New to medicare

[Jaydrvr]

36 minutes ago, docj said:

With all due respect, choosing a Part D plan on the basis of just the month premium is isn't wise unless you have very few prescriptions and/or no expensive ones.  We use an analysis website  to calculate the annualized cost of each plan including premiums and co-pays.   For the meds we take there can be thousands of dollars of difference in the total annual costs across all available plans.   It's my understanding that a similar comparison can be created using just the tools available on the Medicare website.

If you go back and read his posts, Glenn doesn't actually use any prescription drugs, therefore absolutely no point in getting more than a very basic plan. Jay

[docj]

2 hours ago, Jaydrvr said:

If you go back and read his posts, Glenn doesn't actually use any prescription drugs, therefore absolutely no point in getting more than a very basic plan. Jay

My post was relative to Bill Joyce's comment not Glenn's.  As a senior, Glenn is very lucky that he uses to no prescription drugs.  That's definitely not true of most Medicare recipients.  

[GlennWest]

3 hours ago, docj said:

With all due respect, choosing a Part D plan on the basis of just the month premium is isn't wise unless you have very few prescriptions and/or no expensive ones.  We use an analysis website  to calculate the annualized cost of each plan including premiums and co-pays.   For the meds we take there can be thousands of dollars of difference in the total annual costs across all available plans.   It's my understanding that a similar comparison can be created using just the tools available on the Medicare website.

I take no drugs. So makes perfect sense. Only reason I have it is to prevent future penalties. 

Edited October 13, 2021 by GlennWest

[Bill Joyce]

13 hours ago, docj said:

My post was relative to Bill Joyce's comment not Glenn's.  As a senior, Glenn is very lucky that he uses to no prescription drugs.  That's definitely not true of most Medicare recipients.  

I agree to check the plans to see which is cheaper for you.  I do take prescriptions, but they end up with a zero copay via my Part D plan, so my out of pocket is the Part D premium.  I do feel lucky 

[2gypsies]

20 hours ago, docj said:

With all due respect, choosing a Part D plan on the basis of just the month premium is isn't wise unless you have very few prescriptions and/or no expensive ones.  We use an analysis website  to calculate the annualized cost of each plan including premiums and co-pays.   For the meds we take there can be thousands of dollars of difference in the total annual costs across all available plans.   It's my understanding that a similar comparison can be created using just the tools available on the Medicare website.

Yes, always do comparisons for the drugs you take and we use the Medicare drug comparison program to do that.  We also do comparisons every year during enrollment time and change to the best price.  We use two very expensive meds and this last time Aetna Silverscript came in with the best price for us - $6.60/m.

[Barbaraok]

Also get one of the prescription plans like Good Rx, sometimes that can be cheaper than your insurance.  

[Blues]

Thanks for starting this thread, GlennWest.  I'll be eligible for Medicare in a few months and, like you, don't have any prescriptions.  I've read a lot of discussions about Medicare but never knew about the penalty that comes from not signing up for Part D from the beginning.  I probably would have signed up for it anyway, but it's good to know the long-term ramifications if I decided not to.

I also thought getting a supplement was pretty much a given, but now I find out it's not, especially for a person like me who rarely goes to the doctor.  I'd like to be one of those Medicare people who never see a bill, but not if it costs me more money. 

Here's what I think, and please correct me where I'm wrong:

Medicare Part A covers hospitalization, and Medicare Part B covers outpatient services.  There's no premium for Part A if you have 40 quarters of eligible employment (most people meet this), and the premium for Part B is $148.50/month for most people. 

Both Part A and Part B have deductibles, which people either pay out of pocket for (like traditional major medical insurance), or buy a supplement (medi-gap) that covers those deductibles (and results in never seeing a bill for services).  The annual deductible for Part B (outpatient services) is $203, apparently regardless of how many doctor visits you have.  That's almost nothing.

The deductible for Part A (hospitalizations) is different because it applies to each hospital stay, and depends on the length of the stay.  For a stay of 60 days or less, the deductible is only $1,484 total.  But after 60 days, it jumps significantly, to $371 per day for days 61-90, and even more after that.  Is that what most people who get a supplement are insuring against (assuming they think about it at all, and don't just do it because everybody thinks you should, or because a salesman talks them into it)?  I don't think I'd insure against a $203 Part B deductible, or even a $1,484 Part A deductible, but things get much more interesting at $12,500 for a 90-day stay.

https://www.cms.gov/newsroom/fact-sheets/2021-medicare-parts-b-premiums-and-deductibles

Then there are Medicare Advantage plans, which have their own issues but there are some plans out there that will work for a traveling fulltimer.  For some of these plans, you don't have to pay the $148/month premium, which is enticing for someone who doesn't go to the doctor regularly.

But--I swear I remember that there are some plans out there, and I'm not sure whether it's supplements or Advantage, that you have to medically qualify for.  And I'm remembering some provision that you can try a plan and if you don't like it you can get back on it within a year or something, without having to qualify, but can't remember which type of plan it was.

I don't want to make a mistake by signing up for a certain plan, and inadvertently limiting what I can do in the future.  Like with the Part D--not signing up because I don't currently take any medications, only to find out I'm going to pay a lifetime penalty for that if I do sign up in the future.

So if I don't get a supplement when I first sign up for Medicare, can I get a either a supplement or an Advantage plan during the next open enrollment, no questions asked?  Or if I sign up for a supplement, can I switch to an Advantage plan during the next open enrollment, no questions asked?  Or if I sign up for an Advantage plan, can I switch to a supplement during the next open enrollment, no questions asked? 

It's not unlike getting the Part D coverage--every year, you put in what drugs you take, and it spits out which plan is the cheapest for you.  For people who require very little medical care, you get whatever is cheapest (possibly an Advantage plan that has a nationwide network and a $0 premium) for a year, and see how things go and whether you're going to want more traditional coverage because your health has changed.  But that works only if, like Part D plans, you can just switch, without having to medically qualify.

Edited October 15, 2021 by Blues

[Barbaraok]

You can get a supplement at any time.  If I paid premiums for a supplement (retirement package) then I wouldn't because I have very little beyond what Medicare pays - just yearly visits with ophthalmologist, dermatologist and internist.   However, for Dave it is several visits a year to his cardiologist, dermatologist, ophthalmologist, internist, nephrologist (kidney doctor) plus outpatients tests every 6 weeks or so for one or more of his aliments.   

With Advantage plans you need to be very careful as there can be problems changing or going back to original, depending upon the plan.   I have a philosophical problem with those plans which is why we wouldn't get one.  But I understand they work for some people.   

The thing with Part D is that a lot of people think they don't need anything for prescriptions because they hardly every take one.  UNTIL suddenly their body lets them know that they are getting old and hits them hard, out of the blue.   My sister thought the same, and then all of a sudden she had medical problems resulting in maintenance meds, and she has to pay a penalty for life because she didn't get enrolled in the cheapest one possible.  I understand the feeling that one doesn't want to pay for something they don't need, but in this case just look upon it the same as any other insurance you pay but don't need - insurance against what might happen.   And believe me that there are a lot of prescriptions that are out of sight without the negotiated prices that big insurance companies can get.  

[Blues]

9 hours ago, Barbaraok said:

You can get a supplement at any time.  

...

With Advantage plans you need to be very careful as there can be problems changing or going back to original, depending upon the plan.

Okay, I found a place that says:

Quote

If you sign up for a Medicare Advantage Plan during this time [first enrollment when turning 65], you can drop that plan at any time during the next 12 months and go back to Original Medicare.

https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf

This must be what I was remembering.  Now I just have to figure out what it means.  Like once you're on an Advantage plan more than a year after you become eligible for Medicare, you can never enroll in Original Medicare? That same document says that during the October 15 - December enrollment period:
 

Quote

You can:

- Change from Original Medicare (with or without a Medicare Prescription Drug Plan) to a Medicare Advantage Plan.

- Change from a Medicare Advantage Plan back to Original Medicare (with or without a Medicare drug plan).

And from January 1 - March 31 (Medicare Advantage open enrollment):
 

Quote

You can:

- Disenroll from your Medicare Advantage Plan and return to Original Medicare.

So you can go from Advantage to Original, but it says "back to Original Medicare" and "return to Original Medicare," which to me means you have to have been on Original Medicare at some point, if you're going back it or returning to it.  So if you sign up for an Advantage plan when you first enroll, you can't "go back" to Original Medicare because you were never on it.

However, in the part I quoted for initial enrollment, it says "go back to Original Medicare," but a person who signs up for an Advantage plan as his initial enrollment won't ever have been on Original Medicare, so in this case, the "go back" can't mean what "go back" usually means, and maybe it doesn't mean what it usually means in the other examples, either, even though it would be possible to require a person to have been on Original Medicare at some point in order to leave an Advantage plan.

This is what I'm talking about when I respond to people who cry, "Medicare for all!" with "Watch out what you ask for."

 

9 hours ago, Barbaraok said:

If I paid premiums for a supplement (retirement package) then I wouldn't because I have very little beyond what Medicare pays - just yearly visits with ophthalmologist, dermatologist and internist.   However, for Dave it is several visits a year to his cardiologist, dermatologist, ophthalmologist, internist, nephrologist (kidney doctor) plus outpatients tests every 6 weeks or so for one or more of his aliments.  

Wouldn't all of Dave's doctor visits be covered by the $203 Part B annual deductible?  And isn't testing covered by Part B, and at most subject to the $203 annual deductible?  So he wouldn't be out of pocket for any more than anybody else as long as he stays out of the hospital, even though he goes to the doctor and gets tests all the time.  Or am I misunderstanding the Part B deductible?

Edited October 16, 2021 by Blues

[Jaydrvr]

1 hour ago, Blues said:

Okay, I found a place that says:

https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf

This must be what I was remembering.  Now I just have to figure out what it means.  Like once you're on an Advantage plan more than a year after you become eligible for Medicare, you can never enroll in Original Medicare? That same document says that during the October 15 - December enrollment period:
 

And from January 1 - March 31 (Medicare Advantage open enrollment):
 

 

So you can go from Advantage to Original, but it says "back to Original Medicare" and "return to Original Medicare," which to me means you have to have been on Original Medicare at some point, if you're going back it or returning to it.  So if you sign up for an Advantage plan when you first enroll, you can't "go back" to Original Medicare because you were never on it.

However, in the part I quoted for initial enrollment, it says "go back to Original Medicare," but a person who signs up for an Advantage plan as his initial enrollment won't ever have been on Original Medicare, so in this case, the "go back" can't mean what "go back" usually means, and maybe it doesn't mean what it usually means in the other examples, either, even though it would be possible to require a person to have been on Original Medicare at some point in order to leave an Advantage plan.

This is what I'm talking about when I respond to people who cry, "Medicare for all!" with "Watch out what you ask for."

 

Wouldn't all of Dave's doctor visits be covered by the $203 Part B annual deductible?  And isn't testing covered by Part B, and at most subject to the $203 annual deductible?  So he wouldn't be out of pocket for any more than anybody else as long as he stays out of the hospital, even though he goes to the doctor and gets tests all the time.  Or am I misunderstanding the Part B deductible?

You've done a quite thorough job of navigating the Medicare maze. Well done! It's difficult to understand at best. Couple things.. Medicare itself is the default form of insurance. Should something screw up between the annual election periods, you default back to Original Medicare, which happen to us one time when I messed up my late wife's Medicare Advantage. You don't "qualify" in any way for an Advantage plan, but you do for your typical Supplement, as I understand it. Finally, the Medicare charges for days 61-90 are one of the most compelling reasons we've always used an Advantage Plan. We've been very happy with that. Jay

Edited October 15, 2021 by Jaydrvr
Typo

[Jaydrvr]

1 hour ago, Barbaraok said:

With Advantage plans you need to be very careful as there can be problems changing or going back to original, depending upon the plan.   I have a philosophical problem with those plans which is why we wouldn't get one.  But I understand they work for some people.   

This is quite inaccurate. There's absolutely nothing to be careful about. There are dozens of Advantage Plans available (disclaimer, I'm looking in FL), so many that it's difficult to navigate them all. If there's a hiccup and you default back to Original Medicare, you simply pick a new Advantage Plan in your next open enrollment period. There are no restrictions to changing back and forth between Medicare and Advantage, other than the yearly enrollment calendar. I've personally done it and also discussed it with Medicare personnel. Jay

Edited October 15, 2021 by Jaydrvr
Typo

[Barbaraok]

1 hour ago, Blues said:

Wouldn't all of Dave's doctor visits be covered by the $203 Part B annual deductible?  And isn't testing covered by Part B, and at most subject to the $203 annual deductible?  So he wouldn't be out of pocket for any more than anybody else as long as he stays out of the hospital, even though he goes to the doctor and gets tests all the time.  Or am I misunderstanding the Part B deductible?

Remember in addition to the Annual Deductable, Medicare only pays 80% of each visit, test, etc.  now that is 80% of what Medicare says is a fair charge, not what they bill.  Your supplemental then pays that 20%.  

[Jaydrvr]

59 minutes ago, Barbaraok said:

Remember in addition to the Annual Deductable, Medicare only pays 80% of each visit, test, etc.  now that is 80% of what Medicare says is a fair charge, not what they bill.  Your supplemental then pays that 20%.  

This is true and yet another thing to consider. However, my experience, from a single source, (me),  is that the 20% portion of the bills are very modest and reasonable. In most cases, they were still much less than the Supplements I priced. An extreme example - a Medicare bill for approximately $1.4m billed out the 20% portion to me at less than $6k, or 0.4% of the actual bill. Very manageable and certainly not shocking at all to me. This may have been the one time where a Supplement would've actually been less. Jay

Edited October 15, 2021 by Jaydrvr

[Barbaraok]

Jay,  Would your premiums have been greater than $500/month for that year?  That’s the question to ask.   And as we age, the number of tests, office visits, outpatient surgeries, etc., can all add up.   So it is a case of doing risk assessment each year.

[Jaydrvr]

3 minutes ago, Barbaraok said:

Jay,  Would your premiums have been greater than $500/month for that year?  That’s the question to ask.   And as we age, the number of tests, office visits, outpatient surgeries, etc., can all add up.   So it is a case of doing risk assessment each year.

Good question, and this is all true. We all have different levels of comfort with risk and need to evaluate that independently. Incidentally, yes, I've (I think??) seen Supplements in the $600 range. Each person needs to calculate the risks and costs for themselves, as Blues has done so well. Jay

[Kirk W]

5 hours ago, Blues said:

But--I swear I remember that there are some plans out there, and I'm not sure whether it's supplements or Advantage, that you have to medically qualify for. 

That is true when you change plans. Pam was on one occasion declined for a change in Medigap coverage. For that reason you make any changes in October/November to take effect Jan. 1, then do not cancel the present coverage until after the new policy has been accepted and approved by the underwriters. 

Not all doctors who accept Medicare are willing to accept Advantage plans. That is one of the reasons that we have stayed with our Medigap, plan G. Our primary care physician does not accept Advantage. 

Edited October 16, 2021 by Kirk W

[Blues]

6 hours ago, Barbaraok said:

Remember in addition to the Annual Deductable, Medicare only pays 80% of each visit, test, etc.  now that is 80% of what Medicare says is a fair charge, not what they bill.  Your supplemental then pays that 20%.  

Well, I can't "remember" it because I didn't know it in the first place.  😀  The website I was looking at (the one I linked to) is about premiums, deductibles, and coinsurance, but didn't mention the 20% coinsurance for Part B at all.  The site discusses the most recent changes in the premiums, deductibles, and coinsurance, and maybe since the 20% coinsurance didn't change they didn't feel the need to mention it, but I think they should have, because you don't know what you don't know.  They could have just had a little thing in there that said the 20% coinsurance for Part B is not changing, which would tip people off that there is a 20% coinsurance for Part B.

Gah. 

[sandsys]

When we turned 65 we got Medicare cards in the mail but we had already signed up for an advantage plan. It took me awhile to find out I should not carry the Medicare card at all--only the one for the advantage plan. Yes, it is all very confusing.

Linda Sand

[2gypsies]

Here's yet another site you may want to investigate.

We are so glad we've had a Medicare supplement.  Honestly, we have never had to pay out-of-pocket for anything, including regular exams, specialists and multiple surgeries.  We don't pay deductibles and we don't need referrals.  We can go to any doctor or medical facility we want if they take Medicare and we've never, in 20 years, came across a doctor that didn't take Medicare.  We didn't have any problems with travel and medical help.

https://www.medicarefaq.com/faqs/medicare-supplement-insurance-worth-cost/

There's a lot to read on the subject.  It IS overwhelming.

[Barbaraok]

1 hour ago, Blues said:

Well, I can't "remember" it because I didn't know it in the first place.  😀  The website I was looking at (the one I linked to) is about premiums, deductibles, and coinsurance, but didn't mention the 20% coinsurance for Part B at all.  The site discusses the most recent changes in the premiums, deductibles, and coinsurance, and maybe since the 20% coinsurance didn't change they didn't feel the need to mention it, but I think they should have, because you don't know what you don't know.  They could have just had a little thing in there that said the 20% coinsurance for Part B is not changing, which would tip people off that there is a 20% coinsurance for Part B.

Gah. 

So you didn’t go to Medicare.gov site and download “Medicare and Me” or something like that?  You really, really, really need to do that and then spend a lot of time going through it!   I knew a lot of stuff because I sorted through it all for my mom and dad when they retired. 

[Kirk W]

The official book of answers from Medicare...             Medicare and You

This book isn't the best reading material but it pretty much covers any questions if you read far enough.  Here is a link to the page that addresses what you pay when you have Medicare coverage:    Listed below are basic costs for people with Medicare.

For Part A, or hospital coverage{

Quote

You pay:

• $1,484 deductible for each benefit period
• Days 1-60: $0 coinsurance for each benefit period
• Days 61-90: $371 coinsurance per day of each benefit period
• Days 91 and beyond: $742 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
• Beyond lifetime reserve days: all costs

For Part B, outpatient coverages:

Quote

The standard Part B premium amount is $148.50 (or higher depending on your income).

Part B deductible $203. After your deductible is met, you typically pay 20% of the Medicare-Approved Amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment (dme)

 

[trostberg]

I went on Medicare last year and found the videos from Boomer Benefits very helpful.  I have worked in healthcare all my life and still learned a few things I did not know.   One thing I also learned this year is that if you have an HSA account, you cannot use that to pay for a supplement.    I have a high deductible G plan which is a low premium and it worked out better for me since the medical expenses before I reach my high deductible can be paid from my HSA account.

[DanZemke]

Glenn,

Like you, I'm blessed with good-health/lucky.

I chose a high-deductible meda-gap plan for each of the 7 years I've been eligible for Medicare.  My average annual premium over those 7 years was about $600.  And my average annual out of pocket cost, for Medicare reimbursable expenses, was about $500.  Total = $1,100 per year.

For me, $1,100/year turned out to be much better than $6,000 a year.

[docj]

2 hours ago, DanZemke said:

For me, $1,100/year turned out to be much better than $6,000 a year.

  I don't know where you got $6,000/yr from but my Plan F supplement now costs me about $3k/yr and, of course, it covers pretty much everything.  So your cost comparison should be more like $1,100/yr compared to $3k/yr.  My Part D AARP prescription plan is ~$350/yr but I don't think that was included in your comparison.

Until this 2021 I would have been ahead if I had used your approach, but this year my knee replacement and subsequent PT would have wiped out a lot of the accrued savings to date.  

Like any insurance policy it's all a matter of how much risk you are willing to handle on your own.  Since the chances are good that one's medical needs will increase with increasing age, I'm content to let Medicare take all the risk.  JMO.

Edited October 18, 2021 by docj

[2gypsies]

3 hours ago, docj said:

  I don't know where you got $6,000/yr from but my Plan F supplement now costs me about $3k/yr and, of course, it covers pretty much everything.  So your cost comparison should be more like $1,100/yr compared to $3k/yr.  My Part D AARP prescription plan is ~$350/yr but I don't think that was included in your comparison.

 

We have a grand-fathered Plan J supplement which is comparable to the current Plan F at $2700/year.  We don't pay co-pays and we've never received a bill for medical procedures/exams even with surgeries.  Our prescription is $84/yr.   

So, yes, $6000 is very high.