New to Medicare

[Twotoes]

I know that there are several threads on this topic but I am confused so I thought I would start a fresh new thread. I am a fulltimer and about to turn 65 in a few months. I use the Escapees South Dakota address. My current health insurance is with Avera and only covers me for emergencies outside of SD, which I am never in the state.

Now I am in the State of Confusion heading to the State of Insanity. All this alphabet soup Part A, B, D, F, G etc. I was told that when I reached 65 and was eligable for Medicare that it would be eaiser. Now I am finding out that I have to apply in SD for my Medicare coverage and Supplemental Insurance. I thought I could apply anywhere since it is a national program. Not even sure how the Supplemental Insurance works. And what the hell is a donut hole? PLEASE HELP A NEWBIE TO MEDICARE. 

[Barbaraok]

Relax, take a deep breath.  We've all been there, done it, and you will make it.

PartA - Hospital part.  You  have already paid for it, you get it for any needed hospitalizations. You will be responsible for 20% of Medicare approved charges.

Part B - Drs visits, labs, out patient, etc.   You have already paid for PART of this.  It will cost you ~ $135 (IIRC) for new participants this year.  If you are on SS, they will just deduct the premiums.  If not, you need to pay directly to Medicare.  SET THIS UP NOW.  IF YOU DELAY YOU WILL PAY A PENALTY.     You will be responsible for 20% of Medicare Approved charges

Part D - Prescription coverage.  You will pay for this.  Start immediately - if you delay you will pay higher costs later.  Find one that covers the meds you currently take and each year look to see if it is a good one.  All the major pharmacy changes offer Part D plans.  Look at Wal-Mart/Walgreens/CVS for nationwide coverage and also look at mail order (Express Scripts is what we use) for maintenance meds.

Part F-N. These are supplemental programs that cover the 20% that Medicare doesn't.   You want a program that is nationwide.  You need to spend some time on the Medicare.gov site to learn about all of the supplementals that will be available to you.  It will be based upon your zip code, but several companies write coverage that is nationwide.

 

[Velos]

Here is an article discussing the "alphabet soup" https://medicare.com/medicare-supplement/medigap-plan-benefits-chart/

We have used an insurance broker to handle our health insurance for 20 years so when DH turned 65 we asked him what was best for us. Each person is different and though the alphabet soup is supposed to be the same coverage in any state the price is different among the various companies that offer them so you need to shop around. If you have access to an insurance broker in SD they will compare the products available for you and match you to what is best for your circumstances.  There is no charge to you and since brokers service several companies they have access to more information than a proprietary service that only handles one brand.

Donut Hole, Medicare Prescription Drug Definition:  https://www.healthcare.gov/glossary/donut-hole-medicare-prescription-drug/ 

"Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole"). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again."

[Kirk W]

The reason you must apply in SD is that you have claimed it as your domicile. While Medicare is the same everywhere, supplemental policies are different by area and not all insurance companies sell policies in every state, even if they do cover the claims in all states. Each state requires the insurance sales to be licensed to do business in that state and to meet that state's laws.

7 minutes ago, Twotoes said:

All this alphabet soup Part A, B, D, F, G etc.

There is a pretty good explanation of the Medicare parts A, B, C, & D at this AARP page. The Medicare supplement plans are insurance policies from private insurance companies that are available to cover the things which Medicare does not and some even cover the Medicare deductible. Because they are from private companies they do depend on where you are domiciled. You can find those listed on the Medicare website with an explanation of what each plan covers. You are not required to carry any of those but most of us do. There are private companies like AON/Hewitt who will assist you through the maze of choices to get what is best for you and they are paid by the insurance companies, much as an insurance agent is paid. We have found them very helpful. 

[JRP]

TwoToes,  not sure why it would surprise anyone that you need to use your official home address when applying for any Gov benefit program. Remember that you have certified that SD is your legal home state. Yes Medicare coverage is national, so is social security and IRS taxes; but they all want to know where you live and what your official mailing address is.

You don't have to go to SD of course, you apply online. For the basic Gov run part of Medicare that's all there is to it.  Apply online when you're within 3 months of turning 65 and you're covered.  Receive your card in the mail and remember your Medicare ID number.  Medicare doesn't cover everything and even what it covers, only pays 80% after the annual deductible.

If you're Ok with paying out of pocket for the Medicare deductible, the 20% they don't pay, and all the uncovered items, then you're done.  If you prefer to buy a separate insurance policy to cover some or all of those deductibles & uncovered expenses, then you look into Medicare Supplements A-Z.  This is where it can get complicated, because you must make a choice of which optional supplement plan, based on balancing how much premium you can afford VS how much coverage of the otherwise out of pocket expenses you want.

  Since these Supplement Policies are private insurance, although they're defined by the Feds, they are also regulated by each state based on where you live. Just like your pre 65 private insurance. The difference is that each Medicare Supplement Plan must provide the exact same coverage, regardless of your home state. So a Type  G or F supplement in SD is exactly the same coverages as a G or F in TX or Fl, and good for treatment at any doctor or hospital throughout the country that accepts Medicare. (but the price of the premiums will vary by state)

 

[GlennWest]

DW called Kyle Henson. Helped her greatly. 

[docj]

On 7/17/2018 at 10:43 AM, Barbaraok said:

Part F-N. These are supplemental programs that cover the 20% that Medicare doesn't.   You want a program that is nationwide.  You need to spend some time on the Medicare.gov site to learn about all of the supplementals that will be available to you.  It will be based upon your zip code, but several companies write coverage that is nationwide.

With all due respect, I believe that all standard Medigap supplemental plans are national.  The plans that are regionally based, are the Medicare Advantage Plans which combine your Supplemental and Part D payments into a combined plan which is managed like a PPO/HMO.  It's more difficult for full-timers to use an Advantage Plan unless they intend to stay in the plan's geographic area much of the year.

It's worth noting that if you want any coverage outside of the US I believe you have to buy one of a selected set of Supplemental Plans.  They don't provide a lot of coverage, but they do offer $50k of emergency treatment coverage which probably would be enough to get you back to the US.  

FWIW lots of folks on this forum subscribe to Supplemental Plans F or G.  They pay pretty much everything that Medicare A and B don't pay.  I've had a Plan F for 6 years and haven't paid a dime other than my premiums.   The only difference between the two is that Plan F includes the Medicare Part B deductible whereas Plan G doesn't.  I believe F is being phased out unless you already have it so you may have to sign up for G.

[Kirk W]

2 hours ago, docj said:

It's worth noting that if you want any coverage outside of the US I believe you have to buy one of a selected set of Supplemental Plans.

 

Not so. My previous plan F policy has international coverage. 

[docj]

1 hour ago, Kirk Wood said:

Not so. My previous plan F policy has international coverage. 

I never said it didn't.  What I said that you have to have a Supplemental that provides international. I didn't suggest in any way which plans do and don't provide coverage.  We have a Plan F, also, and we are well aware that it provides this benefit.

According to Medicare.com:

Standard Medigap Plans C, D, F, G, M, and N provide foreign travel emergency health care coverage when you travel outside the U.S.

That is not the entirety of all Medigap plans, which is precisely why I said that only "selected plans" provide this coverage.

[Sehc]

I have the F supplement. I could never figure out why the doctors liked it that i had that supplement as medicare sets the fee they can charge. My best guess is the plan leaves no extras for me to pay, leaving the doctors no collection problems. It costs more on most months than if I paid the deductibles and co-pay, but gives me peace of mind.

I started with AARP supplement but changed over to my retired union member plan. AARP was good, but union plan saved about $10 month.

Don't get me started on Plan D. What a crime.

[Dance Chick]

fyi...While some (most??) Medicare Advantage plans are regionally based, there are some that are a nationwide PPO.

[docj]

1 hour ago, Dance Chick said:

fyi...While some (most??) Medicare Advantage plans are regionally based, there are some that are a nationwide PPO.

But they may or may not be available in your domicile state.

[Randyretired]

There are some excellent national Medicare Advantage ppo plans but most are through employers.  

[docj]

1 hour ago, Sehc said:

I have the F supplement. I could never figure out why the doctors liked it that i had that supplement as medicare sets the fee they can charge. My best guess is the plan leaves no extras for me to pay, leaving the doctors no collection problems. It costs more on most months than if I paid the deductibles and co-pay, but gives me peace of mind.

In addition under Plans F and G a doctor can bill up to, I think, 110% of the Medicare allowance and still have his charges covered.

[Dance Chick]

43 minutes ago, docj said:

But they may or may not be available in your domicile state.

That is true, but something one needs to know to do one's research and be fully informed. Ours is FL and is not employer based.

[Kirk W]

6 hours ago, Sehc said:

My best guess is the plan leaves no extras for me to pay, leaving the doctors no collection problems.

That is the main reason. It means that they never need to bill you. Also, if you have Medicare and Medigap Plan with limits, they then have to send out a third bill to you.

5 hours ago, docj said:

In addition under Plans F and G a doctor can bill up to, I think, 110% of the Medicare allowance and still have his charges covered.

Would you post a link to the source of this information? I have searched the Medicare site and could not find that. I  also asked the office manager at my doctor's office just an hour ago she said no.

[docj]

16 minutes ago, Kirk Wood said:

That is the main reason. It means that they never need to bill you. Also, if you have Medicare and Medigap Plan with limits, they then have to send out a third bill to you.

Would you post a link to the source of this information? I have searched the Medicare site and could not find that. I  also asked the office manager at my doctor's office just an hour ago she said no.

On the Medicare site it shows that Plans F and G cover excess charges, but I couldn't find any discussion.  Here's discussion of the issue on a non-Medicare website: Medicare excess charges

[Kirk W]

I see what you refer to and there is a key statement there.

Quote

If you are on Medicare, and happen to go to a doctor who does not accept Medicare assignment (accept full payment by Medicare), he is allowed to have an "excess charge". This excess charge would be an amount above and beyond what Medicare approves for a specific procedure / doctor office visit.

 

 If your doctor does accept Medicare assignment, as most do, then he does not have this option. Since neither Pam not I go to any doctors who do not accept Medicare assignment, I really never considered that issue. That source does state that F & G cover 100% of those charges. I thought that it must be somewhere and I finally found it in the Medicare booklet that we get each year. In section 2, Mediap Basics it does state that plans F and G will cover those charges.

[docj]

2 minutes ago, Kirk Wood said:

Since neither Pam not I go to any doctors who do not accept Medicare assignment, I really never considered that issue.

All our doctors accept Medicare assignment, also.  However, one never knows if you'll come across one you really want to go to who doesn't.

[Barbaraok]

Anesthesiologists often don't except Medicare and you don't know until after the surgery.   

[Randyretired]

Our Advantage plan ppo covers the additional 15% Mayo doctors charge but I am not sure if Medicare would cover it.

[docj]

13 minutes ago, Randyretired said:

Our Advantage plan ppo covers the additional 15% Mayo doctors charge but I am not sure if Medicare would cover it.

That's the level of "excess charge" that Plans F and G will cover.