Medicare, Supplemental, Advantage, and other Insurances, Oh My Aching Wallet

[EtheltoTillie]

19 hours ago, StatisticalOutlier said:

That's interesting.  I stay out of the Medicaid angle of Medicare, as well as the still-employed arena. I have enough trouble keeping the "regular" stuff straight.

Who are you consulting?  Insurance agents or SHIP counselors?  Are there other people who do this?  How are they paid?  (Agents make a commission, and SHIP counselors are volunteers for a government program.)

I actually wondered if I should try to be a SHIP counselor, since I like helping people navigate this mess, but I'm gathering that there are (understandable) restrictions on what SHIP counselors can tell people.  Like, I know they can't recommend specific companies, but I wonder if they can even mention them.  I wouldn't like not being able to tell someone that Cigna is being sued for using AI for claims evaluations in their Advantage plans.  I'm not even sure they can talk about how Advantage plans reverse the vast majority of their denials on appeal, which sounds great until you know that almost nobody actually appeals.

Or, as I mentioned above, that Mutual of Omaha is known for closing the books on supplements, resulting in people who can't switch supplements being trapped and suffering extreme premium increases.  And for the record, my understanding is that both Aetna and Cigna are known for doing this, as well, although not to the extent that MoO does it.  And MoO doesn't do it in every state. 

So my advice would be to beware of these three companies, especially if the premium is a lot lower than other companies, because it might be a teaser rate.  But I don't think SHIP counselors can do that.

Well, that is, if they even know.  I was reading a discussion forum where a SHIP counselor told about a client he'd worked with who was suffering high premium increases and only in reading that discussion about closing the books did he grok to what might have been going on. 

I'm not taking social security yet, either.

Are you using Medicare Easy Pay for recurring payments?  When I go to sign up, it says, "Pay your premiums with automatic recurring payments from a checking or savings account with Medicare Easy Pay."  It doesn't give me the option to use a credit card.  But I can use a credit card for a one-time payment, so I log in every three months and put it on the credit card. 

I had to self-pay the Medicare premiums for a year before collecting Social Security, but I just waited till they sent bills.  I didn't know they had such a service, but I probably wouldn't have bothered with it for the anticipated short term.  I started collecting SS at 66 instead of waiting for the higher payments. 

[EtheltoTillie]

@StatisticalOutlier You have acquired such a depth and breadth of knowledge in this area.  The world needs your efforts.

I know New York only, and I stick to my narrow areas of practice, which do involve Medicare/Medicaid duals.  In NY we generally steer non-Medicaid people to the straight Medicare with the AARP supplement for the best and easiest coverage, if they can afford it.  But if people don't want to or can't pay that extra $233 per month, they get stuck in bad Advantage situations sometimes.  Or they sign up when they are younger and healthier and then they need much more care when they are older. 

I'm not sure how the SHIP counselors get paid--probably they are civil service jobs?  But I suspect you are right, you couldn't pass on all the juicy information.  That's like when I'm on the subway and I hear someone ask the token booth clerk for directions and the clerk gives some MTA prescribed direction that I know is longer than necessary.  Well, now they no longer have token booth clerks, so there's that. 

Are you looking for a paying job?  Or volunteer?  You'd be great in a Legal Aid/Legal Services office doing intake/advice calls if they have a health law practice.  Or the Medicare Rights Center. 

[Yeah No]

20 hours ago, StatisticalOutlier said:

Who are you consulting?  Insurance agents or SHIP counselors?  Are there other people who do this?  How are they paid?  (Agents make a commission, and SHIP counselors are volunteers for a government program.)

We consulted a few different independent insurance counselors that told us they were salaried and not receiving commissions from any companies.  We found them generally unbiased, helpful, and not pushy at all.

I also spoke with agents at United Healthcare since we eventually decided to sign up for one of their supplemental plans on the advice of a few friends who told us theirs was the best.  After hearing their tales of woe on other plans, even Advantage plans, we agreed that plan G from AARP/United Healthcare was the best fit for us.  And now that I'm on it too we get a 7% discount for both having it.

I didn't get very far with the SHIP counseling when I looked into it.  In my state it's focused on low income and the disabled and when I followed the links to find a counselor in my area, I found a list of separate contact numbers for each town. Despite the web page listing my town as being covered for SHIP counseling, the list of contact numbers and locations did not even include my town at all.  And as far as the other towns went, the numbers listed in those towns were only for either residents of the town or residents of public and assisted housing in that town.  So I didn't even pursue that any further.  I did later contact my state's medical insurance hotline and was told that we could attend in-person seminars at the state capitol to talk with a counselor there, but we didn't want to do that for several reasons.  I'm not sure that even if we were eligible to contact anyone on any of the numbers listed on the town contacts list we would have gotten phone counseling.  If they were at least in our local area we might have been more willing to show up in person to talk with one.

20 hours ago, StatisticalOutlier said:

Are you using Medicare Easy Pay for recurring payments?  When I go to sign up, it says, "Pay your premiums with automatic recurring payments from a checking or savings account with Medicare Easy Pay."  It doesn't give me the option to use a credit card.  But I can use a credit card for a one-time payment, so I log in every three months and put it on the credit card. 

We're using Easy Pay.  Interestingly they only accept a bank account for that with Medicare itself, but they will accept credit card payments for the Part D prescription premiums.  So we are doing the bank account for one and a card for the other.

I have a question maybe you can answer - If you have a supplemental plan, should it show up under your plans on your Medicare.gov account?  Because regular Medicare parts A and B and the prescription plan show up on my account, but not the supplemental.  It could be because it's too soon yet, or because my husband and I are considered one account with United Healthcare and it shows up on his account (I'll have to check) or maybe because it doesn't get listed there since it's not something you pay for through them.  I'm not sure and once again no one I talk to on the phone or online chat seems to be able to give me an intelligent answer.

[EtheltoTillie]

@Yeah No we pay for the AARP plan separately.  It's not billed from our Social Security checks.  We set up an automatic deduction from our checking account.  I think Part D shows up on your Medicare account, because Part D is actually a Medicare plan.  Whereas the supplements are not.  We have no part D right now, as my husband is still working so we also have that coverage as primary.  Don't ask why we also have the other coverages.  It has to do with my husband maybe was going to quit his job at one point and we needed to be ready. 

[Yeah No]

55 minutes ago, EtheltoTillie said:

@Yeah No we pay for the AARP plan separately.  It's not billed from our Social Security checks.  We set up an automatic deduction from our checking account.  I think Part D shows up on your Medicare account, because Part D is actually a Medicare plan.  Whereas the supplements are not.  We have no part D right now, as my husband is still working so we also have that coverage as primary.  Don't ask why we also have the other coverages.  It has to do with my husband maybe was going to quit his job at one point and we needed to be ready. 

Yep, that's what I was told and know (and we have already set up payments with UHC for our supplementals separately), however Medicare said they didn't show me in their records as having a supplemental plan, at least not yet.  They said that UHC would probably be sending them that information soon although that was a week ago now so maybe that's changed (and I did check with UHC and they said they do inform Medicare).  I'm figuring that Medicare at least needsto know about it for everything to go right, don't they?  And I'm wondering if it should show up on my list of plans on my Medicare.gov account since the site seems oriented to listing all your coverages, A,B,C,D, etc., LOL, and it recommends getting a Medigap plan right there on my account as if I don't have one yet and provide links to find out how to get one.  I didn't get the impression that the site was oriented only to reflect what Medicare manages and gets paid for itself, but toward what coverages you have, including a stand-alone private Medigap plan.

Edited August 3, 2023 by Yeah No

[StatisticalOutlier]

2 hours ago, Yeah No said:

I have a question maybe you can answer - If you have a supplemental plan, should it show up under your plans on your Medicare.gov account? 

I don't know what the "official" answer is, but I just logged in to my Medicare account and under "your plans" it has a box for Original Medicare that has Part A and Part B in it, a box for Drug Insurance (Part D) with SilverScript SmartSaver in it, and a box for Other Insurance that has Unitedhealth Group (my supplement).  Everything has a coverage start date of 5-1-22.

So Medicare does list supplements there.

However, I'm single, and this is the only place my coverage would show up.  I would think your supplement would show up on your own "your plans" page on the Medicare site and not on your husband's, even if United Healthcare considers you and your husband one account.  But I can't test that for you.

Considering your luck with phone reps, if I were you I'd give it another week or couple of weeks to show up in your Medicare account.  I assume that if United Healthcare says you have the supplement, then you have it.

[StatisticalOutlier]

6 hours ago, EtheltoTillie said:

In NY we generally steer non-Medicaid people to the straight Medicare with the AARP supplement for the best and easiest coverage, if they can afford it.  But if people don't want to or can't pay that extra $233 per month, they get stuck in bad Advantage situations sometimes. 

Is $233/month the premium for the AARP supplement?  New York has only community-rated supplements, so a given policy will be the same price for everybody regardless of age.  $233 seems low.  For zip codes in New York City and Long Island, the AARP supplement is $281.50.  Poughkeepsie and Albany are both $245.

[EtheltoTillie]

37 minutes ago, StatisticalOutlier said:

Is $233/month the premium for the AARP supplement?  New York has only community-rated supplements, so a given policy will be the same price for everybody regardless of age.  $233 seems low.  For zip codes in New York City and Long Island, the AARP supplement is $281.50.  Poughkeepsie and Albany are both $245.

Yes, $233 is low.  I think I just had a typo. 

[Laura Holt]

As a Canadian reading the above posts - is it as complicated as it sounds?  Because if it is I don't know how anyone navigates this without some help, especially the more senior of seniors!

[StatisticalOutlier]

37 minutes ago, EtheltoTillie said:

Yes, $233 is low.  I think I just had a typo. 

And it just happens to be what the Part B deductible was in 2022 (it went down to $226 in 2023), which is why it caught my eye.

35 minutes ago, Laura Holt said:

As a Canadian reading the above posts - is it as complicated as it sounds?  Because if it is I don't know how anyone navigates this without some help, especially the more senior of seniors!

It's every bit as complicated as it sounds, and as I've said a thousand times, this is no way to treat the elderly. 

I read a study about people's behavior when it comes to selecting Medicare plans, and a whole lot of people never change from whatever they pick when they turn 65 because the process is so overwhelming they never want to do it again. 

And when I was looking up supplement prices in New York, I saw the AARP one EtheltoTillie mentioned, with a premium of $281.50.  I also saw the same Plan G supplement from Mutual of Omaha for $476.04, and from Humana for $526.80.  (New York requires all supplement premiums to be community-rated, which means everybody with a given policy pays the same premium regardless of age.)

The thing is, New York is a guaranteed-issue state, so people can change their supplement any time they want without undergoing medical underwriting.  So who the hell is paying $476 or $526 when they could be paying $281 for exactly the same coverage?  Someone who was so put off by the process they never looked at it again.  Or someone who doesn't know they can change.  Or someone who "likes" Mutual of Omaha or Humana and wants to stick with them (the study showed that seniors have a lot of brand loyalty, even though in the case of supplements, the company has no discretion whatsoever in what they pay--if Medicare pays, they have to pay, period). 

And as if all this isn't bad enough, the way to "fix" healthcare in the U.S.?  Medicare for all!  So many more millions of people can go through this shit.

[shapeshifter]

4 hours ago, StatisticalOutlier said:

Is $233/month the premium for the AARP supplement?  New York has only community-rated supplements, so a given policy will be the same price for everybody regardless of age.  $233 seems low.  For zip codes in New York City and Long Island, the AARP supplement is $281.50.  Poughkeepsie and Albany are both $245.

I'm in Rochester NY. 
My Medicare Part B is $168/mo.
My Blue Cross Blue Shield Excellus Medicare Advantage is $20/mo., which includes drugs, dental, vision, hearing etc. with lower copays than my former employer's United Health Care insurance. 
The only possible high expense is an $8K out-of-pocket if I wind up with some serious hospitalization. But, as a stage IV cancer survivor, I know that if I am sick enough to rack up the $8K, that will not be my biggest problem.

Before I signed up for it, my son-in-law looked it over (he was a health insurance sales person a few years ago) and he said it looked okay and that BCBS is a good provider in this state.

[Yeah No]

14 hours ago, StatisticalOutlier said:

I don't know what the "official" answer is, but I just logged in to my Medicare account and under "your plans" it has a box for Original Medicare that has Part A and Part B in it, a box for Drug Insurance (Part D) with SilverScript SmartSaver in it, and a box for Other Insurance that has Unitedhealth Group (my supplement).  Everything has a coverage start date of 5-1-22.

So Medicare does list supplements there.

However, I'm single, and this is the only place my coverage would show up.  I would think your supplement would show up on your own "your plans" page on the Medicare site and not on your husband's, even if United Healthcare considers you and your husband one account.  But I can't test that for you.

Considering your luck with phone reps, if I were you I'd give it another week or couple of weeks to show up in your Medicare account.  I assume that if United Healthcare says you have the supplement, then you have it.

Thanks for that.  I'm going to continue to monitor the site to see if it shows up after a week or so, like you suggested.  I am LOL that you see how bad my luck is with phone reps.!  If you think that's bad, my luck with shopping carts in supermarkets is even worse - Every one a clunker with a shaky wheel or worse!  LOL  You can't make this stuff up!

[shapeshifter]

It's that time of year again when all those OTA TV stations are hollering about the December 7 deadline to sign up for Medicare Advantage plans. 

That's true. 

But if you already have a Medicare Advantage plan, you can also switch plans January 1 - March 31.

[Yeah No]

53 minutes ago, shapeshifter said:

It's that time of year again when all those OTA TV stations are hollering about the December 7 deadline to sign up for Medicare Advantage plans. 

That's true. 

But if you already have a Medicare Advantage plan, you can also switch plans January 1 - March 31.

Is that only for Advantage plans or for regular supplemental plans too?

[shapeshifter]

3 hours ago, Yeah No said:

Is that only for Advantage plans or for regular supplemental plans too?

If I understood correctly, you'd have to already have an Advantage plan to make changes during the Jan. 1 - Mar. 31 timeframe. 

So, in theory, you could switch to any Advantage plan between now and Dec. 7, and then between Jan. 1 and Mar. 31 you could either switch back to your original plan or go to some other. 
But any changes made during the current open enrollment period of Oct-Dec 7 would not take effect until Jan. 1.

This was information from calling Medicare. 

[Yeah No]

12 hours ago, shapeshifter said:

If I understood correctly, you'd have to already have an Advantage plan to make changes during the Jan. 1 - Mar. 31 timeframe. 

So, in theory, you could switch to any Advantage plan between now and Dec. 7, and then between Jan. 1 and Mar. 31 you could either switch back to your original plan or go to some other. 
But any changes made during the current open enrollment period of Oct-Dec 7 would not take effect until Jan. 1.

This was information from calling Medicare. 

Right, I got that part of it.  I'm asking if the timeframe to change plans between Jan 1 and Mar. 31  also applies to the regular supplemental plans in addition to the Advantage plans.  The two types of plans are different.  I have AARP/United Healthcare Plan G, not an Advantage plan.  I have no desire to switch from that to a different plan, but I also have a stand alone prescription plan which I do want to switch because suddenly the premiums are going way up in 2024 for reasons I don't fully understand.  I just want to know if I can delay switching to the later timeframe.  I can always ask my Medicare counselor - I have a phone appointment with him scheduled for Dec. 1.

[shapeshifter]

7 hours ago, Yeah No said:

Right, I got that part of it.  I'm asking if the timeframe to change plans between Jan 1 and Mar. 31  also applies to the regular supplemental plans in addition to the Advantage plans.  The two types of plans are different.  I have AARP/United Healthcare Plan G, not an Advantage plan.  I have no desire to switch from that to a different plan, but I also have a stand alone prescription plan which I do want to switch because suddenly the premiums are going way up in 2024 for reasons I don't fully understand.  I just want to know if I can delay switching to the later timeframe.  I can always ask my Medicare counselor - I have a phone appointment with him scheduled for Dec. 1.

Definitely keep that appointment.
My notes show that you should be able to switch from one D to another Jan 1 - Mar 31, but I currently have an Advantage plan, so I may have not paid close attention to that part. 
Let us know what they say!

 

BTW, I just✱ called this Medicare number from the Medicare website when I was logged into Medicare: 
(800) 633-4277
It was just last Saturday and I didn't have an appointment. 
But the person I spoke to was part-angel, part-grief-counselor, but also deeply knowledgeable about Medicare. She had it down pat, so she wasn't looking stuff up and was focusing on my responses and questions.
She was willing and able to transfer me to a specialist/advisor, but I just kept asking her questions because she was who she was. ❣️

✱This is only my second year since breaking up with my former employer's po$t-retirement benefit in$urance

Edited November 21, 2023 by shapeshifter

[Yeah No]

17 hours ago, shapeshifter said:

Definitely keep that appointment.
My notes show that you should be able to switch from one D to another Jan 1 - Mar 31, but I currently have an Advantage plan, so I may have not paid close attention to that part. 
Let us know what they say!

Thanks, I will.  Right now this is the most important appointment on my calendar.

[StatisticalOutlier]

On 11/21/2023 at 3:29 AM, Yeah No said:

I'm asking if the timeframe to change plans between Jan 1 and Mar. 31  also applies to the regular supplemental plans in addition to the Advantage plans. 

No it doesn't, but supplements can be changed at any time of the year (but very important caveats on that below).

The open enrollment period at the beginning of the year is called "Medicare Advantage Open Enrollment" and the only people who can participate in it are people who are already on an Advantage plan: they can switch Advantage plans and they can switch from Advantage to traditional Medicare.  They can buy a Part D prescription drug plan if they switch from an Advantage plan with drug coverage to an Advantage plan without drug coverage, or if they switch from an Advantage plan to traditional Medicare (traditional Medicare never includes drug coverage--anyone with traditional Medicare must buy a Part D drug plan if they want drug coverage).

The open enrollment period we're currently in is called "Open enrollment," and it applies to everybody on Medicare.  You can do pretty much anything--switch from traditional Medicare to Advantage, switch from Advantage to traditional Medicare, switch from one Advantage plan to another, and (to answer your question) switch (or sign up for) Part D drug plans.  If a person on traditional Medicare wants to switch their Part D drug plan, it can only be done during Fall open enrollment period we're currently in.

Notice I didn't say anything about supplements (which you said you don't want to change).  But FYI, supplements can be changed at any time of the year.  HOWEVER, in most states, the only time you have guaranteed issue rights to a supplement is in your initial enrollment period (when you turn 65). 

Therein lies the rub.  In most states, once your initial enrollment period has passed, and you no longer have guaranteed-issue rights, supplements can refuse to accept you based on your medical condition (by doing "medical underwriting").  So while supplements CAN be switched at any time of the year, you might be unable to switch because no other supplement will accept you.

The same thing applies to people on Advantage--during either open enrollment period they have an absolute right to switch from Advantage to traditional Medicare.  But if they want a supplement, they will have to pass medical underwriting.  They can choose have traditional Medicare without a supplement, but if they do, they will be responsible for the 20% of charges Medicare doesn't pay, stiff copays on hospitalization, with no out-of-pocket limit.

Back to switching Part D--I posted upthread about changing my friend's Part D plan (his broker said he was too busy to do it for him (but he's happy to collect a continuing commission on the drug plan he sold him in the past), and my friend is too computer illiterate to do it himself).  Basically, log into your Medicare account and list all the drugs you're taking (it'll be saved in your account so you just need to update it in the future), and get quotes for Part D plans.  The number cruncher will tell you which plan is cheapest, taking into account the premium, deductible, and cost of drugs you're currently taking.

That's about the best you can do, since the plan it selects is based only your current drugs, and obviously can't include drugs you don't know yet that you'll be prescribed next year.  The plan that is the best for the drugs you're currently on might actually be the worst for some expensive drug you get prescribed next June, but there's nothing you can do about it.  It's a terrible, awful, ridiculous system but it's what we have. 

Medicare for all!!

[Yeah No]

On 11/24/2023 at 11:31 AM, StatisticalOutlier said:

No it doesn't, but supplements can be changed at any time of the year (but very important caveats on that below).

The open enrollment period at the beginning of the year is called "Medicare Advantage Open Enrollment" and the only people who can participate in it are people who are already on an Advantage plan: they can switch Advantage plans and they can switch from Advantage to traditional Medicare.  They can buy a Part D prescription drug plan if they switch from an Advantage plan with drug coverage to an Advantage plan without drug coverage, or if they switch from an Advantage plan to traditional Medicare (traditional Medicare never includes drug coverage--anyone with traditional Medicare must buy a Part D drug plan if they want drug coverage).

The open enrollment period we're currently in is called "Open enrollment," and it applies to everybody on Medicare.  You can do pretty much anything--switch from traditional Medicare to Advantage, switch from Advantage to traditional Medicare, switch from one Advantage plan to another, and (to answer your question) switch (or sign up for) Part D drug plans.  If a person on traditional Medicare wants to switch their Part D drug plan, it can only be done during Fall open enrollment period we're currently in.

Notice I didn't say anything about supplements (which you said you don't want to change).  But FYI, supplements can be changed at any time of the year.  HOWEVER, in most states, the only time you have guaranteed issue rights to a supplement is in your initial enrollment period (when you turn 65). 

Therein lies the rub.  In most states, once your initial enrollment period has passed, and you no longer have guaranteed-issue rights, supplements can refuse to accept you based on your medical condition (by doing "medical underwriting").  So while supplements CAN be switched at any time of the year, you might be unable to switch because no other supplement will accept you.

The same thing applies to people on Advantage--during either open enrollment period they have an absolute right to switch from Advantage to traditional Medicare.  But if they want a supplement, they will have to pass medical underwriting.  They can choose have traditional Medicare without a supplement, but if they do, they will be responsible for the 20% of charges Medicare doesn't pay, stiff copays on hospitalization, with no out-of-pocket limit.

Back to switching Part D--I posted upthread about changing my friend's Part D plan (his broker said he was too busy to do it for him (but he's happy to collect a continuing commission on the drug plan he sold him in the past), and my friend is too computer illiterate to do it himself).  Basically, log into your Medicare account and list all the drugs you're taking (it'll be saved in your account so you just need to update it in the future), and get quotes for Part D plans.  The number cruncher will tell you which plan is cheapest, taking into account the premium, deductible, and cost of drugs you're currently taking.

That's about the best you can do, since the plan it selects is based only your current drugs, and obviously can't include drugs you don't know yet that you'll be prescribed next year.  The plan that is the best for the drugs you're currently on might actually be the worst for some expensive drug you get prescribed next June, but there's nothing you can do about it.  It's a terrible, awful, ridiculous system but it's what we have. 

Medicare for all!!

Thank you so much, SO!  I tried a few drug combinations in that online thingy to try to figure out what might be jacking up the premium but it still came up that high which is a head scratcher for sure.  I'm only down for 3 medications and one of them is tier 2 but even taking that out didn't change the higher premium.  And neither did taking any of the others out.  I still can't figure it out.

[shapeshifter]

2 hours ago, Yeah No said:

Thank you so much, SO!  I tried a few drug combinations in that online thingy to try to figure out what might be jacking up the premium but it still came up that high which is a head scratcher for sure.  I'm only down for 3 medications and one of them is tier 2 but even taking that out didn't change the higher premium.  And neither did taking any of the others out.  I still can't figure it out.

The Advantage plans include a drug benefit. 
🤔

[Yeah No]

2 hours ago, shapeshifter said:

The Advantage plans include a drug benefit. 
🤔

Yup, I know but I prefer a supplemental plan.  Also, my husband's boss pays our premiums in lieu of not offering health insurance.  I could just let him pay the $72 a month for my prescription plan but I don't think that would be fair, although I'm not making any changes before talking to my Medicare counselor.  I trust his advice.

[StatisticalOutlier]

5 hours ago, Yeah No said:

I'm only down for 3 medications and one of them is tier 2 but even taking that out didn't change the higher premium.  And neither did taking any of the others out.  I still can't figure it out.

I have a friend with six drugs, and I was trying to find out why the annual cost (drug plus premium) varied so greatly depending on the plan.

Have you been entering pharmacies for price comparisons?  That's giving me some good information.  For my friend in Austin, I select H-E-B, CVS, Walgreens, Walmart, and Safeway, just to get the data.  Then in the list of plans where it has for each plan the premium and the yearly cost of premium + drugs, I LEFT click on either "view drugs and their costs" or "plan details" for a given plan.  (Left-clicking to open in a new tab doesn't go to the correct place.)

That brings up what each drug costs at each pharmacy I've selected, and I can kind of track the drugs across various pharmacies to get a feel for what's going on.  It's been real helpful for me to understand the landscape.  I'm not sure where you're hitting the roadblock.

Also, you said "premium" but did you mean "premium plus drug costs?"  I have found that the amount of the premium has little correlation to what will the the cheapest or most expensive when totaling the annual premium plus drug costs, so I barely even look at the premium.

[StatisticalOutlier]

4 hours ago, shapeshifter said:

The Advantage plans include a drug benefit. 

Some do, but they don't have to.  If they don't have a drug benefit, you can either just go without drug coverage or buy a drug plan under Part D.

Since you're in one of the states where there are periods during the year when people can get a supplement without undergoing medical underwriting, joining an Advantage plan keeping in the back of your mind the possibility of switching to traditional Medicare if your health gets really bad isn't as fraught as it is in some states. 

There are still only two periods during the year when a person (regardless of what state they're in) can change from Advantage to traditional Medicare, so if you're diagnosed with something in April that would be better handled with traditional Medicare, you can't switch until the next January at the earliest.

But if you're in a state that has no guaranteed-issue rights for supplements after your initial enrollment period, it's possible whatever you have been diagnosed with will prevent you from buying a supplement (and if you do get approved for one, it can be more expensive because of your condition), which could act as a de facto bar to switching away from the Advantage plan.

It's something people in states without guaranteed issue rights have to keep in mind.

[shapeshifter]

On 11/26/2023 at 11:55 AM, StatisticalOutlier said:

Since you're in one of the states where there are periods during the year when people can get a supplement without undergoing medical underwriting, joining an Advantage plan keeping in the back of your mind the possibility of switching to traditional Medicare if your health gets really bad isn't as fraught as it is in some states. 

There are still only two periods during the year when a person (regardless of what state they're in) can change from Advantage to traditional Medicare, so if you're diagnosed with something in April that would be better handled with traditional Medicare, you can't switch until the next January at the earliest.

Yes, it was a big relief to realize I don't have to decide to switch to "traditional Medicare" from my Advantage plan until Jan-March of 2024. 

I just got the all clear on my follow-up mammo and ultrasound, but still need to get my CEA blood test done (planning for this week) to detect a return of colon cancer that wasn't caught by the colonoscopy earlier this year — a very remote possibility. 

ETA: CEA results were fine.

Up next: Hearing.

Edited November 28, 2023 by shapeshifter

[Yeah No]

On 11/26/2023 at 11:47 AM, StatisticalOutlier said:

I have a friend with six drugs, and I was trying to find out why the annual cost (drug plus premium) varied so greatly depending on the plan.

Have you been entering pharmacies for price comparisons?  That's giving me some good information.  For my friend in Austin, I select H-E-B, CVS, Walgreens, Walmart, and Safeway, just to get the data.  Then in the list of plans where it has for each plan the premium and the yearly cost of premium + drugs, I LEFT click on either "view drugs and their costs" or "plan details" for a given plan.  (Left-clicking to open in a new tab doesn't go to the correct place.)

That brings up what each drug costs at each pharmacy I've selected, and I can kind of track the drugs across various pharmacies to get a feel for what's going on.  It's been real helpful for me to understand the landscape.  I'm not sure where you're hitting the roadblock.

Also, you said "premium" but did you mean "premium plus drug costs?"  I have found that the amount of the premium has little correlation to what will the the cheapest or most expensive when totaling the annual premium plus drug costs, so I barely even look at the premium.

Yes, I was entering the pharmacies too.  Ironically the name of the plan is the AARP/United Healthcare "Walgreens" plan but the copay at CVS was the same as at Walgreens for all 3 drugs so there was no advantage to going to Walgreens just because it was in the title.

My husband's boss is paying the monthly premium alone, not the copays when I fill a prescription.  But get this - I was identified as "low income" by the government given that I don't have a job and I'm only collecting a small pension and annuity at this point.  I'm putting off collecting SS until I'm of full retirement age, which for me is 66 and 8 months (I'm 65 and 3 months).  I'm also putting off collecting other retirement money rolled over from my 401Ks, etc.  So because of that I can't be charged more than $1.45 for ANY prescription!  And it doesn't matter how much money my husband makes, either.  I confirmed that with my medicare counselor.

Speaking of my medicare counselor, he advised me not to change my prescription plan because he said the gov't. is tricky and I would likely give up my low income designation (I forget what he called it).  He was very adamant that I shouldn't change my plan until I absolutely have to and I figure he knows what he's talking about.  And I don't think my husband's boss would complain about it either.   Another $30 a month to him is like another 3 cents to me.  Maybe even less!

The counselor looked at everything online about the plan and said there are so many factors that might bump up a monthly premium amount that he couldn't even figure out why it happened from the information he had access to.  So he said not to fret over it and just be happy I got this much coveted low income status from the gov't. for at least another year and a half.  He said when the time comes it will be OK to change my prescription plan.

I'm lucky to have found this guy.  He's the best I've dealt with so far and very easy to talk to.  He's a keeper!

 

[Salacious Kitty]

I have to start the process for my husband next August. Where do I begin? How do I find supplemental plans? Part D? I'm overwhelmed just reading this thread! 

[StatisticalOutlier]

14 hours ago, Salacious Kitty said:

I have to start the process for my husband next August. Where do I begin? How do I find supplemental plans? Part D? I'm overwhelmed just reading this thread! 

Eh, just watch a bunch of youtube videos. 

If you're not overwhelmed when starting Medicare, you're not doing it right, and you're definitely not making an informed decision.  As I noted upthread, there are untold numbers of people who don't know there are two types of Medicare to choose from (traditional vs. Advantage), and therefore don't even understand what they have.  It's a crime.

The first order of business is what state you're in.  There's a lot of consistency among states when it comes to Medicare EXCEPT when it comes to supplement/medigap policies.  The state you live in can affect how you approach the decision to keep original Medicare (with a supplement) or to get an Advantage plan.

Part D is a mess, but actually kind of easy to choose.  You go to the Medicare website and go to the section where you look for Part D plans.  You don't have to set up an account or enter any personal information except your zip code.

You enter the drugs you take, and pick pharmacies you might use, and the website will spit out all the Part D plans available to you, with the cost for the next year, taking into account premium + drug costs.  But be sure to drill a little further to see which pharmacy the amount they're giving you applies to. 

The friend I do this for could get a plan that would be $120 a year for his premium and six drugs (what a deal!) BUT that price is applicable only if he goes to Walmart, and there was no indication of that until I drilled further down.  The website just gave me the name of the drug plan and $120.

He likes his guy at Walgreens, so he's going to stick with his current plan, which will cost him $500 a year.

But of course all of this is based only on the drugs he knows he takes.  Nobody can predict what they will be prescribed in the upcoming year, so all of this is actually an enormous crapshoot.  But it's what we have, so we deal with it.

One thing to know is that your husband should sign up for a Part D drug plan or get an Advantage plan with prescription drug coverage when he becomes eligible for Medicare, because if he doesn't and later wants to get drug coverage, he'll pay a penalty for the rest of his life based on how long he went without it.

I don't take any drugs so I just got the cheapest one, for $6.60/month.  I'm switching for next year, to one that is 50¢/month.  It's $0 in a lot of areas.

I think this is the one I've heard has terrible coverage for brand name drugs, which will be a definite drag if there's no generic for a drug I'm prescribed.  And I've heard that the reason they offer this super-low-premium plan is so you're a customer, and they can market Advantage plans to you and not be cold-calling.

But since I don't take any drugs I'm flying totally blind when it comes to Part D, so I'm going with the cheapest and hoping for the best.  Actually, that's actually what people who do take maintenance drugs do, too--they find the cheapest (premium + drug cost) for what they know they will be taking at the pharmacy they want to use, and hope for the best on what happens in the future.

It's a horrible horrible system. 

[Salacious Kitty]

Thanks for the information. Clear as mud, eh? 

[shapeshifter]

5 hours ago, StatisticalOutlier said:

One thing to know is that your husband should sign up for a Part D drug plan or get an Advantage plan with prescription drug coverage when he becomes eligible for Medicare, because if he doesn't and later wants to get drug coverage, he'll pay a penalty for the rest of his life based on how long he went without it.

I'm pretty sure when I signed up about a year ago that I was told chemotherapy drugs are not part of a Part D or Advantage drug plan; chemotherapy is covered more like regular medical procedures.

But if you've had cancer, it is a "pre-existing condition" for Medicare, unlike other health insurances that no longer penalize people for having had cancer.

So I feel I need to have either a Medicare Advantage (also known as Part C) plan, which requires paying for Part B, or I can (I think?) skip the Advantage Plan and pay for "original" Medicare Parts B, G, and D?
But, yeah:

16 minutes ago, Salacious Kitty said:

Clear as mud

 

 

[Yeah No]

23 hours ago, Salacious Kitty said:

I have to start the process for my husband next August. Where do I begin? How do I find supplemental plans? Part D? I'm overwhelmed just reading this thread! 

When I started this process, which was only several months ago, I was in the same boat.  Head swimming and more confused by the minute.  What really helped more than anything was talking to friends who've already been there and done that.  Their info. and advice was invaluable.  If you can start off with that, it can be a big help.

I also compared plans on the Medicare site, which really helped too.  You have to open an account with them which you'll need anyway, but it has a function where you can compare plans side by side.  I know there are a few websites that do this too but I haven't used them.

Also, a friend sent me this link to the YouTube channel for Medicareschool.com.  I didn't use their Medicare advising service but their free videos really helped answer a lot of my questions.  The guy seems like a huckster but he's really not and he tells it to you straight!

https://www.youtube.com/@MedicareSchool

I also googled on big questions like "what's the difference between an Advantage plan and a supplemental plan?"  Or "How do I decide between an Advantage plan and a supplemental plan?"  That helped too.

Anyway, that's what helped for me!https://www.googleadservices.com/pagead/aclk?sa=L&ai=DChcSEwjV3vrR-fSCAxWPSEcBHVPBDTIYABAAGgJxdQ&ase=2&gclid=Cj0KCQiA67CrBhC1ARIsACKAa8Ra08NjLW8-ich0n9KQV2S8nhOB3lWZ-hPMzjllphiWMDx3cqcDTvIaApcpEALw_wcB&ohost=www.google.com&cid=CAESVuD2cMfavURhS7NOr8fkMx5BNdf9Ubr0rrAB4Lmn7v8gDV4ceyICamYNqVUObwqqyf6m3w7OBhuKqYIqEbfq5qRJ5P4JnI63hiyf4UQa2oqJsyWusuip&sig=AOD64_2s7FEVbdv5sMBky6LzHRJAEMxKQA&q&nis=4&adurl&ved=2ahUKEwii2vTR-fSCAxW5vokEHb2iC0UQ0Qx6BAgKEAEhttps://www.googleadservices.com/pagead/aclk?sa=L&ai=DChcSEwjV3vrR-fSCAxWPSEcBHVPBDTIYABAAGgJxdQ&ase=2&gclid=Cj0KCQiA67CrBhC1ARIsACKAa8Ra08NjLW8-ich0n9KQV2S8nhOB3lWZ-hPMzjllphiWMDx3cqcDTvIaApcpEALw_wcB&ohost=www.google.com&cid=CAESVuD2cMfavURhS7NOr8fkMx5BNdf9Ubr0rrAB4Lmn7v8gDV4ceyICamYNqVUObwqqyf6m3w7OBhuKqYIqEbfq5qRJ5P4JnI63hiyf4UQa2oqJsyWusuip&sig=AOD64_2s7FEVbdv5sMBky6LzHRJAEMxKQA&q&nis=4&adurl&ved=2ahUKEwii2vTR-fSCAxW5vokEHb2iC0UQ0Qx6BAgKEAEhttps://www.googleadservices.com/pagead/aclk?sa=L&ai=DChcSEwjV3vrR-fSCAxWPSEcBHVPBDTIYABAAGgJxdQ&ase=2&gclid=Cj0KCQiA67CrBhC1ARIsACKAa8Ra08NjLW8-ich0n9KQV2S8nhOB3lWZ-hPMzjllphiWMDx3cqcDTvIaApcpEALw_wcB&ohost=www.google.com&cid=CAESVuD2cMfavURhS7NOr8fkMx5BNdf9Ubr0rrAB4Lmn7v8gDV4ceyICamYNqVUObwqqyf6m3w7OBhuKqYIqEbfq5qRJ5P4JnI63hiyf4UQa2oqJsyWusuip&sig=AOD64_2s7FEVbdv5sMBky6LzHRJAEMxKQA&q&nis=4&adurl&ved=2ahUKEwii2vTR-fSCAxW5vokEHb2iC0UQ0Qx6BAgKEAE

[StatisticalOutlier]

19 hours ago, shapeshifter said:

So I feel I need to have either a Medicare Advantage (also known as Part C) plan, which requires paying for Part B, or I can (I think?) skip the Advantage Plan and pay for "original" Medicare Parts B, G, and D?

G isn't a "part" of Medicare.  Medicare's parts are Part A (hospitalization insurance), Part B (medical insurance), and Part D (prescription drug coverage. 

It's a good idea to buy a supplement/medigap policy to pay your share of Part A & B charges if you choose traditional fee-for-service Medicare.  Supplements are plans, not parts.  But in the vast majority of states they're identified by letters, so it's confusing.  They come in letters A-N.  The majority of supplement buyers turning 65 get Plan G.  Other common choices are a high-deductible Plan G, or Plan N.

The other "part" of Medicare is Advantage, or Part C.  It is a managed care substitute for fee-for-service Parts A & B under traditional Medicare.  Some Advantage plans include prescription drug coverage, but some don't; for those that don't, if you want drug coverage you have to buy a standalone Part D plan.

My advice is always that if you can afford it, get traditional Medicare and a Plan G supplement; this is the most comprehensive and easiest to deal with choice.  It's also the most expensive. 

And add to that whatever Part D drug plan suits your drug needs, knowing that Part D is a huge crapshoot no matter what you do because you're not a fortune teller.

16 hours ago, Yeah No said:

What really helped more than anything was talking to friends who've already been there and done that.  Their info. and advice was invaluable.  If you can start off with that, it can be a big help.

https://www.googleadservices.com/pagead/aclk?sa=L&ai=DChcSEwjV3vrR-fSCAxWPSEcBHVPBDTIYABAAGgJxdQ&ase=2&gclid=Cj0KCQiA67CrBhC1ARIsACKAa8Ra08NjLW8-ich0n9KQV2S8nhOB3lWZ-hPMzjllphiWMDx3cqcDTvIaApcpEALw_wcB&ohost=www.google.com&cid=CAESVuD2cMfavURhS7NOr8fkMx5BNdf9Ubr0rrAB4Lmn7v8gDV4ceyICamYNqVUObwqqyf6m3w7OBhuKqYIqEbfq5qRJ5P4JnI63hiyf4UQa2oqJsyWusuip&sig=AOD64_2s7FEVbdv5sMBky6LzHRJAEMxKQA&q&nis=4&adurl&ved=2ahUKEwii2vTR-fSCAxW5vokEHb2iC0UQ0Qx6BAgKEAEhttps://www.googleadservices.com/pagead/aclk?sa=L&ai=DChcSEwjV3vrR-fSCAxWPSEcBHVPBDTIYABAAGgJxdQ&ase=2&gclid=Cj0KCQiA67CrBhC1ARIsACKAa8Ra08NjLW8-ich0n9KQV2S8nhOB3lWZ-hPMzjllphiWMDx3cqcDTvIaApcpEALw_wcB&ohost=www.google.com&cid=CAESVuD2cMfavURhS7NOr8fkMx5BNdf9Ubr0rrAB4Lmn7v8gDV4ceyICamYNqVUObwqqyf6m3w7OBhuKqYIqEbfq5qRJ5P4JnI63hiyf4UQa2oqJsyWusuip&sig=AOD64_2s7FEVbdv5sMBky6LzHRJAEMxKQA&q&nis=4&adurl&ved=2ahUKEwii2vTR-fSCAxW5vokEHb2iC0UQ0Qx6BAgKEAEhttps://www.googleadservices.com/pagead/aclk?sa=L&ai=DChcSEwjV3vrR-fSCAxWPSEcBHVPBDTIYABAAGgJxdQ&ase=2&gclid=Cj0KCQiA67CrBhC1ARIsACKAa8Ra08NjLW8-ich0n9KQV2S8nhOB3lWZ-hPMzjllphiWMDx3cqcDTvIaApcpEALw_wcB&ohost=www.google.com&cid=CAESVuD2cMfavURhS7NOr8fkMx5BNdf9Ubr0rrAB4Lmn7v8gDV4ceyICamYNqVUObwqqyf6m3w7OBhuKqYIqEbfq5qRJ5P4JnI63hiyf4UQa2oqJsyWusuip&sig=AOD64_2s7FEVbdv5sMBky6LzHRJAEMxKQA&q&nis=4&adurl&ved=2ahUKEwii2vTR-fSCAxW5vokEHb2iC0UQ0Qx6BAgKEAE

One problem with that tactic is that a whole lot of people don't actually know what they have, or just took someone's advice.

If someone says they have traditional Medicare with a supplement, ask them why they didn't get an Advantage plan, just to see if they know the difference.  And ask them the type of supplement (e.g. Plan G or Plan N), to be sure they're not confusing supplements and Advantage plans (Advantage plans offer "extra" benefits that some people could mistakenly think are a "supplement" to Medicare).

If someone has an Advantage plan, ask them why they chose that instead of traditional Medicare, and more importantly, ask if they know of any possible disadvantages of Advantage plans.  If they don't, then they might not know how their Advantage plan actually works, and therefore didn't make a truly informed decision.

[EtheltoTillie]

@shapeshifter why do you think Medicare has a preexisting condition restriction?  Or are you talking about underwriting for supplements?  

[shapeshifter]

9 minutes ago, EtheltoTillie said:

@shapeshifter why do you think Medicare has a preexisting condition restriction?

Because older people tend to have more expensive medical needs, and Medicare does not have any younger (read my lips: healthier) people to balance those expenses. Right?  

Hrmmm. I guess this is why there's a movement among some folks to have "Medicare for All." 

 

11 minutes ago, EtheltoTillie said:

Or are you talking about underwriting for supplements?  

Say what, now? 
🤣
Paging Dr. @StatisticalOutlier!

[EtheltoTillie]

1 hour ago, shapeshifter said:

Because older people tend to have more expensive medical needs, and Medicare does not have any younger (read my lips: healthier) people to balance those expenses. Right?  

Hrmmm. I guess this is why there's a movement among some folks to have "Medicare for All." 

 

Say what, now? 
🤣
Paging Dr. @StatisticalOutlier!

So this was something you assumed existed?  If so, then no, there is no preexisting conditions limit for basic Medicare. There is sometimes a problem with underwriting for supplements for people who are not in a guarantee issue period.  

Medicare for all?  I always laugh at that because people who don’t understand Medicare think Medicare for all would be a freebie with no copays and so on. 

[StatisticalOutlier]

3 hours ago, EtheltoTillie said:

@shapeshifter why do you think Medicare has a preexisting condition restriction?  Or are you talking about underwriting for supplements?  

I'm talking about underwriting for supplements.  You're in New York, which prohibits medical underwriting, but that's the exception. 

I have a friend who's on a Plan F, and would come out ahead if he switched to Plan G even though he'd have to start paying the Part B deductible, because the premium is that much lower.  However, he's in Texas, where they allow medical underwriting after the initial enrollment period, and he can't pass.  And since Plan F doesn't accept new (younger) enrollees, the population on his plan is going to get older, making for even higher premiums to make up for the increased healthcare costs.  He's stuck.

And I've read reports of people who have a Mutual of Omaha supplement and have experienced a spike in the premium due to closing the book but they can't pass underwriting and are stuck with it.  

It's something people in states without guaranteed-issue periods need to be aware of. 

[Yeah No]

7 hours ago, StatisticalOutlier said:

One problem with that tactic is that a whole lot of people don't actually know what they have, or just took someone's advice.

If someone says they have traditional Medicare with a supplement, ask them why they didn't get an Advantage plan, just to see if they know the difference.  And ask them the type of supplement (e.g. Plan G or Plan N), to be sure they're not confusing supplements and Advantage plans (Advantage plans offer "extra" benefits that some people could mistakenly think are a "supplement" to Medicare).

If someone has an Advantage plan, ask them why they chose that instead of traditional Medicare, and more importantly, ask if they know of any possible disadvantages of Advantage plans.  If they don't, then they might not know how their Advantage plan actually works, and therefore didn't make a truly informed decision.

Oh for sure, but I guess I factor in that I can usually spot people that don't know what they're talking about and I'm fortunate enough to have a couple of knowledgeable friends that were willing to share their experiences and advice.  Both of them came to me with why they chose a supplemental plan over an Advantage plan.  Actually both of them started off with an Advantage plan and then switched so they were able to tell me based on their own trial and error why a supplemental worked better for them.  The fact that both of them live close to me also helped since plans can vary by location.  Also both of them highly recommended plan G and gave me reasons for that based on their experience there too.  They both started with cheaper plans and went through a list of reasons why for them plan G was a better choice.  And neither of them know each other so hearing them say similar things also helped.  Of course both of them also told me that what worked for them might not be the best choice for us, but given that I have seen my share of medical issues in the past several years and that my husband is a diabetic, plus the fact that his boss is paying our Medicare part A and B premiums, we saw no reason not to take their advice into consideration.  What they told us was really a springboard for us doing more of our own research and then armed with that we made our final decision.  By the time we called the Medicare counselor we basically knew what we were going to do, although his advice echoed what we had already learned for ourselves so it only made us more secure in our final decision.  He did give us the most help with choosing a prescription plan, though.

[StatisticalOutlier]

On 12/4/2023 at 8:13 PM, EtheltoTillie said:

@shapeshifter why do you think Medicare has a preexisting condition restriction?  Or are you talking about underwriting for supplements?  

Do you remember what it is I said that made you think I thought Medicare has a pre-existing condition restriction?  If I still can, I'll edit it.  But if it's too late for that, I can change the way I word things going forward. 

[EtheltoTillie]

54 minutes ago, StatisticalOutlier said:

Do you remember what it is I said that made you think I thought Medicare has a pre-existing condition restriction?  If I still can, I'll edit it.  But if it's too late for that, I can change the way I word things going forward. 

This was not from your postings.  This was something @shapeshifter had a misconception about. She somehow thought Medicare had a restriction.   This is cleared up now. 

Edited December 6, 2023 by EtheltoTillie

[shapeshifter]

30 minutes ago, EtheltoTillie said:

This was not from your postings.  This was something @shapeshifter had a misconception about. She somehow thought Medicare had a restriction.   This is cleared up now. 

Not for me. 😞
But no worries. I think I'm paying the lowest I can without running into too much financial trouble if I get cancer again. 

[partofme]

Is this thread just about Medicare or insurance in general?   I was wondering if anyone has ever had Cobra, and if it is worth the $800 a month (plus extra if I want vision or dental) that I would have to pay?   I have until April 29 to decide and I’m hoping to have a job by then but I’m currently without insurance and it’s scary.  

[shapeshifter]

1 hour ago, partofme said:

Is this thread just about Medicare or insurance in general?   I was wondering if anyone has ever had Cobra, and if it is worth the $800 a month (plus extra if I want vision or dental) that I would have to pay?   I have until April 29 to decide and I’m hoping to have a job by then but I’m currently without insurance and it’s scary.  

Since the thread title includes "…and other insurances…," yes, this is the place.

However, so far I think you're the first person asking specifically about Cobra insurance. 

You might contact the HealthCare.gov people to at least point you in the right direction: https://localhelp.healthcare.gov/

[Bastet]

It was more common for people to need to suck it up and pay the high cost of COBRA before the ACA, for example if pre-existing conditions would keep them from being able to purchase an individual plan.  These days, you're more likely to find something more affordable that will still suit your needs until your next employer-provided group health plan comes along rather than paying a steep price for the continuity COBRA provides.

In deciding, one big thing to look at is your deductible, if you have one, as if you're close to meeting it or have already met it, COBRA could wind up being the cheaper choice than starting fresh with a new plan.  But since it's only March, that's probably not an issue.

Lots of personal factors go into deciding, of course, but every report I've come across says the majority of people eligible for COBRA elect not to utilize it. 

[Yeah No]

3 hours ago, Bastet said:

It was more common for people to need to suck it up and pay the high cost of COBRA before the ACA, for example if pre-existing conditions would keep them from being able to purchase an individual plan.  These days, you're more likely to find something more affordable that will still suit your needs until your next employer-provided group health plan comes along rather than paying a steep price for the continuity COBRA provides.

In deciding, one big thing to look at is your deductible, if you have one, as if you're close to meeting it or have already met it, COBRA could wind up being the cheaper choice than starting fresh with a new plan.  But since it's only March, that's probably not an issue.

Lots of personal factors go into deciding, of course, but every report I've come across says the majority of people eligible for COBRA elect not to utilize it. 

I agree.  I advised a friend to do this and she saved a bundle.  She was just a year shy of going on Medicare and was going to go the COBRA route until I advised her to try the ACA.  Every time I've been offered COBRA I've declined it and it always turned out to be the best move.  In at least one case I was actually able to extend my previous medical coverage for a while with a cheaper premium but I forget now how that was possible.  In another case before the ACA my husband, who usually went on my health insurance because his employer's was more expensive, was able to cover both of us through his employer for about half of what it would cost if I went on COBRA.