Medicare: figuring out what to do...

[motley]

Due to my military allowing me Tricare, I think my plan is clear: Medicare A and B plus Tricare should pretty much cover me, as that basically acts as my "Medigap." But I still found it kind of a maze and took more than a little reading and research, and realize others may be debating which way to go and thought it might be worth having a thread about it...

 

[Nuke]

Replying mostly to make sure I come back to the thread.

 

[wearefinishedworking]

Yes, we need to start researching. We both become Medicare eligible in 2025.

 

[Texas Proud]

I have NO idea what Tricare covers.... but is it a medigap plan?

IOW, can you go to any Dr anywhere in the US and get any procedure medicare covers and it will pay your share? If not, it is not a medigap plan. If so, then what letter is its coverage?

 

[motley]

I have NO idea what Tricare covers.... but is it a medigap plan?

It's not an actual Medigap plan, as it's military retirees only, but effectively, it functions much the same.

IOW, can you go to any Dr anywhere in the US and get any procedure medicare covers and it will pay your share? If not, it is not a medigap plan. If so, then what letter is its coverage?

Again, it is not a Medigap plan; it's roughly the military equivalent. I can go to any doctor that Medicare Part B would cover, which I think is just about anyone.

 

[zl55lz]

I believe the op is referring to Tricare for Life as it is different than Tricare. See attached link regarding Tricare for Life (with Medicare).

TRICARE For Life | TRICARE

tricare.mil

 

[wrigley]

Due to my military allowing me Tricare, I think my plan is clear: Medicare A and B plus Tricare should pretty much cover me, as that basically acts as my "Medigap." But I still found it kind of a maze and took more than a little reading and research, and realize others may be debating which way to go and thought it might be worth having a thread about it...

Talk about Deja Vu. I just started looking into this 2 days ago. I turn 65 in March 2025 and I'm also Tricare Prime. I, too, figured Medicare A and B along with my Tricare for life will be enough.

Mike

 

[motley]

I believe the op is referring to Tricare for Life as it is different than Tricare. See attached link regarding Tricare for Life (with Medicare).

TRICARE For Life | TRICARE

tricare.mil

Correct, pardon not being clearer...that among other Tricares fall under the umbrella of "Tricare."

Before I found that out, however (of course the military in its infinite brilliance never even told me it existed), I was surfing the waves of Part A/B vs Part C etc.

 

[Koolau]

I know nothing of Tricare or whether it overlaps with gap plans. I do know that we are fairly well satisfied with our gap plan and it costs less that I expected and covers us pretty well. I do encourage motley to research carefully as the decisions made can have real financial and treatment consequences. All the best in your search for the best care at reasonable cost.

 

[rk911]

I have NO idea what Tricare covers.... but is it a medigap plan?

IOW, can you go to any Dr anywhere in the US and get any procedure medicare covers and it will pay your share? If not, it is not a medigap plan. If so, then what letter is its coverage?

When my BIL passed in 2021 he had traditional Medicare, Tri-Care as well as retirement coverage from IBM. It was a spider web of conflicting plans as I was trying to figure out who paid for what and if any co-pays were due. I finally just 'let go' of the wheel and figured that IBM and Tri-Care would work it out...and they did. But it sure seemed overly complicated.

 

[motley]

I know nothing of Tricare or whether it overlaps with gap plans. I do know that we are fairly well satisfied with our gap plan and it costs less that I expected and covers us pretty well. I do encourage motley to research carefully as the decisions made can have real financial and treatment consequences. All the best in your search for the best care at reasonable cost.

I appreciate that, but this isn't a "what should I do" thread; my plan is pretty well figured out. I just thought it could be good to have a thread to discuss for those who are new to navigating the process to figure out what's best.

Here are a couple of links I found with some good general info:

• Medicare overview: Medicare Benefits | SSA
• Medigap plans: Compare Medigap Plan Benefits

 

[motley]

This is curious; I was checking out the Part C thing and found out even if you have part C, you still have to pay the Part B monthly cost. ? What's the point of Part C then? Just getting little extras like visual and dental?

 

[PaunchyPirate]

This is curious; I was checking out the Part C thing and found out even if you have part C, you still have to pay the Part B monthly cost. ? What's the point of Part C then? Just getting little extras like visual and dental?

Part C (Medicare Advantage) plans often have zero or low premium costs. And you aren't paying the premium of a Medicare Supplement (you cannot have a supplement with Part C). So when you sign up for Part C, many times, all that you do pay for is the Part B premium. So, I would say that lower cost is why most people sign up for Part C plans.

However, you need to be very comfortable with the rules that the Part C plan coverage. It will operate much like traditional health plans during employment. There may be additional hoops to jump through for pre-authorizations and such. There are also usually co-pays for services.

 

[motley]

Part C (Medicare Advantage) plans often have zero or low premium costs. And you aren't paying the premium of a Medicare Supplement (you cannot have a supplement with Part C). So when you sign up for Part C, many times, all that you do pay for is the Part B premium.

From what I have seen of plans so far, this is not so. They still have deductibles etc.

 

[PaunchyPirate]

From what I have seen of plans so far, this is not so. They still have deductibles etc.

Yes, of course they do. And they have co-pays too as I said in my first post. I was specifically referring to the premium portion of the costs. Part C plans often have zero $ premiums -- and they advertise the heck out of that. Or very low ones. There are certainly many other costs -- deductibles and co-pays. These are defined in the plan and have to be considered when determining how "free" the plan is. There are also often limited networks of physicians and providers that must be used.

 

[Texas Proud]

This is curious; I was checking out the Part C thing and found out even if you have part C, you still have to pay the Part B monthly cost. ? What's the point of Part C then? Just getting little extras like visual and dental?

Think of it as Part B/C premium.... you choose which letter you want...

I am not curious.... do they call it Part B premium or is that what 'we' call it...

 

[Gotadimple]

Think of it as Part B/C premium.... you choose which letter you want...

I am not curious.... do they call it Part B premium or is that what 'we' call it...

Not exactly. If you only choose Part B you are exposed for all prescription drug costs (no prescription without insurance ever really just costs $5), and 20% of all lab, emergency, and doctor visits.

Part B is that part of Medicare that pays for physicians, other providers, labs, etc. You are required to pay a premium for Part B. It does not cover prescription drugs.
Part A is free and it comes with Medicare - it is for hospitalization. Drugs are only covered under Part A if dispensed by the hospital (and only at 80% of the hospital billing).

Both pay out at 80% and you are responsible for the other 20%.

You are required to take Part B and pay a premium if you want to expand coverage to include Drugs (Part D), Medicare Advantage (Part C)/Medicare Supplement coverage.

Medicare Supplement picks up the 20% Medicare doesn't pay for, but, there is a premium for buying a Supplement plan and you must be enrolled in Part B. It is also to your advantage to enroll in Part D Prescription drugs, even if you take nothing to avoid a premium surcharge for late enrollment.

Medicare Advantage (Part C) plans may have no or low premiums, co-pays and deductibles, cover drugs, and can include other coverage such as vision, dental, gym memberships, case management, etc. All of these are above and beyond what Medicare covers, but are required by CMS in order for an insurer to offer a Part C plan.

Medicare.gov is a great resource for understanding health care coverage for Medicare eligible people. So is AARP. AARP does have a licensing agreement with other supplement and Part C plans, but the general information about Medicare on their site is excellant.

 

[Koolau]

Not exactly. If you only choose Part B you are exposed for all prescription drug costs (no prescription without insurance ever really just costs $5), and 20% of all lab, emergency, and doctor visits.

Part B is that part of Medicare that pays for physicians, other providers, labs, etc. You are required to pay a premium for Part B. It does not cover prescription drugs.
Part A is free and it comes with Medicare - it is for hospitalization. Drugs are only covered under Part A if dispensed by the hospital (and only at 80% of the hospital billing).

Both pay out at 80% and you are responsible for the other 20%.

You are required to take Part B and pay a premium if you want to expand coverage to include Drugs (Part D), Medicare Advantage (Part C)/Medicare Supplement coverage.

Medicare Supplement picks up the 20% Medicare doesn't pay for, but, there is a premium for buying a Supplement plan and you must be enrolled in Part B. It is also to your advantage to enroll in Part D Prescription drugs, even if you take nothing to avoid a premium surcharge for late enrollment.

Medicare Advantage (Part C) plans may have no or low premiums, co-pays and deductibles, cover drugs, and can include other coverage such as vision, dental, gym memberships, case management, etc. All of these are above and beyond what Medicare covers, but are required by CMS in order for an insurer to offer a Part C plan.

Medicare.gov is a great resource for understanding health care coverage for Medicare eligible people. So is AARP. AARP does have a licensing agreement with other supplement and Part C plans, but the general information about Medicare on their site is excellant.

Thanks for the refresher. I've been on MC for 12 years and forgot many of these details.

 

[motley]

Medicare.gov is a great resource for understanding health care coverage

I wouldn't call it great tbh. It's OK.

 

[zl55lz]

Not exactly. If you only choose Part B you are exposed for all prescription drug costs (no prescription without insurance ever really just costs $5), and 20% of all lab, emergency, and doctor visits.

Part B is that part of Medicare that pays for physicians, other providers, labs, etc. You are required to pay a premium for Part B. It does not cover prescription drugs.
Part A is free and it comes with Medicare - it is for hospitalization. Drugs are only covered under Part A if dispensed by the hospital (and only at 80% of the hospital billing).

Both pay out at 80% and you are responsible for the other 20%.

You are required to take Part B and pay a premium if you want to expand coverage to include Drugs (Part D), Medicare Advantage (Part C)/Medicare Supplement coverage.

Medicare Supplement picks up the 20% Medicare doesn't pay for, but, there is a premium for buying a Supplement plan and you must be enrolled in Part B. It is also to your advantage to enroll in Part D Prescription drugs, even if you take nothing to avoid a premium surcharge for late enrollment.

Medicare Advantage (Part C) plans may have no or low premiums, co-pays and deductibles, cover drugs, and can include other coverage such as vision, dental, gym memberships, case management, etc. All of these are above and beyond what Medicare covers, but are required by CMS in order for an insurer to offer a Part C plan.

Medicare.gov is a great resource for understanding health care coverage for Medicare eligible people. So is AARP. AARP does have a licensing agreement with other supplement and Part C plans, but the general information about Medicare on their site is excellant.

I believe Part A covers 100% for days 1-60 after the deductible, then for days 61-150 there is a certain copay.

Costs

What you pay for Medicare will vary based on what coverage and services you get, and what providers you visit.

www.medicare.gov

 

[Texas Proud]

I was trying to get the poster to not dwell on Part B premium... it is a requirement to have medicare... so you can call it anything you want as long as you pay it..

Well, I just checked and they do say it is Part B premium.... so I guess I was wrong...

 

[GJW1]

We have Medicare Parts A & B. We also have Tricare for Life (TFL). The way it has always worked for us is Medicare is our Primary insurance, TFL is our secondary insurance. Claims always go to Medicare first, then Medicare forwards claims to TFL. Each insurer pays there part - our deductibles are very low. There is no premium for TFL. TFL is also our prescription insurance - we can go to almost any pharmacy or use TFL mail order pharmacy. In the 8 years we have been on these plans we have never had any issues - 9 times out of 10 we never even pay a co-pay. YMMV...

 

[KimmK451]

This thread is a good idea! I have FEHB (fed insurance) so if I don't take Part B, Blue Cross would stay my primary insurance BUT I've seen posts by various advisers cautioning that a) the insurance companies are for profit and assume you will be taking Medicare A/B when you retire and are likely to adjust your plan accordingly and b) government can adjust FEHB any time they want to (adviser used gov forcing mail handlers to take Part B as an example) and c) an adviser mentioned he had a client who only had FEHB and Medicare A and developed a condition later in life that neither covered, yet Part B would have but starting B at that point would've cost him an additional 90% penalty annually. But on the other hand, several advisers mentioned that if you're paying the higher Part B premiums, it might not be worth it. So, am interested in what everyone else is doing! I'll keep FEHB so Part D or Advantage are not necessary in either case.

 

[zl55lz]

This thread is a good idea! I have FEHB (fed insurance) so if I don't take Part B, Blue Cross would stay my primary insurance BUT I've seen posts by various advisers cautioning that a) the insurance companies are for profit and assume you will be taking Medicare A/B when you retire and are likely to adjust your plan accordingly and b) government can adjust FEHB any time they want to (adviser used gov forcing mail handlers to take Part B as an example) and c) an adviser mentioned he had a client who only had FEHB and Medicare A and developed a condition later in life that neither covered, yet Part B would have but starting B at that point would've cost him an additional 90% penalty annually. But on the other hand, several advisers mentioned that if you're paying the higher Part B premiums, it might not be worth it. So, am interested in what everyone else is doing! I'll keep FEHB so Part D or Advantage are not necessary in either case.

The FEHB and Part B topic is much debated. FEHB is a relatively small group of people so not sure if you will get many replies. I am FEHB with Parts A and B. Works great. Haven't paid a penny other than premiums and Rx in years. The big issues I have seen seem to revolve around IRMAA tiers and the 10% penalty per year for delaying Part B. Once on FEHB + Medicare it is possible to find cheaper plans which offer "wraparound." I have benefited from subscribing online to checkbook.org to plug in various scenarios, and it has good articles. I have looked at the Part B/no Part B with FEHB issue a lot so if there are specific questions I can try to help give an answer or at least give an opinion based on my research.

 

[KimmK451]

The FEHB and Part B topic is much debated. FEHB is a relatively small group of people so not sure if you will get many replies. I am FEHB with Parts A and B. Works great. Haven't paid a penny other than premiums and Rx in years. The big issues I have seen seem to revolve around IRMAA tiers and the 10% penalty per year for delaying Part B. Once on FEHB + Medicare it is possible to find cheaper plans which offer "wraparound." I have benefited from subscribing online to checkbook.org to plug in various scenarios, and it has good articles. I have looked at the Part B/no Part B with FEHB issue a lot so if there are specific questions I can try to help give an answer or at least give an opinion based on my research.

I'm worried about the IRMAA premiums for Part B. I also have BCBS, which is probably the most expensive, but not sure I want to go to BC Basic because it limits providers altho it does give some $ back for taking Part B.

I'll check out checkbook.org, thanks! I've just used BCBS for years - haven't checked out the other plans in awhile so if you have recommendations....? One of the articles I read did say if you have GEHA, you should really look at getting Part B! But I don't know about the other plans. I do like that BCBS works internationally, and with Standard I can choose my own docs.