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Medicare

TooPatient

Ideal_Rock
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Sep 1, 2009
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9,506
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.

Great to know! He is definitely NOT good at paperwork details so it makes life easier if I can do most of the managing.

I just managed to update his driver's license. No small task given it didn't have the usual password so needed a reset. Of course that was an exercise in frustration as the new password can't be the old password :rolleyes:
 

pearlsngems

Brilliant_Rock
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So, given your observation that he is not good at paperwork details, when it comes time for you to choose your Medigap plan you may want to choose a plan that will be easy for him to manage for you, should you be unable to do so yourself when you are older.

My husband is nearly 10 years older than me, but I'm the one who has a family history of dementia. Will one (or both) of us have trouble managing our bills as we get older? Maybe. But our daughter is only 25 and I don't want her tied up with managing our care if we can do it ourselves. This is why we chose Plan G. It's the plan that will be easiest to manage. The price of that is a higher premium, but so be it.

At the end of the day, choosing your Medigap plan (like all insurance) is about peace of mind. Select whichever plan gives you peace of mind for your particular circumstances. The plan with the lowest premium may not be the best choice.
 

TooPatient

Ideal_Rock
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So, given your observation that he is not good at paperwork details, when it comes time for you to choose your Medigap plan you may want to choose a plan that will be easy for him to manage for you, should you be unable to do so yourself when you are older.

My husband is nearly 10 years older than me, but I'm the one who has a family history of dementia. Will one (or both) of us have trouble managing our bills as we get older? Maybe. But our daughter is only 25 and I don't want her tied up with managing our care if we can do it ourselves. This is why we chose Plan G. It's the plan that will be easiest to manage. The price of that is a higher premium, but so be it.

At the end of the day, choosing your Medigap plan (like all insurance) is about peace of mind. Select whichever plan gives you peace of mind for your particular circumstances. The plan with the lowest premium may not be the best choice.

I will load up with every coverage they have available for me. My medical expenses are well over $100,000 each year already. Ideally, he can have instructions to just renew the same each year and not have to change anything. Sounds like Part G is right in line with that!
 

pearlsngems

Brilliant_Rock
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I agree. Plan G is sometimes called the Cadillac plan. (There is a plan F that used to be the Cadillac plan, but it's only for people who turned 65 by Dec. 31, 2019. That plan covered you from the first dollar spent, but the premiums were higher than Plan G + deductible! Not a bargain; more of a convenience for which one paid extra.)

There is a high deductible G but that is best for people who are very healthy, and have no chronic conditions that could cause them to deteriorate with age, and who don't mind the nuisance of scrutinizing and paying every bill as it comes in. The premiums are low but the deductible is $2370 for 2021. In any year that you meet the deductible you would have been better off with regular plan G. One can save a good amount on premiums every year, but do people actually stash those savings away to pay for years when they meet their deductible? My guess is , probably most do not. And even people who are healthy now could decline with the years. They may wish to switch to regular G in the future, and may not be able to, because of underwriting. As usual with insurance, the more risk you take on, the less you pay; the less risk you take on, the more you pay.
Edited to add: In the course of deciding which plan to get, I read forums for insurance agents. :cool2: I read that agents typically don't like to sell HD G because their commission is so low. (Their commission is based on the monthly premium.) Some insurance companies don't even offer HDG plans. The company we bought our plan from doesn't (not that I wanted it anyway, but some folks might.)

In urging my husband to get Plan G, I told him that even though he is older than me, I could still die first, and then in his old age he would be stuck figuring out his bills. Even though you are much younger than your husband, if he ends up being alone in his old age, he might be better off with Plan G, too.


This brings me to what Medicare does not cover. Medicare doesn't cover long term custodial care. It doesn't cover routine physical exams (only yearly "wellness visits") dental, or refraction, or eyeglasses. There are other things -- see the Medicare & You book for details. Some people purchase dental plans (like Delta Dental) and vision care plans. Others just pay out of pocket.
 
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Beagles

Rough_Rock
Joined
Sep 20, 2017
Messages
69
I don't know about all states, but many have free Medicare counselors available through local Council on Aging services. My husband turned 65 in December, and we met with a counselor in September who walked us through all the different types of plans and how to determine what fit his needs best,, like keeping his current physicians. I learned a lot for when I am eligible in a few years.
 

TooPatient

Ideal_Rock
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Parts A & B are set up. Card came in the mail this week. Now is the headache inducing part D, gap coverage, and other stuff. Haven't even begun to touch the dental, vision, hearing, and whatever else options.
 

pearlsngems

Brilliant_Rock
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Part D is a cinch! Seriously the easiest part.
Go to the following page:

He can log into his Medicare account, or create an account if he doesn't yet have one, or click "continue without logging in". But it would be most useful to log into his account.

You will see the question, "What type of 2021 coverage are you looking for?" Click on "Drug Plan (Part D)".
You will be cued to enter your zip code.

Then a question pops up. If you don't receive help from Medicaid or the other programs listed, select "I don't get help from any of these programs".

On the next page select "Yes" to see drug costs when comparing plans.

Answer how you normally fill your prescriptions-- retail pharmacy, mail order , or both.

On the next page enter each drug your husband takes and the dose. Then you are cued to enter the quantity and frequency.
Click Save , and add another drug, until you have added all of them. Then click "Done adding drugs".

On the next page, use the drop down menu to select your search radius (the default is 1 mile; I selected 5 miles as it gave me more options.) Click up to 5 pharmacies and click "done" in the lower right corner of the page. (You can go back later and select 5 different pharmacies if you want to compare more.)

On the page that comes up, the plans will be listed in order of least costly to most costly. (The default setting is to list the plans by "lowest drug + premium cost.") I used the default setting; you can instead choose to select for plans to be listed by lowest yearly deductible or by lowest monthly premiums if you prefer. You can run the search various ways to compare, if you wish. Nothing is set in stone until you actually enroll.

Click on "Plan details". This will show you all the details of what the drugs would cost at different pharmacies. Some pharmacies may be preferred by the plan and those will cost him less.
I just chose the plan that cost me the least. (Why pay more for the exact same drugs?)

When you decide which plan you want, click "enroll." Then you decide how you want to pay for it. I have the premium deducted from my Social Security payment.


It is important to run the same search every year during the open enrollment period in the Fall, as it is quite common that the plan that is least expensive for him this year will not be next year. Checking is easy, and not checking can be a costly mistake.
Enrolling in a new plan automatically dis-enrolls you from the old plan.
 

cflutist

Ideal_Rock
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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 start Kaiser Senior Advantage in May.
Just got billed for Part B, but not Part D yet even though Kaiser already sent me a Medicare Rx card?
 

snowballs mom

Rough_Rock
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Nov 24, 2017
Messages
97
I start Kaiser Senior Advantage in May.
Just got billed for Part B, but not Part D yet even though Kaiser already sent me a Medicare Rx card?

Some Medicare Advantage plans include prescription drug coverage, so there is no need to purchase a separate Part D plan. Kaiser Senior Advantage in Colorado includes prescription coverage, which is rolled into the premium. I picked their zero monthly premium plan, and pay Part B out of my social security. Oddly, Kaiser sends a bill for the premium every month anyway - it is for $0.00...
 

pearlsngems

Brilliant_Rock
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@ TooPatient,

When you are ready to choose your Medicare Supplement (i.e., Medigap) plan, go to this page on Medicare.gov :


Enter your zip code. It will ask his age, male or female, and smoker or non-smoker. You then click to update pricing.

The next page lists the various Medigap plans (A, B, C , D, F, HD-F, G, HD-G, K, L, M and N). There is information on what the plans pay and any copays and deductibles. You can click to see Plan Details or to View Policies.

When you click to View Policies, the next page lists all the companies that sell that plan in your state. There are phone numbers for each of the companies and links to their websites.

This page also tells you how pricing is determined (whether the plan is Community-rated, Issue-age-rated, or Attained-age-rated) with a link to the Medicare.gov page that explains what these terms mean.
 

pearlsngems

Brilliant_Rock
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When we were deciding on a Medicare Supplement (Medigap) plan, my husband found a handy chart listing all the plans available in CT and their costs, here:


It is on CT.gov website. That page is for CT specifically. I suggest you go to your state's .gov website and search for "Medicare Supplement" for a similar chart. It certainly saved us time, being able to see all the insurance companies' plans, and the premiums for each one, laid out plainly on one chart.
 

House Cat

Ideal_Rock
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Feb 22, 2009
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4,467
I called eHealth insurance and took care of everything with an agent. My plan is free.
 

pearlsngems

Brilliant_Rock
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There are Medicare Advantage plans that have $0 premiums, but there are copays and deductibles that must be paid when one receives care.
 

snowballs mom

Rough_Rock
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Nov 24, 2017
Messages
97
There are Medicare Advantage plans that have $0 premiums, but there are copays and deductibles that must be paid when one receives care.

Yes, and one should do a cost-benefit analysis before signing up. Kaiser in Colorado has three levels of coverage. The lower premium plans have slightly higher copays and out-of-pocket maximums. It all depends on one's healthcare usage and whether you want to pay more up front and less as you go. I am only familiar with the plans that Kaiser offers - it has been my insurance plan since 1988 and I had no interest in switching, so I did not look at other options.

There is an issue with Traditional Medicare that people may not be aware of. Doctors are not required to accept Medicare insurance. A coworker of mine could not find any doctors in her area (an expensive Denver suburb) that accepted Traditional Medicare when her father moved in with her, so they had to switch to a Medicare Advantage plan.
 

pearlsngems

Brilliant_Rock
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...

There is an issue with Traditional Medicare that people may not be aware of. Doctors are not required to accept Medicare insurance. A coworker of mine could not find any doctors in her area (an expensive Denver suburb) that accepted Traditional Medicare when her father moved in with her, so they had to switch to a Medicare Advantage plan.

That is so interesting! I wonder why that is so in her area? Nationwide the vast majority of doctors do take original Medicare, but of course one should never assume. It could prove to be a costly mistake.

Mind you, the same is true for Medicare Advantage-- never assume a doctor will accept it. When my husband had his pre-surgery visit with the surgeon that he chose to do his hip replacement, the doc told him he only accepts original Medicare, not Medicare Advantage. My husband had Medicare Part A along with his employer health plan; the surgeon did his hip replacement. The other hip is also very deteriorated on X-ray, and he may need to have that one replaced too at some point (it doesn't hurt yet). He wants to have the same doctor do the surgery, when the time comes. (The center where he operates has an extremely low infection rate.)
 

snowballs mom

Rough_Rock
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Messages
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That is so interesting! I wonder why that is so in her area? Nationwide the vast majority of doctors do take original Medicare, but of course one should never assume. It could prove to be a costly mistake.

Mind you, the same is true for Medicare Advantage-- never assume a doctor will accept it. When my husband had his pre-surgery visit with the surgeon that he chose to do his hip replacement, the doc told him he only accepts original Medicare, not Medicare Advantage. My husband had Medicare Part A along with his employer health plan; the surgeon did his hip replacement. The other hip is also very deteriorated on X-ray, and he may need to have that one replaced too at some point (it doesn't hurt yet). He wants to have the same doctor do the surgery, when the time comes. (The center where he operates has an extremely low infection rate.)

She lives in the foothills west of Denver, in a wealthier community. My guess is that most people there have private insurance that reimburses at a much higher rate than Medicare, so the docs have plenty of business without accepting new Medicare patients.

From what I have seen in the Denver area, most MA plans are associated with either HMOs or PPOs, so they have a list of docs to choose from. (The ones offered by our state retirement association are like that.) Kaiser is a regional HMO and only covers out of network if they initiate the referral. However, urgent care or emergency care is covered worldwide. That is a plus for us since we like to travel.
 

pearlsngems

Brilliant_Rock
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Regarding foreign travel, our AARP UHC Medigap G plan covers 80% of medically necessary emergency care services beginning during the first 60 days of each trip outside the USA, to a maximum lifetime benefit of $50,000, after one meets a deductible of $250. (Medicare pays nothing toward care outside the USA.)
 

pearlsngems

Brilliant_Rock
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I should edit the previous post but it's too late. Plan G is Plan G is Plan G-- no matter which company sells it. They all have the same coverage for foreign emergency care.
 

snowballs mom

Rough_Rock
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Nov 24, 2017
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I should edit the previous post but it's too late. Plan G is Plan G is Plan G-- no matter which company sells it. They all have the same coverage for foreign emergency care.

I would go with Plan G if I was using traditional Medicare. It seems to have the most comprehensive coverage. If we ever relocate we would be looking at that option.
 
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