I went to my local SHIP rep this morning. She confirmed what I had found online at the medicare website. Next year, we will each pay fifty cents a month for premiums, and zero dollars for our prescription drugs. If nothing changes during the year, we will pay a grand total of 12 dollars for the entire year. We will be on the Wellcare Value Script plan.
I was surprised - but I found one in NYC with premium of under $4 per month. My drug costs will be a lot higher, but I’m not surprised as it would of course depend on specific prescriptions.
I have a question (it may have been answered already, but I didn’t see it) If I start collecting SS before age 65, do I need to enroll in Medicare or will it be automatic?
It’s my understanding that Ss recipients under age 65 are automatically enrolled in Medicare A and B. You shouldn’t have to do anything but pick your script and supplement plan in the open enrollment window.
You have to have been on social security for at least 4 months before you turn 65 in order for enrollment to be automatic when you turn 65. If that’s not the case, you’ll need to sign up. You can do so online.
That’s great - I won’t have to worry about remembering 'cause I will definitely be on SS more than 4 months before I turn 65 and my retiree health insurance will be my supplement/prescription coverage.
That’s excellent! I’m so glad it’ll work out so well for you!
I found the first several posts in this thread to be pretty confusing, so let me jump in with a question now.
My situation:
I’m retiring from the Federal government at the end of the year. I have the Federal BCBS health coverage, which is great.
My wife is 59 but already retired. I have a teenage son. I’m going to keep my Federal health coverage because that’s how they’re covered, and it won’t cost me any more than it does now.
My question: Is there any reason I should sign up for anything besides Medicare A&B at this time?
Seems I’m already getting the benefits of a Medicare Advantage or a Medigap plan through my Federal coverage. It looks to me like I’d be paying for 6 years of probably useless (for now) Medigap just to maintain eligibility for when I might need it six years or more down the road. And AIUI, I can switch from Part B to a Medicare Advantage plan six years from now without any penalty.
And I can also start up Part D in any future year’s open season without penalty, right? (I am taking no prescription drugs at this time.)
Just seems to me that if I can switch to Medicare Advantage and start up Part D later on, there’s no need for me to think about them now.
Your mileage may vary, but the usual decision for retired Feds is to stay with FEHB. When you sign up for Medicare, it becomes primary and your FEHB coverage is secondary, essentially a Medigap policy. Since FEHB policies include prescriptions, there is no need for part D.
Before I retired, my agency had a presentation from a GEHA representative that was incredibly helpful explaining the options. The cases presented where you might want to do something different is if you have military service and are covered by Tricare. Probably a few other odd cases as well.
Buying a Medicare Advantage plan was shown to be a poor choice. But now there are Medicare Advantage plans offered in FEHB, so I don’t know how they fit in.
If you can afford both the Medicare and FEHB premiums, it’s solid coverage.
Edit: if you want to have your wife eligible for FEHB in the event you die, you need to select a survivor benefit on your annuity. Unless she qualifies on her own if she is also a retired Fed.
You should also check on whether the Federal coverage will continue once your wife is eligible for Medicare and how much will it actually cost - my state employee retiree health insurance will reimburse me for my and my spouse’s Medicare part B premiums and any IRMAA. At the current rates, my reimbursement for Medicare would be more than the premium I pay to the retiree insurance so they would be sending me a check for the difference. It’s a little hard to believe but true
If your Medicare reimbursement exceeds your
health insurance premium, you will not be billed
since the Medicare credit will pay your premium.
If your Medicare reimbursement is more than your
premium, you will be reimbursed the difference
in the form of a quarterly refund check from the
Office of the State Comptroller.
Thanks, this was extremely helpful.
The main reason to pay for Medicare Part B is just to keep the option open of dropping FEHB when my wife turns 65, and both of us being on Medicare. Although it looks like between the two of us, once we were on Medicare, we’d be paying premiums that weren’t that much less than the FEHB premium, so maybe it does make the most sense just to keep FEHB indefinitely for the two of us, and I can keep the kiddo on our insurance too for another decade.
There’s a recent article in USA Today detailing how a few hospitals and doctors are starting to cut off in-network access from some Medicare Advantage plans, citing crappy payment from them as the reason. Their wording is a bit confusing - they call these plans “private Medicare” and only define them as Medicare Advantage further down the article.
I’m still reading it for details as I write, but I thought I’d link to it - hopefully it’s relevant to this discussion.
I’m meeting with my agency’s retirement counselor on Monday, I’ll add this to my list of questions for her.
I haven’t followed your specifics @doreen but you should be aware that when you are automatically enrolled, you are usually enrolled into Medicare Advantage, not the other plan. If you have health issues now, I do not recommend Advantage because you will pay more out of pocket. For those who are healthy at retirement, Advantage may be your best plan.
I’m not sure what you mean by “other plan” - but I checked and the automatic enrollment is into Part A and B - aren’t Advantage plans Part C and you have to choose one?
This is not what the AARP site says.
If you are receiving benefits, the Social Security Administration will automatically sign you up at age 65 for parts A and B of Medicare. …
You can opt out of Part B — for example, if you already have what Medicare calls “primary coverage” through an employer, spouse or veterans’ benefits and you want to keep it. (Check with your current insurance provider to make sure your coverage meets the standard.) Opting out will not affect your Social Security status, but you might pay a penalty in the form of permanently higher premiums if you decide to enroll in Part B later.
If you want to enroll in Medicare Part C (also known as Medicare Advantage), an alternative to Part B that is provided by private insurers, you must sign up on your own.
ETA: Also questioned by @doreen
I have a friend who was on SSI disability and was told he didn’t need to fill out any paperwork. They automatically enrolled him on Medicare Advantage, which is anything but advantageous to someone with a disability that requires medical care. He was able to get it changed to Medicare Supplement but for reasons beyond me, it took about two years to make it happen. I’m not sure of all his details but it sounded the alarm to be very cautious to me. So, I threw in a warning about letting them choose as opposed to choosing your plan yourself. Yes, I’m paranoid. Please excuse me for the previous post, which I could have written better.
If he was on SSI, that’s different from Social Security disability - and many (if not most) SSI recipients get Medicaid. Some people who get Social Security benefits qualify for both Medicaid and Medicare - some states require those people to get all their benefits through one plan.
6 months in, my (thankfully limited) experience with what Medicare covers is…confusing, but I’m learning.
As suggested by a variety of knowledgeable people, including our own @JohnT , I chose a Medicare Supplement a/k/a Medigap plan. Thankfully, nothing I’ve encountered in the past 6 months have needed to tap that well.
What I have learned:
Medicare does not pay for annual physicals
This was a shock to me, and I had not read this until I contacted Medicare. They DO pay for an “annual wellness visit”, which is more like an interview. If you should mention something to your doctor during that AWV that requires further investigation, there are nuances in coding and scheduling to ensure it is payable by Medicare.
Routine examinations and related services are not covered
That is a direct quote from my Medicare Summary Notice (MSN), stating the reason for denial. I learned this because my doctor ordered 10 lab tests (blood work) as part of my annual visit; 4 were denied (Vitamin D level, as an example) by Medicare. Of course, if Medicare doesn’t approve the charge, your Supplement ain’t gonna pay anything. So I got a nice $336 bill from the lab for the 4 denied tests.
There is an appeals process (which involves sending a lot of paper back and forth, which is odd for an organization that seems pretty well-connected to the 21st century). But having read their philosophy and rules, I don’t know that I could win. I had been previously diagnosed (several years ago) with a Vitamin D deficiency, and I have been on a supplement since, but how would we know if the level is still correct?
There is probably some trick of getting my doctor to use certain diagnostic codes, but at this point they don’t have a dog in the fight; their charges were fully paid by Medicare - it’s the lab work and the lab billing, handled by an outside lab, that is the issue.
So this is disconcerting, and I am now genuinely missing those carefree days of my employer health plan that would cover pretty much any test my doctor ordered. It now seems I will have to carefully monitor what lab tests my doctor orders, in advance, to prevent future lab bills, and I hate second-guessing my doctors when they are actively monitoring my health.
Get an advocate. It’s free and they will help you through this. If you are in California, I love askariana.com. They may do other states as well.
I was on SSDI for a couple of years, There was no other option but Medicare Advantage. When you hit 65, you can enroll in a Medicare supplement plan,kwhch I did.
Many local docs here don’t take Advantage plans. One doctor told me, “It’s only a half-step better than medicaid.”
That’s only true if you remain in good health until you suddenly keel over and die. As we age, we generally develop more issues, and those issues are tend to be more serious. If you could switch from MA to a supplement planet down the road, that’d be great. Alas, it doesn’t work that’s way. That is, you might be able to transfer, but it’d be rough, and you could be denied for having a pre-existing condition, a horrible little loop-hole.