Medicare starts soon

R

ran

Senior Member
So Medicare is a $135 hit to my Soc Sec. OK. Now I have to decide on Traditional or Advantage --G care. I am almost 65, decent weight and health, one generic med and controlling diabetes with diet and exercise. Asking on other forums, I see that my State--Oregon is a bit different. No big HMO's.
My wife will be at this point and $265 a month in plans is fine with her. I'm in good health and do not want to give up all my fun $ to this. ideas? thanks
 
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ran said:
So Medicare is a $135 hit to my Soc Sec. OK. Now I have to decide on Traditional or Advantage --G care. I am almost 65, decent weight and health, one generic med and controlling diabetes with diet and exercise. Asking on other forums, I see that my State--Oregon is a bit different. No big HMO's.
My wife will be at this point and $265 a month in plans is fine with her. I'm in good health and do not want to give up all my fun $ to this. ideas? thanks
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I'm all ears on this thread as I'm turning the clock to 64 this year!
All insights most welcome too.
 
So this is my business, I am an advisor and have been helping folks with this for about 7 years now. state insurance laws vary greatly and I am not licensed anywhere close to you. as a general rule advantage plans are cheaper to own but more expensive to use particularly if you end up in the hospital and or need surgery. where Medicare Supplement plans or Medigap plans are more expensive to own but cheaper to use, lower out of pocket expenses. if you just go to the doctor once or twice a year you'll wonder what you're paying for. but if like a close relative of mine you find yourself after being hospitalized for your second heart attack having a combo defibrillator and pacemaker installed in your chest, which is about a $500,000.00 surgery and you walk out of the hospital with zero out of pocket you'll understand why you've been paying more for the supplement plan. what is right for you is dependent on a myriad of variables. think long term, most people once they make this choice don't really change it, so your health now matters, but so does your future health. people as a general rule don't get healthier as they age. on the other hand one bad (expensive) year and four good years averages out. bottom line is it's complicated. Chatting with someone who really truly knows the ins and outs of these systems is quite valuable. Please don't confuse that with people who have been to the same "picnic" folks that have one anecdotal story about this one time and one situation and think it translates to everyone all the time. hope this helps.
 
It shouldn't be complicated, but is. Or probably more like speaking a different language that you are used to. My wife turned 65 a year ago, I turn 65 this month. I retired in November after several good earnings years. None of that fits into their mold, so we have been fighting with them for a year to get it all correct. Every time we deal with them, they agree we are right. Then they return to the old decision. I literally have a book of documentation we have provided for them. They still can't get it. I think part of the problem is, you are dealing with government, and then you are dealing with 2 different government agencies, they don't always communicate effectiveliy with each other.
Medicare handles the medical stuff, social security handles the money.

As for the other parts, You have paid into it for your working years, so you already paid for part "A", the premium you pay is for part "B" and possibly part "D". You need to know and understand what the different parts mean and what they are for. Then the options to cover other things that medicare doesn't cover.
Also important to know. If you plan to travel, make sure you have coverage. Some supplement policies won't cover you out of your area. Some will. If you are out of the country, Medicare MAY reimburse you, but make sure everything, all receipts, and documentation is in English.

I am slowly getting educated on the ins and outs, but knowledge is expensive and can be hard to come by. I think finding a decent "Broker" to help you might be a good idea.
 
I am basically going thru a Broker. All these years with insurance thru work or my wife when my right arm was messed up, this is the first to pay for Medical out of pocket. does hurt that way. I will do Medicare Advantage now. the Part D Aetna is $15.40 a month. My generic meds are $2.00. I can't see paying that much for $2.00 of meds. yes, I know, the future is unknown.
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2007 SE V6 Titanium
 
With a double incomes, you could have tipped the scales of income. So worth understanding what MAGI is and IRRMA. That's where they over charge you for what you have already paid for. It's pretty simple, but worth knowing. And if it effects you, it looks simple to deal with, but SS has trouble with it.
Also worth knowing. Many govt workers pay into medicare. So check your SS statement when they tell you that you are "A Govt worker, and not eligible"!
We were told that multiple times. My wife was not eligible because she didn't have enough credits. However when totaling up her GOVT part time job, she did. Plus she was eligible because of my work history. Took six months and some denied claims, numerous phone calls, trips to the SS office to get that straightened out. We are still hopeful...………………….
 
Something else. get acquainted with how their websites work. Get registered on their websites. They work pretty well for most things. Get your passwords etc set up. If you have not used them, the security codes are sent every time you log in. Works well. Better than sitting on the phone for hours waiting. They also have the ability to call you back. So if you call on the phone, they can give you an estimate of when they will call you back. Then they do, you don't have to sit on hold/voice response for hours.
 
Oldmanb777 said:
With a double incomes, you could have tipped the scales of income. So worth understanding what MAGI is and IRRMA. That's where they over charge you for what you have already paid for. It's pretty simple, but worth knowing. And if it effects you, it looks simple to deal with, but SS has trouble with it.
Also worth knowing. Many govt workers pay into medicare. So check your SS statement when they tell you that you are "A Govt worker, and not eligible"!
We were told that multiple times. My wife was not eligible because she didn't have enough credits. However when totaling up her GOVT part time job, she did. Plus she was eligible because of my work history. Took six months and some denied claims, numerous phone calls, trips to the SS office to get that straightened out. We are still hopeful...………………….
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All federal workers who don’t pay into social security (if there are any like that left) under the old civil service retirement system, did pay into Medicare, just not social security. Medicare itself should have that on your record. Also, if you are a retired Fed, you can keep your federal employee health plan (the govt pays 70 percent of the premium) as a backup for the free part A Medicare. Since my wife won’t be eligible for Medicare for a few years, I am going part A only and keeping my govt health insurance, for a little under $400 a month for both of us. Plus, as a retired public safety officer, the first $3000 of the premiums can be used to lower your annuitant income by $3000, for a significant tax savings. It works out to about $350 a month with the tax savings. Plus it’s good anywhere in the US and covers me for international travel.
 
These are good conversations to have. It helps me learn the ins and outs of the system. Get more of a working knowledge than a "book" knowledge.
We are paying just over $300 each for our supplement that includes most drugs, or part "D", and should be paying the $135 for part "B". But even though they agree that we should be paying that, they are still billing us $265/mo each.
They have denied my wife's "Welcome to Medicare" physical payment. Says she isn't eligible for Medicare. but she has just enough credits on her own. And would be eligible under mine anyway. They says she isn't eligible, but are still billing us for it.
Something else. You are eligible for a physical once a year. Not so fast...…..Your first physical isn't called a yearly physical. It's called a "Welcome to Medicare Physical". I think pretty much the same thing, but coded differently. Amazing how many people get denied the claim because of the code. Also, know this, the DR must prescribe the EKG and have a reason for it, in order to include it in your physical. It's available to you in your physical, but must be prescribed separately.
 
I am going thru a Broker from my wife's old employment. Part C is Regence, a big 36 state coverage, for $15 a month and Part D coverage for Dental, Hearing and Vision is $20 a month. Starting this month $135 comes out of my Soc Sec. Parts C&D is a bill sent monthly. Like most of you, we went thru life with Insurance and stuff taken out of our paychecks. We never cared. I turn 65 in a few weeks. I guess this is the last big thing in life to happen. time to redo my budget. fun.
______________________
2007 SE V6 titanium.
 
Hppy Birthday:lalala:Couldnt find a birthday jingle, so that will have to do...I'll be 65 in a few weeks my self. Whole new world of health care. I think one of the main reasons its out of control, is like you said, it was supplied. So we never really paid enough attention to the escalation of the prices.
 
Bringing back an old thread. Sometimes its good to review, and also to get expert advice. I think it is pretty much ironed out,at least for now. But enrolment period is here, so who knows what next year will bring. Our supplement administrator for dental is changing. The plan isn't just the administrator. I have not heard about the major medical supplement yet.
 
It's another gubermint sponsored disaster. Having a good supplement to help is probably a must. They can be confusing at best. Dealing with SS and Medicare is a real mess. They play a shell game that you can't decipher. WE have had problems from, "your not eligible, or you applied late and therefor pay a penality" neither was true. Tooks months to sort out. To IRMAA hassles. Our January bill for Medicare is $3160 each, for one month premium! No explanation included. We have gotten 5 letters since late Oct telling us what our premium will be for 2022. every letter indicated a different amount. Then this bill. Dues on Christmas day. Merry Christmas from your gubermint. WE are trying to find out what the bill is for, so far no one can tell us. Medicare says it's a Social security problem, social Security says its a Medicare problem. But no one can tell me who made the decision and what the bill is for. It absolutely makes no sense. So good luck!
 
Medicare is NOT and insurance company. It's government run socialized healthcare for senior citizens that have paid into the program for at least 10yrs of working life. There is a lot to it. The money is administered by Social Security, as dictated by Medicare. So you deal with two government agencies when you have a problem with something. There are numerous styles or types of "supplement" plans that deal with Medicare for you for a price. Most employment pays into Medicare. There are some places of employment that doens't. So you pay a tax every month and your employer pays something on your behalf. Then when you turn 65 yrs of age you can go on Medicare if you have paid into it for approximately 10 yrs. It's not free. You pay a premium every month for part "B" and maybe part "D". Part "B" is your DR visits, part "D" is your prescription drugs. then you MAY also buy some sort of supplement that pays what Medicare doesn't. The price for part "B" and "D" are set every year by congress. Most people pay the basic fee, but if you have been somewhat financially successful and saved for your retirement, you can easily get into the MAGI and IRMAA traps. Lots of people who sell assets after retirement find themselves in those traps. The supplements are varied and confusing, probably a good (if you can find one) consultant to help is a good idea. Hope that is a good intro into Medicare.
 
I should include.......Part "A" is hospitalizations, you paid that while you worked through pay roll taxes.
Be careful with Medicare. You MUST go on it when you hit 65 yrs of age or you will pay a fine the rest of your life. The exception, (and document this) is if you still are working for a company that supplies medical coverage.

it's a mess, but it does work for most people. It's just unnecessarily complicated and confusing and expensive.
 
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That's not really possible. For most people, its Medicare, no choice. You pay for it no matter if you want it or not. And if you decide not to do it, then at a later date change your mind, the penalty is huge. Health care is a mess, Medicare makes it worse.
 
This isn't a good forum for discussing Medicare. There are others with better information. I'll add my anecdotal experience and information

I have been on Medicare since I retired in 2013. I have never had a problem using it. I was eligible in 2012 but if you have other insurance (I was still working and covered by my employer's insurance plan) there is no penalty if you don't join while you are still covered elsewhere. But if you are eligible for Medicare and have no other insurance plan to cover you, then yes, there is a penalty, also for the prescription drug program, and it's a lifetime penalty. It's a percentage increase in your payment for coverage. The longer you don't have any medical coverage (Medicare or other), the higher the penalty percentage. The reason is that they don't want you to not pay into the plan for your insurance until such time that you are seriously ill and have big bills. They want to collect from you over time, into Medicare or other insurance plan. When you turn 65 get your Medicare card for Part A. There is no cost to you if you have been paying into the plan from your work.

Parts
There are 4 parts to Medicare:

Part A - Major medical/hospitalization (you paid into this from your employment)

Part B - Wellness care (doctor appointments for ongoing care) This payment is subtracted from your Social Security. Everyone has the same deductible and payment.

Part C - Advantage plans - These are the plans hawked on TV for months on end. You go with an insurance company and they provide the benefits. You pay them and they collect from Medicare. There are different plans with different benefits. You may or may not have a payment but the more options you take, the more you pay. They are HMO plans, so be careful where you are covered. If you choose an Advantage plan you don't have to be concerned with Parts A,B,D and I think supplemental. I have always used regular Medicare with a supplemental plan.

Part D - Prescription drug programs - You pay for these from your Social Security, just like the Part B coverage. You go on the Medicare site and look at the available, standardized plans. Coverage and costs vary. I chose one with a low monthly payment because I never have reached the deductible for my medications. I'm 76, exercise 5 days a week for 30-60 minutes. I ran a marathon at 65 and I'm planning on walking a 200 mile trek in Spain this summer. Your mileage may vary. I work at staying young

Supplemental Insurance -
This is not part of Medicare. It's a separate policy you get with an insurance company from standardized plans you choose from at the Medicare website. Medical bills are submitted to Medicare, who will forward them to your supplemental insurance (after they pay or not pay their part) for the supplemental insurance company to pay or not pay. These plans are not required and there is no penalty for joining later, but you will pay more as you age. They are a good benefit to have but make sure your doctor accepts the company you choose.

Re-enrollment
Whatever you choose, every year there is re-enrollment. You can choose to go back to regular Medicare or switch to an Advantage plan. If you are on regular Medicare you can change your prescription drug provider/plan and supplemental insurance plan. If you do not re-enroll your coverage automatically rolls over to the new year.
There are other times/conditions when you can change/start enrollment. My wife's birthday is December so her old insurance terminated at the end of November and she enrolled in Medicare for that one month in that one year and also enrolled for the next year. We opted for a different supplemental plan for each, but the same prescription plan for both.

MEDICAID
If you are below a certain annual income level (I don't know what it is) you may also qualify for a Medicaid benefit, particularly to help pay for your prescription drugs

Donut Hole
The donut hole is when you have received the maximum benefit for your prescriptions, as directed by the Part D coverage (each plan is different). When you reach the maximum benefit, coverage stops and you pay for all of your medications. At some point you will possibly be eligible for Medicaid to assist you with these payments. That's when you have reached the other side of the donut.

TRAVEL
Medicare does not follow you outside of the USA; nowhere. You can get temporary medical and travel insurance from other companies. If you have an Advantage plan you can select that as a benefit if you want, like dental and vision, but costs extra.

Advantage plans are HOAs, so your coverage is local. If you are traveling in the USA and have an emergency then the Advantage plan may cover you, depending on the emergency.

Medicare covers you anywhere in the USA for any facility that accepts Medicare. (I have never found a place that didn't.)

DENTAL and VISION

Medicare, at present, has no coverage for dental or vision. Advantage plans can cover these at extra cost. My dentist has a plan that we each pay into, about $275/year, that covers 2 cleanings and 1 set of full x-rays. There is a 20% discount on other dental work.

This has been my experience with regular Medicare. I have been very pleased with how everything is handled and while it was somewhat confusing at first, it's helpful to know that every year you can change and take a different option. It did take me several years to discover that I was paying for a premium benefit with the prescription drug plan but never reaching the deductible. I have switched to a lower cost plan with fewer benefits but I actually pay less for the prescriptions, saving on both.

Be careful who you deal with. These insurance companies are looking out for themselves and there are a lot of advertisements for Advantage plans. Check with a local senior service program for advice.
 
Not everyone pays the same for part B. It's based on your MAGI. Medicare MIGHT pay if you are out of the country. It MIGHT not. If it does, everything will need to be in english and coded properly. So that is, all hospital/dr records etc must be in english etc. The payment will be in the form of a reimbursement, not at point of service. So you will pay upfront and then try to get Medicare to reimburse you. That sometimes works. Some Advantage plans may be very localized. As in cross a state line and no supplemental coverage. Some plans my cover internationally. They tend to be cafeteria plans. every plan is different.
 
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