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Thread: Medicare

  1. #1
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    Default Medicare

    I turn 65 next spring. I am starting to get all kinds of crap about Medicare. I work, my wife doesn't and turns 64 in 2020. I may retire in 2030. So it all seems premature.

    Must be a lot of scams for so much crap mail. Typical government program.

  2. #2
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    Default Re: Medicare

    You are seriously considering working until you are 76?
    Remarkable!
    It really is quite difficult to build an ugly wooden boat.

    The power of the web: Anyone can post anything on the web
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  3. #3
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    Default Re: Medicare

    Medicare eligibility and when you retire are not connected.
    Steve

    Boats, like whiskey, are all good.
    R.D Culler

  4. #4
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    Default Re: Medicare

    I am 86 and my wife is 84. We both have Medicare, thank God. Don't get me started on the corporate insurance industry.

  5. #5
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    Default Re: Medicare

    I figure by the time I retire my social security, medicare, and 401K benefits will be taxed to the max to help support the rich so I need to work as long as I can. True, I don't have to take Medicare when I am eligible but I have read somewhere that you may pay a penalty if you don't register at 65. Quite confusing so far, need to work on it some more.

  6. #6
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    Default Re: Medicare

    Quote Originally Posted by Dave Gray View Post
    I figure by the time I retire my social security, medicare, and 401K benefits will be taxed to the max to help support the rich so I need to work as long as I can. True, I don't have to take Medicare when I am eligible but I have read somewhere that you may pay a penalty if you don't register at 65. Quite confusing so far, need to work on it some more.
    I'm turning 65 in Feb, and since there is a 3 month window open before your birthday, I'm signing up next month. This way coverage will start on my birthday which only leaves a month between the end of my current Health insurance and the beginning of Medicare.

    I believe the penalty is for part 'B' coverage premium costs, they are permanently higher if you don't sign up when you turn 65.

    This site explains it pretty well National Council on Aging.

  7. #7
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    Default Re: Medicare

    A couple of hours after starting this thread I got email from the company I work for that states I have "Creditable Coverage" and won't have to pay a penalty for not enrolling in Medicare prescription coverage while I am under my current medical plan. Tick that box off!

  8. #8
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    Default Re: Medicare

    Thank you Presidents Eisenhower, Kennedy, and Johnson for pushing it through.
    Вещи меняются 6 ноября.
    سيتم إجراء التاريخ في 6 نوفمبر
    歷史將於11月6日完成
    역사는 11 월 6 일에 만들어 질 것입니다.

  9. #9
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    Default Re: Medicare

    Perhaps President Harris will expand it to include all Americans.

  10. #10
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    Default Re: Medicare

    I’m in the same boat- more complex than it needs be. Have to sign up for A and B, not d if credible coverage. 1% penalty/ month, for life , if you don’t have credible coverage. I’m debating AB and F or G, vs Medicare advantage plans.
    There's a lot of things they didn't tell me when I signed on with this outfit....

  11. #11
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    Default Re: Medicare

    I'm pretty sure I'll do AB and D, but I'll have another look at the Advantage plans. I believe they vary state to state, and all the ones I've seen for AZ, you pay the premium for B plus more for the plan. The complications seem to come in when private HC companies get involved.

  12. #12
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    Default Re: Medicare

    As I read it, the advantage plans may cost you less but it limits your dr options and hospitals- go out of system, you’re not covered. Doesn’t wor for snowbirds.
    There's a lot of things they didn't tell me when I signed on with this outfit....

  13. #13
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    Default Re: Medicare

    The way to go if you have any issues is A+B (traditional Medicare) + a G supplement. With that combination all you will pay beyond premiums is the annual Part B deductible (currently $183). On paper the F supplement looks better than a G since F covers the Part B deductible. However, starting in 2020 there will be no more supplements sold that include the part B deductible although people that already have an F supplement will be able to keep it IF their company continues to offer it. The result of that is that over time starting in 2020 the pool of people with F supplements will get smaller every year so you can expect rather steep premium rises for continuing F policies. If you have a normal work history there is no premium for Part A. The 2018 premium for Part B is $134/mo. A G supplement will cost in the $170-$200 range. Traditional Medicare has no networks except that the provider your see must accept Medicare (most doctors and institutions). You do NOT need referals to see a specialist with Medicare. Traditional Medicare is also good nationwide - it isn't good outside the US although some supplements provide some international coverage. You will also need a Part D drug plan. In general the cheapest plan is normally the way to go since they all offer the same coverage and only differ in their formularies (drugs they cover) and if they have a deductible. So as long as the plan you pick includes coverage for the drugs you take (or will take) your are good to go with pretty much any plan.

    Now lets look at Medicare advantage plans. The look cheaper than A+B with a supplement and they are in terms of premiums. However, they have copays that average about 20% that can add up although there is a cap typically in the $5K-$7K per year range. You can NOT buy a supplement to pay those copays. Their drug plans are the are as any Part D drug plan with substantial copays, particularly for expensive drugs. There is no cap on drug copays. To buy a Medicare Advantage plan you have to pay the Part B premium ($134 in 2018) plus whatever premium the Advantage plan has (from $0 for some HMO plans to $150 or more for PPO plans). Medicare advantage plans are like all private insurance plans with networks of providers. They are also regional. If you go outside your network you may have no coverage except for emergencies (HMO plans) of significantly higher copays (PPO plans). You do need referals to see specialists.

    For reference I have traditional Medicare Parts A and B and pay the $134/mo Part B premium. I also have an F supplement ($198/mo) and the Humana-Walmart Part D plan $20.40/mo. The Humana-Walmart Part D drug plan has a $400 deductible, but that doesn't apply to generics. So my cost is $352.40/mo. However my coverage is 100% for all medical costs. I do have copays for drugs, but they add up to $1/mo. So far this year my medical bills have come to about $225,000 (cancer treatment) and my copay has been $0. Without he supplement my copays would have been around $45,000.

    Incidentally most of the junk you get in the mail is from private insurance companies trying to sell you Advantage plans or supplements.
    Last edited by Todd D; 10-11-2018 at 07:21 PM.

  14. #14
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    Default Re: Medicare

    Good summary.
    There's a lot of things they didn't tell me when I signed on with this outfit....

  15. #15
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    Default Re: Medicare

    Is Part 'G' gap insurance?

  16. #16
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    Default Re: Medicare

    Thanks, that is interesting. So far the only benefit from my company medical coverage, from a financial point of view, is vision, dental, and pharmaceutical, where they pay 75% of non-generic drugs like Eliquis. I could almost not have any insurance at all due to a $3K deductible for my wife and I and end up with less out of pocket except that the plans do keep costs to reasonable amounts instead of whatever a lab or doctor decides to charge. As my daughter found out, that can be pretty expensive.

  17. #17
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    Default Re: Medicare

    Quote Originally Posted by Arizona Bay View Post
    Is Part 'G' gap insurance?
    Yes a Medicare supplement is also called gap or Medigap coverage. A G supplement pays all copays after the $183 Part B deductible. Copays are 20% of the Medicare approved amount for a service. There are no copays for lab work/tests - lab work is covered at 100% by Medicare Part A+B.

  18. #18
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    Default Re: Medicare

    Quote Originally Posted by Dave Gray View Post
    I turn 65 next spring. I am starting to get all kinds of crap about Medicare. I work, my wife doesn't and turns 64 in 2020. I may retire in 2030. So it all seems premature.

    Must be a lot of scams for so much crap mail. Typical government program.
    My guess is that much of the mail you are getting is not from the government but from Medicare Advantage and Part D promoters, all of which are private insurers. They often create their envelopes and enclosures to make it look like they are government mailings, which they aren't. And you don't have to take advantage of any of the government programs ever if you and your wife don't wish to, i.e., Medicare and Social Security.
    If I had a dollar for every girl who found me unattractive, eventually they would find me attractive.

  19. #19
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    Default Re: Medicare

    It should be noted that those mailings can be extremely misleading. We have had a serious uptick in patients in the last year or more that have sworn they have Medicare with a supplemental. When we go look it up, it turns out they have switched to the Medicare Advantage plans. Something, somewhere in all the advertising is making them believe this. It is really hard to see again and again. It seems like it is always United Healthcare.

  20. #20
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    Default Re: Medicare

    If you live in an area with good (and numerous) health care providers and hospitals, and are reasonably healthy, you should take a serious look at Medicare Advantage plans.

    My wife and I have been enrolled in zero premium Medicare Advantage plans for seven years now. So far our annual costs (deductibles, drugs, etc.) have been far, far, far less than the annual costs of Medigap plans. Going over all of our costs (I keep complete records) I estimate that together we have saved roughly $37,000 over the seven years. $37,000 that we would have blown on Medigap plans.

    As an example of service, I had to go to a hospital emergency room two months ago (first time in many years). Total bill $7,780, my total share $80.

    For any out patient surgery we pay a flat $300, that's it. I've had one outpatient surgery in seven years, my wife has had two. The included drug plan is great for us - my wife takes no prescription medicines, I take two, they're both generic one is free, the other is $15 for a 90 day supply. The drug plan is included in the Advantage plan at no additional cost.

    You should know the state of your personal health better than anyone else. You can carefully examine the benefits of every plan (it's a royal pain in the ass to do so, but that's the way it is) and make a reasonable decision based upon your health.

    If you have some unusual health needs, that may steer you away from an Advantage plan. However, for a typical person, the maximal out of pocket costs costs of an Advantage plan are unlikely to be reached in any one year. That $37,000 that we have saved so far can cover our plans $5,500 annual max out of pocket potential costs quite well.

    You study the plans, you get help with this if you need it. Help is free and you can go to several sources until you are satisfied that the help is accurate. I go to a trustworthy agent who provides seminars on every available advantage plan in my county. But I also read the plan literature and formularies. He gets paid by the insurance companies if I sign up with him, but there's no requirement that I have to, I can sign up myself if I want to. Sure it's work, it's just like a job, but the potential savings is your pay.

  21. #21
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    Default Re: Medicare

    Sounds like socialism to me...
    I rather be an American than a Republican.

  22. #22
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    Default Re: Medicare

    The FIRST THING YOU NEED TO KNOW is if you do not enroll in Medicare when you turn 65, it will be much more expensive to do so later. I have a friend who did not, now he cannot afford to

    Supplemental plans are just plain weird, and here's part of why. My friend is still working, so her Medicare is secondary. Her work insurance is primary. I'm retired, so my Medicare is primary, I kept my federal BC, which is secondary.

    You might want to talk to your pharmacist before choosing a supplement.

    I remember having to figure out how much the medication I was taking would cost under different plans, but Dr. is apt to change the medication at any time.

    My advice: Enroll at 65. If you wish to continue working, you may be better off keeping insurance from work if you get insurance from work.

    How which is primary matters: My wife and my friend both go to the same Dr. to get shots for arthritis in some joints. This doctor does NOT participate in my Blue Cross, but he does participate in Medicare. My wife has NO copay, as Medicare is primary and BC pays whatever Medicare does not. Our friend must pay a $40 copay as he's not participating in her primary insurance.

    Welcome to the chaos.
    How do we form a mutiny? Our new captain is navigating poorly.

  23. #23
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    Default Re: Medicare

    Well, 65 in December. Lots of booklets in the mail as others have indicated. I've got an appointment this month to iron out what the providers say and more importantly, what they DO NOT say.

  24. #24
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    Default Re: Medicare

    This is a good thread - and I would advise anyone coming up on this 'anniversary' to start investigating early. John Smith - I'm surprised to hear of a dr. not accepting BCBS - in this area, they're among the best payers - we roll out the red carpet for them!
    There's a lot of things they didn't tell me when I signed on with this outfit....

  25. #25
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    Default Re: Medicare

    Quote Originally Posted by George Jung View Post
    As I read it, the advantage plans may cost you less but it limits your dr options and hospitals- go out of system, you’re not covered. Doesn’t work for snowbirds.
    I enrolled in a Blue Cross / Blue Shield Medicare Advantage program, when I turned 65 and enrolled in Medicare.... and I am very pleased with the results, so far.

    The BCBS offered 3 plan levels, which differed relatively little, just in the cost of co-pays... I picked the middle plan, for $99/month.... which has since dropped to $96/month (when was the last time a health insurance bill actually went DOWN? )

    Of course, being in the Boston area, there are several relatively large health care provider groups, so perhaps it works better here (or in other metropolitan areas) than it might, in rural areas. My PCP, and all of the specialists I see, are all part of Steward Health Care, which also operates the two nearest hospitals, so I'm well-covered, and Steward's 'on-line' facilities work quite well... I can visit one site which can provide me with virtually all of the medical record information I need to access.

    Of course, if I had some serious condition, and felt I needed to see a top specialist in one of the famous Boston hospitals, I'd be able to.... BCBS is accepted by all of them. With BCBS, especially in this area, there are few providers which would be considered 'out of system'.
    "Reason and facts are sacrificed to opinion and myth. Demonstrable falsehoods are circulated and recycled as fact. Narrow minded opinion refuses to be subjected to thought and analysis. Too many now subject events to a prefabricated set of interpretations, usually provided by a biased media source. The myth is more comfortable than the often difficult search for truth."







  26. #26
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    Default Re: Medicare

    Incidentally:

    One pleasant surprise, in the BCBS Medicare Advantage plan: some prescription drugs are 'free', i.e., no co-pay required. I take both a calcium channel blocker, as well as a beta blocker, for my blood pressure (and the combination works exceptionally well... my BP is VERY good, with no side effects). In my plan, I get these 'free'.

    Most other drugs call for a $5 co-pay... none of the medications I regularly take, cost more than that.
    "Reason and facts are sacrificed to opinion and myth. Demonstrable falsehoods are circulated and recycled as fact. Narrow minded opinion refuses to be subjected to thought and analysis. Too many now subject events to a prefabricated set of interpretations, usually provided by a biased media source. The myth is more comfortable than the often difficult search for truth."







  27. #27
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    Default Re: Medicare

    Some good resources: https://www.amazon.com/Get-Whats-You...words=medicare

    I haven't looked at this one, but looks promising: https://www.amazon.com/Medicare-Clea...medicare&psc=1

    and it's free with Kindle Unlimited

    And there's always this: https://www.amazon.com/Medicare-Dumm...words=medicare


    I suspect my best option is visiting with an insurance agent. Lot's of potential 'mistakes', some of which cannot be corrected.
    There's a lot of things they didn't tell me when I signed on with this outfit....

  28. #28
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    Default Re: Medicare

    I'm shocked! Shocked! that you'd have investigated all your options, Norman!

    Sounds like you've got a good one.
    There's a lot of things they didn't tell me when I signed on with this outfit....

  29. #29
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    Default Re: Medicare

    Quote Originally Posted by George Jung View Post
    I'm shocked! Shocked! that you'd have investigated all your options, Norman!
    I can't take the credit... most of what I learned came from a couple of folks who investigated Medicare extensively, before I became eligible, so I leveraged off of their research.

    Quote Originally Posted by George Jung View Post
    Sounds like you've got a good one.
    So far, yes, it's worked out quite well.

    Interestingly, my enrollment in Medicare seems to have coincided with my PCP's decision to send me off to see no fewer than 4 different specialists... nothing serious for any of them, just minor stuff, and I'm doing fine, but it seems I'm forever seeing one of them. I guess, at age 67, many men will see a cardiologist regularly. I am having a stress test and echo-cardiogram once per year now, just to make sure all is OK.
    "Reason and facts are sacrificed to opinion and myth. Demonstrable falsehoods are circulated and recycled as fact. Narrow minded opinion refuses to be subjected to thought and analysis. Too many now subject events to a prefabricated set of interpretations, usually provided by a biased media source. The myth is more comfortable than the often difficult search for truth."







  30. #30
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    Default Re: Medicare

    As I said earlier, if you have a continuing health issue then traditional Medicare (Parts A and B) with a supplement and a Part D drug plan is the way to go. In my case, with an incurable leukemia I will have high medical bills for the rest of my life and will have years when my bills are very high. So I can expect to hit the copay limit on a Medicare Advantage plan every year. Thus for me the somewhat higher cost per month of Parts A, B and D plus an F supplement is a better deal. I also like the lack of required referrals and the fact that if I feel like it I can get my care at a major cancer center anywhere in the US at no extra cost.

    Incidentally Norm should have pointed out that he is also paying the Part B premium. Finally my copays for the two generic drugs I take are $1 each per month through my Part D plan not the high $5 a month Norman pays Heck, even if I bought my drugs without insurance they would only cost $4 each per month. I am OK with the Part-D premium because there is an very good chance that I will ultimately end up on a VERY expensive prescription drug - i.e. - $10,000-$13,000 per month cost that my insurance will pay around 95% of.

    Finally, I want to make a point about insurance. I view insurance as a safety net for high medical bills in the event of a serious medical problem. Routine medical expenses are not a problem from my perspective, but a serious issue or injury can cost hundreds of thousands of dollars. My cancer treatment this year is an example - $200K+ that insurance covered. In my case the problem already existed when I started Medicare, but that may not be the case for many people. Given what having insurance saved me this year alone, my insurance costs for the rest of my life have already been covered.
    Last edited by Todd D; 10-12-2018 at 09:18 AM.

  31. #31
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    Default Re: Medicare

    Quote Originally Posted by Todd D View Post
    Incidentally Norm should have pointed out that he is also paying the Part B premium.
    Yes, that is absolutely true. It doesn't really 'feel' like it, though, because it's deducted from my Social Security payment, so I never see the bill.
    "Reason and facts are sacrificed to opinion and myth. Demonstrable falsehoods are circulated and recycled as fact. Narrow minded opinion refuses to be subjected to thought and analysis. Too many now subject events to a prefabricated set of interpretations, usually provided by a biased media source. The myth is more comfortable than the often difficult search for truth."







  32. #32
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    Default Re: Medicare

    Norman, your Medicare Advantage plan is working for you, and don't forget, if there are any 5 star rated plans in your area that might be better, you can transfer to them at any time. No open enrollment period required for a 5 star plan. It's nice to keep this in mind if any non immediate, serious health problems occur.

  33. #33
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    Default Re: Medicare

    Good thread, now I need to go back and re-evaluate

    Basic question:

    What is the difference between Prefered Cost Sharing and Standard Cost Sharing, regarding drugs?

  34. #34
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    Default Re: Medicare

    Quote Originally Posted by Dave Wright View Post
    Norman, your Medicare Advantage plan is working for you, and don't forget, if there are any 5 star rated plans in your area that might be better, you can transfer to them at any time. No open enrollment period required for a 5 star plan. It's nice to keep this in mind if any non immediate, serious health problems occur.
    That's good to know, although I don't see why my existing plan wouldn't be fully satisfactory. If, God forbid, I developed something very serious, all the top hospitals in the Boston area accept BCBS coverage. Some of the best specialists and hospitals in the nation are only 30 miles way from me.
    "Reason and facts are sacrificed to opinion and myth. Demonstrable falsehoods are circulated and recycled as fact. Narrow minded opinion refuses to be subjected to thought and analysis. Too many now subject events to a prefabricated set of interpretations, usually provided by a biased media source. The myth is more comfortable than the often difficult search for truth."







  35. #35
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    Default Re: Medicare

    Gee when I retire nothing changes, same doctors, same coverage, same non premium or copayment, no brochures to read and no right or wrong decisions to make. Yay single payer healthcare, you guys should try it.

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