New to medicare

[Kirk W]

We are fortunate in that my previous employer supplied our health care coverage until we each reached 65 to get Medicare coverage and then became supplemental, but the passage of the ACA in 2010 the new regulations caused them to shift all retirees who are Medicare eligible into a program of supplying an HSA to pay for supplemental coverage that is purchased on the open market. Fortunately they also contracted for a benefits provider company to supply counselors to retirees to help us through the process of figuring out what is our best plan for the situation we have and the funds available. The amount of money provided us increases each year, because insurance premiums generally increase as your age does. Pretty much everything the counselors do could be done by anyone if you can wade through all of the volumes of information from Medicare, but we have found the counselors to be very helpful and time saving. We are now part of Plan G and have a additional part D policy for drugs. The result is that we pay about $400/month for supplemental coverage, plus the part B and part D deductibles out of pocket and premiums we pay are reimbursed. I feel very fortunate to have retired from the company that I did. 

 

Edited October 18, 2021 by Kirk W

[Blues]

Okay, this is a surprise:  medical underwriting, a/k/a pre-existing condition exclusions.

The over 100-page-long Medicare and You "brochure" doesn't mention underwriting at all, and mentions pre-existing conditions only to say that you can join an Advanage plan even if you have a pre-existing condition, but nothing about pre-existing conditions when it comes to Medigap policies.  Which makes me suspicious.

The merely 50-page-long "Choosing a Medigap Policy" guide says that if you're in your initial Medigap open enrollment period (when you're turning 65), an insurance company can't refuse to sell you a Medigap policy, can't charge you more than they'd charge someone with no health problems, and can't make you wait to start coverage.  Which tells me they CAN do all of those things at any other time.  Denials, rate increases, and exclusions based on pre-existing conditions in insurance for old people. 

The guide says the best time to buy a Medigap policy is during that initial open enrollment period, presumably to take advantage of the one time they can't subject you to medical underwriting.  But how to choose?  The brochure helpfully says, "Think about your current and future health care needs when deciding which benefits you want because you might not be able to switch Medigap policies later."

Who the hell knows what their future health care needs will be? 

People who are healthy and choose high-deductible plans because they don't currently need a lot of health care--have they screwed themselves if/when they do get sick, because they can't change to a plan that works better not only for sick people, but for people who are sick in a particular way? 

I think the whole drug plan thing is ridiculous, where you enter the drugs you're currently taking and pick a plan based on those, even though it's possible that plan will be HORRIBLE for the very expensive drug you're prescribed on March 15th and will be taking for six months.  But at least you CAN change once a year, right?

But it sounds like if you want to go the Original Medicare route plus a Medigap (supplement) policy, you'd better sign up from the beginning, and you'd better sign up for the one you want to keep for the rest of your life because if you get sick and want to change, whatever it is you're sick with can be used to deny you a new policy. 

Please tell me I'm misunderstanding all of this. 

[2gypsies]

32 minutes ago, Blues said:

Please tell me I'm misunderstanding all of this. 

Blues:  Medicare is very helpful on the phone.  Why not give them a call to answer your concerns?

[Kirk W]

8 hours ago, 2gypsies said:

Medicare is very helpful on the phone. 

There are also companies that assist folks in finding the best match which operate in a way very similar to a travel agency, where they are paid by the insurance company and add nothing to the cost. A couple of examples are AON and Via Benefits, but there are several others. There is really nothing that they do which you couldn't do yourself, but they have already done the research and usually are very helpful. 

[docj]

1 hour ago, Kirk W said:

There are also companies that assist folks in finding the best match which operate in a way very similar to a travel agency, where they are paid by the insurance company and add nothing to the cost. A couple of examples are AON and Via Benefits, but there are several others. There is really nothing that they do which you couldn't do yourself, but they have already done the research and usually are very helpful. 

We use Via Benefits through my previous employer.  I just did our plan analysis for 2022; it took less than 30 minutes because all our Rx data had already been on file.  I find using them especially helpful when I want to, for example, change from one Part D carrier to a different one.  The entire process is automated and doesn't involve  me having to look up anything.

[DanZemke]

On 10/17/2021 at 8:50 PM, 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.

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.

docj,
 
Fair point about the $6000 /yr.  I sourced that $500 a month cost from a prior post in this thread.  My Plan D cost was included in my $1,100 a year.  I continue to buy the least expensive Plan D I can, and have never submitted a Plan D claim.  I currently subscribe solely to avoid penalties. Yes, I'm lucky, health-wise, but Glenn professes to also be lucky in this regard.
 
"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."

I don't understand why, that would have been the case.  For 2021, the Plan F and Plan G High Deductibles were $2370 per year.  My cost for my HD Plan G was $594 for 2021. $2370 + 594 = $2964.  After paying the deductible, we have the exact same coverage.  It appears we would also have had about the same out of pocket cost too. 

I've had a HD plan for all of the 7 years that I've been eligible for Medicare.  My average out-of-pocket cost for medical expenses and a High Deductible Medicare Supplement plan has been about $800 a year.  When this year is over, I expect my 7 year savings, over a plan that costs $3000 a year, to be about $15K.

Here's a simple table from Connecticut.  I'm linking to it because it's concise, and I'm familiar with it.  I consider it to be a representative example of Medicare Supplement prices.

https://portal.ct.gov/-/media/CID/1_LifeHealth/Medicare_Supplement_Insurance_Rates.pdf

BTW, my former employer (IBM) also outsourced Medicare help/processing to Via Benefits.  Since I don't have any medical issues, or needs, I'm ambivalent about them.  That's not intended to disparage them, just citing that their current services are not useful to me.  Every year, I've signed up for a HD plan, that is much less expensive than any they offer.

Edited October 21, 2021 by DanZemke
Clarity

[lappir]

Lot's of info to review. I have read most and almost thought the cost for Medicare would be near what I'm currently paying for BC/BS, but then I reread the info. 

I have been very healthy for the majority of life, but recently was told I have a huge risk for an event due to a high cholesterol and some mild hypertension. I didn't do well with Statin drugs many years ago and only recently had the elevated blood pressure on subsequent visits to my health care provider. I'm also a health care provider and you know what they say about nurses who are patients.....

I'm trying not to be that nurse/patient, but it's hard. 

I was able to sign up for the Medicare card last week and in a few weeks I will check with my mail box to see if the info has arrived. At first I thought why have all the stuff included with the card sent, but it might have important info in it. I'd rather they send the card with a link to an on line source for information that is able to be updated as needed and not forms that may be from 1999 (exaggeration). 

I won't be taking Social Security until forced to. My plan is to keep working and seeing the USA. 

 

Rod

 

[Kirk W]

4 hours ago, lappir said:

I won't be taking Social Security until forced to. My plan is to keep working and seeing the USA. 

As far as I am able to find, there is no age at which it is mandatory to start taking Social Security payments but at age 70 your SS benefits stop increasing and there is nothing gained by not getting it. You do not have to be receiving SS in order to get Medicare and probably should unless you have employer provided health insurance. 

[2gypsies]

10 hours ago, lappir said:

I won't be taking Social Security until forced to. My plan is to keep working and seeing the USA. 

 

Here's a good explanation:  https://www.ssa.gov/benefits/retirement/planner/1943-delay.html

[Blues]

On 10/20/2021 at 4:15 PM, DanZemke said:

Here's a simple table from Connecticut.  I'm linking to it because it's concise, and I'm familiar with it.  I consider it to be a representative example of Medicare Supplement prices.

https://portal.ct.gov/-/media/CID/1_LifeHealth/Medicare_Supplement_Insurance_Rates.pdf

Look at the Colonial Penn plans on that site.  The premium for Plan A (why oh why do they use letters for plans when they were already using letters for the parts of Medicare????) is $1,519.42 per month, which is $18,000 per year.  Why would someone choose get that instead of that same company's high deductible Plan G, where the premium is $66 per month and there's a deductible of $2,370, and once that deductible is met, the plan pays 100% of "covered services" for the rest of the year?  Is the "covered services" a gotcha?  Seems to me the total exposure of the high-deductible Plan G is $3,162 per year ($792 in premiums plus $2,370 in deductible), compared to $18,000 per year for the Plan A (assuming the premium is all you have to pay).

Or for that matter, Colonial Penn has two types of Plan G--regular and high deductible.  The regular Plan G is $630 per month.  A year's worth of premiums is $7,560, while the high deductible version of that plan is $3,162 for a year's worth of premiums plus the deductible, after which the plan pays 100%.  Why choose the non-high deductible version? 

And if plans are standardized, why are the premiums so different?  For Plan A, they range from $204.17 up to $1,519.42, depending on the company. 

[docj]

35 minutes ago, Blues said:

And if plans are standardized, why are the premiums so different?  For Plan A, they range from $204.17 up to $1,519.42, depending on the company. 

Some plans are community rated, some are based on your current age.   The Connecticut table doesn't appear to have a reference age which makes me question its value in helping you make a selection.  

[DanZemke]

2 hours ago, Blues said:

Look at the Colonial Penn plans on that site.  The premium for Plan A (why oh why do they use letters for plans when they were already using letters for the parts of Medicare????) is $1,519.42 per month, which is $18,000 per year.  Why would someone choose get that instead of that same company's high deductible Plan G, where the premium is $66 per month and there's a deductible of $2,370, and once that deductible is met, the plan pays 100% of "covered services" for the rest of the year?  Is the "covered services" a gotcha?  Seems to me the total exposure of the high-deductible Plan G is $3,162 per year ($792 in premiums plus $2,370 in deductible), compared to $18,000 per year for the Plan A (assuming the premium is all you have to pay).

Or for that matter, Colonial Penn has two types of Plan G--regular and high deductible.  The regular Plan G is $630 per month.  A year's worth of premiums is $7,560, while the high deductible version of that plan is $3,162 for a year's worth of premiums plus the deductible, after which the plan pays 100%.  Why choose the non-high deductible version? 

And if plans are standardized, why are the premiums so different?  For Plan A, they range from $204.17 up to $1,519.42, depending on the company. 

You missed the foot note about Plans A, B and C : "Plans for Disabled - All companies must offer Plans A.  If a company also offers Plan(s) B and/or C, then it must also offer the plan(s) to disabled Medicare beneficiaries. However, Plan C is only available to disabled.

The Plans are standardized.  The reason for the difference in premiums for Medicare Supplements, is principally due to marketing costs and profit goals.   Some plans spend lots of money on marketing, which must recovered in the premiums.  The coverage of every Medicare Supplement Plan F and G is identical.

[DanZemke]

2 hours ago, docj said:

Some plans are community rated, some are based on your current age.   The Connecticut table doesn't appear to have a reference age which makes me question its value in helping you make a selection.  

That was my initial impression too.  But when I compared policy prices for ages much older than me the cost-effectiveness stayed about the same.  High price plans remained high-priced for folks 20 years older.

[2gypsies]

Here's why there are different costs for Medicare Supplements among different companies:

https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap/medigap-costs/costs-of-medigap-policies

[docj]

5 hours ago, DanZemke said:

But when I compared policy prices for ages much older than me the cost-effectiveness stayed about the same.  High price plans remained high-priced for folks 20 years older.

I don't disagree with your conclusion.  What I was saying is that the CT table is misleading because it cites prices for plans without noting that the prices can change significantly depending on a person's age.  It's not clear to me why someone would issue a table relating to an age-dependent premium without at least noting that the premiums quoted were for a person of a specific age and gender.  

[Blues]

7 hours ago, DanZemke said:

You missed the foot note about Plans A, B and C : "Plans for Disabled - All companies must offer Plans A.  If a company also offers Plan(s) B and/or C, then it must also offer the plan(s) to disabled Medicare beneficiaries. However, Plan C is only available to disabled.

I did see that footnote.  Are you thinking it means that Plan A is only for the disabled (i.e. people who aren't yet 65 but qualify for Medicare because they're disabled)? 

I don't think that's the case.  A government Medicare website says:

Quote

Medicare Supplement Plan A is the most basic of the standardized, lettered Medicare Supplement plans. It usually includes only those benefits listed above.

From there, the benefits in the 10 standard Medicare Supplement plans vary a bit more.

https://medicare.com/medicare-supplement/what-is-medicare-supplemental-insurance/

I think the "Plans for Disabled" footnote you quoted is describing which plans must be made available to the disabled, and not plans that are available only to the disabled.  It says that all companies must offer a Plan A, and the Plan A they offer must be available to people over 65 as well as people who qualify because of their disability and not their age. 

Companies can choose to offer a Plan B and/or a Plan C.  They don't have to offer a Plan B or a Plan C (unlike Plan A, which they are required to offer), but any Plan B or Plan C they choose to offer must be made available to people who qualify for Medicare because of their disability, and can't be restricted to people who are 65 and over.

And you cut off the last part of the footnote.  It's not "However, Plan C is only available to disabled."  It's "However, Plan C is only available to disabled individuals who become eligible for Medicare prior to 1/1/20."  That's not really necessary, because the chart has a section called "Only available to those eligible for Medicare prior to 2020," and Plan C is in that section.  So it applies to everyone who has Plan C, whether eligible for Medicare because of age or disability.  I'm guessing since they had a footnote talking about which plans are available for the disabled, they figured they'd put this qualification in there for the sake of completeness.

[Blues]

1 hour ago, docj said:

I don't disagree with your conclusion.  What I was saying is that the CT table is misleading because it cites prices for plans without noting that the prices can change significantly depending on a person's age.  It's not clear to me why someone would issue a table relating to an age-dependent premium without at least noting that the premiums quoted were for a person of a specific age and gender.  

But are all of Connecticut's premiums age-dependent?  Because if a policy's premium is community rated, the premium is the same for everyone, regardless of age, and won't go up because of your age.  Of course, it can still go up "because of inflation and other factors," which kind of puts it in the same field as the advice to predict your future healthcare needs when picking a plan you may not be able to change.  But at a given moment in time, everybody is paying the same premium regardless of age. 

I'm guessing it changes every year as the mix of people in the plan changes, but that's not really clear.  Is that one of the "other factors" that can affect the premium?

And for the record, there are also "issue-age-rated" policies, which vary depending on the age you were when you first got the policy and don't go up as you age (but can still go up "because of inflation and other factors").  And we have "attained-age-rated" premiums, which do depend on your age, and may start out cheap but will go up as you get older (in addition to going up "because of inflation and other factors"). 

Do people actually know how the premium for the supplement they choose is set?  Because I think it would be important to know if your premium is going to change as you get older (as most people would expect), or it's actually not going to change (issue-age-rated), or any change will be dependent on the general health of the people in their area. 

[DanZemke]

17 hours ago, docj said:

What I was saying is that the CT table is misleading because it cites prices for plans without noting that the prices can change significantly depending on a person's age.

docj,

You're right, I forgot that most States don't have two of the benefits that my State (Connecticut) provides.  Although Medicare Supplement Plan coverage is identical across all States, purchase terms vary.  Blues was correct. All CT Medicare supplements are "community-rated".  As I understand this, identical, or similar, rules apply for residents of Arkansas, Massachusetts, Maine, Minnesota, New York, Vermont and Washington.  

The other benefit I enjoy, is that I can freely change Medicare Supplement Plans once a year. without any penalty or requirement for underwriting.  New York residents enjoy a similar privilege.

Why do some states have these privileges and others do not?  I don't know, but I suspect it was part of the horse-trading required to pass the original, or perhaps a lfollow-on, Medicare bill.

And of course, what I've described as a privilege, probably raises the cost of all Supplements for me.  That, and the fact that the cost of living in CT is much higher, on average that Texas.

[DanZemke]

Blues,

The two most popular Medicare Supplement Plans are F and G.  Both provide coverage for in-hospital and doctor visits.  So Plan A and B supplements seem to have substantial overlaps with Plans F and G.  I don't remember doing any research on A and B supplements.  I suspect I went with the wisdom of crowds.