Medicare Experience

[KennyG]

I'm not trying to start a rant here but just retired and have had some interesting experiences with Medicare. I'm wondering if this is typical.

I have a Medicare Supplement plan and a Part D plan from a private insurance company and it's been a very positive experience. They provided very clear information on the options. When I call them I get someone on the phone right away. When there has been some problem, they just fixed it, and sent me something for a confirmatory form for signature.

Medicare itself has been different. The people are very courteous but they can't directly do anything. They can only fill out forms or refer you someone else. The first problem was they set Medicare to start a month early, before I retired. Although the form I filed showed the correct date of retirement, they automatically start the coverage the month after the form is signed. I gather this happens all the time but nothing tells you this. Additional forms have to be filed to appeal the original start date. After a month I'm still waiting to see if this is corrected. My next step will be appealing my "high income" surcharge based on 2015. The website suggests making an appointment when visiting the local office. However, the voice mail system at the local office has no way to reach a real person unless you know their name or phone extension. Fortunately, the first time I went in the wait was less than 45 minutes. It will be interesting to see if that is typical. I'm hoping everything will be on autopilot once I get the signup issues resolved, but it's not encouraging.

 

[Bird]

Of course, I "retired" before I was old enough for Medicare, but when I signed up, and later my wife signed up, I don't remember any problems. My only complaint would be with the cost of the Medicare Supplements we have, and especially the Part D cost when it doesn't even pay for everything.

 

[k0ua]

I'm not trying to start a rant here but just retired and have had some interesting experiences with Medicare. I'm wondering if this is typical.

I have a Medicare Supplement plan and a Part D plan from a private insurance company and it's been a very positive experience. They provided very clear information on the options. When I call them I get someone on the phone right away. When there has been some problem, they just fixed it, and sent me something for a confirmatory form for signature.

Medicare itself has been different. The people are very courteous but they can't directly do anything. They can only fill out forms or refer you someone else. The first problem was they set Medicare to start a month early, before I retired. Although the form I filed showed the correct date of retirement, they automatically start the coverage the month after the form is signed. I gather this happens all the time but nothing tells you this. Additional forms have to be filed to appeal the original start date. After a month I'm still waiting to see if this is corrected. My next step will be appealing my "high income" surcharge based on 2015. The website suggests making an appointment when visiting the local office. However, the voice mail system at the local office has no way to reach a real person unless you know their name or phone extension. Fortunately, the first time I went in the wait was less than 45 minutes. It will be interesting to see if that is typical. I'm hoping everything will be on autopilot once I get the signup issues resolved, but it's not encouraging.

Kenny normally Medicare starts the 1st of the month that you are eligible. For example if your birthday was Nov 27th your medicare would start on Nov 1st. Unless you birthdate is Nov 1st then it would start on Oct 1st. You are free to apply for Medicare 3 months prior to your birth month, your birth month and 3 months after your birth month. You do not want to wait until your birth month to sign up or the 3 months post birth month, because this will delay your eligibility date. Those first 3 months before your birth month is when you want to sign up.

I am glad to see you have your supplement and Part D all worked out, as that is something you DO NOT want to delay or miss. Especially if you have any kind of Medical conditions. During your initial enrollment you can be near death and the insurance company must take you without questions asked, but after you miss that period than you will have to go thru medical underwriting unless you have a special enrollment period which can be invoked by too many things to list here. There are hundreds more rules...at least!

Yes, the whole Medicare thing is very complicated and many of the rules seem arbitrary and capricious to me, but then again no one asked me.!


By the way all questions can be answered at Medicare.gov,

When will my coverage start? | Medicare.gov

 

[rekees4300]

I'm hoping everything will be on autopilot once I get the signup issues resolved, but it's not encouraging.

Yes once the bureaucrats get all your info they will be happy campers and the system will work without intervention.

 

[brown40]

You have joined up with the single largest health insurer in the world. Where most insurance companies will look at the specific details of their business to earn more customers, improve the member service experience, shore up expenditures, attempt to prevent illnesses, and negotiate rates on medications, DME, and services, Medicare is an insurer that looks at things in broad strokes, and has a captive enrollment regardless of performance.
Federally funded medical insurance initiates many of the ripples that cause prices to go up everywhere when they adjust their fee schedules. Rates for Aetna, BCBS, Humana, etc. are adjusted to follow suit within the calendar year, and ensure the Feds are getting the "best" deal come cost-report season.
More dangerous is changes to State Medicaid funding: generally by law their rate must be "break-even", and is the basement of rates charged. When those rates change, the ripples go everywhere. In some cases, companies are left scrambling to spend money, so they don't have to repay a aggregated lump sum or get their rate reduced and lose it the next year.
Medicare IS the very best health insurance going. Not that they cover the most, or pay the best, but they do pay, and even pay self-imposed penalties to providers if the do not process timely.

 

[GaryM]

I'm 70 and have been retired on Medicare for 6 years. I have an Advantage PPO plan for which I pay about $120 a month. I have a $20 copay for my primary care doctor. I have no supplement plan or anything like that. I'm very happy with my coverage.

My BiL has Medicare with a supplement plan for which he pays almost $800 per quarter. I believe his supplement takes care of his copays, but unless you go to the Dr. several times a month I don't believe he's got a good thing going.

 

[KennyG]

If you are reasonably healthy and don't mind being restricted to a PPO, the Advantage Plans seem to be a better deal than the Supplement Plans. However, my employer subsidizes a Supplemental plan for retirees, so it was a obvious choice for me.

 

[k0ua]

If you are reasonably healthy and don't mind being restricted to a PPO, the Advantage Plans seem to be a better deal than the Supplement Plans. However, my employer subsidizes a Supplemental plan for retirees, so it was a obvious choice for me.

The key word is "seems". And the qualifier, "if you are healthy" is absolutely true. So if you are healthy, it IS a better deal. So when are you going to be non healthy?. That's the rub. I sell both. And I recommend supplements if you can afford them. AND I make more money selling advantage plans instead of supplements. If you have an advantage plan and you become seriously ill, you need to pay attention to that yearly total out of pocket, because that is what you are going to be paying each year. If you never become seriously ill or never need a surgery or hospital stay, then you are going to come out ahead of the game with an advantage plan. If a person knew when they would die and how sick they would become along the way all of these decisions would be ridiculously simple.

 

[k0ua]

I'm 70 and have been retired on Medicare for 6 years. I have an Advantage PPO plan for which I pay about $120 a month. I have a $20 copay for my primary care doctor. I have no supplement plan or anything like that. I'm very happy with my coverage.

My BiL has Medicare with a supplement plan for which he pays almost $800 per quarter. I believe his supplement takes care of his copays, but unless you go to the Dr. several times a month I don't believe he's got a good thing going.

That seems like a very high monthly premium for an advantage plan. What is your total yearly out of pocket, and what is your daily hospital stay expenses. Many advantage plans range from $0 to around $36 per month. Our most popular one is the $0 monthly premium as you would imagine. For a male at 65 in Missouri in his initial enrollment period a G plan is $147.75 from one large A rated carrier. This pays everything but your part B annual deductible of $183.00

 

[GaryM]

The HMO type plan is around $30 as I recall. When I had my hip replacement in May last year my OOP was about $500 as I recall.

 

[TMR]

My wife and I have Medicare and a supplement that includes RX (Part D)...we have had for about 5 years and it has been without issue. Occasionally the drug formulary changes but that is usually not a big issue. During our time on Medicare I had open open heart by-pass and my wife has had a atrial fibrillation issues...a number of cardio-versions and two ablations which required a hospital overnight. I also had prostate surgery (BPH) and my wife had hernia surgery. More "events" than we wish for The Medicare and supplements covered very close to 100% of all costs (not counting the drug copays and "donut hole" costs which are specified by gov't). Our supplement w/RX is now up to about $140 each per month plus whoever the basic Medicare is currently.

Prior to Medicare we were on an individual plan as we were both self-employed...I our total insurance bill was between $18K and $20K and that was more than five years ago. The current Medicare system works great for us and has been of very little heart ache. I get nervous whenever the Donald or more importantly Paul Ryan speaks. While the Donald does not have the spine to truly change Medicare the House and Senate Republican leadership has been waiting for this "opportunity" for many years. I trust that they will eventually figure out that Medicare is a great system and any attempt to throw it into the ObamaCare change package would result in disaster in two years. There has been discussion of "block granting" Medicare to the states...states could then do what they want with the money. Even though I believe common sense will prevail...I do not want a voucher to buy medical insurance with no Medicare!

FWIW...TMR

 

[Tractor Seabee]

The best deal going is for us retired military. Medicare + Tricare For Life = no bills. Just had a serious call bladder situation and ultimate removal; included ER, 4 days in critical care, and 1 day medical floor plus home care and therapy. Total retail price was over $500K. I paid $0. I have never had a mistake or hassel so service has been perfect. You younger retired military have a good future for after 65 so don't screw it up.

Ron

 

[k0ua]

The best deal going is for us retired military. Medicare + Tricare For Life = no bills. Just had a serious call bladder situation and ultimate removal; included ER, 4 days in critical care, and 1 day medical floor plus home care and therapy. Total retail price was over $500K. I paid $0. I have never had a mistake or hassel so service has been perfect. You younger retired military have a good future for after 65 so don't screw it up.

Ron

Yep, good deal, but you guys that retired Military earned it and deserve every bit of it. Thank you for your service.:thumbsup:

 

[check]

The HMO type plan is around $30 as I recall. When I had my hip replacement in May last year my OOP was about $500 as I recall.

And how much would that cost if you had NO insurance?

 

[GaryM]

And how much would that cost if you had NO insurance?

With no insurance of any kind, and if I'm remembering correctly, the bill was around $25K. I do remember when my wife had both knees replaced 4 years ago the bill was $48K. We were out of pocket around $800 or so.

KØUA mentioned that it depends on how your health is to determine the best plan, and that's certainly true. I can switch to the HMO type of Advantage plan during an open enrollment period when I get a little older. Assuming I do get older that is.

I like the PPO, at least at this point, because there are no referrals required. Now where I live it seems most of the health services are associated with SSM or St. Joseph organizations. I'm told that if your primary care Dr. is in that system referrals are not an issue. Back about 25 years of so I was in an HMO type system through work and I did not like having to always go see Dr. A if I wanted to see Dr. B. I think the term used was "gatekeeper" where the primary guys job was to save money for the insurance company by keeping you in house. After 2 years of so I'd decided I'd rather pay a little more and have more control.

It may no loger be that way. Perhaps KØUA can supply further information?

 

[k0ua]

With no insurance of any kind, and if I'm remembering correctly, the bill was around $25K. I do remember when my wife had both knees replaced 4 years ago the bill was $48K. We were out of pocket around $800 or so.

KØUA mentioned that it depends on how your health is to determine the best plan, and that's certainly true. I can switch to the HMO type of Advantage plan during an open enrollment period when I get a little older. Assuming I do get older that is.

I like the PPO, at least at this point, because there are no referrals required. Now where I live it seems most of the health services are associated with SSM or St. Joseph organizations. I'm told that if your primary care Dr. is in that system referrals are not an issue. Back about 25 years of so I was in an HMO type system through work and I did not like having to always go see Dr. A if I wanted to see Dr. B. I think the term used was "gatekeeper" where the primary guys job was to save money for the insurance company by keeping you in house. After 2 years of so I'd decided I'd rather pay a little more and have more control.

It may no loger be that way. Perhaps KØUA can supply further information?

It depends. Many advantage plans Do require a referral, but some do not. The one I sell (which is an HMO) does not. Of course a Medicare supplement never requires a referral nor does it have any networks at all and is not regional in nature. You can take your supplement with you if you move to another region or anywhere in the US. All advantage plans are regional in nature, if you permanently move to another region you will need to enroll in another one in your region.

 

[GaryM]

That's true about moving to another area. If I'm correct, in a case like that you don't have to wait for an open enrollment period. I think it's called a life change or something like that.

 

[k0ua]

That's true about moving to another area. If I'm correct, in a case like that you don't have to wait for an open enrollment period. I think it's called a life change or something like that.

That is correct, if you move you would have what is called a special enrollment period.

Special circumstances (Special Enrollment Periods) | Medicare.gov

 

[lt190b]

It depends. Many advantage plans Do require a referral, but some do not. The one I sell (which is an HMO) does not. Of course a Medicare supplement never requires a referral nor does it have any networks at all and is not regional in nature. You can take your supplement with you if you move to another region or anywhere in the US. All advantage plans are regional in nature, if you permanently move to another region you will need to enroll in another one in your region.

kOua, help me understand. You can switch plans HMO/PPO Advantage plans during open enrollment, or switch supplement plans during open enrollment. But not from Advantage to supplement or supplement to Advantage? Is this correct? If it is, then it is very important to choose carefully.

 

[k0ua]

kOua, help me understand. You can switch plans HMO/PPO Advantage plans during open enrollment, or switch supplement plans during open enrollment. But not from Advantage to supplement or supplement to Advantage? Is this correct? If it is, then it is very important to choose carefully.

It is not quite that simple. Yes you can change your advantage plan during the fall open enrollment. But switching supplement plans depends on many things. Here in Missouri we can switch to a different supplement of same coverage for a lower price during our anniversary date without going thru medical underwriting, but most states do not allow that. To switch from Advantage to supplement you will have to go thru medical underwriting. This is a very important point. If you are not Healthy and cannot answer no to the medical underwriting questions, you will NOT be eligible for a supplement, like the one time in your life, the 3 months prior to your birth month at age 65 , your birth month and 3 months post your birth month at age 65 upon your initial enrollment. This is the one most important 7 month period of your life where the decision you make COULD affect the rest of your life as pertains to health. If you remain healthy then you have no worries.

What happens is people fall ill and having been on an advantage plan and having hospital stays etc. They get tired of paying out of pocket up to their yearly maximum and decide a supplement plan looks good. Sorry Charlie, ain't gonna happen. You will be stuck in Advantage plan world for the rest of your days. Advantage plan world is not all bad, the monthly premiums are either very low or $0 and the copays are reasonable on most of them. If your remain reasonably healthy, you are going to come out ahead when the final tally is taken. The problem comes when you are diagnosed with "something",, then it can get dicey and most then wish they had taken the supplement when they had that golden opportunity to take it at age 65.

For those that are ill at 65 or know they will soon be ill then it is a no brainer, you choose a good supplement from a reputable company (A rated) and never look back, and don't be lured by the siren song of Advantage plans. You can be near death at age 65 and as long as you can sign the paper or have your POA sign it for you, then you are eligible for a supplement. You cannot be refused by the insurance company. The only reason you can be dropped no matter how ill you become is because you failed to make the monthly payment. This is why I advise everyone to always sign up for automatic bank draft from your account. You DO NOT want to forget to make a payment.