Help with Medicare selection PLEASE!

[Annalisa Eschmann]

Searching previous discussions about Medicare enrollment, I am more confused than ever. I welcome insight as I am trying to gather information and prepare well in advance of making my selection. At 54 y.o. I was recently approved for SSDI due to my muscular dystrophy advancing to where I can no longer work. I am currently on a HDHP through my husband's employer, but come December 2025 I will be eligible for Medicare. That Medicare eligibility precludes me from remaining on my husband's employer's plan. Thankfully, I do not currently incur a lot in the way of medical costs. Very few doctor's visits and only a couple of prescriptions. We're hoping Medicare coverage will be a savings over the workplace plan which has a sizable deductible before we'd see any benefit.

I am reading in many places and being told by some providers that I should steer away from Medicare Advantage plans. Seems they promise a lot but people have experienced them falling short when coverage really matters. I'm led to believe regular, straight, Medicare will suit me best. Is that the consensus of those of you who have experience with what's covered and what's not? What advice is offered with regards to the Medicare coverage and the supplements, particularly Part D?

Thank you

 

[Jerry1]

I can only speak for myself, but I want and obtained regular Medicare with a supplemental plan with no payment beyond the Medicare deductible. I also paid for the most expensive Part D plan but I'm on a very expensive drug and I think it was a good trade off since they agreed to cover my specialty drug.

Personally, there's no way I would go on a Medicare Advantage plan. Beyond the potential they have to deny payment, my concern is the limited network. When I got sick, I went to the university hospital which is probably out of network for most Medicare Advantage plans. I have a dislike for someone telling me which doctors and/or hospitals I can get care at. If I had financial concerns, I would scrutinize each Medicare Advantage plan available and look for the best network.

With muscular dystrophy, I suspect that you would do best with regular Medicare and the best supplemental plan you can afford. As for Part D, there are good tools online to price out the plans in your area given the medications you are taking. Without a specialty drug like I'm taking, I'd find the least expensive one and go with it. The pricing programs will show you if the medications you're taking are in the formulary of any plan you're looking at.

 

[rk911]

As I understand it if you elect to go with a Medicare Advantage plan and decide later to switch to traditional Medicare you can make that switch but you may have to undergo underwriting to get a Medicare Supplement plan.

Me? I'd go with traditional Medicare and then shop price for the supplement plans. The good news is that all of the alphabet supplement plans are identical in what they cover. They differ only in price.

I recommend you shop for a Part D drug plan now. The Medicare website has a shopping/price guide. Answer a few questions, input your current Rx's and it will return a number of plans/providers servicing your address.

Good thoughts and prayers for you in your battle with MD.

 

[MC Rider]

Talk to a broker. There is no extra cost to you.
Maybe look here.

Harry P Thal Insurance | Medicare Made Simple

Discover personalized Medicare guidance with Harry P Thal Insurance. We offer expert advice on Medicare Advantage, Part D, and Supplement plans.

www.harrythal.com

 

[Koolau]

I agree that traditional Medicare is the way to go - with a supplement.

Welcome to the forum. So sorry to hear of your MD. Feel free to introduce yourself here:

Hi, I am...

Introduce yourself here! (But hey -- start a new thread, so we can see your post!)

www.early-retirement.org

 

[Irishgirlyc58]

Check your state laws about the availability of Medicare Supplemental plans for people under 65. The federal government does not require that the supplemental plans are available to those under age 65 but some states might?
I would go to the Medicare site and see what they say is available to you.

 

[Texas Proud]

I also agree with regular with a gap plan... the question is do you go to Drs a lot? If not, go N and pay the $20 as the premiums are much less IMO...

I forget the letter where you only pay your deductible and nothing else... someone will come and mention it..

Be careful about what a broker tells you... I talked to two of them that are highly rated on this forum and IMO got 'not good' advice... it was not bad advice but not what was best for me... when I mentioned the UHC plan and the price I was quoted from their mailer one said they did not sell it... the other wanted me to pay MORE than what UHC was going to charge for the same plan!!! Told me they were worth the extra money...

 

[GoBears]

You will need to determine what plans are available to you in your state because plans can be limited (or non-existent in many other states) for Medicare beneficiaries under age 65. Also, you should be aware that individuals under age 65 who are Medicare eligible due to disability can pay much higher premiums for their MediGap plans than those who are 65. For example, my wife’s premiums for the same UHC Plan G in California are about 3 times higher than mine because she is disabled and under 65, despite being 2+ years younger than me.

 

[Sarah S]

I am someone who has another neuromuscular disease. Like you I haven’t needed a lot from my insurance yet. I know I will though I also will need other doctors besides my neurologist and want choice.

For me the equivalent of plan g ( I am in Massachusetts we are different) was my supplement choice. The part d drug plan can be changed yearly so I choose based on current need. If you have the option of a good supplement I think it is probably the way to go. You do get to change when you are 65 if you are an ssdi person who started early. No underwriting but no discount like people who never had medicare before often get. I believe this is true everywhere becuse I know someone in Florida with my disease said they had this option

 

[sengsational]

If I had MD, I'd stay with traditional Medicare. This is because what if your network happens to have a "dud" MD expert? Or one who bows to the corporate master to get that promotion? With any preexisting condition, I'd want maximum flexibility.

And brokers are sales people, and many, if not most, put their financial success ahead of all but the most obvious inappropriate recommendations.

You can get help from your state's SHIIP office.

 

[stedmakr]

I would strongly recommend reaching out to a Medicare SHIP counselor (google that phrase). These are volunteer counselors who are trained to provide one on one counseling to Medicare beneficiaries. The SHIP program is financed by the federal government. Ask for a "New to Medicare" brief and then ask for your Medicare options and the associated costs. Counseling sessions can take place at a cousleing site, via ZOOM or telephonically. You could very easily get the answers to your questions and peace of mind within a week.

You have two primary options, original medicare with a medigap plan and a prescription drug plan or an Advantage plan. Medigap plans can be very expensive for indiviuals under 65. These plans are managed by your state. The SHIP counselor will be able to provide cost information. Advantage plans which also include a prescription drug component may be much less expensive but you need to be wary of prior authorization requirements.

When you turn 65 you will be able to purchase what will be a much cheaper medigap plan. You will have guaranteed issue rights which means that all plans are required to sell you a plan at their least expensive rate without medical underwriting.

You may also want to ask your husband's benefits counselor if there are options other than the high deductable plan that would allow you to stay on his insurance.

 

[Midpack]

Talk to a broker. There is no extra cost to you.
Maybe look here.

Harry P Thal Insurance | Medicare Made Simple

Discover personalized Medicare guidance with Harry P Thal Insurance. We offer expert advice on Medicare Advantage, Part D, and Supplement plans.

www.harrythal.com

+100. A broker doesn't cost you ANYTHING whether you buy through them or not - so there is no reason against working with one. I did months of research to make my choices, and then called Boomer Benefits shortly before applying, only to find they could have told me everything I needed to know - I am sure only because of all the research I did on my own.

Boomer Benefits is just one resource. And again, if you use their services it costs you nothing. And you are not obligated to use them. Of course they hope you will use them, that's how they get paid (not by you), but they did not apply any pressure IME. And they make the application process easier too.

While there are many knowledgeable members here, there are some who don't know what they are talking about or others whose (undisclosed) circumstances may differ from yours. Unless you know better, you may have a hard time figuring out who is who...

https://boomerbenefits.com/

 

[pacergal]

I second Boomer Benefits, great place to learn.
Medicare Advantage plans do have a place, it is important to investigate everything available in your area, and how that insurance may cover if out of town.

We chose an Advantage plan, but we had coverage through it for the last two years during work. It was seamless to stay with it after age 65.

 

[Tom57]

Searching previous discussions about Medicare enrollment, I am more confused than ever. I welcome insight as I am trying to gather information and prepare well in advance of making my selection. At 54 y.o. I was recently approved for SSDI due to my muscular dystrophy advancing to where I can no longer work. I am currently on a HDHP through my husband's employer, but come December 2025 I will be eligible for Medicare. That Medicare eligibility precludes me from remaining on my husband's employer's plan. Thankfully, I do not currently incur a lot in the way of medical costs. Very few doctor's visits and only a couple of prescriptions. We're hoping Medicare coverage will be a savings over the workplace plan which has a sizable deductible before we'd see any benefit.

I am reading in many places and being told by some providers that I should steer away from Medicare Advantage plans. Seems they promise a lot but people have experienced them falling short when coverage really matters. I'm led to believe regular, straight, Medicare will suit me best. Is that the consensus of those of you who have experience with what's covered and what's not? What advice is offered with regards to the Medicare coverage and the supplements, particularly Part D?

Thank you

There are 2 types of Medicare Advantage plans available.
The first MA plan is available to everyone on Medicare, is advertised heavily, and causes some problems for some customers due to claims denials, in-network provider size, etc.
The second MA plan is from an employer/previous employer that subsidizes this MA plan and is only available to current or retired employees. This is the MA plan I have and it has great benefits, very low co-pays, great Part D benefits, and a low out-of-pocket annual limit of $600.00. I can use any doctor, hospital, lab, etc. that accepts Medicare without regard to network membership.
If your current or previous employer has this MA plan, ask your HR people for details.

 

[old medic]

I'll qualify for Medicare under disability come November and been also looking into it.
Still not sure what I'm going to do, but love the info here...

 

[sengsational]

I agree you can get a wealth of guidance from a broker. They will probably tell you most of the basic information to get your footing as a new entry to Medicare.

The problem is that even though you are not obligated to buy through them, as in any sales relationship, it can be hard not to. They are "nice" after all. And they've probably convinced themselves that their recommendation is the best for you, and the fact that they're making a few more bucks with "this over that" is fine.

But if you're in the market for Medicare Supplemental insurance, and they don't talk about each company's propensity to "close the book," then you have uncovered a bias.

When I called boomer benefits, I was an uniformed noob, and was convinced by the nice man to buy a Medicare Supplemental policy that was offered by a serial book closer. No mention of getting stuck in a "sick duck pool." Only because I persisted before committing did I decide they weren't looking out for my long term interests.

 

[newuser]

When my husband went on SSDI I did lots of research as well and he ended up going on a Medicare Advantage plan that is highly rated in our area and is sponsored by the health system he uses and includes under 65/SSDI eligibility. It's been 4 years now and he's been very happy with the choice and has definitely come out ahead financially with the low co-pay and the other benefits offered (OTC allowance, vision, premium subsidy rebate, etc) The only reason I was comfortable with this choice was the fact that he could re-choose at 65 so essentially would have a do-over.

Just this month I became Medicare eligible and chose standard Medicare and a supplemental plan. Our state department of insurance was very helpful in explaining the available options and differences between both supplemental and Part D plans offered in our area.

I kind of hate that I'm going to be paying so much more for insurance than I was through my previous high deductible ACA plan, but I guess for now I'm more comfortable with the knowns of a budgeted cost and open network.

It will be interesting to see how things develop over the next 3 years and what we choose for my husband when he turns 65. As others have said, this is a very personal choice. Good luck finding the best option for you.

 

[skipro33]

I have a supplemental but it is PPO not HMO. I can go to any doctor, or special, in or out of plan, referred or by my choice. For example, if I've torn my rotator cuff and want to consult a surgeon or a physical therapist, I do not need my PCP to refer me, nor get prior approval from the insurance provider.
I went through a year of chemo and labs and imaging, surgeries, COVID pneumonia that put me in the hospital, etc with bills totalling in the hundreds of thousands and never paid more than a few hundred dollars a year out of pocket. Mine is through my previous employer retirement, but j have neighbors with AARP United Health Care PPO that is identical to my retirement UHC PPO.

 

[Dtail]

My fiance is also on SSDI. She currently has a Part C plan and has had it before we were together. She does go to the doctor a decent amount with a bunch of prescriptions. She has great access to any doctor.
However, as she is turning 65 next year, she has one opportunity to switch to original Medicare plus a Medigap policy without medical underwriting.
We will be researching it this year along with using the assistance of Boomer Benefits.
So, this ability to switch at 65 is something to consider if you want Medicare Advantage, although you have a bunch of years before you reach that age.

 

[Scuba]

DH went on Medicare in 2024. Thanks to this forum, and the advice of two brokers, we selected traditional Medicare Plan G with the AARP UHC supplement. We have been extremely happy with this choice. Virtually all providers take this insurance, and all he has to pay is the Medicare deductible, which is negligible.

I will be going on Medicare this year and plan to take the same plans. While I’ve been healthier than DH has, it is truly wonderful to have coverage that is so widely accepted. Makes our healthcare stress free at least from a financial perspective.

 

[tominboise]

I just signed up today, as matter of fact, for a Plan N through AARP/UHC. As brokered by boomerbenefits.com. I signed up for Parts A&B at the beginning of February (turn 65 in March). Plan N through AARP/UHC and now all I need to pick is a drug plan. I am on a statin and two eyedrops for Glaucoma. So it will be interesting to see which plan is the cheapest.