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…