Over the weekend, the annual Medicare Open Enrollment Period started. People can switch their insurance including their drug coverage for any reason right now. However their access to Medicare supplements may be limited depending on the state they live in. The two big types of Medicare are traditional Medicare, potentially with a supplment, and Medicare Advantage which is offered by private insurers. The Commonwealth Fund has a good description of the trade-offs of these two programs:
Medicare Advantage plans typically provide some coverage for benefits not included in traditional Medicare, such as eyeglasses. Plans also have a cap on out-of-pocket expenses for services covered by traditional Medicare, while traditional Medicare does not have a similar limit. On the other hand, traditional Medicare allows beneficiaries to go to any doctor, hospital, or other health care provider that accepts Medicare, without the need for prior approval; Medicare Advantage enrollees typically need a referral from their primary care physician as well as plan approval if they want services from specialists, such as oncologists, covered by the plan.
Medicare Advantage tends to give more financial protection with more restrictions. Traditional Medicare has less financial protections (at least without a supplement) but way more flexibility.
Those are reasonable trade-offs.
The big thing is that this is a big decision with a lot of complexity. Get help!
Use navigators, assistors, and federal and state funded help lines.
Use the Area Agency on Aging!
Use a broker or an agent while acknowledging that they only have to give you reasonably good advice instead of optimal advice which means there can be conflicted incentives.
Use help as this is a tough decision.
Ladyraxterinok
Do you have to have your Medicare supplement and your drug insurance from the same company?
Ladyraxterinok
@Ladyraxterinok:
Also I read someplace that the monthly supplement premium was going to be $164 and change.
Is that true, or does it vary according to the type of supplement you get?
Spanky
@Ladyraxterinok: {Digs through wallet.} Well, I do (AARP), but they’re completely separate plans, chosen at different times, without any of the same numbers. So I would say the answer was “no”.
Spanky
@Ladyraxterinok:
Regarding premiums, Google “IRMAA” and beware.Ahhhhh, that’s for Medicare. I don’t think it applies to the Supplement.
Jeff Del Papa
I turn 65 in December, I will b signing up for the first time. Wish me luck.
My big concern is finding drug coverage. I am an expensive patient, costing >$3K a month (retail) for the routine stuff. I assume the supplement plans are picky in what they cover, trying to avoid covering all the expensive things on my list, while making a big deal over all the cheap stuff they are happy to provide.
I will indeed be seeking professional help.
Duke of Clay
@Ladyraxterinok: No. I have my supplement with Harvard Pilgrim and Part D with CVS-Caremark.
Scout211
@Jeff Del Papa: Make an appointment with your county’s Medicare advisor right away. Appointments fill up quickly this time of year. The advisor should have access to each part D plan’s formulary for 2023.
Here in California, it’s called HICAP and other states have different names. It’s not too early to choose a plan because your Medicare will start on December 1st.
Duke of Clay
@Ladyraxterinok: There are various supplements designated by letters, e.g., Plan F. The premium varies according to the amount of coverage and by insurance company. The nice thing is that the coverage is the same for each plan regardless of the company you buy it from, so you know you are comparing apples to apples.
Scout211
@Ladyraxterinok:
This is helpful from CMS.gov.
This article lists information about costs for 2023.
The $164 you are referring to appears to be Medicare Part B (coverage for doctor’s visits).
Scout211
And here is the CMS.gov article about Medicare Advantage plans for 2023.
Ladyraxterinok
@Spanky:
Thank you
Ladyraxterinok
@Scout211:
Thank you
Ladyraxterinok
@Duke of Clay:
Thank you
Ladyraxterinok
@Duke of Clay:
Thank you
Ohio Mom
Re: Drug plans if you go the traditional Medicare route (Part D):
There is a handy-dandy site where you plug in your adress/Zip and all your medications. The site calculates and lists in order, from the cheapest, plans available to you.
This works well if you’ve been taking the same daily meds for years, for example, blood pressure and cholesterol pills. But the catch is, what happens if three months into the coverage year you develop a big, bad medical condition?
You did not include those drugs when you were entering your info! They may or may not be reasonably priced on your plan. Oh well. You now know why every time someone declares, “Medicare for All!” I start muttering, “Nope, traditional MedicAID for all!”
Sure Lurkalot
Medicare Advantage is private insurance that leeches off Medicare. I had my fill of dealing with United Health Care and the other big boys when my employer picked the offerings each year.
For straight Medicare, you pay a premium for Part B which covers doctor visits and equipment. Also need Part D prescription plan and a “gap” supplement because Medicare was designed with a “skin in the game” hole. In 2022, I paid about $330/month in premiums. Part B and D premiums are deducted from my SS benefit.
Most companies that offer Part D drug coverage have calculators that let you input the drugs you take so you can find what suits your particular needs. It’s a trade off between premium and drug cost and takes some analysis. Seeking out help via your state’s advisors is a good idea especially when first signing up.
SW
Someone persuade me that I am wrong to believe that Medicare Advantage Plans are a plot to bankrupt Medicare and enrich private insurers?
Anyone?
Ohio Mom
Other advice: We called our local Council on Aging which gave us the phone number for the state agency which gave us the number for the local volunteer coordinator who matched us up with a fellow who met us at the local library and gave us a tutorial on our Medicare options, for free.
That was a helpful start and since he wasn’t selling anything, no pressure. I believe most if not all states have similar programs.
The thing that will hang you up is future unknowns — as I explained above, Part D choices are something of a gamble because you don’t know how your relative health will evolve and what medications you might start to need going forward.
Another is, if you are on an Advantage Plan and years down the road you acquire a big, bad medical condition and you want to see the specialist who is not in your plan and you think,”Eh, I’ll just switch to traditional Medicare,” you may not be able to. Part B plans will look at you and say, “They’re crazy if they think we are underwriting THAT!” or they may agree underwrite you only at a very steep price.
IIRC, the only time your pre-existing conditions can’t be held against you is your first year in Medicare. Again, now you know why I think we should be clamoring for MedicAID for all (Because of his disability, Ohio Son has traditional Medicaid (Ohio also has HMO options) and it is the best coverage any of the three of us has ever had).
Ohio Mom
@SW: Medicare Advantage plans are definitely a racket. The NYT just had an article on this:
“The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions
By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.”
Sorry I couldn’t figure out how to create a link.
Is it aluminum foil-hat to think the big plan is to do away with traditional Medicare and force everyone into Advantage plans? I’m not wearing my hat at the moment, I don’t know.
I do feel a little pride in sticking with traditional Medicare because I am more confident that I am not complicit in defrauding the government. But I also recognize my privilege in that I can afford traditional Medicare. Friends who are on very limited budgets felt an advantage Plan was their only choice.
narya
@Spanky: Are you happy with AARP coverage? I’m looking for Medigap (for next year, not for now).
narya
@Ohio Mom: Yeah, I’ve been doing some research, and I am staying far away from Medicare (dis)Advantage plans.
Sure Lurkalot
@SW: Precisely. Our taxes pay for our government to advertise and offer plans from private insurance companies that directly compete with and leech off of traditional Medicare.
The advisor I worked with said that MA looks attractive if/when one doesn’t have a lot of issues but in the long run, it’s likely to cost more with aging and illness. And once you go the MA route, you can’t easily go back to traditional Medicare.
Butch
I had thought that Medicare Advantage was basically a way to have someone else take care of the Medicare paperwork. Maybe I need to talk to someone?
Ohio Mom
@Ohio Mom: Oops, not Part B plans, Supplemental/Gap plans. I am always mixing those two up.
Traditional Medicare:
Part A: Hospitalization
Part B: Doctor visits
Part D: Drugs
Supplemental plan, aka Gap plans (pay completely out of pocket, that is why it has no Letter): pays for what Parts A and B don’t. Since there is no cap on what you could end up paying (20% of a gazillion is a lot!), Gap plans are essential.
Gap plans are the ones who may not want to underwrite you at a reasonable cost if you try enrolling years after you’ve been in an Advantage Plan for a long time.
Part C: Advantage plans
Sorry for any confusion! Good luck to all you newbies!
Alabama Blue Dot
My husband went on Medicare 5 years before I did. Once I started, a Medicare Advantage plan saved us $400 a month over Medicare + Supplemental. We went with a Blue Cross plan because it’s a de facto monopoly in our state which means pretty much everyone is in the PPO. We are both relatively healthy, and when we travel we buy separate travel health insurance. If I understand correctly, the Medicare premiums go to the Advantage plan. The only thing that concerns me is that it looks like payments to providers are pretty low unless they are getting paid outside what I see on my statements. But TBH the main factor was the $$$ savings.
Scout211
I am in agreement with everyone here who are not fans of Medicare Advantage plans. Their narrow networks can really be a problem. And they do make a profit off of Medicare, a non-profit government program. Some plans are indeed scams and some states are worse than others in what plans they allow.
But as bad as some of them can be, they are affordable for some seniors who are only living on the barest amount of social security and really can’t afford the premiums for part B, part D and an additional supplement. Some will quality for Medicaid in some states, but not in other states.
Reform is needed. But not the Republican kind. Which means “private plans for all.”
Scout211
@Butch: No, Medicare Advantage is a Medicare plan offered by private health insurance companies that provide HMO or PPO type coverage in your area. It is less costly up front but typically has a much narrower network that often is only covered in your state. Plans do vary, though.
Make an appointment with the free Medicare advisor person in your area and they can answer all your questions.
Scout211
Here is a listing of contact information for Medicare advisors/navigators by state:
https://www.shiphelp.org/
Click the SHIP locator button and it lists all states.
Butch
@Scout211: Thanks for that. I live in an area most people have trouble finding on a map and my search for a local advisor came up blank.
frosty
After a couple of months of trying to get a straight answer I figured out Medicare Advantage is useless if you live in one state and your doctors are in another. We went with Medigap which has been great when we’ve needed health care (including surgery) on the road.
Paying out if pocket for dental and glasses is an OK compromise.
J R in WV
W worked for WV state government, specifically in environmental protection software develpment, so relatively high paying for state government work, while low paying for IT software work. Averaged out OK, and the state public employee benefit guys set up the Medicare benefits for everyone. Relatively low cost, so far. Humana is the non-Medicare provider, with a plan negotiated with the pension plan staff, so they had bargaining power in the beginning what with thousands of customers.
I was in line at my pharmacy one day recently, and the older lady in front of me asked loudly “Did the insurance not pay anything?” She was obviously upset with pricing on a specific prescription, and a more senior pharmacy tech came over to answer her questions. James opened up the folded receipt, and showed her that her insurance actually paid $2,800 on the prescription, and her copay was $780-odd.
I wasn’t eavesdropping, I sat down in the waiting area chair when it became obvious I was going to be a while, and none of them was being quiet as they discussed the situation. She wound up paying over $700 for a group of prescriptions being refilled, so no surprise there. She took the receipt to show her doctor. to be sure he was aware of her cost and could puzzle an alternative, or beg big pharma for a discount, something, whatever.
I told her while we were alone together that the best thing she could do was vote Democratic every race in every election, and she looked over and said “You sure got that right!” We were probably around the same age. My new prescription was $4.49…
Spanky
@narya: Coming back way late to answer this. We’re happy with AARP, though we haven’t really stressed it. Mrs. Spanky is doing PT for her back and IIRC the supplemental does NOT kick in to cover PT after Medicare is exhausted. Please check with your provider(s) to see what the deal will be for you.
Scout211
@Spanky: If Medicare doesn’t cover a service, your supplement will not. It’s a healthcare plan that helps pay for Medicare services, not an additional healthcare plan.
So many people get confused about this, even some healthcare workers.
la caterina
SLIGHTLY OT: I turn 65 on 9/1/23. I am still working and have health care thru my job. I’m not sure if my collective bargaining agreement requires me to enroll in Medicare when I turn 65. If I do enroll, I do it after my 65th birthday, right?
Scout211
Example: A few years ago, Mr. Scout was told by a health care provider at Quest labs that a blood test that was ordered for him would not be covered by Medicare, adding, “We will bill your secondary insurance to see if they will pay.” He went along with it, not understanding the difference between a supplement and a secondary insurance.
We ended up having to pay over $500 for that lab test.
Now I go to all of his appointments with him. I was a health care provider in my former career so some of this is easier for me to understand.
Quest Labs is particularly bad about this because I have had to correct them several times since. “No, we do not have a secondary insurance. We have a Medicare supplement. If Medicare won’t pay for this lab test, our supplement will not pay for this lab test.” Sigh.
Ohio Mom
@la caterina: IIRC, the enrollment period for people turning 65 is three months before you turn 65 and three months after.
Being covered under insurance from your employer does NOT excuse you from this deadline; you will PAY MORE (IIRC for Part B) for the rest of your life if you miss the deadline (somewhat similar concept to the penalty for not partcipatingbthat was originally part of the ACA).
Coverage is a bit different for people with employment-based coverage but you must wade through the same choices and paperwork we already-retired people do. Sorry. Better get hustling, the clock is ticking — your HR dept may be able to help you.
Ohio Mom
@J R in WV: She may have fallen into the Part D donut hole. As you probably already know, some people spend so much in the doughnut hole they eventually escape it for the last part of the year. Maybe she’ll reach that happy spot, considering how much she is spending now.
But I am not sure that being sick enough to have to buy that much medicine is cause for celebration.
sab
@Ohio Mom: And those appointments fill up fast. I called three months before I turned sixty five and the first available appointment was several months later.
Scout211
@la caterina:
Most companies do require you to enroll in Medicare at 65. But check your company’s policy.
No, sign up prior to your 65th birthday, you can do that up to 3 months before. Coverage will start on the first of the month that you turn 65. In fact, in some cases there are penalties if you sign up late. But that also depends on your company health care plan for age 65 and over. I think you are exempt from the penalty if your company pays for your health care insurance. Many companies will enroll you into an equivalent medicare supplement once you are on Medicare (that is what my husband’s company did).
Getting started with Medicare should answer most of your questions.
More information: when does Medicare coverage start
Ohio Mom
@Scout211: Thanks for the clarification. I am all for being corrected when needed.
S Cerevisiae
I am still a few years from 65 but I am on Medicare because I am on SSD. I chose traditional part A & B and because MN is a fairly civilized state I also qualify for traditional Medicaid which covers everything Medicare doesn’t. The state also pays my premiums even for the AARP prescription plan.
gus
Re: Medi-gap and Part D coverage…
I turn 65 in January ’23. I’ve been to the various CMS websites and have a pretty good idea which drug plan and which supplemental plan I’ll be signing up with in the next 2 months. My question is whether the decision that I make regarding a Medi-gap plan before 01/01/23, can be changed next year during the open enrollment period, and without any penalty? My understanding, and please correct me if I’m wrong, is that there is no penalty for switching supplemental providers; and that one Medi-gap plan ‘G’ is the same as every other plan ‘G’, correct?
Not sure whether this is true of Part D drug plans – can I switch without penalty during open enrollment in the Fall of 23?
gus
I would also like to thank David Anderson for his essential assistance to me (and many others, I’m sure) while navigating both the ACA and now Medicare. Well worth the monthly Patreon donations to John et al..
Scout211
@gus: Yes, you can change your Part D every year during the open enrollment period. Joining or changing Medicare Advantage or Medicare Part D plans
Open Enrollment Period for Medicare Advantage and Medicare drug coverage.
As for Medi-Gap part G:How to compare Medi-gap policies