Medicare question, supplemental vs. advantage?

[MikeBiDude]

Follow up, I pulled the trigger on an AARP/United Healthcare supplemental policy Plan G, and with same group a Part D prescription policy.

[+ newatthis]

Follow up, I pulled the trigger on an AARP/United Healthcare supplemental policy Plan G, and with same group a Part D prescription policy.

One more thing (just in case you didn't know). I believe the first time you sign up for a supplemental policy ("medigap"), there's a limited time frame during which you can switch providers if you're unhappy with the company you've chosen. Beyond that time, you might have to pay a higher premium and/or provide evidence of insurability if you want to switch providers

[Tommygunzz]

When you turn 65, you automatically have to pay for Medicare. It's currently about $144/month, and it is deducted from your SS check each month, or if you are not taking SS yet, you must pay 6 months in advance. I don't think there is any way around paying for Medicare, even if you are "covered" by another plan, or even an employer's plan.

 

My Medicare Advantage plan (AARP Medicare Complete SecureHorizons Plan 1 through United Healthcare) has a ZERO premium, and covers prescriptions, annual physicals, and even the Silver Sneakers gym plan that allows you to go to just about every gym chain in the country for free. There is a max $3900 out of pocket for covered Part A and Part B services from network providers. Primary care Dr. visits have a $0 copay for in network physicians; in network specialist visits have a $35 copay. In patient hospital visits: you pay $275 for each day for days 1-5, the rest is paid by the plan. RX have no deductible, but you pay a sliding scale for drugs, depending on the "Tier" that they fall under. Tier 1 is $2 co-pay for 30 days. Tier 2 is $14. Tier 3 is $47. Tier 4 is $100. Tier 5 is 33% of the total. Select insulin drugs are $35. All of my prescriptions fall into Tier 1 and are generics. Finding a doctor, specialist, hospital, etc. "in-network" has not been a problem and all of my existing physicians were covered with no changes.

 

My husband and I are also covered by his retirement plan health plan. Since we have to be on Medicare, his plan is "secondary" to Medicare and Medicare Advantage. It is only considered by a provider if Medicare doesn't cover something. In the past year, it has only kicked in 3 times: for my dermatologist, for PT for a hand surgery I had, and for one medication that didn't fall under Tier 1 and his insurance paid more than Medicare Advantage would have.

 

Some basic dental services are covered under Medicare Advantage (at no charge), but I have a "Dental Platinum Supplemental Plan" through United Healthcare that I pay $39/mo. (Under my husband's retiree plan, we paid $75/mo for similar coverage.)

 

Very satisfied with Medicare Advantage. I think our care is better than before.

[wsc]

When you turn 65, you automatically have to pay for Medicare. It's currently about $144/month, and it is deducted from your SS check each month, or if you are not taking SS yet, you must pay 6 months in advance. I don't think there is any way around paying for Medicare, even if you are "covered" by another plan, or even an employer's plan.

 

My Medicare Advantage plan (AARP Medicare Complete SecureHorizons Plan 1 through United Healthcare) has a ZERO premium, and covers prescriptions, annual physicals, and even the Silver Sneakers gym plan that allows you to go to just about every gym chain in the country for free. There is a max $3900 out of pocket for covered Part A and Part B services from network providers. Primary care Dr. visits have a $0 copay for in network physicians; in network specialist visits have a $35 copay. In patient hospital visits: you pay $275 for each day for days 1-5, the rest is paid by the plan. RX have no deductible, but you pay a sliding scale for drugs, depending on the "Tier" that they fall under. Tier 1 is $2 co-pay for 30 days. Tier 2 is $14. Tier 3 is $47. Tier 4 is $100. Tier 5 is 33% of the total. Select insulin drugs are $35. All of my prescriptions fall into Tier 1 and are generics. Finding a doctor, specialist, hospital, etc. "in-network" has not been a problem and all of my existing physicians were covered with no changes.

 

My husband and I are also covered by his retirement plan health plan. Since we have to be on Medicare, his plan is "secondary" to Medicare and Medicare Advantage. It is only considered by a provider if Medicare doesn't cover something. In the past year, it has only kicked in 3 times: for my dermatologist, for PT for a hand surgery I had, and for one medication that didn't fall under Tier 1 and his insurance paid more than Medicare Advantage would have.

 

Some basic dental services are covered under Medicare Advantage (at no charge), but I have a "Dental Platinum Supplemental Plan" through United Healthcare that I pay $39/mo. (Under my husband's retiree plan, we paid $75/mo for similar coverage.)

 

Very satisfied with Medicare Advantage. I think our care is better than before.

Tommygunzz said "When you turn 65, you automatically have to pay for Medicare. It's currently about $144/month, and it is deducted from your SS check each month, or if you are not taking SS yet, you must pay 6 months in advance. I don't think there is any way around paying for Medicare, even if you are "covered" by another plan, or even an employer's plan."

 

FWIW -

 

When I turned 65, this was not my experience. Before that 65th birthday, and at each subsequent birthday until retirement, my company provided a notice, which I was advised to keep to later show proof, if needed, that I was covered by a "creditable plan" as defined by Medicare, and was therefore not required to enroll in Part B so long as that plan remained in effect.

 

It's true that, generally speaking, within a few months after turning 65, you must enroll in Part B, but that's unless covered by such a plan. If not covered by such a plan, and you wait too long to enroll, you'll have to pay a penalty in addition to the premium, and that penalty will apply each month from then on for as long as you stay in Part B. If, however, you are covered by such a creditable plan, then you have 90 days after coverage under that plan ends to enroll in Part B without incurring the penalty.

 

If this has changed, I am not aware of it.

[MikeBiDude]

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

I got the notice of my “premium” premium today. Not the maximum, but certainly not the minimum. I only realized in the last few months this was the program as I researched Medicare. Surprising how little people know about details of the program before they’re eligible for it.

[Guest MikeThomas]

Tommygunzz said "When you turn 65, you automatically have to pay for Medicare. It's currently about $144/month, and it is deducted from your SS check each month, or if you are not taking SS yet, you must pay 6 months in advance. I don't think there is any way around paying for Medicare, even if you are "covered" by another plan, or even an employer's plan."

 

FWIW -

 

When I turned 65, this was not my experience. Before that 65th birthday, and at each subsequent birthday until retirement, my company provided a notice, which I was advised to keep to later show proof, if needed, that I was covered by a "creditable plan" as defined by Medicare, and was therefore not required to enroll in Part B so long as that plan remained in effect.

 

It's true that, generally speaking, within a few months after turning 65, you must enroll in Part B, but that's unless covered by such a plan. If not covered by such a plan, and you wait too long to enroll, you'll have to pay a penalty in addition to the premium, and that penalty will apply each month from then on for as long as you stay in Part B. If, however, you are covered by such a creditable plan, then you have 90 days after coverage under that plan ends to enroll in Part B without incurring the penalty.

 

If this has changed, I am not aware of it.

Actually the Special Enrollment Period is 8 months after employment ends.

[wsc]

And we're off!

 

A problem I thought had been solved has come back, thanks to the wonderful civil servants who run SSA and Medicare.

 

As posted previously, my Parts B and D premiums in the year of my retirement and enrollment in those plans were increased in accordance with IRMAA policies, and were substantially higher than I had anticipated. My 2018 income put me in the highest IRMAA bracket, but knowing my income would decline significantly for 2019, and even more in 2020, I filed a Form SSA-44 to request a decrease in the IRMAA amount for 2019 (to a lower tier) and its elimination for 2020. The people at my local SSA office agreed and my requests were approved and implemented. Problem solved.

 

Oh, really?

 

I have now learned that the IRMAA amount for any given year (2021) is based on the 1040 AGI from two years before (2019). Accordingly, I recently received a notice of (a) a same-for-everyone 1.3% increase in benefits, and (b) the re-imposition of IRMAA amounts for both Parts B and D, based on 2019 income, the aggregate effect of which being a reduction in monthly cash in hand, apparently because SSA/Medicare seem to be believe income increases in retirement, even after it's already gone down. I've checked; it doesn't. Well, not that much.

 

I called SSA (a 40-minute wait, followed by a 20-minute conversation) and was told I could appeal, if I wanted. I was also told that if SSA later determines that too much money was taken in the IRMAA increase for a given year, the excess will be refunded. When I asked if that didn't automatically impose a two-year delay, I was told, "Gee, I guess it does!" Nothing like working with the best and the brightest. And this was nothing like working with the best and the brightest.

 

I said that arrangement sounded fair and, if needed, they could just put the refund check on my grave. No response.

 

Being retired, I clearly have the time to fight this fight again, but I don't know if I have either the strength or the stomach for such a re-match.

 

This is so much harder that I though it would be. On the plus side, it might turn me into a day-drinker.

[+ newatthis]

...As posted previously, my Parts B and D premiums in the year of my retirement and enrollment in those plans were increased in accordance with IRMAA policies, and were substantially higher than I had anticipated. My 2018 income put me in the highest IRMAA bracket, but knowing my income would decline significantly for 2019, and even more in 2020, I filed a Form SSA-44 to request a decrease in the IRMAA amount for 2019 (to a lower tier) and its elimination for 2020. The people at my local SSA office agreed and my requests were approved and implemented. Problem solved....

When I dealt with a similar situation, I was denied because the reason for the decrease in income was not on their (quite limited) list of reasons...to be clear (for those who have yet to deal with this), you can request an IRMAA decrease only if your income will decline (or has declined, since they work with a 2-year lag) for a reason on their list.

[Beancounter]

And we're off!

 

A problem I thought had been solved has come back, thanks to the wonderful civil servants who run SSA and Medicare.

 

As posted previously, my Parts B and D premiums in the year of my retirement and enrollment in those plans were increased in accordance with IRMAA policies, and were substantially higher than I had anticipated. My 2018 income put me in the highest IRMAA bracket, but knowing my income would decline significantly for 2019, and even more in 2020, I filed a Form SSA-44 to request a decrease in the IRMAA amount for 2019 (to a lower tier) and its elimination for 2020. The people at my local SSA office agreed and my requests were approved and implemented. Problem solved.

 

Oh, really?

 

I have now learned that the IRMAA amount for any given year (2021) is based on the 1040 AGI from two years before (2019). Accordingly, I recently received a notice of (a) a same-for-everyone 1.3% increase in benefits, and (b) the re-imposition of IRMAA amounts for both Parts B and D, based on 2019 income, the aggregate effect of which being a reduction in monthly cash in hand, apparently because SSA/Medicare seem to be believe income increases in retirement, even after it's already gone down. I've checked; it doesn't. Well, not that much.

 

I called SSA (a 40-minute wait, followed by a 20-minute conversation) and was told I could appeal, if I wanted. I was also told that if SSA later determines that too much money was taken in the IRMAA increase for a given year, the excess will be refunded. When I asked if that didn't automatically impose a two-year delay, I was told, "Gee, I guess it does!" Nothing like working with the best and the brightest. And this was nothing like working with the best and the brightest.

 

I said that arrangement sounded fair and, if needed, they could just put the refund check on my grave. No response.

 

Being retired, I clearly have the time to fight this fight again, but I don't know if I have either the strength or the stomach for such a re-match.

 

This is so much harder that I though it would be. On the plus side, it might turn me into a day-drinker.

Are you finding it difficult to survive on a $500,000 plus income?

[wsc]

Are you finding it difficult to survive on a $500,000 plus income?

LOL! Given your apparent talent for estimating income, perhaps you should start working for SSA/Medicare.

 

Although I have little to complain about regarding retirement income, half-a-mill is, and sadly so, out of my league.

 

My annoyance in all this is with (a) the principal, and (b) the sloppiness.

 

The principle was discussed earlier and is an objection to a means-based pricing in a mandated market.

 

The sloppiness consists of misinformation in the most recent letter from Medicare, which reads "2018" when it means "2019," says the IRS reported XYZ as my AGI for the year in question but gives a number that never appears on any 1040. The exact number quoted -said by them to come from IRS- was the precise number I supplied to SSA as an estimate on the SSA-44 form when I requested a lower adjustment.

 

This kind of inaccuracy and attention to detail is acceptable and effective -or so it's said- in horseshoes and nuclear war, but leaves something to be desired in financial accounting. And the inability of the SSA representative to explain the process, even to the point of admitting she knew nothing of how these determinations are made, underscores a lax prep and review process, supported by an inadequate and ill-qualified labor pool. To say they're doing their best may be true, is hardly encouraging, and simply adds to the tedium.

 

But thanks for asking.

[Beancounter]

LOL! Given your apparent talent for estimating income, perhaps you should start working for SSA/Medicare.

 

Although I have little to complain about regarding retirement income, half-a-mill is, and sadly so, out of my league.

 

My annoyance in all this is with (a) the principal, and (b) the sloppiness.

 

The principle was discussed earlier and is an objection to a means-based pricing in a mandated market.

 

The sloppiness consists of misinformation in the most recent letter from Medicare, which reads "2018" when it means "2019," says the IRS reported XYZ as my AGI for the year in question but gives a number that never appears on any 1040. The exact number quoted -said by them to come from IRS- was the precise number I supplied to SSA as an estimate on the SSA-44 form when I requested a lower adjustment.

 

This kind of inaccuracy and attention to detail is acceptable and effective -or so it's said- in horseshoes and nuclear war, but leaves something to be desired in financial accounting. And the inability of the SSA representative to explain the process, even to the point of admitting she knew nothing of how these determinations are made, underscores a lax prep and review process, supported by an inadequate and ill-qualified labor pool. To say they're doing their best may be true, is hardly encouraging, and simply adds to the tedium.

 

But thanks for asking.

My estimate on your income was simply based on your post that said your income placed you in the highest IRMAA bracket. The highest IRMAA income level is $500,000 and above.

[wsc]

My estimate on your income was simply based on your post that said your income placed you in the highest IRMAA bracket. The highest IRMAA income level is $500,000 and above.

Well, this is awkward.

 

To quote Professor Higgins in My Fair Lady, "Damn, damn, damn, damn!" I, who so recently wrote of sloppiness and inattention to detail, must now come face to farce with my own.

 

You are quite correct regarding the highest IRMAA income level being $500,000+. I've rechecked and seen that the table I used has two entries in the same box, one being that highest tier, and other being the next to highest, and that latter being the one that applied to me.

 

My apologies for any aspersions, however and altogether unintended, cast your way by my previous response, now seen to have been delivered directly from my ass, where I apparently keep my "facts." I am mortified and will now slink away to be one with my shame.

 

Actually, I'll meet friends later this evening and drink to forget this embarrassing episode. I don't really need the drinks to make me forget; at this stage in my life, I can do that on my own. But the Scotch makes it more fun.

 

Again, my apology for the error, and my thanks for the correction.

[Beancounter]

Well, this is awkward.

 

To quote Professor Higgins in My Fair Lady, "Damn, damn, damn, damn!" I, who so recently wrote of sloppiness and inattention to detail, must now come face to farce with my own.

 

You are quite correct regarding the highest IRMAA income level being $500,000+. I've rechecked and seen that the table I used has two entries in the same box, one being that highest tier, and other being the next to highest, and that latter being the one that applied to me.

 

My apologies for any aspersions, however and altogether unintended, cast your way by my previous response, now seen to have been delivered directly from my ass, where I apparently keep my "facts." I am mortified and will now slink away to be one with my shame.

 

Actually, I'll meet friends later this evening and drink to forget this embarrassing episode. I don't really need the drinks to make me forget; at this stage in my life, I can do that on my own. But the Scotch makes it more fun.

 

Again, my apology for the error, and my thanks for the correction.

Actually it’s none of my business. Being a retired accountant i still make assumptions based on what I read as it relates to tax law. Have a Merry Christmas!

 

And there’s no need to apologize. ?

[MikeBiDude]

Follow up on drug coverage here’s what my costs will be, not SO bad for a year. Painful for a few months. Truvada plus one generic daily blood pressure med. Hopefully some future generic help?

[+ Hoover42]

Follow up on drug coverage here’s what my costs will be, not SO bad for a year. Painful for a few months. Truvada plus one generic daily blood pressure med. Hopefully some future generic help?

Just curious, is the bulk of that monthly charge attributed to the cost of Truvada? I wouldn't think generic bp meds would be especially expensive

[MikeBiDude]

Just curious, is the bulk of that monthly charge attributed to the cost of Truvada? I wouldn't think generic bp meds would be especially expensive

Yes, the BP med is like $10-15 a month

[Rudynate]

 

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

 

Thoughts? Advice?

 

 

Part B premiums are based on your income. Your first couple of Medicare premium payments are really low and then you get the letter from Social Security telling you, that, based on your income, you have to pay more. In my case, it was a LOT more.

 

Then there's the monthly premium to the carrier for your Medicare Supplemental Coverage or for Medicare Advantage. Between part B premiums and Medicare advantage, I pay about half of what I was paying before I went on Medicare. My monthly premium for Kaiser Medicare Advantage is 84.00. I had AARP Supplemental coverage through United Health that cost twice what I'm paying Kaiser and that didn't include part D. That would have been another 40.00 - 50.00 and any prescription coverage I could've gotten wouldn't have covered most of my scripts.

 

I tried switching to a dentist that provided reduced-cost care to Kaiser's Medicare Advantage members, and I went to him twice. He had a crumby office in a rundown medical office building and the waiting room was packed with creaky old people. I decided I could afford my old dentist and started seeing him again.

 

I hate the whole scene. I actually investigated going back to conventional insurance, but everybody that I talked to said that, once you're on Medicare, there's no going back. It would be worth it to me to pay what I used to pay and be free of all the headaches that Medicare involves.

[silentworker]

One option to consider: making your initial choice something that you can wiggle out of easily if you change your mind.

[Rudynate]

I don't hate Medicare as much as I did, but I'm not in love with it.  I just had a hip replacement.  My out of pocket cost was $210.00 and Kaiser billed Medicare $65K.  I haven't looked at my medicare account to see how much of the 65K Medicare covered. 

[+ bashful]

I go on Medicare next year too.  I retired when I was 57, and got retiree medical on the same basis as active employees.  

Part of the retiree medical benefit is a supplemental plan once you go on Medicare.  

I began reading the Medicare.gov website, but haven’t got far yet, mostly because I grow tired of reading a computer screen.  Much prefer paper so I can jot notes, or highlight to keep me from getting lost.

My stupid question:  Is a supplement plan the same as a Medigap plan?

Apologies in advance if I missed the answer in all the good info above.

Edited December 1, 2021 by bashful

[MikeBiDude]

This book was recommended by @Act25to me a year ago when I was researching my options. Really good info:

[Epigonos]

The Medicare Advantage Program does function like an HMO thus you are required to use a network of physicians.  He does provide numerous different services.  I have friends who make a point of using all the available serves provided every year even if they don't need them.  Medicare Advantage is incredibly costly and is the major reason why the entire Medicare program is facing insolvency.

I have always refused to use an HMO thus I have a costly Anthem Blue Cross supplemental plan.  I'm a fanatic when it comes to researching medical services I need.  With my plan I can use any physician who take medicare.  Thus my orthopedist (knee replacement) is located in Santa Monica, my urologist (enlarged benign prostrate) is associated with the City of Hope and is located in Pasadena.  My primary concierge physician (everyday needs) is located in Brea, and my ears/nose and throat physician is located in Fullerton.  Fortunately I'm able to afford a plan than allows me to pick and choose the best of the best regardless of where they are located. 

 

Edited December 1, 2021 by Epigonos

[+ tassojunior]

While working I was in the GWU HMO and upon retirement and Medicare went into the Kaiser Advantage HMO. So I've been in "managed care" all my adult life. Because of the worker shortage Kaiser is on hard times staff-wise right now but I'm not sure that doesn't also affect "private" MD's, maybe more. There are changes to prescription etc benefits in the proposed BBB bill that may make a difference between plans but they're not set to start for a few years, if passed. The upside to Advantage is the freebies like most drugs, gym memberships, hearing aids, glasses, and some dental. Also worldwide coverage so no need to buy travel insurance. The downside is extreme exposure to clerical/nurse understaffing; ie 1 of 2  prep nurses leave and an 8-doctor team is crippled. Also since specialists are very shared, any shortage ripples down into long waits for appointments. But I think private MD's have the same problems now.  

[+ jrhoutex]

13 hours ago, bashful said:

I go on Medicare next year too.  I retired when I was 57, and got retiree medical on the same basis as active employees.  

Part of the retiree medical benefit is a supplemental plan once you go on Medicare.  

I began reading the Medicare.gov website, but haven’t got far yet, mostly because I grow tired of reading a computer screen.  Much prefer paper so I can jot notes, or highlight to keep me from getting lost.

My stupid question:  Is a supplement plan the same as a Medigap plan?

Apologies in advance if I missed the answer in all the good info above.

Not a stupid question. Yes, a supplemental plan is also referred to as a Medigap plan.  The supplemental plan fills in the gaps that Medicare does not cover.  If you don’t have a group retiree supplemental medical plan, then you would need to consider a private supplemental plan or consider the managed care options of a Medicare Advantage Plan. 

I’m in a similar situation.  I retired from an employer with group retiree medical benefits on the same basis as active employees.  When I turned 65 (in 2021), the group retiree plan becomes a secondary supplemental plan to Medicare.  Medicare is the primary insurance and once Medicare pays its share; the group retiree medical plan pays secondary.  If you have a group retiree medical plan, you likely don’t need another supplemental plan, unless of course you want dental coverage or vision coverage.  I also have those policies through my group retiree plans.

Upon retiring, the company’s retirement counselors made it clear that if you did not sign up for Medicare when you turned 65, the group retiree plan would only pay after you paid what Medicare would have paid. 

I also recommend the book recommended my @Act25and @MikeBiDude.  It helped me understand the complexities of Medicare.

Edited December 1, 2021 by jrhoutex
typo

[Epigonos]

If you are tired of long waits for appointments with doctors in both private practice and HMO's you might want to consider a MDVIP Concierge Physician if one is available in your area.  If you sign-up with one you are guaranteed a minimum half hour appointment within forty-eight (48) hours of calling.  You are also provided with the physicians personal cell phone number in case of emergency.  These doctors will work with any specialists you wish to use and will assist you with appointments with your chosen specialist.  I love the system.  Now cost - I pay over and above my medicare B and D and my Anthem Blue Cross Supplement about $2,000.00 a year.  Fortunately I can afford it and I absolutely love it.

Edited December 1, 2021 by Epigonos