So far I have never had a provider refuse to take Medicare. I have Plan G with AARP United Health Care with a $185 deductible. The hard part (no pun intended) is Part D. Easy if you know what meds you know you’re going to take, especially if they’re generic, not so easy if your doc wants you to use something more exotic in the middle of the year.
We have not explored this at all. H’s former employer allowed us to remain on family plan medical insurance, which covers whatever copay would be left after Medicare A/B, as well as great drug coverage instead of D. Our portion of the premiums is modest.
As stated above, have been very impressed with Medicare presentations by our local Dept of Health, Office on Aging, Medicare/SHIP division.
This!
DH is on Medicare but still covered under my insurance from work. When I hit 65 but still working, not sure what happens then.
Dad’s PCP went to concierge service for his Medicare patients. Rather than try to find a new PCP that takes Medicare, at his advanced age and doesn’t know him, we all chipped in to pay the $4000 annual fee.
All of this makes my head spin. Why or WHY is it so difficult to manage/maneuver!?
H is retired and has insurance through his state retirement plan now but turns 64 in November and has a year to figure out what to select - based on the plans that the state plan offers - I suppose maybe it’s an advantage that the state narrows down what you can choose?
I’m a few years behind and have insurance through my employer - which is health care - and our choices still change yearly!
Just went through a big ordeal with my 86 year old mom where we were encouraged to go through her county office for seniors and see if she could qualify for some reductions (she currently has a Medicare, a supplemental plan she pays monthly for + long term care insurance. No drug coverage) In this process we first of all found out that she doesn’t qualify for any reductions at this time due to $$ savings. We also found out that she should have signed up for Part D YEARS ago - but now would pay a penalty if she signed up. Who knew - clearly not us or her! 
It boggles my mind and I find is VERY scary how scattered the info is.
The landscape of ALL health insurance is a moving target. Not that long ago, Medicare Advantage plans didn’t exist…at all.
I realize change isn’t an easy or quick thing.
As noted above, look at what you need…and your premium threshold payment. Around here, some folks have been happy using a broker to hear what plans they can suggest…and get explanations.
My only suggestion…if you travel out of state frequently, don’t get a HMO Advantage plan. It might not have coverage in other states. So check check check.
My advantage plan is a group Premium PPO plan with coverage in all states. That mattered to me.
H & I are currently too young for Medicare, but we have been watching the MANY commercials for Medicare plans on TV lately. We consider ourselves very “in the know” people … and we are confused. Why is this so difficult? How can it be okay for things like @abasket 's mom’s Part D issue to happen? Why on earth doesn’t Medicare default to some basic plan for anyone who doesn’t enroll on time? I feel like Medicare is set up to hurt those who need it the most. The whole Part D thing - picking a formulary when you don’t know what disease might strike you within the next year - ridiculous. I can’t imagine being 90 and not realizing that my plan changed & I no longer have the coverage I have had for years.
Why must our health care system be so difficult to navigate??
Advantage plans have been officially around for 20 years, but not all in areas. Kaiser was approved in CA as a Medicare alternative back in teh '70’s as a demo/exception plan. Other HMO’s came and went on the Left Coast. They were very slow to grow in the East.
The best you can do is list the drugs you take today on medicare.gov. (I take zero Rx so I get the lowest plan available.) If you do become ill with something in the upcoming year, you can change Rx providers every year during open enrollment. Checking Rx lists and drug plans every year is a good habit to get into as companies come and go and the drug tier lists change frequently. (And yeah I get that someone later in age will probably need assistance from an able family member.)
Designed by Congress? But there are many social science research projects that indicate that too much choice leads folks to make no choice, i.e., too many options can be a bad thing.
DH did the same thing as @Wellspring and also found choosing a drug plan to be the most difficult to decide since you never know what meds you’ll be taking a year from now. Since he takes nothing now, he opted to take his chances with the least expensive drug plan.
@mom2collegekids
"anyway, I really know ZERO about any of this and hope that y’all will share info that will make me better informed. "
First understand Medicare is not an unlimited passport to free medical care.
Medicare has 4 parts (ie A, B, C, D). Together A and B are referred to as Original Medicare. Medicare Part A covers hospital costs. One typically gets Part A based on their or their spouses work record at no cost (aka premium). There is no part A deductible.
Part B covers doctor’s costs (eg MD fees, lab tests, imaging). Like part A, one typically gets Part B based on their or their spouses work record. I’ve read that the monthly premium is expected to rise from current $135.50 to 144.30 in 2020. (This monthly premium can be higher depending on one’s income). The Part B deductible is expected to rise from current $185 to 197 in 2020. After deductible is met, one pay’s 80% of the approved Medicare fee. For example after deductible is met, if MD submits a bill for say $200, you might get EOB saying the Medicare approved fee is say $100. You would then be responsible for $20 (20%). So this 20% is a “gap” in your coverage. Insurance companies sell supplemental, also called Medigap policies, to cover this “gap”. These plans have different letters G, C…. The plans are pretty much the same from company to company in terms of what kind of gap coverage you get. Plans like Plan G are more comprehensive in what they cover after the Part B deductible is met. Other plans like Plan A would cover less and could lead to much higher out of pocket costs… Because a Plan G covers more than say a Plan A, one’s monthly premium would be higher for the Plan G.
The biggest advantage of signing up for Original Medicare and a supplemental policy is you have a lot of freedom on what doctors you see, facilities you can go to, etc.
Also as I understand it, a big, big plus of signing up for Original Medicare and supplemental policy at 65 during your initial enrollment period (IEP) is that there will be no medical underwriting (review of your medical history) at this time. If you instead sign up for a part C plan during initial enrollment and want to change to Original and supplemental plan later, you would probably be subjected to medical underwriting and could be denied coverage.
Part D deals with drug coverage. I believe one is required to have Part D. Go to link below as to comparing all 2020 plans in your area.
Part C plans (also called Medicare Advantage) are plans that pretty much wrap Parts A, B, and D, into one package. You would still have to pay Part B premiums. The Part C plans could also have a separate monthly premium, and co pays. These are HMOs, meaning you will be limited to MDs, facilities who are part of these plans.
https://www.medicare.gov/plan-compare/#/?lang=en
The link below is link that explains various Parts.
https://www.medicare.gov/index
The IEP includes the 3 months before your b-day, the month of your b-day, and 3 months after. If you enrolled early enough in IEP, you could expect Medicare to go into effect on the first day of your b-day month. For example, your b-day is April 25 and you apply on January 1. You could expect coverage to start on April 1. You can sign up online at social security website. As a note once you are notified that you have coverage (recently took about one month for my wife), you have to go to https://www.mymedicare.gov/ and set up a separate acct for Medicare.
Which plans are best is probably dependent on one’s medical needs, cost., location…it depends on one’s needs.
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My Medicare advantage plan is a Premier PPO. It is not an HMO. Nationwide coverage that is supposed to be taken by any provider who takes standard Medicare. Mine is a group plan.
So many folks think that all Advantage plans are HMO plans and that is not true.
@thumper1
Didn’t know that.
Thank you all for your thoughtful and helpful posts. I’ll show them to DH so we can try to make a good choice.
How much do these monthly premiums run? We’ve been so horribly spoiled that H’s company has been generously providing healthcare for us for 35+ years.
I can also see where getting Rx generics that can be filled at places like Sams Club, Target, Walmart, Walgreens, CVS, etc, for $4 or less will also help with the Rx issues. I have a Sams Club list of very low cost generics, especially if you’re a Plus member, which we are.
Please continue posting…many of us have a lot to learn!! It is a moving target!
Go to the 2020 medicare plan finder link above. You don’t have to log in. Choose part D, enter your zip code. Enter your drugs. It will show you the plans in your area, costs, copays, etc. It’s a very useful tool. good luck
@mom2collegekids & those just starting to look into Medicare
As you can see from the comments, similar to Social Security Benefits, the details are more involved than one might expect, at least they were for me.
One suggestion, if you begin this year to research options, is to go to the 2019 medicare plan finder. It’s much easier to navigate than the one for 2020. Although plans can alter, the version of a plan for 2019 most likely will be similar to 2020. As noted, it will most likely be an easier way to get a general handle on what the options are.
It’s important to compare monthly/annual drug costs with other costs, e.g. deductibles, co-pays, & the premiums for supplements for traditional medicare.
I recently began Medicare coverage. For me, because I have one medication that I refill monthly, it was least expensive to enroll in a Medicare Advantage plan, rather than pay additional premiums for supplements to add to traditional Medicare’s premium, currently ~$135/month.
I have heard that traditional medicare with supplements could be preferable, if cost is not an issue, because it has a longer track record. For me, because one of my doctors, whom I see once/year is out-of-network, I chose a high-level Medicare Advantage PPO plan.
As noted, plans vary not only state-by-state, but at least in NYS, county-by-county. Based on my experience & the coverage my mother has in Southern California, I believe one has more options if one lives in a large urban area with teaching/research/university-affiliated hospitals.
And, if one has begun receiving Social Security benefits before turning age 65, then one is automatically enrolled in Medicare.
Good Luck to all,
as I assume re-researching medicare plans is an annual event.
Part F is identical to Part aside from the fact that F covers the Part B deductible and G does not. However, for every plan I looked at, the additional cost of F was greater than the cost of Part B’s deductible. You pay more overall to have the deductible covered. So it’s cheaper to go with Part G rather than F. A broker I spoke to said F is for people who are mathematically challenged.
All Part G plans are identical. The only differences are the cost and customer service. Part G has nothing to do with which doctors you can see or which medical facilities you can use. Our state’s Insurance Commissioner’s office has a list of all the vendors on-line, with pricing. I was able to find a Part G plan that was quite a bit cheaper than the other options. It happened to be State Farm, but that was specific to Washington State and for 2019. There should be a new list for 2020.
Selecting a Part D Rx plan is tricky when you don’t have any current medications. The Part D plans vary widely: covered drugs, pricing tiers, participating and preferred pharmacies, etc. Some reviews complain that insurance companies change their lists of covered drugs after the enrollment period closes, so people end up paying more than expected. Reviews are all over the place, so it is difficult to choose a plan with confidence.
I found an older CC thread on this topic to be very helpful.
Went through this process last year. It took a lot of research time. Finally chose Original Medicare & Supplemental “G”. We worked with a broker, but also checked options on our own via state services. Our broker was very helpful answering questions, and also provide an after-sale service if there are later problems in billing or mis-coding. (We’ve already used it).
Talking to individual companies proved worthless. We never got through to someone actually at the insurance company. They only sent you to regional sales reps, who often service multiple companies in multiple states. We were given so many different and often contradictory messages that it was almost a comedy. Had nothing to do with the government, and more with the sales personnel.
One over-simplified but helpful explanation given to us, was to consider Original plus Supplement (O+S) as a pay-up-front plan, and consider an Advantage plan as a pay-as-you-go plan. Premiums can be much higher for the O+S plans, but once the deductible is met, there are no additional co-pays or out-of-pocket costs. Advantage plans are more like employer plans, and can offer extra perks (Dental, Vision, Gym memberships, etc.). If you’re healthy, O+S plans are typically more expensive than most of the Advantage plans. If you’re not-so-healthy, the Advantage plans CAN be more expensive if you have to see a lot of specialists, and reach the maximum out-of-pocket costs due to procedures, etc.
Reality check is that any Supplement plan will only cover the difference in cost if Medicare covers the service first. If Medicare decides it is experimental, cosmetic, or not included in their basic coverages (some GYN exams for example), the Supplement won’t cover it either. Our former employer plan was more generous in what they covered than Medicare. Not sure how the Advantage plans work.
We’re healthy (so far), but still decided on a G supplemental plan. Advantage plans in our area included HMO, and PPO options, but even the PPO plans had limited networks of doctors both in and out of state. Plan G allows you to go to ANY Dr. (that accepts Medicare). No networks at all.
As stated above, we also wanted to get into a Supplement plan while we could – with no underwriting. We can change Advantage plans, but not O+S plans every year without underwriting, as some other states offer (WA & CA?)
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“F” plans are being eliminated. We were still eligible, but advised that as members of the older “F” plans age (and shrink), premiums might increase faster. Plus the G plan premiums were ultimately cheaper than our local F plans.
Supplemental plan premiums in our state all increase as you age. Different companies have different rates, but also much different track records regarding increases. If you live long, premiums can become substantial (when funds are likely tighter). But who knows what will happen to Health Insurance in a few years.
Anyone still working or getting insurance through current or former employer should read through their policy and talk with HR about if and how that may change when current or former employee turns 65.
For H, while he worked, his insurance was primary and Medicare was 2ndary. He was allowed to keep his insurance in retirement, continuing to pay his portion of the premium but Medicare became primary & his insurance secondary. For the rest of us on the family plan, the insurance remains primary.
Other employers can have different rules. HR and insurer should be able to tell you the rules. All of this was spelled out in the insurance policy—I got a paper copy and read it carefully.
Everyone who doesn’t get Medicare A/B/D in the time window they’re supposed to will pay a penalty forever when they try to add it. Ignorance won’t help, so please educate yourself and loved ones.
I went through this almost a year ago. The Medicare.gov sight is not intuitive, but if you fool around with it, changing various parameters, you start to get helpful information. I ended up choosing a PPO Medicare Advantage plan, because my husband was very happy with his Medicare advantage plan for the last 7 years. All those people who say MA is horrible are referring to HMO MA plans. Most of this have $0 monthly premiums. If it sounds too good to be true, it is.
What sold me in Medicare Advantage plans is that they cover vision, dental, and hearing as well as a Silver Sneakers membership. They also include prescriptions, so everything is in one plan. I pay a higher premium than my husband, but since I’ve joined in May, I’ve had a sonogram, biopsy, MRI. two surgeries, and a physical, at no out of pocket cost. My physical therapy required a co-pay. My network is great and the out of network costs are often the same as in network, so not worried about travel.
Basic primer – when your H turns 65 and the employer health coverage ends, he will have two options.
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Go with standard Medicare, and purchase a separate drug plan (Part D) and a medicare supplemental (Medigap) plan. The supplement covers the copays and co-insurance for things that are covered by Medicare; it does not cover things that not covered by Medicare).
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Opt instead for a Medicare Advantage (MA) plan – that is basically going with private insurance in lieu of Medicare, with all the respective pros and cons that come with it. The advantage is that many have a lower monthly premium cost than the Most MA plans include drug coverage – but of course that is something to check.
Note: If you go with option #1 (including supplement) – your husband will NOT be eligible for an F plan - anyone who turns 65 in 2020 or later is not eligible. Instead the best plan he will be able to get will be a G plan, which covers everything BUT the ~$200 annual deductible for Medicare. But historically the G’s have also had a lower premium – though in 2020 going forward there really is no incentive for the insurance companies to keep the G premiums lower.
There is an annual open enrollment period in which everyone can change MA plans and/or prescription drug plans (Part D). No medical underwriting. There are also some limited circumstances in which plans can be changed outside the open enrollment period.
After the initial enrollment window in the first year, the Medigap plans can require medical underwriting – so if you don’t buy into it to start, there is no guarantee you can get it later. You can always switch from Medigap to MA during the annual open enrollment period You can’t have both at once.