I will be turning 65 at the end this month and have a few questions about Medicare. I have decided to sign up for parts A, B, and D. Here are my questions:
Part D is provided via private insurance, correct? Can I sign up for all three parts via the Medicare
department or do I need to contact an insurance company to get part C?
Is medigap insurance worth purchasing?
For dental and eye care I am on my own and will need to purchase separate insurance policies for each, correct?
Anything else I should know about?
Thank you for your answers and I wish you all a happy new year!
That’s almost 300 posts of a Medicare professional explaining all of this stuff.
In your question number 1 you start talking about Part D, but end asking about Part C. Is that a typo or are you confused? Part C & D are mutually exclusive; you can’t have both.
In a nutshell, Part C (Medicare replacement) replaces all the other stuff with just part C which you get only from a private insurer, but Medicare pays most of the premiums. If you get part C you can’t get (and don’'t need) anything else. part C works OK if your broke but they make their money through massive care rationing. So don’t get an expensive disease and you’ll be fine.
The other alternative, if you can afford it is …
If you want Part A & B (Traditional medicare) you order those from Medicare’s website.
It would be foolhardy not to get Part D as well, which you get only from private insurance companies. If you don’t get part D you will go broke paying full retail for meds as you get older.
If you go with parts A, B, & D it would be foolhardly not to also get some sort of Medicare Supplement (“medicap”) plan. If you don’t you will go broke paying out of pocket for all the stuff traditional Medicare doesn’t cover, or only covers partly. Medicare itself (A & B) is much much less complete than any modern employer-provided health insurance you may be familiar with, and the Medicare Supplement plans fill in those many shortfalls.
You get those Supplement plans from private insurers. There are many gradations of Supplement plans, all labeled by letter. “Part G” being the most comprehensive plan.
Yes, dental and eye care is totally separate from all the above. Buy it or not as you prefer.
If you have not gotten the Medicare book from Medicare you need to get it and read it.
There are mistakes you can easily make that will cost you thousands of dollars for the rest of your life with no ability to have a do-over. Read that thread and the book. Then come back with detailed questions.
Lots of us have done this recently and can provide good advice once you understand the basic outline of how the alphabet soup works.
In your question number 1 you start talking about Part D, but end asking about Part C. Is that a typo or are you confused? Part C & D are mutually exclusive; you can’t have both.
Sorry that was a typo. The sentence should have read:
Part D is provided via private insurance, correct? Can I sign up for all three parts via the Medicare
department or do I need to contact an insurance company to get part D?
I am not an expert, but I have been on Medicare with gap insurance for 9 years. Medicare pays 80% and you are responsible for 20% if you don’t have gap insurance. What I pay in premiums is now about a wash for what I save on doctor’s visits, but that’s only because I have had a lot more visits to different doctors over the past couple of years, plus some relatively minor procedures (including colonoscopies). It’s like any insurance, you pay it to protect yourself from huge medical bills that can but may not happen, or may happen later. If you can afford it, I recommend it, as a safety net. You will still have to pay a little for those doctor visits, mine are usually in the $30-$40 range.
Absolutely agree with the sentiment, just adding that there’s a page on the Medicare website which will allow you to plug in your location and meds (current and anticipated). It will return what may seem to be an overwhelming amount of information on your Part D options.
(One mistake a lot of people make is to focus on premiums alone, only to find out that one or more of the drugs they take either aren’t in the plan’s formulary or fall into an expensive tier. So while it seems a lot to wade through, doing so carefully pays off in the end.)
ETA a plug for SHIP, which can be an Ogsend when it comes to navigating the labyrinth.
No argument with any of the good advice offered here so far. You can do everything through the Medicare website. Besides checking to see if the drugs you use are in the formulary of the insurer, check which pharmacies they have agreements with for lower prices.
I have a Medigap plan, and have been very happy with it. My wife has two new knees and a new hip, and all three procedures cost us less than $100 total for drugs. We got the most expensive one, because our cash flow could handle it. I’m not sure I’ve made back my premiums over 7 years but I was looking at heart surgery a while ago and it would have done it. Medigap also evens out your medical spending, a good thing.
I found Medicare for Dummies a really good source explaining all the complexities. And do your application ASAP. I think you can do it three months before your 65th birthday. Plan to spend some time - I took most of the day, some of which was spent with the customer service agent for the companies I chose reading all the fine print to me.
I did not do Plan C because at the time I enrolled in Medicare no plan covered my current doctor and medical center. I have no regrets - we travel a lot and it is reassuring that we’ll never be hit with out of network charges.
Selecting Part G is the second-smartest decision I have made.
The smartest it getting Medigap and not Medicare Advantage.
The dumbest - which I have just corrected - is selecting a very expensive ($109/month) Part D program when a much less costly one will suit me just fine. I now pay $5.20/month for Part D.
Once one has settled on which letters they want, it’s important to shop around for which insurer to buy that letter from.
In general Part D = coverage for medicines. But each of the probably 3 dozen insurers in your state (yes, it’s regulated by the Feds, but is different in each state. Welcome to the USA) has a different premium and a different list of meds they cover. Most of the lists cover most of the common meds, but not all. it pays dividends to pick smartly. And in later years, to consider switching companies if your ever-changing med needs become incompatible with your insurer’s ever-changing list of covered meds.
As to the other parts G or H or K or L or whatever, again the basic coverage for any given letter is set by the Feds, but within your state there can be huge differences in premiums between one insurer and another for the very same letter. And significant differences in which, if any, optional extras they cover beyond the Federal minimums. A careful shopper can save a lot of money here and the person who just picks the shiniest most familiar brand name is probably paying extra for a nifty logo and not much else.
Changing carriers for these higher parts is totally doable each subsequent year too, but AFAIK, can be extra costly as you get older and/or if your health is or becomes crappy. Locking in the right answer early is smarter than throwing a dart at it at age 65 and thinking you’ll fix it at age 67 or 70 or whatever.
Another factor health plans use to compete for your Medicare parts C and D business is “Stars” or Medicare Stars. This is a quality measure of how closely a health plan keeps to the government regulations around Medicare. More stars (up to 5, I beleive) = better compliance, measured through audits, which include customer satisfaction. It’s just another way to compare plans, and the rating can be an indicator of the health of the company and how important the Medicare business is to them. Of course, health plans put this forward in their marketing to you.
Having just recently gone through this myself, some things to point out:
Medicare part A and B are obtained through the SSA (not private insurance companies)
You will need your Medicare ID to sign up for Part D, an “advantage” plan (Part C), and/or a “supplement”. Mine took a couple weeks, so you’ll want to get this started first, and then you can decide on the other parts.
Part D (prescription drug plan) is through private insurance
Here is the confusing part: you are probably being inundated from various health insurance companies for “advantage” and/or “supplement” (Medigap) insurance. There is a significant difference:
Medicare “advantage” (or Part C) plans are generally less expensive, but are limited to services provided in the state of your residence.
Medicare “supplements” (Medigap) will cover services from providers out of state. This is where the various “plans” (G, N, etc.) come in as to just how much is covered. So if you are planning to travel, you may want to opt for a “supplement”. Some supplement plans offer optional dental and vision if that might interest you.
I dug around to find out what the premiums from various insurance companies would be for a supplement plan G would cost, and it was maddening. On some websites you can get a quote, but on most, you end up leaving contact information so someone can discuss it with you. And most didn’t contact me.
I finally ended up working with an insurance broker to obtain both my supplement and Part D plan. He did not represent all the providers available, but he did handle a number of the bigger names. There’s no charge for using most brokers (they get commission from the insurance companies), and I would recommend going this route.
You should sign up for medicare once you turn 65 yrs old.
If you are still working and/or covered by other insurance plans, you don’t have to start paying for the part B coverage, which is about $160 per month. Once you begin collecting Social Security benefits they will begin deducting that payment from your SSA benefit. They will not be sending you a bill before you start collecting benefits.
I retired at 66.4 at full retirement age. The payment for part B started to be deducted from my SS payment at that time. I have been covered under my wife’s insurance for prescription drugs, until recently when she changed jobs.
This year at 67 I signed up for a part D plan to cover my prescriptions. And that was also through the Social Security web site. They show you a few options of providers in your area and you chose, or find a plan on your own.
There are penalties if you have not signed up at 65, but all you have to to is prove that you have had other coverage during the period between 65 and whenever you begin. It was a very simple form I mailed back, and a phone call. Done. Now I think that there is another $8 coming out of my SS benefit. No penalties.
A quick search leads me to believe that you live in California. (The following may be true in other states as well).
In order to do business as a provider of California Care or Medicate in the state, the companies have to pay money into a fund that pays for independent advocates to talk you though all of this and help you decide. They are licensed agents (not brokers) who are paid hourly.
It is free to you and I highly recommend that you talk to one of them. They will even do all of the online “paperwork” for you if you want.
I used askariana.com for California Care and liked them a lot but there are others you can use. I gave the same advice to @teela_brown and they were very happy.
You can sign up for a PDP (Prescription Drug Program) via the Medicare . gov website. PDPs are the insurance for meds that Med D does not cover. At the website you need to enter the names, dosages, etc. of all your meds. And your home address and zip code. They’ll spit out the 3 different insurance providers that will have the smallest co-payments. You select one and they sign you up. It’s been a while since I did this so how I got to auto pay my premium (not a lot) via debit card but that happens. Most of my co-pays are $4.15 for a 90 day supply. They’ll also tell you what 3 pharmacies near you will charge annually for co-payments.