Medicare question, supplemental vs. advantage?

[MikeBiDude]

So as I approach that magical birthday I’m doing a lot of research. I’ve already applied to SSA and been approved for Part A & B, I’m not retiring. I’ll continue to receive W2 and Schedule C income for the foreseeable future.

 

Although I’m pretty well informed and well researched… I’m still a little confused over Medicare advantage versus a Medicare supplemental plan? Also not crystal clear on Parr D, and which plan best allows for an add on prescription plan?

 

Premium cost is really an issue, whatever I choose will be about 75% less than my current self insured plan!

 

Thoughts? Advice?

[+ Lucky]

I have had both and prefer the Medicare Advantage program I have. It even pays my gym membership.

[Act25]

I recommend "Get What's Yours for Medicare" by Philip Moeller.

 

I've read the book once and will need to read it at least once more before I turn 65 in August. Medicare is very complicated and this is coming from someone who was a tax professional in my working career. There is a companion book about Social Security which I also recommend.

[+ Charlie]

I was lucky enough to retire from an employer who agreed to keep retirees in the institution's group insurance plan with a supplemental payment that is so reasonable (currently $89/mo) that I have never paid any attention to the other options. It covers dental, prescription drugs and eye care, and gym membership. My spouse, on the other hand, has a supplemental PPO policy with Anthem that doesn't cover dental, but costs almost as much per month as our mortgage. Luckily, we have both had reasonably good health over the many years we have been in Medicare, so we haven't really had to test any differences between our coverage, but we have been equally satisfied with both so far. If I were to lose my ability to participate in the group policy, however, I would certainly look first at the new Advantage plans.

[down_to_business]

At 65 I am required to enroll in a specified Medicare Advantage Plan by my employer coverage.. so I really don't have an option to choose.. although I have heard nothing negative from others I know who are enrolled.

[MikeBiDude]

Thanks all for the replies so far. Although I mentioned I will still have W-2 income, I will not be covered by any employer plan, I’m not covered now - self insured.

[craigville beach]

i have a Medicare Advantage Plan that i like

[wsc]

I was auto-enrolled in Part A (hospital and institutional care), for which there is no premium, when I turned 65. I was still employed at that time and had medical coverage provided through an employer plan. When I retired at age 69, I enrolled in Part B and Part D, with supplemental plans instead of Advantage plans; premiums were significantly cheaper. My employer still provides a generous annual HSA to help defray premium costs and out-of-pocket expenses. It doesn't cover everything, but certainly helps, and overall I am very happy with my situation.

 

I would counsel looking into two things.

 

First, I retired from a large Fortune 500 company, plans of which and transitions from which Medicare was quite familiar with. I have spoken with friends in a variety of other circumstances, such as retiring from a Federal agency or from a certified small business, and learned the rules are almost as diverse as the individuals. If you are self-employed and/or self-insured, you may benefit from a Medicare Benefit Review service to help guide you through all the rules and options. I complained at the time, and to no avail, of a system that waits until one is older and more easily confused, then confronts them with a horridly complex system and a thousand similar, yet all different, options. My company paid for the services of such a review service and it was of great help.

 

Second, be aware that your Part B premium cost will have to be paid under any plan - basic, supplemental, or advantage - and that the Part B premium goes up with your income. In the first two years, my monthly premium was almost 5x the normal amount paid by those below the first threshold for income-related adjustments to the premium. There's no escaping it, but you should look into it and be prepared for the possible shock. Instead of about $150/mo I paid out over $500/mo, which may explain why my blood pressure med costs were so high.?

 

Hope some of this helps. Best of luck to you.

[mike carey]

God, I'm glad that health coverage is just 'there'. I have insurance that will get me past waiting lists for some hospital procedures, but for the most part I won't need it.

[+ newatthis]

wsc has hit many of the important points. I decided against advantage because most plans available in my area had limited networks of doctors and hospitals while I have free choice with Medicare B plus a medigap policy. There was one advantage plan without those network restrictions, but it was way more expensive than part b + medigap.

 

Stand alone drug plans (part D) are a bit of a pain in the ass; you need to check during the open enrollment every year b/c their provisions change. I've had a different plan every year so far.

[+ newatthis]

PS Friends of mine recommended a particular insurance broker in my area who was very knowledgeable, worked with all the companies, and even did most of the enrollment paperwork for me the first time. He is paid by the companies, so it cost nothing. But I wouldn't choose someone off the street; a lot of them work for only one or two companies.

[marylander1940]

I have had both and prefer the Medicare Advantage program I have. It even pays my gym membership.

 

They pay for your gym?

 

Tax deductible gym membership has been a dream of mine for a long time. Obviously as long as the person goes to the gym.

[+ Lucky]

They pay for your gym?

 

Tax deductible gym membership has been a dream of mine for a long time. Obviously as long as the person goes to the gym.

Yes. Mine participates in the Silver Sneakers program, to which many gyms subscribe. Your gym visits are free with Silver Sneakers, even if you go to different gyms.

Edited November 26, 2020 by Lucky

[+ Charlie]

PS Friends of mine recommended a particular insurance broker in my area who was very knowledgeable, worked with all the companies, and even did most of the enrollment paperwork for me the first time. He is paid by the companies, so it cost nothing. But I wouldn't choose someone off the street; a lot of them work for only one or two companies.

I have used an insurance broker for years for all my insurance policies.

[wsc]

wsc has hit many of the important points. I decided against advantage because most plans available in my area had limited networks of doctors and hospitals while I have free choice with Medicare B plus a medigap policy. There was one advantage plan without those network restrictions, but it was way more expensive than part b + medigap.

 

Stand alone drug plans (part D) are a bit of a pain in the ass; you need to check during the open enrollment every year b/c their provisions change. I've had a different plan every year so far.

Yes, quite right that Advantage plans may be more limiting in your choice of providers, restricting you to specified networks. Some are very much into "managed care," with the emphasis clearly on "managed," and less on the "care" part.

 

I have a friend who has to drive more than 50 miles for in-network testing that is easily available within 5 miles of home, but by providers out of the plan's network and therefore not covered by the plan.

 

Experience is the best, yet harshest, of teachers.

[+ Billsboy4]

It depends on whether you want an HMO (Medicare Advantage) or a PPO supplement where you chose your own doctors and you need to add a Part D drug plan.

[MikeBiDude]

Yes, quite right that Advantage plans may be more limiting in your choice of providers, restricting you to specified networks. Some are very much into "managed care," with the emphasis clearly on "managed," and less on the "care" part.

I have a friend who has to drive more than 50 miles for in-network testing that is easily available within 5 miles of home, but by providers out of the plan's network and therefore not covered by the plan.

Experience is the best, yet harshest, of teachers.

Managed care is one reason I’m leaning towards a Supplemental “Medigap” plan at the moment.

 

I recommend "Get What's Yours for Medicare" by Philip Moeller.

I’m about 2/3 through, it. Thanks and I agree it’s a “must read”.

 

Second, be aware that your Part B premium cost will have to be paid under any plan -

Ugh, I wasn’t aware of this until a few months ago...and I also won’t be paying the lowest Part B premium.

[Beancounter]

Here’s a good website to see if you’re subject to IRMAA limits. (income related monthly adjustment amounts)

 

https://www.medicare.gov/your-medicare-costs/part-b-costs

[MikeBiDude]

Here’s a good website to see if you’re subject to IRMAA limits. (income related monthly adjustment amounts)

 

https://www.medicare.gov/your-medicare-costs/part-b-costs

Great info/link....thanks!

[+ newatthis]

Here’s a good website to see if you’re subject to IRMAA limits. (income related monthly adjustment amounts)

 

https://www.medicare.gov/your-medicare-costs/part-b-costs

Read it and weep! (Actually, once I got over the sticker shock, I was happy to pay the extra and help keep the system solvent.)

[wsc]

Read it and weep! (Actually, once I got over the sticker shock, I was happy to pay the extra and help keep the system solvent.)

There is that perspective, to be sure, and I, too, want the system to be and to stay solvent. But, overall, my view was, and is, a bit different.

 

During my working years, I was content ["happy" would be too strong a word] to pay more into both SS and Medicare, just as I paid more in taxes as my income rose through the years. But when I retired and enrolled in Medicare, I was surprised and annoyed by the extra premium costs under the IRMMA rules. The money was less an issue than the principle. I objected to being required to pay more, and relatively speaking, substantially so, for exactly the same service and coverage. I don't have to pay more for bread, butter, or Scotch because of a higher income, and saw no just reason for being forced to do so for health insurance. I paid my higher income-related share through payroll deductions in my working life, and was fine with that. But when I found myself on a "fixed" income, I had looked forward to a bit of a break. It didn't come.

 

I'm in a good situation in retirement, and ask or expect neither Argentina nor others to cry for me. But I find the perceived inequity irksome.

 

On the plus side, when I and my sympathizers meet to commiserate, we don't need to hire a large space.

[MikeBiDude]

Read it and weep! (Actually, once I got over the sticker shock, I was happy to pay the extra and help keep the system solvent.)

The price of being comfortable!

[+ Lucky]

Isn't it amazing that we even have Medicare available to us? Whatever premiums I pay are more than compensated for in benefits.

[MikeBiDude]

Isn't it amazing that we even have Medicare available to us? Whatever premiums I pay are more than compensated for in benefits.

Agree, It is a good program to be thankful for!

[Beancounter]

There is that perspective, to be sure, and I, too, want the system to be and to stay solvent. But, overall, my view was, and is, a bit different.

 

During my working years, I was content ["happy" would be too strong a word] to pay more into both SS and Medicare, just as I paid more in taxes as my income rose through the years. But when I retired and enrolled in Medicare, I was surprised and annoyed by the extra premium costs under the IRMMA rules. The money was less an issue than the principle. I objected to being required to pay more, and relatively speaking, substantially so, for exactly the same service and coverage. I don't have to pay more for bread, butter, or Scotch because of a higher income, and saw no just reason for being forced to do so for health insurance. I paid my higher income-related share through payroll deductions in my working life, and was fine with that. But when I found myself on a "fixed" income, I had looked forward to a bit of a break. It didn't come.

 

I'm in a good situation in retirement, and ask or expect neither Argentina nor others to cry for me. But I find the perceived inequity irksome.

 

On the plus side, when I and my sympathizers meet to commiserate, we don't need to hire a large space.

I’m in the same boat. And it’s not only part b that high income individuals must pay more for but part d drug coverage premiums too. According to the SSA IRMAA only affects 7% of Medicare recipients. I guess I should count my blessings.