I got my plans through BoomerBenefits, which happens to be located near Fort Worth although they deal nationwide. I have found them to be extremely friendly and helpful, and I heartily recommend them without reservation. They will help you see what you need and want, and then work to find companies that meet those needs. They follow up with you to make sure you are happy and gladly answer any questions, and will also help you file claims, etc. However, I'm sure there are others who also are good.
Call your Local Office of Aging. They may be able to take you thru what is available in your State. My friend just did this and OA made it so much easier. Be aware of Medicare Advantages verses straight Medicare and a supplimental. I have a friend who needed surgery. The doctor was right up the street. Medicare covered him but he wasn't in the MA network. Open enrollment she went back to straight Medicare with a suppliment.
I don't know where you live. I was a nurse my life long and did NOT work for Kaiser, but since I have been retired these 15 years I have been on Kaiser and I LOVE it. I LOVE it. My partner as well. I never see a bill. I pay my copay, and that is IT. My bro, who I am currently POA for has United Health/AARP and I will say that their coverage is great for his hospitalizations, but the billing of each entity and person drives me nuts, the constant inflow of Medicare info and of what is covered. I have a massive GRID for all the entities, each of which uses billing system not out of their office but out of a company somewhere across the worlds. It drives me NUTS and that was for one 5 day hospitalization and 30 day rehab. So I sound like a Kaiser ad and I guess I am one. Sorry. Some admin may delete me. I have had people say "Well, you have to have their docs. " Right. But that is the way of it. You have a hospitalist all the time these days. And I love their docs, and I can CHANGE anyone I don't love. Once my partner ran into problems with a detached retina, and Kaiser actually offered to send us ANYWHERE if we chose another place. Turned out fine and we stayed right where we were. Another time my step daughter, also on Kaiser, was sent to UC hospital because she was so ill and needed non invasive gallbladder OR in their opinion for a stone in a duct; at that time the only endoscopic removals were done there. In any case, if you don't have them, I find while more expensive, that United Health covered very well for my bro, were very responsive when communicated with. I am unfamiliar with all others. It is a maze of them I am sure. Good luck. Hope folks will let us know who they have and if they are happy.
Formerly worked for an HMO, ten years. Wrote customer appeals. Both spouse and I were in the Humana Medicare Advantage Plan in south FL, until we relocated to GA. If you are new to Medicare, and can scrape together premiums for a supplemental plan, in conjunction with Original Medicare, please stay away from the Advantage plans. Plus, you can switch back from a Medicare Advantage Plan, but would be subjected to underwriting. Neither of us can get through medical underwriting, but qualified to change to Original Medicare due to moving out of the FL Humana Plan area. What I did to evaluate, was enter three years’ copays, doctors, hospitals, drug copays, to weigh it against the supplemental premiums. It was a wash, so we went back on Original Medicare. Now we can be treated by the good doctors, don’t have to obtain referrals. Also, the Humana HMO was denying care left and right. When hubs had a stroke, for a completely blocked carotid artery, Humana dragged out the surgery for six months, which should have been done the day he had the stroke. Very routine for HMOs to deny medically necessary care. HMOs routinely use referral clerks to make your medical decisions, rarely even nurses. As far as I’m concerned, the grief we received by being forced to see sub-par providers, the constant appealing every single service we needed, was way too much work to fight the HMO to obtain that service. HMOs are a stay away, IMO.
I ditto the response about not liking Humana. I had my parents with them and they were a nightmare to deal with. Their customer service was horrible and one department did not speak to the other so I would have to explain the situation to multiple departments. I switched m dad over to blue shield and have been happy with them. It is very region specific who offers what so best to check with an insurance agent to find out what is offered in your area and then read reviews on the ones you are considering. Good luck.
I contacted Medicare directly because I was so confused and they told me what I am telling you - find an agent.
You must know someone that is getting their Medicare plan through an agent.
I called my SIL and am using her agent.
You don't pay the agent but they have access to hundreds of insurance companies and plans - mine found me the best deal in just a few minutes. Ditto on the Drug Plan. Because I am not on any medications, I am able to go with the "lowest bid" for my drug plan.
I do the same on drugs because I am on no “maintenance” drugs. But I have found that when I do need a drug that the GoodRX card discount gives me a better price than the insurance policy does. But I keep the insurance in case I do someday need to use drugs on a regular basis. There is a penalty for not having had the drug plan from the time you were eligible although you can still sign up for one when needed.
Avoid Advantage Plans if you can. Stick with regular Medicare and select a Supplemental Plan at a level that meets your needs. Medicare provides information about what is covered by Supplemental Plans A-H. This may initially seem more expensive than an Advantage Plan, but you will not have co-pays and you will not need referrals and you will not be limited to doctors within a specific network. A drug plan would be a separate policy. Regular Medicare does not cover drugs, hearing aids, glasses etc. Those things are out-of-pocket and expensive, but regular Medicare plus a Supplemental is the best choice for flexibility.
Get interviews with a couple of agents in your area. AARP sometimes has folks locally that can help explain Medicare plans that are not Advantage plans.
1 - Write down the medical needs you already have: medications, health problems, doctors you already visit.
2 - Write down medical problems your parents had. Genetically, you are at risk of developing the same issues.
3 - Look over the plans to see which will cover your needs and how much they cost (co-pays, medications, hospitalizations...). If you do not have a hefty saving account, opt for the best plan you can afford and also buy a "gap" plan to cover the costs you can not afford (usually hospitalizations).
I helped my mom find a local advantage plan when she moved closer to me, Illinois to Florida. My husband and I also have mom under our dental plan since ours covers more than hers... and she needed a lot of dental work.
My current MA plan "offers" dental but it is only basic cleaning/exams. I kept my high option from work and it has been worth every penny!! They also have hearing and eye exams, but with copay (at least with the eye exam, don't have a hearing problem!)
There are there are a lot of entities that offer free seminars on Medicare and how it works, comparison of risk under different plans, etc. You want to be sure they're not trying to sell you something, though. We are very pleased with our experience.
Some things nobody tells you, and we've learned the hard way. If you don't go on Medicare as soon as you are age-wise eligible, your effective date could be set some months in the past. This could complicate your HRA (health retirement account) if you have one, and your tax filing. Consult with your employer sooner rather than later.
Whatever your medical insurance has been in the past, if Medicare replaces that insurance, make very sure that Medicare's own records show that they are your only coverage. I.e., that they are the primary. Call 855-798-2627 Medicare coordination of benefits. Also, make sure any doctors you use remove your former insurance from their records. Otherwise, Medicare will decline claims because they are not primary, or the doctor will send claims to your former Insurance Company and the claims will be declined. Wastes a lot of time and causes lots of frustration.
And while you're talking to MediCare at the phone number above, give them permission to discuss your account with your spouse or other trusted representative.
I used an insurance agent who came to my house to set up Medicare Supplemental. It was free of charge and he picked the correct "letter" designed just for my needs. You, too, may want to try this. I have never once received a bill from any doctor. Also case in point - while I was living with my mother in another state 7 states from my own, I had to use the services of the town's ER. Those charges were also covered IN FULL by my Medicare and my Medicare Supplemental. Not a penny owed! I used Plan letter F with United Health Care through AARP.
I forgot to finish my earlier comments on Medicare. If you are able to go with Regular Medicare plus a Supplemental Plan and have chosen which Supplemental Plan (A-H) you want, then you can compare prices for that specific Supplemental Plan among available insurance companies. I see several companies represented among the answers on this post. A Supplemental Plan is not a requirement, but it is well worth the cost. Not every doctor in the world accepts Medicare, but the largest percentage of them do. With Medicare plus Supplemental, you will rarely see a medical bill. Like Llamalover47, I use AARP United Plan F. I chose F specifically b/c it covered medical costs while traveling as easily as at home.
I attended a Medicare seminar a couple years ago when I was investigating these subjects, and one person said that if you go to a doctor's practice and find that you are the youngest person in the waiting room, you can be quite sure this doctor accepts Medicare.
My only experience has been with my husband and my father. My husband got a medigap plan from United Healthcare and it we went through knee surgery and many expenses involved with his brain tumor and we never had to pay anything. We decided to go with medigap due to the fact he had many health issues and we knew that our expenses for any given year would only be the cost of the premiums which were about 170 a month. My father has a Medicare advantage plan through Kaiser and dealing with them has not been good. he has a lot of co-pays and there have been a lot of other issues with his care. He pays the same amount per month we did for my husband’s medigap plan. If you go with a Medicare advantage plan you cannot then change to a medigap. But you can go to an advantage plan after medi gap if you want. Seeing the differences has convinced me to go with medigap and be able to keep my same doctor as well.
You've absolutely got it right! I started out with MA plans - under several companies, including AARP/United Health, which was the worst! Besides a considerable monthly premium to the company I paid through the nose for co-pays to docs, procedures (scans, etc.), ER visits, etc. I started out with Kaiser when first eligible and that was when Obamacare first started, and Kaiser (which I'd had as regular insur. before that because I couldn't switch at that point). I personally hate Kaiser? Their "Sr. Advantage" plan is no better - or less expensive - than anyone's "HMO" Advantage plans. Through a fortuitous situation (my Advantage plan company discontinued my particular plan) I had the option of signing up for any plan as if I'd never had Medicare yet. I chose a Medigap policy, and there is no comparison to how much better it is! My monthly premiums are somewhat higher - but not that much - and after the 80% covered by "original/basic" Medicare, the Medigap (Part G) plan covers all of the remaining 20%. I have a $198/year co-pay and then it's gravy! One thing? If you didn't opt for the Medigap policy when you were first eligible, you might still be able to switch but it would probably be more expensive and they can then require info on pre-existing conditions, etc., and refuse you...
There was a recent article about using Medicare + supplemental vs Medicare Advantage plans. The one thing that stood out to me in that article was using original Medicare with a supplemental allowed you to go to any doctor who accepts Medicare. Many MA plans either have a "preferred network" or are HMO based. One thing I avoided was any plan that was HMO based, Then you have to use their doctors. I live in a fairly rural area, so that might be an issue. I also think while the supplemental plans work differently, the coverage is still provided by private insurance companies. The other issue that needs to be understood is that with Medicare you need a drug plan. Most MA plans include this. It is important to check that anything you currently take or might need would be covered by whatever plan you choose.
I poked around online, starting with the Medicare website. There IS a lot of information both through them and sent through the mail (I get a TON of mail still from companies trying to get my business and toss them all.)
See https://www.ehealthmedicare.com/articles/
They list a lot of articles and cover all types of plans and information (MA, MediGap, supplemental plans) It would be wise to understand what the options are, and you know your own medical situation best, so combining the two should at least point you in the right direction. THEN you can see what each of the insurance companies offer and choose wisely. There is also, at the bottom, a way to enter your zip to get a list of plans and an 888 number to call a licensed insurance agent..
UHC was our company insurance, but when I retired but was not Medicare age, it cost me almost 12K that last year! The way it was set up, I got a physical (actually not much of one) and that was it. It required that we pay the first $700 of ANYTHING other than "preventative" care before insurance kicked in. Being relatively healthy, I got nothing for that 12k. Had an eye exam and one doctor visit outside of the physical and I had to pay in full for both.
Once I entered online what I would require, it provided a list of companies and costs. I was able through the various lists to check on whether it was HMO and if my doctors were "preferred" providers. I also, after comparing what was listed, called to ask questions. I ended up staying with UHC because the plan I have includes all the doctors I have used in my area. I have no need to travel or be elsewhere, so that shouldn't be an issue for me.
It irks me to see what my mother gets vs we the people. Dad had been a government employee, so his BCBS insurance plan is awesome. She gets a lot of care and 99.99999% of the time NEVER pays a dime other than the premium cost - so you KNOW all that scum working for you gets similar coverage while we have to pay through the nose and then some! She even gets yearly pay increases on his pension!!!
Do beware if you seek help, as others suggested, that they are not associated with an insurance company. Do also beware that you sign up for at least Medicare within the time frame or you will get penalties. If you do chose a MA plan, if you don't like them, you can change your plan during the open enrollment period (other change options are available, such as plan is discontinued or you move to another location.)
One little point on the advertising. All of it is from private companies. Most of it is from Medicare advantage plans. The rest might be from supplement plans. Traditional medicare does not advertise.
This agency helped me immensely: HICAP | California Health Advocates cahealthadvocates.org/hicap HICAP (the Health Insurance Counseling & Advocacy Program) provides free and objective information and counseling about Medicare. Volunteer counselors can help you understand your specific rights and health care options. - - - If you are not in California, ask County Senior Services if there have a similar program.
P.S. I loved SCAN. Unfortunately, they no longer cover seniors in my county. I had to go with UHC (United Healthcare). SCAN was good as it handled more areas - and very efficient. I was very sad to lose SCAN. Do look it up. Actually, HICAP mentioned it to me at the 'last second' of the overview of possibilities. When I heard about them, I knew right away it was right for me.
Need to add: i worked with Boomer Benefits online, and they were fabulous. You don’t pay them extra, to use as your insurance broker. They are available by email or phone, and you speak with agents in the US, not a call center overseas. Our situation was complicated by a retirement relocation to a neighboring state. I was hospitalized immediately after furniture was unloaded. Medicare and the supplement plan worked seamlessly for me. Other than my premiums, I usually only owe the yearly deductible. Boomer benefits can answer any questions you may have.
If needed, you can fill in their form, for them to find the best drug plan offered in your zip code.
Another thought - If you go with Original Medicare plus a supplement to pick up the Medicare Co insurance, Your claims will be sent to the supplement plan for processing, once Medicare has processed the claim. We ended up purchasing the Medicare supplements offered by United Healthcare. Boomer Benefits helped get it all set up for the effected date we needed. They assisted
Regarding TouchMatters comment, the one listed is California. From the link I posted, selecting by state and then Texas, they list this:
"Texas State Health Insurance Counseling and Assistance Program (SHIP): Health Information Counseling & Advocacy Program of Texas (HICAP) is the Texas branch of SHIP. HICAP has 28 Area Agency on Aging offices where you can speak with benefits counselors who provide unbiased information and assistance and can act as advocates when necessary."
NOTE: I clicked the link on that page and it gave an error. Try this:
Their "About" page says: "The State Health Insurance Assistance Programs (SHIPs) provide local, in-depth, and objective insurance counseling and assistance to Medicare-eligible individuals, their families, and caregivers."
The original link I posted has MANY articles, so you can at least be more informed if still confused (it's like choosing from thousands of items, not knowing which is best!) Knowing more is better.
For OP, the number to call for your Texas SHIP/HICAP is 1-800-252-9240
https://www.ehealthmedicare.com/articles/
Regarding the link I posted - if you start at the above link, on the left are many topics, about original Medicare and what it covers/doesn't cover, Advantage plans, supplemental plans, drug coverage, etc. If you scroll to the bottom of the page, enter your zip, it provides a list of plans available in your area, starting with Advantage plans, HOWEVER at the top are links to Supplemental and Drug plans that you can also list.
They list monthly premiums, co-pays, features, a way to add your Rx and doctors to see if they are covered/participants and a link to the plan for more detail (without going to the plan sites, each plan entry on the list has a link for "more detail".) There are also filters on the left (extra coverages, insurance companies, premium ranges, etc).
Keep in mind the lowest premium isn't always the best - the devil is in the details! A combination of what kinds of coverage you need, whether your doctors accept the plan and what medication is needed, plus co-pays, out of pocket limits, etc are also important.
Some explanation from the website:
Types of Medicare Advantage (Part C) Plans HMO (Health Maintenance Organization) allows you to see doctors and other health professionals that participate in its network.
HMO-POS (Health Maintenance Organization with Point of Service) covers both in- and out-of-network health services, but with lower rates and less out-of-pocket for in-network.
MSA (Medical Savings Account) offers a high deductible and a bank account to help you pay that deductible.
PFFS (Private Fee-for-Service) pays a specific amount for health care services, which the treating doctor has to accept, even if it is less than the usual charge.
PPO (Preferred Provider Organization) gives you the freedom to choose any doctor.
SNP (Special Needs Plan) is for people who receive both Medicare and Medicaid (dual eligible), live in an institution, or have certain chronic conditions.
Medicare Tip: In most states, all Medigap (or Medicare Supplement Insurance) Plans pay 100% of Medicare Part A coinsurance and a percentage (50%-100% depending on your plan) of Medicare Part B coinsurance or copayment.
Medicare Tip: How do you know if a plan covers your prescriptions? Each Medicare Prescription Drug Plan has a formulary, or list of prescription drugs it covers. To find out if a plan covers your prescription drugs, click on the "Add Rx Drugs" links and enter your medications. A plan's formulary may change at any time. You will receive notice from your plan when necessary.
To my knowledge (and experience) Medigap plans (F & G) cover the 20% basic Medicare doesn't cover totally (you do pay a monthly premium over the basic social security-deducted cost and with Plan G a low annual deductible, $198/year in my case). I don't know what you mean about the 50-60% Medicare Part B costs? Part A for everyone covers in-hospital charges and 20 post hospital-stay costs for a rehab/skilled nursing facility - as long as Medicare deems it necessary and helpful (progress made). Does Medigap cover any of the additional "potential" 80 days coverage, with daily co-pay, under Part A?
The page for OP's state has the following in their 'About' page. Note at the bottom is a number to call to locate your state SHIP/HICAP.
Help for yourself or your loved ones Considering making coverage changes during Medicare’s Annual Election Period (Open Enrollment)? Contact your SHIP for one-on-one assistance with reviewing health or prescription drug plan options. Worried about the out-of-pocket costs associated with Medicare? Contact your SHIP to find out about assistance programs you or your loved one might be eligible for. Unsure about Medicare’s eligibility criteria? SHIPs can help you understand the guidelines. Wondering what Medicare does and doesn’t cover? Medicare can be complicated. Contact your SHIP for answers. Confused about who pays first, Medicare or another insurance? SHIPs can explain how Medicare works with supplemental policies, retiree coverage, Medicaid, and other insurers. Uncertain of yours or your loved one's rights, under Medicare? Contact your SHIP for assistance. Can’t find your SHIP? Use the SHIP Locator or call 1-877-839-2675.
Please note that if you enroll in Medicare Advantage Plan and later wanted to enroll in a Medicare Supplement Plan, the latter could be more benefit enriched and you will pay a higher premium than if you enroll with the Medicare Supplement now at age 65 due to being underwritten for adverse selection.
The most we have to pay out-of-pocket for the entire year is $4,100 each. We now have no copay for primary care visits, and $35 for specialists. A trip to the ER costs $90. Diagnostic tests and procedures $35 copay, lab services $10 copay, CT scans $75 copay, x-rays $20 copay. Hospital stays are $300 per day for days 1-5 and zero after that. Most screening tests and immunizations are free of charge, and we can be reimbursed up to $500 a year for dental expenses from any dental provider.
I don’t understand the negative comments about Medicare Advantage plans. That’s part C, right? It is what my husband and I have through Aetna/Coventry, and it’s been great. It has an excellent rating at the government Medicare website. The only thing we don’t do through them is dental, because I don’t like their dental providers.
We are in an HMO plan and our only premiums are the Medicare premiums deducted from our SS payments. We pay $5 copay for doctor visits and $35 for specialists. We do pay coats for prescription drugs and tests and hospital stays (haven’t had to use the hospital, I’m happy to say). We can choose any doctors in their system and are quite pleased. Plus we get free OTC stuff from CVS (limited) each month if we want.
We never have to deal with the government nor do we have to search for providers that take Medicare patients.
I just wanted to Shout Out a great, big THANK YOU to everyone that gave advice, experiences, and information!! I actually jotted all your answers down By Hand so that in Mid October I can begin this "fun" adventure of finding the proper Medicare plans because I'm turning 65 in November....so, THANK YOU all so very much!!! 😁.
Also turning 65 in November. Why would I want to go on Medicare if I have health insurance paid through my employer. I won't retire for years, caregiving drained me financially.
I think it would depend on your health, how well the private insurance pays and if you take meds.
I’m sure you know that at 65 you must sign up for Medicare Part A. There is no charge to you for Part A which covers inpatient hospital charges.
AND it can come in handy should you have a deductible on your private insurance for a hospitalization. My husband kept his private employer paid insurance primarily because it has a great drug plan and he is a diabetic who uses expensive drugs.
Plus it saved him the Part B, MediGap and Drug premiums and no doubt when he is on a Medicare drug plan, he will reach the dreaded donut hole.
In Jan of this year DH had a heart attack. He had a $6000 annual deductible for hospital care with the private insurance. At first I thought whoops maybe we should have switched over in total to Medicare (because he would have gone with a Full coverage MediGap plan).
But in this case we were better off with the combo of the private insurance and Medicare Part A. Part A (as secondary insurance) took care of the remainder owed to the hospital. I think we paid $200.
Thanks, 97. I will get signed up for Part A. I work with a woman, a year older than me, so 66 now. We talked about this today. She did not sign up for Part A when she should have. Still hasn't. Now I think she will, though. It will be interesting to see what she has to do to get this straightened out.
My health is really very good. Knock on wood. No meds.
Anyone eligible for Medicare automatically is covered by Part A - you don't have to sign up for it! Part B, on the other hand, has to be signed up for. Part A covers in-hospital expenses, and then post-hospital rehab/skilled nursing for up to 100 days (20 at no patient cost, and then 80 with co-pay) - as long as Medicare deems the patient NEEDS THAT LEVEL OF CARE AND IS MAKING PROGRESS (yes I'm yelling!). Facilities estimate at what point they "think" Medicare wouldn't consider continued care necessary and would stop paying - and then give the patient a discharge notice per that "guess"(with almost no "notice" to the patient). Under Medicare rules, at that point the patient is supposed to be provided with information and directions to challenge the discharge (one phone call process - easy!), and if Medicare decides in favor of the appeal (after their medical staff review records) the facility has to keep the patient for awhile more. With my Mom, I had to challenge the discharge 4 times, and my appeal was upheld by Medicare every time, and Mom ended up being able to stay 96 days! (That's almost unprecedented, though...) The co-pay to the facility for the days after the initial covered 20 was $257/day, which sounds like a lot? Not anywhere near the cost without Medicare A's help!
One small piece of advice: Cross Humana off your list. My mom went to it this past year as it was 100 bucks cheaper a month than UCare, what she had. I sort of encouraged her to change.
Wouldn't you know she fell and broke her pelvis and when it came time for rehab the choices were much more limited. She was only in rebab for three weeks, so not the end of the world., but this next enrolment period, she is goingn back to UCare.
Our Medicare Advantage Plan HMO abysmal experience was also Humana. Actually, to evaluate the true cost of the Plan, against the monthly premiums for a supplement plus a drug plan, I made a spreadsheet of three years of all our copays and out of pocket expenses with Humana’s HMO, for each of us. Added it all up, divided to get average monthly cost. It ended up being a wash. Why on earth give up access to the good doctors, the best hospitals, and go through the constant referrals, plus being denied accepted medical testing, screenings, and care, under an HMO trying to cut costs, when we can have our own choice of any doctor accepting Original Medicare? Even my pulmy pulled me in behind closed doors and told me to get rid of the HMO, and the internist who was denying care so she would receive a larger year-end capitation check for not treating my lung disease. He told me to my face the HMO was trying to not treat my lung disease. Then when I was sent to their gastro, he did a colonoscopy in a filthy facility, and told me he wasn’t allowed to treat my chronic, uncontrolled diarrhea and stomach pain, as it was not cancer. He told me that was the way Humana wanted it. Now I am being treated by a good gastroenterologist, using accepted diagnostic criteria, and am now correctly diagnosed as having BAM as well as IBSD. Humana didn’t care that I had lost 45 pounds from stomach disease. They were perfectly happy for me to slowly die. Those who are happy with your HMOs under Medicare are lucky. You won’t be so happy as you age, your health declines, and you can’t get the generally accepted care in the specialty. You’ve been warned.
Girlsaylor.... What Plan exactly do you have, if you don't mind me asking here on this open forum. I think I'll Have to sign up in October...I'm 65 soon. I'm so very sorry you have these tough health issues....I don't know what is BAM nor IBSD.... however, in time I'm sure I'll be facing my challenges as I've got a slow gut, complicated by a major scar that runs from my belly button down to my pubic bone.....had emergency, exploratory surgery about 38 years ago. They warned me not to get any blockages, but they didn't tell me how to do that. At 27, I didn't think to ask how to make sure I didn't get a blockage....so, I'm sure, I'm headed for trouble down the line. I pray you get the proper help you need, and the correct meds, or if you're like me, no meds, but natural means, through careful, healthful diet. Praying for the best for you. Shalom! 🌺🕊🌺
Thank you for the kind words! It means a lot to have supportive people here.
We relocated from south FL to coastal GA. It was considered a move out of Plan area, as the Medicare Advantage Plan HMO, Humana was only in south FL. That was our chance to go back onto Original Medicare, plus a supplement plan. We chose a Plan G, and pay monthly premiums plus yearly Medicare deductible, times two people. The one we are in is the AARP United Healthcare supplement. They pay quickly, and get billed automatically after Medicare processes claims. They generally pay within two weeks. Neither of us could get approved in underwriting, so the out of state move was our chance at guaranteed issue of the supplement G. If a person signs up as soon as they are eligible for Medicare, that’s also a guaranteed issue, not required to go through underwriting. If a person goes on a Medicare Advantage Plan HMO when first eligible for Medicare, you throw away that protection from medical underwriting, if you ever want to go back to Original Medicare plus a supplement. There is one exception to the Medicare Advantage Plan fatal decision. In the first 11 months after you become eligible and sign up for one of the Advantage Plan, you can go back on Original Medicare in the first 11 months, without being subjected to medical underwriting. If you do have to go through medical underwriting, don’t sign up as soon as eligible, have a lapse in your employer health insurance, you can end up with much higher premium, assessed by the insurance company. Since Ive got so many health issues, hubs has had cancer twice and his cardiovascular system is crap, neither of us could even get approved, had it not been for guaranteed issue. I never worked for Medicare, but did work for a Blue Cross/Shield HMO. I went through Boomer Benefits to purchase our supplements. You have to join AARP initially to purchase the United Healthcare supplement, but aren’t required to renew the AARP membership second year. The vast majority of Medicare supplement plans are age rated, so when you move to a different age band, the premium will increase. I was pleased that United Healthcare did not increase premiums across the board for 2020. Some years they all raise rates. The way of insurance. I found the insurance agents at Boomer Benefits totally knowledgeable, and you don’t pay an extra commission to use them. There are many other companies that sell supplement policies. We’ve been very happy with them. They also send us yearly forms to fill out, with our maintenance medications, and will plug them into the Medicare site and make recommendation as to the most cost effective drug plan for you each year. Saves me time, I let them do it on my behalf. However, the Medicare drug plans have preferred pharmacies, and formularies. I have found I sometimes get better prices using WalMart instead of CVS, which is SilverScripts’ big preferred chain. Sometimes best drug price is not using my drug plan, using the GoodRX coupons. It’s extra work to check prices every time one of our maintenance drugs is due for refill. But our experience with SilverScripts is that they keep moving generic drugs into the higher copay non-generic tiers.Medicare doesn’t prohibit this type of price gouging. It pays to get the list of specially-negotiated promo drugs for the various pharmacies, like Target, WalMart, Kroger. You can save a chunk by checking prices before using your drug plan. Good luck whatever plan you choose!
My lawyer recommended a broker. She’s been very helpful, and she works on commission so we don’t pay her. I already had Medicare but this year (if they accept me; I haven’t heard back yet but I’m optimistic), I’m getting a Medigap plan for the stuff Medicare doesn’t pay for. My plan is through AARP and United Healthcare. They have a range of plans to choose from. I hope to change my Part D to something more affordable as well. I would at least start looking on the AARP website. Good luck!
That’s an excellent Medicare supplement plan. The only difference between supplement plans F and G is that the G supplement does not pay the yearly deductible. Many states are doing away with F, and only those already on it are allowed to keep it. For us, the yearly premiums difference between Plans F and G were more than the cost of the deductibles.
One additional item I thought of the other night. My DH is 68 years of age and also has Medicare and AARP Medicare Supplemental through United Health Care - also Plan letter "F," same as me. When his pc doctor was billing him $40, I actually went down to his pc doctor's office twice to clear this faux charge up. The pc doctor told me twice "It is owed to us." So I paid on visit #2. Then a few months went by and we received a check from our Medicare Supplemental Insurance in the exact amount of $40!
This is better called the Medigap supplemental policy because people just enrolling have trouble understanding the difference between this and Medicare Advantage plans...
GirlSaylor.... Since you and hubs have multiple health issues, this is only a suggestion..... I watch a Chiropractor on YouTube who is very health oriented and knowledgeable about how our bodies work. He's helped many people to reverse their diabetes, go off meds, improve their health tremendously....his name is Dr Eric Berg.... his videos are short, concise and to the point. But, imagine going totally healthy, organic and such, and getting healthy enough to stop the meds, perhaps ending the pain, and improving one's life! So, that's a suggestion...to check out this guy's videos! They are really interesting and educational! May God be with you, and to all who read this. Shalom!
I had a medical policy for years. As you age the premiums become too expensive for the average senior. Also medigap policies do not include prescriptions so that's another expense. I just joined an advantage plan thru United Healthcare that includes prescription coverage. A friend has had the same plan for years and very pleased. He had a stroke and although the plan didn't play everything it paid most. Everyone's case is different but if and ONLY if money is no issue go for the medigap policy. Setup up you own medicare.gov account and you can learn a lot. Good luck.
My experience has been different. Two sick seniors here, a lot of specialists. We previously were on a Medicare Advantage plan, and the copays for many specialists, tests, prescription drugs, ended up costing more than the monthly supplement premium and drug plan premium combined. I ran three years of numbers for each of us, to make the comparison. So, as a person becomes sicker, should that happen, your copays with an Advantage plan may end up higher than the supplement and drug plan. Happened to both of us.
So I sound like a Kaiser ad and I guess I am one. Sorry. Some admin may delete me. I have had people say "Well, you have to have their docs. " Right. But that is the way of it. You have a hospitalist all the time these days. And I love their docs, and I can CHANGE anyone I don't love. Once my partner ran into problems with a detached retina, and Kaiser actually offered to send us ANYWHERE if we chose another place. Turned out fine and we stayed right where we were. Another time my step daughter, also on Kaiser, was sent to UC hospital because she was so ill and needed non invasive gallbladder OR in their opinion for a stone in a duct; at that time the only endoscopic removals were done there.
In any case, if you don't have them, I find while more expensive, that United Health covered very well for my bro, were very responsive when communicated with. I am unfamiliar with all others. It is a maze of them I am sure. Good luck. Hope folks will let us know who they have and if they are happy.
You must know someone that is getting their Medicare plan through an agent.
I called my SIL and am using her agent.
You don't pay the agent but they have access to hundreds of insurance companies and plans - mine found me the best deal in just a few minutes. Ditto on the Drug Plan. Because I am not on any medications, I am able to go with the "lowest bid" for my drug plan.
There is a penalty for not having had the drug plan from the time you were eligible although you can still sign up for one when needed.
A drug plan would be a separate policy. Regular Medicare does not cover drugs, hearing aids, glasses etc. Those things are out-of-pocket and expensive, but regular Medicare plus a Supplemental is the best choice for flexibility.
1 - Write down the medical needs you already have: medications, health problems, doctors you already visit.
2 - Write down medical problems your parents had. Genetically, you are at risk of developing the same issues.
3 - Look over the plans to see which will cover your needs and how much they cost (co-pays, medications, hospitalizations...). If you do not have a hefty saving account, opt for the best plan you can afford and also buy a "gap" plan to cover the costs you can not afford (usually hospitalizations).
I helped my mom find a local advantage plan when she moved closer to me, Illinois to Florida. My husband and I also have mom under our dental plan since ours covers more than hers... and she needed a lot of dental work.
There are there are a lot of entities that offer free seminars on Medicare and how it works, comparison of risk under different plans, etc. You want to be sure they're not trying to sell you something, though. We are very pleased with our experience.
Some things nobody tells you, and we've learned the hard way. If you don't go on Medicare as soon as you are age-wise eligible, your effective date could be set some months in the past. This could complicate your HRA (health retirement account) if you have one, and your tax filing. Consult with your employer sooner rather than later.
Whatever your medical insurance has been in the past, if Medicare replaces that insurance, make very sure that Medicare's own records show that they are your only coverage. I.e., that they are the primary. Call 855-798-2627 Medicare coordination of benefits. Also, make sure any doctors you use remove your former insurance from their records. Otherwise, Medicare will decline claims because they are not primary, or the doctor will send claims to your former Insurance Company and the claims will be declined. Wastes a lot of time and causes lots of frustration.
And while you're talking to MediCare at the phone number above, give them permission to discuss your account with your spouse or other trusted representative.
A Supplemental Plan is not a requirement, but it is well worth the cost. Not every doctor in the world accepts Medicare, but the largest percentage of them do. With Medicare plus Supplemental, you will rarely see a medical bill. Like Llamalover47, I use AARP United Plan F. I chose F specifically b/c it covered medical costs while traveling as easily as at home.
I poked around online, starting with the Medicare website. There IS a lot of information both through them and sent through the mail (I get a TON of mail still from companies trying to get my business and toss them all.)
See https://www.ehealthmedicare.com/articles/
They list a lot of articles and cover all types of plans and information (MA, MediGap, supplemental plans) It would be wise to understand what the options are, and you know your own medical situation best, so combining the two should at least point you in the right direction. THEN you can see what each of the insurance companies offer and choose wisely. There is also, at the bottom, a way to enter your zip to get a list of plans and an 888 number to call a licensed insurance agent..
UHC was our company insurance, but when I retired but was not Medicare age, it cost me almost 12K that last year! The way it was set up, I got a physical (actually not much of one) and that was it. It required that we pay the first $700 of ANYTHING other than "preventative" care before insurance kicked in. Being relatively healthy, I got nothing for that 12k. Had an eye exam and one doctor visit outside of the physical and I had to pay in full for both.
Once I entered online what I would require, it provided a list of companies and costs. I was able through the various lists to check on whether it was HMO and if my doctors were "preferred" providers. I also, after comparing what was listed, called to ask questions. I ended up staying with UHC because the plan I have includes all the doctors I have used in my area. I have no need to travel or be elsewhere, so that shouldn't be an issue for me.
It irks me to see what my mother gets vs we the people. Dad had been a government employee, so his BCBS insurance plan is awesome. She gets a lot of care and 99.99999% of the time NEVER pays a dime other than the premium cost - so you KNOW all that scum working for you gets similar coverage while we have to pay through the nose and then some! She even gets yearly pay increases on his pension!!!
Do beware if you seek help, as others suggested, that they are not associated with an insurance company. Do also beware that you sign up for at least Medicare within the time frame or you will get penalties. If you do chose a MA plan, if you don't like them, you can change your plan during the open enrollment period (other change options are available, such as plan is discontinued or you move to another location.)
All of it is from private companies.
Most of it is from Medicare advantage plans.
The rest might be from supplement plans.
Traditional medicare does not advertise.
HICAP | California Health Advocates
cahealthadvocates.org/hicap
HICAP (the Health Insurance Counseling & Advocacy Program) provides free and objective information and counseling about Medicare. Volunteer counselors can help you understand your specific rights and health care options.
- - -
If you are not in California, ask County Senior Services if there have a similar program.
P.S. I loved SCAN. Unfortunately, they no longer cover seniors in my county. I had to go with UHC (United Healthcare). SCAN was good as it handled more areas - and very efficient. I was very sad to lose SCAN. Do look it up. Actually, HICAP mentioned it to me at the 'last second' of the overview of possibilities. When I heard about them, I knew right away it was right for me.
i worked with Boomer Benefits online, and they were fabulous. You don’t pay them extra, to use as your insurance broker. They are available by email or phone, and you speak with agents in the US, not a call center overseas. Our situation was complicated by a retirement relocation to a neighboring state. I was hospitalized immediately after furniture was unloaded. Medicare and the supplement plan worked seamlessly for me. Other than my premiums, I usually only owe the yearly deductible. Boomer benefits can answer any questions you may have.
If needed, you can fill in their form, for them to find the best drug plan offered in your zip code.
Another thought - If you go with Original Medicare plus a supplement to pick up the Medicare Co insurance, Your claims will be sent to the supplement plan for processing, once Medicare has processed the claim. We ended up purchasing the Medicare supplements offered by United Healthcare. Boomer Benefits helped get it all set up for the effected date we needed. They assisted
"Texas State Health Insurance Counseling and Assistance Program (SHIP): Health Information Counseling & Advocacy Program of Texas (HICAP) is the Texas branch of SHIP. HICAP has 28 Area Agency on Aging offices where you can speak with benefits counselors who provide unbiased information and assistance and can act as advocates when necessary."
NOTE: I clicked the link on that page and it gave an error. Try this:
https://www.shiptacenter.org/about-medicare/regional-ship-location/texas
They have phone number and website to use.
Their "About" page says:
"The State Health Insurance Assistance Programs (SHIPs) provide local, in-depth, and objective insurance counseling and assistance to Medicare-eligible individuals, their families, and caregivers."
The original link I posted has MANY articles, so you can at least be more informed if still confused (it's like choosing from thousands of items, not knowing which is best!) Knowing more is better.
https://www.ehealthmedicare.com/articles/
Regarding the link I posted - if you start at the above link, on the left are many topics, about original Medicare and what it covers/doesn't cover, Advantage plans, supplemental plans, drug coverage, etc. If you scroll to the bottom of the page, enter your zip, it provides a list of plans available in your area, starting with Advantage plans, HOWEVER at the top are links to Supplemental and Drug plans that you can also list.
They list monthly premiums, co-pays, features, a way to add your Rx and doctors to see if they are covered/participants and a link to the plan for more detail (without going to the plan sites, each plan entry on the list has a link for "more detail".) There are also filters on the left (extra coverages, insurance companies, premium ranges, etc).
Keep in mind the lowest premium isn't always the best - the devil is in the details! A combination of what kinds of coverage you need, whether your doctors accept the plan and what medication is needed, plus co-pays, out of pocket limits, etc are also important.
Some explanation from the website:
Types of Medicare Advantage
(Part C) Plans
HMO (Health Maintenance Organization) allows you to see doctors and other health professionals that participate in its network.
HMO-POS (Health Maintenance Organization with Point of Service) covers both in- and out-of-network health services, but with lower rates and less out-of-pocket for in-network.
MSA (Medical Savings Account) offers a high deductible and a bank account to help you pay that deductible.
PFFS (Private Fee-for-Service) pays a specific amount for health care services, which the treating doctor has to accept, even if it is less than the usual charge.
PPO (Preferred Provider Organization) gives you the freedom to choose any doctor.
SNP (Special Needs Plan) is for people who receive both Medicare and Medicaid (dual eligible), live in an institution, or have certain chronic conditions.
Medicare Tip:
In most states, all Medigap (or Medicare Supplement Insurance) Plans pay 100% of Medicare Part A coinsurance and a percentage (50%-100% depending on your plan) of Medicare Part B coinsurance or copayment.
Medicare Tip:
How do you know if a plan covers your prescriptions? Each Medicare Prescription Drug Plan has a formulary, or list of prescription drugs it covers. To find out if a plan covers your prescription drugs, click on the "Add Rx Drugs" links and enter your medications. A plan's formulary may change at any time. You will receive notice from your plan when necessary.
Help for yourself or your loved ones
Considering making coverage changes during Medicare’s Annual Election Period (Open Enrollment)? Contact your SHIP for one-on-one assistance with reviewing health or prescription drug plan options.
Worried about the out-of-pocket costs associated with Medicare? Contact your SHIP to find out about assistance programs you or your loved one might be eligible for.
Unsure about Medicare’s eligibility criteria? SHIPs can help you understand the guidelines.
Wondering what Medicare does and doesn’t cover? Medicare can be complicated. Contact your SHIP for answers.
Confused about who pays first, Medicare or another insurance? SHIPs can explain how Medicare works with supplemental policies, retiree coverage, Medicaid, and other insurers.
Uncertain of yours or your loved one's rights, under Medicare? Contact your SHIP for assistance.
Can’t find your SHIP? Use the SHIP Locator or call 1-877-839-2675.
So far it's been a wonderful deal for us.
We are in an HMO plan and our only premiums are the Medicare premiums deducted from our SS payments. We pay $5 copay for doctor visits and $35 for specialists. We do pay coats for prescription drugs and tests and hospital stays (haven’t had to use the hospital, I’m happy to say). We can choose any doctors in their system and are quite pleased. Plus we get free OTC stuff from CVS (limited) each month if we want.
We never have to deal with the government nor do we have to search for providers that take Medicare patients.
I think it would depend on your health, how well the private insurance pays and if you take meds.
I’m sure you know that at 65 you must sign up for Medicare Part A. There is no charge to you for Part A which covers inpatient hospital charges.
AND it can come in handy should you have a deductible on your private insurance for a hospitalization. My husband kept his private employer paid insurance primarily because it has a great drug plan and he is a diabetic who uses expensive drugs.
Plus it saved him the Part B, MediGap and Drug premiums and no doubt when he is on a Medicare drug plan, he will reach the dreaded donut hole.
In Jan of this year DH had a heart attack.
He had a $6000 annual deductible for hospital care with the private insurance.
At first I thought whoops maybe we should have switched over in total to Medicare (because he would have gone with a Full coverage MediGap plan).
But in this case we were better off with the combo of the private insurance and Medicare Part A. Part A (as secondary insurance) took care of the remainder owed to the hospital.
I think we paid $200.
.
My health is really very good. Knock on wood. No meds.
Wouldn't you know she fell and broke her pelvis and when it came time for rehab the choices were much more limited. She was only in rebab for three weeks, so not the end of the world., but this next enrolment period, she is goingn back to UCare.
Actually, to evaluate the true cost of the Plan, against the monthly premiums for a supplement plus a drug plan, I made a spreadsheet of three years of all our copays and out of pocket expenses with Humana’s HMO, for each of us. Added it all up, divided to get average monthly cost. It ended up being a wash. Why on earth give up access to the good doctors, the best hospitals, and go through the constant referrals, plus being denied accepted medical testing, screenings, and care, under an HMO trying to cut costs, when we can have our own choice of any doctor accepting Original Medicare? Even my pulmy pulled me in behind closed doors and told me to get rid of the HMO, and the internist who was denying care so she would receive a larger year-end capitation check for not treating my lung disease. He told me to my face the HMO was trying to not treat my lung disease. Then when I was sent to their gastro, he did a colonoscopy in a filthy facility, and told me he wasn’t allowed to treat my chronic, uncontrolled diarrhea and stomach pain, as it was not cancer. He told me that was the way Humana wanted it. Now I am being treated by a good gastroenterologist, using accepted diagnostic criteria, and am now correctly diagnosed as having BAM as well as IBSD. Humana didn’t care that I had lost 45 pounds from stomach disease. They were perfectly happy for me to slowly die.
Those who are happy with your HMOs under Medicare are lucky. You won’t be so happy as you age, your health declines, and you can’t get the generally accepted care in the specialty. You’ve been warned.
What Plan exactly do you have, if you don't mind me asking here on this open forum.
I think I'll Have to sign up in October...I'm 65 soon.
I'm so very sorry you have these tough health issues....I don't know what is BAM nor IBSD.... however, in time I'm sure I'll be facing my challenges as I've got a slow gut, complicated by a major scar that runs from my belly button down to my pubic bone.....had emergency, exploratory surgery about 38 years ago. They warned me not to get any blockages, but they didn't tell me how to do that. At 27, I didn't think to ask how to make sure I didn't get a blockage....so, I'm sure, I'm headed for trouble down the line.
I pray you get the proper help you need, and the correct meds, or if you're like me, no meds, but natural means, through careful, healthful diet. Praying for the best for you. Shalom! 🌺🕊🌺
We relocated from south FL to coastal GA. It was considered a move out of Plan area, as the Medicare Advantage Plan HMO, Humana was only in south FL. That was our chance to go back onto Original Medicare, plus a supplement plan. We chose a Plan G, and pay monthly premiums plus yearly Medicare deductible, times two people. The one we are in is the AARP United Healthcare supplement. They pay quickly, and get billed automatically after Medicare processes claims. They generally pay within two weeks. Neither of us could get approved in underwriting, so the out of state move was our chance at guaranteed issue of the supplement G. If a person signs up as soon as they are eligible for Medicare, that’s also a guaranteed issue, not required to go through underwriting. If a person goes on a Medicare Advantage Plan HMO when first eligible for Medicare, you throw away that protection from medical underwriting, if you ever want to go back to Original Medicare plus a supplement. There is one exception to the Medicare Advantage Plan fatal decision. In the first 11 months after you become eligible and sign up for one of the Advantage Plan, you can go back on Original Medicare in the first 11 months, without being subjected to medical underwriting. If you do have to go through medical underwriting, don’t sign up as soon as eligible, have a lapse in your employer health insurance, you can end up with much higher premium, assessed by the insurance company.
Since Ive got so many health issues, hubs has had cancer twice and his cardiovascular system is crap, neither of us could even get approved, had it not been for guaranteed issue.
I never worked for Medicare, but did work for a Blue Cross/Shield HMO. I went through Boomer Benefits to purchase our supplements. You have to join AARP initially to purchase the United Healthcare supplement, but aren’t required to renew the AARP membership second year. The vast majority of Medicare supplement plans are age rated, so when you move to a different age band, the premium will increase. I was pleased that United Healthcare did not increase premiums across the board for 2020. Some years they all raise rates. The way of insurance.
I found the insurance agents at Boomer Benefits totally knowledgeable, and you don’t pay an extra commission to use them. There are many other companies that sell supplement policies. We’ve been very happy with them. They also send us yearly forms to fill out, with our maintenance medications, and will plug them into the Medicare site and make recommendation as to the most cost effective drug plan for you each year. Saves me time, I let them do it on my behalf. However, the Medicare drug plans have preferred pharmacies, and formularies. I have found I sometimes get better prices using WalMart instead of CVS, which is SilverScripts’ big preferred chain. Sometimes best drug price is not using my drug plan, using the GoodRX coupons. It’s extra work to check prices every time one of our maintenance drugs is due for refill. But our experience with SilverScripts is that they keep moving generic drugs into the higher copay non-generic tiers.Medicare doesn’t prohibit this type of price gouging. It pays to get the list of specially-negotiated promo drugs for the various pharmacies, like Target, WalMart, Kroger. You can save a chunk by checking prices before using your drug plan.
Good luck whatever plan you choose!
I would at least start looking on the AARP website. Good luck!
Since you and hubs have multiple health issues, this is only a suggestion.....
I watch a Chiropractor on YouTube who is very health oriented and knowledgeable about how our bodies work. He's helped many people to reverse their diabetes, go off meds, improve their health tremendously....his name is Dr Eric Berg.... his videos are short, concise and to the point. But, imagine going totally healthy, organic and such, and getting healthy enough to stop the meds, perhaps ending the pain, and improving one's life!
So, that's a suggestion...to check out this guy's videos! They are really interesting and educational!
May God be with you, and to all who read this. Shalom!