64 and Need to Look Into Medicare (Part 2)

Parents Forum Parent Cafe
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I put this in on “How much do you think you need to retire” Parent Cafe thread, but really more appropriate on its own topic thread. It was a process to go through the definitions, understand how the categories are termed and the key decisions one needs to make. This is our situation, and the solution I came up with after a bit of digging and putting together and had a ‘aha’ moment.

I just finished figuring out our Medicare choices - which I can trigger in July – will go from company supported health insurance for H and I to both of us on Medicare (H has Medicare A until we both finish on our group health insurance the end of Sept). We will both have the same health and drug plan with total cost of $728.40/month for both of us (together, combined cost) – choosing Medigap Supplemental G and the lowest of 3 drug plans that go with that since we have so few medications and all current ones are generic or near generic pricing. The different between lowest cost ‘essential’ and next level ‘enhanced’ is $600/year for each of us. We will get low copays at the standard network pharmacy which included both of our area 24 hour pharmacies (one which we use now which is very close/convenient). The Part B annual deductible is $203; the Drug plan has $445 deductible for each of us before cost sharing - but that is in there for the ‘enhanced’ plan too. Each year choosing a drug plan can change with our needs. I could possibly have a lower cost drug plan (27 county specific and 32 others state specific – but typically the drug plan goes together with the Medigap or the Medicare Advantage plan).

Medicare Part B is currently $148.50 each. We pay $0 for Medicare A due to having participated in payments for plan with company (FICA).

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I’ve been retired for a few years. We have a Plan G costing $347.07 a month (combined cost for both of us) and a Part D Plan costing $14.60 a month ($7.30 each) Our Plan G and Part D are with different companies.

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i have a BC/BS Medicare Advantage Plan for $79/month which covers all health including meds. No drug plan or supplement needed.

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I was advised that one way to consider Traditional Medicare (plus Supplement and Drug Plan) vs Advantage plans is that the first is more like insurance paid upfront, and the second is more “pay as you go”. Advantage plans are typically much cheaper if you’re healthy – and until you need it for more expensive or longer term health issues. Then they can be more expensive with multiple copays, deductables, etc.

You can typically switch between Advantage plans during open enrollment, if you don’t like your current plan. But in most states, you only have one year to choose a Traditional plan without underwriting, and can’t switch back to Traditional from Advantage after that time - without underwriting. (A few states have exceptions to that).

There were a lot more subtle differences between plans when we researched our options. If your state has an advisory council for Medicare, they can be a great resource.

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Our Medicare Supplement (Medigap) Plan G is $384.88 per month for both us us, combined.

Our Part D prescription drug plan is not from the company with which we bought our Plan G. We each chose the Part D plan that was least expensive for the meds we take, using the tool on Medicare.gov. His and my Part D plans are from different companies and even from different pharmacies this year. (Next year it could be different, of course.)

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I went to three financial counselor for help choosing and all of the three suggested the plan I am on. I am not all that healthy. I have been considering changing. I didn’t realize there was a problem with changing back to traditional Medicare. Another thing to do once I am vaccinated- pay a visit to financial counseling at my local hospital.

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Can anyone point me to some online resources to understand the general parameters in this process? My spouse will be 65 this year and will be continuing to work (he is a tenured professor) for 5+ years, and we both have health insurance through his university employer. I am younger than he is, so not eligible for Medicare for a while. I know generally that, on the one hand, one can keep one’s health care through the employer but also that there can be consequences/potential penalties in not switching to Medicare at 65. I’d generally thought that as long as one stayed with employer health care, the penalties were not a big issue. I thought there would be general info through the employer, but I’m not really finding much guidance. Can the wise people of CC point me in the right direction?

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Go to the medicare.gov website and start reading the info under the “Signup/Change Plans” tab

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Thank you!

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An important thing to realize is that Medicare A/B and the various supplements do virtually nothing to cover long term care in assisted living, nursing home and most home health care scenarios. These expenses will blow up a retirement plan if not protected. There is some minor physical therapy / rehab coverage (I think 100 days based on memory) and I know my mom needed it for a back injury. Had a physical therapist come to the house for the 100 days but then it was over. She was fine but if she wasn’t she would have been out of pocket (or better put, I would have) going forward.

Look in to coverage. Warning, it’s expensive but a lot less than the actual cost of care if needed. The new trend in coverage is “linked benefits” which ties LTC coverage to a life policy. The advantages include: Much easier underwriting (life is easier than LTC and some policies actually do Simplified Issue), return of premium features, the life benefit exists if you don’t exhaust the LTC benes so it’s not a “use it or lose it” plan. Very few standalone LTC contracts in the market today as the carriers got crushed. GE Capital was a leader and damaged the whole enterprise killing GE stock for a long time.

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For those beginning Medicare I highly recommend looking into your state SHIP (State Health Insurance Program) resources. Typically basic information sessions are offered and counselors (mostly volunteers with extensive training and certification requirements) are unaffiliated with any insurance company and will help you figure out which plan to want to choose and comparisons between them. It’s important to remember that Medicare plans are individual - the best plan for your spouse may not be the best plan for you. Different rules apply in different states and pricing of plans is done differently eg community pricing means everyone on that plan pays the same amount whereas age based pricing means rates are higher the older you are. Whether an advantage plan or a supplement is best for you will depend on such things as finances, the area in which you live (advantage plans tend to be local vs supplement plans that can typically be used in any state) and your projected health care needs. Additionally if you choose a supplement you have to choose a Part D drug plan - again by making the best estimate of drug needs in the next year. This isn’t an easy process and there are lots of moving parts which are subject to change.

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In MA it is SHINE and they have presentations at senior centers. The other resource is hospital financial counseling offices.

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concur on state State Health Insurance assistance Programs (SHIP) plans, or whatever its named in your state. (check your state’s senior’s services).

The SHIP is one of the few places which will give you unbiased info. Local hospital/health plans tend to push Medicare Advantage plans which tend to work like HMO’s, but there are some Advantage PPO plans in some states.

A good insurance broker can help too, but they may tend to recommend a higher cost plan (as it results in higher commissions).

Absolutely no need to get the same provider for Rx (Part D) as Part B. You can change Part D every year, so get the cheapest plan for the scripts that you are taking today by entering your scrips on the medicare.gov site.

CA has a great site which lists all approved Part B Supplement plans and their prices. Your state might have something similar.

https://interactive.web.insurance.ca.gov/apex_extprd/f?p=111:30

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For Medicare while employed with employer medical insurance, https://www.medicare.gov/sign-up-change-plans/i-have-employer-coverage may help. However, the benefits people at the employer will be able to give more specific information about employer insurance with Medicare.

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@Midwestmomofboys Are you in Ohio? Google OSHIP They have a great website and ability to call and ask questions. Other states might have similar programs.

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Now that there’s limitless editing – I should edit my response to say – although I didn’t find it just searching through in.gov, a quick google search of IN and SHIP turned it right up. Thank you all!

Edited to add: a simple google Indiana and SHIP and I got it!

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Check the official Medicare site. There is a section with links to official state resources. If I can find that link…

ETA: I see you already found what you needed! :slight_smile:

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Here it is:

https://www.medicare.gov/talk-to-someone

There is a drop down menu at the bottom which will lead you to state resources.

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I will research the drug plans - our family used the tool on the drug plan for my mom years ago. I will ‘do the work’ for H and I as it seems we can save $$ there - we are on low level drugs at this time, and can switch drug plan year by year w/o issue. I can sign up as early as July for Oct 1 start date for us as we get off employer supported insurance at end of Sept retirement.

I didn’t break down cost on my initial post - the Part B (everyone pays the same) is $297 for both of us ($148.50 this year, Medicare takes out of people’s SS check, or if not taking SS they pay via bank drafts). Our Supplement (Plan G) is $176/person, $352 together - and it will go up at age 66-69 according to current table, then a bit more at 70+. Their drug plan is I am sure more costly than what I can find. I would like to have a plan that will include Walgreen’s (our 24/7 pharmacy where we fill drugs now) and if possible CVS (the 24/7 pharmacy near our major hospital).

Although I was told one could go from Advantage to Supplement plan year by year, I do believe there may be underwriting involved and then maybe higher premiums. It is one thing when one is more elderly/less mobile taking a MC Advantage plan that encompasses everything and gets all services in their community - and is more budget friendly. Or if one’s retirement budget is strained and that is the best option.

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@Midwestmomofboys – Medicare and SS are like eating an elephant, one bite at a time.

In your situation, you sign up your H for Medicare A (he pays $0 but still need to sign up) - window is 3 months before and 3 months after the month he turns 65. On Medicare.gov there is a checklist online “Medicare, Retirement and Spouses Applications” - I printed that page and applied for DH’s Medicare A (he turns 65 in June - so I applied in March at the earliest opportunity), and he is still under my insurance. There is a document “Medicare and You 2021” with a lot of information - I printed a lot of pages, because even though you can order the free publication, it takes FOREVER now to get it. I still haven’t received the one I ordered. In that document, it shows where your H’s health insurance will be primary and his Medicare A will be secondary. It explains things - but it does take time to absorb all and put the pieces together on your individual circumstances.

We got a letter a few weeks after signing up H for Medicare A online, and it indicated his Medicare card was coming - that was a very carefully written letter with a section “Information About Medicare” and other short topics in this 3 page letter.

If your H retires before you are 65 and eligible for MC, you may be ‘close enough’ to 65 under COBRA. I have a friend who did this (her H retired a month before she turned 65 so she had his COBRA health insurance for a month - he was 9.5 years older than her).

One point they make “Note: COBRA and Retiree health coverage do not count as health insurance based on current employment” - meaning once one is 65. Many need COBRA to get to 65/Medicare.

“If you do not sign up for Medicare Part B when you are first eligible, you may have to pay a late enrollment penalty for as long as you have Part B” So my H has to sign up for Part B by Sept - which actually by then I will also be signing up for Part B etc. - I can do it all in July. During his application for Part B, we have credible coverage through Sept and his will begin with mine Oct 1. It didn’t make sense to pay $148.50/month for his Medicare B early, but I definitely don’t want the penalty. It is a bit nerve-racking on this process when you type things in - and you cannot hit submit until all is correct, otherwise I imagine you have to go through the 1-800-MEDICARE (1-800-633-4227) - the ‘Notice of Award’ letter we received also had a BNC number, and came from the Great Lakes Program Service Center, Chicago IL. To talk to a live person may take setting an appointment – for example I thought I was going to take early retirement at age 63 and called SS - after a long wait, I got an appointment and email confirmation; but then when employer offered me a better job, I had to call SS and wait wait wait and then canceled the appointment - I couldn’t cancel by email. We did call the Medicare number when my mother died, and they took the information on the phone and it was an easy process - so maybe calling Medicare is not going through difficulty, but so far we have been good with online on Medicare.

If you have not done so already, have each of you obtain a SSA.gov log in – they obtain some personal information from you to establish, but then you each will have a log in (user name and password) and can see earnings records and estimate of SS payments at full retirement and at current time (if 62 and older).

I had checked with several financial sources on the amount one gives up on SS with receiving SS before the full retirement age - and now I have the formula thanks to link provided on CC.

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