health care for seniors?

[Rob Base 2.0]

So my mommy made it to 72, but she got let go from job last week due to company merger. She should get unemployment. i have been uninvolved with her financial situation because she usually never listens anyway (unless in dire straights). So i havent really looked st medicare snd whatever.

i know she got healthcare through her work. And they paid thru July.

What options are available for a 72 year old? And what supplemental options should be considered?

i am just trying to research in advance. i don't think she will ask me for any advice for a few months. thx.

[The Walk of the Penguin Mich]

At 72, she is eligible for Medicare.  As Medicare only covers 80%, she will need a supplemental policy (Medigap) and a prescription plan.

What supplemental plans are available for her is dependent upon her county.  However, she needs to take into consideration what doctors she has and if they are on the plan.  For instance, my orthopod takes Medicare, but he is not in the only Medigap plan (an Advantage plan....like an HMO) I have available.  As this doctor is my most important doctor, I do not have a Medigap plan.  As I receive Medicare via disability, I am not eligible for most Medigap plans due to age.  My options would be better if I was 65.

For her prescription plans, again this is county dependent.  She needs to research this, usually taking into account which pharmacies she uses and prescriptions she needs.  I use Well Care, it is ok and accepted by Costco.  It is around $30/mo.

[phil5185]

i know she got healthcare through her work. And they paid thru July.

What options are available for a 72 year old? And what supplemental options should be considered?

She would have been required to sign up for Medicare at age 65 - her company would refuse her health bills and send them to Medicare.  Whole she was employed her company probably bought a supplemental plan and a drug plan for her - she'll now need to buy her own.  As Penguin said, the drug plans cost about $30/m, we're using a Blue Cross mail order plan.

[Deleted]

Jul 7, 2017 10:05:41 GMT -5 phil5185 said:

i know she got healthcare through her work. And they paid thru July.

What options are available for a 72 year old? And what supplemental options should be considered?

She would have been required to sign up for Medicare at age 65 - her company would refuse her health bills and send them to Medicare.  Whole she was employed her company probably bought a supplemental plan and a drug plan for her - she'll now need to buy her own.  As Penguin said, the drug plans cost about $30/m, we're using a Blue Cross mail order plan.

Not necessarily true. DH was covered by my employer's policy till I retired. He was 76 then and we'd never dealt with Medicare till then. Will post more later (I'm at the gym) but Mom needs to get a Letter of Creditable Coverage from her employer stating that she was covered from age 65 to now with a "creditable" plan- otherwise they hit you with big surcharges. Naturally they don't want people to wait till they get sick to sign up. She won't be surcharged since she had continuous coverage.

I found the whole process of scrambling for Medicare for DH confusing and I'm an actuary. She may want to take COBRA through August just to buy some time and make the right decision.

[The Walk of the Penguin Mich]

Jul 7, 2017 10:52:55 GMT -5 @wxyz said:

Now that she is no longer working you need to check the requirements that people sign up for medicare.  If you dont sign up when required there is a lifetime penalty that gets bigger and bigger the longer you dont sign up.  Also part D, drug plan.

As long as you had access to a drug plan, you are not penalized.  You just need to show proof of credible coverage (which I'm assuming the OP's mom had at her employer).

[Deleted]

First, a few resources. Does she have friends on Medicare? They may be able to tell here which Medigap/Medicare Advantage plans have the best coverage in her area. She can also buy Medicare Advantage/Medigap through an insurance agent. The insurer pays their commission so it won't cost her anything to use their services. Finally, the people at her local SS office can help with Medicare. Don't wait for her to consult you on this in a few months- make sure she doesn't go without coverage after she loses the company coverage.

Medicare A was funded through her payroll deductions over the years, so no charge for that- but it covers hospital stays only. Medicare B covers 80% of doctor and outpatient expenses- but not eyeglasses, hearing aids or dental care. It does have a monthly premium. You sign up for these through the Social Security office.

I'm not as clear on Medicare Advantage- backed away from it as soon as the agent told us that if you enroll in Medicare Advantage, if you decide you don't like it and want Medigap coverage instead, the Medigap insurer can decide not to accept you based on your medical history. DH had chronic health problems. My impression is that it's more of an HMO-type coverage- a lot less claim paperwork for you, but a limited network.

So, DH went with United Healthcare through AARP for Medigap (the other 20% of Medicare B costs). I was very happy with them and plan to use them when I get Medicare next year, My Dad, OTOH, has Mutual of Omaha and likes them.

She'll also need a prescription plan- if she doesn't get it now she'll be penalized with higher premiums for waiting when she does enroll. Which plan you choose is highly dependent on her prescription needs. Which plan has the best coverage for what she's taking? If she's not taking much, she can get a cheaper plan with a high deductible.

I'm not crazy about dental and vision insurance-  coverage is pretty limited.  Dental typically maxes out at  $1,500 max payout per year so it offers little protection when you need really expensive repairs.  I highly recommend Costco for glasses and hearing aids if she needs them. 

As I said- many moving parts. Get started now, and think about getting COBRA for August so you have some time.

[The Walk of the Penguin Mich]

e through AARP for Medigap (the other 20% of Medicare B costs). I was very happy with them and plan to use them when I get Medicare next year, My Dad, OTOH, has Mutual of Omaha and likes them.

Just be aware that Medigap plans are available by county, so what is available in one area may not be available in another.  My choices were a LOT different if I lived 100 miles south, when I researched this for me.  It is a lot like cell plans and who has the better coverage for your area.  

Ask your mom to ask her friends who are on Medicare who they have.  They should be able to give her an idea as to who as the better benefits where she lives.

[emma1420]

If she's enrolled in Medicare, she has two supplemental options.  Either to get a Medigap plan, which are the alphabet plans or to get an Advantage plan.

Medigap plans are supplemental insurance plans offered by private companies to help individuals pay for the cost sharing components of original medicare.  You must have parts A & D to buy a Medigap plan.  Medigap plans are often referred to as alphabet plans (A, B, C, D, F, G, K, L, M, N).  You have to review all of them carefully, because Plan F has good gap coverage in most places, but Plan L really doesn't.  A separate Medicare Part D plan must be purchased.

An Advantage plan is a private insurer that manages all of an individual's medicare.     Advantage plans differ from original Medicare + Medigap in their cost sharing structure.   With an Advantage plan individuals “pay as they go” through copayment and coinsurance to an out-of-pocket maximum, they function a lot more like an employer group health plan from the patient perspective. They tend to be less flexible but they can also offer extras like dental coverage, etc., that  Medigap plan won't cover.

There are advantages and disadvantages to both options.  What will be important for your mom though is if she has been covered by her employer and she deferred enrolling in Medicare during her initial eligibility window she has 8 months from the time her employer group health insurance ends to enroll (during her special enrollment period) in either an Advantage plan or a Medigap plan.

[Deleted]

Oh, yeah- forgot about the "special enrollment period".  Ordinarily you can sign up only during the "Open enrollment period" (typically the last couple of months of the year for coverage starting 1/1 of the upcoming year).  Losing your job means that you can sign up now- you don't have to wait for open enrollment.  She should get a copy of any document that says, in effect, "your employment is terminated as of (date)."  DH signed up in May for coverage starting in June when I quit.

[dee27]

If your mom does not sign up for Medicare, supplemental, and drug plans by the first of the month, she will not have coverage until the 1st of the following month. Cobra sounds like a good idea until Medicare starts.

[dee27]

Rob,

Mom can start here: www.medicaresolutions.com/original.aspx?
temp1=3&refid=msn_med&utm_source=bing&utm_medium=cpc


Plug in her zip code, and she can view the plans available for her area.

[dee27]

Mom can sign up for plans via the phone, in person at Social Security, or on line. Also, she can contact an insurance broker who will explain her options. Make sure she has a list of all prescriptions she takes before she applies for Part D.

[Anne_in_VA]

Also, if your father was a retired military member and they were never divorced, she may be eligible for military medical benefits (Tricare for Life) once she has Medicare Parts A & B.  I am 70 and DH is retired military.  I signed up for Medicare Parts A and B and have Tricare for Life.  I don't need to have an Advantage plan as they cover most of my medical expenses including prescriptions.  You also need to sign up for dental , but their vision coverage is very limited.  You would probably need to have Medicare vision and dental policies oe separate coverage for those if she's eligible.

[dee27]

If your mom is a member of AARP, see can receive a low cost, annual eye exam for $30-40/year. This fee only covers routine eye exams. She has to show her membership card at the OV. 

[Happy prose]

Just curious as I'm not there yet- some of you posted that certain plans are only available in certain areas; what happens if you enroll and move?

[Deleted]

Typically you're affected only if you move from one state to another- not within a county, for example.  Medicare A and B won't change- the Federal Government is in charge of them.   I don't remember it being a big deal when DH and I moved 2 years ago from one state to another in the same metro area; we contacted  United Healthcare (Medigap insurer) and they did whatever they needed to do.  Delta Dental was a brick wall- we left messages multiple times and no one got back to us so DH just kept the same coverage.  I cancelled it when he died.

My guess is that moving in or out of state triggers a "special enrollment period" and you basically select a new plan.   

[Deleted]

Jul 7, 2017 10:05:41 GMT -5 phil5185 said:

i know she got healthcare through her work. And they paid thru July.

What options are available for a 72 year old? And what supplemental options should be considered?

She would have been required to sign up for Medicare at age 65 - her company would refuse her health bills and send them to Medicare.  Whole she was employed her company probably bought a supplemental plan and a drug plan for her - she'll now need to buy her own.  As Penguin said, the drug plans cost about $30/m, we're using a Blue Cross mail order plan.

Not necessarily true.  If she was working, her health care would be primary and Medicare secondary.  It's a nice little "trick" that the government uses to reduce Medicare spending.

My husband does have Medicare, but it isn't required since I am still employed.  He is 74.  Most people choose not to pay twice.

[TheOtherMe]

The Medigap plan my dad is using only covers 5 counties, so if he were to move out of this area, he would have to find a new plan.  I was told when researching that it would trigger a special enrollment period. 

My biggest problem with dad is that, at 93, he takes no prescription drugs and doesn't want to have the insurance.  Most likely, before he dies, he will need prescription drugs, so I don't let him drop the coverage.

Mom and dad were covered by the company where he retired for both health insurance and prescription drug coverage.   About 5 or 6 years ago, they stopped covering retirees.  They did receive letters stating they had continuing coverage.

They contracted with a company to help the retirees find health insurance and prescription drug coverage.  They reimbursed them a certain amount.  This current year, the reimbursement was half of what it was last year.  I'm guessing the reimbursement will go away before long.

If I ever drop out of the federal retiree program, I will receive the same kind of letter and have to get my own prescription drug coverage.  I am currently covered for my Medigap through the federal retiree program but it includes prescription drug coverage.

I am so happy I got Medicare Part B because with 3 hospital stays and 1 surgery since November, I didn't pay a penny out of pocket--only co-pays for prescriptions.  So far, that hasn't been out of pocket either because they gave me a $50 Wellness card.

[TheOtherMe]

Jul 8, 2017 11:15:19 GMT -5 @wxyz said:

Since going on medicare we have not had to pay for anything at all between the medicare and medigap coverage.  The cost to us is less than half per year compared to what we were paying under private coverage, even with the extra premium we have to pay for medicare and plan D due to higher income.

Since I turned 65 last October, I have had 3 hospital stays and a surgery.  Paying for Medicare and Medigap is far less than what I would have paid.  I have not paid for anything except prescriptions out of pocket.

[seriousthistime]

Jul 7, 2017 14:36:38 GMT -5 dee27 said:

Mom can sign up for plans via the phone, in person at Social Security, or on line. Also, she can contact an insurance broker who will explain her options. Make sure she has a list of all prescriptions she takes before she applies for Part D.

And also be careful of any restrictions regarding coverage for those drugs.  If you are taking it for an off-label use, it may not be covered under the Part D plan.  It has to be prescribed for a "medically accepted indication" no matter how well it may work for your off-label condition.  If you glance at the drug plan's coverage list and see it's there, that doesn't mean it will be covered for your off-label use.  

For example, immunosuppressants approved for FDA use after a specific type of organ transplant may be covered for that use, but the very same drug prescribed for an autoimmune disease may not be covered no matter how effective it is at treating your autoimmune disease. Even if there is NO drug approved by the FDA to treat your autoimmune disease. 

[lund]

OP,
This is one of the instances where I think that you should act fast and "meddle" as needed, using previous history and emotional manipulation if needed.

Getting on Medicare/Medigap/prescription coverage on time is $$$$$!
Being uninsured is a risk, paying for COBRA is expensive, and getting hit with surcharges for life very expensive.

Your parent may not know about any future surcharges, and if your parent is usually not smart about money, the risk of trying to hit you up for money if there is less of it may increase...

[NastyWoman]

I won't claim that I fully understand this, but it seems like COBRA and the special  enrollment period may have some potential conflict build in according to this website:

www.medicareadvocacy.org/people-with-medicare-beware-cobra-is-not-coverage-as-a-current-employee/