As we all know, the cost of medical insurance in the US is skyrocketing. Ain’t gonna get better any time soon. The only silver lining, for me, is that I’m going to be eligible for medicare in a few years. (Yay for getting old!!)
So, I’m wondering what it’s like. Please let us know which state you live in, as I believe the benefits vary by state. I’m in CA, so I’m especially interested in MediCal, which I believe is what they call it here.
What’s it like finding a doctor? Do you buy supplemental insurance? If so, from where. I’m eligible for USAA, so if anyone uses that, let me know what you think.
OK fellow geezers, give me the skinny on one of the wonders of geezerhood.
Medicare is for the elderly; Medicaid is for some of the poor. Traditional Medicare doesn’t vary state, while Medicaid does. Medi-Cal is California’s Medicaid program.
There are two approaches to getting Medicare: traditional Medicare (probably with a supplement) or Medicare Advantage (a managed care plan).
Medicare Advantage would probably have better benefits but a much more restrictive network of providers.
My wife and I switched to medicare (and Medicare supplement plans) about a year ago when she retired and her work plan dropped us. We also purchased drug prescription plans, as that’s not covered by medicare. Once we switched, we simply informed our doctors and pharmacists.
I think when you factor in medicare B premiums, medigap insurance, part D insurance and long term care insurance premiums it runs about $300-500 a month. Then you have all the costs not covered by medicare.
I believe the average retiree gets about $200,000 in benefits from medicare and pays about $100,000 in premiums and private expenses during their retirement (age 65 until death). However those stats are from a few years ago and with medical expenses growing so rapidly I’m sure those numbers are bigger now.
Not fun to pay that, but it’s about 1/4 what I’m paying for my full insurance right now. I would not mind having an extra $900/month in my pocket. That should about pay my bar tab.
Prepare for TONS of mail. I believe they sell your info and you will be SWAMPED with old people offers for everything. Cremation, hearing aids, trusts, wills, etc. And it never stopped and only ramps up at open enrollment.
That’s not Medicare that sold your age info. Your age is available via lots of public and private lists, and advertisers use those lists. And of course those ads ramp up during open enrollment periods - that’s when you’re most likely to switch plans.
I turned 50 on my last birthday, and AARP is courting me hard.
I have lots of experience with Medicare for disabled people, because I used to work in community living services, and was in charge of lots of people’s medical care.
Definitely sign up for Medicare, even if you have other insurance. Medicare will be your secondary, and will pay for any copays and oher OOP expenses you have left from the primary.
You need to purchase separate prescription medicine insurance, and there are all different kinds. They all have caps, and what cap you choose will depend on your needs. If you take several meds on a regular basis, choose a high cap. They don’t like paying for brand names, even if what you need is available only in brand name, so be prepared to negotiate with your doctor. It’s possible for the sudden need for a brand name medication to wipe out your prescription insurance. I had a guy taking Prozac before it was available in generic, and he didn’t even both to claim it on his insurance; he just used a program (originally designed for AIDS patients) for people to get subsidized expensive medications.
When I say be prepared to negotiate with your doctor, be sure that anything they prescribe is available from your insurance. I had a client who could not take opioids because he was allergic, so he couldn’t take codeine cough medicine, and he couldn’t take OTC cough medicine because he took an SSRI (they don’t mix). The only cough med he could take was Tessalon, which was very expensive, and not available in generic. When he came down with pneumonia and really needed a cough suppressant, his doctor had to call the insurance company and explain why Tessalon was really, truly the only choice for him. Even taking him off the SSRI was not a choice because he had to be off it for six weeks, and he needed a cough suppressant NOW. He got the waiver, but it really took some arguing.
Other people on SSRIs who couldn’t take OTC cough meds had to have codeine, and we had to convince the doctor that it wasn’t going to be abused.
Sometimes the doctor will want to put you on an expensive antibiotic, and you will have to point out that you have an insurance cap-- can it be something else? So you have to be informed about such things.
If you have something you take on a regular basis, you may need to get the doctor to give you bigger pills than you need so you can break them, that way you need fewer tabs. I had a client on Risperdal when it was brand name, and I forget what the exact dosage he needed was, but if he got 30 a month, it would have wiped out his insurance in 3 months. So he got 8 bigger pills a month that we broke into quarters, and it worked out. Not only were fewer pills cheaper, but the bigger pills were cheaper per pill than the smaller ones. Go figure (probably something to do with more of the bigger ones being produced).
Make sure your current doctor is on board with stuff like this. If your current doctor is not Medicare friendly, and Medicare will be your only insurance, you might need to change doctors.
I am a professional Medicare Consultant. I work with people everyday to help them set themselves up with Supplements, advantage plans, prescription drug plans etc. I recertify with CMS (the center for Medicare and Medicaid services, the organization that runs Medicare) annually.
I am likely not licensed in your state, I am not soliciting business but I’m happy to answer specific questions.
I was figuring that Medicare would be my primary insurance and then I would get a supplement. Maybe that’s just a semantic issue, but is that really the way Medicare works?
It depends on your state and your prescriptions. If you are turning 65 a supplement (not an advantage plan) will average between 80 and 160 a month depending on the level of coverage you want.
Medicare advantage plans cost less and generally come bundled with a prescription plan, but typically offer less quality coverage.
Most prescription plans are 20-50/m.
All of this is variable based on your county and zip code.
It can be. If you have Medicare and a supplement Medicare is your primary. You can make it your secondary if you have other insurance. This is usually not a good idea. But in some circumstances it is.
My Medicare research taught me that it can be quite different from private or employer provided health insurance.
You are responsible for (low deductibles), 20% of every charge and there is NO out of pocket maximum. If a provider charges more than Medicare will pay, you are responsible for the excess charges.
You can buy additional coverage to cover the 20% coinsurance, excess charges and establish an out of pocket maximum.
Everyone gets Part A (hospital), Part B (medical) and must purchase Part D (drugs) coverage - you and your doctor make medical necessity decisions.
You can buy Part C (Advantage), which combines those three but puts the insurance company in charge, possibly with treatment restrictions or pre-approvals. Generally they are PPO or HMO plans with local networks and co-pays. Some plans offer some sort of vision and dental coverage, often minimal.
You can buy MediGap (Supplemental) coverage to cover the deductibles, 20% coinsurance and any excess charges. No network or other restrictions on treatments. You still need to buy Part D coverage.
MediGap eligibility is only guaranteed issue during the first 6 months of Medicare. After that the can deny coverage for pre-existing conditions.
Costs are:
Part A - usually covered unless you worked too little.
Part B - $134/month (changes each year and increases for high incomes)
Part D - varies by plan and insurance company
Additional coverage - Part C and MediGap varies by state, plan type and insurer.
This is true. Having medicare with no supplemental coverage at all is a VERY BAD IDEA.
That said, excess charges are largely a boogyman. It is extraordinarily unlikely you will ever run into them. The out of pocket maximums (or lack thereof) is more important.
This is semantically inaccurate, but probably true enough. With a supplement you wouldn’t technically be establishing out of pocket maximums so much as eliminating co-pays. These supplement plans are, by the by, fully regulated by the federal government (though administrated on a state level). You get a raft of plans to chose from and every company offering supplement plans must offer only these plans and the plans must be identical.
How do you know if you are looking at a Supplement plan and not an Advantage plan (we will get to that in a later bit)? It will have a letter. Plan A, B, C, D, F, G, K, L, M or N. Every plan N (for example) is identical to every other plan N in the united states offered by any company. Has to be. It’s the law.
This is not right on more than just a semantic level (I think).
You get automatically enrolled in Part A when you turn 65 and for 98% of American’s over 65 it’s free. Part B is opt in. You DONT HAVE TO TAKE IT. You should, but you don’t have to. It’s not free. If you chose not to enroll when you are first eligible and then chose to enroll later you will be hit with a penalty. They penalties for late enrollment are draconian. Bite the bullet and enroll. Same with the RX plan (part D). Just do it, even if you don’t take meds. You will someday. You don’t want to pay a 135% penalty.
This is just to clarify some information. A lot of this might seem redundant or unnecessary but this whole thing is confusing enough as it is without potentially confusing information floating about.
This is true. Having medicare with no supplemental coverage at all is a VERY BAD IDEA.
That said, excess charges are largely a boogyman. It is extraordinarily unlikely you will ever run into them. The out of pocket maximums (or lack thereof) is more important.
This is semantically inaccurate, but probably true enough. With a supplement you wouldn’t technically be establishing out of pocket maximums so much as eliminating co-pays. These supplement plans are, by the by, fully regulated by the federal government (though administrated on a state level). You get a raft of plans to chose from and every company offering supplement plans must offer only these plans and the plans must be identical.
How do you know if you are looking at a Supplement plan and not an Advantage plan (we will get to that in a later bit)? It will have a letter. Plan A, B, C, D, F, G, K, L, M or N. Every plan N (for example) is identical to every other plan N in the united states offered by any company. Has to be. It’s the law.
This is not right on more than just a semantic level (I think).
You get automatically enrolled in Part A when you turn 65 and for 98% of American’s over 65 it’s free. Part B is opt in. You DONT HAVE TO TAKE IT. You should, but you don’t have to. It’s not free. If you chose not to enroll when you are first eligible and then chose to enroll later you will be hit with a penalty. They penalties for late enrollment are draconian. Bite the bullet and enroll. Same with the RX plan (part D). Just do it, even if you don’t take meds. You will someday. You don’t want to pay a 135% penalty.
Semantics again, but you are not actually combining Parts A B and (sometimes) D when you chose an advantage plan. You are replacing Medicare with private insurance. You still pay any medicare premiums, but Medicare is no longer your primary insurance, the insurance company is. This has advantages and disadvantages.
This is true. You can’t buy a medigap if you have an Advantage plan though because MedSups (medigap is outdated terminology though it is still used for clarity) supplement medicare, and if you have a Medicare Advantage, you have replaced your medicare.
True. But probably not as big a deal as you think. Most reasonably healthy people can pass the underwriting. And they can’t deny coverage, they can not accept you into the plan. It’s not as though they will turn you down for a procedure once you are paying them.
Costs are:
Or have too many assets
yes, but won’t change much once you are in. Goes up more steeply for new enrollees
No way around it, Part D plans are mostly not great if you need serious drugs. If you are insulin dependent or have another condition requiring regular expensive medication prepare to learn all about the donut hole and watch you main expense in your life become your drug costs.
Well, Medicare has a different idea than I do of what constitutes health. Here is what’s not covered unless you buy something else: Dental, hearing, vision, and mental health. You have to buy additional coverage for these things (except mental health, I don’t know about that) and it costs about the same as buying insurance for those things when you’re not old. And covers about the same, which is, not much.
One thing Medicare did, that perplexes me, is, they encouraged me to get a flu shot, which was free. (To me; somebody paid for it.) Once I had gotten my flu shot, they gave me a $25 Starbucks card. So that flu shot was worth something to somebody, but I can’t figure out who.
I could get another $25 Starbucks card for going in and getting a physical, also free to me. I figure it’s like taking your car in for a tuneup. They will find something else wrong that has to be fixed. I’m not doing that.
It’s weird, it’s mostly not covered but it sometimes will be. Things that are considered “medically necessary” will be covered. Cataracts surgery would be covered. Emergency dental is covered. Cleanings are not.
Medicare Advantage plans typically have dental and vision coverage included but the coverage there isn’t great either. You can buy separate dental and vision coverage which is also mostly mediocre.
Mental health is covered though. It’s a part B service.
