Author Topic: Two months to decide on my Medicare plan  (Read 2340 times)

BTDretire

  • Magnum Stache
  • ******
  • Posts: 3077
Two months to decide on my Medicare plan
« on: January 02, 2020, 02:33:16 PM »
It time for me to decide on a Medicare plan. I now have a HDHP from BCBS with my family.
I'm guessing I will be removed from that plan and get my own Medicare plan.
Part A,
 I understand Part A is Hospital Insurance, skilled nursing, hospice and few other goodies and that
it comes with no charge to me.

Part B, Covers Certain Doctor Services, medical supplies and preventive care,
I left to talk with an agent--------
 ahh the heck with my understanding.
Did you go with a PPO or HMO, I'm in the Florida Panhandle.
Did you get and a Medicare advantage plan or a Medicare supplement plan
 I was told the advantage plan was an additional $47 and the supplement plan was $200+.
 But the only difference I could get from the agent was if I needed chemo it would cost a lot more with the Advantage Plan.

Another Reader

  • Walrus Stache
  • *******
  • Posts: 5236
Re: Two months to decide on my Medicare plan
« Reply #1 on: January 02, 2020, 04:45:12 PM »
You might find more help from people your age with similar concerns over at early-retirement.org.

I would not touch an Advantage plan.  You hand over all medical decisions to an insurance company.  Most are HMO's with limited networks and no coverage out of state except for emergencies.
Many of the best medical centers in the country - MD Anderson cancer center for one - do not take Advantage plans.  There are substantial out of pocket expenses if you require surgery or other treatment. 

If you are shopping, a lot of people over at early-retirement.org use Boomer Benefits to shop for them.  They are a consumer-oriented insurance agency with a wide range of plans to choose from.  If you have an HRA through your retirement plan, you may be required to use ViaBenefits or a similar benefits manager to get the HRA money.  If you are on the ACA now, I would at least talk to the people at Boomer Benefits.  There is also another nationwide agency that provides a similar service called Senior Savings Network.  They have a lot of helpful videos on their site. 

If you go with original Medicare, you will have to pay for Part B, Part D (drug plan) and a supplement to cover the costs Medicare does not cover.  It will likely be somewhat less expensive that an ACA plan, and a lot more comprehensive.

DaMa

  • Pencil Stache
  • ****
  • Posts: 587
Re: Two months to decide on my Medicare plan
« Reply #2 on: January 02, 2020, 08:53:04 PM »
Do you have a regular doctor that you like?  If so, call the office and ask what plans they like.

If you have a Medigap plan, Medicare pays their part, then the Medigap pays secondary.  Medicap G is the best coverage.  It covers everything except the Part B deductible, which is $198 in 2020.  Find out what that costs.  If you are ok with that, go for it.  Otherwise, that gives you something to compare other options with.  Medigap plans do not include drug coverage, so you have to get a separate Part D plan.

Medicare Advantage (MA) actually replaces your Medicare completely with an insurance company plan.  There are some really good MA plans out there, so I would not just rule them out.   And they offer substantially lower prices, because of things like narrow networks.   Some of them offer extra benefits, though, like dental.  Network is the biggest issue, but they can be good for people if their doctors are in network and out-of-state non-emergency coverage isn't needed.  MA plans have out-of-pocket maximums, which Medicare does not. 

You should be able to find an agent who will help you.  Ask people who they use.
You can use the Medicare plan finder to look at your options.  https://www.medicare.gov/plan-compare

If you have health problems, and can afford it, get the Medigap G.  Plug your drugs into the plan finder and pick the Part D plan that gives you the lowest costs.

The issue with chemotherapy is that these are usually Part B drugs, not Part D drugs.  Part B is medical, Part D is pharmacy.  With Medicare, you pay 20% on Part B drugs (and everything else in Part B) after deductible.  You'll also pay 20% on Part B drugs with most Medicare Advantage plans.  That 20% can be HUGE when it comes to chemo.  But, as I mentioned, MA plans have OOP max.  Medicare does not.

If you were in Michigan, I could give you more specifics.  I don't know the Florida market.  I'm happy to answer any questions I can.

Rural

  • Magnum Stache
  • ******
  • Posts: 4958
Re: Two months to decide on my Medicare plan
« Reply #3 on: January 03, 2020, 05:06:07 AM »
One thing my mother found out the hard way this year: if you ever go on an Advantage plan, you can switch back to regular Medicare later, but not at the same price as everyone else - the cost will be based on your age and will likely be much, much higher.


Also there can be a great deal of fighting with an advantage plan to get needed treatment preapproved, and that does not get easier as the years go by.

DaMa

  • Pencil Stache
  • ****
  • Posts: 587
Re: Two months to decide on my Medicare plan
« Reply #4 on: January 03, 2020, 07:47:58 AM »
One thing my mother found out the hard way this year: if you ever go on an Advantage plan, you can switch back to regular Medicare later, but not at the same price as everyone else - the cost will be based on your age and will likely be much, much higher.

Also there can be a great deal of fighting with an advantage plan to get needed treatment preapproved, and that does not get easier as the years go by.

Everyone pays Part B premium for Medicare, which is $135.50 in 2019.  There is means testing, and you could pay more if your income is above $85k (single). 

If you don't sign up for Part D when you are first eligible, you will pay a late enrollment penalty when you do sign up.  That can add up over time. 

Some Medicare Advantage plans are so cheap they PAY your Part B premium for you.  I would guess this is what Rural's mom had.

Dealing with a Medicare Advantage plan has all the trials and tribulations of dealing with any insurance plan.  With one very big difference - complaints to Medicare (CMS) are actually dealt with timely, and every one counts against the insurance plan. 

Another Reader

  • Walrus Stache
  • *******
  • Posts: 5236
Re: Two months to decide on my Medicare plan
« Reply #5 on: January 03, 2020, 08:44:54 AM »
One thing my mother found out the hard way this year: if you ever go on an Advantage plan, you can switch back to regular Medicare later, but not at the same price as everyone else - the cost will be based on your age and will likely be much, much higher.

Also there can be a great deal of fighting with an advantage plan to get needed treatment preapproved, and that does not get easier as the years go by.

Everyone pays Part B premium for Medicare, which is $135.50 in 2019.  There is means testing, and you could pay more if your income is above $85k (single). 

If you don't sign up for Part D when you are first eligible, you will pay a late enrollment penalty when you do sign up.  That can add up over time. 

Some Medicare Advantage plans are so cheap they PAY your Part B premium for you.  I would guess this is what Rural's mom had.

Dealing with a Medicare Advantage plan has all the trials and tribulations of dealing with any insurance plan.  With one very big difference - complaints to Medicare (CMS) are actually dealt with timely, and every one counts against the insurance plan.

Could not disagree more with the last statement.  What you get with an Advantage plan depends on the insurer and the location.  You can wind up with a low-end managed care plan that routinely denies services.  You will likely have to go through extended step therapy if there is a new very expensive drug they don't want to pay for.  You will have limited options for cancer treatment.  If you get any help from CMS, it will be too little and too late. 

I suggest you talk to Boomer Benefits or Senior Savings Network to get a feel for the Advantage plans in your area.  Also, the supplement plans pay some or all of the balance for any Medicare approved service.  Not much in OOP expense if you sign up for Plan G.  There isn't a lot of difference between insurers except price and timeliness of payment.

When you talk to any insurance agent, you should be aware that the commission paid by the insurance company is much higher for an Advantage plan.  Guess which type of plan most agents will push...

Another Reader

  • Walrus Stache
  • *******
  • Posts: 5236
Re: Two months to decide on my Medicare plan
« Reply #6 on: January 03, 2020, 08:46:50 AM »
One thing my mother found out the hard way this year: if you ever go on an Advantage plan, you can switch back to regular Medicare later, but not at the same price as everyone else - the cost will be based on your age and will likely be much, much higher.


Also there can be a great deal of fighting with an advantage plan to get needed treatment preapproved, and that does not get easier as the years go by.

You may be able to switch back during open enrollment, but you will have to pass medical underwriting. 

DaMa

  • Pencil Stache
  • ****
  • Posts: 587
Re: Two months to decide on my Medicare plan
« Reply #7 on: January 03, 2020, 09:32:23 AM »
My point of view is certainly influenced by the fact that I worked for a good plan.  Medigap G is always going to be the best option, if you can afford it.

@Another Reader, I'm sincerely sorry your mom had such a bad experience.


Another Reader

  • Walrus Stache
  • *******
  • Posts: 5236
Re: Two months to decide on my Medicare plan
« Reply #8 on: January 03, 2020, 09:49:00 AM »
My point of view is certainly influenced by the fact that I worked for a good plan.  Medigap G is always going to be the best option, if you can afford it.

@Another Reader, I'm sincerely sorry your mom had such a bad experience.

That's someone else.  My folks were on the AARP/UHC Plan F, which is what I have.  So far, it's worked out well.

I will likely fire the Wellcare people that took over from Aetna for Part D next year.  First, they tried to upgrade the people that moved over to a more expensive plan, even those that signed up for a comparable, less expensive plan during open enrollment.  The paperwork was botched and people got multiple letters and cards.  They are primarily known for Medicaid managed care plans and Medicare Advantage plans, i.e. the low end of the insurance pool, and it really shows.  My Part D is really a placeholder for the future, when more expensive drugs may be needed.  If you do not sign up for Part D initially, there is a permanent penalty for signing up late.

BTDretire

  • Magnum Stache
  • ******
  • Posts: 3077
Re: Two months to decide on my Medicare plan
« Reply #9 on: January 03, 2020, 10:14:41 AM »
You might find more help from people your age with similar concerns over at early-retirement.org.

I would not touch an Advantage plan.

That is what friends have said, first thing the salesman wants to sell me is the Advantage plan.

Quote
You hand over all medical decisions to an insurance company.  Most are HMO's with limited networks and no coverage out of state except for emergencies.
Many of the best medical centers in the country - MD Anderson cancer center for one - do not take Advantage plans.  There are substantial out of pocket expenses if you require surgery or other treatment.
That's kind of a biggy, I am pretty healthy but if I get sick I want the best care and still protect my nest egg. 
Quote
If you are shopping, a lot of people over at early-retirement.org use Boomer Benefits to shop for them.  They are a consumer-oriented insurance agency with a wide range of plans to choose from.  If you have an HRA through your retirement plan, you may be required to use ViaBenefits or a similar benefits manager to get the HRA money.  If you are on the ACA now, I would at least talk to the people at Boomer Benefits.  There is also another nationwide agency that provides a similar service called Senior Savings Network.  They have a lot of helpful videos on their site. 

If you go with original Medicare, you will have to pay for Part B, Part D (drug plan) and a supplement to cover the costs Medicare does not cover.  It will likely be somewhat less expensive that an ACA plan, and a lot more comprehensive.
Thanks, I have non ACA policy that was grandfathered in.
I'll look at the Boomers site, I previously signed in with fake name, because I didn't want some salesman giving me a pitch, but it seems they are on the up and up. Fake name didn't get me anywhere! :-)
« Last Edit: January 03, 2020, 10:34:47 AM by BTDretire »

BTDretire

  • Magnum Stache
  • ******
  • Posts: 3077
Re: Two months to decide on my Medicare plan
« Reply #10 on: January 03, 2020, 10:29:46 AM »
Do you have a regular doctor that you like?  If so, call the office and ask what plans they like.

I have ask, but the answer is who ever has the least paperwork and pays the most.
So the doc is a very biased source.

If you have a Medigap plan, Medicare pays their part, then the Medigap pays secondary.  Medicap G is the best coverage.  It covers everything except the Part B deductible, which is $198 in 2020.  Find out what that costs.  If you are ok with that, go for it.  Otherwise, that gives you something to compare other options with.  Medigap plans do not include drug coverage, so you have to get a separate Part D plan.[/quote]

Early on I figured I would just get Medigap G, but I'm now doing my due diligence.
Quote
Medicare Advantage (MA) actually replaces your Medicare completely with an insurance company plan.  There are some really good MA plans out there, so I would not just rule them out.   And they offer substantially lower prices, because of things like narrow networks.   Some of them offer extra benefits, though, like dental.  Network is the biggest issue, but they can be good for people if their doctors are in network and out-of-state non-emergency coverage isn't needed.  MA plans have out-of-pocket maximums, which Medicare does not. 

 I don't travel much, and I know my doc is tight on what he accepts, however I wouldn't cross out changing my doc, as he is a bit of a minimalist, which is OK while I'm healthy, but he doesn't order anything extra unless ask.

You should be able to find an agent who will help you.  Ask people who they use.
You can use the Medicare plan finder to look at your options.  https://www.medicare.gov/plan-compare

If you have health problems, and can afford it, get the Medigap G.  Plug your drugs into the plan finder and pick the Part D plan that gives you the lowest costs.

The issue with chemotherapy is that these are usually Part B drugs, not Part D drugs.  Part B is medical, Part D is pharmacy.  With Medicare, you pay 20% on Part B drugs (and everything else in Part B) after deductible.  You'll also pay 20% on Part B drugs with most Medicare Advantage plans.  That 20% can be HUGE when it comes to chemo.  But, as I mentioned, MA plans have OOP max.  Medicare does not.

That's troublesome, is there no limit on OPP with any Medigap plan. I'd like limit OOP to $10,000, but would even go to $20,000 if it dropped the premium a lot.

Quote
If you were in Michigan, I could give you more specifics.  I don't know the Florida market.  I'm happy to answer any questions I can.
Sorry moved form Kalamazoo 25 years ago. No cleaning snow off the windshield for me!

BTDretire

  • Magnum Stache
  • ******
  • Posts: 3077
Re: Two months to decide on my Medicare plan
« Reply #11 on: January 03, 2020, 10:31:25 AM »
One thing my mother found out the hard way this year: if you ever go on an Advantage plan, you can switch back to regular Medicare later, but not at the same price as everyone else - the cost will be based on your age and will likely be much, much higher.

Also there can be a great deal of fighting with an advantage plan to get needed treatment preapproved, and that does not get easier as the years go by.

Everyone pays Part B premium for Medicare, which is $135.50 in 2019.  There is means testing, and you could pay more if your income is above $85k (single). 

If you don't sign up for Part D when you are first eligible, you will pay a late enrollment penalty when you do sign up.  That can add up over time. 

Some Medicare Advantage plans are so cheap they PAY your Part B premium for you.  I would guess this is what Rural's mom had.

Dealing with a Medicare Advantage plan has all the trials and tribulations of dealing with any insurance plan.  With one very big difference - complaints to Medicare (CMS) are actually dealt with timely, and every one counts against the insurance plan.

Ya, I don't like paperwork BS, I don't even like this process of figuring out what plan to pick.

BTDretire

  • Magnum Stache
  • ******
  • Posts: 3077
Re: Two months to decide on my Medicare plan
« Reply #12 on: January 03, 2020, 10:33:09 AM »
One thing my mother found out the hard way this year: if you ever go on an Advantage plan, you can switch back to regular Medicare later, but not at the same price as everyone else - the cost will be based on your age and will likely be much, much higher.

Also there can be a great deal of fighting with an advantage plan to get needed treatment preapproved, and that does not get easier as the years go by.

Everyone pays Part B premium for Medicare, which is $135.50 in 2019.  There is means testing, and you could pay more if your income is above $85k (single). 

If you don't sign up for Part D when you are first eligible, you will pay a late enrollment penalty when you do sign up.  That can add up over time. 

Some Medicare Advantage plans are so cheap they PAY your Part B premium for you.  I would guess this is what Rural's mom had.

Dealing with a Medicare Advantage plan has all the trials and tribulations of dealing with any insurance plan.  With one very big difference - complaints to Medicare (CMS) are actually dealt with timely, and every one counts against the insurance plan.

Could not disagree more with the last statement.  What you get with an Advantage plan depends on the insurer and the location.  You can wind up with a low-end managed care plan that routinely denies services.  You will likely have to go through extended step therapy if there is a new very expensive drug they don't want to pay for.  You will have limited options for cancer treatment.  If you get any help from CMS, it will be too little and too late. 

I suggest you talk to Boomer Benefits or Senior Savings Network to get a feel for the Advantage plans in your area.  Also, the supplement plans pay some or all of the balance for any Medicare approved service.  Not much in OOP expense if you sign up for Plan G.  There isn't a lot of difference between insurers except price and timeliness of payment.

When you talk to any insurance agent, you should be aware that the commission paid by the insurance company is much higher for an Advantage plan.  Guess which type of plan most agents will push...

 Yep, the one agent I talked to was quick to push the Advantage plan. And mentioned the high cost of the Medigap plans.

DaMa

  • Pencil Stache
  • ****
  • Posts: 587
Re: Two months to decide on my Medicare plan
« Reply #13 on: January 03, 2020, 12:53:23 PM »
You do not need to worry about OOP max with Medigap G.  Your OOP is the Part B deductible.  Everything else is paid (as long as Medicare covers it.)

I never paid attention to the other Medigap plans. 

Another Reader

  • Walrus Stache
  • *******
  • Posts: 5236
Re: Two months to decide on my Medicare plan
« Reply #14 on: January 03, 2020, 12:58:55 PM »
That's troublesome, is there no limit on OPP with any Medigap plan. I'd like limit OOP to $10,000, but would even go to $20,000 if it dropped the premium a lot.

Plan G should pay the balance between what Medicare pays and the cost.  The major quirk is there are some things that are not approved by Medicare.  Annual physicals are not, but something called an annual wellness visit is.  If the service is not approved by Medicare, you pay for all of it.  I would be very surprised if you had much OOP beyond the deductible with Plan G. Certainly not $10,000.

I suggest you call Boomer Benefits and ask your questions.  If something is not clear, come back and ask.  Also check out early-retirement.org.  Lots of experience with the ins and outs of Medicare over there.

Rural

  • Magnum Stache
  • ******
  • Posts: 4958
Re: Two months to decide on my Medicare plan
« Reply #15 on: January 03, 2020, 04:01:00 PM »
My mom did try to switch from an advantage plan to regular Medicare in open enrollment. I think it was the Part D that was going to be unaffordable- she was going to have to part the penalty for later enrollment, and it was a higher premium, not a one-time fee, so she's priced out of part D for the rest of her life. She'll be fine; I'm bringing it up because no one had told her that going with an advantage plan would make her subject to the part D penalty later on.