66 year old man with wife turning 67 soon. Work for an organization with a “qualified plan” and last year opted to not sign up, keeping our BCBS plan as insurance. Now the company is switching to Imagine360 which despite HR reassurances sounds crappy. They do this reference pricing thing and fears of balance billing are rife in reviews. I don’t have my premium information in front of me but the set of my company and my position as a shareholder in it means I pay for the whole thing out of compensation, including the “employer” share. My wife is on multiple meds and sees multiple specialists, PT, etc., not all of whom take Medicare. 24 year old daughter in a Masters program now covered by my family plan but could sign up for coverage through the university plan. Not yet sure how much that costs
Options?
Sign up for A as secondary to my work qualified plan? Only comes into play rarely but if this plan really sucks it is a backstop…
Pocket my premiums, pay for my daughter’s university sponsored plan, and sign up for all Medicare offers and a supplemental?
Just keep going as is?
My WAG (and need to check) is that I pay about $26 K for premiums now, but deductibles copays etc.
Talk to a medicare insurance broker. I don’t remember the details, but was of the understanding that not having everything up front when first eligible, such as medicare supplement and part D could cause potential issues with getting them in the future.
I’m about to go see mine again in a week or so during open enrollment, so I can get a fresh version of the details if that would be helpful.
@mixdenny apparently usually but not necessarily. It can be secondary to a qualified work plan. Doing that just rarely adds much. But maybe this is a time it does …
@Beckdawrek her program is year round and by the time she’s done she will be turning 26 and off my plan.
@DMC again the “qualified plan” - no penalty for not signing up yet as long as I am in a qualified plan. No matter how bad that plan is.
I’ve written the broker who wants all the details including all the medications we each are on, costs and specific benefits which aren’t released yet … before giving opinion. Trying to get some rough ideas before then.
Speaking just to you and your wife, not daughter …
This sounds superficially attractive. But …
For someone in your position as (I assume) a rather high earner, IRMAA is a major cost factor to keep in mind. It sure is for 67yo me.
Part A is of course zero cost. My part B runs ~$590/mo for one person once ~$405/mo of IRMAA is piled onto the base $185/mo. I also get whacked for ~$80/mo of IRMAA on my part D on top of its premium.
Overall, the components of my total annual health related spending in descending order are IRMAA, basic Part B, Part G (albeit a HDHP version), all OOP expenses, Part D. The first two are the lion’s share and everything else is almost a rounding error.
Presuming your notso-healthy wife is a low- or non-earner (as my late wife was), at least you have the advantage of married filing jointly status which bases IRMAA on higher income brackets than single me is subject to. OTOH, you may well have a lot more taxable income than I do.
That’s helpful. Thanks. Still I am just now realizing that I paid over $34K for coverage last year (I pay both employee and employer portion) then deductibles and only getting so much back for out of pocket … yeah after adding it all up after those fees and a good supplemental plan? Probably same ball park. And if I keep working into mid 70s at least as I want to I will also have required distributions and SS to add as income Plus those premiums are pre tax?
Hence why I get so confused!!!
I have written my broker who last time told me to just keep up with my work plan
Oh fortunately wife is health annoyed more than serious illness currently! But regular care consumed.
My first retirement year I had AARP-UHC Part G. At my then-second now-ex wife’s insistence. It was rather costly per month per person (~$350?).
For 2025 & planned subsequent years I switched to AARP-UHC Part G High Deductible. It costs ~$75/mo. for the exact same coverage. Yes, there’s a few $K of potential OOP before they pick up the heavy lifting. But for somebody with only small cheap chronic issues and pockets deep enough to absorb that $fewK in any unlucky years, it’s a great deal.
Something that’s different about Medicare from typical employer plans we’re all used to is that there is no connection between your plan choices and your wife’s. She could have completely different insurers than you do.
Such that you might compare the total cost of premiums + deductibles + expected OOP given her heavy care consumption across both the high- and low- deductible versions, while simply taking the high-deductible version for low-consuming you.
Hooray for that!
You’ve given only teeny hints about her status over the years and I was guessing she’d probably retired by now, almost regardless of her prior career or health status.
Holy cow, that’s a lot. Is it practical for you to abandon the employer’s insurance, buy a high deductible plan as @LSLGuy guy suggests, and fund a Health Savings Account instead?
AFAIK you can’t use an HSA with a high deductible medicare supplement. You can with a high deductible personal policy, but good bet that would net more expensive.
Sorry, now I was unclear. The OP is indeed still working and intends to continue doing so.
So you’re right that a commercial HDHP with HSA is an option he could pursue. Because he’s over 65 he also has access to Medicare + a supplement plan, which he mentions as a possibility. To which I added the idea of an HDHP supplement.
In response to your comment my (unstated) assumption was that medicare + a medicare HDHP supplement as I suggested earlier would necessarily be cheaper than any commercial HDHP plan. Such that the benefit of gaining access to an HSA wouldn’t be worth the price.
Sorry to not include all my thinking, just my conclusion.
If we go on Medicare as primary with a supplemental plan can we still see providers who do not take Medicare and have that picked up by the supplemental?
My understanding, as it comes to Medicare supplemental policies (“Medigap”), is that, no, it wouldn’t work that way. Medigap plans simply cover the out-of-pocket portion which “Original Medicare” (Parts A and B) doesn’t cover; it doesn’t change the fact that your health insurance is Medicare. So, if you have a provider who won’t take Medicare, Medigap wouldn’t seem to change that.
Medicare Advantage plans, on the other hand, generally tie you to the private insurer’s provider network, and work more like private insurance in a lot of ways. But, Advantage plans may also have a lot of limitations – the insurers like to sell them, and a lot of people have them, but I’ve rarely seen positive things said about them in discussions like this. YMMV, of course, and if those particular providers are important to you, it might be worth looking at Advantage plans.
Reading up it seems there are three groups of providers: those who accept Medicare assignment (agree to accept Medicare payments); those who are “non-participating” (will accept Medicare but can charge up to 15% over Medicare approved fees with the patient balance billed); and those who “opt out”.
A supplemental plan may help with the unpaid portion of a non-participating provider but an opt out one is all on you.
I think.
I would be fine in an Advantage plan. While I have no specialist needs the group I am part of is part of a plan and for my own care I would trust them. They actually do proactively work to keep their Advantage participants healthy. My wife though? Has specific people she wants to see, and does not want the restrictions inherent in an Advantage plan.
Anyway yeah with IRMAA, even a HD supplemental, and paying for daughter’s coverage it adds up to more than the after tax money back in if I took the premiums as cash comp instead. At least by my back of envelope. As long as the new plan isn’t really really bad.
My dad is on a Kaiser PPO advantage plan, so goes to Kaiser for everything, but the PPO part does give him the option to go out of network without a big penalty. I don’t remember the exact amounts for out of network copays, but they seemed reasonable to me.
You may be able to find a PPO advantage plan through a provider that is convenient for you.
Again bear in mind that you and she have no need to be on the same medicare supplement or replacement plan. After decades of employer coverage which is always the same for both members of a married couple this can be a mind-bending change to get your head around.
Yeah I know it but brain still slips into the default!
Another new cost saving company policy for all is that if a spouse is eligible for insurance through their job their coverage is not a benefit, with application to if eligible for Medicare in ‘27. So my spouse will have to take Medicare then even though I plan on working for the indefinite future.
Having now decided to keep fingers crossed on the new plan, my next task will be to give my accountant a heads up question for the future, given that IRMAA bit. My income is significantly more than my wife’s. The question will be if we should file separately for the ‘25 year so her IRMAA is less, no matter what I do with my policy.
I’m a bit disappointed with the broker I’ve been referred to. I texted my broad question with benefits and costs information as known asking if we should consider going Medicare now and she dug in with no way to answer until I email a list of both our meds and doses, as if the pharmacy coverage was the biggest factor. No question asked about our current respective incomes and tax brackets, which seem to me to swamp everything else for any cost analysis. And my wife is not eager to share her personal medical information with anyone not bound by HIPPA.
It also seems important to know if her chosen providers are at least just “non participating” rather than “opt out” but no request for that information.
It sure happened to me when I was in that situation. More than once. Hence my specific call-out.
The broker asking about scrips is good info for Part D of course, but IMO/IME Part D is a rounding error in the total premiums + IRMAA.
OTOH, a Part D policy that leaves a bunch of your specific meds in a high cost tier can easily swamp all the expenses. Perhaps said another way, there are few ways to get part D right, and lots of ways to get it wrong. At least for the typical older senior with a mountain of non-generic chronic maintenance drugs.
The “Which physicians participate how?” question is equally huge for a heavy care consumer, but essentially orthogonal to the Part D question.
