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.

[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.

[scho63]

Originally Posted by 2bikemike

We used Boomer Benefits to walk us through it.

https://boomerbenefits.com/

Thank you very much for posting this.

POS REP

[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.

[philfree]

I appreciate all the replies.

[Rain Man]

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.

That's a really good 43rd post. I think I'll go back and look at your previous 42.

[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.

[HemiEd]

Wow, what a bunch of old farts we have posting! Bunch of Boomers!

I must say, the Mrs. signed us up for a supplemental insurance through Mutual of Omaha 8 years ago when we retired and it has been awesome. No cost above the $180 per month for my share.

[philfree]

Originally Posted by HemiEd

Wow, what a bunch of old farts we have posting! Bunch of Boomers!

I must say, the Mrs. signed us up for a supplemental insurance through Mutual of Omaha 8 years ago when we retired and it has been awesome. No cost above the $180 per month for my share.

If I can get by with $180.00 a month I'd be ecstatic. My wifes insurance on our group plan is over $1,500.00 a month. She has lot's of meds so It's probably a better deal then it sounds but damn.

[HemiEd]

Originally Posted by philfree

If I can get by with $180.00 a month I'd be ecstatic. My wifes insurance on our group plan is over $1,500.00 a month. She has lot's of meds so It's probably a better deal then it sounds but damn.

Yeah, that is not including meds as I buy my one script through the VA, but my Mrs. has a med plan through Humana.
I probably don't even want to know what that costs.

[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.

[tooge]

Originally Posted by 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.

Pm me. My wife is a medicare specialist

[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.

[TripleThreat]

Originally Posted by blake5676

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.

MA plans have MOOP as well though. I'm not very familiar with Regular Medicare since I haven't worked with Medicare as a company but I've seen members come to our MA plan and their total OOP limit for any Part A & B services traditionally hovers around $3k - $4k. We just introduced a new plan for $1.1k but that plan is meant for diabetics and we usually only put MediCal members on that plan so they never really meet that maximum OOP in one year anyways (genius selling idea). Also most MA plans have supplemental drug coverage included in all of their PBP (plan benefit packages) our company sure does!

Part D though is the one thing that won't count towards a members maximum OOP for the year so I'm not sure how Medicare navigates that with their Maximum OOP system. However, Medicare Part B drugs are covered under that maximum OOP limit, so services like chemotherapy etc when you hit that 3-4k payment range for the year, the plan picks up the rest of the services for that calendar year.

Also agreed, 100$ confusing. Luckily I can read EOC's pretty well for MA plans but I still urge anyone who wants to sign up for a MA plan, hear the sales pitch but request an EOC before any decision is made!