Signing up for Medicare: very confused

Saph

New member
I am 3 months away from my 65th b'day.

I know I have to sign up for Medicare and I just did. But here starts the confusion.

I signed up for Medicare and then said I want plan B (was that correct?). But I also know that I should have additional insurance as Medicare doesn't cover everything. So I should have Medicare advantage plan? Right? Plus maybe dental and vision? When do I sign up for those? Now (as of the month I turn 65) or later? When?

Is there a place where I can ask those questions? Our SS office is often clueless, can't explain anything clearly (this is from prior experience of others). I would seat in line for hours if I knew I could rely on info provided, but that is often not the case.

Guidance would be appreciated. Thanks
 

mathjak107

Well-known member
I am 3 months away from my 65th b'day.

I know I have to sign up for Medicare and I just did. But here starts the confusion.

I signed up for Medicare and then said I want plan B (was that correct?). But I also know that I should have additional insurance as Medicare doesn't cover everything. So I should have Medicare advantage plan? Right? Plus maybe dental and vision? When do I sign up for those? Now (as of the month I turn 65) or later? When?

Is there a place where I can ask those questions? Our SS office is often clueless, can't explain anything clearly (this is from prior experience of others). I would seat in line for hours if I knew I could rely on info provided, but that is often not the case.

Guidance would be appreciated. Thanks

you are confused for sure .


You need to evaluate these four criteria -
  1. your health
  2. your need/desire for doctor/provider flexibility
  3. your ability to pay Medigap (and Part D) premiums
  4. carrier reliability (especially true for Advantage and some Part D plans)
If you have a lot of chronic health issues or foresee serious issues - and can afford it - then a Medigap G or F - provides the most flexible, worry-free, and trouble-free choice. You can see any provider anywhere in the country who accepts Medicare, no gatekeepers on treatment approval, no provider networks. Bills go to Medicare and your Medigap.

Generally, with a Medigap F/G, your Medicare-approved expenses will be paid 100%. For the most part, medical expenses are pretty much limited to Medigap premium (and Part D premium and copays if you take medication).

There are less expensive (premium) cost-sharing Medigap plans available, as well, but often these prove to be a false economy when managing chronic illness or worse. Copays and hospital deductibles can eat up any premium savings in short order.

If you are reasonably healthy and can afford some premium and the very low 20% not paid by Medicare the few times you doctor - then a high-deductible Medigap F, which, again, provides the most provider flexibility and caps your annual max out-of-pocket (your 20%) at $2,180, worst case scenario, all at one-half to one-third the cost of a regular Medigap F. Bills go to Medicare and your Medigap. Medicare pays its 80%, you pay 20% up to a maximum of $2,180. Thereafter, the Medigap pays 100%.

If you're healthy, over a period of years, you'll probably be much further ahead financially with an hd-F. (If you haven't done so, as yet, strongly recommend you read this: Help - In Texas: Thinking Original Medicare and hi-D Plan F - thoughts?

If you are cost-conscious, then an Advantage (aka Medicare health plan) (if you're healthy - or, even if you're sick - depending on plan) can be an appropriate choice, as it bundles docs and drugs, for a low or zero premium. Pay close attention to:
  1. copays and max out-of-pockets, especially if you're sick or anticipate health issues.
  2. restricted networks - an issue if you need specialty care or if you travel a lot.
  3. drug formulary (tiers and copays).
For the chronically ill, annual Advantage copays could exceed twice the cost of a Medigap F, as max out-of-pockets can be set at $5-$7k, or more.

If you travel a lot or snowbird, unless it is a PPO with out-of-network coverage, Advantage is not an appropriate choice.

If you choose Advantage, know that you are divorcing yourself from Medicare and putting the decisions for treatments, benefits, and payment in the hands of the PRIVATE (this means for-profit) Advantage insurer. Some are good actors, others are not. Common bad behaviors by MA's are denials of mandated Medicare benefits, onerous oversight on long-term therapies and preapprovals, etc., slow pays, denials they've received the provider claims, customer-service run-around, and more.

Check with network providers and providers' billing people on ease of use, timely payment, preapprovals, insistence on use of generic drugs, verify with the provider that provider is, in fact, in that network - insurance reps and websites often are wrong - and talk to people you know who have the same plan.

Unless you are in a guaranteed issue state, know that once past the Initial Open Enrollment, you will not be able to switch to a Medigap without undergoing health underwriting, although you can move from one Advantage plan to another Advantage plan during Annual Open Enrollment.

So, choose carefully, because there may not be a do-over if you decide later you prefer a Medigap.
 

Saph

New member
Original Poster
Thank you @mathjak107 .

I appreciate the answer but I am still in the very beginning stages. I am not sure if I should or should not have signed up for Part B. I am not sure when to sign up for advantage/F/G or any other letter of the alphabet. The very, very basic stuff.

As I said. Confused
 
Thank you @mathjak107 .

I appreciate the answer but I am still in the very beginning stages. I am not sure if I should or should not have signed up for Part B. I am not sure when to sign up for advantage/F/G or any other letter of the alphabet. The very, very basic stuff.

As I said. Confused
Definately sign up for part B. Unless you are in a very high income bracket you will only pay $135.50 a month. That represents 25% of what the total premium is. The government pays the other 75% or $406.50. So you get $542 a month worth of coverage for $135.50. That's a pretty good deal if you ask me.

And don't delay signing up for it. Every year you delay will cost you an extra 10% penalty added to your premium.
 

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mathjak107

Well-known member
Thank you @mathjak107 .

I appreciate the answer but I am still in the very beginning stages. I am not sure if I should or should not have signed up for Part B. I am not sure when to sign up for advantage/F/G or any other letter of the alphabet. The very, very basic stuff.

As I said. Confused

Medicare is handled by the government.....medigap supplements are handled by insurance companies not Medicare ....advantage plans are something very different... insurers sell equals
Definately sign up for part B. Unless you are in a very high income bracket you will only pay $135.50 a month. That represents 25% of what the total premium is. The government pays the other 75% or $406.50. So you get $542 a month worth of coverage for $135.50. That's a pretty good deal if you ask me.
Actually what you pay is linked to your income ... the highest level pays 595.00 for coverage .

While not many have incomes that high , selling an asset can get you that high .

 

mathjak107

Well-known member
Govt Medicare consists of part A which is free if you paid in enough from working ... that covers mostly hospital care .....part b we pay for and covers mostly out patient stuff and doctors .

Then you may need a part d drug plan ....... but Medicare only covers 80% of the charges and has lots of other expenses so a medigap plan is bought from an insurer to cover the gaps .

A cheaper option but in my opinion not better option is to buy a private insurers packaged plan called an advantage plan ....they are supposed to cover what Medicare does but they can basically do as they like as your gate keeper ....you can’t prove what Medicare would have covered in your case since you don’t have Medicare when you have an advantage plan ....you have a private for profit insurer version administrated by them and not , not for profit govt Medicare
 

Butterfly

Well-known member
Govt Medicare consists of part A which is free if you paid in enough from working ... that covers mostly hospital care .....part b we pay for and covers mostly out patient stuff and doctors .

Then you may need a part d drug plan ....... but Medicare only covers 80% of the charges and has lots of other expenses so a medigap plan is bought from an insurer to cover the gaps .

A cheaper option but in my opinion not better option is to buy a private insurers packaged plan called an advantage plan ....they are supposed to cover what Medicare does but they can basically do as they like as your gate keeper ....you can’t prove what Medicare would have covered in your case since you don’t have Medicare when you have an advantage plan ....you have a private for profit insurer version administrated by them and not , not for profit govt Medicare
I always thought advantage plans had to provide benefits as least equal to the ones Medicare provides. Is that not true?
 

fmdog44

Well-known member
Location
Houston, Texas
I am 3 months away from my 65th b'day.

I know I have to sign up for Medicare and I just did. But here starts the confusion.

I signed up for Medicare and then said I want plan B (was that correct?). But I also know that I should have additional insurance as Medicare doesn't cover everything. So I should have Medicare advantage plan? Right? Plus maybe dental and vision? When do I sign up for those? Now (as of the month I turn 65) or later? When?

Is there a place where I can ask those questions? Our SS office is often clueless, can't explain anything clearly (this is from prior experience of others). I would seat in line for hours if I knew I could rely on info provided, but that is often not the case.

Guidance would be appreciated. Thanks
If you don't belong to AARP sign up and you can get a lot of free info from them. Don't do anything until you have researched it.
 

mathjak107

Well-known member
I always thought advantage plans had to provide benefits as least equal to the ones Medicare provides. Is that not true?
saying you are providing the same basic benefits vs actually paying for a certain treatment procedure or path are two different things . they can deny certain procedures because they want to .

a friend experienced the differences between a for profit insurer vs not for profit gov't medicare when she had pituitary gland cancer discovered .

she bragged for years how little her advantage plan cost her compared to medicare and a supplement .

well she had one half of the pituitary gland turn cancerous and the other side was not in good shape either . the surgeon and her doctors wanted both halves of the gland removed .. her for profit insurer said no , only the cancerous side can be removed , the other half has to wait until it turns cancerous also ...her doctors argued that is nuts , medicare ALWAYS pays to remove both halves ... the insurer said they are not paying for both sides and you can't say what medicare would have paid for in this case .. you don't have medicare to be able to compare so they gotcha.

nothing is ever a problem--until its a problem . but like any for profit hmo your fate is in their hands because they are your gate keeper .. not for profit gov't medicare can be much more liberal in what they approve .

so it is not a case of covering the same basic components . there can be a difference in what your advantage plan allows as far as treatment because they have the last say and without having medicare too you can never say what medicare would have done in your instance . .

you can't have both gov't medicare and an advantage plan so they have you over a barrel
 
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Saph

New member
Original Poster
Thank you for such an informative discussion. I am not in danger of paying any more than $135 as DH is retired and I haven't worked since age 61 by design. I have a small pension and that is my only income right now. DH is receiving Social Security plus small income from investments. We don't need much and are both fairly healthy.

Now I need to go and read up on all the alphabet letters (F, D, G, N, etc) and see what they are.

one question, I read that Plan F is going away as an option next year. Can someone who is currently on one of the Advantage plans change to F for next year? or is he SOL on that. talking about DH.

Thank you all for your help.
 

mathjak107

Well-known member
Thank you for such an informative discussion. I am not in danger of paying any more than $135 as DH is retired and I haven't worked since age 61 by design. I have a small pension and that is my only income right now. DH is receiving Social Security plus small income from investments. We don't need much and are both fairly healthy.

Now I need to go and read up on all the alphabet letters (F, D, G, N, etc) and see what they are.

one question, I read that Plan F is going away as an option next year. Can someone who is currently on one of the Advantage plans change to F for next year? or is he SOL on that. talking about DH.

Thank you all for your help.
It depends on your state , and your health
 

Olivia

Well-known member
Location
Hawaii
Another thing to consider is locally what insurance do doctors in general accept? I don't think there is a law that makes private doctors take everyone. Some here say they don't accept any new patients, and some take some with a particular insurance coverage. You need to be aware of that. There have been big news headlines here in Hawaii about the huge doctor shortage we have and continue to have. So we need to consider that.
 

Liberty

Well-known member
Location
Texas
New Jersey has medical underwriting if you want to switch plans ...they can deny you.

We pay more in New York but we have no medical underwriting
We have med underwriting in Texas too, and we've switched plans with no problem. Of course they do call you and ask you questions, besides asking or knowing what drugs you may be using and why. But, with that said, we saved money and all they can do is say no, right? So why not try?
 

Ken N Tx

Older than Dirt !
Location
Texas
We have med underwriting in Texas too, and we've switched plans with no problem. Of course they do call you and ask you questions, besides asking or knowing what drugs you may be using and why. But, with that said, we saved money and all they can do is say no, right? So why not try?
I could not switch due to previous med conditions.. :( :(
 
Medicare is handled by the government.....medigap supplements are handled by insurance companies not Medicare ....advantage plans are something very different... insurers sell equals

Actually what you pay is linked to your income ... the highest level pays 595.00 for coverage .

While not many have incomes that high , selling an asset can get you that high .

Actually you are wrong.

The current 2019 Maximum Part B premium is $406.50 not $595.

Neener neener!
 

Liberty

Well-known member
Location
Texas
I am on F and want to switch to G.or another company..Greensky tried to find another company, but no go..
I am on F and want to switch to G.or another company..Greensky tried to find another company, but no go..
Now that's odd...as F and G are the same basic plans, just the deductible is different and the savings are more with G of course, which is why the switch. Do you know, did he try Philadelphia Life? That's what we have.
 


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