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TooPatient

Ideal_Rock
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We have about 12 weeks to decide on Medicare coverage for DH. This was not expected as we thought he could just stay on his plan through his employer and only swap when he retired. With his employment there ended, I am setting up COBRA and found that his coverage with that will end the first day of the month he turns 65. (I will still be covered on COBRA). Now I am scrambling trying to make heads and tails of the different options. Part A, Part B, and various supplemental. Is there a good resource with all of the options well laid out? Any advice, experience, or whatever welcome too. Neither of us knows much about this so any information is appreciated!
 

diamondringlover

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yeah my hubby will retire early this fall...I need to start looking at this info as well...I work in the medical insurance industry but medicare stuff even confuses the heck out of me..
 

TooPatient

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yeah my hubby will retire early this fall...I need to start looking at this info as well...I work in the medical insurance industry but medicare stuff even confuses the heck out of me..

Every time I think it is just another insurance thing so easy enough to just read and choose, I learn a bit more. Found out this morning that not signing up for Medicare (part b, I think?) by the age of 65 can cause a fine and/or increased rates for life unless you had a qualifying plan. Had no idea! I know my grandparents were confused as if they changed to this one thing it would save $ but could limit certain areas and can't be changed back if you don't like it. So many little details that I haven't been able to find explained clearly in any one spot!
 

Elizabeth35

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We are just starting our research as DH turns 65 this year. Start with Medicare.gov to wrap your head around it.
Then find a good insurance agent—our financial guy recommended an agent. Or, if you know others in your area already on Medicare-ask for a recommendation.
Gather up your last years medical bills and your prescriptions-it will help guide your choices.
 

diamondringlover

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we checked with the medicare office, my hubby is still working and we have coverage thru them for now and they are considered primary so we didnt have to file with them yet
 

Demon

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Medicare.gov is definitely the place to start. D is drug coverage. Its part A, IIRC, that you need to sign up with by 65. Supplement plans are better coverage, but you pay for those and the costs go up as you get older. But if you're going to go with a supplement plan, start off with one. If you want to change to supplement later, they can deny you. When you're looking for a plan, make sure and plug in your prescriptions as the costs between plans can vary quite a bit.
 

rcjtraveler

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I just got finished signing up for Medicare which starts the first day of the month you turn 65. Medicare A and B were signed up automatically for me as I am collecting Social Security. If your DH is not I believe he will have A automatically and you will need to contact Social Security to sign up for B. This is what my husband had to do when I retired. I used an insurance agent to help select plans for the supplement and plan D for prescription coverage based on medications I am on. Crazy but each person has 4 plans unless you select a Medicare Advantage plan that includes medications There are several Medicare supplement plans to pick from. There is a great deal of info online that compares them. The insurance agent was helpful sharing the plans and costs and how Medicare works. They did not charge for the service but do get a commission based on the plan you select, I think.
There are also seminars that some insurance companies put on to explain everything. I have a healthcare background and despite that found it confusing. Just finished for an April start date. Best of luck. Glad to share any more info if it would be helpful.
 

rcjtraveler

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Just wanted to add that the supplement is optional. It does cost extra. Because I definitely wanted one it was better to sign up right away as it was less expensive that later and did not require any medical review for eligibility.
 

snowballs mom

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I just started full Medicare coverage as of my retirement date, January 1st. I agree that it is a confusing process, more so if you are still covered under an employer once you turn 65. This is what I learned. Even if you are still employed and covered by a group plan, sign up for Medicare Part A for the month of your 65th birthday. If you wait, there is a penalty and your premiums will be higher as a result. Wait to sign up for Part B once you are ready to start using Medicare as your insurance.

Part A is hospitalization, Part B is physician-type services. Neither pays for everything, so you will also need a supplemental policy as well as a prescription drug policy. You can either choose Part D for prescription drugs along with a supplemental plan that covers other medical expenses - there are a number of different categories with different coverages. The other choice is a Medicare Advantage plan - this is an HMO-like plan, and many of them include prescription drug coverages. The ones in my area have three levels of premiums with different copays and services, ranging from $0 per month and up.

I am lucky. I have had Kaiser insurance for a very long time so I just continued with their Medicare Advantage plan. I second the suggestions to go to medicare.gov as a start, as well as to find an agent if you intend to explore the other types of plans.
 

Demon

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I just started full Medicare coverage as of my retirement date, January 1st. I agree that it is a confusing process, more so if you are still covered under an employer once you turn 65. This is what I learned. Even if you are still employed and covered by a group plan, sign up for Medicare Part A for the month of your 65th birthday. If you wait, there is a penalty and your premiums will be higher as a result. Wait to sign up for Part B once you are ready to start using Medicare as your insurance.

Part A is hospitalization, Part B is physician-type services. Neither pays for everything, so you will also need a supplemental policy as well as a prescription drug policy. You can either choose Part D for prescription drugs along with a supplemental plan that covers other medical expenses - there are a number of different categories with different coverages. The other choice is a Medicare Advantage plan - this is an HMO-like plan, and many of them include prescription drug coverages. The ones in my area have three levels of premiums with different copays and services, ranging from $0 per month and up.

I am lucky. I have had Kaiser insurance for a very long time so I just continued with their Medicare Advantage plan. I second the suggestions to go to medicare.gov as a start, as well as to find an agent if you intend to explore the other types of plans.

I just wanted to add that there are PPO advantage plans also.
 

snowballs mom

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I just wanted to add that there are PPO advantage plans also.

Another consideration is that if you initially go with a medicare advantage plan and decide to change to traditional medicare at a later date, the insurance company can charge you a higher premium. I think you have a year to decide before that rule kicks in.
 

Demon

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Another consideration is that if you initially go with a medicare advantage plan and decide to change to traditional medicare at a later date, the insurance company can charge you a higher premium. I think you have a year to decide before that rule kicks in.

Yeah? I didn't notice that! But I wasn't interested in that anyway, because I didn't want to have a separate drug plan. It just seemed to be a PITA that way. But is confusing, and why do that to us just when we're getting older? Things should be easier, lol.
 

snowballs mom

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Yeah? I didn't notice that! But I wasn't interested in that anyway, because I didn't want to have a separate drug plan. It just seemed to be a PITA that way. But is confusing, and why do that to us just when we're getting older? Things should be easier, lol.

My whole experience was terrible. Since I turned 65 in November and retired at the end of December, I wanted to start Part B on January 1st. However, their rules and tables would not allow that. I had a choice of starting December 1st or March 1st - made absolutely no sense to me and I still do not understand the reasoning. In addition there are no in-person appointments at this time. It took a lot of time on hold and speaking with at least three different people to figure this out. I won't even go into how awful their website is.
 

TARSHA

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Another possible consideration is how much you want to stay with your current physicians. Most do accept Medicare (I think I read 1% - ??? Pediatric Physicians opted out - Medicare & Peds ???), BUT, I think Advantage plans might limit you to their network of physicians.
 

Demon

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My whole experience was terrible. Since I turned 65 in November and retired at the end of December, I wanted to start Part B on January 1st. However, their rules and tables would not allow that. I had a choice of starting December 1st or March 1st - made absolutely no sense to me and I still do not understand the reasoning. In addition there are no in-person appointments at this time. It took a lot of time on hold and speaking with at least three different people to figure this out. I won't even go into how awful their website is.

Ugh. I had ordered a couple of their booklets beforehand, so I think that helped me. Plus I worked for 16 mo after I was eligible to retire and stayed on my companies insurance till then, so doing it in shifts might have been easier? It all went pretty smoothly for me.
 

Demon

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Oh and there are plans that offer dental, hearing and vision too, But not all of them. And some even offer transportation.
 

pearlsngems

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My husband and I both started on Medicare recently.

If you have not yet checked out Medicare's own website, do so.
See this publication in particular: https://www.medicare.gov/medicare-and-you

In addition, I found the following book very informative and easy to understand: Medicare For Dummies 4th edition (for 2021):

link to Amazon listing: https://www.amazon.com/Medicare-Dummies-Patricia-Barry/dp/1119689937/ref=sr_1_2?crid=1G6QHJ2VW062C&dchild=1&keywords=medicare+for+dummies+2021+4th+edition&qid=1613569032&sprefix=medicare+for+dummies,aps,185&sr=8-2

I learned all I needed to know from Medicare.gov and from books, but if it's all just too much for you it may be best to get the help of a licensed insurance agent who knows Medicare. Google to find one in your area.

You mentioned your husband's on COBRA and that it will end the first day of the month he turns 65. Medicare begins the first day of the month one turns 65 so there should not be any gap. But it's important to apply for part B a few months before you want it to start, as it takes time for the Part B application to be processed. Also, you can't sign up for a part D prescription plan until you have your Medicare number-- so all the more reason to allow enough time.


Here is some very basic information about Medicare:

Part A starts at 65 and is mostly for hospital care. This is funded by payroll taxes.

Part B is basically for outpatient care (doctor visits, lab work, mammograms, PT etc.) One can start on this at 65 (as I did recently) but if one has other qualifying health insurance one can delay this and get a "special enrollment period" later (as my husband did).
For 2021 the premium is $148.50 per month. If one receives Social Security the Medicare premium is deducted from one's SS payment each month. Also, if one receives Social Security one is automatically enrolled in Part B at age 65; otherwise one must enroll oneself.
There is also a yearly deductible for Medicare. For 2021 the deductible is $203.

Some go a different route with Part C, a.k.a. Medicare Advantage Plans. These substitute for traditional Medicare Parts A and B and for Medicare Supplement Plans (a.k.a. Medigap, see below) and sometime also include a drug plan that substitutes for Part D. There can be limitation in which doctors are in network, so do your homework carefully if you go this route.

Part D is an outpatient prescription drug plan (that is, meds you take at home, as opposed to meds given to you while in a hospital or in the doctors office.) There is an easy-to-use tool on Medicare.gov (https://www.medicare.gov/plan-compare/#/?lang=en&year=2021) to help you find the most inexpensive plan for you based on your current meds. You can enroll in a part D plan online through that tool.
You can (and should) use this tool every year during Open Enrollment to re-evaluate whether it will still be the cheapest plan the following year, as plans and formularies change all the time.

While you don't have enroll in Part D it is best to do so; you may not need expensive meds now but if you get a diagnosis later that requires expensive meds, you will wish you had-- and if you enroll late, there is a penalty for every month for the rest of your life.

There are significant lifelong penalties if one does not sign up for Part B and Part D (or a comparable Part C plan) by the deadlines.
Do NOT miss deadlines.


Medicare Supplement Plans (a.k.a. Medigap)

These are insurance products that you purchase from an insurance company. The premium can be up to several hundred dollars each month. Why would you want one? Here is why:

Medicare only covers 80% and you are responsible for the other 20% and there is no out of pocket limit!
This means you could potentially be on the hook for a massive bill if you ever need costly medical care. This is why Medigap plans are so important. Medigap pays the 20% that Medicare doesn't cover. This is very oversimplified but that's it, basically.

There are various Medigap plans -- A through N. They cost different amounts because of what they cover. (e.g. with some plans your premium is lower but there are copays and/or deductibles.) You choose the plan that best fits your budget, your tolerance for dealing with medical bills, how much you travel, etc.) This page on the Medicare website explains: https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies

Every Plan G or Plan N (for example) will cover the exact same things as every other Plan G or Plan N no matter what state you are in or which insurance company you buy it from. However, every insurance company has its own price for the plans. You can pay more or pay less for the exact same coverage, depending on the company you buy it from, so you need to do some careful shopping. This is where an agent can be particularly helpful if you have time constraints. But you can easily find out which Medigap plans are available in your area by looking at the Medicare and You publication put out by Medicare. You can call the companies and find out the premiums and choose the one that best suits you. That is what we did.

I just want to add that you should choose your Medigap plan with the long term in mind. If you sign up when your are first eligible you cannot be charged more or denied outright for pre-existing conditions, but if you sign up later, or change plans later, you may be subject to underwriting.
So think about what your medical needs may be later on, because you just may need to keep the same plan for the rest of your life.
 
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pearlsngems

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Also-- you said you will still be on COBRA even after your husband is not. Be sure you apply for Medicare Part B a few months before you turn 65. There is "gotcha" when it comes to COBRA in respect to Medicare and many people get caught out and end up paying avoidable, lifelong penalties for their Part B.

Quoting from the Medicare For Dummies book, in the chapter "Top Ten Medicare Mistakes", p. 371:

"You should be aware that retiree benefits and COBRA coverage, though provided by a former employer, do not count as "active" employment and therefore do not protect you from delayed coverage and late penalties....

"COBRA coverage: This allows you to continue on your former employer's health-care plan after your job ends, usually for about 18 months, while paying full premiums. In this situation, to avoid late penalties, you need to sign up for Part B before the end of your initial enrollment period at age 65, or (if your job ended after that period) no later than eight months after you stopped work."

Sorry for all the edits...typos!
 

wildcat03

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Another consideration is that if you initially go with a medicare advantage plan and decide to change to traditional medicare at a later date, the insurance company can charge you a higher premium. I think you have a year to decide before that rule kicks in.

I am NOT a Medicare expert by any means. I have also heard that if you elect a Medicare Advantage plan and develop additional conditions, it can be very difficult/impossible to switch to Medicare parts A and B. I often see the fallout of this because the Medicare Advantage physician directories are limited and I work in a city with two large competing healthcare systems, one of which is quite a good regional hospital but the other is a national name in healthcare (the kind of place you might avoid if you have garden variety hypertension, but might choose to get your cancer treatment/major surgery, etc.).
 

pearlsngems

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Regarding the above post, I believe one can switch from Medicare Advantage to traditional Medicare (parts A, B and D) without a problem -- you would not pay more for Medicare even if you had pre-existing conditions. The monthly premium would be the same as for everyone else.

Where the difficulty arises is that you would be subject to underwriting when you tried to buy a Medicare Supplement (Medigap) plan. They could charge you more for your pre-existing conditions, or even deny you outright.
 

pearlsngems

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Also my husband signed up for Medicare part B by faxing his forms into Social Security. He did not have to go in in person. The rules changed becuse of the pandemic. You can call your local SS office to find out more.
 

SparklieBug

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This thread... :???: :eek-2: It seems like one needs full-time training to navigate medical insurance. I never knew it could be so complex! :oops2: I'm getting educated and will no doubt, hear from various friends in the next few years as they work their way through this.
 

Rfisher

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Thank you @pearlsngems for all that concise info.
This is eye opening.
Are any of these rules/guidelines state specific?
 

pearlsngems

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There are some difference between states when it comes to regulations for Medicare Supplement (Medigap) and Medicare Advantage (Medicare Part C) plans. Some states even have their own plans. Here is some information I found on that:

Also, there is the matter of so-called "excess charges". Most physicians accept Medicare assignment (which means they can't bill you for more than Medicare pays them.) But some physicians and hospitals don't accept assignment, and they are allowed to bill you up to 15% extra. There are a handful of states that have passed laws prohibiting excess charges-- Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont.

Why does this matter? Because the only Medigap plan that pays for excess charges is Plan G. If you live in a state that allows excess charges-- and most of them do-- Plan G may be more attractive to you than other plans, even the premium is a bit higher. However, even if you live in a state that prohibits excess charges, you may still prefer Plan G for other reasons, including if you are someone who travels a lot, or if you expect to need care at a clinic that is in a state that allows excess charges (like Mayo Clinic) or even if you just don't want to deal with copays.

There is a whole other issue that anyone who plans to apply for Parts B or D after age 65 needs to be aware of. To avoid penalties you have to be able to prove that ever since you turned 65 right up to when your Medicare will start, you have not had a period of over 63 days when you didn't have equivalent health-care coverage (my husband had to have Human Resources fill out a particular Medicare form to prove this) and that the prescription coverage was what is called "creditable". That is, it has to be as good as what you could get through Part D. Every year your employer is supposed to give employees a form telling them whether their prescription coverage is "creditable". Save those forms! My husband threw out a few year's forms and had to have Human Resources write a letter on company overhead to assure Medicare (actually the company that he bought his Part D plan from) that he had "creditable drug coverage" for all those years since he turned 65. If you can't prove that you had creditable coverage, then you will face a monthly penalty for the rest of your life. It's costly! They are not fooling around!

From Medicare:
"Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.06 in 2021) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium."
https://www.medicare.gov/drug-cover...-drug-coverage/part-d-late-enrollment-penalty

Sorry for edits...I type too fast and make typos!
 
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pearlsngems

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For anyone in their 60s freaking out about all this information...I give this free advice in the interest of preserving sanity! :)

1. Plan to learn all about Medicare during the year before you turn 65. Just bite the bullet and do it. It's less scary when you have plenty of time to digest it. Don't bother with it years in advance, as laws may change by then.
And just to reiterate, don't miss deadlines!

2. When it's time to actually apply for Medicare and Medigap, you will get quickly swamped with paperwork.
Create 3 files.

• One for CMS (Centers for Medicare and Medicaid) which is where you will place all your Medicare info and the statements that CMS will send you detailing what Medicare and Medigap paid for of charges from your medical visits. Probably you will need a new file folder every few years as statements accumulate.
• One for your Part D prescription drug plan. The specific plan and company may change from year to year so keep the file label generic.
• One for the company from whom you purchase your Medigap policy. They will send you information about what your plan covers, and you may also get mailings if the rate increases. (Note: Rate increases will not be based on your personal health condition. The law mandates increases based on how much companies are paying out. They have to stay solvent.) This file is where you will file all communications from them.

3. Make paying for all of it as easy and automated as possible. I already mentioned that the premium for Medicare Part B is deducted from my SS payment. I also elected to have my part D premium deducted from my SS payment. (If you don't take SS yet you can pay the premium other ways.) In addition, I set it up for my Medigap premium to be automatically drawn from my checking account (the same account to which my SS payments are deposited.) That way even if I end up in the hospital and am unable to manually pay my bills for an extended time, my Medigap coverage won't get canceled. (If canceled, it might or might not be able to be reinstituted, but it would be subject to underwriting.)

It's a bit of a hassle setting it up, but then you're done.
 

TooPatient

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My husband and I both started on Medicare recently.

If you have not yet checked out Medicare's own website, do so.
See this publication in particular: https://www.medicare.gov/medicare-and-you

In addition, I found the following book very informative and easy to understand: Medicare For Dummies 4th edition (for 2021):

link to Amazon listing: https://www.amazon.com/Medicare-Dummies-Patricia-Barry/dp/1119689937/ref=sr_1_2?crid=1G6QHJ2VW062C&dchild=1&keywords=medicare+for+dummies+2021+4th+edition&qid=1613569032&sprefix=medicare+for+dummies,aps,185&sr=8-2

I learned all I needed to know from Medicare.gov and from books, but if it's all just too much for you it may be best to get the help of a licensed insurance agent who knows Medicare. Google to find one in your area.

You mentioned your husband's on COBRA and that it will end the first day of the month he turns 65. Medicare begins the first day of the month one turns 65 so there should not be any gap. But it's important to apply for part B a few months before you want it to start, as it takes time for the Part B application to be processed. Also, you can't sign up for a part D prescription plan until you have your Medicare number-- so all the more reason to allow enough time.


Here is some very basic information about Medicare:

Part A starts at 65 and is mostly for hospital care. This is funded by payroll taxes.

Part B is basically for outpatient care (doctor visits, lab work, mammograms, PT etc.) One can start on this at 65 (as I did recently) but if one has other qualifying health insurance one can delay this and get a "special enrollment period" later (as my husband did).
For 2021 the premium is $148.50 per month. If one receives Social Security the Medicare premium is deducted from one's SS payment each month. Also, if one receives Social Security one is automatically enrolled in Part B at age 65; otherwise one must enroll oneself.
There is also a yearly deductible for Medicare. For 2021 the deductible is $203.

Some go a different route with Part C, a.k.a. Medicare Advantage Plans. These substitute for traditional Medicare Parts A and B and for Medicare Supplement Plans (a.k.a. Medigap, see below) and sometime also include a drug plan that substitutes for Part D. There can be limitation in which doctors are in network, so do your homework carefully if you go this route.

Part D is an outpatient prescription drug plan (that is, meds you take at home, as opposed to meds given to you while in a hospital or in the doctors office.) There is an easy-to-use tool on Medicare.gov (https://www.medicare.gov/plan-compare/#/?lang=en&year=2021) to help you find the most inexpensive plan for you based on your current meds. You can enroll in a part D plan online through that tool.
You can (and should) use this tool every year during Open Enrollment to re-evaluate whether it will still be the cheapest plan the following year, as plans and formularies change all the time.

While you don't have enroll in Part D it is best to do so; you may not need expensive meds now but if you get a diagnosis later that requires expensive meds, you will wish you had-- and if you enroll late, there is a penalty for every month for the rest of your life.

There are significant lifelong penalties if one does not sign up for Part B and Part D (or a comparable Part C plan) by the deadlines.
Do NOT miss deadlines.


Medicare Supplement Plans (a.k.a. Medigap)

These are insurance products that you purchase from an insurance company. The premium can be up to several hundred dollars each month. Why would you want one? Here is why:

Medicare only covers 80% and you are responsible for the other 20% and there is no out of pocket limit!
This means you could potentially be on the hook for a massive bill if you ever need costly medical care. This is why Medigap plans are so important. Medigap pays the 20% that Medicare doesn't cover. This is very oversimplified but that's it, basically.

There are various Medigap plans -- A through N. They cost different amounts because of what they cover. (e.g. with some plans your premium is lower but there are copays and/or deductibles.) You choose the plan that best fits your budget, your tolerance for dealing with medical bills, how much you travel, etc.) This page on the Medicare website explains: https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies

Every Plan G or Plan N (for example) will cover the exact same things as every other Plan G or Plan N no matter what state you are in or which insurance company you buy it from. However, every insurance company has its own price for the plans. You can pay more or pay less for the exact same coverage, depending on the company you buy it from, so you need to do some careful shopping. This is where an agent can be particularly helpful if you have time constraints. But you can easily find out which Medigap plans are available in your area by looking at the Medicare and You publication put out by Medicare. You can call the companies and find out the premiums and choose the one that best suits you. That is what we did.

I just want to add that you should choose your Medigap plan with the long term in mind. If you sign up when your are first eligible you cannot be charged more or denied outright for pre-existing conditions, but if you sign up later, or change plans later, you may be subject to underwriting.
So think about what your medical needs may be later on, because you just may need to keep the same plan for the rest of your life.

Thank you! This and your following posts have been very helpful! Great overview and intro into what all this is. Seeing it laid out so directly is super helpful. I will take a look at the website again and that book you suggested. I knew it was complicated (I got my insurance license years ago and was told to take another class if I want to work with Medicare stuff) but didn't realize just how complicated for the people needing coverage.
 

pearlsngems

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Sorry, I reread my posts and realized I left out one thing about Medigap that you'd want to know. I mentioned that you need to have your Medicare number before you can sign up for a Part D prescription plan, Well, you also need to have your Medicare number before you can sign up for a Medigap plan. So definitely apply for Medicare parts A and B first. Then choose a Medigap plan, and finally choose the most cost-effective part D plan, using that tool I mentioned on Medicare.gov.

Your husband's Medigap and Part D prescription drug plan coverage will begin the same day his Medicare begins (the first day of his birth month.) As long as he started the process with enough time to spare, he should have his wallet cards (Medicare, Medigap and Part D) before that.

Don't stress-- you have enough time to do this, but start very soon.
 

TooPatient

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Working through the tangle.....

1. Update DH's driver's license with new address
1B. Follow up with state fraud investigation to ensure identity confirmation is proceeding and won't interfere with this process.
2. Set up social security administration online account
3. Sign up for part A&B
4. Select and sign up for medigap
5. Select and sign up for part D
6. Ensure all are set to auto pay


Glad I have a couple of decades before I have to deal with signing myself up!
 

pearlsngems

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1,593
That list is looking good!

Also-- As your DH sets up accounts for SS, Medicare and Medigap , he can set his preferences to name you (or anyone else) as his representative. (Otherwise Medicare, SS and his Medigap company will not deal with anyone but him.) IMO this is a good idea as we get older, in case we are incapacitated for any reason. I set my preferences for my husband to be my representative, and he did the same for me.
 
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