Some Medicare new enrollment questions

rodi

rodi

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I know some of this has been covered, but I'm trying to nail down some nuances.

DH turns 65 in January - so he qualifies to start Medicare in Jan. We have an appointment with a friend who does insurance to go through our options later this month, but I've been researching online. Let me know if I've got it right... He's already claiming SS.

Part A is automatic?

Part B will be automatic and deducted from his SS unless he signs up for a Medicare Advantage (HMO type) plan - which effectively replaces Medicare B?

Part D covers drugs and needs to be signed up for... Is there a penalty for not signing up for it if his only prescription is a generic statin?

Medicare Part F aka Medigap aka Medicare supplemental covers the deductibles etc not covered by Medicare A and B. If you don't sign up for it when you first enroll you could be charged a much higher rate later if they even agree to cover you?

Community rating appears to be a rare unicorn in our zipcode... Only AARP/United Healthcare seems to be priced that way... All the other part F plans seem to be age rated. Correct me if I'm wrong - but age rated plans could potentially increase in price significantly as you age?....

Since he'll be new to medicare - hold harmless won't apply to him for part B for 2017... He'll pay the $149 (or whatever it ends up being)...:confused:? Not the $121 that people who enrolled in 2016 will pay, or the $104 that people enrolled before 2016 might pay? (IRMAA does not apply to our household.)

Any way I look at it - all the parts premiums added together will still be less than our HDHP premiums which puts most of the costs on us and really only buys us negotiated rates.
 
I'll address a couple of your questons:

rodi said:
Part D covers drugs and needs to be signed up for... Is there a penalty for not signing up for it if his only prescription is a generic statin?
Click to expand...

Yes, there is a late enrollment penalty.

See https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html

rodi said:
Medicare Part F aka Medigap aka Medicare supplemental covers the deductibles etc not covered by Medicare A and B. If you don't sign up for it when you first enroll you could be charged a much higher rate later if they even agree to cover you?
Click to expand...

Yes - and worst case you may not be able to sign up at all:

The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period, because you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you're 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more.
Click to expand...

Have you looked into the cost of Plan F High Deductible? It isn't available everywhere but if your DH is relatively healthy it can be a money saver.
 
I will second plan F HD, I like it.
For instance in my area if just starting out in medicare using the
same company monthly premium plan F, 262, plan F HD 68.
If you look at the plan docs for age rated plans there should be a
table of premium increases by age.

Medicare advantage plans usually have a built in drug plan, but some
may not have a built in plan not sure.

One disadvantage of an Advantage plan, is if they just happen to take your drug off of
the plan formulary, you are screwed.
You can't change advantage plans to a medigap plan, after 12 months without medical underwriting, unless the plan is cancelled or you move.

With a supplement plan you of course also need a part D drug plan which you may change every year.

Whatever you do , choose wisely.

Old Mike
 
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Rodi,
Medicare Advantage plans include Part D, drugs. They will caution you that you can't have both MedAdvantage and Part D. So, Part A is free, you pay a Part B premium, plus a premium for:

Supplement plus Part D, or
Medicare Advantage

Some Medicare Advantage plans have no premium, depends on the state. Rather than looking at the cost of the coverage (the premiums), you should factor in the premiums plus deductibles plus co-pays (if any for dr visits, or for prescription drugs). The total is your likely medical expense for the year.

Rita
 
Look at Medigap plan G vs. F(full). G is much less expensive and the difference is you only have to pay the $166/year Medicare deductible. Plus, it is my understanding that the rate of yearly increase of Plan G is less than Plan F (full). Long term, this can save a bunch. Brokers like to sell plan F as that plan generates the highest commissions.

As others said, once enrolled, you my have a hard time switching Medigap plans. He will have to qualify medically and if he has any preexisting conditions, he may not get accepted. There are exceptions to that (moving out of the area is one).

I switched from F (full) to G last year and made it (healthy, no preexisting conditions) and saved ~$100/month at age 72.

A good friend of mine is a Humana rep and did me good.
 
aja8888 said:
Look at Medigap plan G vs. F(full). G is much less expensive and the difference is you only have to pay the $166/year Medicare deductible.
Click to expand...

Good advice, and I agree this is probably the way to go should you not be interested in the Plan F HD option.
 
kaneohe said:
Did you mean medigap (supplement ) plans?

https://www.medicare.gov/sign-up-ch...ans/when-to-join-medicare-advantage-plan.html
Click to expand...

Yep will correct that, and also correct the 6 months.
Old Mike
Can I Switch from Medicare Advantage to Medigap?

There are generally only a few situations that allow you to leave Medicare Advantage and pick up a Medigap plan without being subject to medical underwriting.
If you joined a Medicare Advantage plan when you were first eligible for Medicare and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining.
If you are moving to a different state or part of the state and your Medicare Advantage plan does not serve that area, you also have special rights to return to Original Medicare and pick up a Medigap plan.
Remember, If you had a Medigap policy in the past then left it to get an MA plan, when you return to Original Medicare, you might not be able to get the same Medigap policy back or in some cases, any Medigap policy unless you have a “trial right” or “guaranteed issue” right.
 
I turn 65 this month and got Medicare starting October 1 (YAH!!). I am not yet receiving Social Security so I had to go online and sign up for Medicare and got a bill for my premium. If you are on Social Security you will be signed up for SS automatically and the premium will come out of your SS check.

I did quite a bit of research on Supplements and Part D prescription plans. I live in North Carolina and for me the best Supplement was Mutual of Omaha G which cost me around $90 per month. The G Supplement is quite a bit cheaper than the F Supplement and the only difference is that on the G you pay the deductible of around $165 per year. I looked at the F high deductible which was a little cheaper than the G but I did not want to mess with all the paperwork in dealing with the F deductible each year.

On the Part D the best way to research plans is to go to Medicare.gov and enter all your prescriptions and preferred pharmacy and it will tell you the best Part D pain for your situation. I do not take any prescriptions (Yah!) so the best plan for me was Humana Walmart at $18 per month. Even if you don't take prescriptions you should go ahead and sign up for a D plan. In my case I just signed up for the cheapest D plan. The D plans change every year so you should go on Medicare.gov every year to see which will be the best for you. The sign up dates for D plans are 10/15-until the first part of December. For me it will make sense to change my Part D because there will be a cheaper plan with a lower deductible available for me in 2017.

I am very grateful to be on Medicare because I pre-Medicare I had a terrible health insurance policy that was way more expensive. The only negative is that I will no longer be able to contribute to my HSA account.

Jo Ann
 
golftrek said:
I looked at the F high deductible which was a little cheaper than the G but I did not want to mess with all the paperwork in dealing with the F deductible each year.
Click to expand...

I'm curious as to what paperwork you think you'd have to mess with if you chose Plan F HD. Medicare and the Plan F insurer both track your medical spending for you and both send statements showing exactly where you stand in meeting your annual deductible.
 
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My birthday is May 1st, and my Medicare started on April 1st. You might want to go onto Medicare.gov and read when his starting date should be.

When working, we were enrolled in HMO's and my wife had 2-3 serious problems. Our 3 year old daughter came down with tuberculosis and had treatment for years. We quickly figured out how to work the system since my wife is a medical professional.

We felt that our HMO was good for the sniffles. But for anything really serious, they were very, very hesitant to refer us to the top specialists. They were more interested in customer ratings and holding down costs vs. getting the best treatment for their members.

Since Medicare Advantage plans operate much like HMO's, we're very, very hesitant to consider them. Our hospital of choice for anything serious is Vanderbilt in Nashville. And they absolutely refuse to accept any Medicare Advantage insurance plan. In total, that means 1700 physicians, PA's and Nurse Practitioners in their employment are automatically excluded from the plan.

We're now both on Medicare with a conventional Medicare supplement through my ex-employer and SilverScript for Part D. We want nothing to do with Medicare Advantage plans.
 
Interesting about plan G. I think we're going to stay away from Plan F HD.... DH is in good health - but has some potential big ticket items in his future... his knee gives him trouble and he's thinking a new knee is sooner rather than later... I learned the hard way last year that high deductible plans aren't always the best choice - even if you're healthy... my kids are/were healthy... just accident prone.
 
rodi said:
Interesting about plan G. I think we're going to stay away from Plan F HD.... DH is in good health - but has some potential big ticket items in his future... his knee gives him trouble and he's thinking a new knee is sooner rather than later... I learned the hard way last year that high deductible plans aren't always the best choice - even if you're healthy... my kids are/were healthy... just accident prone.
Click to expand...
I understand what you're saying and will leave it - after "just one more thing" (channeling Colombo... :) )

Have you compared the full cost of annual premiums for Plan G vs the full cost of Plan F HD annual premiums including the annual deductible (currently ~$2,200)? My belief is you'll pay about the same if even if you have to pay the full deductible. But with plan F HD you have the potential of paying less in years without a knee replacement or a few accidents.

Worth running the numbers?
 
REWahoo said:
I'm curious as to what paperwork you think you'd have to mess with if you chose Plan F HD. Medicare and the Plan F insurer both track your medical spending for you and both send statements showing exactly where you stand in meeting your annual deductible.
Click to expand...

If you have a $2000 deductible you will have to pay a portion of every medical bill during the year until you meet the deductible. Every time you go to the doctor or have a medical procedure or lab work you will be getting bills and have to pay them throughout the year. Pre-Medicare I have had high deductible insurance and found it to be a pain to keep up with all the medical bills and write checks to pay them. As I get older I don't want to have to write a lot of checks and keep up with the bills. In my case the difference in the cost between the Plan G and the High Deductible H was not very large--not enough to justify the higher deductible.

Jo Ann
 
golftrek said:
If you have a $2000 deductible you will have to pay a portion of every medical bill during the year until you meet the deductible. Every time you go to the doctor or have a medical procedure or lab work you will be getting bills and have to pay them throughout the year.
Click to expand...

Gotcha.

You are willing to pay the higher monthly premium rather than pay individual bills as you incur them, even if those bills total less than the $2,000 deductible and result in a net annual savings to you. A perfectly reasonable choice - we all make decisions on how much we are willing to pay for convenience.
 
I recently signed up for a medigap plan F insurance plan. My buddy is 70 and has a plan G policy. He said that navigating the medical bills each year has been a confusing nuisance and wishes he had signed up for plan F instead of plan G.

The price difference between the plans F and G did not pose a problem for me and I took his advice to limit the complexity by getting a plan F policy.
 
template said:
I recently signed up for a medigap plan F insurance plan. My buddy is 70 and has a plan G policy. He said that navigating the medical bills each year has been a confusing nuisance and wishes he had signed up for plan F instead of plan G.

The price difference between the plans F and G did not pose a problem for me and I took his advice to limit the complexity by getting a plan F policy.
Click to expand...

What medical bills?

The only out of pocket billable cost with G is the annual $166 deductible (if used). All other costs are paid by Medicare or the insurance company.
 
I'm pretty tired of dealing with paying deductibles up front at the doctor's office. Usually what they have me pay (after they call the insurance company to determine my responsibility) is not what the insurance ultimately says I was responsible for, although it's often close. It just becomes such an annoyance and I'm getting pretty burned out on dealing with it. Another doctor works better and has me pay a smaller amount upfront then sends me a bill after the insurance company processes the visit, and I pay the balance. That's easier.

Still, I just don't think I want to deal with this when I am older. $165 or $200, or whatever is OK - and probably dealt with in the first visit or two. But higher than that and it might take half the year to get through all the payments.

For this reason I'll be leaning hard towards plan G, though I'm still a few years away.
 
template said:
I recently signed up for a medigap plan F insurance plan. My buddy is 70 and has a plan G policy. He said that navigating the medical bills each year has been a confusing nuisance and wishes he had signed up for plan F instead of plan G.

The price difference between the plans F and G did not pose a problem for me and I took his advice to limit the complexity by getting a plan F policy.
Click to expand...

DH and I both have Plan G. We get billed by the provider up to the annual Medicare deductible ($166 this year) and never see another bill. We get explanations of benefits from both Medicare and our insurance company but all plans probably involve those. No navigation of medical bills necessary, but sounds like you are happy with Plan F, which is all that matters.
 
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audreyh1 said:
I'm pretty tired of dealing with paying deductibles up front at the doctor's office. Usually what they have me pay (after they call the insurance company to determine my responsibility) is not what the insurance ultimately says I was responsible for, although it's often close. It just becomes such an annoyance and I'm getting pretty burned out on dealing with it. Another doctor works better and has me pay a smaller amount upfront then sends me a bill after the insurance company processes the visit, and I pay the balance. That's easier.

Still, I just don't think I want to deal with this when I am older. $165 or $200, or whatever is OK - and probably dealt with in the first visit or two. But higher than that and it might take half the year to get through all the payments.

For this reason I'll be leaning hard towards plan G, though I'm still a few years away.
Click to expand...

I've had Plan F HD, with it's $2,000 annual deductible, for five years and only been asked once in all that time to pay up front at a doctors office. I said "I think I've already met my deductible" and that ended the conversation.

Bestwifeever said:
DH and I both have Plan G. We get billed by the provider up to the annual Medicare deductible ($166 this year) and never see another bill. We get explanations of benefits from both Medicare and our insurance company but all plans probably involve those. No navigation of medical bills necessary...
Click to expand...
Exactly how my Plan F HD works. I don't pay any of the provider bills for my deductible until after I receive the EOB from both the insurance company and Medicare. Most of the time I don't even get the provider bills until after I get the EOBs.

Not really a hassle, just another bill to pay.
 
Every state has a senior health insurance program or SHIP. They have free counsellors who are expert in all Medical care plans and can advise you at no charge. Phone or in person appointments are available, highly recommend that you find the SHIP in your state. Usually housed in the department of insurance.


Sent from my iPad using Early Retirement Forum
 
In MA you only have two options for a Medigap policy. The "core plan" that does not cover Part A or Part B deductibles as well as skilled nursing facilities and "supplement 1" plan that is comprehensive and covers all deductibles and services. The premiums for the supplement 1 plan is about $90 per month higher than the core plan.

DW will be 65 next year and I will be eligible the following year. We plan on enrolling in a "supplement 1" plan so we will only pay the premiums and nothing else. This will simplify the process and will make our health care cost predictable.

Also in calling the state SHIP program we found out that BC/BS of MA will give a 15% premium discount the first year, 10% the second year and 5% the third.
 
do any of these medigap policies or supplement policies cover both drugs and doctors? I am on medicare and would like to check on a policy so that I don't have to deal with both insurances separately.
 
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