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

[beowulf]

Your not going to get any "pay back benefit" unless you can qualify for Medicaid. And you have to be pretty poor to qualify for that. Only dual eligible's get their part B paid for by the government. And my guess is anyone that owns a tractor is not going to qualify for Medicaid. Joe Namath and George Foreman's lies aside. If the zero dollars monthly is all you can afford towards your healthcare plan, then that is cool. Just don't get chronically ill. You will have to pay a little as you go and you will likely be able to afford that, just don't get really sick.

Yep. And that slick marketing with all the promises is going to hook a lot of people who will later get hit hard - surprises lurk. It may be a fit for a few, but the risks are huge.

The lesson is to learn all you can before you leap. Read it all and then read it again. Ask all the "what ifs". And remember: “The man who does not read has no advantage over the man who cannot read.” Mark Twain

 

[hube2]

Your not going to get any "pay back benefit" unless you can qualify for Medicaid. And you have to be pretty poor to qualify for that. Only dual eligible's get their part B paid for by the government. And my guess is anyone that owns a tractor is not going to qualify for Medicaid. Joe Namath and George Foreman's lies aside. If the zero dollars monthly is all you can afford towards your healthcare plan, then that is cool. Just don't get chronically ill. You will have to pay a little as you go and you will likely be able to afford that, just don't get really sick.

If you don't have any chronic problems and your in fairly good health, now is the time to plan. Actually, that was 5 years ago, but as long as you don't have major issues for the next 5 or 6 years.... Talk to a financial adviser or lawyer that specializes in trusts. Medicaid can be used for assistance with your assets in certain types of trusts BUT it must be set up at least 5 years before you need the assistance. I am not a financial advisor, but I do plan on getting all of my assets in a trust in the very near future so that it is done before I retire and I need to worry about insurance, or I should say at least 5 years before my better half retires because she's the one with the insurance through work. I don't know how this works with medicare, but that's not really what I'm worried about.

 

[k0ua]

Keep in mind you have the 7 month window for a supplement where you can get coverage NO MATTER HOW SICK YOU MAY BE. It doesn't matter the insurance companies HAVE to cover you. After that window closes, if you are ill, and cannot say no to the 23 questions about your health, then that is IT. You will never qualify for a supplement again.

Unless you are somehow miraculously cured of your chronic illness. Don't blow your window, 3 months prior, the month of turning 65 and 3 months post. Of course if you have credible coverage (like your plan at work or your wifes plan) then you can defer going on Medicare.

Once you go down Advantage road, you chances of turning around are slim. You MUST clear underwriting, AND they will have full access to all of your medical records. There will be no hiding your health status. Choose wisely and choose what is best for you, NOT what was best for your buddy.

If you have a supplement and you can not keep up the payments, you can bail out and go to an Advantage plan. But unless you are in very good health, you can't go the other way. It is a once in a lifetime deal for most people. But if you are poor, and not eligible with the military service to get on tri-care, then Advantage plan may be the route you have to take. But unless you are REALLY poor and can get on Medicaid too, then don't expect that money back for part B premium. MOST people have to pay their part B premium no matter which road they go down.

The lies they tell on the ads on TV are just so you will call. You know why? Because they CANNOT call you about an advantage plan. It is against the law for an agent to call a prospective client out of the blue about an Advantage plan. . AND before they can even talk to you after going to their home to a meeting they have agreed upon (pink card) they will ask you to sign a paper stating that you give them permission to talk to them. Government safeguards to prevent unscrupulous agents from "churning" clients each year.

Ask yourself this: "why would the Advantage plans want me?" After all a lot of the plans, depending on where you live and the risks, are ZERO dollars monthly premiums. How can they do this? Why would they do this? MONEY. That is the entire reason. MONEY. And no other reason.

The government kicks back your part B premium to them so that it can wash its hands of you and have you put into managed care under the kindly insurance companies. They want that monthly guaranteed income from your part B premium. And they are going to Nickle and dime you as you go along for doctors, durable medical equipment and hospital stays.

Medicare (the government and its taxpayers) still has to pay the lions share, but the insurance company deals with Medicare and the providers and sucks the rest out of you. And if you stay healthy, they collect your Part B like clockwork.

Well anyway, this is becoming a "book", and there is more. Always more, and the rules change every year. But I will just say this: If I thought an Advantage plan was an advantage for me, I would have chosen one. I did not. But it can be the only choice some people have. But I REALLY REALLY hate the skating on the edge of truth and lie that the advertisements do.

I highly recommend you get a life and health insurance agent licensed in your state, that you trust and consult with them. Pick carefully.

 

[Diggin It]

This is one plan I'm looking at:

-----------------

PPO plans do not require a prior authorization or referral for out-of-network services.

Monthly plan premium $0

You must continue to pay your Medicare Part B premium.


Part B Premium Reduction

This plan offers a $60 give back every month in your Social Security check.

Maximum out-of-Pocket Responsibility $5,500 in-network annually

---------------------

It also offers basic hearing, vision and dental, with some exclusions and exceptions. Most are $0 deductible, some are not. I'm not sure I'd ever get to the $5,500 number since I try not to use services very often. My hand accident a couple of years back might have been the exception.

I just checked with my clinic insurance specialist and they confirmed they accept this plan. Looks like my dentist does too, but I still need to verify that.

One thing I cannot get a straight answer on is whether of not the VA plan I'm on qualifies as Part D. I call the regional registration office and get double talk. They say to check with the local clinic. I went there yesterday and they're still on silly restrictions and won't let anyone in without a prior appointment and jumping through hoops. I asked the person that meets everyone outside the building for screening and got double talk. 'We don't discuss that here, you have to call regional registration.' I tried to explain I already did that and they referred me here. She just shrugged. She also snipped at me that I had missed an appointment a year ago ... 'you were a no show'. That's not possible because I never made an appointment there. They had already started the restrictions and I refused to be involved in that.

I've tried the national 800 number too and the MyHealtheVet portal and none of them will answer the Part D question. The booklet I have says I have prescription coverage, but apparently only for items written by VA doctors. I don't know if that takes care of the Part D qualification or not.


"I highly recommend you get a life and health insurance agent licensed in your state, that you trust and consult with them. Pick carefully."

I've talked to several and tried to contact several others. The ones I've been able to talk to will only discuss plans they sell. They will not answer any questions about other plans. I've also talked to several so called counselors that are not tied to plans and they seem to know even less than I do.

 

[TractorGuy]

You guys haven't listened and done what JJ Walker and Joe Namath are telling you? It sounds DYNOMITE!

seriously, I'm interested and watching as I'm just a few years away.

Yeah you NEED TO CHECK YOUR ZIP CODE!

like that has anything to do with anything.

When I went on Medicare I talked to my doctor and they recommended an advantage plan that happened to be provided by the HMO I already had and was happy with. I didn't learn until after the fact I couldn't revert to regular Medicare if I went that route.

So far it has worked out for us. We don't get dental or hearing. That has cost us plenty on the wife's side. We have limited vision benefits. We get free and reduced prescriptions. Wife had one overnight stay in the hospital that cost us nothing out of pocket.

We pay about $30 a month each over the regular plan B rate. Doctors will readily accept us as patients. The plan pays them a monthly rate. Office visits are a $10 copay. My GP will answer portal messages on the weekend.

 

[Snobdds]

This is one plan I'm looking at:

-----------------

PPO plans do not require a prior authorization or referral for out-of-network services.

Monthly plan premium $0

You must continue to pay your Medicare Part B premium.


Part B Premium Reduction

This plan offers a $60 give back every month in your Social Security check.

Maximum out-of-Pocket Responsibility $5,500 in-network annually

---------------------

It also offers basic hearing, vision and dental, with some exclusions and exceptions. Most are $0 deductible, some are not. I'm not sure I'd ever get to the $5,500 number since I try not to use services very often. My hand accident a couple of years back might have been the exception.

I just checked with my clinic insurance specialist and they confirmed they accept this plan. Looks like my dentist does too, but I still need to verify that.

One thing I cannot get a straight answer on is whether of not the VA plan I'm on qualifies as Part D. I call the regional registration office and get double talk. They say to check with the local clinic. I went there yesterday and they're still on silly restrictions and won't let anyone in without a prior appointment and jumping through hoops. I asked the person that meets everyone outside the building for screening and got double talk. 'We don't discuss that here, you have to call regional registration.' I tried to explain I already did that and they referred me here. She just shrugged. She also snipped at me that I had missed an appointment a year ago ... 'you were a no show'. That's not possible because I never made an appointment there. They had already started the restrictions and I refused to be involved in that.

I've tried the national 800 number too and the MyHealtheVet portal and none of them will answer the Part D question. The booklet I have says I have prescription coverage, but apparently only for items written by VA doctors. I don't know if that takes care of the Part D qualification or not.


"I highly recommend you get a life and health insurance agent licensed in your state, that you trust and consult with them. Pick carefully."

I've talked to several and tried to contact several others. The ones I've been able to talk to will only discuss plans they sell. They will not answer any questions about other plans. I've also talked to several so called counselors that are not tied to plans and they seem to know even less than I do.

That out of pocket is high, especially if you have some part b and part d cost in addition to the deductible.

I just went through this with my mom. I got her a true Medicare supplement and plan G. Her out of pocket is $200 per year. Her premium on that plan is $170 per month. She has to pay part b of 208. Part D is around $20 per month.


So total out of pocket is

208*12
+ 170 * 12
+20*12
Total = 4776

plus the deductible of 200

Grand Total = 4976.

She could have a surgery every day of the year and the total out of pocket for premium and deductible is only $4,976.
No surprises, all known.

 

[Diggin It]

But you're paying that $4700+ each year whether she goes to the doctor or not. I haven't been to a doctor at all in the last two years. Prior to the hand accident, I'd been going once a year for a basic checkup. There was a small infected spot on my back that had to be drained three times a few years back, but that was all done at a clinic and would have been minimal cost.

In fifteen years, I might have been to a doctor less than a dozen times including all of the above. Aside from the hand issue, my annual costs would not have been any where near that $4700+, likely less than a quarter of it.

Yes, I know, the next fifteen years could be an entirely different story.

 

[Tinhack]

I had a bleeding stomach ulcer, blood loss of 7 pints, and open heart surgery to replace my aortic valve all on the same 11-day hospital stay in 2018. Medicare paid for all but about $3,200 and all I have is A & B. And I went to the best hospital in a five county area. The ambulance folks made me sign a release in case I died on the way. It was about a 30 mile trip. I told them to turn up the oxygen and get me there.

I looked into supplemental insurance but the monthly premiums would be far more than that each year. Blue Cross wanted $300+ a month with a $3,500 deductible. That's about $7k out of my pocket before they even start paying for anything.

My Medicare deductible is $200 a year. I hit that by February each year for my arthritis. Otherwise, I'm paying about $25/month on doctor visits and about $30/month on prescriptions. I can't find ANY insurance with premiums that low.

 

[beowulf]

What all these posts reveal is that you have to learn as much as you can and then make very individualized choices for your particular situation. Knowledge of the options and consequences of your choices is critical.

 

[ultrarunner]

Yep and it is s full.time job keeping up!

Mom pays a lot but the couple of times needed it was covered... kind of limiting your exposure.