H will have to enroll in October, I follow a year later. We of course will be closely reading the official website and probably will look for a Consumer Reports or similar piece on supplemental plans, but I just wanted to check in here and see if anyone has any tips or caveats, experience with various supplemental carriers, etc., that would be helpful. To use terminology from a more dire context, I’m comfortable with the known unknowns, but could use help with the unknown unknowns!
I have a very specialized surgical procedure looming in the next year, and doc has cautioned that I will have many fewer options in surgeons once I’m a Medicare patient, so he recommends that I have the surgery before then. Has that been anyone else’s experience? Can docs really afford to completely exclude Medicare patients from their practice these days? Is the reimbursement really that much less than from private insurance plans?
I have a card, but I am scared to think about time when we are retired and do not have 2 employer’s insurances. My Medicare is tertiary for me now. We are also trying to get a residency status abroad so that we have an option for going abroad for some procedures if we cannot afford them in the USA. Overall, I heard very bad stories so far and thinking about being only on Medicare is very very depressing saying the least. I am past full retirement age and I am praying every day that I and my H. are capable to work and not kicked out.
I do not know if they can exclude Medicare patients on not but nobody can prevent them from closing practice because they cannot afford seeing that many patients on Medicare and Obamacare. I heard about cases like that. MD practice is also a business, nobody can operate at loss for a long time.
I would definitely try to have done at least a procedure known to me before I retire. But we cannot prevent the future ones except for some life style changes, nothing can guarantee the perfect health anyway. I do not think that perfect health is even possible after certain age.
My only advice is to keep in mind that your medicare enrollment will begin on the first day of the month of your birthday…not on the day that you actually turn 65 years old. So you will be on medicare earlier than you think, while you are still 64 unless you were born on the first of the month. Consider this when you are thinking about the timing of things like procedures and physicals.
Also, medicare will not pay for a physical. You’ll get a “wellness” consult when you enroll, which amounts to “How’re you feeling?”. So if you are overdue for a physical, get it ahead of time before you’re into the big single-payer in the sky.
My Medicare supplemental plan pays for 100% after reaching the small deductibles. I know a number of others with the same supplemental plan (the one offered by Ct teachers retirement board). All have had no difficulties with this.
I am 64 and will get my Medicare card 3 months before my next birthday. I have already discussed this with all of my current doctors…and there is no issue with them accepting Medicare and my supplemental.
There are a couple of things I will hopefully have done prior to my birthday…just in case.
I just paid my first premium on July 31st and my birthday is August 12th. Also know that you are charged for 3 months the first time and after that it is monthly.
They base your payment on the last two years of your income.
These were things we did not know/realize. H’s income was the highest of his career for the two years prior to retirement. Also, we did not realize that he should have retired on Dec.31 rather than on his 65th B-day in May as that threw his 1st year of Medicare into 1/2 full income and 1/2 at half income (he works .5 now). This year he had a full year of .5 income and his Medicare cost will go down.
“My only advice is to keep in mind that your medicare enrollment will begin on the first day of the month of your birthday…not on the day that you actually turn 65 years old. So you will be on medicare earlier than you think, while you are still 64 unless you were born on the first of the month. Consider this when you are thinking about the timing of things like procedures and physicals.”
This is NOT exactly correct. If person has another insurance (for example, if person is working or a spouse is working and there is an employer based plan), then Medicare is secondary, not primary. As I mentioned, in my case, it is tertiary, after my own insurance and my H’s insurance. Medicare In cases like this, will pick up whatever is left on the bill after other insurance(s) cover the majority of it. So, basically, your Medicare will start in “full swing” so to speak only after you loose employer based insurance. You can have your Medicare card any time you are eligible, but if your spouse is still working and you are covered under his plan, you are good in terms of your choices.
Miami, what happens when you are not working but have a private insurance on top of Medicare. What rates are they paying? If doctors who don’t accept Medicare, can you go to the doctor that accepts your private insurance.
I do not think that I will be able to afford any private insurance when I do not work. So, I do not think about it.
Sorry, forgot about " Medicare is primary if employer has less than 20 employees.", not the case with either my H. or me.
The only thing I can see that we possibly will be able to afford if certain procedure become totally un-affordable is to consider medical tourism, there are countries out there that are developing this part of their economy as we speak. It is scary, but having surgery is always scary anyway. It is an option though. But dying is the part of life, we all die from something at the end, as sad as it is, this also needs to be accepted.
MommaJ, more docs in my area accept Medicare than other insurances. They know they will be paid promptly, with no need for authorizations.
Dads, if your b/d is on the 1st, Medicare starts the month prior.
There is a program called Silver Sneakers, that allow you to use any gym. After enrolling, I learned this was not on my plan. It seems it just applies to HMOs, but I would check UHC/aarp.
Some plans cost less for females. UnitedAmerican is one such plan.
Some plans cover the deductible, others don’t. If deductible is $147 plus the secondary, I divided that my 12 months to figure out the real cost of each plan.
I used an insurance agent, who is in same office as my LTC agent. It saved me research time. She was willing to fill in the computer info too. She was also helpful in finding a prescription plan. As I only take one prescription med, and it is not covered, I went with a low cost plan. The cheapest was a Walmart plan, but for personal reasons, I don’t give them my business.
Fine, although it wasn’t my take from the OP that this was likely to be the situation.
In cases like that where there are multiple insurers, the better question is whether it makes any sense to sign up for medicare when you are 65 or to wait. The issue is whether the secondary or tertiary coverage you get from being enrolled is worth the premiums, and whether the higher later premiums (for not having enrolled at the earliest moment) are better off ignored. I don’t have a sense of the answer to that question. I’d be surprised if anyone else does either.
Again, potential misinformation. All insurance is state-specific. Some states require unisex rates.
Excellent advice. An agent does not cost anything. Rates are set by the insurance company and the state. For any particular policy, you pay the exact same premium whether you use an agent or not.
My husband has to enroll in the private health insurance because I’m his wife and I’m not old enough to get Medicare when he retires, and also the insurance for the whole family as well, not just him. Plus the insurance is good that it can be used overseas, even though he does have the National Insurance overseas.
I’ve had Medicare for a year and a half. I think it’s wonderful.
You can have basic Medicare Parts A and B and nothing else, if you wish, but there is a lot of out-of-pocket cost if you do that. You can sign up for Medicare Parts A and B and a Medicare Supplement plan (also known as a Medicap plan), which means that the Supplement plan pays the things that Medicare doesn’t pay. Supplement plans are standardized and are labeled by letter. So an “A” plan offered by one insurance company covers the same things as an “A” plan offered by another insurance company. See here: https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html
You also have a choice of not taking the basic Medicare Parts A and B plus a Medigap plan and instead taking a Medicare Part C, which is a Medicare Advantage plan, which is basically an in-network-only plan. This is what I did. I pay my Medicare premium to Medicare and then I pay a small additional monthly amount to the Medicare Advantage plan, which handles all of my care. Medicare forwards my premiums to the Medicare Advantage plan. When I switched from my big fat expensive corporate plan to this Medicare Advantage plan, every single one of my doctors remained in my plan.
My plan covers routine exams with no copay. I’m a bit annoyed that the copay to see a specialist is $50 but it’s that high because I chose lower monthly premiums. I could change plans this coming January 1 if I wanted to lower the copay, but of course the premium would be higher.
I also have Medicare Part D, which covers prescription drugs.
I also get dental coverage for a small charge through the Medicare Advantage plan.
This is timely for me. I am old enough to have Medicare, but I didn’t sign up because I have group health insurance through my husband’s employer. My understanding is that I won’t be charged higher premiums for signing up “late.” I’m trying to figure out when I should sign up because I won’t have my husband’s insurance much longer, and it’s not clear that I have a good option through my employer.
I was just reading this for family members. Here is the publication that addresses Medicare B and prescription drug premiums for higher-income taxpayers:
We can argue about what a physical is, but medicare doesn’t pay for what most people call one. The point is to know what they pay for. If you schedule a physical with your doctor, medicare won’t cover it.
OP here again. Just to clarify, H and I pay for our own private insurance. He’ll drop his coverage when he qualifies for Medicare. So the complication of multiple plans is not one we have to deal with.
I was wondering if anyone had good or bad experiences with the various Medigap providers. I know the coverage is the same, but the customer service could be very different. I’d also love to hear some more on the Advantage alternative, i.e., what factors should go into deciding whether it’s a good option. Do I check with all our docs (between the two of us we see a number of specialists) to see if they participate?
If there are any great websites or books out there on all of this, I’d love to hear about them. For some reason I find it all rather nerve wracking, maybe because the last time I had to sign up for a healthcare plan (via our state’s ACA marketplace), I ran into endless technical glitches and lengthy phone conversations with reps who tried to troubleshoot them, to the point that just thinking about health insurance issues starts my head throbbing and makes me want to do something more pleasant, like taking out the garbage or cleaning the bathroom.
Do you have HMO coverage now, MommaJ? If so, you’re probably familiar with the kinds of restrictions Medicare Advantage plans have – narrow networks, and significant restrictions on the hospitals and other providers you can use on a non-emergency basis. But, in return, most of the Medicare Advantage plans either offer more coverage (like dental or vision coverage) or lower out-of-pocket costs. You really need to investigate what is available in your area. If you travel a lot, a Medicare Advantage plan may be too limiting.
Somewhere in your county is the designated Area Agency on Aging – it could be at a senior center, county office, or some other location. Within that office, there will be someone who can help you review the specific options available in your area. (Free!)
In my area, except for my dermatologist, all of the hospitals and doctors who I see also see Medicare patients. But I have read that in some areas it is hard to find participating providers. I have no idea why it would vary so much from place to place. Where my parents lived in North Carolina it was no problem to find participating doctors; I don’t ever remember having any trouble with that.