Retirement, Medicare and Supplemental Insurance

[philfree]

The wife just turned 65 and I know nothing about this stuff. She's on meds so a good prescription plan is essential. I don't even know what Medicare covers or what supplemental insurance she will even need. Any knowledgeable advice on this subject would be appreciated.

[KINGPIN CHIEFS FAN]

There are several websites that can explain which plans are right for you, just google medicare and social security. I'm turning 65 this year and I have a place called Insurance Solutions in my town where I can go and talk to them and get guidance as to which plans I might want to consider. I know how confusing it can be so see if you have any place close to you to get some expert advice, good luck!

[KINGPIN CHIEFS FAN]

You're supposed to sign up for Medicare 3 months before you turn 65 so her benefits will probably be delayed until they process her paperwork. Get her signed up asap!

[philfree]

Originally Posted by KINGPIN CHIEFS FAN

You're supposed to sign up for Medicare 3 months before you turn 65 so her benefits will probably be delayed until they process her paperwork. Get her signed up asap!

She's drug her feat so she's not signed up yet but she started drawing SS early and they did take the Medicare out of her check. She's still on my insurance though.

[BryanBusby]

I no longer sell it, but I think a Plan G is still what you want.

Need to expedite the process though and not lose out on GI.

Part D isn't as cut and dry as Supplemental plans so take the time to research things thoroughly.

[philfree]

Originally Posted by BryanBusby

I no longer sell it, but I think a Plan G is still what you want.

Need to expedite the process though and not lose out on GI.

Part D isn't as cut and dry as Supplemental plans so take the time to research things thoroughly.

Plan G. I'll have to look into that.

[BigRedChief]

I thought people couldn't retire at 65 anymore. At least and get full benefits,

From the SSA website:

Full Retirement Age
Full retirement age is the age when you can start receiving your full retirement benefit amount. The full retirement age is 66 if you were born from 1943 to 1954. The full retirement age increases gradually if you were born from 1955 to 1960, until it reaches 67. For anyone born 1960 or later, full retirement benefits are payable at age 67. You can find your full retirement age by birth year in the full retirement age chart.

https://www.ssa.gov/benefits/retirem...0at%20age%2067.

[philfree]

Originally Posted by BigRedChief

I thought people couldn't retire at 65 anymore. At least and get full benefits,

From the SSA website:

Full Retirement Age
Full retirement age is the age when you can start receiving your full retirement benefit amount. The full retirement age is 66 if you were born from 1943 to 1954. The full retirement age increases gradually if you were born from 1955 to 1960, until it reaches 67. For anyone born 1960 or later, full retirement benefits are payable at age 67. You can find your full retirement age by birth year in the full retirement age chart.

https://www.ssa.gov/benefits/retirem...0at%20age%2067.

Yeah but what's full benefits? Does it have to do with Medicare or just the amount of the check they send? She probably should have waited to start drawing funds but she likes to think she won't live 10 more years so she wanted to start collecting while she could.

[blake5676]

Originally Posted by GoHuge

I'm an insurance broker and in the Med Supps and Med Advantage plans I always put my client in supps if they can afford it. I get paid exactly the same per policy regardless if it is a supp or Med Adv plan. Main difference is that a private company is going to take over all your Medicare benefits with med adv policies. Positives....for lower income people it's usually better than OG Medicare as they only pay roughly 80%. With Med Adv the biggest downside is they almost always have a network you must stay in and you have to get a referral from your PCP to do anything like getting any kind of imaging or need to see a specialist....some require one for the policyholder to wipe their ass...could be mistaken on that one, but you get the point. Out of network fees I've seen as low as 40% coverage. They tell you what pharmacy you have to go to as well as using their formularies or pay a higher copays elsewhere. Which means it's take it or leave it on each plan. Most Med Adv plans work like an HMO and don't cost you anymore than your part B monthly premium....usually. They are taken over by a private company. Now to the super shitty, they have copays for doctors and about everything you have done. They also have an annual out of pocket max of roughly $5300 to over $7k a year. Get really sick and a person living on $1200 a month from Social Security has an extremely tight budget and no plan for a catastrophic event. I personally think they are dogshit and will only recommend them if we can't get a better option for the client. The PPO plans aren't much better. They give you more freedom as in what doctors and facilities than can use. These plans also allow for much better coverage out of network so they travel better for people that aren't to ****in old to travel, but with that comes a higher premium. Most of the decent PPO plans are going to cost another $40 all the way up to $100 on top of your $134 Medicare premium...which is stupid. A lot of doctors and facilities don't accept a lot of Med Adv plans as their level of reimbursement is so shitty that they just refuse to deal with them. Humana is hit by that the most because they are so God damn cheap.

Now the smart way of doing it. If I have a client enrolling into Medicare part B for the first time as their primary insurance is they have 6 months before, the month of, and 6 months after that when they are in what's called Open Enrollment. Unlike private insurance for people under 65, they are allowed to deny coverage if someone can't pass through underwriting for a pre-existing condition. Beauty of Open Enrollment is the insurance companies can't ask you any questions about your health or medications. They have to take you even if you weigh 500 lbs with diabetes, a substance abuse issue, cancer, and still smoking like a chimney. Once OE is over though any time they want to make a change they have to go through underwriting. Being a broker I can usually find a carrier that I can get them approved through. Some are just ****ed though for things like being on an opioid medication, any chronic condition, stent placement in the last 2 years, pacemaker in the last 3, cancer in the last 5 years, etc. Diabetes is real bitch too as almost every carrier is different in what they allow. That is why it is imperative to get your client in the best possible med supp that fits their budget as it's more than likely going to be the last insurance policy they'll ever be able to buy if they have serious health issues.

I can't list a single negative thing about having OG Medicare as your primary and a med supp secondary....other than cost. Probably the simplest part that confuses policyholders the most until you pound it into their head as many times as necessary. If a medical provider accepts Medicare....they accept your supplement....period. Doesn't matter if it's a carrier they don't accept. The way this works is the provider bills Medicare and Medicare bills your Supplement for the rest. Another positive is guaranteed renewability as long as you pay your premiums. Could run up $2 million in one year in medical Bill's and they can't drop you or raise your rates. Rates are based on 3 factors.....age, gender, and geographic location...so another piece of mind plus.

Then travel is a big one. Medicare is accepted by 98% of providers across the country. So again if they accept Medicare....they accept your Supplement. Plans F, G, and N even cover you internationally for the first 60 days you are out of the US.

Other benefit is you are in complete control of your healthcare. No referrals, networks, wondering who accepts your coverage...all those things that suck about Med Adv.

Now the downside is obviously going to be higher premiums with supps as they pay for so much more. You will be paying probably $90-$150 more a month than if you have a Med Adv plan. I already told you that Med Adv plans have a minimum $5k out of pocket max, so if you can afford a supp it's a no brainers. The biggest reason is with all these copays and out of pocket you pay with Med Adv....you can't budget for your healthcare expenses as there are too many unknowns...and that's shitty because 80% of seniors have Social Security as their main or only source of income. If you're healthy that's great, but we all know father time is undefeated and will eventually gonna kick your ass, and have yet to see a old person get healthier as they age. You get sick at 70 and all of a sudden Med Adv sucks and you want to jump on the Supp program to stop the bleeding, but you ****ed yourself 5 years ago in OE and can't get through underwriting for a supp. Then things become really messy and frankly very sad when you have to tell them sorry.

Last part which is something that the government got right in developing a healthcare program is making each letter med supp plan standardized. The different plans are A, B, C, F, G, K, L, M, and N. They all suck except for F, G,and N.

If you have plan F you will never see a doctor bill and pay any out of pocket cost from a medical provider....of course that means plan F is going to be the most expensive.

The best plan is plan G. It's exactly the same as plan F other than you have to pay your part B yearly deductible which is only $185. Reason it's the best is over the course of the year plan F is about $400 a year more expensive than plan G. The only thing you get is you spent $400 to cover $185....which doesn't take a scholar to figure out you are paying $20 more a month with plan F over plan G for the exact same coverage. Stupid, but as a broker it's your job to give people all their options and steer them in the right direction that fits them and their budget the best. Plan N is a good option for some people to are extremely healthy and wanna save a few bucks. It's exactly like plan G other than when you go to the doctor or ER you will have copays. Up to $20 for your doctor and $50 for an ER visit. Easy way to help someone decide between G and N is ask them how many times a year they see their doctor. I would say there is about $200 a year difference between G and N. If you go to the doctor 7 times a year you take that times 20 to get the true savings. In that scenario they are only $5 a month...and if they end up sick and are having to go to the doctor a lot....plan N can become more expensive than plan G which you just explain it's $5 a month more for plan G, but they are much better protected for what is always an uncertain thing, especially with old folks.

I mentioned standardization earlier. What that means is that every plan letter plan offers the EXACT same coverage regardless of the carrier. So if plan G with Mutual of Omaha is the least expensive....pick that one. Again stupid to pay more for the exact same coverage. Some people are stupid and say "hey I've always had Blue Cross my whole life and never had an issue." Well good for them, but different players for different products. Blue Coss is one of the more expensive plans in the Med Supp market. You gotta just beat it into their heads that they are in a different market now and Blue Cross and a lot of other names people are familiar with suck in med supp.

Last thing....if you go supp over Med Adv, you will have to get a part D drug plan. Nationally they run between $16 to $35 a month. The advantage there is you get to choose the best plan for you and the medications you take, an option not offered when you go Med Adv.

In closing if you can afford to go the supp route absolutely a hands down no-brainer. With plan F and G a person can budget their healthcare cost to the dollar because no matter what they are covered at 100%. Certainty is the most priceless commodity you can offer someone. Unfortunately not everyone can afford a supp and have to go Med Adv. Can't budget that with copays and big out of pocket maximums. Just a mathematical certainty that at some point in your retirement years on your fixed income you are gonna get ****ed. Can't think of anything else in the med supp vs. Med Adv....or more appropriately private company takeover plans debate. Happy to answer any questions anyone has though. Doubtful, but possible I left something out...happens.

This was the best post I'd read on the subject. From a different thread on here years ago but nails the subject even though it's quite lengthy.

[philfree]

Originally Posted by blake5676

This was the best post I'd read on the subject. From a different thread on here years ago but nails the subject even though it's quite lengthy.

That's a lot to digest and I'll probably have to read it a few times to digest it all. I appreciate your post and thanks.

[blake5676]

Originally Posted by philfree

That's a lot to digest and I'll probably have to read it a few times to digest it all. I appreciate your post and thanks.

The gist of it is....if you can afford a supplement, (Plan G is best for almost everyone), then traditional Medicare with a supplement is the best option for you. You can nail down your exact out of pocket health care costs pretty much regardless of anything that may happen throughout a year.

If you go with a Medicare Advantage plan, through someone like United Healthcare or Blue Cross, it may be a no cost monthly premium but you never know your out of pocket costs throughout the year other than your max-out of pocket. You'll be paying co-pays for all your visits, whether you have 3 in a year or 50 of them.

The beauty of traditional Medicare with supplement is the peace of mind in knowing no matter what health issues you have in a calendar year, you already know how much you'll be paying, and it's usually quite a bit less than the $5000 out of pocket max you may have on an Advantage plan.

[BryanBusby]

Originally Posted by blake5676

This was the best post I'd read on the subject. From a different thread on here years ago but nails the subject even though it's quite lengthy.

A lot of that quoted post is dead on and solid advice. There are a few things I will pick apart though.

I sold plans in all 50 states and I don't think I'd agree that most advantage plans were HMO. The offerings will change a lot based on the area of course, but overall I thought the blend was pretty even over HMO, PPO and POS plans.

Second thing is while the info was accurate for the time, I'm not sure you can get a Plan F as a new enrollee anymore. They generally shut the plan off and only keep it active for those already in it and generally jack the costs up to keep you wandering elsewhere. Probably a hell lot more reason to go Plan G today.

If you also get Medicaid, you can get a Dual-Eligible plan that will keep your health coverage free but also can provide you some extra carrier benefits like silver sneakers.

Even if you aren't poor enough for Medicaid but also have a lot of prescriptions, there might be some state programs available that will help pay for part of your drugs.

Originally Posted by scho63

Insurance in US is some complicated shit.

It's insanely stupid how complicated it all is.

You got the sales people that have to walk a tight rope and make an absurd amount of money selling the complicated plans. Guess who pays for that?

And then you have the people that have to sit there and answer the complex bullshit on the phones to customers. More cost.

Then you have the people at the ins Co that have to process the moon formulas. More money.

People at the doctors office that have to decipher and code within the moon formula. Even more money.

But oh hey, you got our moon formula wrong. Now it was to be appealed by a different set or people. Bam. Even more.

Beep beep. Here comes prescription bullshit.

But hey, these execs need 40 yachts. Guess who is paying for that, too? Yep. You.

We could do much better but this really is getting near that political line.

[Lzen]

Originally Posted by BigRedChief

I thought people couldn't retire at 65 anymore. At least and get full benefits,

From the SSA website:

Full Retirement Age
Full retirement age is the age when you can start receiving your full retirement benefit amount. The full retirement age is 66 if you were born from 1943 to 1954. The full retirement age increases gradually if you were born from 1955 to 1960, until it reaches 67. For anyone born 1960 or later, full retirement benefits are payable at age 67. You can find your full retirement age by birth year in the full retirement age chart.

https://www.ssa.gov/benefits/retirem...0at%20age%2067.

Partly depends on if you have retirement through your workplace. I have an employee who is 65 today and he will be retiring this year. I think at 65 you can get Medicare. Full social security might not be for another year or so but he's got our retirement plan and also a supplemental deferred comp plan.

[BigRedChief]

Originally Posted by WarChiefs89

I have the licenses to sell health insurance and Medicare supps but don't because it's too complicated to do it and my regular job (financial advisor). I know enough to be dangerous though.

Here's my rundown of Medicare:
Part A - this is free and covers hospital visits
Part B - this has a fixed cost ($170 a month base price but can be higher based on your income) and covers doctors visits

Part A & B are original Medicare, but they don't cover all your typical healthcare needs... so that's where either Medicare Advantage or a Medicare Supplement + a drug plan comes in. There are different schools of thought when looking at a $0 premium advantage plan vs paying for a supplement + drug plan. I think most professionals tell you to buy a supplement if you can afford it. I believe most people, depending on their income, would rather spend an extra $150 a month for their insurance and drug costs and basically know they will not have any surprises when it comes to medical bills.

As other have said, Plan G is very popular. One item to note: Every company offering a Plan G Supplement offers the exact same benefits. Pick a company that is reputable and easy to work with but don't spend extra for a name. In our area BCBS is typically $40+ per month more than other solid options because they carry a lot of name recognition.

Part D - Drug Plan - You need this if you buy a supplement (like Plan G). Use the government's website and get out all your prescriptions. There is a very handy tool that allows you to plug in your scripts & your preferred pharmacy and look at all the plans by annual cost (premium + cost of buying meds). If you go through a professional they should do this for/with you.

Finally -- your wife has a 6-month enrollment window surrounding her 65th birthday. 3 months on either side. Best practice to do it sooner, but don't sweat if she just turned 65.

Originally Posted by TripleThreat

I work for a Medicare advantage plan believe it or not. Can you emphasize what you're interested in? Are you interested in Regular Medicare, or Medicare Advantage plans? Regular Medicare a lot of people enjoy and a lot of people find MA plans (Medicare Advantage Plans) to be just as good if not better due to the Part C services they provide

A few pointers I can provide:

Choosing between Medicare & Medicare Advantage.

Medicare - You are provided Part A & Part B services, no Part C and you need to sign up with a Part D Medicare Drug plan in order to avoid building a lifetime LEP (late enrollment penalty) after 63 days of not having a valid Part D plan under Medicare (this pertains to MA plans as wel.) Part A & B services are typically what you would get with your normal insurance, a doctor, referrals, treatments, surgerys, hospital stay, SNF's, you name it.

Medicare Advantage Plans - Provide Medicare Part A & Part B services but also include Part C & Part D. Part C is "bonus services" which is why they are called advantage plans which can include chiropractic service that can be better than the standard medicare chiropractic services, Vision benefits, Over the counter allowances that you can use at participating retailors such as CVS/Walmart ETC, some have grocery allowances, you have transportation benefits, GYM benefits, you see where this is going. These are all Part C services that typically aren't covered under original Medicare.

Moving on to choosing plans under Medicare and Medicare Advantage plans
.
I'm not 100% familiar with how original Medicare plans work I've only worked for Medicare Advantage plans so the process of how original Medicare may work may differ a bit so the below is how MA plans work but Original Medicare may be different, for example any MA plan I've work with does not provide Plan's F or G.

Your choosing of a PBP (Plan benefit Package)

HMO - You must stay within your own network of doctors. Typically you sign up with a MA plan but you are assigned to what is called an IPA/Medical Group that 9 times out of 10 are processing your referrals/authorizations to see various specialists or have procedures done. What that means is when Jimmy wants you to see Billy to have your foot amputated, your IPA will review Jimmy's request for you to see Billy and they will either approve or deny your request. If Denied you have the option to appeal said denials with your MA plan. If your MA plan denies your request, your denial goes back to Medicare where Medicares review team reviews the denial to ensure that you are not getting screwed over by your MA plan or IPA. In short it keeps everyone responsible and accountable.

PPO - You can go to any specialist/doctor but you pay a bit more if OON (Out of network) and from what I've learned specialists and doctors can refuse you service and there's nothing your insurance company can do it about it because there is no contract in place so it can be tempting but also not as promising as intended. In 2022, I wouldn't enroll into a PPO under Medicare plans or at least MA plans because I've seen so many specialist and doctors say "we don't take PPO plans.."

Do you qualify for Medical? If so, I'd look into enrolling or at least attempting to enroll into MediCal because it really does help so much. They cover all of your %coinsurances payments (NOT COPAYMENTS) and to add while your financial status plays a big role, I have seen diabetics be approved while taking home 100k a year so again, it doesn't hurt to attempt to see what options you have with obtaining Medical assistance. Here's an example below on how MediCal works in paying your claims that your share of cost would be under an MA plan:

Lets pretend you need a wheelchair and your plan benefits for DME (Durable Medical Equipment) are as follows:

0% Coinsurance if less than or equal to $350.00, 30% if greater than $350.01 With a PA required. What that means is that first you will need a referral from your PCP (Primary Care Provider/Physician) to a DME company and have it be approved, secondly if your wheelchair costs say $12,000.00 you are on the hook to pay 30% of that without having the financial assistance provided by MediCal.


AVOID signing up for plans that are NEW in an area or not established. The reasoning for this is because their provider network in your area may be limited and therefore you may find yourself driving 20-30 Miles to see a provider because the one closer to you that's 15 miles away is booking 2 months out and if you ask your MA plan to see your favorite oncologist down the street they are going to ask you to have your doctor submit a referral to the plan/IPA to be reviewed and if denied they will say you can file an appeal as explained prior. This is a complete waste of time because you will be denied with your appeal 9.9 times out of 10 because you will have been provided and supplied a doctor that can provide the same services and your feelings wont matter and Medicare will agree with the decision and Medicare won't even see the denial for 2-3 months anyways so by that time you could have already had your procedure done rather than being stubborn and trying to go the appeals route.

GET AN EOC (Evidence of Coverage) from any plan that you "MIGHT WANT" to sign up for or if your more computer savvy get it online so you cant cntrl F the things your interested about. If your needing drug information, ask for a drug formulary. Not all PBP's and Plans cover the same drugs. Also something that annoys the shit out of me, Part B drugs are Medicare regulated and theres nothing the MA plan can do or say about your cost or what they do or don't cover. Medicare Part B drugs are always 20% coinsurance, and without MediCal you wil be stuck paying for that coinsurance HOWEVER, your plan will have a Maximum OOP limit you have to reach before your plan will completely pay for everything you have done NOT INCLUDING Part D drugs. The general plan's I see for MOOP( Maximum Out of Pocket) are around $3,000-$4,000 but I've seen one recently which was only $1,100.00 but again, read your benefits.

Also don't expect when you jump from company to company that your same diabetic monitor that was covered under "blank" is going to be covered under "blank" unless its a Medicare covered item, the plans will have completely different providers from one another and their benefits will/may be different so be prepared that your favorite monitor or item you have been using for 5 years may not be covered under this new fancy plan a sales agent sold you on.


I could go on and on so you can just quote and reply with any questions you have and I can try my best to explain them. I've had some conversations with some people that never even knew that when they sign up for a MA plan that they had an IPA that was paying for half their shit and processing their requests..

MY OPINION - Go with Original Medicare for now, and do some research. There are things called SEP (Special enrollment Periods) and you can also change plans throughout the year if you qualify for an SEP... Open enrollment period I believe though begins on OCT 15 each year and ends Dec 31... Then you have from Jan - March 31 to still openly change plans with other plans but with your internal MA plan, you can only change once during this time period. Between March 31 - Oct 15 the only way you can call your plan and change your PBP is by qualifying for an SEP these are like moving out of the area, leaving prison etc. The most common is moving but there are others.. If you want to sleep easy IMO Go with Kaiser and their MA plans... From what I've heard the referral process is non existent since you can only go to Kaiser doctors anyways and their establishments are always good however if you're like some and your PCP isn't a Kaiser doctor, then you're most likely going to find yourself following your PCP to whatever IPA they are contracted with and then whatever plan that IPA is contracted with. A lot of folks prefer to follow their doctors from place to place.

Anywho there's my wall of text and if you have questions feel free to reply to me and I'll answer best I can.

Originally Posted by Lzen

Partly depends on if you have retirement through your workplace. I have an employee who is 65 today and he will be retiring this year. I think at 65 you can get Medicare. Full social security might not be for another year or so but he's got our retirement plan and also a supplemental deferred comp plan.

Damn this is some complicated shit to figure out. Maybe by design? I could see how someone could leave money on the table that they are eligible for and or overpay for something they need.

[blake5676]

Originally Posted by BigRedChief

Damn this is some complicated shit to figure out. Maybe by design? I could see how someone could leave money on the table that they are eligible for and or overpay for something they need.

It 100% IS very confusing. Which is one of the reasons I personally believe that Medicare Advantage plans are getting more popular. They're a simple pitch....we'll give you coverage under our name you're familar with (Blue Cross, United, Humana, etc) and it won't cost you a penny more than your payment for normal Medicare. And we'll throw in drug coverage and some other benefits as well. It's certainly "cleaner" on the surface to have one card for all health needs.

And that option is a good one for some people I suppose. That being said, the certainty of total out of pocket expense with traditional Medicare and a supplement is the safest overall choice if you can navigate the confusion and see the big picture for MOST people.