64 and Need to Look Into Medicare (Part 2)

Parents Forum Parent Cafe
21

My 67 year old husband is retiring soon. He has coverage through his employer. He signed up for part A when he was 65…no charge for that.

I’m not sure what he did…but he did it all online. He applied for Medicare part B. In a week, he received that informational letter. It said he would get his Medicare card in about two weeks. He got it…today. The bill will follow as he is not taking SS.

He will apply for his supplemental coverage (actually we have a MA PPO…very deluxe plan) that he is eligible for because he is married to me! He has to send them a copy of his Medicare Card, and a copy of our marriage license…he is faxing today. He indicated he wants his coverage to start with the MA plan on May 1. We will get a bill for that too.

Once he has that all in place…he will give his notice at work!

1 Like
22

@thumper1 congrats to H on his retirement, and once you are ready - sounds like you have it ‘all together’.

I got ‘aha’ moments as I was rereading and processing information. The muddle comes in as they use A, B, C, and D but confuse Medicare Advantage -C - and Supplement - which they give continuing letters, with max supplement plan now G as one has to be 65 by the date in 2019 for F plan.

Also it may be in some states where you can go from a Medicare Advantage plan to a Medicare Supplement plan w/o underwriting, but to me if a supplement plan makes sense (or if you have a retiree plan from gov’t/employer that makes sense). Sometimes can’t go back ‘use it or lose it’.

23

have any scrips handy, and enter them all in the medicare website and it will recommend a Part D plan for you. Then you can dig thru their online info and see which pharmacies are considered preferred. (Hint: CVS purchase Aetna a couple of years ago, so the Aetna Rx plan definitely has CVS as a preferred provider. But Aetna Rx also uses Alberstson’s pharmacies in my zip code.)

https://www.medicare.gov/plan-compare/#/?lang=en&year=2021

1 Like
24

Maybe this is a dumb question, but … what happens if you need a drug that is not on the drug plan you chose? I know that you can change plans year to year, but what about the interim? I am envisioning someone getting cancer in February …

25

My husband is older and went on Medicare last year when he turned 65. Based on his experience, I highly recommend that folks ask a local friend (or financial planner) to recommend a Medicare broker. There is no fee or additional cost … options are same cost as if you pursued without a broker.

My husband met with the broker twice at our house, pre-covid. At the first visit, he provided a list of his current meds. The broker came back with recommendations. (For him, AARP/UCH + Humana/med was the best option. )

There was no obligation to working with the Medicare broker. You could crosscheck it to your own researched conclusions.

26

We have CVS as close as Walgreen’s, and one of Aetna Silver Script part D plans may be the plan to go with. We have a 24/7 CVS close to our large hospital. The community Walgreen’s is the 24/7 pharmacy. We just have all our prescriptions go to the right pharmacy starting Oct 1 with our part D drug plan carrier.

Thanks for the info @bluebayou

1 Like
27

@kelsmom - for drugs not on your drug plan formulary - your ‘cost sharing/copays’ may be higher (or may have to pay totally out of pocket for those).

New chemo oral drugs - often your oncologist can get from drug company - for example, I work in rehab and we have some patients come in with those — one had pills that were over $1200 a PILL; I told the other nurses we do not drop or waste ANY of these pills! The lady was Medicare/Medicaid and was getting prescriptions and necessary things outside of formulary through drug company programs.

2 Likes
28

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).

This is really a key point to consider. The Advantage plans can be less expensive and offer fun perks like “free” gym membership. But if you run into a serious and chronic health issue and decide it’s better to switch back to traditional Medicare you may not be able to buy a Medigap policy. One cautionary tale is Real World Examples Michigan Medicare

1 Like
29

Although I don’t remember the details, I do recall that the flexibility to switch was definitely an important factor mentioned by the Medicare broker. Honestly I was surprised there were so many options. I guess that is good… just complicated.

30

Medicare Advantage in 2022: Enrollment Update and Key Trends | KFF says that 48% of Medicare users use Medicare Advantage (part C) plans, rather than traditional Medicare (part A, B, D, supplement).

Now, it is easy to see that someone getting a subsidized plan from a former employer or union, or someone eligible for a special needs plan, or someone using Kaiser or a similar organization that is others inaccessible with the associated plan, choosing a Medicare Advantage plan.

But it looks like most using Medicare Advantage are not in the above categories. What is the typical reason that makes Medicare Advantage plans more attractive than traditional Medicare for many people?

31

costs: zero monthly premium, extra benefits such as vision & dental…if you were a happy Kaiser member pre-Medicare, it make sense to stay with them for Medicare

32

As bluebayou says, costs are a huge factor as I’m sure is the aggressive marketing. But it’s all a bit deceptive and the devil is in the details. With an advantage program there’s often $0 / month premium and the plan includes drug cover, gym membership, and sometimes vision and dental etc., so brilliant if you’re healthy and need minimal medical services. However, typically there are Dr visit copays, preauthorizations for specialist visits required and steep out of network costs. Usually, Advantage programs work only with local networks so if you develop a serious condition and want to see someone at Mayo Clinic or Dana Faber for example you may have minimal cover. Another downside that marketers don’t mention is that your preferred provider may not be in the network or may leave it at sometime during the year. Our local Primary Care office only accepts one Advantage Program so important to check before signing up.
Balanced against this is the fact that Medicare Supplements can seem very expensive. We pay approx $190/month each for a Supp in addition to the Part B monthly cost. It’s a lot, but the the only other costs are the Part B deductible ($230 ish I think) and Part D (prescription drug cover - cost depends on drugs you use). Essentially, that means we can use any Medicare provider/hospital in the county and the cover is the same. We budget to pay more up front but know there won’t be any other surprises in the event one of us has serious medical issues (increasingly likely as we age). Having said that, we tried a Medicare Advantage program one year and it was excellent. However, DH was reluctant to go to Dr when needed because it might cost $25 or $65/ specialist visit. No copay or coinsurance means he’s less hesitant which I find very reassuring! Where we live there’s not problem changing between Supp and MA during annual enrollment period but in other states this may not be possible without insurance underwriting other than during the first year.
I know, TMI. Here’s an interesting interview about a NYT investigation - actual article was behind a paywall

33

There were some generalizations in the post by @onetogo2 that don’t apply to all Medicare Advantage plans.

I have an Advantage Program for $79/month that is a PPO. I don’t need referrals or authorizations for specialist visits and they can be in any hospital system or network. No co-pay for PCP. Specialists are $30-40. CT and MRI $125-200 but x-rays and labs are free. There is a cap on annual out of pocket. I do have a deductible for meds.

I have been very happy with it for 6+ years and I have a lot of medical issues.

3 Likes
34

Ditto here. I have never found a doctor in NYC affiliated with of the four big hospital networks that doesn’t take my Medicare Advantage plan. Mine is an HMO-PPO plan, and it just costs the Medicare Part B premium, meds included. I only once had a doctor’s office invoke the PPO part (very high deductible) but he joined the HMO group so I was covered. I have Humana. It’s not a huge player in NYC but it works for me.

In 2017 I had an Empire Blue Cross-Blue Shield Medicare Advantage plan and I was hospitalized three times, including two major surgeries (open gallbladder surgery when the surgeon found an overflow of gallstones and had to cut me open and knee replacement surgery) plus a hospitalization for pancreatitis triggered by an endoscopy ordered before gallbladder surgery. I paid a total of $8000 for everything that year–once I hit that amount, everything else that year was completely covered. I am a very big fan.

1 Like
35

That reminds me. Mine is all PPO (BC/BS of MA) and I don’t pay extra for MD’s in any networks: all are allowed.

There is also a plan for $0/month and one more expensive ($139?) so I took the middle road.

1 Like
36

Medicare Advantage doesn’t work for us because we split our year between AZ and ME and the network limitations don’t work. So, we’re opting for a MediGap plan to supplement traditional Medicare.

3 Likes
37

Absolutely. There are wide variations between plans and much depends on where in the USA you live and your circumstances. The
https://www.medicare.gov/
site is pretty good and allows plan comparisons for different zip codes. It’s not a one-size-fits-all sort of thing and it can change annually.

2 Likes
38

When we were deciding, Advantage plans were more like typical employer plans, and you “pay as you go” with deductibles, copays, co-insurance, and caps. Traditional plus Supplement was pricier upfront, but once you reach your deductible, the rest is fully covered (as long as it is a Medicare covered service).

In my state, you cannot change between Traditional plans during open enrollment. You are only are accepted without underwriting for a limited time after age 65. Once on Traditional + Supplement, they can never deny you, or charge you more than someone else of the same age. But, you also cannot change to another Traditional provider without underwriting. If healthy, it usually is no problem. If seriously sick, a new insurance provider does not have to accept you, or can charge more than others. You can supposedly always change to and between Advantage plans, but once in an Advantage plan, cannot return to Traditional after one year.

DH was a resident of another state, so enrolled there. He could switch back and forth between Advantage and Traditional. His premiums, however were much higher than mine, because they average the cost over all subscribers (a 65 year old pays the same as a 95 year old). In my state, rates start low, but rise with age. Cross-over was around age 87 at the time I enrolled.

No question Traditional was more expensive for us, since we’ve been fortunate to have few complications or chronic conditions. We chose Traditional + Supplement to guarantee we can choose ANY MD (as long as they take Medicare), and ANY location (since we split our time between two very different states).

There are more nuances. A GREAT book we found to walk through pros, cons, & options was “Medicare for Dummies” – at least it was when we started looking. Make sure you get the most recent edition, as policies change.

1 Like
39

Same here. We spend a significant amount of time in NYC where both of our children and their families are but we are CA residents. We want the flexibility in seeking medical care (which we’ve done) at both places. Our medigap plan G pays for gym memberships also, one in CA and one in NYC which makes my DH very happy.

2 Likes
40