OT: Applying for initial Medicare coverage

[cabbie191]

There's a lot of expertise on this board in so many areas, but in particular, since as a group we have a lot of seniors, I am seeking advice as regards Medicare Part B (and possibly C & C).

I'm currently covered under Medicare Part A but have group health insurance through my employer - I'm retiring in July so that coverage ends the end of the month.

I'm looking at options for coverage through United Health Care as an AARP member, both Supplemental Plans as well as Advantage Plans.

My health is generally good so at first blush one of the Advantage Plans seems attractive. But I sense there are a whole lot of nuances and potential traps involved with this.

Any suggestions anyone would care to share would be very welcome, particularly things to be on the lookout for that the glossy brochures might omit. Thank you.

 

[uconnfan68]

You have something like 8 months to get B, with the end of your employer coverage seen as a life event. We just did it this year, and I can’t believe they make old people do stuff this complex. ;^)
Part D is prescription, and can be the same as a supplemental package provider. Part D is gonzo. Pill A, a generic 1mg, was put into tier 3 by my provider, but 0.5mg was much cheaper tier 2. My doctor just changed my script. Another item, an inhaler, they wanted an arm for. And of course they didn’t have X, so I had to switch to Y. I had been using Y for years, before the formulary made me use X, now I’m back.
Do your homework on every prescription. You may need more of a lower amount to get a better price. Also make sure all of your stuff is covered. You have to get this right after you have Part B. We had B, D, and supplemental start on 1/1/20, but my employer ran until 1/22/20. What a mess. We didn’t care who paid, but both employer and medicare “needed” to be primary.
You need to speak with someone at your local Social Security office to sign up for B (I think).
You'll get a chance to fix it in a few months if you don’t like your choices.

 

[wbbfjlf]

If you do not have a medicare account, create one. You may be able to sign up for part B right there. My husband and I are both on social security. He chose to go on the Anthem Blue Cross supplement plan. It's not cheap but we knew he needed two surgeries and didn't want the out of pocket costs with the cheaper plans. Of course medicare has a $185.00 deductible which is out of pocket.

 

[CL82]

FWIW, GoodRX is always worth a look for prescriptions. It is typically cheaper that insurance drug plans. I'm not sure about Part D.

 

[lebronfan23]

Deductible this year is 198.00

 

[FedupFred]

Look at a Medicare Advantage plan. They are HMOs but usually have no charge for primary care visits and low co-pays on specialists. There is no deductible on part D coverage.
Many return part of Part B fees (mine pays $110/month in my SS check. That's $220/month for me and my spouse.)
Hospital co-pays run around $150/day up to 7 days; after that it's ) for 90 days.
Prescription costs usually run 0 for generics, however, some are real screw-jobs. Mexiletine, a heart med, is cheaper through GoodRX and is not covered at all this year. Through anyone. There is no alternative either

 

[Centerstream]

Since the day I turned 65, I have had the AARP/UHC MEDICARE Advantage Plan. I have had no problems with UHC and believe me, I get my monies worth as I have a number of prescription medications and quarterly doctor visits.

Just my 2 cents.

Oh, something from Captain Obvious: no matter what you choose to do Medicare wise because your work insurance expires, you can switch coverage every year during the open enrollment period, October to early December.

 

[KnightBridgeAZ]

I'm not there yet, but my wife's disability plan through her former employer is technically a Medicare Advantage I think, and her mother is definitely on a Medicare Advantage, both through Humana.

The plan costs her Mom nothing except normal Medicare deducted from her Social Security payments For my wife, I don't know what it actually costs beyond the (normal) Medicare deducted from her Social Security payments as I don't know what the plan pays. They actually reimburse the Medicare deduction monthly, as part of her benefit.

Both have seemed to be ok; her Mom is pretty healthy and for my wife it came in 3 days after her transplant (December 28th) so that whole shebang was a split between regular Medicare and Humana. I would say both her Mom's and my wife's plans are pretty decent based on what I've experienced over the years.

Like anything else - research, research, research (which we didn't have any option to do). And when things go wrong, it can be spectacular. Humana pulled 2 payments back from previously approved charges for some tests citing "billed incorrectly" a reason that my provider assured me was just not correct. So we had to protest, and they subsequently approved them as "medically necessary" (which wasn't why they had reversed them). But their explanation back to the doctor leaves me responsible for $1200 (they say it doesn't and the doctor is misreading it) but it looks like I may be paying it. Grr. When things go wrong.

 

[bluedevil]

Its very important to have a prescription drug plan because if you wait and later on want one through Medicare you get penalized (I'm simplifying this but have personal experience because my mother waited so long)Advantage plans are the way to go..some are hmo some ppo. Supplements do not offer rx plans and are outrageously expensive..my 2 cents fwiw...

 

[uconnfan68]

If you do not have a medicare account, create one. You may be able to sign up for part B right there. My husband and I are both on social security. He chose to go on the Anthem Blue Cross supplement plan. It's not cheap but we knew he needed two surgeries and didn't want the out of pocket costs with the cheaper plans. Of course medicare has a $185.00 deductible which is out of pocket.

The Part D has a $485(?) deductible, plus regular costs for drugs... and as I mentioned, they manipulate things to their benefit. I was told by my provider they charged much more for 1mg tabs because they were “ more popular”. Luckily I knew 2x.5mg was the same as a 1mg.

 

[uconnfan68]

Look at a Medicare Advantage plan. They are HMOs but usually have no charge for primary care visits and low co-pays on specialists. There is no deductible on part D coverage.
Many return part of Part B fees (mine pays $110/month in my SS check. That's $220/month for me and my spouse.)
Hospital co-pays run around $150/day up to 7 days; after that it's ) for 90 days.
Prescription costs usually run 0 for generics, however, some are real screw-jobs. Mexiletine, a heart med, is cheaper through GoodRX and is not covered at all this year. Through anyone. There is no alternative either

I have a $485 deductible with Part D. In addition to a monthly charge ($13-14). Not sure why you say $0... Income based?

 

[SEbluebood]

Warning! You are right to be cautious with this decision. While many people have good experiences with Medicare advantage plans and enjoy zero or no premiums, a Medicare supplemental plan paired with a Part D prescription drug plan often offers a far better value ( and less financial risk) for many people. Plus , you only have a limited period of time to enroll in a Medicare Supplement plan WITHOUT medical underwriting. You can easily move from a Medicare Supplemental plan to a Medicare Advantage plan once a year during the fall enrollment period, but you can’t move the other way without passing underwriting. I suggest you talk to two different independent agents to review your situation and see what makes best sense for you. There is no cost or obligation.

 

[Majic Hands]

Any suggestions anyone would care to share would be very welcome, particularly things to be on the lookout for that the glossy brochures might omit. Thank you.

My wife and I Are both veterans and have utilize the VA for our health care. However, it's not the most flexible and you can get kicked out as well as other situation that could interfere or disrupt needed treatment.

My wife had Medicare a prior to January one 2020 so she was eligible for supplement F which is no copay or deductible.

I chose supplement g which goes in effect in July 1 of this year with $198 yearly deductable.

We also got plan D through WellCare RX.

We purchased our plans through Physician Mutual. We have spoken with several companies with offering the services but until we spoke with a lady we met in a local food group and she laid it all out for us. I'm confident that we made the best decisions for us and we're getting the most bang for our buck if we ever need it.

It is a nightmare. Hope this helps.

 

[bantamlaker]

My health is generally good so at first blush one of the Advantage Plans seems attractive. But I sense there are a whole lot of nuances and potential traps involved with this.

I believe what you state here is correct so you really must do your homework if considering an Advantage plan. I didn’t want to have to worry about any limitations on my choices in healthcare so I didn’t consider Advantage plans and went with traditional Medicare. This was several years ago and I understand that some Advantage plans here in CT have gotten less restrictive. I just looked at the Connecticare website and they now have a plan that offers “flexibility to get care nationally outside the Connecticare network.” That is something I might give serious thought to.

For supplements Plan F was the “ Cadillac” plan but as of this year it is no longer available to new enrollees. Plan G is basically the same as F except you have to pay the MC deductible. Remember that all Plan G’s are identical. In CT there are about a dozen companies offering Plan G with monthly premiums ranging from 198 (United Healthcare thru AARP) to 551(Colonial Penn) ! I have a high deductible F which most years has saved me quite a bit of money. A high deductible plan G is currently offered and might be worth considering if in good health. If in CT the Agency on Aging is a good resource but the info is available online.

For prescription drug plans (Part D) you have to run the numbers. The Medicare website is good for this. You put in all your drugs and pharmacies and it will give you the costs for all the plans available in your area. Monthly premiums and deductibles vary considerably. What I care about is the total costs for my drugs for the year which the website will give you for all the plans.

What SEbluebood said about medical underwriting is important to remember. However, CT and I assume some other states are guaranteed issue which means you are guaranteed acceptance into any Medigap plan. There can be a waiting period for preexisting conditions but some companies will waive this. I switched from one high deductible F to another based solely on the premium and the company waived the preexisting conditions because I had continuous coverage,

 

[Dokey]

I was on Kaiser and Kaiser automatically moved with me to Medicare, including part B.

 

[Drumguy]

OMG, you're right about the Boneyard being the source for all knowledge! I turn 65 in Sept. and my wife is retiring from teaching. I was told I need to sign up for Medicare 3 months before so I was just on the SSA website and signed up for Part A and (I think) Part B - It's a little confusing since my employer provided health care doesn't end until August 31!

I signed out of the SSA, checked out the BY and saw this post!!!!

 

[Bronxjeff]

The medicare site itself helps you choose the plans pretty well. For drug coverage particularly (Part D) you input your actual prescriptions, including dosages, and it comes back with the plan options available to you in your location - giving you a yearly out of pocket analysis to compare.

The biggest difference from your health insurance as an employee is that coverage is individual - so you have to do the applications nd make choices separately for your spouse too.

 

[bluedevil]

Many on this site do not live in CT. The original poster of this thread did not specify where he/she lives. It matters.. Also if I recall (I forgot to take those jelly fish pills) when you sign up for social security you are automatically enrolled in Medicare.....If you are in good health I think advantage is the way to go..I have united healthcare aarp plan and you don't have to belong to aarp to join. The popularity of Supplements have waned because they run from 5000 dollars a year and up. Thus are even harder to find...Hope this helps...btw we need another big

 

[bantamlaker]

The popularity of Supplements have waned because they run from 5000 dollars a year and up. Thus are even harder to find...Hope this helps...btw we need another big

Wow, you must live in a state that his considerably higher costs than CT (is that even possible) or you have misinformation. You can get a plan G which is now the most comprehensive plan available from Anthem or United Healthcare in CT for about 200 per month or 2400 a year. For someone in good health a high deductible Plan G is available for about 600 a year.
But, you are right about needing another big.

 

[Rixxx]

As mentioned earlier, get part D taken care of promptly. If you delay for any reason, you will be penalized financially forever. Premium will be increased nominally forever. I have experienced this after delaying one month.

 

[Checkmate 2.0]

FWIW, GoodRX is always worth a look for prescriptions. It is typically cheaper that insurance drug plans. I'm not sure about Part D.

I agree GoodRX is great for all ages. I had a $400. savings on one prescription with it.

 

[bluedevil]

As mentioned earlier, get part D taken care of promptly. If you delay for any reason, you will be penalized financially forever. Premium will be increased nominally forever. I have experienced this after delaying one month.

Carrot and stick....

 

[uconnfan68]

Many on this site do not live in CT. The original poster of this thread did not specify where he/she lives. It matters.. Also if I recall (I forgot to take those jelly fish pills) when you sign up for social security you are automatically enrolled in Medicare.....If you are in good health I think advantage is the way to go..I have united healthcare aarp plan and you don't have to belong to aarp to join. The popularity of Supplements have waned because they run from 5000 dollars a year and up. Thus are even harder to find...Hope this helps...btw we need another big

You are only enrolled in Part A automatically. And you need Part B before you can get any supplemental or advantage plans to go with Part D.

 

[bluedevil]

Correct!

 

[Kaizen]

I was on Kaiser and Kaiser automatically moved with me to Medicare, including part B.

I am on Kaiser too and I really like Kaiser's service.

Kaiser has medical office, lab., pharmacy and most of the test equipment in one building. So just one visit you can have almost everything done. My sisters are on Kaiser Senior Advantage with Supplement plan. They pay only $1.30 for every prescription (Kaiser will select the brand of drugs for you, mostly generic if available not brand name).

But I don;t think Kaiser has offices in CT ( Kaiser Permanente areas: parts of California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington (southwest part of the state), and Washington, D.C. ).