I applied for part A today. It’s easy but there were two things I had to look for old records to complete the app: 1. My date of naturalization. 2. My employment start date and employer-sponsored health insurance start date.
I think the government website for medicare is too confusing for an average citizen.
Figuring out insurance plans when on Medicare is complicated and confusing for we retired physicians as well! So many variables. But- nice comprehensive plan details although it takes time. We’re just doing part D. If we wanted the supplement I favor being able to choose my doctors and we travel. Do print out things so you don’t need to go through everything again when your session times out! For drugs H and I (physicians with knowledge of probable scenarios) did more than one drug list- the resulting least expensive plans changed. Have some printouts to go through for comparisons.
Like H says about many things in this country- too many choices. It was easier when all you did was sign up for the company plan.
@thumper1 Yes, I was already getting SS. Another reason to take SS early. As I get older, I am more easily irritated by paperwork.
I just learned some new Medicare resources for anyone interested:
www.medicarerights.org
www.medicareinteractive.org
Helpline of Medicare Rights (nonprofit) 1-800-333.4114
They provided the training for many of the state Department of Health Office on Aging that help folks get their Medicare training.
I just began the medicare supplement plan with united health through AARP and a separate prescription plan. Does anyone know whether I need to “enroll” again during the general enrollment period? Do I have to do it every year? I know I will call them, but I want to make sure I do not accidentally discontinue my coverage.
Annamm, my payments to my supplemental are taken directly from my bank account. For two years, I’ve never had to re enroll. You have chosen the most popular plan among my patients.
As long as you continue to pay premiums, your supplement plan and Part D plan will continue in force. The open enrollment for the drug plan - Part D – is for your benefit, because each plan is different as to how they schedule and pay for medications. So if your medications change, you may find that a different plan is more economical, even though your existing plan worked well in the past. Or even without a change, you might see competitive pricing from other carriers from year to year.
So bottom line, the company you are buying insurance from is happy to keep you as a customer and take your premiums, but the annual open enrollment is to protect you from being locked into one policy when there are better policies on the market. But open enrollment is for Part D only, not the supplement (medigap).
Haven’t read all the posts, so apologies if already answered. My understanding is that most Advantage plans are basically a post-paid system. Your monthly premiums may be low, but if (when?) you need to see a lot of specialists, your copays can quickly add cost. Supplemental plans lean toward a pre-paid system. Your monthly premiums are higher, but depending on the plan option, can be cheaper in the long run if it covers all your visits to numerous specialists. Is this correct?
I’m also confused about the guarantee enrollment. I know you have 3 months either side of your 65th BD, but when can you (or can’t you) switch between Advantage plans and Supplemental plans and be guaranteed acceptance? Once you choose either route, and don’t have a ‘qualifying event’ such as a move, are you stuck for life in the chosen plan if (when) you develop a major illness?
You can look at it as post-paid vs. pre-paid, but that isn’t really how it is structured.
Essentially, there is single-payer Medicare (Parts A, B, D) or Medicare Advantage (Part C), which means you sign on with a private insurance company to manage your coverage.
Let’s say you get a Medicare Advantage plan with United Health (the AARP-linked company). Let’s say that the UH plan in your area is also an HMO (as it would be for me). That means that you have private insurance with all the same benefits and drawbacks that you always had – deductibles, copays, restricted networks, and the need to pre-approval for many procedures.
The difference is that if you were paying full cost for insurance coverage before, you see a big drop in rates. So maybe your monthly premium at age 64 was $900 and now at age 65 you are paying $100/month. Seems great.
Here’s a comment I heard from one agency: “Everyone on Medicare Advantage loves it … until they get sick.”
On the other hand, a Medicare Supplement (Medigap) policy is not health insurance as you’ve known it – instead it is secondary coverage, and your Medicare Parts A & B are your primary coverage – plus you have to buy your Part D Supplement plan separately. More expensive up front – but you get all the benefits of a single payer system. If you’ve bought Plan F (the most comprehensive) then basically you never have to pay anything BUT the premiums, for any service that is covered by Medicare. No copays, no co-insurance, no deductibles. You go to any doctor or facility that accepts Medicare, and its free. Medicare, and Medicare alone, will decide if something is covered – your Medicare Supplement company doesn’t make that decision. So if Medicare refuses coverage on something, then you have to take it up with Medicare – your supplement pays for the costs that Medicare doesn’t cover (such as copays) – but it doesn’t pay for the procedures that Medicare doesn’t cover. Along the same lines, if Medicare does approve the hospitalization or procedure, the Medicare Supplement company can’t invent some sort of excuse as to why they won’t cover their share. It’s pretty much like an umbrella policy for Medicare – they fill in the gaps for all the things that Medicare covers but doesn’t pay 100%.
Either way you can run into a problem of wanting a procedure such as cosmetic surgery that won’t be covered. And I really don’t know what happens when you get some procedure like a lab test that you think is covered and it turns out that it isn’t — I am hoping that the providers will know enough to tell you upfront that Medicare won’t cover it, but since I haven’t started Medicare yet, I don’t know whether that is how it really works. I think that if a doctor or lab is accepting Medicare “assignment” they are the ones who get stuck if they provide an uncovered service – not the patient – but I am not entirely certain of that.
As to guaranteed enrollment – you can always switch Medicare Advantage plans during open enrollment, but a Medigap Policy is guaranteed issue only if you sign up when first eligible for Medicare. Down the line you can switch, but there is medical underwriting. So let’s say you get diagnosed with cancer and decide that you really don’t like being stuck with your MA plan’s HMO network… you want to be able to go to any cancer clinic and any specialist you choose. Out of luck - what Medigap plan is going to want to pick up a cancer patient?
Now if you are very healthy and just made the wrong choice at age 65 and are now age 68 and realizing you want the Medigap plan instead – then you probably could switch. There is nothing preventing you from applying for a Medicare Supplement – except some procedural stuff because the supplement can’t be sold to you while the MA plan is in effect, but I’m thinking insurance agents would know how to thread that needle.
So Medicare Advantage works a lot like Obamacare – it’s a way that private insurance companies get government dollars in order to provide you with health insurance, and you get to shop around during open enrollment.
In most states, once you select a Medicare Supplement you are pretty much stuck with that company down the line-- though I’m pretty sure any company would allow its customers to move from a more comprehensive, higher cost plan to a lesser, lower premium plan. So if you buy into Plan F and later want to move to Plan G to save on premiums, that probably will work – just not the other way around (from a lesser to greater coverage plan).
California is an exception with its birthday rule, but I still think you have to already have the Medicare Supplement to qualify. So it’s not open, guaranteed enrollment for everyone on their birthday – it’s just a way of protecting we consumers who opt for the Supplement from getting stuck with a plan as premiums rise over time.
So I know… all of this is as clear as mud.
Kaiser Permanente keeps saying it’s no cost to enroll in their plan. What does that mean?
Couple of points - important to remember that it depends where you live. In Massachusetts, for example, you can change between Medicare Suppemental plans, Part D plans and Advantage plans during open enrollment (10/15-12/07) each year. You can also change between plans if you’re in the first year of Medicare coverage.
While you have a 7 month initial enrollment period with your birthday month in the middle, you need to enroll during the first 3 months if you want coverage to begin on the 1st of your birthday month. If you leave it later than this there will be a gap before cover starts. eg if your b’day is in July but you leave it till October to enroll your cover wont begin till the following January.
There’s no one size fits all when it comes to Medicare. If you travel between states a lot or have a second home in a different state a Medicare Advantage program may not cover you whereas a Supplemental plan will be accepted anywhere in the US. On the other hand, a local HMO plan may be fine if you’re generally well, dont travel much within the US, have a good choice of local physicians that take the plan and you can afford to cover the OOP max if necessary. For example, a local Advantage plan has $0 monthly fee, $10 PCP copay and $45 specialist copay. Also copays for ER, Urgent Care and first 5 days of Hospitalization with OOP max of $6500. The best (all inclusive) supplement plan + Part D costs $220/month + drug costs with no copays or deductibles. For a couple that’s roughly an extra $5500 p.a.
We went through the plan D (drugs) decision. The mailed booklet from Medicare was clear, specific to our location and useful, as was the online info (although tedious to plug in different scenarios for different potential meds- we’re physicians and have the knowledge). They don’t assume we senior citizens will use computers.
This year’s drug plan would continue next year if we did nothing. Since we changed we got the info that current plan ends this year and new one takes over. Simple. Insurance cards in the cupboard waiting for January.
For supplemental the above post is good. We are fortunate to figure we are ahead paying that 20% instead of buying supplemental insurance given our current health and travel plans. Starting Medigap insurance now does not change future year premiums. Starting the Medicare plan D does, however- there is a percentage penalty for each month you do not have part D coverage- for the rest of your life.
So many variables and different for each person, even husband and wife. After decades of family insurance it was strange to look at ones’ self only- what works for one may not be the best for the other.
@calmom. Wow, that is a fantastic, concise description. Thanks. It’s pretty much how I understand the lay of the land - we’re also in CA.
H is signed up for traditional Medicare with an AARP UHC supplemental plan G. I did attend our local Kaiser’s presentation on the newly available (in our county) Advantage Plan. My understanding is that there’s some kind of window where one can move out of an advantage plan back to a supplemental without the underwriting requirements. I think it’s a matter of months. They also mentioned something which I’d never heard before and I’m still somewhat befuddled If I understood this point correctly - then, since Kaiser is a five star rated Medicare Advantage plan you can switch into it at any time during the year. Those ratings you see on the Medicare.gov site seem to really have a meaning in certain situations.
Funny thing, at the same time that Kaiser announced their new Advantage plan, Sutter also announce an Advantage plan in our county. I had an absolute panic attack one night when I thought…hmmm…so I wonder if Sutter will now force ALL Medicare patients into the Advantage plan and drop the coverage for traditional Medicare. Knowing that organization as I do, it seemed like a very real possibility. H has a Sutter doc he wants to continue seeing and because he’s an established patient, they needed to accept him when he went on Medicare. We did stop by the local office and ask the question in several different ways - luckily - they are keeping him as a traditional Medicare patient.
None of this is easy…grrrrr
I guess I am really lucky because here in NYC my Empire Blue Cross-Blue Shield advantage plan covered doctors in all three major hospital networks the year I had two surgeries and three hospitalizations. My expenses did hit the $6000 (or whatever it is) limit that year but I had world-class doctors. All it costs me is the Part B premium and it covers my meds too.
However, I got a letter from the network my pcp is connected to and they say their negotiations with Empire BCBS have been unsuccessful so far this year. They gave a list of alternate Advantage plans with coverage and suggested their customers pick one, and then we’ll be able to switch back after 12/31 if they succeed. I think it’s because Advantage users have a trial period with a new insurer?
FWIW, my parents have been with Kaiser* and some of their friends have been with a different (Secure Horizon) Advantage plan for decades. They are happy with their coverage.
As the manager of my parents healthcare for at least the past 10 years, the Kaiser Advantage plan has been a godsend! MIL recently converted to this plan because management of her traditional plan was very difficult for the sibling handling that part of her life.
My friends who have been on Kaiser in the past and were happy with it are also delighted with their Medicare Advantage plans. So I think that really depends somewhat on geography and health care expectations over the years.
I’d note that it is always possible to move FROM a medicare supplement plan TO Medicare Advantage – so if the concern is future affordability of Medigap premiums, then there will be a way out down the line.
I’d add that I just checked premiums, and in my area, the Kaiser plan is the highest MA premium, and only $10 less than what I will be paying for my medicare supplement enhanced F plan with the first year new-to-Medicare discount. So even if I was concerned about premiums, the Kaiser option would not be a good value for me for now. There’s a -0- premium MA plan in my area – all the MA plans are HMO’s – but if a person is a good health and premium cost is the deciding factor, then that’s certainly an option.
I’m just personally not fond of HMO’s & I’m tired of dealing with insurance companies. I just want to be able to go to the doctor and not worry about the bills. And I’m willing to pay a few hundred overall per month to make that happen.
My folks also enjoyed their Kaiser Advantage experience. (It was in NorCal, where Kaiser has a strong presence.)
Does anyone know how Medicare calculates premiums? I just got a notice. They are taking a huge amount from my SS benefit.