The date is getting closer and I'm finally starting to somewhat understand some of the terminology. The big choice is between getting Original Medicare Parts A and B, plus a Medigap policy, and Part D for drugs or Medicare Advantage, which is regular insurance like Humana that adheres to Medicare's policies.

A friend said he had Humana Advantage and liked it, but another friend ran it by his doctor's office and they said to stay away from it.

So, do y'all have opinions on either one?

Depends a lot on where you live and if you are happy with an HMO approach.

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Roswell, GA (Atlanta suburb)

If you have a retiree insurance plan from your former employer (like me), you don't have much choice unless you want to drop your retiree insurance.

Understanding and getting signed up for Medicare is like trying to swim thru a swamp full of gators. Dental isn't covered; vision is only partially covered - normal checkups for new glasses isn't. What they may or may not tell you is there is a base premium for Part B ($104/mo) plus possibly an additional monthly premium if your taxable income two years back was more than $80K. (This is adjusted every year in Nov/Dec.) Then depending on what plan you choose and depending on what type of Supplemental you may have you have to find someone to sell you a Part D compliant plan.

You can easily end up with 3 monthly premiums. The good news is if you're taking Social Security you can have them deducted automatically. You can sign up for Medicare without signing up for Social Security which happens when your normal SS retirement age isn't 65 which is the case for all of us retiring from now on.

The one thing I can be thankful for is I don't have to deal with ACA, but I pity those who will have to deal with it based on how Medicare works. And like ACA a lot of Docs don't want to deal with Medicare. If your Supplemental works before Medicare, most Docs will take you on as a patient. If your Supplemental works after Medicare you'll probably be looking for new Docs.

Slightly off topic but I find many people don't appreciate what Supplemental actually covers. As I understand it, if Medicare doesn't cover it then neither does Supplemental. In general terms, Supplemental only covers the difference between what Medicare says it should cost and what the doc bills.



Edited 1 time(s). Last edit at 11/14/2014 04:33PM by yeoman.

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bobinmurphy
The one thing I can be thankful for is I don't have to deal with ACA, but I pity those who will have to deal with it based on how Medicare works. And like ACA a lot of Docs don't want to deal with Medicare.

I don't understand this comment. Since ACA is a subsidy of private insurance, and many of the regular insurance companies are selling ACA-subsidized plans, how can a doctor even distinguish between someone who is receiving a subsidy and someone who is not. Is it possible for a doctor to refuse patients receiving the subsidies (and what incentives would they have for doing so?)

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"In science it often happens that scientists say, 'You know that's a really good argument; my position is mistaken,' and then they would actually change their minds and you never hear that old view from them again. They really do it. It doesn't happen as often as it should, because scientists are human and change is sometimes painful. But it happens every day. I cannot recall the last time something like that happened in politics or religion." (1987) -- Carl Sagan

Medicare Advantage Plan Worked Great For Me

I signed up for Medicare by going to a Social Security Office nearby. It looked like it was going to be hairy but turned out to be no big deal. Evidently YMMV.

This site was incredibly helpful. You can investigate plans available to you, comparing coverage and cost.
[www.medicare.gov]

I used my employer's for a couple of years. It was good but expensive.

2 years ago I switched to an Advantage HMO plan which has $0/mo premiums plus the $104/mo deducted from my Social Security. Advantage plans all are all in one plans so you just have a single premium. With my plan and my income it's just the $104/mo. Starting this year most common generic drugs are $0. Dental coverage is included - 2 exams, cleanings and Xrays / year. Vision exams and hearing exams are also covered. Coverage for lens, frame and hearing aids is poor. There are copays for doc visits - primary $10/visit, specialist $45/visit. There is a $2300 cap on out of pocket for medical expenses / yr. Also have "Silver&Fit" included - provides me zero cost to gym's for exercising - wonderful addition.

There are other Advantage plans that do have non zero premiums. Depends on the company and the coverage.

I don't agree with the statement " possibly an additional monthly premium if your taxable income two years back was more than $80K."
There is means testing but my memory is that it starts more at about $150k/yr for a single, $200k for a couple.

All is a function of your state but the medicare.gov link above takes that into account.
I can't overemphasize how much that site helped me in selecting my Advantage Plan.

Good Luck



Edited 2 time(s). Last edit at 11/14/2014 05:16PM by STL.

I believe the choice depends on your general health and health outlook when you sign up. I have been on the UnitedHealthCare (AARP) Medicare Complete Plan (Medicare Advantage) for the past five years. I know I have saved at least $150.00 per month during that period because of the extremely low premium. However, I don't often frequent the doctors office (last year 4 visits in total). Basically, the choice between a supplement and Advantage comes down to peace of mind. If you don't want to have to stay in network (which in my case was very extensive), want unlimited portability, and don't want any copays, then a supplement is the way to go. But Advantage plans can have a substantial cost savings due to the low premiums and no Part D plan requirement. Even with the copays, if you put pen to paper and are healthy, it's hard to justify the supplement. I figured that I would have to have have over 6 days in the hospital every year to break even. Since I've had none over this period, I've come out way ahead.

If you go the Advantage route, don't automatically go with Humana. There are a lot of companies that offer Advantage plans, each with different options, premiums and copays. I would suggest on of the many brokers in your area who can explain all of your question at no cost.

All that said, I'm switching to the supplement for next year. I'm now 70 and will likely continue to increase my medical usage in coming years. And I discovered that once you are in an Advantage plan, that to switch to a supplement you have to medically qualify. As I got older, I figured that would be less and less likely to happen.

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yeoman
Slightly off topic but I find many people don't appreciate what Supplemental actually covers. As I understand it, if Medicare doesn't cover it then neither does Supplemental. In general terms, Supplemental only covers the difference between what Medicare says it should cost and what the doc bills.

Not quite. If the doctor accepts Medicare, then he has to accept what medicare "allows" him to accept, regardless of what he "bills." Medicare then pays the doctor some percentage of that "allowed" amount, and the patient is responsible for the remainder of the "allowed" amount. Supplemental plans cover that residue that the patient is responsible for. The doctor rarely gets the full amount that he "bills."

Signed up for Medicare at 65, probably because my wires work Health Insurance (Kaiser), insisted. I am paying 3 x 104 a quarter to pay for Part B Medicare

Now at 66 I sign up for Social Security,and the Part B will be decocted from Social Security Payment.

Is Part A: Hospitalization
Part B: Doctors and outside of hospital expenses
Part C: when I give up my Medicare to Kaiser it is Now called Kaiser Senior Advantage
Part D; Drugs.

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STL
I don't agree with the statement " possibly an additional monthly premium if your taxable income two years back was more than $80K."
There is means testing but my memory is that it starts more at about $150k/yr for a single, $200k for a couple.

The income related monthly adjustment amount (IRMAA) starts at $85k in modified adjusted gross income (MAGI) for an individual and $170k for a couple filing taxes jointly. As MAGI rises, so does the additional charge for both Part B and Part D. IME its not unusual for something as seemingly innocuous as the sale of a house to cause spikes in MAGI and therefore an IRMAA assessment. If you end up being assessed IRMAA, you CAN appeal to SSA.

Disclaimer: I work for a major Part D provider and deal with a IRMAA questions on a far-too-frequent basis. If you have questions about Part D in general, feel free to PM me.

TL
Do you have any comment or a link which would expand on swf's last statement
"And I discovered that once you are in an Advantage plan, that to switch to a supplement you have to medically qualify. As I got older, I figured that would be less and less likely to happen."

It got my attention since I'm on an Advantage plan. I was not aware one had to "medically qualify" to move from an Advantage plan to a supplement.
My first Medicare related plan was an advantage plan through my former employer.

Thanks



Edited 1 time(s). Last edit at 11/14/2014 06:25PM by STL.

[www.medicare.gov]

Quote
CMS says
"When can I buy Medigap?
Buy a policy when you're first eligible

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, and once it's over, you can't get it again.

During open enrollment

Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, if you apply during your Medigap open enrollment period, you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health."

So yes, if you don't buy when you first enroll in Medicare, you are likely going to have to go through medical underwriting. There are exceptions, listed on the linked page.



Edited 2 time(s). Last edit at 11/14/2014 06:32PM by TL.

To clarify, an Advantage plan is NOT supplemental coverage. You will have either regional Medicare (Parts A and B) or an Advantage plan (yes there are exceptions such as Cost and Private Fee For Service plans, but they aren't as common). You may choose to buy a supplement policy (Medigap) which is meant to cover the costs that Original Medicare or your MA plan do not cover.

FYI, you cannot have a Medigap policy covering prescriptions if you are enrolled in Part D, or enrolled in a Medicare Advantage plan that includes Part D coverage.

Thanks again TL

I thought the discussion at the link below was useful and list of exceptions increased my comfort level with having an Advantage plan from the get go.
[www.ehealthmedicare.com]

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rgG
Depends a lot on where you live and if you are happy with an HMO approach.

I'll go a step farther and say Medicare Advantage plans vary so much by region that it depends ENTIRELY on where you live. It can be a night and day difference. The best areas for Medicare Advantage are the "retiree" states, especially Florida but also Texas and Arizona. If you live in Florida, it's not uncommon to have multiple choices of $0 premium MAPDs with $0 or very low copays, PLUS 100% reimbursement of your Medicare Part B premium (they actually rebate the full $104.90 premium that you would normally pay for Part B). Medigap plans are also much more expensive in Florida compared to most other states.

But in my home state, many Medicare Advantage plans are no better than original Medicare, plus you have to pay the insurance company a substantial premium ($0 premium plans are nearly non-existent here and the one or two $0 premium plans have rather large copays).

One disadvantage of Medicare "Advantage" plans is they are network based. Not only HMOs but even PPOs have a network where you'll pay more if your provider doesn't participate in the network. A PFFS is the only MAPD option that might not have a network (some actually do) but PFFSs have their own disadvantages. With a medigap plan, there are no networks; you can see any doctor who accepts Medicare.

Call a local independent agent and use the Plan Finder at [www.medicare.gov] to see what's available in your area.

P.S.: About the Medicare supplement or medigap not supplementing non-Medicare charges, that is true. With a Medicare supplement, the claims are actually sent to Medicare, not the insurance company. Medicare approves the claim (or not) and sends notice to the insurance company--who has no say in the claims process. If Medicare approves it, the supplement pays their part, end of story.

If Medicare does not approve the claim, there is nothing for the insurance company to supplement. But the only example I can give of something somewhat common that Medicare does not cover is acupuncture.

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TL
To clarify, an Advantage plan is NOT supplemental coverage. You will have either regional Medicare (Parts A and B) or an Advantage plan (yes there are exceptions such as Cost and Private Fee For Service plans, but they aren't as common). You may choose to buy a supplement policy (Medigap) which is meant to cover the costs that Original Medicare or your MA plan do not cover.

I want to clarify your clarification. I don't think you really mean what your last sentence actually says, because it contradicts your first sentence. A Medicare supplement cannot co-exist with a MA plan; it's one or the other. You probably meant "a medigap is meant to cover the costs that original Medicare does not cover--or what your MA plan did not cover before you dropped the MA and returned to original Medicare with a medigap."

Also, to further clarify, it is possible (but both illegal and quite silly) to purchase both a MA and medigap. But if you are enrolled in a MA plan, medigap does nothing (except cost you money in premiums) because claims go to your MA insurance company and never make it to Medicare--which is necessary for a medigap to actually pay anything.

The month before I turned 65 I signed up for Part A and Part B. I also have Blue Cross/Blue Shield through the Federal Employee Health Benefit plan. We pay $282 a month for a family plan and $104 a month for each of us for Part B. BC/BS pays for drugs, so I didn't sign up for Part D.
I don't know if I'm overpaying or not, but I wasn't going to let my FEHB plan drop because you can't get back on it if you drop it after you retire. All I know, is that in the two years since starting Medicare, we haven't had to pay out-of-pocket for anything for either of us. That includes two surgeries and two trips to the ER.

Maybe we were lucky, buy all of our doctors accept Medicare. Maybe the fact that we were patients long before signing up for Medicare helped.

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richorlin



Edited 2 time(s). Last edit at 11/14/2014 08:20PM by richorlin.

OMG, STOP, PLEASE STOP! i'm 61 and reading this is making my head swim and scaring me!

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If you want to fix our country, work with us in the states. statesproject.org

"Success isn't about how much money you make. It is about the difference you make in people's lives."--Michelle Obama

$#%#$% we've created a @#$%& way to pay for healthcare.

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graylocks
OMG, STOP, PLEASE STOP! i'm 61 and reading this is making my head swim and scaring me!

I'm 61, also. I figure that all the smart people will figure this out and give me a road map for when I'm 65.

Of course, I thought the Falcons would contend this year, as well!


Edit: fat fingers...



Edited 1 time(s). Last edit at 11/15/2014 06:28AM by Michael.

"$#%#$% we've created a @#$%& way to pay for healthcare."
.
You may be intimidated by reading about it but signup and execution is overwhelmingly good.
Haven't talked to anybody on Medicare that says they wish they hadn't signed up.
It's an excellent program.

Like you all, I wish it was simpler...anytime I see complex explanations, I feel like I'm about to get swindled.

To make it simple: when you turn 65, you must sign up for Medicare part A. If you are currently working and have employer health insurance, you do not have to sign up for Part B. If you are not working and/or don't have employer-sponsored health insurance, you must sign up for Part B or you are penalized a certain percentage and pay more for it when you DO sign up. Part D is for drug coverage and is optional. If you do not have your own drug coverage, most people sign up for Part D plus a "Medigap" plan to cover the Part D "donut hole". Here's a good explanation of it: Part D donut hole

Admittedly, it can be confusing, but Medicare.gov has some pretty good explanations and examples and there are a lot of websites that have pretty accurate info.
AARP explains it pretty well: AARP

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richorlin



Edited 1 time(s). Last edit at 11/16/2014 09:04AM by richorlin.

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richorlin
To make it simple: when you turn 65, you must sign up for Medicare part A.

This is incorrect. One is not required to sign up for part A when they turn 65 if (as you mention for part B) they were covered by a group plan from their, or their spouse's employment.

From Medicare and You 2014 "Special Enrollment Period"
"...you can sign up for Part A and/or Part B:
• Anytime you're still covered by the group health plan
• During the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first.

"You may choose to buy a supplement policy (Medigap) which is meant to cover the costs that Original Medicare or your MA plan do not cover."

I thought I read that it was illegal to be sold medigap and Advantage at the same time.