Medicare options?

[Doug Elliott]

Like it or not, it's time for me to be thinking about Medicare.

Medigap or Medicare Advantage? Opinions appreciated. Also interested in opinions on dental, vision, and hearing coverage.
Any specific opinions or experience about companies, plans, etc?

[Posaunus]

Doug,

We have been VERY happy with a Medicare Advantage HMO plan. Much less expensive than a PPO, where we would have the same doctor and medical clinic in any case. Our cost: $0. (It's actually about $140/month, but that's taken out of our Social Security before we ever see it deposited in our bank account.) Covers just about everything (emergencies, referrals to specialists, hospitalizations, ...) at no additional cost. Prescriptions are generally very low cost or often free! Some of our friends are paying several hundred $/month for their PPO coverage for, as far as we can tell, no additional benefit.

We have an insurance agent friend, who specializes in Medicare, review the various plans each year and helps us select the "best" (for us). (There are some differences.) The situation in your state / region may differ, but the past several years ours been Blue Shield (a non-profit). Anything is better here in California than Blue Cross, which has been taken over by Anthem, for whom profit is everything, and service is secondary! We pay nothing for this advice – our agent gets a small commission (kickback?) directly from Medicare; his commission is the same no matter which HMO plan we select.

You must decide soon. Good luck!

[BGuttman]

I just used the Medicare.GOV site to see what drug plans were available. Turns out the one I've been using is the second best and only $2 more per month, so I'm not going through the hassle of change. Last year we found the current drug plan was WAY cheaper than the one I was on and I switched.

I've been using Banker's Life for supplemental coverage. Got good results. I have a plan with copays and given I have a lot of medical issues it's worked out well for me. My wife likes AARP's plan.

[Dennis]

Welcome to 65, Doug.

I had to do that last year. I'd recommend talking to a Medicare navigator. It's pretty confusing overall, and what is best depends on your personal situation. In my case, I had an employer plan, my wife's employer's plan, Medicare A/B/D, and Medicare Advantage. There are lots of gotchas.

First off, you'll get Medicare A whatever else you may choose (except Medicare Advantage). Medicare will be the first insurer for any hospital care you need.

In my case, the optimal solution was to stay on my wife's university plan and take Medicare A. If you have this route available to you, and you choose it, it's important to be sure that you can show that you have been covered continuously by a qualifying plan. That way, when it's time to move off her plan (because she is retiring or changing to a job with a less generous health care plan) you get another free shot at the A+B+D+Medigap or Advantage choice. If you can't show that, you pay a penalty for the rest of your life.

One other thing that the navigator can help you with is the income gotcha. Advantage and Parts B/D are pretty heavily subsidized by CMMS, unless you make too much money. That is determined by your AGI, so your pension income (if any) and your social security (again, if any) plus your earned income enter into the calculation. The worst part of it is that it's something like a 3 year look-back. If you get caught on that rock, you have to pay full freight for three years before you get to the subsidized status, assuming that it is your earned income that is putting you over the limit. If you are over the limit with pension+social security, you get to pay full freight forever. (It's kind of a mixed blessing: you have to have income to get caught on the rock. It's nice to have the money, but it's disappointing that you aren't catching the break on premiums.)

Generally speaking, I think Medicare Advantage plans tend to be better than A/B/D+Medigap, but you have to be certain that your current providers are in your insurer's network. One last thing: if you go the A/B/D route, do not consider the Medigap coverage optional. Plan on buying it and factor that into the cost/benefits.

[SteveFoote]

My wife and I have been using an Advantage Plan for several years and are very happy with it. There is no additional charge over the required medicare premium. It's a PPO rather than an HMO so I can see docs out of network with a higher copay. There are copays for everything but they are reasonable unless you end up going to a specialist like physical therapy several times a week for an extended period of time. Those visits are about $50 / session. Mine includes a dental reimbursement. I think the limit is $600 this year. I go to the dentist, collect the bills at the end of the year and submit them. In a few weeks I get a check. We take a variety of common drugs. At a "Preferred Pharmacy" some are free and most are under $15 for 90 days. I have one eye drop which is Tier 3. The retail cost is about $160 / mo. I pay a $200 annual ded. and then a $47 copay / mo. As long as your drugs are tier 1 or 2 they are cheap but this is an area that can catch you, particularly if you are taking a name brand. It also includes a pharmacy benefit. We can order from a selection of common over-the-counter items.
I looked at medigap and found it to be expensive. However, my sister, who is much older, has medigap. She got it before Advantage plans were available. She has had several falls and several cancer surgeries with some extended rehab facility stays. Her out-of-pocket costs have been minimal.
Advantage plans are moneymakers for the insurance companies so they market them heavily every year. A good time to ask questions is during annual enrollment. They will do everything they can to get you to sign up for their plan because they know that only a very small number of people will ever change once they sign up for a particular plan.

[baileyman]

I have not yet aged into these things, but I did recall some MA criticism:

https://www.eurasiareview.com/23112019- ... aarp-oped/

Personally I hope the situation becomes clear before I have to make a decision, though as a financial analyst the situation smells funny, like sub-prime mortgages or Sallie Mae.

[Cotboneman]

I'll be turning 65 in June, so I will be studying these options very carefully beginning in January. Whatever advice you can give to a divorced, retired guy is most welcome!

[BGuttman]

There are four "parts" to Medicare. The basic coverage is more or less catastrophic level -- hospitalization. I have a supplemental coverage (Part B) to help me pay for doctor visits and lab fees -- there are a bunch of different levels; I chose one with a copay comparable to the policy I had when I worked. There is a Part C to cover Medicare Gap (the lack of coverage when you exceed what Part B covers. Then there is the medicine Part D. Part D coverage varies between providers and changes each year. In November I get the new coverages for my Part D and compare my medicine costs with other providers. The savings can be substantial if your provider changes coverages.

I pay for Medicare (deducted from my Social Security), Part B (deducted from my bank account monthly), and my Part D (charged to my charge card).

People who think "Medicare for All" is free medical care have a mistaken opinion. It's not free, but it is a lot less than the COBRA fees I paid when I was laid off.

[Posaunus]

I've had a Medicare Advantage plan (HMO) for several years. Steered there by a qualified Medicare "counselor" (who is also an insurance agent). He reviews plans yearly, and helps us select the best for us.

Premium cost (~$140/month) is deducted from Social Security – and worth every penny. Services are administered by a non-profit insurer (Blue Shield of California). We've had a variety of medical issues and prescriptions, including several seamless referrals to high-quality specialists. Almost zero out-of-pocket expenses (No MD co-pays; one pricey drug - $140 every 3 months. Most others are less than $5 per Rx). Hospitalization free. Outpatient procedures free. Ambulance ride (if needed) $50. Great physicians in our HMO network and those we've been referred to.

Friends who have tried PPOs (higher premiums and co-pays, but you can go to any doctor) have not been quite so lucky, nor have those who have insured through for-profit companies. But it is certainly not as bad as fear-monger Ralph Nader would have you believe!

We are blessed.

[CharlieB]

Doug...
The options vary quite a bit from state to state.
I live near you in MD, and a few years ago I had to hack my way through the jungle of medical options for retirees.
I chose a Kaiser Permanente Advantage Plan. I am extremely happy with Kaiser.
Kaiser operates their own medical facilities to deal with all but the most serious problems, (One is in Silver Spring) and has no hesitation referring you to, paying for, and coordinating treatment at Johns Hopkins, University of MD, St. Agnes, Holy Cross, etc. for the really serious stuff.
I was at first uneasy about being required to select one of their doctors as my personal physician, but now I see the advantage to that. Kaiser also employs all the specialist doctors, and whether you've been to their endocrinologist, urologist, neurologist....whatever, they can all review your total health picture on their computers to coordinate treatment. On a typical visit, my doctor will get on the computer, review my entire medical history, schedule me for lab work, and enter a prescription for medicine at their in-house pharmacy. All in the same building. In and out. Done.
And the best thing.....I never have to deal directly with Medicare. All I need is my Kaiser card, and they deal with Medicare.

[Doug Elliott]

My parents used Kaiser (Kensington) and although I saw exactly what you mean, and a lot of things about it were nice, I also saw fatal incompetence for both of my parents.

[CharlieB]

Hmmmmm.
I'm very sorry to hear that.
I have had very competent care from Kaiser through some serious problems, but I can see why the memories of your parents' problems would always make you uncomfortable with Kaiser. I wish I had been more helpful. Good luck with your search.

[BGuttman]

I looked into HMO in New Hampshire but they did not include the physician I had been seeing for some 30 years. That's why I went the PPO route.

[Posaunus]

Apparently all such services depend on locality. Folks around here have very mixed opinions about Kaiser Permanente (in its home state). Some are happy; some are very displeased with the bureaucracy and inconsistent standards of care. We're much happier where our counselor (and some MD friends) sent us. And our regular physician was within the HMO umbrella!