Two Fold Medicare Question

[Ronald Blue]

In a few months I will transition to Medicare from private group insurance. Is there a place to get straight info that's not an insurance advertisement about what options I should or can choose? I've seen part D and other letters mentioned but it seems like a lot of double talk. Also is supplemental insurance something needed in addition to the options I may or may not choose? I know some is peoples experience/opinions and that's fine. I'm just trying to determine my best options before the big day arrives.

[Paul F Franklin]

The official medicare site is useful, and I found the AARP materials useful as well.

Your biggest decision will likely be to go with traditional medicare or one of the medicare advantage plans. Pros and cons both ways. If you go traditional medicare, then you will likely want a supplemental plan. I have a "G" supplemental plan, which in most cases has the broadest coverage of all the various supplemental options ("F" was a little better, but is no longer available to new retirees).

Once you decide on the basic direction, the official medicare site is very useful for identifying which plans are available in your area.

[John K Jordan]

In a few months I will transition to Medicare from private group insurance. Is there a place to get straight info that's not an insurance advertisement about what options I should or can choose? I've seen part D and other letters mentioned but it seems like a lot of double talk. Also is supplemental insurance something needed in addition to the options I may or may not choose? I know some is peoples experience/opinions and that's fine. I'm just trying to determine my best options before the big day arrives.

When transitioning from an employer-provided insurance to medicare years ago we got advice from our employers, medical and prescription insurance. We went with AARP for the supplemental. It's been very good - payed for almost everything Medicare doesn't. We also pay for the supplemental prescription insurance but if we don't use it all they send refund checks. Besides the medical and prescription we have dental and eye care insurance. I don't know the details since my wife took care of everything and she is extremely thorough in her research and decisions. Maybe discuss this with your current group insurance provider.

JKJ

[Brian Tymchak]

[QUOTE=John K Jordan;3187440]We also pay for the supplemental prescription insurance but if we don't use it all they send refund checks./QUOTE]

That's good to know! I'm a few years away from Medicare but I've been making an effort this year to start the education curve.

[Jerome Stanek]

I have an advantage plan from Anthem they seem to be pretty good. My SIL had the same Anthem as me and decided to try Aetna and she thinks she will go back to the Anthem as her INR check ups she has a $35 copay and with Anthem it was covered. She listed to one of those people that push plans and that woman was if you need air ambulance it could cost you a lot and Aetna it has a $600 copay. I asked what if you have met you total out of pocket and she couldn't answer that. My other SIL had Anthem and she did use an air ambulance and it was covered.

[Stan Calow]

I found the official site at medicare.gov to be pretty simple to understand. Even with that information, its making a decision that's difficult. Just make sure you understand the difference between supplement plans vs advantage plans.

[Ken Fitzgerald]

We have been on Medicare for a decade. We opted to get a "Plan F" gap supplemental at the time and still have it. Basically, it pays everything that is Medicare approved but Medicare doesn't pay. So, for instance, if an x-ray is needed, Medicare might approve a cost of $74 and only pay $54. The gap insurance plan pays the $20 difference. We do have to have a "Part D" prescription medication plan. The corporation that I worked for provides an advisory company who uses our current prescriptions medication list and annually checks among the prescription medical insurance plans to advise us each year as to which prescription medical insurance would be the most economical. We also have to pay for our own vision and dental expenses.

To me there are two options: Get a gap supplemental which is more expensive monthly but leaves one with less a potential big expense. The Advantage plans are cheaper monthly, may provide additional coverages like dental, vision and prescription medication coverage but give one a larger liability in the event of a major health issue. Some of the Advantage plans may require you to use approved hospitals or physicians.

It really is subjective. As suggested, go to the Medicare website and plan on doing some intense serious reading. Then decide what is right and comfortable for you.


BTW, the large corporation I retired from had similar type coverages for insurance while I was employed. You could have HMO's or regular health insurance. The HMOs were less costly and worked for those living in large cities. There were no HMO hospitals in our area, so we used regular insurances.

[John M Wilson]

Is there a place to get straight info that's not an insurance advertisement about what options I should or can choose?

Just went through this recently when my wife became eligible. Like you, I started early & checked out the official web sites, trying to figure out the best plan for us. This is one of those things where the more people you talk to, the more confused you get. This stuff varies considerably by geographic area, as well as your health status, prescriptions you take, who your doctors are, travel plans, etc. etc.

I started off thinking I knew the best way to go, and then got "information overload" & I was getting frustrated. Among the 48 lbs of brochures the mailman would deliver every day was a hand-typed & hand-signed letter from a lady at a local independent insurance agency. She said she was very familiar with the dozens of plans available in our area, and would help us pick the best one. I contacted her, a bit suspicious, and asked her who she worked for & how she got paid. She said that she was an independent agent, and would get a commission from the plan we picked, but that the commissions were basically the same across the different companies, which means she wasn't pushing a particular plan. My wife & I did a remote meeting thing over the computer (this was during a Covid surge, & we didn't want to go into the office). Our agent asked a ton of very specific questions, then took a few days to match us up with a plan. It was pretty stress-free!

We went with a Cigna Advantage plan -- but don't let that sway you, as your circumstances are absolutely different from ours, and that may or may not match your needs.

By the way, my very healthy wife just had a mild heart attack, we spent over a week in the hospital getting a triple bypass, and so far, we are out-of-pocket a total of $50, for an office visit. The statements keep rolling in, but so far, either Medicare or Cigna have just about paid for everything! (We joke that Cigna may not have wanted her had they known the future, lol). Our plan has worked spectacularly, for us.

I strongly recommend finding an independent insurance agent in your area that is familiar with all of the plans available to you. Talk with them, tell them your unique circumstances, and then listen to their advice.

Many folks have very, very strong opinions on what you should do, often based on their own very real experiences. I had to tune some of these folks out when I figured out that they were responding to a different set of needs from ours.

Good luck on your journey!

[Mike Henderson]

I went with Traditional Medicare. My supplement (F) is through USAA. Most of the "Advantage" plans are HMO's. An HMO is good as long as you're healthy but the horror stories about them are usually when someone gets a serious (expensive) illness.

Also, once you go with an Advantage plan, you might have problems going back to traditional Medicare if you have some expensive illness at the time you want to go back. The problem is not Medicate but the supplemental plan. You may have to go through underwriting for the supplemental plan and it can wind up expensive.

Mike

[Bob Turkovich]

Please be aware that -while Medicare Plan A and B coverage/cost is the same from state-to-state - Plan D, Advantage and Supplemental Plans are controlled by each state and will vary in availability, coverage and cost.

[roger wiegand]

Check with your local Senior Center, Council on Aging, or whatever they may call that function where you live. At least in our town there are volunteer experts who can show you the alternatives, with the benefits and drawbacks of each. You can do something similar yourself on the official medicare site, but having someone who had been through it a hundred times to guide you helps!

We went with traditional Medicare and a Blue Cross supplement. DW racked up a ~$50K hospital bill at the end of last year, our out of pocket will be a couple hundred, if they ever send a bill. I'm really enjoying not being at the mercy of an insurance company trying to extract every last dime of profit by denying coverage on every possible excuse, so no Advantage plans for me.

[Scott Winners]

As two posters have already mentioned, what is 'ideal' will vary somewhat by geography, and partly by the patient's underlying health.

If the main medicare website does not answer your questions, then as previously suggested something like a local "Council on Aging and Disability Resources" should be a decent resource. There are no Medicare Advantage plans currently offered in Alaska, but it does indeed -seem to me- you can elect really good ongoing routine coverage, or have a plan that will cover occasional large expenses.

[Bruce Wrenn]

Wife has United Health thru AARP. I have Humana, paid for as part of my retirement. Wife pays no premiums, other than actual Medicare, which is deducted from her SS each month. I pay actual Medicare, and former employer pays for supliment.

[Jim Becker]

The official Medicare site is always the first go-to place. They also have a lengthy publication that 'splains a lot of the ins and outs about things like supplemental type coverages if you opt for traditional Medicare over a Medicare Advantage plan. Roger also mentioned other resources. In addition to those that are available from organizations, there are also independent advisors that can help with comparisons and AFAIK, they do not receive commissions from any one company.

I will be following you in your footsteps a little more than a year from now when Professor Dr SWMBO retires. Currently, I'm covered under her group plan and only have Part A. So about this time next year, I'll be slicing and dicing the options to make a decision as I'll need to deal with coverage independent of her at that point. Continuing the present group coverage is unaffordable because the employer subsidy disappears.

[Lawrence Duckworth]

Just went through this recently when my wife became eligible. Like you, I started early & checked out the official web sites, trying to figure out the best plan for us. This is one of those things where the more people you talk to, the more confused you get. This stuff varies considerably by geographic area, as well as your health status, prescriptions you take, who your doctors are, travel plans, etc. etc.

I started off thinking I knew the best way to go, and then got "information overload" & I was getting frustrated. Among the 48 lbs of brochures the mailman would deliver every day was a hand-typed & hand-signed letter from a lady at a local independent insurance agency. She said she was very familiar with the dozens of plans available in our area, and would help us pick the best one. I contacted her, a bit suspicious, and asked her who she worked for & how she got paid. She said that she was an independent agent, and would get a commission from the plan we picked, but that the commissions were basically the same across the different companies, which means she wasn't pushing a particular plan. My wife & I did a remote meeting thing over the computer (this was during a Covid surge, & we didn't want to go into the office). Our agent asked a ton of very specific questions, then took a few days to match us up with a plan. It was pretty stress-free!

We went with a Cigna Advantage plan -- but don't let that sway you, as your circumstances are absolutely different from ours, and that may or may not match your needs.

By the way, my very healthy wife just had a mild heart attack, we spent over a week in the hospital getting a triple bypass, and so far, we are out-of-pocket a total of $50, for an office visit. The statements keep rolling in, but so far, either Medicare or Cigna have just about paid for everything! (We joke that Cigna may not have wanted her had they known the future, lol). Our plan has worked spectacularly, for us.

I strongly recommend finding an independent insurance agent in your area that is familiar with all of the plans available to you. Talk with them, tell them your unique circumstances, and then listen to their advice.

Many folks have very, very strong opinions on what you should do, often based on their own very real experiences. I had to tune some of these folks out when I figured out that they were responding to a different set of needs from ours.

Good luck on your journey!

Ditto, ....except my wife had a hip replaced. Maybe we have the same agent , a wonderful lady.

I've been self employed all my life and for me family medical insurance has always been a pain in the ass, and I really expected medicare to be the same. But I gotta say it's been a huge relief seeing Medicare work the way it does and not having to worry about medical expenses like I used to..... I can't help think how wealthy this country is and does not provide Medicare for everyone...sad really