Author Topic: Starting Medicare in 2 weeks - any suggestions- number of options are large  (Read 446 times)

0 Members and 1 Guest are viewing this topic.

Online TXAZ

  • Uses Solvent For Toothpaste
  • ******
  • Posts: 7713
  • أنا لست إرهابياً
    • View Profile
Next month I (apparently have to) get on Medicare. I have excellent insurance now from my employer.

Any suggestions on navigating all the options and land mines to avoid?
Thanks in advance.
.

Online Gilgondorin

  • Concealed Carry Pro
  • ****
  • Posts: 2940
  • .: Gear of War :.
    • View Profile
Gilgondorin's suggestion: Budget time..... Lots, and LOTS of time. Also, you're gonna need one hell of a coffee machine: https://m.media-amazon.com/images/M/MV5BYjA5ZDU3MTAtM2UwNy00YThlLWFjYjMtNzQ1ZTBjMGVkMzAzL2ltYWdlL2ltYWdlXkEyXkFqcGdeQXVyNTMzMTE1NzY@._V1_UY1200_CR109,0,630,1200_AL_.jpg

:th_thicon_lol:

It took me literally 8 days of sealing myself in my room with my computer, like an ascetic monk, doing round-the-clock online research weighing the pros and cons of all the plans that were available to my dad, to pick the one best suited to his personal circumstances. I spent literally hours on the phone, skimmed through sales pitches, read through a library of congress' worth of legalese/fine-print/policy guides/sales brochures/etc.; the few times I left my house that week was to talk with a few agents in person; I even spent a whole night comparing the same general policy from several different companies once the search began to narrow.

I can't recommend strongly enough that you do all your homework before you commit to a policy; the long-term implications for your health, welfare, and finances are too great. For example, one of the rules I didn't find out until later (when it was almost too late) is that -- in our case, anyway -- you only get one guaranteed shot to be accepted for a policy of your choosing when you first become eligible. You only get a small window of time -- like, two weeks I think it was -- after that to change your mind, ONCE, and go with a different policy if you find another that is better suited to you and still receive guaranteed acceptance. After that, if you ever need to switch or start a new policy (particularly if you let your current one lapse), you're up the creek because you then are required to submit to under-writing and health questionnaires, both of which will can mean drastic increases in the cost of your monthly premiums if you're successful in getting approved.

Do as much research as you possibly can before you commit, and speak to trained/licensed insurance agents as often as you need; don't rely only on the advice you get from us rando's on a web forum, especially given the laws and regs change -- they may already be waaaay different than what it was like when I had to go through this process on behalf of my dad.

(My approach to researching things may seem extreme at first. However, now that I have the clarity of 5 years of hindsight behind me, I can safely say the benefits have proved to be well worth it.)

Online Alte Schule

  • Military
  • Always in the 10 Ring
  • *****
  • Posts: 3091
    • View Profile
I was somewhat lucky. My wife is a older than me and sorted everything out for us a few years ago and before I had to give up the insurance I had, and very was satisfied with, for the past 35 years. To tell the truth I'm pretty impressed with my medicare coverage so far.

Previously for every visit I had a $40 co-pay. Now it's "0". Lab work I need every three months was right around $150 per visit. Now nada. My wife had retina surgery three weeks ago and our out of pocket expenses was  $250. Keep waiting for the gimme more money hammer to drop but the clinic says we are paid in full. We will see.

My wife is gone visiting her sister, again, so I don't have any specific information. I'll run this by her when she returns and let you knw if she has any useful information.
This gun is liberty; hold for certain that the day when you no more have it, you will be returned to slavery.
Toussaint Louverture

Offline randyjaco

  • 7 Yard Shooter
  • ***
  • Posts: 573
    • View Profile
I don't envy you, the search is maddening. I finally ended up with United Healthcare through AARP. I have been with them for about 12 years. No complaints.

Randy
Do yourself a favor, find America One News Network (OANN) on your cable carrier. 208 on Uverse. News without the Network BS or bias

"A gun is like a parachute. If you need one, and don't have one, you'll probably never need one again." (Unknown)

"There are three and only three ways to reform our Congressional legislation, familiarly called, the ballot box, the jury box and the cartridge box" (Frederick Douglass)

Offline RaySendero

  • Doesn't Run Downrange
  • *
  • Posts: 136
    • View Profile
Gilgondorin's suggestion: Budget time..... Lots, and LOTS of time. .....
It took me literally 8 days .....

Appreciate the heads up.
So tell us what you chose and why please.
Ray

Online TXAZ

  • Uses Solvent For Toothpaste
  • ******
  • Posts: 7713
  • أنا لست إرهابياً
    • View Profile
Gilgondorin's suggestion: Budget time..... Lots, and LOTS of time. .....
It took me literally 8 days .....

Appreciate the heads up.
So tell us what you chose and why please.

Yes please!
.

Online Gilgondorin

  • Concealed Carry Pro
  • ****
  • Posts: 2940
  • .: Gear of War :.
    • View Profile
Appreciate the heads up.
So tell us what you chose and why please.

Unfortunately, I was doing some preliminary research to answer this question and as I feared, things have changed fairly significantly since we went through this about five years ago. What I chose for dad is no longer available to newly eligible individuals.

This link seems to have a good 'quick and dirty' as to what is out there, and should serve as a jumping-off point for all interested parties -- it's got a lot already detailed on one page that took me an afternoon to find digging through separate sources and literature: https://www.tdi.texas.gov/pubs/consumer/medsup.html

On the other hand, the company that published the following graph does not appear to do business in the state of Texas specifically; the things they have listed on their site which you can visit through the source link posted for reference may not have much other pertinent info as to what else may be available here that's not available elsewhere. However, given that the plans it talks about SHOULD still be on offer at the national level given Medicare itself is a federal program, think of it as a very broad teaching aid.

Looking at the graph, we have a collection of the different standardized supplement policies available to medicare recipients:


(source: : https://libertymedicare.com/medicare-plans/medicare-supplement-plans/what-are-medicare-supplement-changes-in-2020/)

..........Being standardized, you should be able to go to any major insurance company offering medicare supplement insurance, and they're all going to give you the same basic coverage -- kinda like one dozen eggs from H-E-B will feed you the same as one dozen eggs from Wal-Mart.

There's also such a thing as a Medicare Advantage plan, which is different than a Supplement Plan. They can be structured the same, and insurers sometimes offer better fringe benefits than other insurers that are not officially part of the federally mandated aspects of the plan; when and where available, this can include extremely basic vision care, some dental (not a lot), rides to/from your doctor's visits in some cases, and so on. From what I understood, these plans operate like the health care you're already used to having through your employer, with these types of plans dealing with being in-network wherever you go; supplement policies apparently don't restrict you to a network and are good nation-wide. Furthermore, Advantage plans aren't standardized and region-specific, meaning they wouldn't be available to everyone everywhere like the federally mandated plans are.

As I mentioned previously: if you have health problems, or if insurance premium costs are a factor, or if you're by yourself, or if you got dealt a crappy hand in the black jack game of family genetics, this is where you'll have to custom tailor what's out there to your own personal situation by choosing what works best for your family. Some of you may need the optical and dental benefits, which are (or were in our case) typically NOT offered under supplement plans except as strictly medically necessary (for example: a once-yearly visit for a diabetic to have their eyesight checked, which doesn't cover glasses or a prescription for glasses, and no dental at all).

Another thing I noticed is that even with the standardized supplement plans where supposed to have the same basic coverage no matter which insurance company you go with, in practice, there could be a pretty big discrepancy in price of the insurance premium for the plan itself (I remember being given quotes for a policy that wound up being $168 a month with Company A, whereas Company B offered to sell me their version of the same plan for $348 a month). This is where the leg-work in finding the best rate for the same amount of coverage comes into play.

From my understanding, the plans that don't cover much of anything are intended for healthy people who only see the doctor like once or twice a year. The monthly premium is therefore going to be very cheap (some are like $20, and some are even free to you because the Government picks up your part of the tab for you) since paying for extra and unnecessary coverage would be pointless for a healthy person. The downside to these types of policies is you may wind up spending a lot more if you ever DO actually need to go to the hospital, because you're more than likely going to have an out-of-pocket maximum of like $5,000 or more, which means you're on the hook for at least $5,000 before your insurance will pay for everything else for the rest of the year if you randomly have a heart attack or stroke.

On the flip side, some of the other policies cost several hundred dollars a month, because they are in some cases far more comprehensive than the 'healthy person' plans. At a glance, you'll notice plan 'F' has all the check marks the other plans don't. This is because plan 'F' is intended for very sick people who frequently go to the doctor's office. Although you'll probably spend several thousand dollars over the course of a year in insurance premiums, the high-roller plans typically cover more services and require you to pay less per visit with a healthcare provider, sometimes not even having to pay a co-pay for office visits depending on which plan you choose.

Unfortunately from what I gather, at the beginning of this year, the apparently Government took away plans C, F, and F* (high deductible) and said that anyone not already eligible for medicare by the 1st of January is no longer able to pick any of those plans, which means just about everyone here. Apparently, the Government replaced them with other policies like the 'G' and 'N' plans. At a glance using the link from that Liberty insurance link above, to me it looks like 'G' is the closest substitute for 'F'. 'G' is apparently also supposed to be guaranteed acceptance, even for newbies, and LOOKS like it covers most of the same basic things 'F' did. The actual situation on the ground here in Texas may be different -- as before (and I'm sorry for sounding like a broken record), I'd recommend doing some more research.

In our particular case, I chose a supplemental policy, plan 'F', for Dad-Gondorin because we only had to pay $195 out of pocket once a year, every year, at the beginning of the year with his first visit to any doctor. Then, everything -- EVERYTHING -- after that was covered by the one-two punch of Medicare and (in our case) Humana, which is who our particular policy is through. I don't know about how it works with Advantage plans since I decided against them fairly early on in my search, but, one of the things that was explained to me was that the way the money breaks down with a supplement policy (again, at least in our case): if you can get Medicare to pay for the first portion of whatever service dad needed, the supplement policy would then have to kick in and cover whatever the policy guidelines allow. The insurance company does not have the ability to say 'no' to paying for a service unless it was deemed not medically necessary. So, as a result in our case, the miracle of 'F' coverage would pick up the cost of the second half of the bill completely, no matter how much it ended up being and no matter what the services were. We never pay for lab work, we don't have copays for office visits no matter if it's his PCP, a specialist, or a surgeon, and he practically never gets denied for any treatment his doctors suggest. In-office procedures are covered 100%, the whole nine yards.

Dad-Gondorin has gone through partial-foot amputations with month-long stays at rehab facilities afterward, that didn't cost us anything. And, because I use the same relentless, borderline neurotic methods I used to research any new specialists Dad needs as I did with finding his insurance policy, I knew I could find and take Dad to the best specialists in any field without having to worry about whether they were in-network like we would have had I gone with an Advantage plan; from my understanding, he could theoretically go to any facility run by any doctor anywhere in the US and it wouldn't be a problem so long as we could get him physically there.

Knowing what kind of headaches and expenses it's saved us in the past, I still actually get excited to pay his premium for the year. It's almost fun; absolutely zero regrets. The only downside I've noticed is that his insurance is TOO good. We have a few times in the past had to give some doctor's offices the boot because I felt they were using any old reason to wave dad in for another billable office visit when there didn't really seem to be a need for it. It became less about treating whatever condition he was there for, and more about scheduling a 15-minute follow-up where all he'd get is a glancing over and a handshake (and another appointment card).

I apologize for the overly wordy post, so I'll hurry up and conclude with some final recollections: invest the $0.70 in a composition notebook and keep it and a pen(cil) handy any time you call an insurance agency. Write down the name of the company, the phone number, name (and if applicable, insurance agent or employee number) of anyone you speak to, along with their department and time/date, along with any notes you feel you need to record. Have a list of questions handy that you'll need to have answered no matter what, so that you've got all your bases covered no matter what direction the rest of the call heads in; you can compare different answers from different companies this way.

Also, using your notes, be ready to point the finger at somebody who gave you faulty information, or on the opposite end, be ready to refer back to any good info THEY knew that another operator (say, one who is new at their job, or just sucks) is not presently aware of. And of course, above all, don't commit to any policy until you're absolutely sure it's what you need, because as I said previously you only get one shot.

(Obligatory disclaimer: No, I'm not a trained or licensed insurance agent. Treat the above as me just thinking out loud.)

Online Gilgondorin

  • Concealed Carry Pro
  • ****
  • Posts: 2940
  • .: Gear of War :.
    • View Profile
A Step-by-Step Guide to Selecting Medicare Coverage

https://www.barrons.com/amp/articles/enrolling-in-medicare-can-be-tricky-here-is-a-step-by-step-guide-to-selecting-your-coverage-51595682001

Quote
[ . . . . ]

The graying of the baby-boom generation means that roughly 300,000 Americans were going on Medicare every month even before the coronavirus caused thousands of older workers to lose their jobs and health insurance. These seniors are being asked to navigate a confusing new landscape that blends public and private insurance coverage with complicated trade-offs between premiums and out-of-pocket costs.

Barron’s talked to financial planners, Medicare consultants, insurance brokers, and Medicare enrollees to create a guide for this labyrinth.

Signing Up
If you’re already receiving Social Security benefits, enrollment in Medicare is automatic at age 65. Otherwise you must enroll within a seven-month period of turning 65, which includes the month you turn that age, and the three months before and after. Even if you’re getting Cobra coverage, where you remain on the health plan of a former employer or enrolled in a retiree health-care plan, you must sign up for Medicare or face penalties.

One big exception: If you’re still working at a company with at least 20 employees and covered by a health-care plan there, you don’t need to sign up. After your employer health insurance ends, you have eight months to do so.

[ . . . . ]

Online DCD327

  • Concealed Carry Pro
  • ****
  • Posts: 2225
  • Military.
    • View Profile
Im not there yet.
So I dont know that information. And hopefully dont have to learn it either. 

My wife is 2 years older, kinda a control freak when it comes to insurance stuff, and VERY anal about paperwork.

So I'm kinda hoping to skate through that crap without ever actually even looking at it.  :th_thicon_lol:

All these years putting up with her mouthy bullshit about insurance paperwork, this
 is one time I'm COUNTING on it.  :th_thicon_funny:

And I'm not dumb enough to tell HER that either,.  :P been there, did that.  :th_thicon_idea:
Politicians are like diapers, they should be changed often, and for the same reason.

There are two kinds of people in the world my friend. Those with loaded guns, and those who dig. YOU DIG.  " Blondie".

Well, any man that wouldnt cheat at cards for a poke, dont want one bad enough. " Gus".

Offline cporfe

  • Military
  • Expert Magazine Loader
  • *****
  • Posts: 80
    • View Profile
Not that my experience is anything like yours, but I had BCBS federal employee and Tricare when I retired for good.  I kept the BCBS federal employee mainly because I was only 62 when I retired but my wife was older.  I still have the BCBS federal employee even though it's somewhat expensive, but their prescription plan is top shelf and better than anything I could find elsewhere.  Between BCBS and Tricare for Life (you have to have both A and B medicare for Tricare to continue, don't know why but it's a fact) we hardly have any co-pays on prescriptions and Walgreens files both insurances for me so I don't have to do anything (we both have long-term maintenance prescriptions) so it works for us.

Medicare if primary insurance by law so the other insurances we have fill in the gaps.  I had to have orthopedic surgery on my wrist last year and between all three insurances I didn't pay a dime.  Of course it took a little bit of looking to find someone who took all three insurances.

I think, but it's only my opinion, that picking a supplemental is fraught is challenges.  What your health is today my not be the health of your future.   Some plans sound great, only to find a waiting period for some things.  My wife had cancer and with BCBS and Tricare, it was taken care of quickly and she is an 11 year survivor.  BUT, we have been challenged by secondary issues from the surgery.  We've been lucky that we stayed with BCBS, I don't know if we could have managed switching to a new supplemental and been as blessed as we have with almost no costs to speak of.

That's my story.  I wish you God's blessing on making the right choices.
I'm on the 7 day weekend plan.  I'm retired!!