Medicare Choices

[athena53]

I'd also recommend boomerbenefits.com. Didn't go through them personally but their site has a lot of good, clear information. You may also find that your Motor Vehicle Bureau has sold its mailing list and as you get closer to signup, all kinds of mailings will show up. I even had an agent appear on my doorstep, uninvited. (I'd already signed up with AARP on-line.) Using an agent doesn't cost extra and the good ones can walk you through everything.

And yes, it's complicated. I ER'd a week after I made the decision to quit (four years ago- no regrets at all), so hadn't really thought it through. I was 61 but we got an agent to walk us through getting DH signed up for Medicare, the supplement and the prescription plan. (He was 75 but had been on my employer's policy till then.) This, despite the fact that I'd been in property-casualty insurance for almost 40 years so I know the jargon better than most.

 

[REWahoo]

I read somewhere that Medicare requires your PCP to be within 25 miles of your zip code.

I don't think this is accurate. One of the best features of Medicare and Medigap IMO is that you can use whatever doctors you choose, so long as they accept Medicare. No network, no geographical limitations (within the US).

 

[MichaelB]

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.

All MediGap plans are in the same provider network as Medicare, so there can be no difference in providers. Coverage is also regulated, so plans are identical between insurers. The only difference is price. Page 11 of this PDF has an easy to use chart that summarizes all the MediGap options https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf

The only exception is a group of plans called “select” which are lower cost options with some restrictions, and these are clearly designated

 

[CRLLS]

I don't think this is accurate. One of the best features of Medicare and Medigap IMO is that you can use whatever doctors you choose, so long as they accept Medicare. No network, no geographical limitations (within the US).

I agree. For reasons that aren't germane to this discussion, I do not have a PCP and I signed up for Medicare Part A & B, and its various other 3rd party coverages last Fall. There is no place on the Medicare, Medigap or Part D sign-up that asks for a PCP.

 

[braumeister]

I read somewhere that Medicare requires your PCP to be within 25 miles of your zip code.

Some HMO plans have such a requirement, but Medicare doesn't.

 

[MBSC]

I read somewhere that Medicare requires your PCP to be within 25 miles of your zip code.

I don't think this is accurate. One of the best features of Medicare and Medigap IMO is that you can use whatever doctors you choose, so long as they accept Medicare. No network, no geographical limitations (within the US).

+1

Some Medicaid managed care programs require the contractor to have PCPs within 25 miles of each zip code. Traditional Medicare does not use the PCP model.

2018 Medicare & You Booklet: https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf

CMS Guide to Choosing a Medigap Policy: https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf

CMS Guide to Part D Coverage: https://www.medicare.gov/Pubs/pdf/11109-Your-Guide-to-Medicare-Prescrip-Drug-Cov.pdf

 

[Another Reader]

It was Medicare, not Medicaid. But it was a couple of years ago that I read the article. I encountered the problem with the employer-provided insurance years ago, but was surprised to see that it might carry over to Medicare and be even more restrictive. If not, I'm a happy camper.

 

[John Galt III]

I've been seeing a lot of ads on TV lately stating that some seniors may be eligible for both Medicare and Medicaid simultaneously....just to add to the complexity ! I did some internet searching, and found that Medicare is the primary and Medicaid is the secondary insurance in that case, with Medicaid paying for the Medicare copays and coinsurance (including the unlimited 20% coinsurance for hospitalization under Medicare, I'm guessing). Nice. Maybe in this scenario, one would not need a supplement or an advantage plan. Oh wait, there's that Medicaid estate clawback thing, in which the deceased medicaid recipient's estate is charged for medicaid payments made during his lifetime (sometimes enforced, sometimes not) that could ruin the fun.

 

[Gotadimple]

One can always drop a Medigap plan and return to traditional medicare. Same for Part C (Medicare Advantage). At open enrollment time you can retun to traditional Medicare. What you may not be able to do is move to a different Medigap plan with being underwritten.


Al, the insurance commissioner in the state of California also has great resources about Medigap. Start here:
Guide to Medicare Supplement

 

[NoMoreJob]

Just FYI in case it hasn't been mentioned.....If you choose Traditional Medicare (parts A,B, D) as opposed to an Advantage plan and you don't buy a part D (Drug) plan when you become eligible for Medicare you will be subject to a forever penalty if and when you decide you need one. I do not take a regular medications so just signed up for the cheapest plan available to avoid the future penalty.

 

[Katsmeow]

It was Medicare, not Medicaid. But it was a couple of years ago that I read the article. I encountered the problem with the employer-provided insurance years ago, but was surprised to see that it might carry over to Medicare and be even more restrictive. If not, I'm a happy camper.

I think you are confusing Medicare Advantage plans with traditional Medicare with a Medigap supplement. Medicare Advantage plans are typically like an HMO (some are more like a PPO) and you do have a network with them.

With traditional Medicare you can see anyone who takes Medicare. The supplement will be the same.

FWIW, while my mother was ill with lots of chronic health conditions various health professionals uniformly told me it was good she was on traditional Medicare. There were no network problems.

One can always drop a Medigap plan and return to traditional medicare.

What? Medigap policies are used with traditional Medicare. That is the point. I guess you could drop a Medigap policy and not have one (although that makes no sense).

 

[kaneohe]

Quote:
Originally Posted by Gotadimple View Post
One can always drop a Medigap plan and return to traditional medicare.


What? Medigap policies are used with traditional Medicare. That is the point. I guess you could drop a Medigap policy and not have one (although that makes no sense).

Perhaps Katsmeow meant you could add an Advantage plan. Katsmeow did say you couldn't change Medigap w/o underwriting.

 

[Another Reader]

I'm aware of the differences between the various plans and between Medicare and Medicaid. I'm not sure where I read the article, so I'm going to rely on what I read at Medicare.gov.

I'm pretty sure that as a cost cutting move, we will eventually see Medicare contracts with providers and restrictions a la HMO's. Not today, but as health care becomes more expensive, cutting costs will become paramount.

 

[Bamaman]

Your Advantage plans already operate somewhat like a HMO--paying providers a set amount monthly. Some hospital chains have opted out of Advantage programs, and that includes their hospital owned physicians practices. That means many patients have had to change doctors and even change hospitals--going to other towns. But the hospitals and doctors still accept traditional Medicare and supplements.

 

[Katsmeow]

I'm aware of the differences between the various plans and between Medicare and Medicaid. I'm not sure where I read the article, so I'm going to rely on what I read at Medicare.gov.

I'm pretty sure that as a cost cutting move, we will eventually see Medicare contracts with providers and restrictions a la HMO's. Not today, but as health care becomes more expensive, cutting costs will become paramount.

The point isn't between Medicare and Medicaid. What you seem to not be mentioning is that there is a difference between original (traditional) Medicare and Medicare Advantage. Medicare Advantage is usually much like an HMO (some function more like PPOs but that is not common). Original Medicare is different. You as the patient can see anyone who takes Medicare but the providers aren't required to take Medicare patients.

Perhaps Katsmeow meant you could add an Advantage plan. Katsmeow did say you couldn't change Medigap w/o underwriting.

I think you mean Gotadimple not me....

 

[Gotadimple]

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".

In my earlier message, I was responding to this post:
If you have Medicare Advantage, at open enrollment time you can go back - to Traditional Medicare. You MAY not be able to get a Medicare Supplement based on health underwriting.
Hope that's clear!

 

[audreyh1]

One can always drop a Medigap plan and return to traditional medicare. Same for Part C (Medicare Advantage). At open enrollment time you can retun to traditional Medicare. What you may not be able to do is move to a different Medigap plan with being underwritten.


Al, the insurance commissioner in the state of California also has great resources about Medigap. Start here:
Guide to Medicare Supplement

Huh? A Medigap plan goes along with traditional Medicare, Dropping it means you are on the hook for the 20% copays. Can get very expensive if you are diagnosed with cancer, as my in-laws unfortunately found out a couple of years after they decided their Medigap was just too expensive and dropped it.

 

[Another Reader]

This was original Medicare, not Medicare Advantage. I understand the difference and would never enroll in a Medicare Advantage plan. The information was in a link from the pension system's contractor site IIRC, but I can't find it now.

I have a couple of months before the window opens, but I'm leaning towards the AARP plans, probably F if they offer it. It looks like their contractor offers it, but I can't see the plans until the window opens. I guess part of the price of the insurance is a lot of junk mail and junk e-mail from AARP and all the companies to which they sell the list of members. I would never join AARP if it were not for the insurance...

 

[NoMoreJob]

This was original Medicare, not Medicare Advantage. I understand the difference and would never enroll in a Medicare Advantage plan. The information was in a link from the pension system's contractor site IIRC, but I can't find it now.

I have a couple of months before the window opens, but I'm leaning towards the AARP plans, probably F if they offer it. It looks like their contractor offers it, but I can't see the plans until the window opens. I guess part of the price of the insurance is a lot of junk mail and junk e-mail from AARP and all the companies to which they sell the list of members. I would never join AARP if it were not for the insurance...

It's interesting you say that because I felt exactly the same way. I started working with a broker who recommended AARP because of his clients' high satisfaction with their plans but I said I would never use them because I belonged once and couldn't stop the flood of junk mail (it literally took years after I cancelled my membership. I capitulated and signed up for the AARP plan but had to re-join AARP first. While talking to them on the phone to sign up I let them know that I was doing so only if I could opt out of ALL junk mail for AARP and their associated companies/advertisers. I was told I could. I have been very pleasantly surprised that after over a year I haven't received any junk mail from them!

 

[TromboneAl]

Okay, my zip is 95570 (Trinidad, CA), but when I put in 95501 (McKinleyville), there are some to choose from.

Medigap Policy A, Medigap Policy B, etc. Are those standard policy types? That is, do all Policy Bs have the same benefits, etc??

Are independent agents a good idea, or should I view them as I do financial planners?

Thanks, guys.

 

[REWahoo]

Al, are you saying you don't see ANY Medigap providers when you put in your 95570 zip because I see dozens when I use your zip in Medicare.gov.

 

[MichaelB]

Okay, my zip is 95570 (Trinidad, CA), but when I put in 95501 (McKinleyville), there are some to choose from.

Medigap Policy A, Medigap Policy B, etc. Are those standard policy types? That is, do all Policy Bs have the same benefits, etc??

Are independent agents a good idea, or should I view them as I do financial planners?

Thanks, guys.

When I input zipcode 95570 I see an assortment of plans available, including 11 Plan F Hi-Ded.

See this PDF, https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf especially page 11. Medigap policies are standard an regulated, so all "A" are exactly the same, B, etc.
What you want to understand is the difference in coverage for each "letter" and the premium, so you can compare.

 

[Another Reader]

I got two plans in your zip from medicare.gov. New to Medicare was the key. Both are low cost UHC products. Try the AARP health insurance site. That might give you better options. Or you could always move...

 

[REWahoo]

I got two plans in your zip from medicare.gov. New to Medicare was the key. Both are low cost UHC products.

Did you input his zip here? https://www.medicare.gov/find-a-plan/questions/medigap-home.aspx

When I input the 95570 zip and checked "no" to the "Do you have a Medigap poicy?" question it brought up a page listing all the policies available in 95570 (Plans A, B, C, D, F, F-HD, G, K, L, M, and N). Clicking on the right column of each of those Plans (where it states "View companies that offer plan__") will bring up another page with a list of the names, addresses and phone numbers of all insurers offering policies in 95570.

For example, I clicked on Plan G and found "18 companies offer Medigap Policy G in your area". Other plans have as many as 31 separate companies offering them.

 

[Another Reader]

I got a different page. Apparently, I'm even more Medicare-challenged than Al!