Is there any exception (to the Medigap / 6 month / take everyone) if you’re still working and covered under your employer’s plan?
Oh - and as a personal anecdote: Just for fun, I looked at costs for Medigap policies a couple years back. I turn 62 this year, so it’s something we’ll have to deal with sooner vs. later. I’m fortunate enough to have some money set aside by my company for “retiree health care”. They changed their rules a couple years back so that rather than a medigap policy of their own, the money could be used to pay the cost of a commercially-available policy.
I looked for my home county (a DC suburb), and for the county where my in-laws live (Palm Beach County, FL). Both are fairly wealthy counties with large populations; theirs has a higher proportion of retirees as evidenced by the plethora of 55+ communities. Yet the same level of coverage would cost something like 4 times as much in Palm Beach County.
Yes:
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The 6 month period technically begins when you get Part B. Most 65+ people employed delay their Part B as they don’t need it.
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Even if you enroll in a MA plan right off the bat, you have a ‘take back’ period where you can enroll in a MS plan.
What do we want? Socialism! When do we want it? When we retire!
Playing musical chairs today, Patty from Chula Vista got on the phone. Nice woman, a bit scattered, but she was just frustrated at the massively over-complex system facing her.
“So, I have AARP Medicare Advantage Plan 1”
“No, ma’am, you have AARP Medicare Advantage Choice.”
“So which is the one that’s better for me?” (They’re both rather blah, to be honest)
I go into a description of differences so minor they can be calculated in Planck units. Patty listens, gets things backward, her frustration growing.
”So, do either of these plans give me more money on my social security?”, she cuts in.
”No, ma’am, that’s the AARP Medicare Advantage Freedom Plan, and it increases your social security check by $51. However, one of your doctors isn’t in network, which is why I didn’t bring this up.”
”Dammit, they’re all AARP plans and the networks aren’t the same? And why don’t I get all $144 back? Joe Namath says I can get $144 back every month!”
”The plans are divided by county, with each county having their own plans…”
”Are you kidding me?”
”And the only county I can remember which gives back all $144 is Pinellas County, FL. Palm Harbor area.”
”So the rich people who get everything also get their Part B. back?”
”Well, that is where Mar-A-Lago is.” (I would not be my mortgage on this, just letting you know. But I said it.)
”…”
”So, yes, everyone who lives in the same county as Mar-A-Lago, they qualify to get their $144 back.”
She bursts out, “I just don’t understand! All I get is this measly social security check which I worked for for 40 years, this system is stupid – Why don’t they just have one plan for everybody, wouldn’t that make it cheaper? Why am I even talking about no fewer than three plans with ‘AARP’ in the name? Why can’t I just sign up for Medicare, have it be affordable, and have all these phone calls stop?”
”Patty, I completely understand your frustration, possibly more than you think I do, and God knows if we were sitting on your front porch we would have a good rantathon and I could tell you some stories, that is for certain. But for better or worse, I don’t talk about politics, religion, or sex at work… but, yes, I completely understand your frustrations and you are not alone in expressing them.”
I didn’t do anything, there was no clear advantage (yuck yuck) to one plan over the other, but she was so close in identifying the Great Con, hell, she did identify it, she just doesn’t believe the world can be where there is just one plan… or payer.
What Patty wants is for her life to be simple and affordable: 100% of the people in the same group, maybe selecting from different plans w/in that group, but all paying into a common account. She wants universal insurance, not networked financial contracts. What Patty wants is a system which is fair(er), where you’re not fucked because you live in the wrong county. What Patty wants is for Joe Namath to speak to her, and not to Donald Trump’s neighbors.
What Patty wants is socialism.
I assume you didn’t tell her that AARP doesn’t actually have a plan, but just slaps its name on a plan from an insurance company. UHC in my case.
I assume all the AARP plans are with the same company - but I’m probably wrong.
No, I tell them that these plans are cross-branded and am very clear that this is United Healthcare and not AARP, Medicare, etc.
Was she even more put out?
Naw, most don’t care.
JohnT, I probably will be in the situation in a couple of years where my wife (unemployed) turns 65 five months before I do, and probably I will continue working at least a little bit past 65 myself (if they’ll have me).
In this scenario, from what I think I’ve learnt from you, is that:
- she files for full Medicare (part A, part B and either MA or MS as we decide) effective on her 65th birthday;
- I, while still employed a few months later on my 65th birthday, do NOT file for part B, but wait until approximately when I terminate employment.
If I’m correct, then regarding #2, is there still something I need to give Medicare before my 65th? Like a notice that “hey, someday I want Medicare, but I will continue on my employer’s plan right now”?
No, Part A starts automatically, but you need to apply for Part B. This is usually done when people apply for their Social Security benefits.
Be sure to call Medicare and find out 100%, though. I work with MA plans, not Medicare regulations.
John, Thanks for this enlightening thread. It’s been such a steep learning curve trying to navigate this insurance change since turning 65 last July. I still don’t know if I’m doing the right thing.
Last year in July I got put on part A because I earned it with a lifetime of labor. I also got thrown off my PPACA insurance at the same time. In a way I liked that insurance, pay the out of pocket and everything else is covered. Easy enough. I also signed up for part B and D via an Advantage plan offered by the same company that held my previous PPACA policy. part B paid out of my SS and the UHC premium taken automatically from a bank account. I thought I did the right thing.
But then shortly after being on these plans last year I found out that the ‘out of pocket maximum’ used in the insurance policy wasn’t the same as the ‘out of pocket limit’ mentioned when explaining when the part D ‘donut hole’ upper limit and nothing I paid in part D applied to the out of pocket maximum as applied to parts A and B. I felt like I got screwed hard by these apparently deliberately obfuscated differences.
At the end of last year I decided to drop my previous insurer and again kinda got screwed I think, by making comparisons on the internet of different plans, that you have indicated are all but identical in every respect except cost. Based on all the confusion offered I sent AARP $12 for a one year subscription just so I could get a Plan G with United Healthcare - Original parts A and B and AARP MedicareRx Saver Plus for part D, all together making Part G. The UHC premium being over $100/month with yearly increases.
I was able to make this transition from advantage to supplement without penalty because I fell within that 6 month window.
I did not get the offered dental or vision upgrades as in my experience dental coverage is merely two cleanings per year and an xray every 2 years and everything else is on you type of uselessness. The vision coverage being a vision check once a year, a pair of shit frames and one pair of hard divided tri-focal lenses, in my case, every couple of years. Somehow, those didn’t seem like such good deals.
This year I got a molar pulled, a permanent bridge and a broken crown replaced with a temporary one that’s supposed to last a long time, all the the tune of $3,000. Yikes. I’m not sure any policy I paid for would have covered these costs in any significant way.
Questions:
Did I screw up with this AARP/UHC purchase?
How do I get out from under it if I did make a mistake?
Should I have gotten vision and dental?
-I live 20 minutes from the Canadian border
Could traveling there for meds, dental, vision or any other healthcare thing be worth it?
If so, what’s the smart way to do that?
-I was unfortunately in a cardiac cath lab with an overnight stay in the hospital “for observation” last month. This upcoming bill scares me. I haven’t seen it yet. I was told by the UHC guy that I would only be on the hook for $203 and change and then everything else would be covered.
Is this really true?
As an example, I had to make a couple of phone calls using the phone at the bed. Is that covered?
Any other sneaky costs?
- It was supposed to be in and out in one day but no, I was kept overnight for observation. As far as I can tell I was apparently NOT technically admitted to the hospital.
Is medicare gonna stink this up and hang me on a technicality?
I’ve got a hundred more questions. This stuff is incredibly confusing. Thanks for any insight you might be able to offer.
Which county and state? Feel free to PM me if you don’t want to put that here.
OOps! Should read - part B paid out of my SS and the UHC premium taken automatically from a bank account. I thought I did the right thing.
Thanks, JohnT. I sent you a PM. I think anyway. Let me know if you got it.
My god, what a mess!!! Tricare For Life ftw! I pitty everyone who needs to figure this shit out. Appreciate the thread, JohnT. Great idea!
Another voice of appreciation but I do think you sell MA short in a very important aspect. I say this from the perspective of one who sits on a large medical group’s QA/UM committee.
When we take an MA plan we are signing up getting paid based on value metrics more than volume of visits. (Value Based Care - VBC) We focus energy on achieving these quality outcome metrics in this population, especially the medically complex, reaching out to them, nagging even, facilitating care that prevents the need for hospitalization or readmission. Patients in MA therefore often get better health outcomes.
Better care is nothing to dismiss out of hand.
Here’s my personal experience with Medicare Advantage plans:
We ask the patient when they come in if there is any insurance change.
The patient says “No-I still have Medicare”.
I see the patient and bill Medicare which denies the claim.
We call the patient who insists they still have Medicare but a nice person on the phone managed to get their monthly costs down and give them new benefits.
We ask to see their new card and point out that they are now on a Medicare Advantage plan and either we don’t participate or we do participate but the patient neglected to select a primary MD so they were randomly assigned to a different doctor.
The patient states that nobody told them that they had to choose a primary doctor; they just told them that they weren’t getting all of the Medicare benefits they deserve and that they would make sure they got them.
The Medicare Advantage plan refuses to pay us because we are not the primary.
If we participate, the plan makes us the primary but will not do so retroactively. If we do not participate, the patient or family spends hours on the phone trying to get back into regular Medicare because it is not open season.
Medicare forbids billing for “uncovered” services unless the patient has signed a release in advance.
We cannot bill the patient for the visit without risking our Medicare participation.
We eat the cost of the visit as well as the indirect costs of cleaning up this mess.
Every. Freaking. Open Season.
Let me just add that I am sure that the OP tries to explain all this to the patients but there are two problems. One is that patients don’t listen or understand because it’s just too complicated. The other is that there are in fact a lot of unethical people preying on the elderly, again probably not the OP who appears to be trying to help.
@psychobunny, Would it help if, when the call/visit/selection of plan is over that the OP and his kind give the newly insured person a list of to-do’s and a timeline to do them in?
I’ve put on my professional hat here. In my job, we create job aids to help direct people to complete a task correctly without intervention. Asking newly insured elders to remember what their new plan entails is asking a lot and pointing to a website for answers is, while helpful to young folks, not always so for seniors. I think if insurance sales/marketing/brokers/customer service would help people this way, the path might be a bit more clear.
And, yes, having worked in insurance in general for a long time, I know that obfuscation might seem to be the goal (and for a few terrible companies, it is) but helping people help themselves usually gains appreciation and more customers.
I’m going to continue to push back some more. Bolding mine.
Strong advice to all:
Pick a primary doctor whose advice and judgement you trust.
If you think what you are feeling is your heart fluttering first touch base with that doctor. It is rarely a waste of your time. Self-diagnosing that what you feel is in the realm of a cardiologist (or fill in the blank specialist) is OTOH possibly wasting your time, and often will result in poorer (and most costly) care to you.
Going directly to a specialist because you “know” already that it is something “above the pay grade” of your PCP, and you already know what sort of problem it is, is one of those many short cuts that ends up taking longer, costing you, let alone “the system”, much more.
Get a “medical home” and use it.
This advice holds if you are on a PPO or an HMO product. The difference is only that a PPO makes these often poorer decisions an easy thing to do. Inappropriate use of specialists, is part and parcel of why American healthcare costs money more while delivering poorer quality.
Another strong bit of advice. If you have a physician whose advice and judgement you value and trust, don’t pick a plan without knowing for sure that they are part of it. Some docs, some complete large groups, are moving into Medicare Advantage only. Ask.