Medicare Revelation

[Mike Henderson]

I just discovered something about Medicare and want to pass it along to others who might be on Medicare or who will soon be on Medicare.

Some background: There are two ways you can take Medicare. You can take “Original Medicare” or you can take a “Medicare Advantage” offering.

With original Medicare, Medicare pays 80% of most charges and you can purchase a Medicare supplement policy that will pay the other 20%. When you turn 65 and choose Original Medicare, the companies offering the supplemental policies have to take you, no matter what pre-existing conditions you might have. On Original Medicare you can go to any doctor who accepts Medicare, whenever you choose and as often as you choose.

If you choose a Medicare Advantage plan, you don’t purchase a supplemental policy – the Advantage plan covers all your medical costs. The Medicare Advantage plans are HMOs.

The Medicare Advantage plans are growing, I assume because of the costs advantage.

At any time during open enrollment you can switch between plans.

However, there’s an issue that I just learned about.

The “problem” with a Medicare Advantage plan is that it’s an HMO and that means you have to go to doctors in the plan and you may need a referral from your primary doctor to see a specialist. Some people, when faced with a life threatening diagnosis, choose to switch from the Medicare Advantage plan to Original Medicare so that they can choose which specialist they want to have treat them. And this is where the problem comes in.

You can switch from a Medicare Advantage plan to Original Medicare at any time (during open enrollment), but the companies who offer the supplemental plans are not required to accept you. And if you have some life threatening (expensive) diagnosis they will either not accept you or the costs will be extremely high. They only have to accept you during the initial enrollment period when you qualify for Medicare at age 65.

Nobody ever tells you this when they sell you the Medicare Advantage plan.

Basically, what this means is that once you go with a Medicare Advantage plan you’re pretty much stuck in an HMO unless you can afford to pay the 20% yourself or very high prices for the supplemental plan, especially once you get a life threatening diagnosis.

My advice: Think carefully about enrolling in a Medicare Advantage plan. It could be a one way street.

Mike, who is on Original Medicare.

[Paul F Franklin]

I just went through the whole figuring out Medicare thing. I have many members of my family in the healthcare industry and they all cautioned against signing up for a MA plan for several reasons, one of which is the one you point out. For someone who is healthy, and stays healthy (who has *that* crystal ball), and doesn't travel much (if you are traveling, you are almost certainly going to be out of network), then the plans can save you money.

A big hint is how many robo calls and fancy glossy brochures you get in the mail from the MA companies as you approach 65, and the number of ads on TV. They push it very hard because it's a good deal for the companies, not necessarily for the customers.

[Edwin Santos]

The Medicare Advantage model is fairly simple.

The Feds pay the MA plan roughly 92 cents out of every dollar that they would have otherwise spent, paid to the plan on a per member per month basis. From that point on the plan has accepted delegated responsibility for the member's Medicare benefits and the Feds have saved 8%. So how do the MA plans make a living at the discounted reimbursement? Three prong strategy: (1) Build a provider network that has agreed to lower pricing than Medicare pays them (usually these will be the lower grade providers who are a little more desperate for business and hence will agree to lower rates) (2) Ration the care using a team of case managers to deny benefits wherever possible, (3) Drag out payment to providers to make more float interest on the money. This can include finding ways to deny payment altogether for failure to obtain prior authorization or meet complicated billing requirements.

To draw a parallel to an industry that many of us are familiar with, this is like the general contractor whose mode of business is to win business as the low bidder by using the cheapest possible subs, cutting quality corners wherever he can, and not paying his bills timely or sometimes at all.

For anyone on a MA plan, please be aware that you have the right to file an appeal for any decision or action your plan takes, and there is a fast track (<72 hour) method for adjudicating these appeals. It involves a third party company designed as a "QIO" Quality Improvement Organization. These companies contract with the Medicare program to provide review of cases to hold the MA plans to task. So if a case manager is trying to ration or deny your care, or kick your loved one out of a hospital early, file a Medicare appeal ASAP. Often the MA plan will back off immediately because if they receive too many dings from the QIO it triggers a compliance flag for them with the Medicare program. In my experience this remedy is not widely known.

These comments come from a former hospital CFO who has lived inside the sausage factory of healthcare. My advice to anyone is concern yourself with preventive health and minimizing or forestalling your reliance on the health care system. There are a lot of good people who work in the industry, but the incentives for the management of care too often have less to do with the patient's well being than we'd like to think.

Edwin

[John Goodin]

Mike, your information definitely gives people something to think about. Hopefully, you did not learn this the hard way after an illness.

I once had a girlfriend who made a killing selling a Medicare Advantage plan. It didnt take for me long to figure out it is not hard to sell a product that does not require a direct out of pocket cost.

[Kev Williams]

My wife's been on medicare for 18 years. About oh, 8 years ago I decided to add her to the Humana thing. First thing that happened was her monthly check increased by nearly $100. Yeah, the 'in network' thing can suck, her doctor of 28 years wasn't in the network until just last year, so all his expenses have been out of pocket. However, he discounts his rate for non-insured like 40%, so I look at the extra $100 as how HE gets paid. So we're basically even on that. Then one night in March 2016, about 2am Sunday morning, my better half, who's suffered from migraines her entire adult life, has a really bad one come on. She declined a trip to the emergency room, figuring it was just a really bad migraine. TWO DAYS LATER she's had enough of the pain so I take her to emergency. After an MRI found a brain bleed, they pumped no less than 15 bottles of 'cocktails' into her veins over the next 6 hours, followed by an ambulance trip to the U of U hospital. Once there, they determined she'd suffered a Subarachnoid hemorrhage. (I'm not too worried about Covid-19, look up the mortality rates of an SAH...) She spent 11 days in ICU and 3 days of followup, had 2 angiograms and several x-rays and other tests, Once home we got the bills; ER and ambulance was just south of $9k, the hospital a bit north of $115k... I was fully expecting $15-$20k out of pocket. Instead, our end was $1,845... and the next summer after that, I accidentally pinned her between the back of our motorhome and the chainlink fence at our storage lot, hurt her pretty bad-- the ER trip that day was over $14 grand, our out of pocket was $75...

The catch? The U of U hospital was out of network, but obligated to take her in as the only facility close enough to keep her alive, but afterward they DID invite us NOT to show up to their place ever again. But seriously, we have no complaints AT all. If the difference between looking at 20% of the bill or the high supplemental insurance premiums vs. an average of 1.4% of the bill (and getting an extra $100 a month) is going 'in network'-- For me that's a no-brainer. (I've been on the Humana plan since I turned 65 last July :) )

Works for us, but of course, this may not work for others, due diligence applies...

[Doug Dawson]

My wife's been on medicare for 18 years. About oh, 8 years ago I decided to add her to the Humana thing. First thing that happened was her monthly check increased by nearly $100. Yeah, the 'in network' thing can suck, her doctor of 28 years wasn't in the network until just last year, so all his expenses have been out of pocket. However, he discounts his rate for non-insured like 40%, so I look at the extra $100 as how HE gets paid. So we're basically even on that. Then one night in March 2016, about 2am Sunday morning, my better half, who's suffered from migraines her entire adult life, has a really bad one come on. She declined a trip to the emergency room, figuring it was just a really bad migraine. TWO DAYS LATER she's had enough of the pain so I take her to emergency. After an MRI found a brain bleed, they pumped no less than 15 bottles of 'cocktails' into her veins over the next 6 hours, followed by an ambulance trip to the U of U hospital. Once there, they determined she'd suffered a Subarachnoid hemorrhage. (I'm not too worried about Covid-19, look up the mortality rates of an SAH...) She spent 11 days in ICU and 3 days of followup, had 2 angiograms and several x-rays and other tests, Once home we got the bills; ER and ambulance was just south of $9k, the hospital a bit north of $115k... I was fully expecting $15-$20k out of pocket. Instead, our end was $1,845... and the next summer after that, I accidentally pinned her between the back of our motorhome and the chainlink fence at our storage lot, hurt her pretty bad-- the ER trip that day was over $14 grand, our out of pocket was $75...

The catch? The U of U hospital was out of network, but obligated to take her in as the only facility close enough to keep her alive, but afterward they DID invite us NOT to show up to their place ever again. But seriously, we have no complaints AT all. If the difference between looking at 20% of the bill or the high supplemental insurance premiums vs. an average of 1.4% of the bill (and getting an extra $100 a month) is going 'in network'-- For me that's a no-brainer. (I've been on the Humana plan since I turned 65 last July :) )

Works for us, but of course, this may not work for others, due diligence applies...

This probably varies by state, and by whatever private handshakes take place behind the scenes, but it sounds like you got really lucky, most of the horror stories are in the opposite direction.

There is a supplemental part B, called "type F" or something like that, that takes care of the extra 20% but with a high deductible (something like $2k) and costs less than a hundred a month. _That_ is the best deal going. There's been some talk of phasing it out for new enrollees, which I hope will not happen.

Now if we can only get rid of the providers who won't take Medicare at all....

[Jon Grider]

Last year at this time, I was still working but being nudged toward retirement on my 65th birthday in June. I was having health issues and after several months and a battery of tests it was determined that my pericardium [the sac around the heart] had hardened and calcified to the point that blood flow was being restricted. At the same time, as most people have experienced at 64 years old, I was being deluged with mailings of offers of medicare advantage programs that would cover up to and including everything that I could possibly ever need as far as care. I even went to a local Seniors Center meeting to learn all about the ins and outs of Medicare. That turned out to be a sales push for an advantage plan. Although the speaker ignored this section, the Medicare booklet they provided had details of original Medicare and Medigap supplemental policies. Never one to like being hoodwinked, I decided to look into the Medigap route and finally elected to go with original Medicare and a supplemental policy that costs about $104 per month. In July I had a pericardiectomy [open heart surgery] at University of Michigan by a highly recommended surgeon. To abbreviate this story, my bills including tests at the local hospital, local cardiologist care and reference to UM, surgery with all the incumbent charges, 5 days at UM hospital, more post surgery testing all totaled were in excess of 250K. With Medigap supplemental G and original Medicare my out of pocket has been about $2500. My premiums for the supplemental policy did not go up this year either. I feel like for me anyway, my choice was the right one.

[Dave Anderson NH]

At our house we go 2 different ways. My wife with preexisting conditions went with regular Medicare and got the part B (Category G) supplement through Anthem BC/BS at a reasonable rate. I am on regular Medicare with no supplement. My part B is the Veteran's Administration. Fortunately I m exempt from the means test which I would fail. My 2 Purple Hearts from Vietnam actually turned out to be worth something after all. In spite of all the complaints in the media about the VA, I have had nothing but excellent care and and completely satisfied. As for MA plan advertising, I still get tons of solicitations after turning 65 six years ago. It'll probably never end.

[Sam Force]

My wife is on regular Medicare with a supplemental insurance. In December she was hit with multiple health related problems. Heart related, loss of blood, and worst of all a massive tumor in her breast. Spend 8 days in the hospital with every test imaginable and 2 surgeries. Over $100K we had to pay 0 dollars, now going through chemotherapy, has had 6 rounds so far with 11 more to go. Then surgery followed by radiation. We still have not paid 1 dollar for any treatment or appointments with oncologists or cardiologists. Medicine is costing a couple hundred a months but we consider ourselves fortunate everything else has been covered.

[Paul F Franklin]

There is a supplemental part B, called "type F" or something like that, that takes care of the extra 20% but with a high deductible (something like $2k) and costs less than a hundred a month. _That_ is the best deal going. There's been some talk of phasing it out for new enrollees, which I hope will not happen.

New enrollees can no longer get a type F supplemental as of Jan. 1. If you already have one, you can continue on it. The Type G plan includes everything the type F did, except coverage for the medicare deductible. There are no longer any medigap plans that are allowed to cover the deductible. The type G medigap plan that I have has no deductible, it starts paying pretty much everything Medicare B doesn't cover right away (except for the Medicare B deductable).

I went with original Medicare, A & B, an inexpensive but highly rated drug plan (type D) (even though I am on zero meds) and a medigap G plan. The monthly cost for it all is less that what my wife was paying to include me on her health insurance.

[Rich Engelhardt]

You can switch from a Medicare Advantage plan to Original Medicare at any time (during open enrollment), but the companies who offer the supplemental plans are not required to accept you. And if you have some life threatening (expensive) diagnosis they will either not accept you or the costs will be extremely high. They only have to accept you during the initial enrollment period when you qualify for Medicare at age 65.
That right there is THE single most important piece of information anyone should take away from this discussion.

Once you sign on board the Advantage plan - sucked in by the (supposed) no or low cost, you burn your bridges back to the far better coverage and far less expensive (in the long run) supplement plan(s).

Of course - life and politics in this country being what they are.......those of use that actually - like - look into these things and try to do the right thing to begin with - will take it tough.
Meanwhile, the whiners that are too lazy to bother and more concerned about the right now - - will eventually whine their way by.
(God - I'm glad I'm old and going to die soon.....)

[Mike Null]

I'm 83. I am an advocate of Medicare Advantage simply because it works and saves us tons of money. Several years ago we were on the regular medicare and bought supplemental insurance to the tune of several hundred a month for the two of us. We picked our own doctors without having to get referrals. Net result--for this small convenience we paid several hundred a month and because we have been fairly healthy it was a total waste of money.

Seven or eight years ago I switched to MA and have been kicking myself for not doing it sooner. It has saved us a ton of money and our medical care hasn't suffered a bit. BTW, our doctors were all on the plan.

Two years ago I had cataract surgery, which was nothing short of a miracle, and my expenses were less than $200 including two pairs of prescription glasses. I would not consider switching back to regular Medicare.

[Mike Henderson]

Mike, your information definitely gives people something to think about. Hopefully, you did not learn this the hard way after an illness.

I once had a girlfriend who made a killing selling a Medicare Advantage plan. It didn't take for me long to figure out it is not hard to sell a product that does not require a direct out of pocket cost.

Thank you for your note. No, I've been on Original Medicare since I turned 65. I've seen the way HMOs operate. They're a business and they're in business to make money. That means they have to spend less than Medicare pays them. One way to do that is to try and keep people healthy and they generally stress that approach. They also try to enroll healthy people. But you can only do so much with these two approaches. The real savings come from rationing care.

They may, for example, contract with your primary care doctor on a capitation (https://www.acponline.org/about-acp/about-internal-medicine/career-paths/residency-career-counseling/guidance/understanding-capitation)basis. In capitation, the doctor receives a fixed amount of money for each patient assigned to him/her and usually has to pay for all the tests and referrals made. In this environment, the doctor is under a strong financial incentive to limit services to you. Whatever the doctor does not spend is his/her profit.

In capitation, the doctor's interest is not aligned with the patient's interest.

Even if you're not in a capitation environment (and even if you are), they may ration care by only having a limited number of specialists. So when you call the specialists for an appointment you may find that the next available opening is several months away.

Original Medicare has it's problems, also. When you have a supplemental plan with Original Medicare you don't pay anything for your care. This can lead to overutilization. There are many stories of lonely seniors who go to the doctor just to have some human contact and to have a person listen to them. While this is wasteful, at least it does not put your health at risk as can happen with an HMO.

Mike

[Kev Williams]

Once you sign on board the Advantage plan... - sucked in by the (supposed) no or low cost, you burn your bridges back to the far better coverage and far less expensive (in the long run) supplement plan(s).

just wanted to say this again: When I signed the wife onto Humana, her SS check INCREASED $100-ish per month. So, no matter how you slice or dice the numbers, the wife has earned nearly $10,000 extra in 8 years just because of her advantage-plan.

The downside............. ?


:)

[Alan Rutherford]

...If you choose a Medicare Advantage plan, you don’t purchase a supplemental policy – the Advantage plan covers all your medical costs.....

That must depend on the plan. With ours, visits to our Primary Care Physician are $10. Specialists, whether it's cardiology or physical therapy, are usually $40. There are co-pays for hospital stays and just about everything else, but they're mostly reasonable. Overall, we've been satisfied and we like the HMO concept but it's eye-opening to read your message about Medicare supplements.


...my bills including tests at the local hospital, local cardiologist care and reference to UM, surgery with all the incumbent charges, 5 days at UM hospital, more post surgery testing all totaled were in excess of 250K. With Medigap supplemental G and original Medicare my out of pocket has been about $2500....

With our Medicare Advantage plan, out of pocket for my triple bypass including 8 days in hospital was in the same ballpark.

[Lisa Starr]

I'm not 65 yet, but was forced into Medicare 3 years ago due to receiving disability after beginning treatment for Lymphoma. After much research, I chose a MA plan that is a PPO, not an HMO. I was careful to choose one with my Oncologist and his team listed as in network. The plan has a small Deductible ($750.00), but also a low ($1750) Maximum Out of Pocket, which I consider more important. For a whopping $22.00/month plus my $1750 max, I've had spectacular coverage. Each year I've met my deducible and max out of pocket and never paid another cent more. Every drug, every chemotherapy, the Stem Cell Transplant, the follow up visits, PET scans, and 2 other hospitalizations were all 100% covered by the plan.

I think the take away on this is like all things. Due diligence is needed. Make sure you know what your purchasing and what the ramifications of your choice will be down the road.

[Jim Becker]

Thanks for bringing that up, Lisa...my daughter's setup is MA via the state and it's a PPO, too, not an HMO. That said, I'm finding this discussion interesting as I'm going to have to deal with it myself in two years, although as long as Professor Dr. SWMBO remains in her tenured position at the university, her health insurance will continue to cover me, albeit with modifications once I have to sign up for Medicare. 'Kinda a shame we have to do all this dancing, but that's the way the system is setup currently. So EVERYONE has to do their own due-diligence to insure they have coverage that best fits their needs.

[Rich Engelhardt]

The downside............. ?Coverage....
The amounts the advantage plans cover here where I'm at are pathetic. One trip to the hospital will wipe you out.
Also - Humana doesn't provide Silver Sneakers anymore - they have some other rinky dink provision instead that nobody accepts in my area. That alone is lose to $100 a month for the two places I am a member at.

[Jim Becker]

It's important to fully understand what's covered and what isn't covered and what providers are part of the network for HMO/PPO plans. Don't assume that because the plan is from a particular carrier that it's the same coverage and network as other plans they offer. Case in point...as a family, we've been on Keystone Health Plan East (Independence BC/BS) for many years now. The coverage is good and there are many in-network providers. Prescriptions are through OptumRX. Our older daughter also now has a state provided "MA" type plan because of her disability to supplement Medicare. It's also a Keystone plan...but...there are far few providers on the network. Prescriptions are via Humana. Same company; different coverage and network for the medical.

Right now, "traditional Medicare" is looking more favorable for many folks in some areas...choose carefully.

[Ken Fitzgerald]

The Medicare Advantage plans using HMOs may work in metropolitan areas but in some rural areas there may not be a provider within 100 or more miles radius.

Before being old enough for Medicare, the corporation I worked for offered 2 insurance plans. One was cheaper using a HMO. The other plan used regular providers and was more expensive but we had no real choice since there were no providers in our immediate area.

When my wife and I went on Medicare, we went with original Medicare and our supplement is a plan F supplement. We may pay more each month but have no out of pocket expenses other than drug plan Part D expenses. We can budget for the Plan F monthly expense.

[Mike Henderson]

Medicare Advantage plans can be very worthwhile if you don't have any serious or chronic conditions. The horror stories are essentially all about someone who comes down with an expensive condition or disease or has some expensive long lasting (chronic) condition.

As long as you never have anything like that, a Medicare Advantage plan works well. The point I was making in my original post is that if you do come down with one of those situations, you will essentially be blocked from going back to Original Medicare because you won't be able to purchase a supplemental policy.

Mike

[Bob Grier]

Mike - I believe you can move to Original Medicare (this should be easy to verify) but you may not be able to get a Supplemental Plan. If you apply for a Supplemental Plan it may have to go through the underwriting process and you may or may not be allowed into the plan. If you are accepted then it could be subject to conditions like: 1) Probation for 2 years with accompanying conditions such as who pays for preexisting conditions and for how long, 2) Possible ejection from the plan at end of probation period of say 2 years and then a retroactive settlement of who reimburses who for expenses incurred during the probation period. 3) Or you may have a higher premium (I don't know about this higher premium first hand but have been told that it can happen). I do know about the first 2 conditions because I traversed those.

Another way I believe you can do it is to move to a place where your Advantage Plan does not cover you and then get a broker or someone very knowledgeable to help you navigate Medicare application and enrollment in a Supplemental Plan. This may be limited to only certain states, I do not know that but moving from Washington State to Phoenix area works. No underwriting.

If you have traditional Medicare only with no plan, you can also apply for a Supplemental Plan years after initial eligibility but again, you will have to go through the underwriting process and there is no guarantee of being accepted, even with conditions. It is not a gamble I would take but I accidentally did it because I did not understand the system when I needed to apply. I was off cruising on a sailboat and not in the States.

I completely understand how people struggle with what to do regarding Medicare. TV ads all sound so good with the one bill for everything plus the extras thrown in but ......

[Doug Dawson]

Medicare Advantage plans can be very worthwhile if you don't have any serious or chronic conditions. The horror stories are essentially all about someone who comes down with an expensive condition or disease or has some expensive long lasting (chronic) condition.

As long as you never have anything like that, a Medicare Advantage plan works well.

"As long as you never have anything like that." Those are the operative words. But we're all getting older, and there's no way to know.

[Doug Garson]

Wow, as the title says this is a real revelation. As a Canadian this thread makes me appreciate our healthcare system that much more. Our system is far from perfect, doesn't include visioncare, dental, physiotherapy etc or prescription drugs (we can and I do buy supplemental coverage for this) and there are constant debates on whether the program is adequately funded and we do have waitlists for non life threatening procedures but we aren't faced with the kinds of decisions described in this thread which could lead to bankruptcy or worse if made incorrectly. This year in BC, premiums for basic medical insurance were eliminated, last year the highest rate which depended on income, was $900 per year for couple making over $42000 per year. Everytime I hear the phrase " doctors who accept Medicare" I shake my head. In Canada there is no such thing, the rate for all medically required procedures is negotiated between the Ministry of Health for each province and the doctors association of that province and that's what the doctor receives there is no option for a doctor to not accept the negotiated rate for medically required procedures. I've had four minor surgerys, two for my sinuses, one for my sleep apnea and one last year to remove a basil cell mole, three or four emergency room visits and two colonoscopies in my soon to be 71 years, my out of pocket cost? Not counting parking, $0 and I can choose which hospital I go to not which one some HMO owns. As someone commented earlier insurance companies are not business to provide health care they are in business to make a profit for their shareholders and huge paychecks for their executives.
And before anyone asks, life expectancy in Canada is about 3 years longer than the US, infant mortality rates are lower and we pay just over half of what the US pays per person.

[Rich Engelhardt]

Wow, as the title says this is a real revelation. As a Canadian this thread makes me appreciate our healthcare system that much more. Before you get to feeling too comfortable with what you've got.....

You pay pretty close to what I would pay - - only difference is - you pay it as taxes.

If I lived in Canada - my income taxes would be very close to what I pay for Medicare & my supplement & ancillary programs - like Silver Sneakers.

[Lisa Starr]

Mike - I think you missed the point of my post. I DO have a serious medical condition and my MA plan is working just fine. I consider a total cost of $2000/year a pretty reasonable amount to pay per year for my health care. I paid $8500/year + $3700 Max out of pocket prior to becoming eligible for Medicare.

[Mike Henderson]

Mike - I think you missed the point of my post. I DO have a serious medical condition and my MA plan is working just fine. I consider a total cost of $2000/year a pretty reasonable amount to pay per year for my health care. I paid $8500/year + $3700 Max out of pocket prior to becoming eligible for Medicare.

I don't remember commenting on your situation, Lisa. I'm glad your MA is working out for you. The horror stories you hear about Medicare Advantage plans generally involve someone who was healthy and then came down with a serious disease or condition (often cancer), and then was "limited" in their treatment options because of the Medicare Advantage plan. I'm sure you can find those stories if you look - they're all over.

What I was saying in my opening post is to be aware of that risk. If you decide to switch to Original Medicare at that time, you may not be able to get a supplemental plan which will pay the remaining 20% of your medical expenses because the insurance companies are not required to accept you. They are only required to accept you when you turn 65 and sign up for Medicare.

Mike

[Bob Turkovich]

In Michigan - per my Medicare Insurance Broker - you have three years to decide which type of coverage you want and can switch between Advantage and Supplemental carriers at the annual enrollment period. During that period, any participating carrier can not turn you down for coverage nor cancel you after the three years are up regardless of pre-existing conditions. If you wish to switch after the three years are up, a carrier has the right to not accept you.

[Jim Becker]

Insurance is regulated by the states, so that may very well have some impact on this particular scenario...as Bob's post illustrates.

[Rich Engelhardt]

Insurance is regulated by the states, so that may very well have some impact on this particular scenario...as Bob's post illustrates.Bingo - it most certainly does have an impact.
What's good in one zip code is a disaster waiting to happen in another.
When I log onto my Medicare planner site - I'm given the choice between choosing my current county (Summit) and - the state of West Virginia.
Just for grins and giggles - I chose WV once - just to check things out.
Totally different.

[Kev Williams]

Coverage....
The amounts the advantage plans cover here where I'm at are pathetic. One trip to the hospital will wipe you out.
Also - Humana doesn't provide Silver Sneakers anymore - they have some other rinky dink provision instead that nobody accepts in my area. That alone is lose to $100 a month for the two places I am a member at.
Don't know where you live, but way different here it seems:
427745

[julian abram]

Wow, a lot of great discussion and info on this thread, I appreciate Mike starting this discussion. I'm 66 but still working and have a great family insurance plan through the employer. But know I will be facing these decisions soon. I've causally studied Medicare plans but from this thread it's obvious a fellar needs to study and think about details very carefully. Thanks!

[Jerome Stanek]

Coverage....
The amounts the advantage plans cover here where I'm at are pathetic. One trip to the hospital will wipe you out.
Also - Humana doesn't provide Silver Sneakers anymore - they have some other rinky dink provision instead that nobody accepts in my area. That alone is lose to $100 a month for the two places I am a member at.

I don't know what plan you have but my total cost for my Rotator Cuff surgery with all the test and PT was under $3000 dollars and the PT part was almost $1000. I had x rays then an MRI plus 5 trips to a specialist and the surgery. I have an Anthem advantage Plan Northern Ohio plus silver sneakers

[glenn bradley]

Wow, a lot of great discussion and info on this thread, I appreciate Mike starting this discussion. I'm 66 but still working and have a great family insurance plan through the employer. But know I will be facing these decisions soon. I've causally studied Medicare plans but from this thread it's obvious a fellar needs to study and think about details very carefully. Thanks!


Are there different rules? The info I received define the sign-up period as the three months prior to the month you turn 65 through the three months after. If you miss that window there may be penalty charges. It is certainly a more than generous window but, I have missed larger targets ;-)

[Doug Dawson]

Are there different rules? The info I received define the sign-up period as the three months prior to the month you turn 65 through the three months after. If you miss that window there may be penalty charges. It is certainly a more than generous window but, I have missed larger targets ;-)

When I went through this a few years ago, it turned out that the penalty did not apply if you still had health insurance (say from your employer) up until the point of application _after_ turning 65. It's not a simple process. The application was long, and also asked about the land vs air speed of a swallow, or some such.