Medicare 2016

[marvholly]

NOTE: I am exploring Advantage plans.

Two weeks ago I contacted 4 possible providers.
#1 had NO local info meetings and would NOT do a mailing. Scratched.
#2 promised a mailing in 10 business days. NOT received. If this is the service I get how can I expect anything if I sign up?
#3 Does not cover my preferred Drs. Scratched.
#4 promised a mailing in 2 days – got it in 3. Looking at this one BUT agent promised to call to check that I had the info and has not. Service issue again.

there is one more I need to contact since I apparently forgot them - no notes.

[wvugurl26]

It does sound like bad service. On the other hand I think all plan materials are available at the plan finder website. I would check the star ratings for any plan you are considering. This is also displayed on the plan finder site. Marketing has very strict guidelines. Basically everything must be approved by CMS prior to distribution, certain things must be included, in person events must be registered so many days ahead of time, etc. I guess you made these calls after October 1st? That was when marketing was allowed to start so if you asked them prior to that date by law they couldn't send you what you asked for.

[mroped]

Shopping for medical insurance is something that we shouldn't have to do.
Going to the doctor should be like choosing a route for traveling: you like one, you take it, nobody's asking questions.
But that would be called Universal Health Care and we don't care for that apparently. I don't see the rel reason why but it is what it is!

[NoNamePerson]

Maybe things have changed since I was eligible for medicare, but I went on Medicare website - I think - and was able to pull up providers in my state then by county. I also think I could pull two or three side by side to compare. This was 7 years ago and to lazy to see if still the same.

But also there were mailings about local meeting for at least 4 of the providers. That was a big advantage.

And the stuff arriving in the mail was/is like being under attack       And still is!!! I'm surprised you aren't receiving info from every provider in your area. Then you can go to their website and research for doctors/hospitals in their network, etc.  Oh and keep in mind that just because the doctor is in network now doesn't mean that that can't change at some point. Happened to friend but she raised hell with them and they let her keep using that doc - heart doctor.

BUT and this is a big BUT in my case. I had no Doctors or meds to be concerned with when picking my provider. And I know this is a big concern for people and keeping their doctors.

Maybe it is more difficult/complicated now than when I hit the big 65.   

[Tennesseer]

I am so not looking forward to having to wade through all the information regarding or related to signing up for Medicare for the first time this coming spring.  

[Deleted]

Oct 20, 2015 7:03:55 GMT -5 mroped said:

Shopping for medical insurance is something that we shouldn't have to do.

Why? We shop for homeowners and auto insurance. I'm dumping my current (non-Medicare) health insurer as of 1/1 because they said my current coverage will no longer be available and I "might like" an alternative they offered. I got on their site and found that it has ZERO coverage out-of-network. If it were a single-provider system, I'd have no choice. Single-provider systems can, and do, cut back coverage to the lowest acceptable level.  Ask anyone in the UK about how long it takes to get a doctor's appointment through the NHS vs. how long it takes if you have a private policy.

I like choice.  If I want a better network or a different deductible and want to pay for it, it's an option.  If I get poor service from the insurer I can go elsewhere. 

DH and I really had to scramble when I retired after taking one week to make the decision over a year ago.  We had COBRA but it was expensive and I wanted to get rid of it.  We went through insurance agents- a husband-and-wife team.  She handles Medicare supplements (DH was 76) and he handles non-Medicare, which is what I needed.  They weren't 100% correct on everything but it helped a lot.

[NoNamePerson]

Oct 20, 2015 8:01:48 GMT -5 Tennesseer said:

I am so not looking forward to having to wade through all the information regarding or related to signing up for Medicare for the first time this coming spring.  

Take the easy way out - do all your research online like I did    Medicare.gov is a good place to start!!

[Ombud]

So basically it's no different from shopping when you're only offered HMO's?

I thought it was just:
♤ Medicare A - hospital
♡ Medicare B - 80% out patient
◇ Medicare C - not sure
♧ Medicare D - prescriptions

For the uneducated (me) where's the hangup? Can't you just do Medicare A/ B and skip the others if too restrictive?

[Tennesseer]

Oct 20, 2015 8:21:06 GMT -5 NoNamePerson said:

Oct 20, 2015 8:01:48 GMT -5 Tennesseer said:

I am so not looking forward to having to wade through all the information regarding or related to signing up for Medicare for the first time this coming spring.  

Take the easy way out - do all your research online like I did    Medicare.gov is a good place to start!!

For my 64th birthday, a friend of mine bought me Medicare for Dummies and Medicare Prescription Drug Coverage for Dummies . Just a matter of sitting down and reading the books to at least get started.

[wvugurl26]

Oct 20, 2015 8:31:21 GMT -5 Ombud said:

So basically it's no different from shopping when you're only offered HMO's?

I thought it was just:
♤ Medicare A - hospital
♡ Medicare B - 80% out patient
◇ Medicare C - not sure
♧ Medicare D - prescriptions

For the uneducated (me) where's the hangup? Can't you just do Medicare A/ B and skip the others if too restrictive?

Part C is basically a HMO. It covers, usually, the other three pieces. Before Part D came into play this was how some got drug coverage. Not all Part C plans offered it prior to the start of Part D but some did. The plans are required to have plan offerings at least as robust as traditional fee for service Medicare. Many plans offer additional optional items such as gym memberships or dental.

[Blonde Granny]

For me, it wasn't complicated 6 years ago.  I chose original Medicare and a Plan F supplement from Mutual of Omaha.  Part D for drugs was a little more complicated due to the numerous choices available and depending on the drugs you were currently taking.  Again co-pays and deductibles and some plans will only pay for generics, some you have to go with mail companies for refills.

In 6 years I've never received an additional bill, that includes knee replacement and a pacemaker last year.

Medicare Advantage plans are another issue.  Networks, deductibles, co-pays, and other restrictions can be difficult to sort though.  All rolled into a one plan fits all, perhaps with a $0 monthly cost, but wait to you see what the restrictions and deductibles are.

The biggest thing to remember is that there is no free lunch.

[Ombud]

Oct 20, 2015 9:11:39 GMT -5 Blonde Granny said:

For me, it wasn't complicated 6 years ago.  I chose original Medicare and a Plan F supplement from Mutual of Omaha.  Part D for drugs was a little more complicated due to the numerous choices available and depending on the drugs you were currently taking.  Again co-pays and deductibles and some plans will only pay for generics, some you have to go with mail companies for refills.

In 6 years I've never received an additional bill, that includes knee replacement and a pacemaker last year.

Medicare Advantage plans are another issue.  Networks, deductibles, co-pays, and other restrictions can be difficult to sort though.  All rolled into a one plan fits all, perhaps with a $0 monthly cost, but wait to you see what the restrictions and deductibles are.

The biggest thing to remember is that there is no free lunch.

PLAN F?1!?! Holy crap I'm gonna need those books Tennesseer was talking about

[Blonde Granny]

The better the supplement the higher the cost.  Medicare has plans from A-L, and each plan, regardless of the company you are purchasing from requires it to be the identical.  I chose Plan F as it was the most comprehensive and covered the most items.

I was paying $172/mo for the Mutual of Omaha plan, as was my DH.  The Plan A & B from Medicare is $104.90 (IIRC) and it is deducted from our SS checks.  Part D was also deducted from SS.

[The Walk of the Penguin Mich]

Oct 20, 2015 6:50:54 GMT -5 wvugurl26 said:

It does sound like bad service. On the other hand I think all plan materials are available at the plan finder website. I would check the star ratings for any plan you are considering. This is also displayed on the plan finder site. Marketing has very strict guidelines. Basically everything must be approved by CMS prior to distribution, certain things must be included, in person events must be registered so many days ahead of time, etc. I guess you made these calls after October 1st? That was when marketing was allowed to start so if you asked them prior to that date by law they couldn't send you what you asked for.

Most are not, WVU....I'm looking into this myself, and you get a VERY  cursory amount if info on the web site with a "contact them for more info".

It is even worse, if you are disabled.  When I put my birthdate into the site, it bounces back at me telling me I am not eligible.  ARGH!  It truly suck trying to ferret out info.

[Blonde Granny]

Oct 20, 2015 9:26:09 GMT -5 The Walk of the Penguin Mich said:

Oct 20, 2015 6:50:54 GMT -5 wvugurl26 said:

It does sound like bad service. On the other hand I think all plan materials are available at the plan finder website. I would check the star ratings for any plan you are considering. This is also displayed on the plan finder site. Marketing has very strict guidelines. Basically everything must be approved by CMS prior to distribution, certain things must be included, in person events must be registered so many days ahead of time, etc. I guess you made these calls after October 1st? That was when marketing was allowed to start so if you asked them prior to that date by law they couldn't send you what you asked for.

Most are not, WVU....I'm looking into this myself, and you get a VERY  cursory amount if info on the web site with a "contact them for more info".

It is even worse, if you are disabled.  When I put my birthdate into the site, it bounces back at me telling me I am not eligible.  ARGH!  It truly suck trying to ferret out info.

Are you receiving SSDI? If so, isn't  Medicare automatically given to you due to your disability?

[The Walk of the Penguin Mich]

Oct 20, 2015 8:31:21 GMT -5 Ombud said:

So basically it's no different from shopping when you're only offered HMO's?

I thought it was just:
♤ Medicare A - hospital
♡ Medicare B - 80% out patient
◇ Medicare C - not sure
♧ Medicare D - prescriptions

For the uneducated (me) where's the hangup? Can't you just do Medicare A/ B and skip the others if too restrictive?

If you want to go with an advantage plan it appears straightforward.  But for me, it is imperative I keep my orthopedic surgeon.  He takes Medicare, but my problem is that he is out of my local service area.  

I have dealt with my health insurance for 35 years, between choosing among multiple plans.  This is not anything in the same league.

BTW....you are required to pick up D or you are penalized.  My drugs cost MORE under my prescription plan, AND I get to pay $31/mo for the privilege.  

[Gardening Grandma]

I'm with BG. It seemed overwhelmingly confusing 6 years ago.  But once you learn the terminology, it's not that bad.

I got a lot of information from the Medicare site and the Washington state site. Found the Washington site by googling "Washington stat and Medicare"

"Plan F" is a supplementary plan. It is optional. Thete are a number of supplementary plans.
If you opt for Original Medicare Part B, as BG and I have done, you need to know that Part B covers 80% of doctor services. If you don't have a supplementary plan, you pay the remaining 20%.

Now the 80% coveres the Medicare negotiated price, so it isn't the same as the full price, but if you need expensive treatments, that 20% can add up to big $$. That's why so many on Medicare opt to have a supplemental plan. We have Plan F through AARP/United Healthcare and have been happy with it.  

Another reason to opt for a supplementary plan is that Medicare (with a few exceptions) doesn't cover you outside the US.  Some supplementary plans do have coverage outside the US.

There are other supplementary plans; you can opt for less coverage and lower premiums.

[The Walk of the Penguin Mich]

Oct 20, 2015 9:31:22 GMT -5 Blonde Granny said:

Oct 20, 2015 9:26:09 GMT -5 The Walk of the Penguin Mich said:

Most are not, WVU....I'm looking into this myself, and you get a VERY  cursory amount if info on the web site with a "contact them for more info".

It is even worse, if you are disabled.  When I put my birthdate into the site, it bounces back at me telling me I am not eligible.  ARGH!  It truly suck trying to ferret out info.

Are you receiving SSDI? If so, isn't  Medicare automatically given to you due to your disability?

Yes, and yes.  I am looking for a supplement and being disabled throws a whole 'nut her layer of convolution into the system.

[The Walk of the Penguin Mich]

Oct 20, 2015 9:33:13 GMT -5 Gardening Grandma said:

I'm with BG. It seemed overwhelmingly confusing 6 years ago.  But once you learn the terminology, it's not that bad.

"Plan F" is a supplementary plan. It is optional. Thete are a number of supplementary plans.
If you opt for Original Medicare Part B, as BG and I have done, you need to know that Part B covers 80% of doctor services. If you don't have a supplementary plan, you pay the remaining 20%.

Now the 80% coveres the Medicare negotiated price, so it isn't the same as the full price, but if you need expensive treatments, that 20% can add up to big $$. That's why so many on Medicare opt to have a supplemental plan. We have Plan F through AARP/United Healthcare and have been happy with it.  

Another reason to opt for a supplementary plan is that Medicare (with a few exceptions) doesn't cover you outside the US.  Some supplementary plans do have coverage outside the US.

There are other supplementary plans; you can opt for less coverage and lower premiums.

That is who  am looking at now, but I have to call AARP as my birthdate in the web site bounces me back.

[Blonde Granny]

Oct 20, 2015 9:33:23 GMT -5 The Walk of the Penguin Mich said:

Oct 20, 2015 9:31:22 GMT -5 Blonde Granny said:

Are you receiving SSDI? If so, isn't  Medicare automatically given to you due to your disability?

Yes, and yes.  I am looking for a supplement and being disabled throws a whole 'nut her layer of convolution into the system.

Thanks, I didn't know much about it other than what I asked, never considered those who receive SSDI would need a supplement also.

[Gardening Grandma]

Supplemental plans are often referred to as "Medigap" plans.  

[Deleted]

Oct 20, 2015 9:32:21 GMT -5 The Walk of the Penguin Mich said:

BTW....you are required to pick up D or you are penalized.  My drugs cost MORE under my prescription plan, AND I get to pay $31/mo for the privilege.  

There's a reason for that even though it sucks. They don't want people who are on few prescriptions or cheap prescriptions staying out of the plan till they suddenly get a prescription for something very expensive. That's called "adverse selection"- sort of like waiting till hurricane warnings are posted to buy windstorm coverage. (They won't sell it to you!) If things continue the way they are, Medicare is gonna be very happy when I sign up for prescription coverage (not till February, 2018 when I turn 65)- I'm on zero prescriptions.

Can you sign up for the prescription plan but have the pharmacy pretend it doesn't exits and charge you the cheaper price?

[Gardening Grandma]

Oct 20, 2015 9:45:16 GMT -5 @athena53 said:

Oct 20, 2015 9:32:21 GMT -5 The Walk of the Penguin Mich said:

BTW....you are required to pick up D or you are penalized.  My drugs cost MORE under my prescription plan, AND I get to pay $31/mo for the privilege.  

There's a reason for that even though it sucks. They don't want people who are on few prescriptions or cheap prescriptions staying out of the plan till they suddenly get a prescription for something very expensive. That's called "adverse selection"- sort of like waiting till hurricane warnings are posted to buy windstorm coverage. (They won't sell it to you!) If things continue the way they are, Medicare is gonna be very happy when I sign up for prescription coverage (not till February, 2018 when I turn 65)- I'm on zero prescriptions.

Can you sign up for the prescription plan but have the pharmacy pretend it doesn't exits and charge you the cheaper price?

I'm in the same boat. No prescriptions, but I pay $18/mo for Part D (Drug) coverage.  I chose the plan with the lowest premium I could find - could care less about the coverage.

[Ombud]

Why would I be penalized for not having part d? It's not like I'd ever use it!! And how do that do that penalty? Increase the premium for my part a?

[Ombud]

Here's my list of *dumb* questions that I've been trying to understand and I've only got 3 years to find the answers:

1. How do they get paid? Typical Part B withheld from SSA is $1258 per year. If you're not getting SSA (will defer to 66, claim & suspend to 70), how do they get that $1258?

2. Do you have to take the entire alphabet?

3. What if your a gov't retiree who has to have a separate HMO?

4. I FINALLY understand offset - is that impacted?

[Gardening Grandma]

Oct 20, 2015 9:50:28 GMT -5 Ombud said:

Why would I be penalized for not having part d? It's not like I'd ever use it!! And how do that do that penalty? Increase the premium for my part a?

If you never, ever need pres drug coverage, no penalty. But if you don't have continuous coverage and then (say after 3 or 5 or 10 years), your premium will be much much higher as the penalty will be applied.

I don't currently take any pres drugs, but life is uncertain and no one knows what kinds of health issues could arise in the future.

Terminology cheatsheet:

Part A has no premium. Part A is hospital coverage.

Part B (Original Medicare) (pays 80% for office visits and outpatient care) has a premium if $109 and change for most people.  It may be quite a bit more for those just starting on Medicare this year, but that's probably a topic for another thread.

Part C is Medicare Advantage - no premium, but limited to certain drs and hospitals.  (It works very well for some friends of ours who live in a big city. Not available where we live)

Part D is Presc drug coverage - 

All the other letters refer to Supplemental ("Medigap") plans. Each letter represents a defferent flavor with varying premiums and coverage

[Ombud]

Thanks, Gardening Grandma, so basically I only have to concern myself with A & B as I have to have an HMO @ $300M to go with B

[Gardening Grandma]

Ombud
If you are still working and covered through your employer, you don't have to go on Medicare.
If you aren't working, but not drawing SS benefits, I think you can arrange to send payment or have it automatically withdrawn from your bank account (someone correct me if this is wrong)
No, you don't have to take the whole alphabet.
Part A is free - it would be dumb to not take it
You choose between Part B OR Part C
You don't HAVE to take Part D, but if you ever do need it, it will cost you significantly more in a higher premium

All the other letters are optional; if you do want a Medigap plan, you choose one of them

[Gardening Grandma]

Ombud,
I know nothing about the aspect if being a gov't retiree and needing an HMO, though I understand Part C (Advantage) works much like an HMO.

I suggest posting on the Bogleheads Personal Finance forum.  They have gov't retirees who are very knowledgeable.

[Deleted]

Oct 20, 2015 9:50:28 GMT -5 Ombud said:

Why would I be penalized for not having part d? It's not like I'd ever use it!! And how do that do that penalty? Increase the premium for my part a?

I think they apply a surcharge to your Part D premium when you do sign up.  It's a function of how long you went without prescription coverage (from the age you first became eligible for Medicare) and it never goes away.  In our case, we gave them documentation that DH, even though he wasn't on Medicare from age 65 to age 76, had had "creditable coverage" through my employer, so he doesn't pay a surcharge.

While insurance companies can and will do stupid things, this makes sense to me.  Suppose everyone with cheap or no prescriptions didn't sign up till they suddenly got a prescription for something expensive.  Let's say they're diagnosed with Hepatitis C and the doc wants to put them on the new drug that has a 90% chance of curing it but costs $80K for a course of treatment.  "Oops- better sign up for Medicare D."  That means the pool of insureds is only people with very expensive prescriptions.  The premiums will spiral out of control.

I have no intention of ever needing the $2 million umbrella liability coverage I carry, either.  I buy it anyway.