turn 65. Some group insurance plans provide no coverage over age 65 as Medicare is available. If your plan is an ACA plan, contact the carrier to determine if there is coverage for you after you are Medicare eligible and what/how they provide coverage in another plan.

Many BlueCross/BlueShield plans provide international insurance for Medicare Advantage members. Read carefully: it is Part A coverage only - and only for emergencies. The same is usually true for individual policies and group policies. They are not intended to provide health coverage while you live full-time in another country. At that point, you have the left the service area and are no longer eligible to be part of an individual or group medical plan.

Medicare does not provide coverage outside the United States. If you will be living permanently outside the U.S. you will probably need to find coverage in your new home country.
 
Emergency room care is covered under part B not part a. We all know an ER visit can be very expensive. Add to this the common practice of keeping you under observation status if they possibly can. You could be occupying a regular room for a couple of days and still have observation status
 
I qualify for Medicare in exactly a year. All this confusion COULD worry me...... But..... My Insurance agent says it is a breeze and has some great plans (not sure what they are, MediGap, Supplemental, Advantage, and I will worry about it next year) ..... ;) OK my recent ACA application she processed was so easy I could not believe it. I literally did nothing but spend 20 minutes on the phone with her, she did EVERYTHING Else. Next thing I know I get an email with all the info. She said Medicare was easier. I will see.
 
For some of the terminology challenged folks here...

Medicare A - if you qualify there is no premium. It is for hospitalization only.

Medicare B - covers 80% of non hospital doctor visits. No max OOP... so it can get pricey if you need expensive outpatient care.

Medigap - a supplemental coverage for the 20% not covered under medicare B.
Medigap comes in different flavors: E, F, F+, G. F covers most everything. F+ covers like F - but with a deductible.

Medicare Advantage - AKA Medicare C. This is the HMO type plan. It can be good or bad - depending on your area and your network. You don't pay the medicare B with this - just the Medicare C premium. I have many relatives on Medicare Advantage with Kaiser Permanente - and in our area, Kaiser is a good system. If you live in a very restrictive area for HMOs - it's not so bueno.

Medicare D - this is prescription drug benefits... which are not included in the other plans.

We recently went through the education process on this. DH started Medicare in January. The nice thing is he has much better coverage than he did under an ACA HMO, for less than 1/2 the price.
 
I qualify for Medicare in exactly a year. All this confusion COULD worry me...... But..... My Insurance agent says it is a breeze and has some great plans (not sure what they are, MediGap, Supplemental, Advantage, and I will worry about it next year) ..... ;) OK my recent ACA application she processed was so easy I could not believe it. I literally did nothing but spend 20 minutes on the phone with her, she did EVERYTHING Else. Next thing I know I get an email with all the info. She said Medicare was easier. I will see.

It was so easy DH was able to do it by himself :LOL:
 
For some of the terminology challenged folks here...


Medicare Advantage - AKA Medicare C. This is the HMO type plan. It can be good or bad - depending on your area and your network. You don't pay the medicare B with this - just the Medicare C premium. I have many relatives on Medicare Advantage with Kaiser Permanente - and in our area, Kaiser is a good system. If you live in a very restrictive area for HMOs - it's not so bueno.
Must be differences in Medicare C plans.
My wife's Advantage plan is PPO type. She does pay the B premiums and also pays the Advantage premiums too but they are only $44/mo. Also this plan does include drug coverage with dental & vision .
 
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Gayl. Check with your insurance agent or Human Resources department about what happens when you turn 65. Some group insurance plans provide no coverage over age 65 as Medicare is available. If your plan is an ACA plan, contact the carrier to determine if there is coverage for you after you are Medicare eligible and what/how they provide coverage in another plan.
Not an ACA plan so will call HR.
 
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Medicare B - covers 80% of non hospital doctor visits.
And...
Part B: After your deductible is met, you typically pay 20% of the Medicare approved amount for most doctor services (including most doctor services while you're a hospital inpatient).
Medigap - a supplemental coverage for the 20% not covered under medicare B.
Some also include coverage of Part A cost sharing.
Medicare Advantage - AKA Medicare C. This is the HMO type plan. You don't pay the medicare B with this - just the Medicare C premium.
:nonono: There are MA plans with $0 additional premium AFTER the Part B premium. A few MA plans in certain markets refund a portion of the Part B premium, but the member still paid Part B. The only ways to avoid the Part B premium are to not enroll in Part B or be eligible for low income 'extra help' programs that pay the Part B premium for you.
 
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Many of the lower cost Medicare Advantage plans are HMO, but there are a few PPO plans with large national networks. UHC has one. Because they generally include pharmaceutical coverage, premiums can be high. In most cases, the Medicare B premium still needs to be paid. See more here https://www.medicare.gov/Pubs/pdf/11474.pdf
 
For some of the terminology challenged folks here...

Medicare A - if you qualify there is no premium. It is for hospitalization only.

Medicare B - covers 80% of non hospital doctor visits. No max OOP... so it can get pricey if you need expensive outpatient care.

Medigap - a supplemental coverage for the 20% not covered under medicare B.
Medigap comes in different flavors: E, F, F+, G. F covers most everything. F+ covers like F - but with a deductible.


Medicare Advantage - AKA Medicare C. This is the HMO type plan. It can be good or bad - depending on your area and your network. You don't pay the medicare B with this - just the Medicare C premium. I have many relatives on Medicare Advantage with Kaiser Permanente - and in our area, Kaiser is a good system. If you live in a very restrictive area for HMOs - it's not so bueno.

Medicare D - this is prescription drug benefits... which are not included in the other plans.

We recently went through the education process on this. DH started Medicare in January. The nice thing is he has much better coverage than he did under an ACA HMO, for less than 1/2 the price.

Thank you, that’s the best explanation ever.

I went ahead and signed up for “Blue Medicare Supplement HD Plan F” for $25/mo, only because it includes international coverage.

The fine print says that the premium is not the same for all males my age, that BCBS can increase it at will based on my claims...

I was under the impression that Medicare is essentially free, but like you said it’s only cheaper than my ACA Blue Advantage Silver.

No Medicare D, I don’t take drugs, so I’m not sure if an occasional prescription warrants an insurance policy.
 
My bad in the Medicare C thing. I got the b and c premiums confused.... For my relatives the Medicare c premium is zero.
 
My bad in the Medicare C thing. I got the b and c premiums confused.... For my relatives the Medicare c premium is zero.

I hope you got the Medigap right because that's what I signed up for. :D
 
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I hope you got the Medigap right because that's what I signed up for. :D
Yep, Rodi's explanation of Medigap is correct. Various flavors, but the flavor (Plan A, Plan F) is the same for each carrier. What is different is the premium each carrier charges.

- Rita
 
No Medicare D, I don’t take drugs, so I’m not sure if an occasional prescription warrants an insurance policy.

Just because you don't take much medication now doesn't mean you won't do it in the future. My mother didn't take a lot of medication when she went on Medicare either. At 93, when she visits she packs a separate bag just full of her flotilla of medications. Things change. She is glad she has a prescription drug plan.
 
For those who really want a solution, there are cheap part D plans that effectively function as place holders. It is what I did 10 years or so ago, and it is still what I do.

I am amazed at people who come asking for advice, then in advance say that this or that is a scam, or that the US is really behind other countries. Sometimes behind can be a better position to occupy.

Anyway, there is a guaranteed effective cure for these "problems", and I think it is clear what it is.

Today I called 1-800-Medicare and in 10 minutes or so switched to a plan that I think the very pleasant woman on the phone said would cost me $8.95, and could be deducted from my Social security check. I am certainly not as wealthy as many here, but I think I can handle this.

Ha
 
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For some of the terminology challenged folks here...

Medicare A - if you qualify there is no premium. It is for hospitalization only.

Medicare B - covers 80% of non hospital doctor visits. No max OOP... so it can get pricey if you need expensive outpatient care.

Medigap - a supplemental coverage for the 20% not covered under medicare B.
Medigap comes in different flavors: E, F, F+, G. F covers most everything. F+ covers like F - but with a deductible.

Medicare Advantage - AKA Medicare C. This is the HMO type plan. It can be good or bad - depending on your area and your network. You don't pay the medicare B with this - just the Medicare C premium. I have many relatives on Medicare Advantage with Kaiser Permanente - and in our area, Kaiser is a good system. If you live in a very restrictive area for HMOs - it's not so bueno.

Medicare D - this is prescription drug benefits... which are not included in the other plans.

We recently went through the education process on this. DH started Medicare in January. The nice thing is he has much better coverage than he did under an ACA HMO, for less than 1/2 the price.

Which would be the latest date these plans can be applied for in order to have them all in effect on the 1st day of month of your 65th birthday when ACA plan is terminate?
 
A little update: Even though I signed up for BCBS Medicare Supplement, BCBS went ahead and renewed my Blue Advantage from last year at the same $ rate. They think I need 2 insurances?


Thank you, that’s the best explanation ever.

I went ahead and signed up for “Blue Medicare Supplement HD Plan F” for $25/mo, only because it includes international coverage.

The fine print says that the premium is not the same for all males my age, that BCBS can increase it at will based on my claims...

I was under the impression that Medicare is essentially free, but like you said it’s only cheaper than my ACA Blue Advantage Silver.

No Medicare D, I don’t take drugs, so I’m not sure if an occasional prescription warrants an insurance policy.
 
A little update: Even though I signed up for BCBS Medicare Supplement, BCBS went ahead and renewed my Blue Advantage from last year at the same $ rate. They think I need 2 insurances?
The plan may be running two different computer systems, one for MA and one for Medigap (the MA plan requires a significant amount of reporting to CMS, Medigap does not).

Either don't pay the MA January premium and it will cancel, or call Customer Service and have them cancel it.

- Rita
 
I won't be studying up on it for a few months, but the poorly chosen terms sure don't help anybody. Why do they need to have arbitrary letter names?

I would call Part A, "Medicare Hospitalization Coverage"
I would call Part D, "Medicare Prescription Drug Coverage"
I would call Part B, "Medicare Everything Else Coverage"
 
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