It's Time For Medicare (whether I want it or not)

[k0ua]

I will never sell another Advantage plan, My wife has now quit selling them too. I have seen too many folks with tears in their eyes come back and ask "can you help me?". And the answer is always no, I cannot. There are different advantage plans, with different out of pocket expenses, some are much better than others, And if that is all you can do, then that is all you can do. And yes in general Advantage plans pay the agent more than supplements. But I still have to look people in the eye, and they still call after the sale and will need service, drug plan reviews etc. But we have another agency we can refer the advantage plan folks to. I sleep better at night.

 

[ljjhouser]

I don't see that;

I am glad you have as much information - you have done well.
It is against MC law for an agent to sell you a Medigap policy is you ARE enrolled in a Advantage Plan. The reason for this is that Medigap bridges the gaps in Original Medicare. If you are enrolled in an advantage plan, you are not actually on Original MC. Then someone has sold you a product that is of no use to you. Medicare prohibits that.

OK, then lets go further and talk about Can you Switch to or from original MC. Yes you can do that. You are correct. To drop an Advantage plan during open enrollment Oct 15 - Dec 7, simply enroll in a Part D drug Plan and your Advantage Plan will be canceled by MC on Jan 1 of the following year. You will then be on Original Medicare. BUT, that DOS NOT entitle you to purchase a Medigap policy after your IEP if you do not have an SEP Special Enrollment Period.
On the other hand, if you are on Org MC and want to be on an Advantage plan, then simply sign up for the Advantage plan during Oct 15 - Dec 7. Jan 1 you will be on the Advantage plan you selected, MC will cancel your Part D drug Plan.

About SEP. These are exceptions that permit beneficiaries to sign up for various MC products. Without your IEP or an SEP, you will not be permitted to sign up for Medigap.

Let me give you a SEP example. Many people (and a lot of agents) don't know about this SEP. Normally you can only sign up for Medigap during IEP. I can only speak for MO, some states are different. In MO, if you signed up for an Advantage plan during your IEP, and had the plan for less that 12 months, you may have an agent drop the Advantage plan and sell you one of certain Medigap policies. Plan N is excluded from this SEP - it cannot be select then. This gives you an opportunity to use the Advantage plan and if you are dissatified, you may use this SEP to drop the Adv pl and purchase a Medigap on Org MC.

SEP exceptions are needed - for example, if a working person over 65 chooses (Working Aged MC term) to delay enrolling in MC, he/she will be provided a short (usually 30 days) SEP to enroll in Medicare without penality, including Medigap.

This statement made by James k0ua is pretty clear and correct.

"You CANNOT and NEVER WILL be able to buy a Medigap (supplement) policy for the rest of your miserable life."

You must purchase Medigap during IEP or using an exception SEP. Period.

You can switch from Org MC and Advantage every year if you wish. BUT not Medigap. You have limited purchase opportunities.

I am not giving you advice. But as I said before, it is MC law. A lot of people use and like Advantage plans. I had one the first 10 months when I went on MC. It was fine. It may be a good fit for you.

But Original MC may also be a good fit. Those are options for you to consider.

When I was counseling, many people (including my own father-in-law) complained - "Why does MC make it so complicated?' The answer - Because we are being offered a choice about our health care and costs.

Many times I was asked - What do you think is best for me? I would NEVER answer that. It is an individual choice.
This is a hard subject to go much deeper here. I could write you a book. Best Wishes, Larry

 

[ljjhouser]

One more statement about this. It is true that you can sign up for Medigap anytime. ONLY IF THE INS COMPANY CHOOSES TO DO SO. In the 10 years of counseling, I have never, not one time, had a company do that. Wonder why not. Because they understand the chances are that you are now sick and want better health insurance. Medigap is an investment. Good luck to anyone who thinks they can get a Plan G Medigap without investing over the years. But in the OP case, I don't think you are interested in Medigap. That is ok. Just choose the best product to fit your needs while understanding what your future needs may or may not be. Best wishes.

 

[ultrarunner]

I'm not with you a 100%

We have employed working full time with good employer coverage.

Would these employed over 65 with employer insurance be in trouble for not making their elections at age 65?

 

[ljjhouser]

I'm not with you a 100%

We have employed working full time with good employer coverage.

Would these employed over 65 with employer insurance be in trouble for not making their elections at age 65?

No - they would not. That is why they would qualify for exceptions being the "Working Aged." There are SEP s Special Enrollment Periods specifically for that. They have enrollment opportunities beginning even before the employment insurance ends. They also have a 6 month SEP to enroll in part B. But who wants to wait. They should enroll in B (in my opinion) before the insurance ends - who wants to go 5 month without medical. There is a SEP for purchasing a drug policy (pt D) and a Medigap policy if wanted. Or an opportunity to enroll in an Advantage Plan.

The decision to delay enrolling in Medicare is usually based on the effort to not pay the Pt B premium. Good choice, some times. UNLESS there are "coordination of benefit" possibilities that improve the employment insurance by having Part B.

Another reason for delaying MC is the possibility of a spouse being also covered by the employment ins. That might permit you to insure intel the spouse also may reach 65 and MC.

In any case, I would do two things if delayed MC>
1. If you have paid into MC and are entitled to Part A, then there is no premium. I see no reason why you would want to delay enrolling in Part A during IEP. - No cost and you already are on MC rolls for when you want to add Part B.
2. As soon as you know you are going to retire, the opportunities become available either when you leave your job, or when your employment ins ends. I would get with SS as soon as I knew the date that was going to happen and enroll in part B, so there will not be a gap in coverage.

An interesting note - most people think you have to "qualify" to go on MC at 65. Anyone can go on MC at 65, but there is a good premium for part A if someone has not paid anything in to MC - almost $500 a month. We take pt A for granted.

Hope any of this helps.

 

[ultrarunner]

Yes it does...

One of the questions asked during hospital registration is if you are retired and if so how long?

Medicare does not want to pay if other coverage is in place....

This question is relatively new...

 

[ljjhouser]

Ok Now we are talking about Coordination of benefits with MC. Medicare publishes a booklet just for that. I think it is titled "who pays first" - will try to find that for you.

Here it is. Again, MC is incumbered by law. This is MC law. You are welcome to read it.

https://www.medicare.gov/sites/default/files/2021-10/02179-Medicare-and-other-health-benefits-your-guide-to-who-pays-first.pdf

I think the section you are looking for starts on page 11. Who pays first is not an opinion and IS NOT up to the hospital. The first determination on how payment is handled is related to the size of the employment company (more or less that 20 employees). and on from there....

Maybe I am not clear about your answer - Yes it does. What does?

 

[beowulf]

As ljjhouser explains the SEP - my example: I turned 65 in 2009 and signed up for part A only. Because I was insured through my wife's health insurance policy provided by her employment I did not need Part B. When her health insurance was no longer available to us in 2014 I signed up for Part B and obtained a Medigap policy. I was paying attention so fortunately made the right choices - but I could have made some really bad choices. I am glad the non-stop promotions of Advantage Plans were not then constantly on TV or I might have might have listened and then I would still be suffering the consequences.

 

[ljjhouser]

As ljjhouser explains the SEP - my example: I turned 65 in 2009 and signed up for part A only. Because I was insured through my wife's health insurance policy provided by her employment I did not need Part B. When her health insurance was no longer available to us in 2014 I signed up for Part B and obtained a Medigap policy. I was paying attention so fortunately made the right choices - but I could have made some really bad choices. I am glad the non-stop promotions of Advantage Plans were not then constantly on TV or I might have might have listened and then I would still be suffering the consequences.

Thank you for the help. I am glad you made good choices. It is sad when someone regrets their choices and has to live with "what they did not know." I began counseling when I turned 65, NO one seem to know about MC. I even called the 1800medicare number - got wrong answers. I signed up to take the classes and become a counselor - Told my wife, if I do this, at least maybe I will know something about MC.

Hey, I just realized - you must be the same age as me, 2009 also.

 

[ultrarunner]

Ok Now we are talking about Coordination of benefits with MC. Medicare publishes a booklet just for that. I think it is titled "who pays first" - will try to find that for you.

Here it is. Again, MC is incumbered by law. This is MC law. You are welcome to read it.

https://www.medicare.gov/sites/default/files/2021-10/02179-Medicare-and-other-health-benefits-your-guide-to-who-pays-first.pdf

I think the section you are looking for starts on page 11. Who pays first is not an opinion and IS NOT up to the hospital. The first determination on how payment is handled is related to the size of the employment company (more or less that 20 employees). and on from there....

Maybe I am not clear about your answer - Yes it does. What does?

It’s a question added after a directive received.

Of course we have no way to independently verify if patient is currently employed with benefits or not.

Not unusual to have someone retired a year or more with COBRA

Also, on occasion, a patient can be well past Medicare age and not be retired… even in their late 80’s

And then there are some who have never been employed or employed with benefits and even a few that have never worked in the United States but are here for a procedure…

 

[KennyG]

This is an extremely helpful discussion. The information is not easy to understand and the Advantage advertising is very misleading. I was just lucky to avoid it. I retired at 67 and looked at the options. I found that Advantage plans did not cover overseas travel which is something I planned to do and my employer provided a $50/mo contribution to Supplement (Medigap) plans but not Advantage plans. I now realize the Benefits Office felt they couldn't badmouth Advantage plans but want to steer people to Medigap. I feel lucky to have chosen correctly even though I didn't understand some of the disadvantages of "Advantage".

 

[ultrarunner]

It must be popular because we see more with plan provided transportation to and from surgery

 

[ljjhouser]

The sole enrolling agent for MC Part A and Part B is SS and only SS. And they, alone can verify employment for MC.

Cobra is included in the booklet link as possible if your employment goes out of business. Also, for a person who is on Cobra and becomes eligible for MC, he should enroll in MC in his/her IEP and stop paying for Cobra. There is NO SEP for ending of Cobra if you continue on Cobra and DO NOT enroll in MC during your IEP.

The "working aged" (working over age 65) was discussed in post 45 above. Anyone working over the age of 65 (even 80) will have an SEP when they either leave their job OR the employment insurance ends.

Then the person who had not contributed to MC has no entitlement for MC. The can have part A and B, but they must pay for the premium. As mentioned before, the Part A premium in this case is substantial.

If they have never worked in the US and never contributed to MC and come here for a procedure, good for them. They have no claim with MC. No issue there.

Not sure what directive you are referring to.

I see that you are also from "outside the US." All of the training with MC is always presumed to be US citizens within the US. That is why Advantage plans do not cover anything out of US. Only some Medigap plans have foreign Benefit of $50K emergency expense. Because of this, you may have more information that I am not aware of relating to that situation.

 

[ultrarunner]

California born and raised…

Many of the seniors I know have an ever shrinking pool of trusted information and many times a surviving spouse is not the one up on finances…

When I think of the elderly neighbors I’ve had over the years missing a deadline or not understanding fits many…

The biggest complaint I hear is being directed to a website… most don’t own a cell phone let alone a smart phone… some gov offices are still limited adding to the burden.

I think the future ranks of technology peasants will continue grow…

My own grandparents were well read and kept meticulous farm records but had no use for computers, faxes and such… or TV

 

[ljjhouser]

The Advantage plans are popular. They are not bad insurance. But they have been miss represented. Many of those tv ads promise things that are only available to people who are DUAL ELIGILE - On Medicare and Medicaid.
My only concern about Advantage is that they change every year and the Max out of pocket continues to rise. If the network of the Advantage plan fits you doctors, then it may be a good choice. They are somewhat lower cost insurance for staying within their network.

I would also mention - Just because it is a ppo may not mean you want to go out of network (and some do have networks on PPO). Copays Out of network, even in some PPOs have been as high as 45%. Not good for a hospital copay.

I also like Original Medicare. If a person spends time out of town or has a vacation home, they are covered anywhere. But in an Advantage, the only MAY be the ER. Some will permit Urgent care. Some companies (I am referring to employment insurance in this case) - Aetna, for example (who is the same as CVS) does not pay for Urgent care unless it is truly Urgent. Their first treatment option is CVS Minute Clinic.

Well, think I am moving into other areas. Don't really want to do that. I have had tooooo much input about this. I need to back out and read what others have to say. Very interesting though.

Any insurance that helps is good. But in MC, there are choices to be made. Some can be changed, some cannot. Best Wishes. Another side note. 30% of MC beneficiaries are not over the age of 65.

 

[k0ua]

One other thing to consider if your are taking trips overseas is to take out a temporary travel insurance plan for the duration of your trip to cover the possibility of medical needs (accident or sudden severe illness). In many ways this is preferable to any overseas travel your normal plan might cover, BUT getting the payments coordinated and the overseas providers payed can be more trouble than it is worth. It is much easer to take out these temporary policies for a few 10's of dollars per individual and be done with it.

Again, this is "off the wall" and not really relevant to the original questions, but something to keep in the back of your mind if you do overseas travel.

I guess the biggest thing that really torques me off about the advantage plan commercials is this "give back benefit" and the way it is so misleading. Not many of us are going to qualify for this BS "give back benefit" because we won't qualify as "dual eligible" in other words qualified for Medicare and Medicaid. Very few reading these words are going to qualify for Medicaid. As someone pointed out, they may not exactly be liars, but they certainly skate very close on very thin ice.

 

[Jstpssng]

A lot of good info in this thread. Thank you to the OP for starting it and to everybody who has contributed. I will be eligible to sign up in two more years although I expect to work until I am 70. Health insurance is holding me to one job but qualifying for Medicare (?) might allow me the freedom of seasonal, part time, or self employment.

 

[Pixguy]

One other thing to consider if your are taking trips overseas is to take out a temporary travel insurance plan for the duration of your trip to cover the possibility of medical needs (accident or sudden severe illness). In many ways this is preferable to any overseas travel your normal plan might cover, BUT getting the payments coordinated and the overseas providers payed can be more trouble than it is worth. It is much easer to take out these temporary policies for a few 10's of dollars per individual and be done with it.

Again, this is "off the wall" and not really relevant to the original questions, but something to keep in the back of your mind if you do overseas travel.

I guess the biggest thing that really torques me off about the advantage plan commercials is this "give back benefit" and the way it is so misleading. Not many of us are going to qualify for this BS "give back benefit" because we won't qualify as "dual eligible" in other words qualified for Medicare and Medicaid. Very few reading these words are going to qualify for Medicaid. As someone pointed out, they may not exactly be liars, but they certainly skate very close on very thin ice.

and as JJ Walker says....... IT'S FREEEEEEE! BS

 

[ljjhouser]

and as JJ Walker says....... IT'S FREEEEEEE! BS

Or as George Foreman says.....IT'S FreeeEEE!' Wow, we must be starving for entertainment.

 

[Diggin It]

I've been contacted by someone from the medical insurance company I've been with for a few years. Though it was a cold call, he knows enough about the situation that I don't doubt his legitimacy. He says they've been having enough complaints about people calling in to the 800 numbers and getting in touch with knowledgeable people that can answer questions, that they've started to assign account reps. He knows my issue about being put on Medicare and says they already have enough information to assign me to one of their higher level Advantage plans that offers all sorts of extra benefits the others don't. The kicker is that he says this plan will somehow override the Part B deduction ... some sort of dual eligibility thing. I'm still not convinced of that and I'm sort of putting him though the ringer trying to get verification. I'm hoping I don't tick him off.


I mentioned a $500 per year Flex card in an earlier post ... this plan has a $1,500 per year Flex card. I mentioned a monthly allowance for Over the Counter items of something like $75, I don't recall the exact number now. This plan is something like $425 per quarter, either in store (CVS I think), or from a website and shipped to home. Most Prescriptions are covered too so Part D is taken care of. No monthly premium either.

How the heck are they going to offset Part B in full and give me all that 'cash' in credits and allowances each month?

I've verified everything he's been telling me by reviewing documents on their website.

I'm pretty well lost and not sure I believe him, but if it all pans out, it will be a far better plan over all.


There has to be a catch.