Medicare help

[imawino]

Hello everyone!

So my dad asked me to help him find a medicare supplemental plan.  I of course said sure, I'd love to and as it turns out I know exactly zero about Medicare and quite possibly am a complete moron.

It would seem that he has Part A&B, which covers 80% of Doctors visits (I think?) and has never done a Medicare Advantage (is that C?) before.  I'm looking at the plans that show as available in his zip code on the Medicare.gov site - is that even the best way to go about it??

And I truly do not understand how this works.  Many of these plans seem to say there is no premium above what he's currently paying for Medicare.  Is that right?  Do they in fact cover anything more than A&B do?  

Some info about my father and his needs for medical coverage - he's early 70s and sees a lot of specialists.  Looking to bring down what he's paying out of pocket for imaging & other testing at vascular places, biopsies and removals of various skins cancers, that sort of thing.  He doesn't take a ton of meds, so while drug coverage is nice it's not the absolute highest priority.  


Edited to add:  I  feel like there was some conversation about Medicare recently but I could not find that thread so if anyone just wants to point me in that direction, that's fine. If the info is here, I don't want to waste anyone's time.  

[pulmonarymd]

Medicare advantage is Part C. In some cases there is a zero out of pocket cost. Many do offer additional benefits. Sounds perfect, right?

They do this by limiting choice. You need to make sure his doctors and hospital are in network. Otherwise, he either pays out of pocket or changes doctors. Need an MRI. With plain Medicare, go ahead and schedule it. Medicare advantage? Be prepared for prior authorization and denials. Same with Medicare.

So, in summary, plain Medicare has the most freedom of choice, less administrative oversight, but likely will cost more out of pocket. As long as you understand the trade offs, a part C plan may save him money

[imawino]

Oct 25, 2023 14:35:38 GMT -5 pulmonarymd said:

Medicare advantage is Part C. In some cases there is a zero out of pocket cost. Many do offer additional benefits. Sounds perfect, right?

They do this by limiting choice. You need to make sure his doctors and hospital are in network. Otherwise, he either pays out of pocket or changes doctors. Need an MRI. With plain Medicare, go ahead and schedule it. Medicare advantage? Be prepared for prior authorization and denials. Same with Medicare.

So, in summary, plain Medicare has the most freedom of choice, less administrative oversight, but likely will cost more out of pocket. As long as you understand the trade offs, a part C plan may save him money

Thanks, Pulmonary!  Very helpful as always.  I live hundreds of miles away and am trying to get his Dr info out of him now - it sounds like there may be different networks involved.  I just looked at "Medigap" policies, which may be more what he is looking for but I suspect the premiums would be astronomical given his medical history.

Oh - he's just recently added a pulmonologist to his list!  COPD.     That plus a highly complicated abdominal aortic aneurysm repair that nearly killed him a few years back makes me think medigap likely not an option.

[wvugurl26]

Medigap plans would cover his portion of the bill. Premiums are based on your age/history. I changed my grandma's plan once at like 91 and got the premium down somewhat. It was still over $300/month when she passed at 92. She had very little medical expenses even at the end of her life. I guess that's not the norm.

Part C plans are intended to cover traditional Medicare and the extras. They do have a network that can be limited and more hoops to jump through.

I believe the Medicare plan finder will help you find a Medigap plan. I'm pretty sure that's how I found my grandma's when I switched her.

[pulmonarymd]

He can get a Medigap policy. Many companies offer them including AARP. Bigger issue will be if all his physicians are in the Medicare Part C networks. If not, he will have to consider changing physicians. As I said, Medicare is the easiest, but may also be the most costly.

Plain Medicare is Part A-cover hospital care. Part B covers physician care. part C is Medicare Advantage. Part D is drug coverage.

Part C includes A, B, and D
If you have Medicare A and B, you need a Part D plan for drugs and a Medigap plan to cover your coinsurance.
That is how you should be looking at this

[wvugurl26]

You would think they would make this alphabet soup easier for this group to comprehend. I work with it and it's hard to get sometimes.

[pulmonarymd]

Oct 25, 2023 15:32:19 GMT -5 wvugurl26 said:

You would think they would make this alphabet soup easier for this group to comprehend. I work with it and it's hard to get sometimes.

Yes, far too complex. Welcome to the US Healthcare system. We spend a lot, but at least we are in the middle of the road worldwide in regards to health metrics/s

[TheOtherMe]

My parents and sister and BIL had Part A and B.  Their Medigap was through a company associated with the local doctor's group.  It only covered for certain counties here unless it was an emergency.  

That was very reasonable.  

It did require Part A and B.

[Tennesseer]

I have Medicare's plan A, B and D (drug coverage).  I also have AARP/United Health Cafe's plan F.  Plan F pretty much covers all co-pays and procedures.  I have been able to have medical attention from medical specialists without a referral from my PCP except for one time.  And that referral from my PCP  for the examination and procedures was easy.

Plan D sucks as drugs are expensive. Generics are basically $0.00 but brand name drugs can be expensive.

[NomoreDramaQ1015]

Oct 25, 2023 15:32:19 GMT -5 wvugurl26 said:

You would think they would make this alphabet soup easier for this group to comprehend. I work with it and it's hard to get sometimes.

I've been having to wade through it to get all the documents for Medicaid.

I started yelling at the computer demanding it tell me how many freaking letters are there?!

She has A, B, D and G. I think I am finally done.

[Tennesseer]

Oct 25, 2023 15:32:19 GMT -5 wvugurl26 said:

You would think they would make this alphabet soup easier for this group to comprehend. I work with it and it's hard to get sometimes.

That is a concern for me as I get even older. And the older I get and if there is a whole bunch of small print to read I get a bit dyslexic. Reading instructions if the print is too small gets to be a problem.

[TheOtherMe]

As long as I can use my Federal Employee's Health Insurance, I look at the increase in premiums and stay with it.  It covers Parts whatever and D.  

The only out of pocket cost is co-pays for prescriptions.  If it's going to be a maintenance drug, it needs to go through mail order or it is much more expensive.  For the first 30 days supply, most aren't too bad at a local drug store.

[seriousthistime]

Before I retired, I worked in the Medicare field. 

From what I observed, I will never have a Medicare Advantage (Part C) plan.  

The networks are restrictive.  You can live in State A, very close to the state line with State B.  To see a specialist in network, you may have to drive to the other side of your state even though a specialist in State B is much closer to you, and yes, that is even if the insurer (like UnitedHealthcare or Blue Cross Blue Shield) has the same Medicare Advantage Plan for State B. 

The preauthorizations are ridiculous.  You can be on infusions to treat autoimmune disorders and when you are due for the next treatment, they can deny you and you waste time having to appeal.  With Part B, you don't need preauthorization except in rare circumstances. 

I also came across Medicare Advantage plans that had higher copays than Parts A and B. One example, a particular procedure cost $300.  The Medicare Advantage plan had a co-pay of $295 which the patient paid out of pocket; the plan paid $5.  Under Part B, the patient would have paid the 20% co-pay, or $60.  

Also, be aware that the dental coverage in Medicare Advantage plans is not generous and you will have to find a dentist in network. This can be difficult.  I recall people complaining about long waits to see a dentist. 

You don't say how old your dad is, but he has Parts A and B now, so he is past the age of 65, right?  If he didn't sign up for Part D when he became eligible for Medicare, there will be a monthly penalty for him to sign up now. 

ETA: Like TheOtherMe, I kept my employer's health insurance after I retired, and it is now secondary to Parts A and B.  It's basically my Medicare supplement. 

[dannylion]

If you are still looking for Medicare information, look up SHIP counselors in your state:  SHIP

They are usually found in senior centers, sometimes libraries.  They are trained to guide people through the process of signing up for Medicare and finding additional insurance to meet their specific needs and financial circumstances.  They don't sell insurance, they just provide information and help people navigate the Medicare landscape.  Anyone can use their services, even if you've had Medicare for a while and want to look for a different supplemental policy or just have questions about Medicare.  

[TheOtherMe]

SHIP counselors are the best.  Very knowledgeable.

[The Walk of the Penguin Mich]

Another place to look is a Facebook group called Boomer’s Benefits.  

If your dad has not signed up for a prescription plan, he will get penalized.  Back when I got Medicare, my meds were cheap, I could get a 3 month supply for $30 without insurance, so didn’t get any.  Why would I want to pay $30/mo and still have to pay $10/script?   Athena set me straight about this, I was only out a year and am penalized $1/mo for that year and forever.  

Also be aware that different counties/states have different options.  Not all are available to everyone, it is very residence specific.  For instance, plans that I can sign up for in Whatcom county is different than what is available in Snohomish county which is about 50 miles down the road, or King county (Seattle) another 50 miles further south.  

Speaking of which, I need to go on the hunt for a new Plan D plan.  Mine got jacked up 20%.  I don’t have a choice for my Medigap until I turn 65.  Locally, I have 2 choices, an advantage plan and an expensive one.  I pay for the expensive one, about twice what TD pays for his Medigap plan by being on disability.  Next year, I’ll have choices.

[TheOtherMe]

Oct 26, 2023 10:44:17 GMT -5 TheOtherMe said:

SHIP counselors are the best.  Very knowledgeable.

I volunteered with the SHIP program for two years.  Mom was sick the second year and I missed more than I was there because I was out of town caring for her and dad.

If you want to use SHIP, call ASAP.  Their appointments go very quickly.  

We opened up our scheduling about 3 weeks before changes could actually be made and by the date open season started, it was hard to get an appointment.

If you do get an appointment, do everything possible not to change it.

[NastyWoman]

Oct 25, 2023 19:42:05 GMT -5 Tennesseer said:

Oct 25, 2023 15:32:19 GMT -5 wvugurl26 said:

You would think they would make this alphabet soup easier for this group to comprehend. I work with it and it's hard to get sometimes.

That is a concern for me as I get even older. And the older I get and if there is a whole bunch of small print to read I get a bit dyslexic. Reading instructions if the print is too small gets to be a problem.

That is exactly my beef with all that medicare crap. It is at least 10x more complex than going through plans for regular (work related) open enrollment yet it is, presumably, designed for a section of the population that faces cognitive decline over time. I stuck with the HMO I already had prior to retiring but in part that was because also because I have no plans to become old, old in the US. Before that time I will be back in Europe