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Hi all -


I'm in the process of sorting out the best path forward for an 81 year old who left employment in 1993 (when he was 55) and never enrolled in Medicare Part B. I have an appointment next week with the regional SHIP which offers free counseling. And Realyreal per your advice I am also looking for a Medicare specialist to weigh in. But hoping to tap into this Forum knowledge as I continue my research.


This investigation was inspired by the elder's recent move to assisted living and the offer of a Medicare Advantage On-site Special Needs plan that requires enrollment in Parts A and B (that was an Anthem plan that I posted about last week). While he is not currently eligible for that it is very attractive idea as more of his health care would come to him vs. him needing to manage outside appointments and transportation (even with the limited help of the AL that is hard). He has underutilized his insurance in the past and didn't see his doctors regularly, to the detriment of his health. He's been hospitalized with extensive time in SNFs twice in the last two years. He currently has a Blue Cross PPO through his retiree group plan which I was told means he cannot demonstrate "creditable coverage" and so would pay at least a 160% penalty if he enrolls in Part B (the staff at the group plan told me that medicare only honors employer group health plan coverage, not retiree plans, in calculating penalty payments). However the retiree group reimburses for the base cost of Part B, so all he would pay is the penalty portion. And they also offer a plan he could switch to that is like the Anthem one: SCAN Health Plan with very low or no co-pays and full coverage of many items that he currently pays at least 20% of, plus extra assistance with transportation and care coordination.


I requested and received 5 years of his claims and payments through his current provider and I'm analyzing that now. Also confirmed that the only pre-existing condition that would impact coverage if he switched is end-stage kidney disease which he doesn't have, and that he isn't near his lifetime max coverage in the current plan. He isn't attached to any of his old doctors since he hadn't been going to them at all! Based on my initial calculations, his monthly premium would actually go down by $11/month, even with the penalties, and that doesn't capture the savings in out of pocket expense.


So have any of you faced a similar decision about enrolling very late in Part B? How did you make your decision? What am I missing here that I should consider?


He has taken to this AL like a fish to water - LOVES it and the people are wonderful for him. So he could have many happy and healthier years ahead. Changing plans could help get him better access to care at a lower overall cost, even if it means paying that penalty. Thanks for any experiences you can share!

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When you enroll in advantage plans, you will be asked how she will pay for part B such as EFT or it can be taken through the SS monthly payout. Someone who enrolls at age 65, the average B payment is $144 each month. For each month that she was not enrolled there is a penalty to the premium. Around 10 years means she will pay 100% of the premium. You may hear the same costs from wherever she enrolls.

The way it works, is at age 65, consider part B as an insurance plan. It is not used until needed. But each and every one of us has to pay into the pool. She cannot just enroll when she needs it. I hope you understand. Whatever the part B premium will not be discounted.
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My husband had to retire at 61 with 31 years service because the GM plant he worked at shut down. When he was 65 and able to get Medicare, he was told to be able to continue to get supplimental benefits thru Retiree BC/BS he had to have A and B.

If the retiree plan reimburses for Part B then why wasn't the person required to have it at 65. It would have cost them nothing.

I think meeting with SHIP is good. Take the benefit book for this person employee suppliment. I would caution on getting a Medicare Advantage. Read up on them first. You need to stay in network with them to get all the advantages. Medicare allows u to go to any Dr that excepts Medicare.
Not all suppliments pay the 20% that Medicare doesn't pay. My Mom had AARP Medigap and had to "share". We have BC and have to "share". Meaning that 20% is split in half with us paying one of the halves.
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janeinspain Mar 7, 2020
Interesting, thanks JoAnn. I don't think anyone forces you to buy Part B. It was foolish since he would have gotten it for free all these years. He has some significant mental health conditions and was always a very disorganized person. I think he just managed with things the way they were and that trying to figure out if any potential changes were worth it was too daunting. The good news is that he did purchase LTC insurance which will help pay for his AL, so he wasn't completely short sighted!

I hear you on the Advantage plans. And I was wondering about this because the last two times he was hospitalized, he received bills from multiple physician practices or other entities independent from the hospital - ie. the emergency room doctor, other specialists, the labs, etc. So if this happens again should I post a sign on his bed "Don't provide service unless covered by this Plan X"???!!! How do you control this in an environment like that?
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Jane, it's been quite awhile since I've even had to consider Part B premiums, so I'll address your question from a different perspective.

We both had Medicare premiums deducted from SS, and we paid BCBSM Plan C coverage premiums directly.    I do recall seeing annual entries for payment of Part B in the BCBSM EOBs.    W/o checking the older EOBs (which aren't even sent by BCBSM any more), my recollection is that the Part B premium was paid by BCBSM annually.   We never paid BCBSM directly for anything except the monthly premiums, which for me are about $200 now.  

Does that make sense?

I did find a link for you:  these are all the plans BCBSM offers, for Michigan residents.  I don't know about other states.

https://www.bcbsm.com/medicare/plans/2020-supplement.html#

I note there are some additions, so it may be time to re-evaluate and see if there are better options available, especially as I get older...and older... and older.
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FloridaDD Mar 7, 2020
The issue is not with BCBS.  If you do not pay Medicare B from your initial eligibility, generally age 65, the US GOVT imposes a surcharge, not BCBS.  Most people do pay in, not certain how this guy avoided it, possibly he told them he was in an employer plan.  If he wanted Part B now, the amount deducted from SS would be MUCH greater.

https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/original-medicare-enrollment/medicare-part-b-late-enrollment-penalties?gclid=EAIaIQobChMI5IT0_OeI6AIVz4CfCh3XdQwVEAAYASAAEgJNMPD_BwE
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Jane, I can only address one aspect of your situation, and that's the value of BCBSM's Medigap Plan C.    Other than some DME equipment, skin creams and a few other supplies, both my father and I had all our costs covered by the Plan C, which picks up the 20% Medicare does not pay.

I don't recall ever having to pay any Part B costs other than those mentioned above.  

I've never considered any of the Advantage plans b/c of the less than positive things I've heard about attempts to deny claims.
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janeinspain Mar 7, 2020
Thanks for the info! So did you and your dad both pay the Part B monthly premium in order to qualify for this Medigap plan?
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