View Full Version : Figuring out Medicare
DH and I are 66 and 65 years old. We currently have our health insurance through his employer. He will be retiring in February, 2014 and we will be using Medicare. I am trying to figure out Medicare and what supplemental insurance we will need. I need help! Are any of you on Medicare and if so what type of supplemental insurance do you have?? Also, what about Medicare Advantage plans.
I am reading the Medicare and You booklet that the government puts out. It helps some but I keep feeling like I am not understanding it.
Thanks for your help!
Simpler at Fifty
6-19-13, 7:58pm
When we were deciding on a Medicare supplement for DH, we called our insurance guy for our home/cars. We met with them and they gave us 5 options. We went with a local medicare advantage plan and it has been great. You may have to do some math to determine which one is the best. Make sure you take your medicine list with you if you talk to anyone. Find out what tier each drug is (typically they will be the same tier with each different plan) The copay is different for each tier. Then you will need to figure out if you want a free Medicare advantage plan or pay a premium for one that may have low copays.
http://moneyover55.about.com/od/healthinsurance/a/When-And-How-To-Apply-For-Medicare.htm
Have you already applied for medicare? My understanding, which isn't stated in this link, is that the Part B premium goes up a certain percentage over time past the age of 65 if you don't have group insurance up to the point of enrolling for medicare part A if done past the age of 65.
My understanding is that with the supplemental buy-up insurance you can get the various Medigap plans (A-J) all have to cover the same stuff depending on which plan it is (regardless of who you buy it from) but that pricing and copays, etc are not the same, which is what you are shopping for. Note that my knowledge about this is as an insurance professional who has taken a few professional development classes about personal insurance, most recently about 7 years ago. I work in commercial insurance and am only 45 years old, so take my advice with however many grains of salt you may feel is appropriate.
In our county there is a department that offers workshops on all the aspects of Medicare and the extra insurance options. They also offer one-on-one appointments to gather information about the person's medical conditions, medications and then pop all of that into their database, the results of which are the best plans at the lowest costs.
I used them last year, and after our private session, the person asked me if I would like to help other people with the process. I will be training for that in August so that I will be prepared for the October to December period when people can choose a plan or switch plans.
If your county does not offer this kind of service, then every insurance company will be thrilled to present their insurance options. Most of my friends have done that and are quite satisfied that having all of that information from a variety of companies made it possible for them to eventually make a good decision.
When I received the paperwork to volunteer for this program, the woman told me that I would also end up being a good resource for my friends. That part is cool.
Well, I am making progress. This morning I called Social Security and talked to an agent. She is sending me the forms that DH needs to take to his HR department to verify that he has insurance through his employer. We will then mail the forms back. DH has not officially told his employer that he is retiring next year. It isn't a problem for him that his employer will know now that he is retiring next year but it might be in other circumstances. Anyway, that is done.
I am still checking on:
Medigap insurance plans
Medicare Advantage plans
Prescription drug plans
Old age health care is certainly not for the faint hearted!!
We went to an insurance agency that sold several kinds of advantage plans. They suggested what they considered the best plan for us, which turned out to be United Health Care. Our plan has no monthly premium; we are extremely happy with the service. All my meds are generic and a 3-month supply cost $12. (Before I had health insurance, my meds cost $130.)
ApatheticNoMore
6-23-13, 12:49pm
I am still checking on:
Medigap insurance plans
Medicare Advantage plans
Prescription drug plans
Honestly I'm not sure you need all these things. And as for old age health care do any of them even pay for long term care? I get the impression Medigap plans are a waste of money as medicare covers most things pretty well (although not the long term care of course but I don't know if they do either) As for the prescription drug plans those seem fairly straightforward, and I've seen a website to compare the costs of various prescription drug plans (I think it was a government website). However some of the prescription drug plans turned out to be run by drugstores, which isn't really a problem except you get your medicines much cheaper if you go to those drugstores to buy them if you are on those plans. Not a problem if it's all local, just something to be aware of. Sorry to be so vague, it's all I know.
Glo, If there are no premiums how does the company make money?
Cecelia, a Medicare Advantage company is paid by Medicare after you enroll and the company provides and coordinates your care thru their plan/program. They may offer zero premium plans or have smaller premiums for "more" service. You still have to pay for Medicate A and B.
They are all very different and you need a good handle on current needs and what you can take care of $$ wise yourself in the future. Mom, when she moved here, knew she would not do extensive travel and was happy with a local HMO under the Medicare Advantage group. Her doctors and hospital are very close to her home. Each year she will have to review all the changes and perhaps make other selections but I had to do that with my employer provided health care plans each October.
I am sure that each year this will become more complex.
Honestly I'm not sure you need all these things. And as for old age health care do any of them even pay for long term care? I get the impression Medigap plans are a waste of money as medicare covers most things pretty well (although not the long term care of course but I don't know if they do either) As for the prescription drug plans those seem fairly straightforward, and I've seen a website to compare the costs of various prescription drug plans (I think it was a government website). However some of the prescription drug plans turned out to be run by drugstores, which isn't really a problem except you get your medicines much cheaper if you go to those drugstores to buy them if you are on those plans. Not a problem if it's all local, just something to be aware of. Sorry to be so vague, it's all I know.
I know that I won't need all of them but I want to find out what exactly they each are and what they cover. It is all such a muddle!!
Before you assume that Medicare covers almost everything "pretty well", find out just what it does not cover. You will be surprised.
iris lily
6-23-13, 10:35pm
Honestly I'm not sure you need all these things. And as for old age health care do any of them even pay for long term care? ...
If one is financially destitute and it is MEDICALY NECESSARY to have nursing care, yes, Medicaid pays for nursing home care.
More progress:
Social Security sent us the forms that we need to verify that we have current insurance through my husband's employer. We will have this done and mailed back to SS next week. Then we will be all set for Medicare Part B to start when DH retires next February. Whew!
We have decided against a Medicare Advantage plan at this time.
I have narrowed down to 2 likely companies for the Medigap insurance--AARP (United Healthcare) and USAA. The coverage is the same and the premiums are $108/ month and $118/month. Both are sending me written information.
Next I will look into the Part D Prescription drug plans. Both AARP and USAA have prescription drug plans. DH needs 2 inhalers for asthma and I don't have any regular prescriptions.
While this process has been made much easier by the Internet, it has still been rather time-consuming. I am certainly learning a lot about Medicare. My advice to anyone approaching Social Security and Medicare is to give yourself plenty of time for reading and research because there are important deadlines and it can be rather overwhelming (or at least it was for me).
More progress:
Social Security sent us the forms that we need to verify that we have current insurance through my husband's employer. We will have this done and mailed back to SS next week. Then we will be all set for Medicare Part B to start when DH retires next February. Whew!
We have decided against a Medicare Advantage plan at this time.
I have narrowed down to 2 likely companies for the Medigap insurance--AARP (United Healthcare) and USAA. The coverage is the same and the premiums are $108/ month and $118/month. Both are sending me written information.
Next I will look into the Part D Prescription drug plans. Both AARP and USAA have prescription drug plans. DH needs 2 inhalers for asthma and I don't have any regular prescriptions.
While this process has been made much easier by the Internet, it has still been rather time-consuming. I am certainly learning a lot about Medicare. My advice to anyone approaching Social Security and Medicare is to give yourself plenty of time for reading and research because there are important deadlines and it can be rather overwhelming (or at least it was for me).
Imagine having literacy of difficulties of the multiple kinds when going through this?
If one is financially destitute and it is MEDICALY NECESSARY to have nursing care, yes, Medicaid pays for nursing home care.
But that's Medicaid not Medicare. Different programs - but I know you know that already :-) Apathetic is right - Medicare doesn't cover long term nursing home care except for medical rehab type of stuff, and then for only a limited time with costly co pays often times, and they don't cover custodial care at all - although medicaid will cover that if you are poor.
My Mom had a medicare advantage HMO and she liked it a lot. Minimal out of pocket co pays for nearly everything and monthly premiums that cost what regular medicare coverage cost. No medigap coverage was needed.
My Mom had a medicare advantage HMO and she liked it a lot. Minimal out of pocket co pays for nearly everything and monthly premiums that cost what regular medicare coverage cost. No medigap coverage was needed.
We want to keep our current family physician and he is not in an Advantage group. We may look into Medicare Advantage in the future though b/c they definitely have their advantages.
We have United Health Care through DH's work. We went forever fighting with them because they wouldn't pay or wouldn't pay much. Finally a friendly UHC rep told us to drop my Medicare Part B, that as long as we had it, UHC would say Medicare would pay so they wouldn't have to--this never worked. So we dropped Part B and no problem since. However, I too have heard you pay more for Part B if you delay getting it--and we're going to need it when he stops working in a year. As for then, we've been advised by different people to get AARP because it covers most things, or Presbyterian (through a hospital in the next town) because it's used by more providers (doctors). We haven't decided yet. UHC is considered, by most around here, as really crooked at trying not to pay--even have a whole department devoted to how to keep from paying. I don't know that that differentiates them from other health insurance groups. Also, their CEO is one of those who makes an obscene amount of money--I forget how much, but we hate supporting them by having our insurance through DH's job, but we do and may again after he stops working.
More Adventures in Medicare
Today has been dedicated to delving into Medicare Advantage plans. I found the Humana Gold Medicare Advantage through USAA and it seems to provide the coverage we need with the cost being only the Medicare Part B monthly fee. We would have to use physicians and hospitals are in the network but that is not a limitation because our physician group and Memorial Hermann hospital are in the network. The co-pays for physician office visits and prescription drugs are very low. Also there is a maximum yearly out of pocket cap of $3400.
The one thing that has been made outstandingly clear in my adventures in figuring out Medicare is that health insurance with or without Medicare is a complete muddle. Between the two of us JMM and I have 2 Bachelors degrees, 1 MBA, 2 B.S. in Pharmacy degrees, and 1 Pharm.D. And we are reduced to blithering idiots in trying to decipher the outline of coverage limitations and exclusions.
To be continued.
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