I turn 65 in a few months, so my window for initial enrollment in Medicare opens soon.
I had a vague notion that Medicare was a simple government entitlement that paid for everything. But I've since learned that that is far from the case. In point of fact, even for people like me wife and me who have been navigating corporate medical-insurance offerings for several decades, Medicare coverage choices are both a bit complex and perhaps more than a bit financially risky. I bought a for-dummies book to explain the options.
What has been your experience with Medicare? Have you tried MediGap or Medicare Advantage? What has worked well for you and what hasn't? I need to make my initial decisions soon, so looking for good advice.
I’ve never switched to Medicare. I rely on Federal Blue Cross. I could have them both together and pay nothing but I can handle the co-pays. So, I’m not of any help, Jim.
ReplyDeleteThat's interesting, Stanley. Is that a retirement plan for federal workers?
DeleteYes, Jim. The same insurance I had while still working. The employer covers part of it as before. I can change to another insurance company but, having Blue Cross, I I get the federal version.
DeleteI signed up for traditional Medicare when I turned 65. I was still working at the time, and also remained on company insurance. When I retired at 67 of course I had to drop the corporate coverage, and I took out a Medigap policy (Medicare B). Those policies are required to cover the same things as Medicare, so you basically pick out the one which is most affordable. ( but there's a catch, which I will explain). The Medigap covers things like office visit copays and the 20% that Medicare doesn't cover. The Medicare deductible is pretty low.
ReplyDeleteI think I made the right decision, because most doctors and hospitals here accept Medicare, and not all of them accept Medicare Advantage, which is basically an HMO, and you have to stay in network. My cancer surgery last year cost something like 45 K and it was all covered between Medicare and Medigap. There were no hoops to jump through with prior authorization. Which means the surgery got scheduled inside of three weeks.
The only catch is that there would be a pre-existing conditions clause if I were to switch MediGap policies at the open enrollment period. It applies for 5 years after the diagnosis. So I won't be doing that.
You can do it on your own, but we worked through an agent that we know, to enroll in our supplemental (MediGap) plans. We felt more comfortable doing it that way.
DeleteWe have Medicare and Medigap supplemental through AARP. The Advantage plans often cover at least some dental, hearing and vision which Medicare doesn’t. . But - Advantage also requires you to go to in-network doctors. Since we traveled a lot including out of the country when we first signed up and Medicare covers only US medical care we chose a supplement plan that covered international medical care with a $300 deductible. It is only about $20/ month more than the cheapest plan. The year before my husband hit 65 he had a stroke while we were in France. So we were aware of the possibility of serious illness or injury overseas and decided to get the international coverage supplemental plan. For those who leave the country seldom or never (even not to Canada) short- term travel insurance (sometimes a benefit of some credit cards) will usually do it.
Delete. My husband’s medical bills since he fell in Sept 2023 are probably close to $2 million. They were $1 million when I added them up 6 months or so after his accident. I haven’t added them up since. We also had Home Health Care nurses three times/week for about 6 months, then weekly for about 8 more months. They came to the home and were covered 100% by Medicare. We haven’t paid a penny - it’s all been covered by the two plans combined. No worries about co- pays no matter where we were. Medicare covered his Hoyer Lift, hospital bed, a trapeze over the bed, and two wheelchairs - a manual and a power wheelchair. The power chair’s nominal cost without insurance is $60,000 (they are custom made). It covers his colostomy bags, Foley catheters, and related supplies.
My late sister was an elder law attorney and an expert in all this stuff. She said we were lucky - that original Medicare (not sure it’s as good now) and the AARP medigap supplement is the best combination and that we should keep them until the end of life - as she did for herself. But not cheap these days. The supplemental policy goes up every year as we age and are more likely to have big medical bills. Medicare has gone up too. Around here those on a tight budget often get a Kaiser plan but it’s very restrictive in the network requirements, including hospitals. I don’t know if Kaiser even operates in Chicago. They are in Calif, and in the DC metro area, and a few other places. If you want to see an out-of-Kaiser specialist they have to approve and they don’t always give it. Kaiser plans require you to sign over your Medicare coverage to them but I’m not sure exactly how that works. It is sometimes hard around here to find specialists who take Medicare. All of the hospitals take it and the doctors who are associated with them take Medicare also. I have read that sometimes patients are shocked to get big bills from doctors that they don’t hire (like anesthesiologists) who are out of network even though the surgeon they chose and the hospital take Medicare..We’ve been very satisfied with the Medicare/ Supplemental combo.
Anne, you are right that the supplemental policies do go up every year.
DeleteI hope nobody here has a catastrophe like we experienced. But if you do, having the best Medicare+ supplement you can afford is worth every penny. After saving for a comfortable, secure retirement via 401ks and IRA s we weren’t worried. But without the coverage we have paid for for 20 years (my husband is 85) we would be bankrupt. We are not, and we own our home without a mortgage, so we can afford the part- time caregiver we have. At almost 79 the physical toll on me caring for my husband is a lot. Our caregiver comes 5 mornings/week and the harder physical work-bathing him in bed, changing his clothing, range of motion exercises for his legs, wound care, changing the colostomy bag etc. I now ignore the annual increases in premiums. And our insurance coverage is on my daily gratitude prayer list.
DeleteCheck out Via Benefits. It is a free service, and my company (Pearson Education).refers all its employees to them when retirement age approaches. (Or at least they did back in the days when I worked there.) I still use them if I want to switch plans, You'll probably want traditional Social Security, Medigap insurance, and a prescription drug plan (for Medicare Part D)..
ReplyDeleteFrom Today's Washington Post
ReplyDeleteDumped by insurance plans, millions of seniors scramble for health coverage
The privatized version of Medicare — Medicare Advantage — grew rapidly with perks like vision and dental care. In some regions options are dwindling.
https://www.washingtonpost.com/health/2026/03/28/insurance-health-care-medicare-seniors/
I am paywalled out of the WaPo article. But people in our state haven't had very good luck with Medicare Advantage. The number of plans available have dwindled, as have the hospitals and doctors who are willing to accept it.
DeleteThe fiscal hawks are always out to shrink traditional Medicare, and would like to privatize healthcare (even more than it already is). But don't seem to have a problem with funding military adventurism, DSA and ICE.
It is unfortunate that a lot of people don't have a choice other than Medicare Advantage plans because of cost. Also there is a pre-existing conditions period if they switch over to regular Medicare.
DeleteThe article says that hundreds of thousands of people are being dropped by advantage plans, especially in rural areas. One bit of information that might be helpful from the article .
Delete“People who need help finding Medicare Advantage coverage or a medigap supplemental plan can contact a federally funded State Health Insurance Assistance Program (SHIP), which operates in every state plus the District of Columbia. The deadline for people who have an existing Medicare Advantage plan and want to switch or move into traditional Medicare is March 31 .”
If we hadn’t had Medicare+ supplement we would probably be bankrupt by now. I no longer complain about the premiums we’ve paid for 20 years. Our catastrophe’s bills have been 100% covered. But it’s a lot more expensive these days than when we originally signed up.
And now there is this terrible idea (no thanks Dr. Oz!)
ReplyDeletehttps://time.com/7313351/medicare-prior-authorization-pilot-states-concerns/
They are running a pilot program in 6 states to impose prior authorization on regular Medicare. It's nothing but a "flow restrictor" and and a way to delay or deny treatment.
In the case of a cancer diagnosis (mine, for instance) slow-walking surgery could mean that it progressed from an early curable stage to one that required ongoing treatment.
Our nightmare of a healthcare system just keeps becoming a worse nightmare. We’ve been watching The Pitt courtesy of our son’s subscription to HBO Max. It’s won Emmy and it is amazing. Also obviously written to highlight the range of weaknesses in our healthcare system.
DeleteLike Anne I have Medicare with an AARP Medigap policy.
ReplyDeleteOhio Public Employees receive an extra amount of money to pay for Medicare Supplemental Insurance either a Medigap or an Advantage Plan. That amount is not guaranteed and it has been going down as the unfunded PERS liabilities rise. And of course the AARP price has been going up. But I do not notice all that as much as Anne because of the subsidy by PERS. That subsidy is not taxable income like our retirement since it can only be spent for this purpose.
I have been very happy with the arrangement. I never get a bill. I walk into doctor's offices and there are no copays. Every one there is happy when they see my insurance. Less hassles for them as well as myself. They know they are going to get paid.
Early on in retirement we public employee retirees were on a Medicare Advantage Plan offered by PERS. Basically a conservative politically active doctor told me I did not have Medicare benefits only what the Advantage plan said they wanted to p[ay for.
For example I was only allowed 6 physical therapy sessions a year. It took me three years to begin to solve my balance problems. In the meantime I racked up all sorts of money on tests and procedures to try to solve a problem which basically had physical therapy solutions. Penny wise but pound foolish medicine. One suffers physically because of the lack of treatment.
Fortunately PERS ditched their advantage Plan in favor of a medical subsidy for whatever insurance we choose as individuals. We were allowed as a group to move to regular Medicare without going through vetting for preexisting conditions. That was a one time only event. Once you leave regular Medicare for Advantage plans you can't get back without being vetted.
Unfortunately some people cannot afford regular Medicare Supplement plans and opt for Advantage Plans that give them dental, eye care, lower prescriptions fees, and even money to pay for non prescription drugs, etc. Betty is one of those poorer people. She is always looking for the best Advantage plan. Unfortunately the day will come when she will be denied things that she really needs. I hope I have enough money to pay for whatever it is.
What a great fringe benefit for you Jack. Our supplement premiums are now higher than our Medicare premium. Plus we pay for a Part D - prescription plan. My husband takes a lot of medication. Most are available as generic but two are extremely expensive. Only the most expensive Part D plan covers them. My Part D premium is also much higher than it used to be even though it’s the least expensive plan. Until about 6 months ago I never had a chronic condition requiring a prescription. No meds except OTC. Now I do:- at 78 I now have a mild heart irregularity, apparently very common in my age group. We have by far the most expensive healthcare in the world, but rank very low in quality among rich nations. Because it’s the only healthcare system in the rich OECD countries that is based on a profit making model. Minimize costs (by cutting care) and maximize profit. It’s a truly lousy system.
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