# Medicare Annual Enrollment Period coming up!



## simpsontruckdriver (Oct 10, 2019)

One TINY tidbit of politics. A week or so, President Trump stated in "heaven's waiting room" (The Villages in Florida) that he is signing an executive order increasing plans and dropping prices for 2020. The problem is, at least one of the providers I sell dropped prices and increased plans in July! It's best to listen to an agent, NOT politicians.

Anyway, it's time to sit down with an agent. AEP starts on October 15, but you can talk to an agent beforehand to go over what is new and such. You can enroll in a plan then, then if you change your mind find another, repeating if needed, but the plan you're "stuck with" is the one that you're enrolled in on December 7th at 23:59:59. Where I live/sell (Orlando area), I have insurers who sell Preferred Provider Organizations (PPO) for $0 premiums, in addition to HMOs and Medicare Supplements.

TS


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## elaine (Oct 11, 2019)

question. Is someone just nothing, does their plan F supplement and drug coverage just automatically continue? If it's not being offered anymore, they would send notice, correct?


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## simpsontruckdriver (Oct 11, 2019)

Correct, all Medicare Advantage and Supplement Plans are Guaranteed Renewable. What that means is, unless your insurer says they are cancelling the plan, you will stay on it. Plan-F is no longer offered, so if the person cancels it, they lose it forever.

So, if you are OK with what you have now, don't worry about it, just keep enjoying it! If you want to change your PDP (drug) plan, that will not affect your MediGap Plan F.

TS


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## Rolltydr (Oct 11, 2019)

Since this is, by its very nature, a travel site, a word of caution about Medicare Advantage plans. Study the plans very carefully. Many plans may restrict you to in-network providers and your network may be within your state lines. So, depending on your healthcare needs, MA may not be right for you. They can be very good plans and can save you some money but they can also be a problem if you need care while away from home. Original Medicare (A & B) does not have the in-network restrictions. 


Sent from my iPad using Tapatalk


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## simpsontruckdriver (Oct 11, 2019)

In some areas, MAPD can also be PPO (Preferred Provider Organization), where you choose your providers at extra cost. Some MAPD HMOs like United and Humana allow you to go to in-network providers in another region, but only temporarily. ER, hospitalization, and dialysis are always covered out of region. Definitely ask if you plan on traveling next year!

TS


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## simpsontruckdriver (Oct 11, 2019)

But here is the thing... DO NOT use the Medicare plan finder to compare plans. Talk to an agent. Every insurer (for me, Humana, Aetna, and United Healthcare) are telling agents that the revamped plan finder is giving bad numbers (total estimated costs). We can put in your drugs and such and give you correct numbers.

TS


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## rickandcindy23 (Oct 11, 2019)

We are turning 64 in March and May, and we have already talked to the medical insurance we currently have, which is Kaiser.


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## simpsontruckdriver (Oct 11, 2019)

If you're 64 now, start planning. Like, where do you stand with life insurance, retirement accounts, etc. Medicare is 64 yrs 9 months. If your group plan is better and/or cheaper than Medicare, you can delay taking it. If it is worse than Medicare, and you choose to delay it, you're liable for a life-long penalty based on how long from 65.

For instance, my dad is 85, so he had Medicare for 20 years. In 2005, Part-D was introduced, he did not take the PDP. A year ago, he began having drugs covered, resulting in a lifetime Late Enrollment Penalty (LEP) for $40/month. I've heard of people also having a Part-A and/or Part-B LEP. Because my dad does not qualify for Low-Income Subsidy, he just has to pay it.

TS


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## artringwald (Oct 12, 2019)

The Advantage plans limit you to providers that are part of their network, although most have very large networks. The Medicare plan with supplemental works for all providers that accept Medicare no matter which state you're in when you need care. Medicare with all the supplemental options cost more/month, but has $0 copay and $0 deductibles. You never see any bills! Since we started on Medicare 5 years ago, we've had 5 joint replacement surgeries and didn't have to pay for anything except the prescriptions. For us, it certainly paid for itself.


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## bogey21 (Oct 12, 2019)

My take is that Standard Medicare with a Supplement and Plan D is a lot more flexible than most Advantage Plans but is more expensive.  Some can easily afford to take this route, some can't...

George


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## Talent312 (Oct 12, 2019)

My issue with MA plans is that, if you try to switch back to original medicare:
The supplemental plans don't have to take you and can bump up premiums.
But if you choose a supplemental initially, you get standard renewal rates.

DW is sticking with Plan F, although participants will age (driving up premiums).

My State Employee Group insurance offers a Medicare plan, which I may take.
It includes a much better drug plan than any standalone plan for Part D.
For one brand-name drug I use, it's $240/year vs. ~$800 under a Part D plan.
.


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## simpsontruckdriver (Oct 12, 2019)

Another thing about supplements. You can leave your MAPD and switch to a MediGap plan and PDP during Annual Enrollment or Open Enrollment (01/01-03/31). On the other hand, if you decide to switch MediGap plans during the year, you're subject to underwriting, which usually means no pre-existing conditions are covered.

Now, if you are under 65, disabled, and you have a MediGap plan, switching to an MAPD means you won't be able to get another MediGap plan until you hit 65.

Back to MAPDs. If you currently have End-Stage Renal Disease (Kidney failure that needs dialysis and/or need a transplant), you can not get an MAPD. If you are on an MAPD and your kidneys die, you can switch to a MediGap, but it would probably be better to stick with your MAPD until your doctors say you're no longer ESRD. That is the only pre-existing conditions plan on MAPDs.

TS


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## Luanne (Oct 12, 2019)

rickandcindy23 said:


> We are turning 64 in March and May, and we have already talked to the medical insurance we currently have, which is Kaiser.


When I was close to 65 dh and I went and talked to our State Farm agent.  He had sent me a letter.  This meeting was very informational for me as he laid out all of the options.  He did mention that State Farm has a Medicare Supplement Plan, but we were not pushed to buy it.  Dh was already on Medicare and he went with a Supplement (F) through AARP and United Healthcare.  When I turned 65 I went with the cheapest F plan I could find, which was a company called Old Surety.  The advice I'd gotten from several people was, if you are going with a supplemental plan, go with the cheapest, as they are all the same (and have to be).  Neither of us was interested in a Medicare Advantage Plan.

So, my advice is, in addition to talking to who has your current medical insurance, look around and see what is available to you after you have decided which type of plan you want.  There are independent insurance brokers out there who will help you find the cheapest one.


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## WinniWoman (Oct 12, 2019)

From what I have read from other people, always check your Part D plan coverage- even if it is the same plan because suddenly you could be paying a lot more next year for the drugs you are on. So don't automatically renew before you check this out.

I have also read some things about Humana renewing people into another plan and also trying to coerce people into Medicare Advantage plans. Be aware.


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## Luanne (Oct 12, 2019)

mpumilia said:


> From what I have read from other people, always check your Part D plan coverage- even if it is the same plan because suddenly you could be paying a lot more next year for the drugs you are on. So don't automatically renew before you check this out.
> 
> I have also read some things about Humana renewing people into another plan and also trying to coerce people into Medicare Advantage plans. Be aware.


Another piece of advice I got was to be sure to get prescription coverage.  Even if you don't need it when you take Medicare, you never know what will happen.


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## simpsontruckdriver (Oct 12, 2019)

As a Humana (and Aetna and United Healthcare) agent, I never heard of where the company itself is doing any of those things, but agents doing it is possible. If that happens, the customer can call/write their state's insurance regulator, and most likely that agent will lose his license.

On the other hand, SilverScript did that in 2012/2013. In 2013, Part-D recipients started going to pharmacies, finding out they now had a deductible. When the pharmacist and/or recipient looked at their plan, they saw the company changed them. In February of that year, Medicare came down like an Atomic Bomb on the company. They were fined a huge amount, they were not allowed to sign anyone up, and current members were allowed to switch to another company. They do not mess around!

TS


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## Passepartout (Oct 12, 2019)

Luanne said:


> Another piece of advice I got was to be sure to get prescription coverage.  Even if you don't need it when you take Medicare, you never know what will happen.


I can second this advice. We had never been big prescription users. A cheap thyroid drug for DW and some generic joint pain med for me. Period. We contemplated passing on Part D. Then in 2016, DW got an iron overload that quadrupled her spleen size, and leukemia. I had some lung issues and later, heart failure. Our drugs now total over $5,000 a month. Yes, we have a co-pay, but we are glad we signed up for part D when we started.


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## bogey21 (Oct 12, 2019)

mpumilia said:


> From what I have read from other people, always check your Part D plan coverage- even if it is the same plan because suddenly you could be paying a lot more next year for the drugs you are on. So don't automatically renew before you check this out.



This is good advice.  My Part D Provider was acquired by Aetna and they are not only increasing my monthly premium but also raising the cost of the drugs I use...

George


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## simpsontruckdriver (Oct 12, 2019)

Regarding Part-D... if you're not going to take an MAPD (either not taking Part-B or you're taking a MediGap plan), and you're healthy, talk to an agent to get the least expensive PDP. Why pay $30+/month when you can get one as low as $15/month?

TS


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## Brett (Oct 13, 2019)

yes, it's medicare open enrollment season 

"A national network of State Health Insurance Assistance Programs (SHIPs) has trained counselors to offer local, personalized assistance to Medicare enrollees and their families.   SHIPs can help answer questions about coverage, premiums, deductibles, coinsurance, or complaints and appeals. They can also advise you on joining or leaving a Medicare Advantage plan (similar to a health maintenance organization), any other Medicare plan or prescription drug plan.
*https://www.seniorsresourceguide.com/directories/National/SHIP/*


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## WinniWoman (Oct 14, 2019)

What is the best supplement plan now? I know it used to be F but that will not be offered anymore. We need to pick a plan for hubby to begin 1/1. We want the least out of pocket and want foreign travel covered, etc.  

I thought I read somewhere G was almost as good as F.  F comes up when I go on the plan finder, but I think that is for people already on it and for 2019.


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## simpsontruckdriver (Oct 14, 2019)

Yes, Plan-G is the next best thing. You pay the Part-B deductible, then the MediGap pays 100%, not including Part-D (drugs). Yeah, it can be hard to get the premiums for MediGap plans, if you're interested talk to an agent.

TS


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## WinniWoman (Oct 14, 2019)

simpsontruckdriver said:


> Yes, Plan-G is the next best thing. You pay the Part-B deductible, then the MediGap pays 100%, not including Part-D (drugs). Yeah, it can be hard to get the premiums for MediGap plans, if you're interested talk to an agent.
> 
> TS



What about N?


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## simpsontruckdriver (Oct 14, 2019)

Since I am not licensed in New York (but I can be), I can say that here in Florida, the difference in price is $36/month less for Plan-N. The difference between Plan-G and Plan-N is "N" adds a doctor and ER copay. In other words, the $0 copay is only for hospital, rehab, diagnostics, etc. And all plans, whether MAPD or MedSupp, have a $0 copay for annual exams and low/no copays for certain vaccines.

TS


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## pittle (Oct 14, 2019)

simpsontruckdriver said:


> Regarding Part-D... if you're not going to take an MAPD (either not taking Part-B or you're taking a MediGap plan), and you're healthy, talk to an agent to get the least expensive PDP. Why pay $30+/month when you can get one as low as $15/month?
> 
> TS



I will be calling Humana and changing our plans.  Neither of us take prescription drugs, but had to choose one when we went on Medicare 7 years ago. (Never have used it.) Our plan started at $12 then and gradually went up.  It went from $26.10 each in 2019 and now will be $56.30 each for 2020.  I am signing us both up for the $13.20 plan. That will save us $1000 per year for something we do not use.

We do have the AARP United Heathcare Plan F and will keep that for as long as we can.


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## simpsontruckdriver (Oct 14, 2019)

pittle said:


> I will be calling Humana and changing our plans.  Neither of us take prescription drugs, but had to choose one when we went on Medicare 7 years ago. (Never have used it.) Our plan started at $12 then and gradually went up.  It went from $26.10 each in 2019 and now will be $56.30 each for 2020.  I am signing us both up for the $13.20 plan. That will save us $1000 per year for something we do not use


In many - if not all - states, Humana has changed their pricing on PDPs as well as their MAPDs for 2020. Like you, many retirees do not need a PDP, but they're required to by law. You can either talk to an agent or call their sales lines to get it changed.

TS


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## WinniWoman (Oct 14, 2019)

simpsontruckdriver said:


> In many - if not all - states, Humana has changed their pricing on PDPs as well as their MAPDs for 2020. Like you, many retirees do not need a PDP, but they're required to by law. You can either talk to an agent or call their sales lines to get it changed.
> 
> TS



Still- what if suddenly you needed prescriptions that were expensive and you had no drug plan? Nightmare,


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## simpsontruckdriver (Oct 14, 2019)

Precisely. It may be required by law to have Part-D once you hit 65 yrs 3 months old (unless you already have Medicare-compliant drug coverage), but if/when you need an expensive medicine, you're covered.

TS


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## b2bailey (Oct 14, 2019)

artringwald said:


> The Advantage plans limit you to providers that are part of their network, although most have very large networks. The Medicare plan with supplemental works for all providers that accept Medicare no matter which state you're in when you need care. Medicare with all the supplemental options cost more/month, but has $0 copay and $0 deductibles. You never see any bills! Since we started on Medicare 5 years ago, we've had 5 joint replacement surgeries and didn't have to pay for anything except the prescriptions. For us, it certainly paid for itself.


I have Medicare plus supplemental plan and I do see my bills. Pay about $200 initially, then all the rest is covered.


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## pittle (Oct 14, 2019)

mpumilia said:


> Still - what if suddenly you needed prescriptions that were expensive and you had no drug plan? Nightmare,


We will have a drug plan (the cheap one), once we pay the $435 deductible, it will kick in - just like the others. We will most likely pay more, but will take our chances. Just because we choose not to spend it for prescription insurance does not mean that we do not have the money available.  Over the past few years, we have put what we call "Zero Balance" in all of our checking and savings accounts and add $500-$1000 each year.  That is money that is available for emergencies.  These would pay for any meds until the next time we can make changes. We have both been truly blessed with good health.  As for me, both of my grandmothers and mother lived to be 89, 91, and 90, so I am taking my chances at 72.


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## Miss Marty (Oct 15, 2019)

*Medicare Open Enrollment starts today!

Open Enrollment is October 15–December 7
*
Medicare's Open Enrollment Period is here! 

Now's the time to compare Medicare coverage options for 2020.


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## clifffaith (Oct 15, 2019)

simpsontruckdriver said:


> .
> 
> Medicare is 64 yrs 9 months.
> 
> ...



Can you explain the above? I turn 64 on December 30, 2019. Anthem/Blue Cross decided to discontinue my current plan. I had been figuring I needed to find something for 11 months, and that whatever Medicare I choose would kick in in on 12/1/2020. What does 64 years 9 months mean?


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## simpsontruckdriver (Oct 15, 2019)

That is when you can sign up for Medicare

TS


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## clifffaith (Oct 15, 2019)

simpsontruckdriver said:


> That is when you can sign up for Medicare
> 
> TS


I have a note on my calendar that says "can enroll during the seven month period that begins three months before your birthday". By now I don't know where I got that quote. Anyway I thought I'd start researching in March.


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## simpsontruckdriver (Oct 15, 2019)

You can enroll 3 months before 65, birthday month, and 3 months after. That is 7.

TS


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## Talent312 (Oct 15, 2019)

*Even if you enroll early:*
Your coverage won't start until the 1st of the month in which you turn 65.
Unless your birthday is on the 1st, then it starts the 1st of the prior month.

Examples:
(1) Mr. Green's 65th birthday is July 20, 2020. If he signs up for Medicare
in April, May, or June, his coverage will start on July 1, 2020.
(2) Mr. Kim's 65th birthday is July 1, 2020. If he signs up for Medicare
in March, April, or May, his coverage will start on June 1, 2020.

*But if you wait to enroll until the month you turn 65 or later:*
The month you turn 65 -- Coverage starts 1 month after you sign up.
1 month after you turn 65 -- Coverage starts 2 months after you sign up.
2 months after you turn 65 -- Coverage starts 3 months after you sign up.
3 months after you turn 65 -- Coverage starts 3 months after you sign up
General Enrollment Period (January 1–March 31) -- Coverage starts July 1.*
---------------------------------
_*Deferred enrollment may incur penalties, unless covered by employer plan._

Source: Medicare.gov

.


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## Rolltydr (Oct 15, 2019)

Talent312 said:


> *Even if you enroll early...*
> Your coverage won't start until the 1st of the month in which you turn 65.
> Unless your birthday is on the 1st, then it starts the 1st of the prior month.
> 
> ...


Thank you so much for posting this. So, I actually turn 65 this month. My wife has been on Medicare since January when she turned 65. She is a retired federal employee and we also have FEHB Blue Cross Standard Plan for which we pay approximately $500/month. Our plan was for me to wait until December to apply for Medicare and to change to BC/BS Basic during annual open season for federal retirees health insurance. That will drop our BC/BS premium about $200/month, more than paying for my Medicare premium. We do not need a supplemental or part D drug plan. as BC/BS takes care of most of our drug costs and for the small co-pays we do have, I also have a health reimbursement account from my previous employer that reimburses the few hundred dollars of our out of pocket costs. However, according to the info above, I will need to apply in November in order for my Medicare coverage to begin in January. 

I love TUG! I have learned so much since I joined, and oftentimes, it has nothing to do with timeshares!


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## simpsontruckdriver (Oct 15, 2019)

As I mentioned before, if you get retirement or job health benefits equal to Medicare's benefits, you can keep them if you wish and hold off on Medicare. The only time you will get a late-enrollment penalty is if you don't have Medicare-like benefits or none.

If a Medicare-eligible person has health insurance with a deductible, they can have both, where Medicare/MAPD will pay for whatever their plan doesn't, while copays for Medicare/MAPD will apply towards the health insurance deductible.

TS


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## WinniWoman (Oct 15, 2019)

My husband retires the end of this year. Already has Medicare Part A. I went to the SS office today and brought the two forms required for him to get Part B beginning January 1st. (He is not taking SS until age 70 and he is currently age 65).

Then he will go through the company's broker (Via Benefits) in November to pick a supplement and Part D. They will put $60 per month in an HRA account for him.

Then when we move to New Hampshire - which could be very early in 2020, he will have to possibly switch. What a pain...


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## WinniWoman (Oct 15, 2019)

simpsontruckdriver said:


> As I mentioned before, if you get retirement or job health benefits equal to Medicare's benefits, you can keep them if you wish and hold off on Medicare. The only time you will get a late-enrollment penalty is if you don't have Medicare-like benefits or none.
> 
> If a Medicare-eligible person has health insurance with a deductible, they can have both, where Medicare/MAPD will pay for whatever their plan doesn't, while copays for Medicare/MAPD will apply towards the health insurance deductible.
> 
> TS



I do not believe my husband can get his retiree health benefits since he is 65. He has a high deductible plan anyway and would have to pay the premiums I think, so not sure we would want it if he could. 

But I can get it and I will need it until June 2021 when I turn 65. That said, I was told by the company retirement specialist assigned to us that I will prbably be better off on COBRA as it could be less expensive. They are waiting to see what the 2020 rates will be.


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## Luanne (Oct 15, 2019)

mpumilia said:


> I do not believe my husband can get his retiree health benefits since he is 65. He has a high deductible plan anyway and would have to pay the premiums I think, so not sure we would want it if he could.
> 
> But I can get it and I will need it until June 2021 when I turn 65. That said, I was told by the company retirement specialist assigned to us that I will prbably be better off on COBRA as it could be less expensive. They are waiting to see what the 2020 rates will be.


I'm confused.  Is your husband retired?  If so, he should be able to get his retiree health benefits.

And if COBRA is less expensive for you I would be very, very surprised.  When our older dd aged out of my health insurance she could get COBRA, at about $600/month (this was back in 2014).  It was much cheaper to get her a policy through BC/BS on her own.  I have also heard from others who found COBRA to be more expensive than finding a policy on their own.


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## WinniWoman (Oct 15, 2019)

Luanne said:


> I'm confused.  Is your husband retired?  If so, he should be able to get his retiree health benefits.
> 
> And if COBRA is less expensive for you I would be very, very surprised.  When our older dd aged out of my health insurance she could get COBRA, at about $600/month (this was back in 2014).  It was much cheaper to get her a policy through BC/BS on her own.  I have also heard from others who found COBRA to be more expensive than finding a policy on their own.



He retires 12/31, but he would have to pay for the retiree health insurance. It is not company paid. Well- they say a portion of it is but the premiums are expensive. Plus it is a high deductible plan.

But I recall them saying if he is 65 he cannot get it because he is Medicare eligible. A company policy. I guess maybe it is really for younger retirees. I will clarify this with them next week when I have a conference call with the company retirement specialist or look back at my notes.

As for me, the Cobra premium is about $30 per month less than the retiree health insurance. $515 vs. $545 per month based on 2019 rates. Don't have 2020 yet. . I figure to just go that route because in 18 months (the Cobra limit)- actually 17 months since I am born in June- I will be on Medicare. Plus the broker the company uses will give me $60 per month in the HRA account once I go on Medicare and go through them for the supplement and part D, as they are doing for my husband.


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## WinniWoman (Oct 16, 2019)

So I looked on line at the retiree health coverage. It is called non Medicare retiree coverage. Great- so a lot of people have to retire later due to the FRA increase for Social Security so they cannot take advantage of it. Slick.  I also called our retirement specialist at the company and yes- the last day of work his health coverage stops dead cold. He has to have Medicare then- as it would be primary- because if he doesn't- even with retiree health coverage- he would be penalized for applying for Medicare later on or something like that. (see what the company did there?).

(The company also chopped the employees pensions a few years ago on top of this- my husband lost over $100,000+ due to this. SMH....)

So employees who retire younger than 65 can take advantage of the retiree health plan. But who can retire young if they now cut out the pensions and only have a cash balance plan that stinks? I guess just the high salaried people who can contribute huge amounts to their 401k plans or else have some kind of executive perks.

They told me hubby could take COBRA- but since he is Medicare eligible the only thing it would pay out would be the prescriptions so that would not make any sense.

I am only eligible for the retiree health plan IF my husband goes through the VIA Benefits the employer steers retirees to. If hubby gets a supplement on his own, I would not be eligible for the retiree health plan, but I could still do COBRA. He and I would then also lose the $60 each per month in the HRA. (mine I would be able to get once I went on Medicare through VIA benefits in 2021 and if hubby was still on plans through VIA benefits). (yeah- that is their big incentive- $60 per month each- LOL!- But- hey- we'll take it IF it is worth it)

I asked about the rates that VIA benefits offers on the supplements and the specialist said he heard they are competitive. Hmmm.....

I tried to go on the ACA website (for my health insurance - just to see the rates)- but living in NY with it's own health plans it directs me to the NYS website and then there they said closed for maintenance. I don't think the 2020 rates are out until November anyway.

Nothing is easy.  This whole thing gives me such a headache... There needs to be a major overhaul in this country regarding the health care system and insurance.


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## simpsontruckdriver (Oct 16, 2019)

Talk about a quagmire! I don't do anything with the ACA, but you could look up someone in your area who works with an insurer who does. But with Medicare, it sounds like that is the easiest option. Sign up at 64 yrs 9 months for Parts A & B, then sign up for a Medicare Advantage (or Supplement with Part-D) plan, and be done with it. And talk with your HSA/FSA, see if you can cancel the plan, keep the card, and then use the $$$ for Medicare copays.

TS


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## WinniWoman (Oct 16, 2019)

simpsontruckdriver said:


> Talk about a quagmire! I don't do anything with the ACA, but you could look up someone in your area who works with an insurer who does. But with Medicare, it sounds like that is the easiest option. Sign up at 64 yrs 9 months for Parts A & B, then sign up for a Medicare Advantage (or Supplement with Part-D) plan, and be done with it. And talk with your HSA/FSA, see if you can cancel the plan, keep the card, and then use the $$$ for Medicare copays.
> 
> TS



My husband is already 65. He has Medicare A and he just applied for B. 

We do have an HSA account and, of course, it is our money and I am pretty sure we can pay premiums out of it. We don't have that much money in it but it will help for a while as long as (heaven forbid) we don't suddenly have huge medical bills. Hubby couldn't contribute this year because he had Medicare A and though a way around it we decided it wasn't worth the hassle. Just as well as right now we couldn't afford it with this high rent we are paying. He even had to stop his Roth IRA contributions. He's just doing the minimum 401K match enough to get the final employer contribution for this year.


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## VacationForever (Oct 16, 2019)

@mpumilia You can get around the ACA system to get 2019 rates by indicating that you have change of life events and it will let you proceed to get current rates. 2020 rates will be available starting in Nov.  You may be eligible for premium and share of cost subsidies next year since you will both not be working.  Your income will be calculated using your mother's IRA RMD inheritance, interests and dividends from your taxable accounts and whatever amount you want to withdraw from IRA and roll into ROTH.

If you are eligible for subsidies then ACA is likely to be cheaper than COBRA and private individual health insurance.  If you are not eligible, you are most likely going to find private individual health insurance cheaper and better than ACA.  ACA rates without subsidies are always going to be most expensive and have the worst coverage, because the rates are averaged out with the healthy and the private market-rejected very sick group of people.  Without ACA subsidies, you will need to compare oranges to oranges between COBRA rates and coverages and those in the private individual market.  Insurance brokers don't get commission from ACA plans so you will first need to find out whether you will get subsidies or not using the ACA site.  If you are not going to be eligible ffor ACA subsidies, then you need to connect with broker(s) to find all available private individual market plans.

I was on ACA with full subsidies for premiums and share of cost for the one year after we retired.  My premium for their best gold plan was $161 per month and max out of pocket of $850, with $5 copay for PCP and $10 for specialists. No kidding.  However many of the best specialists in the area did not take that insurance.  I moved to the private individual market the following year and picked the best plan where I could see the best specialists -yes I have many medical issues.  Our income also would not qualify for any subsidies.  The best ACA plan which many good doctors would not accept their plan, costs more than the best plan in private individual market which has much better doctor coverage.

If what I have written above is unclear, please holler.


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## WinniWoman (Oct 16, 2019)

VacationForever said:


> @mpumilia You can get around the ACA system to get 2019 rates by indicating that you have change of life events and it will let you proceed to get current rates. 2020 rates will be available starting in Nov.  You may be eligible for premium and share of cost subsidies next year since you will both not be working.  Your income will be calculated using your mother's IRA RMD inheritance, interests and dividends from your taxable accounts and whatever amount you want to withdraw from IRA and roll into ROTH.
> 
> If you are eligible for subsidies then ACA is likely to be cheaper than COBRA and private individual health insurance.  If you are not eligible, you are most likely going to find private individual health insurance cheaper and better than ACA.  ACA rates without subsidies are always going to be most expensive and have the worst coverage, because the rates are averaged out with the healthy and the private market-rejected very sick group of people.  Without ACA subsidies, you will need to compare oranges to oranges between COBRA rates and coverages and those in the private individual market.  Insurance brokers don't get commission from ACA plans so you will first need to find out whether you will get subsidies or not using the ACA site.  If you are not going to be eligible ffor ACA subsidies, then you need to connect with broker(s) to find all available private individual market plans.
> 
> ...



Thanks. I went on the NYS website to see 2019 rates. The only thing is-how can I know what our income would be if it didn't happen yet? And how would NYS calculate it then? We will not have salaries- true.

We were originally planning to only withdraw money from our taxable accounts. Yes- I do get the RMD from mom's inheritance iRA. It is small. But I don't know the amount until next June.


----------



## WinniWoman (Oct 16, 2019)

You know what? I just thought of something and that is since we will be moving out of state, getting the ACA coverage in NY- since it has to go through the NYS website- would not be a good idea. I would then have to switch again mid year or even sooner. His company plan is good everywhere, though it is a high deductible/high premium. 

(Of course, my husband will also have to do so with his medicare supplement, unless maybe the company he gets the supplement with will also be in NH.)


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## VacationForever (Oct 16, 2019)

mpumilia said:


> Thanks. I went on the NYS website to see 2019 rates. The only thing is-how can I know what our income would be if it didn't happen yet? And how would NYS calculate it then? We will not have salaries- true.
> 
> We were originally planning to only withdraw money from our taxable accounts. Yes- I do get the RMD from mom's inheritance iRA. It is small. But I don't know the amount until next June.


It is called estimated income.  You look at how much interests and dividends from taxable accounts that you have been getting each year and adjust for changes in withdrawal of principal or deposits.  There is a table for inherited IRA RMD, percentages based on your age, and you can estimate 2019 year end balance in the IRA account.  You will need to decide how much you want to rollover from IRA to Roth.

The nice thing is if you underestimate and get subsidies for both premiums and share of cost, you will need to make up additional premium payment only and not share of cost when you file 2020 IRS returns.


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## VacationForever (Oct 16, 2019)

Duplicate


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## VacationForever (Oct 16, 2019)

mpumilia said:


> You know what? I just thought of something and that is since we will be moving out of state, getting the ACA coverage in NY- since it has to go through the NYS website- would not be a good idea. I would then have to switch again mid year or even sooner. His company plan is good everywhere, though it is a high deductible/high premium.
> 
> (Of course, my husband will also have to do so with his medicare supplement, unless maybe the company he gets the supplement with will also be in NH.)


Hassle or not has to do with how much it is worth to you to save money. I saved about $12K that year on ACA.

Changing coverage to a different state is trivial.  It is called change of life event.  If you start and continue with ACA, you just go to NH version of ACA.  Same thing with private insurance.


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## WinniWoman (Oct 16, 2019)

VacationForever said:


> It is called estimated income.  You look at how much interests and dividends from taxable accounts that you have been getting each year and adjust for changes in withdrawal of principal or deposits.  There is a table for inherited IRA RMD, percentages based on your age, and you can estimate 2019 year end balance in the IRA account.  You will need to decide how much you want to rollover from IRA to Roth.
> 
> The nice thing is if you underestimate and get subsidies for both premiums and share of cost, you will need to make up additional premium payment only and not share of cost when you file 2020 IRS returns.



Really, this is all too much for me. I still have to consult with our FA in November to see exactly how we are going to live on our savings and from which accounts and how much to withdraw. Last time he said regular savings and brokerage (mostly bond funds). I don't remember if we are doing Roth conversions. All our tax returns are packed and sealed away for the move. Everything is a blur. Forget my husband. He is out of it altogether in this area so no help from him.

I have a massive headache now. I do remember our FA telling me last spring that probably the best solution would be to just do the RMI.

I am not sure what you mean by additional premium payment vs. share of cost.

I did put in different numbers in terms of income for the subsidies. Looks like i could save maybe $200- $300 per month- but the plans look like HMO's. Still no small chunk of change.  So we are talking something like $345 instead of $545 or something like that let's just say. So $4140 for the year vs. $6540 for the Cobra or retiree plan maybe. Or if we show really little income- like $25,000 or less- than it would be nothing. But then you have the who takes this insurance factor also.


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## VacationForever (Oct 16, 2019)

mpumilia said:


> Really, this is all too much for me. I still have to consult with our FA in November to see exactly how we are going to live on our savings and from which accounts and how much to withdraw. Last time he said regular savings and brokerage (mostly bond funds). I don't remember if we are doing Roth conversions. All our tax returns are packed and sealed away for the move. Everything is a blur. Forget my husband. He is out of it altogether in this area so no help from him.
> 
> I have a massive headache now. I do remember our FA telling me last spring that probably the best solution would be to just do the RMI.
> 
> I am not sure what you mean by additional premium payment vs. share of cost.


You can ask your FA to do all these for you. Just show him my posts.

Premium is what you pay each month for health insurance coverage.  Share of cost in the context of ACA is for yearly maximum out of pocket including any deductibles.  You said you paid alot for colonoscopies.  Every dollar you pay for medications, deductibles and copays count towards yearly maximum out of pocket.  With my maximum subsidies, my max out of pocket in that year was capped at $850.


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## Talent312 (Oct 16, 2019)

When I enroll in Medicare (early next year)...

I can stay on my employee/retiree plan. It becomes secondary with a lower premium.
But a Medigap Plan G & Plan D (+drug costs) would cost about $1200/year less.

One my drugs (a brand name) costs $240 with the group plan and $1200 w/Part D.
But the employee/retiree plan is still $1200/year more expensive.

At least I still have a few more months to ponder.
.


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## WinniWoman (Oct 16, 2019)

VacationForever said:


> Hassle or not has to do with how much it is worth to you to save money. I saved about $12K that year on ACA.
> 
> Changing coverage to a different state is trivial.  It is called change of life event.  If you start and continue with ACA, you just go to NH version of ACA.  Same thing with private insurance.



I do not think it is that simple. We first of will be in a middle of moving and all the stress and logistics and work that it entails.  I can see it as a major headache. You still have to evaluate the plans and so on. Every state is different. I already am not finding it easy just looking at the NYS plans on line.  I put in, for example, a $40,000 per year income and it said maximum out of pocket $6500. The premiums would vary for $20 to $200 per month depending on the Bronze plan. If I put in a lower income it says call as might qualify for very low or no cost coverage.

I just don't get it.


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## VacationForever (Oct 16, 2019)

mpumilia said:


> I do not think it is that simple. We first of will be in a middle of moving and all the stress and logistics and work that it entails.  I can see it as a major headache. You still have to evaluate the plans and so on. Every state is different. I already am not finding it easy just looking at the NYS plans on line. All the NYS plans are Bronze that come up. I put in, for example, a $40,000 per year income and it said maximum out of pocket $6500. The premiums would vary for $20 to $200 per month depending on the plan. But all are Bronze- just a few different plans and companies. If I put in a lower income it says call as might qualify for very low or no cost coverage.
> 
> I just don't get it.


If you put in something like $24K you will see a huge difference.  The question is whether your 2020 income will be close to that number.  Your FA should be able to help you.


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## WinniWoman (Oct 16, 2019)

VacationForever said:


> If you put in something like $24K you will see a huge difference.  The question is whether your 2020 income will be close to that number.  Your FA should be able to help you.



Yes- When I put in a figure like that it says to call because may qualify for low or no cost rates. Doesn't bring up rates.

None of the Silver or Gold plans seem to cover out of network I noticed.


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## VacationForever (Oct 16, 2019)

mpumilia said:


> Yes- When I put in a figure like that it says to call because may qualify for low or no cost rates. Doesn't bring up rates.
> 
> None of the Silver or Gold plans seem to cover out of network I noticed.



If you put in so low that it falls into Medicaid, that is what the message is.  Try bumping it to $27K or so.  Do you need out of network?  You will simply have to redo when you move to NH due to life change event.  $24K was what I had used for 2017 but poverty level is adjusted each year and I have not spent anytime to look at 2019 as ACA is no longer of use to me.


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## WinniWoman (Oct 16, 2019)

VacationForever said:


> If you put in so low that it falls into Medicaid, that is what the message is.  Try bumping it to $27K or so.  Do you need out of network?  You will simply have to redo when you move to NH due to life change event.  $24K was what I had used for 2017 but poverty level is adjusted each year and I have not spent anytime to look at 2019 as ACA is no longer of use to me.



I had to bump it to $35,000 to get rates. I wanted out of network option just in case, but they don't seem to have that. This is what I mean- not simple. I have been on line on the NYS site comparing and ugh..


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## WinniWoman (Oct 30, 2019)

Should my husband choose part F or Part G? He is eligible for Part F but I keep hearing about rising premiums....

And what is a good Part D plan., I am very confused with the prescription plans.What is this $435 deductible? Crazy...


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## simpsontruckdriver (Oct 30, 2019)

Part-G, since Part-F will no longer be available on January 1st. They do have a High-Deductible Plan-F, where the person pays "Basic Medicare" deductibles + 20% up to the plan's deductible, which is around $2300. If the person hits that deductible, the rest is $0.


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## bogey21 (Oct 30, 2019)

My recollection is that the deductible on my High Deductible Plan F is something South of $3,000.  I'm a little fuzzy on the exact amount  as my health is good and the amounts I pay out of pocket are so small it never comes into play for me...

George


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## simpsontruckdriver (Oct 30, 2019)

Essentially, health is the biggest factor with MediGap plans. Very healthy? Plan-HDF (High-Deductible F). Health issues requiring more than one doctor/specialist/diagnostics per year? Plan-G. The easiest way to get up-to-date numbers is to talk to an agent or call United Healthcare, as they are the nation's largest MediGap provider.

TS


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## WinniWoman (Oct 30, 2019)

simpsontruckdriver said:


> Part-G, since Part-F will no longer be available on January 1st. They do have a High-Deductible Plan-F, where the person pays "Basic Medicare" deductibles + 20% up to the plan's deductible, which is around $6500. If the person hits that deductible, the rest is $0.



Since my husband was eligible for Medicare Part A in 2019 he is eligible to enroll in Part F - the regular one or the high deductible one-for 2020.


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## WinniWoman (Oct 30, 2019)

bogey21 said:


> My recollection is that the deductible on my High Deductible Plan F is something South of $3,000.  I'm a little fuzzy on the exact amount  as my health is good and the amounts I pay out of pocket are so small it never comes into play for me...
> 
> George



You are right, George. It is $2300.


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## simpsontruckdriver (Oct 30, 2019)

If he is eligible, again, it is what you can afford. Deductible or not. All MediGap providers like United offer the same plans and deductibles, premiums and extras vary. Since rarely do I get anyone interested in MediGap plans, my numbers could be off so I changed them above.

TS


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## WinniWoman (Oct 30, 2019)

My husband's health is good right now thankfully. The only difference with G is the Part B deductible $185  outlay, but the premiums are similar. Hey- $185 is $185. I am just not sure what to do because people keep saying that the F premiums are going to rise over time and so forth.

G premium is $210 per month and F is $230. Both Empire. I guess either way- the F you lay out $20 more per month for the premium. With G you lay out up to about $15 per month for the deductible IF you use it.

Then again, I assume the Part B deductible can go up?


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## WinniWoman (Oct 30, 2019)

Looking at these Part D plans is crazy. Ok, so you know what drugs you are currently on, but you have no way of knowing what you COULD be on in the future. So how can you really compare plans other than looking at the deductible and copays and pharmacies and mail order? So I am assuming if you are ok with those, then choosing the cheapest option is the best?

To think- we will be moving early in the beginning of the year and have to immediately change these again. Has to be a better way usa.....


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## simpsontruckdriver (Oct 31, 2019)

Nope, all Medicare insurers have different plans for every zip code in the USA. So, if a person moves within their zip code, they do not have to change plans. Moving outside usually requires a new plan. With Medicare Supplements, you can keep your plan BUT the premiums may change. And depending on your state, your premiums are either fixed at when you first sign up or rise based on age. Florida is one that is fixed based on age. If a Floridian signs up for a MedSupp at 65 and keeps it for a decade, premiums won't go up much (any premium rise must be given the OK by the state legislature). In some states, premiums rise yearly.

In terms of Part-D plans, other than varying by zip code, you can estimate current drug costs, and future drug costs, based on levels. For example, if you develop something, you should start out on a generic if available. A lot of times, if a doctor prescribes a name-brand drug, the drug maker gives them a commission/kickback. If you develop cancer, since most chemotherapy is done in-office, those are always 20% (Part-B). So, once you get your new plan materials, save it and keep it handy until you change plans.

TS


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## WinniWoman (Oct 31, 2019)

simpsontruckdriver said:


> Nope, all Medicare insurers have different plans for every zip code in the USA. So, if a person moves within their zip code, they do not have to change plans. Moving outside usually requires a new plan. With Medicare Supplements, you can keep your plan BUT the premiums may change. And depending on your state, your premiums are either fixed at when you first sign up or rise based on age. Florida is one that is fixed based on age. If a Floridian signs up for a MedSupp at 65 and keeps it for a decade, premiums won't go up much (any premium rise must be given the OK by the state legislature). In some states, premiums rise yearly.
> 
> In terms of Part-D plans, other than varying by zip code, you can estimate current drug costs, and future drug costs, based on levels. For example, if you develop something, you should start out on a generic if available. A lot of times, if a doctor prescribes a name-brand drug, the drug maker gives them a commission/kickback. If you develop cancer, since most chemotherapy is done in-office, those are always 20% (Part-B). So, once you get your new plan materials, save it and keep it handy until you change plans.
> 
> TS



Good to know about the fixed premiums. So then, if one is lucky enough to be in a state that has fixed premiums, there should be no concerns about Part F premiums skyrocketing? I have to check into this for NY and New Hampshire.

So I guess the plans that are community rates are obviously not one of those and the ones we are looking at right now in NY are community rated.

Goes to show ya- things are more involved than they seem.


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## WinniWoman (Oct 31, 2019)

OK. I found this. New Hampshire is like Florida. Still- convoluted system. As far as I can tell- you can't win to lose whether or not you get an attained age policy, an issue age policy or a community rated policy. 

https://mymedicaresupplementplan.org/attained-age-vs-issue-age-vs-community-rated-medigap-plans/


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## WinniWoman (Oct 31, 2019)

bogey21 said:


> My recollection is that the deductible on my High Deductible Plan F is something South of $3,000.  I'm a little fuzzy on the exact amount  as my health is good and the amounts I pay out of pocket are so small it never comes into play for me...
> 
> George




George- I am curious, other than the lower premiums, what was your thinking in choosing High deductible F over regular F or G?


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## bogey21 (Oct 31, 2019)

mpumilia said:


> George- I am curious, other than the lower premiums, what was your thinking in choosing High deductible F over regular F or G?



Pretty much it is simple math.  First, I am healthy and have few medical bills.  The small amounts I have to pay above what Simple Medicare pays          (because I have a High Deductible Plan F)  when added up are less that the premium difference between Regular Plan F and High Deductible Plan F times 12...

George


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## WinniWoman (Oct 31, 2019)

bogey21 said:


> Pretty much it is simple math.  First, I am healthy and have few medical bills.  The small amounts I have to pay above what Simple Medicare pays          (because I have a High Deductible Plan F)  when added up are less that the premium difference between Regular Plan F and High Deductible Plan F times 12...
> 
> George



So a gamble that you remain healthy for most of your life and save on the premiums. I understand. I was considering it for my husband, but that $2300 deductible bothers me. Plus, they could increase the deductible over time?


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## simpsontruckdriver (Oct 31, 2019)

With Medicare Supplements, yes, premiums and deductibles can go up, but state legislature must approve it. I know you've heard of your electric company or other utility company asking your state legislature to raise rates. It's the same thing, MediGap companies must ask the state to raise rates/deductibles. Medicare Supplements are regulated by your state, while Medicare Advantage Plans (with/without drugs) are regulated by Centers for Medicare and Medicaid Services (CMS - aka "Medicare").

TS


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## bogey21 (Oct 31, 2019)

mpumilia said:


> So a gamble that you remain healthy for most of your life and save on the premiums. I understand. I was considering it for my husband, but that $2300 deductible bothers me.* Plus, they could increase the deductible over time*?



The deductible has in fact increased almost every year but the money I have saved over the 10 years of so I have had the plan has been significant.  I'm guessing but I think if my health starts heading South I can switch to Plan G...

George


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## WinniWoman (Oct 31, 2019)

bogey21 said:


> The deductible has in fact increased almost every year but the money I have saved over the 10 years of so I have had the plan has been significant.  I'm guessing but I think if my health starts heading South I can switch to Plan G...
> 
> George



When you switch don't you have to undergo underwriting?


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## bogey21 (Oct 31, 2019)

mpumilia said:


> When you switch don't you have to undergo underwriting?



I don't know.  My guess, purely a guess, is I don't if I stay with the same company.  But I could be way off base here...

George


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## Luanne (Oct 31, 2019)

mpumilia said:


> When you switch don't you have to undergo underwriting?


I need a better understanding of what all underwriting entails.  I've had to go through a series of questions when I've changed carriers (but not plans) the last two years.


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## WinniWoman (Oct 31, 2019)

bogey21 said:


> I don't know.  My guess, purely a guess, is I don't if I stay with the same company.  But I could be way off base here...
> 
> George



I think you are right. A new company will ask questions for their underwriting and that will determine the premium. I also read somewhere that you can downgrade from a plan (like an F to a G) but not upgrade. 

Craziness...my brain has been on overdrive for days. LOL!


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## Talent312 (Oct 31, 2019)

I haven't seen a Plan D plan with a reasonable premium that covers expensive brand-name drugs well. For those with the $435 standard deductible, I'd pay that p-front in January, with a total cost of ~$1100/year.

I'g gonna see if an Advantage Plan can provide better coverage.
The drug may go generic in 2022, so maybe I should tuff it out.
.


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## Luanne (Oct 31, 2019)

mpumilia said:


> I think you are right. A new company will ask questions for their underwriting and that will determine the premium. I also read somewhere that you can downgrade from a plan (like an F to a G) but not upgrade.
> 
> Craziness...my brain has been on overdrive for days. LOL!


I can't seem to find anything that talks about whether or not you can upgrade.  Everything I've seen just talks about changing Medigap plans.


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## WinniWoman (Oct 31, 2019)

Luanne said:


> I can't seem to find anything that talks about whether or not you can upgrade.  Everything I've seen just talks about changing Medigap plans.


 

I cannot remember where I read it. I have been reading so much about this these past few days I am going loony.


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## simpsontruckdriver (Oct 31, 2019)

Underwriting is ONLY if you are changing MediGap plans between AEPs (between January 1 and October 14). When turning 65 or during AEP, you can join or up/downgrade MediGap without underwriting. If you disenroll from an MAPD plan during Open Enrollment (January 1 - March 31), you won't have to go through underwriting. Underwriting is similar to older Group Plans, with pre-existing conditions not covered (MediGap plans outside Annual Enrollment Periods are exempt from the Affordable Care Act ban on pre-existing conditions).

Essentially, just do like MAPD plans and enroll/change during AEP or certain Special Enrollment Periods (SEPs), and you won't have any concerns with underwriting.

TS


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## simpsontruckdriver (Oct 31, 2019)

mpumilia said:


> I cannot remember where I read it. I have been reading so much about this these past few days I am going loony.



Yeah, but on the other hand, everyone who has questions about Medicare in 2020 are getting their questions answered!

TS


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## DancingWaters (Oct 31, 2019)

We have just went through these supplemental choices the last 4 months and I read everything and called everyone asking questions so I would make the best choice..   I went with my retirement supplemental—-only time will tell if I made the right choice.  My husband went and talked to 1 insurance lady and signed up for the G plan with a company that has Silver Sneakers.  I was shocked since he hates to exercise and shocked he made his decision so effortlessly.   Should he have picked the F Plan?


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## WinniWoman (Oct 31, 2019)

DancingWaters said:


> We have just went through these supplemental choices the last 4 months and I read everything and called everyone asking questions so I would make the best choice..   I went with my retirement supplemental—-only time will tell if I made the right choice.  My husband went and talked to 1 insurance lady and signed up for the G plan with a company that has Silver Sneakers.  I was shocked since he hates to exercise and shocked he made his decision so effortlessly.   Should he have picked the F Plan?



That is what we are trying to decide. As for what the insurance company offers- like Silver Sneakers- I can't even see where that information is online.

And not for anything, but with VIA Benefits- only a couple of insurance companies come up! Not like there are lots of choices! But I do have an appt. with Via Benefits in a couple of weeks so I can ask about that as well.


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## DancingWaters (Oct 31, 2019)

Hmmm, what are VIA Benefits? My husband went with Anthem BC/BS for his plan G. (They had the silver sneakers he wanted) In Ohio it was $118 @ month.  Then he went with WellCare for his prescriptions since he’s only on one cheap pill.  That costs $15 @ month, but I can’t remember his deductible on that. He’s then is waiting a year to get dental and vision insurance since he just had all those appointments under his work.   I also have the silver sneakers and use the YMCA a couple times a week for an aqua ice class and aqua Zumba.   Hopefully we are both covered medically. Moving toward getting a few other things in order.  Time consuming decisions for sure.


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## WinniWoman (Nov 1, 2019)

DancingWaters said:


> Hmmm, what are VIA Benefits? My husband went with Anthem BC/BS for his plan G. (They had the silver sneakers he wanted) In Ohio it was $118 @ month.  Then he went with WellCare for his prescriptions since he’s only on one cheap pill.  That costs $15 @ month, but I can’t remember his deductible on that. He’s then is waiting a year to get dental and vision insurance since he just had all those appointments under his work.   I also have the silver sneakers and use the YMCA a couple times a week for an aqua ice class and aqua Zumba.   Hopefully we are both covered medically. Moving toward getting a few other things in order.  Time consuming decisions for sure.



VIA Benefits is essentially a broker that his employer uses but anyone can use. The benefit for us going through them is his employer will deposit $60 per month in a HRA for him (and me when I turn 65 and am on Medicare and go through VIA benefits for my plan- so $120 per month total.)

Also- Each state has different insurance companies for these Medigap policies. For example- NY does not have Anthem, but NH does. This is what is making things difficult for us to decide. Can we switch- let's say- to Anthem in NH when we move since Empire Blue Cross is not in NH? NY has Humana and NH has Humana- but in NY- the Humana plans are much more expensive since they are not community rated from what I can tell. Should we go with them anyway since we want to switch when we move? Will Humana then lower the rate we pay? NH Medigap policies are cheaper.

I don't care much about things like Silver Sneakers, though I have a friend that loves it. I am not even sure where/if one is held where we are moving. To me good medical coverage is the priority. I have exercise equipment at home and can take walks. But I would like to join a class or a gym- just doesn't seem to be any close by where we are going to live.

It doesn't matter which insurance company you go with except for the rates, since all the Medigap plans are the same.

Yeah- we are probably picking the Wellcare plan-though it is really hard to compare these drug plans, but moving to NH we will have to start over with another one. We never take vision insurance and we will not be taking dental insurance unless I see something great on the market- which I doubt exists with dental. I know the dental Cobra was very expensive, like $80 per month for the 2 of us.

It's crazy because by the time we get this insurance we will most likely be moving- probably in January or February and then have to change.


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## simpsontruckdriver (Nov 1, 2019)

You mentioned only BCBS and Humana. I am pretty sure United Healthcare/AARP MediGap policies are available in most of the United States. Anyway, for those who have a Medicare Supplement plan in any state except Massachusetts or Wisconsin, this article may help you decide. Essentially, call your MediGap plan for information.

TS


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## MULTIZ321 (Nov 1, 2019)

mpumilia said:


> VIA Benefits is essentially a broker that his employer uses but anyone can use. The benefit for us going through them is his employer will deposit $60 per month in a HRA for him (and me when I turn 65 and am on Medicare and go through VIA benefits for my plan- so $120 per month total.)
> 
> Also- Each state has different insurance companies for these Medigap policies. For example- NY does not have Anthem, but NH does. This is what is making things difficult for us to decide. Can we switch- let's say- to Anthem in NH when we move since Empire Blue Cross is not in NH? NY has Humana and NH has Humana- but in NY- the Humana plans are much more expensive since they are not community rated from what I can tell. Should we go with them anyway since we want to switch when we move? Will Humana then lower the rate we pay? NH Medigap policies are cheaper.
> 
> ...


Hi MaryAnn,

It seems to me you should be able to get answers to these questions if you talk to a licensed insurance agent.  A phone number is listed in the article about moving out of state posted by SimpsonTruckdriver in the next post.


Richard


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## WinniWoman (Nov 1, 2019)

MULTIZ321 said:


> Hi MaryAnn,
> 
> It seems to me you should be able to get answers to these questions if you talk to a licensed insurance agent.  A phone number is listed in the article about moving out of state posted by SimpsonTruckdriver in the next post.
> 
> ...



Yes. I did mention in another post that I have an appt. with them in a few weeks.


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## WinniWoman (Nov 1, 2019)

simpsontruckdriver said:


> You mentioned only BCBS and Humana. I am pretty sure United Healthcare/AARP MediGap policies are available in most of the United States. Anyway, for those who have a Medicare Supplement plan in any state except Massachusetts or Wisconsin, this article may help you decide. Essentially, call your MediGap plan for information.
> 
> TS



I mentioned them because that is what VIA benefits offers for the F and G plans and others- 9 plans altogether for supplements. (BTW- the price of BCBS is the same as AARP United Healthcare in NY.) Again- we are usign Via Benefits because then my husbands employer will contribute to an HRA for us every month.


----------



## coachBoris (Nov 2, 2019)

simpsontruckdriver said:


> One TINY tidbit of politics. A week or so, President Trump stated in "heaven's waiting room" (The Villages in Florida) that he is signing an executive order increasing plans and dropping prices for 2020. The problem is, at least one of the providers I sell dropped prices and increased plans in July! It's best to listen to an agent, NOT politicians.
> 
> Anyway, it's time to sit down with an agent. AEP starts on October 15, but you can talk to an agent beforehand to go over what is new and such. You can enroll in a plan then, then if you change your mind find another, repeating if needed, but the plan you're "stuck with" is the one that you're enrolled in on December 7th at 23:59:59. Where I live/sell (Orlando area), I have insurers who sell Preferred Provider Organizations (PPO) for $0 premiums, in addition to HMOs and Medicare Supplements.
> 
> TS


You seem to know a lot about this subject.  I am only 58 and retired Army so I will have Tricare for Life and believe I have to enroll in Medicare Part B.  Can you explain options for retired military?  I like to be informed and plan ahead.  Currently I have Tricare Prime and a supplemental group plan for copays through the Military Officers Association of America (MOAA), works great for my wife (49) and I (58).


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## simpsontruckdriver (Nov 2, 2019)

Well, a lot can change in the next 7 years. In terms of medical, when you hit 64 years 9 months (or 3 months before your 65th birthday), talk to your TriCare benefits person. Right now, some veterans who have VA benefits take Medicare Parts A & B, then they take just a Medicare Advantage plan without drugs. In that respect, they go to any private Medicare doctor, but let the VA take care of the prescriptions. On the other hand, if your Tricare benefits match or exceed Medicare benefits for less, you don't have to take Medicare.

TS


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## csxjohn (Nov 2, 2019)

I chose to go with a UHC Medicare Advantage plan.  It costs me about $21 per month.  I'm now 72 so its been 7 years of payments.  When we looked at the costs we factored in that we are both very healthy and seldom see doctors for problems knowing that may change in the future. Over those 7 years my monthly payments would have been much higher than what I've spent had I gone with a supplement plan.

With my plan I have an out of pocket maximum of around $3,600 to $3,900.  When looking at the monthly cost of a medicare supplement plan plus a drug plan we felt this would end up being cheaper.  I pay $5 for my Primary Care Physician and $25 for specialists.

I had two total knee replacements last year.  The total amount I paid the hospital and doctor was $900 total  for both and another $600 for physical therapy sessions so under $2,000 total, not even close to the $3,600. 

So for me the advantage plan is way cheaper then paying the high monthly costs for the supplement plans.  Plus my drugs are included as well as eye care and dental.  I also get free rec center visits and UHC gives us $320 per year to purchase health care products from them.  This includes thinks like canes, toilet seats, bathtub grab rails,  bandages and band aids, ibuprofen, sea sick pills, hand lotion and a whole slew of things like that.

So for my circumstances the advantage plan is much more cost effective.  The supplement plans would have been over $2,400 per year so we gambled that we would not pay over that the majority of the years.  I don't recall the exact amount we would have been paying but it just seemed to us that worst case we might have to pay more in some years but the other years would make up for it

It's has worked out to our advantage so far.


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## bogey21 (Nov 2, 2019)

No question that Medicare Advantage is cheaper.  I go the traditional Medicare, Supplement, Plan D route to have maximum flexibility but I pay more for it.  Why do I do it?  Because the cost difference is not important to me.  To each his own...

George


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## csxjohn (Nov 2, 2019)

bogey21 said:


> No question that Medicare Advantage is cheaper.  I go the traditional Medicare, Supplement, Plan D route to have maximum flexibility but I pay more for it.  Why do I do it?  Because the cost difference is not important to me.  To each his own...
> 
> George


Exactly, everyone's situation is different.  I wasn't trying to convince anyone how to go, just what I did and why.


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## VacationForever (Nov 2, 2019)

My husband has Aetna Medicare Advantage Select PPO and it is working out very well.  We have not found any doctor or specialist who is not in the network. It also covers out of state local PPO network, as well as overseas medical care if necessary, but we buy a medical and evacuation separate policy for the latter, regardless.

It includes a $75 per quarter OTC medical allowance, Silver Sneakers and twice a year dental cleaning and dental coverage up to $1000.  His premium is $67 per month for this year and next year it is going to $70+ per month.


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## simpsontruckdriver (Nov 2, 2019)

In terms of Medicare Advantage plans, they vary by zip code. For instance, I am working with a disabled (under-65) woman in Spokane WA to find her a good Medicare Advantage plan. Here in the Orlando area, she could get a Humana PPO for $0 premium, and because her meds are all generic, she could pay $0 for medicines with mail-order. Out there, PPOs from Humana and Aetna have a $100-ish/month premium. HMOs are inexpensive, but her doctors are not in the Humana network, only a couple take United Healthcare, and most take Aetna. Her only specialists are Ob/Gyn, chiropractor, and psychiatrist (neither require a referral). All plans from my 3 plans pay for mental health care.

Or, my sister-in-law who lives in Thousand Oaks CA is now Medicare-eligible. If she joined up with any of "my" Medicare Advantage plans, she would have an additional premium HMO. There are no PPOs in that part of Southern California, even in plans that I do not offer.

Or, I had a Medicare-eligible guy ask me a couple years ago about Mount Shasta CA. They do not have one single MAPD. They're only eligible for a Medicare Supplement + PDP. He was on our company's HSA plan and is not retired. The reason is, his area had a PFFS (Paid Fee For Service) plan through United, but they stopped offering it. PFFS is like a PPO, they can go to any doctor who accepts Medicare, BUT the doctor can deny that one plan if they choose.

So, if you look at any posts of people here saying they have x benefits with their MAPD with a certain company, your area's benefits are most likely different.

TS


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## WinniWoman (Nov 3, 2019)

I know I am hammering on about this, but I have thus far spoken with 4 different agents- 2 at via benefits and two at Empire BCBS and none of them know anything regarding my specific question- "when you move to another state with Medigap, will the insurance company adjust the rate once you notify them of the new zip code?

So much for agents- no offense to simpsontruckdriver- I know more than the ones I spoke to. I was an account executive for a health insurance company, so it is not like I am wet behind the ears- though I did not work with Medicare- I did commercial lines for large (and some small) employer groups many years ago.

Anyway, the VIA benefits agent said I should just call them after I move- have to get the Part D changed- that I knew- and then they will find me another M plan in NH. He said not to even call Empire. Ummm- NOT!

I did find something online that said to call the carrier 30 days before you move so they can tell you what your new rate will be. I mean- why change the plan and insurance carrier if you don't have to- especially if there is a possibility the rate will go down? That is what I am hoping for.

Also- not one of them even explained to me that Empire BCBS is the same company as Anthem BCBS (which is the equivalent in NH). I found this out on line myself. In fact- if I go on Empires website and put in the NH zip code, it immediately brings me to the Anthem website with the quotes! (Excellent website Empire has BTW)

So there you go- this is why I am on forums like this (and others) asking questions rather than depending on agents. One agent at BCBS simply told me he didn't know. Offered no help to find out. Was like talking to a dead rag.

For the life of me I don't understand how an agent would not know the answer to this simple question. It's not like people over 65 with a Medigap plan never move to another state!

And the customer service agents- reading a script that has nothing to do with anything. They cannot think for themselves. I had to tell one to stop dead in her tracks and just get me to someone who can answer the question. But no- they have to go through an entire script for 20 minutes (after your 10 minute phone menu) asking for all kinds of info like your name and address and date of birth, etc. - when all you have is a generic question-only to tell you they don't know anything.

Bottom line- when we move I am going to notify SS and the insurance carrier and then I am going to see what the rate is- hopefully they will be able to tell me- or I will wait for the bill- and then call VIA Benefits for the new Part D drug plan.

I have an appt on 11/20- via phone- I *have to call *VIA BENEFITS and speak to a particular agent. Yet when I was on the phone with them the other day an agent admitted that none of the agents have direct lines anyway and he could enroll me right then. Really? I could really just sign up on line for my husband and get it done, but I do want to know more about the HRA account. I might just call them againbefore 11/20 and get it done.

Meanwhile- I have done all the work and they will get the commission...Wait until I ask them about the drug plans and find out what they don't know....SMH....


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## simpsontruckdriver (Nov 3, 2019)

I understand... I am not familiar with Blue Cross Blue Shield, and there are plenty of issues why I can't be appointed with them. MediGap plans for the subscriber is pretty simple on one point: the plans have the same benefit. But, different areas have different premiums and regulations on signing up. There's not much else I can say, other than sometimes the consumer has more information than the agent. And after the last couple posts here, I saw the same information: call them near the moving date to get your new premiums.

As a side note, I used to work for AARP/United Healthcare call center, so I know that scripts are to be followed, and most of them are required by CMS ("Medicare"). Essentially, "go with the flow", then ask away once everything is in their system. It stinks, but they're following federal regulations. Even as an independent agent, if I do a telephonic sign-up, I have to follow the script word-for-word. I know you were not calling to sign up, maybe there is a different customer service number?

TS


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## MULTIZ321 (Nov 3, 2019)

mpumilia said:


> I know I am hammering on about this, but I have thus far spoken with 4 different agents- 2 at via benefits and two at Empire BCBS and none of them know anything regarding my specific question- "when you move to another state with Medigap, will the insurance company adjust the rate once you notify them of the new zip code?
> 
> So much for agents- no offense to simpsontruckdriver- I know more than the ones I spoke to. I was an account executive for a health insurance company, so it is not like I am wet behind the ears- though I did not work with Medicare- I did commercial lines for large (and some small) employer groups many years ago.
> 
> ...


Hi MaryAnn,

You probably have already looked at the New Hampshire Medicare Supplemental Insurance - NH.gov Website. They have a PDF File that has a lot of info. Here's a copy and paste of some info that has some phone numbers you probably would be interested in:




NH.gov › 2019_medsupratesPDF
*Web results*
New Hampshire's Guide to Medicare Supplement Insurance - NH.gov


You may also contact the NH Insurance Department's Consumer Services Division at 1-800‐852‐3416 (option #2) to obtain updated plan and rate information. enrollment periods, please visit Medicare.gov, speak with a local agent or contact a state-certified, Medicare Counselor at ServiceLink.
(866-634-9412) . 


Richard


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## simpsontruckdriver (Nov 3, 2019)

As I mentioned before, Medicare's website - if you put in drug information - will give bad numbers. Several insurers have sent letters to CMS to get them to fix it, but as of now, I have not heard if they did or not. If you use the Medicare website, DO NOT put in drug info.


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## VacationForever (Nov 3, 2019)

mpumilia said:


> Anyway, the VIA benefits agent said I should just call them after I move- have to get the Part D changed- that I knew- and then they will find me another M plan in NH. He said not to even call Empire. Ummm- NOT!


The agent said not to call Empire BCBS directly because they will stop receiving commission from the health insurance company.  I would say do what you feel is right for you.


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## WinniWoman (Nov 3, 2019)

VacationForever said:


> The agent said not to call Empire BCBS directly because they will stop receiving commission from the health insurance company.  I would say do what you feel is right for you.



I wonder if that will also affect the employer HRA contribution then. We have to go through VIA Benefits to get that contribution and we most certainly are going through them. It is just we are moving right afterwards. We aren't going to be changing plans if the only thing the carrier is doing is changing the rate of the plan. if we need to change the plan altogether we would have VIA benefits do it. And we are having them change the Part D plan when we move. 

See how convoluted things can become? This is why I have a headache. It should be pretty simple but not in this country. Government and insurance companies. What an awful mix. I hate them both..


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## VacationForever (Nov 3, 2019)

mpumilia said:


> I wonder if that will also affect the employer HRA contribution then. We have to go through VIA Benefits to get that contribution and we most certainly are going through them. It is just we are moving right afterwards. We aren't going to be changing plans if the only thing the carrier is doing is changing the rate of the plan. if we need to change the plan altogether we would have VIA benefits do it. And we are having them change the Part D plan when we move.
> 
> See how convoluted things can become? This is why I have a headache. It should be pretty simple but not in this country. Government and insurance companies. What an awful mix. I hate them both..


I high suspect the HRA contribution comes out from their commission.  It is just that everyone wants a cut of the money.  If you find a good agent it is worth using him/her but many agents out there just want their commission and once you are onboard you are pretty much ignored because they just want to move on to get the next customer.  Right now we buy our health insurance plans directly with the insurers.


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## simpsontruckdriver (Nov 3, 2019)

The way Medicare commissions work, the agent is paid by the money that Medicare gives the insurer. If you stay with your insurer for over a year, the agent is paid every year. If you call and talk to a call center, they are paid wages which may or may not come from your sale, but they are agents in your state. For instance, if you call Humana, their call center is in Phoenix AZ. United Healthcare's is in several states. Foreign? No, since most states require agents to be USA citizens.

TS


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## Ewiike (Nov 5, 2019)

simpsontruckdriver said:


> One TINY tidbit of politics. A week or so, President Trump stated in "heaven's waiting room" (The Villages in Florida) that he is signing an executive order increasing plans and dropping prices for 2020. The problem is, at least one of the providers I sell dropped prices and increased plans in July! It's best to listen to an agent, NOT politicians.
> 
> Anyway, it's time to sit down with an agent. AEP starts on October 15, but you can talk to an agent beforehand to go over what is new and such. You can enroll in a plan then, then if you change your mind find another, repeating if needed, but the plan you're "stuck with" is the one that you're enrolled in on December 7th at 23:59:59. Where I live/sell (Orlando area), I have insurers who sell Preferred Provider Organizations (PPO) for $0 premiums, in addition to HMOs and Medicare Supplements.
> 
> TS


It's so confusing.....the monthly premium should be a percentage of your income , and it should cover everything , doctor's visit , hospital , drugs....etc....


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## simpsontruckdriver (Nov 5, 2019)

That sounds like an idea, but not yet. If you make less than $1700/month, you can get assistance from Social Security ("Extra Help") and/or your state. If you make over $80000/year, your Part-B premiums are higher.

TS


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## Talent312 (Nov 5, 2019)

Ewiike said:


> It's so confusing.....the monthly premium should be a percentage of your income, and it should cover everything, doctor's visit, hospital, drugs....etc....



What about those who have no income per se, but live off their wealth/savings?


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## simpsontruckdriver (Nov 6, 2019)

Same thing, Social Security looks at income from interest and such, as well as money in the bank.

TS


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## MULTIZ321 (Nov 6, 2019)

Open enrollment season for Medicare can be confusing but worth the effort.


https://www.rollcall.com/news/opini...edicare-can-be-confusing-but-worth-the-effort.


Richard


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## simpsontruckdriver (Nov 6, 2019)

Agreed. Usually, if you signed up in 2018 and had MAPD in 2019, you may not benefit with a new plan *unless* your health/address changed. But, if you signed up for your MAPD before 2017, chances are the 2020 plans are cheaper and/or have more benefits.

TS


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## VacationForever (Nov 6, 2019)

simpsontruckdriver said:


> Same thing, Social Security looks at income from interest and such, as well as money in the bank.
> 
> TS


Not entirely true money about in the bank. Medicare IRMAA looks at income including interests and dividends but not assets.  SS income tax also looks at total income.

My favorite ACA flaw is that it only looks at income and not assets.  I was able to get maximum subsidies for premium and share of cost for max out of pocket when I had very little income for the year. $161 monthly premium and max out of pocket of $850 per year.


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## simpsontruckdriver (Nov 6, 2019)

Yeah, I should have said money in interest-bearing bank accounts (like savings). So technically, you could have tons of money in a non-interest-bearing account to live on, and Social Security (SSA) won't see it. And yes, other assets are not seen. Essentially, I am an agent as well as a truck driver, I only have limited knowledge of how Social Security works. If someone makes less than $1700/month, I refer them to SSA and let them handle it (what is counted and what isn't).

TS


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## WinniWoman (Nov 6, 2019)

i am not understanding this. When does Medicare look at income? I thought the rates you see on line when you apply are the rates.


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## simpsontruckdriver (Nov 6, 2019)

Medicare decides your rates when you apply close to your 65th birthday. If you make less than $1700, and you apply for Extra Help, Social Security will look at income to see if you qualify.


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## WinniWoman (Nov 6, 2019)

simpsontruckdriver said:


> Medicare decides your rates when you apply close to your 65th birthday. If you make less than $1700, and you apply for Extra Help, Social Security will look at income to see if you qualify.



So when we choose this Medigap policy for my husband and apply they are going to ask for past income and the rate we see could be different? I mean- we are selecting it partially because of the rate.

(my husband was 65 in April and only applied for Part A at that time)


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## simpsontruckdriver (Nov 6, 2019)

SSA would look at your income on record, but your rates will change only if income exceeds $80000.

TS


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## WinniWoman (Nov 6, 2019)

simpsontruckdriver said:


> SSA would look at your income on record, but your rates will change only if income exceeds $80000.
> 
> TS



I assume that is income reported on last year's w-2- AFTER the , etc. is taken out? 

This is yet another confusing thing.


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## Luanne (Nov 6, 2019)

mpumilia said:


> So when we choose this Medigap policy for my husband and apply they are going to ask for past income and the rate we see could be different? I mean- we are selecting it partially because of the rate.
> 
> (my husband was 65 in April and only applied for Part A at that time)


I've never had to provide income information when applying for a Medicare Supplement (Medigap) plan.  I think what you may be confusing it with is how your Medicare Part B payment is determined.  That goes by your income. When dh first started paying Medicare Part B (which is withheld from your Social Security) his payment was very high since he had worked recently. But when he went into the Social Security office and provided information showing he was no longer employed, the amount went down. When I became Medicare eligible since I had not worked for at least two years prior my payment was low.


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## Ewiike (Nov 6, 2019)

Talent312 said:


> What about those who have no income per se, but live off their wealth/savings?


They shuld pay a percentage of their yearly profit .


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## Ewiike (Nov 6, 2019)

MULTIZ321 said:


> Open enrollment season for Medicare can be confusing but worth the effort.
> 
> 
> https://www.rollcall.com/news/opini...edicare-can-be-confusing-but-worth-the-effort.
> ...


It should be smooth and not Part A,B,C,D....etc , plus Medigap and suplementary indurance and penalties if you not signing up until x date....
I was just visiting Norway , working people pay 20% of their income and everything is covered.I'm not sure if they have to pay a premium after retirement , but I'm pretty sure it's only one( low!) payment .


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## WinniWoman (Nov 6, 2019)

Luanne said:


> I've never had to provide income information when applying for a Medicare Supplement (Medigap) plan.  I think what you may be confusing it with is how your Medicare Part B payment is determined.  That goes by your income. When dh first started paying Medicare Part B (which is withheld from your Social Security) his payment was very high since he had worked recently. But when he went into the Social Security office and provided information showing he was no longer employed, the amount went down. When I became Medicare eligible since I had not worked for at least two years prior my payment was low.



Oh ok. Thanks. That is interesting. So- hubby should go to the SS office if his premium is over the $144.30 per month (he is not taking SS until age 70 so we have to pay directly) and show proof that he is retired and no salary. I wonder what kind of proof you would need?

My premium should be low when the time comes since my last day of work was in 2018 and I am not eligible for Medicare until 2021.


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## VacationForever (Nov 6, 2019)

simpsontruckdriver said:


> SSA would look at your income on record, but your rates will change only if income exceeds $80000.
> 
> TS


$170K for a couple.


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## simpsontruckdriver (Nov 6, 2019)

You don't need proof, SSA already has it. You (and anyone who needs help paying medical bills) can go to www.medicare.gov and search for EXTRA HELP and you can apply there. For the next few weeks, they will look at reported income and give you a decision.

TS


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## VacationForever (Nov 6, 2019)

mpumilia said:


> I assume that is income reported on last year's w-2- AFTER the , etc. is taken out?
> 
> This is yet another confusing thing.


$170k for a couple MAGI income then the person is subject to pay Medicare IRMAA penalty, aka higher premiums to Medicare.  If you retire and income drops, you submit an appeal and they will drop the IRMAA penalty.


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## simpsontruckdriver (Nov 6, 2019)

The ways SSA and Medicare determine premiums:

For $0 Part-A, they look to see if you worked for 40 quarters (10 years). If not, like immigrants who moved here under 10 years before 65, they are subject to a premium.
For Part-B, they look at your last tax return on file before the application. So, if you applied for Medicare in 2019, they would use 2017 or 2018 depending on when you applied.


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## Luanne (Nov 6, 2019)

mpumilia said:


> Oh ok. Thanks. That is interesting. So- hubby should go to the SS office if his premium is over the $144.30 per month (he is not taking SS until age 70 so we have to pay directly) and show proof that he is retired and no salary. I wonder what kind of proof you would need?
> 
> My premium should be low when the time comes since my last day of work was in 2018 and I am not eligible for Medicare until 2021.


Neither dh or I remember exactly what we took into the Social Security office when we had our appointment.  I may have had a letter showing my retirement date (they wanted to know that I had no additional income either) but dh doesn't remember what he took in.  Sorry not to be of more help with this.  I do remember the woman we talked to being very nice and very helpful.


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## Fredflintstone (Nov 6, 2019)

Question?

Why is the health care insurance system so complex in the US? Part A, B, C, medigap, Medicare, Medicaid, COBRA, etc.

Is it intended to confuse?

Not to compare but here in Canada you get Provincial Health Care and can supplement (like dental, glasses) with Blue Cross. Simple, and easy to access...


Can’t they just make it easier? It almost seems everyone needs a PhD in Health Insurance to figure out what benefits they have and what they can get....


Sent from my iPad using Tapatalk


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## Luanne (Nov 6, 2019)

Fredflintstone said:


> Question?
> 
> Why is the health care insurance system so complex in the US? Part A, B, C, medigap, Medicare, Medicaid, COBRA, etc.
> 
> ...


All valid questions and one we have been wondering about for years.


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## Rolltydr (Nov 6, 2019)

Fredflintstone said:


> Question?
> 
> Why is the health care insurance system so complex in the US? Part A, B, C, medigap, Medicare, Medicaid, COBRA, etc.
> 
> ...



Because in the USA, medical care is part of the free enterprise system and profit is the motive, not healthcare. If that statement runs afoul of the TUG rules, sorry. I’m just trying to answer the gentleman’s question.


Sent from my iPad using Tapatalk


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## Fredflintstone (Nov 6, 2019)

Rolltydr said:


> Because in the USA, medical care is part of the free enterprise system and profit is the motive, not healthcare. If that statement runs afoul of the TUG rules, sorry. I’m just trying to answer the gentleman’s question.
> 
> 
> Sent from my iPad using Tapatalk



That’s a fair comment.


Sent from my iPad using Tapatalk


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## VacationForever (Nov 6, 2019)

Fredflintstone said:


> Question?
> 
> Why is the health care insurance system so complex in the US? Part A, B, C, medigap, Medicare, Medicaid, COBRA, etc.
> 
> ...


That is why being retired is a full-time job in itself, to figure out retirement health insurance coverage and finances.


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## Fredflintstone (Nov 6, 2019)

VacationForever said:


> That is why being retired is a full-time job in itself, to figure out retirement health insurance coverage and finances.



Yes, I’m not trying to be critical of the US system, I am just confused on its complexity.

Couldn’t money still be made with a simple process? For example:

1. Bronze service. High deductible, only covers life and death situations and emergency services only. No hospital bed or care covered. You go in, get operated on, patched up and escorted out to the parking lot. Everyone gets this I suppose.

2. Silver service. Ok all of the above except you can get a hospital bed to recover for up to 72 hours then out... low monthly charge

3. Gold service. Deductible lower. Higher premium but you do get up to 3 days ICU if needed. 

4. Platinum coverage. Higher premium but you get up to 2 weeks recovery including ICU. Pills are now covered.

Kind of like timeshare coverage.. easy, peasy. The more premium you pay, the better the coverage. 

We could add at the very top:

Butcher Shop service: need help. Get cut up, splashed with antiseptic and sent on your way crawling or not. The operating room is shared with the local morgue.  Premiums start at 1 dollar a month...






Sent from my iPad using Tapatalk


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## VacationForever (Nov 6, 2019)

Fredflintstone said:


> Yes, I’m not trying to be critical of the US system, I am just confused on its complexity.
> 
> Couldn’t money still be made with a simple process? For example:
> 
> ...



It is not hard to unravel...
Medicaid as a health insurance for the very low income.  Assets used to come into play but since ACA, assets don't get counted.  For long term care and nursing home, assets are still counted.

Medicare as a retiree health insurance.  Everyone who works, pays into it, matched by employer contribution.  The basic / original Medicare covers only 80%.  Hence private insurance comes in to sell you different flavors to cover the other 20%, Supplement which requires purchase of a separate drug plan, Advantage HMO and PPO.  Medicare covers hospitalization, doctor visits, drugs, Home Health and Hospice.

Before becoming eligible for Medicare, is a bigger issue. Large employers partially pay for health insurance in various flavors and many smaller employers just cannot afford to  provide this coverage.  ACA uses a very narrow definition of large employers which is not the same as how Small Business Association defines, to force "large" employers to provide coverage otherwise these businesses have to pay a substantial penalty.  Now politicians are throwing in a promise of Medicare For All.  I think most of us agree that Medicaid and Medicare are not broken, so don't try to fix it.    I don't want to get into politics but personally as a pre-Medicare eligible citizen, I would love to pay in full unsubsidized Medicare insurance.  Instead of paying $1500 a month at the age of 64, Medicare negotiated reimbursements will very likely get my monthly premium to say, $1000.


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## MULTIZ321 (Nov 6, 2019)

Even if You Have Medicare, You'll Still Pay Thousands Out-Of-Pocket For Health Care.


https://www.forbes.com/sites/howard...s-out-of-pocket-for-health-care/#1ed823eb124a.


Richard


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## Fredflintstone (Nov 6, 2019)

VacationForever said:


> It is not hard to unravel...
> Medicaid as a health insurance for the very low income.  Assets used to come into play but since ACA, assets don't get counted.  For long term care and nursing home, assets are still counted.
> 
> Medicare as a retiree health insurance.  Everyone who works, pays into it, matched by employer contribution.  The basic / original Medicare covers only 80%.  Hence private insurance comes in to sell you different flavors to cover the other 20%, Supplement which requires purchase of a separate drug plan, Advantage HMO and PPO.  Medicare covers hospitalization, doctor visits, drugs, Home Health and Hospice.
> ...



Thank you.

So, as I understand this, you pay 1500 a month for health care? I assume you pay nothing when you qualify for Medicare at 65? So Medicare covers 80 percent of any health care cost and then you either pay the other 20 percent out of pocket or have added insurance? Medicare is state issued right? Medicaid is Federal? Do Medicaid get the same coverage as Medicare?

Let’s say you make a bit more than low income and you are younger but your small employer has no coverage, are you basically screwed or left with big bills?

Why 1000 a month? Does it go up as you get older?

I assume the medigap coverage is to cover that other 20 percent right?

Finally, is every US citizen covered for basic health care regardless of income?

If you were in welfare, do you still get Medicare or just stay on Medicaid?




Sent from my iPad using Tapatalk


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## VacationForever (Nov 6, 2019)

Fredflintstone said:


> So, as I understand this, you pay 1500 a month for health care?
> *Premiums are coverage, age and state related. Someone who is 30 will pay around $350 and around $1500 at 64 for a Gold plan.  These numbers vary greatly by state, type of coverage, copays and deductibles.
> *
> I assume you pay nothing when you qualify for Medicare at 65?
> ...



*See reply in message.*


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## Fredflintstone (Nov 6, 2019)

VacationForever said:


> *See reply in message.*



Cool. Ty. It’s easier than I thought. What trips me up are the buzz words.


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## Ewiike (Nov 6, 2019)

Ewiike said:


> It should be smooth and not Part A,B,C,D....etc , plus Medigap and suplementary indurance and penalties if you not signing up until x date....
> I was just visiting Norway , working people pay 20% of their income and everything is covered.I'm not sure if they have to pay a premium after retirement , but I'm pretty sure it's only one( low!) payment .


No , they don't have to pay anything once they are retired and there is a gap on health insurance premium , about $250 a year!


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## Steve Fatula (Nov 7, 2019)

Fredflintstone said:


> Cool. Ty. It’s easier than I thought. What trips me up are the buzz words.
> 
> 
> Sent from my iPad using Tapatalk



The ones who can be in trouble are the self employed who have no employer coverage. If they make 400% of the poverty level or above, they get $0 subsidy for buying their own, and then it becomes super expensive in many states. Or, early retirees who don't get continuing coverage from their employer. Or, the low income folks who get 100% subsidy so the insurance is free, however, they cannot possibly pay the co-pays and deductibles, making it essentially useless in some cases. I fit into the self employed bucket a few years back) and now early retirement bucket. It can be troublesome.

Some can defy logic, yet, sort of make sense at the same time. For example, say I make 375% of the poverty level (just guessing the number that will cause this issue). So, I get an ACA plan, and, in the end I can buy one that costs me $0/month. Great! Now, an unexpected event occurs, and, I need surgery, and, it of course costs far more than the maximum out of pocket. And, say, I don't have the cash, I live check to check or have early retirement. So, I have to take money out of retirement to pay for it. Taking the money out, raises my income! Now that my income is raised, I don't qualify for the subsidy and I now owe the full premium for the entire year (which is a massive amount), and, I have to take even more out of retirement, which then raises my income further or bankrupts me. This is an actual example though, not theoretical. So, by having a medical problem, your income goes up (even though you have less money in reality). Still it is taxable, so I get it but it also doesn't make sense. There are ways around this, but you can see it can get semi complex.


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## VacationForever (Nov 7, 2019)

Steve Fatula said:


> The ones who can be in trouble are the self employed who have no employer coverage. If they make 400% of the poverty level or above, they get $0 subsidy for buying their own, and then it becomes super expensive in many states. Or, early retirees who don't get continuing coverage from their employer. Or, the low income folks who get 100% subsidy so the insurance is free, however, they cannot possibly pay the co-pays and deductibles, making it essentially useless in some cases. I fit into the self employed bucket a few years back) and now early retirement bucket. It can be troublesome.


Self employed folks are no different from an employee working for an employer who does not provide health insurance coverage.

Low income folks who get 100% subsidy fall under Medicaid and have $0 copay for dr visit and prescriptions.  If you fall under 400% of poverty level, you get premium subsidy which can be very good.  The trick is to buy a silver plan as only silver plans get cost sharing subsidy in addition to premium subsidy.  I paid only $161 per month in premium and max out of pocket of $850.  There are many articles out there which explain that ACA is actually helping alot of early retirees because it only uses income to determine affordability and ignores assets.


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## VacationForever (Nov 7, 2019)

Steve Fatula said:


> Some can defy logic, yet, sort of make sense at the same time. For example, say I make 375% of the poverty level (just guessing the number that will cause this issue). So, I get an ACA plan, and, in the end I can buy one that costs me $0/month. Great! Now, an unexpected event occurs, and, I need surgery, and, it of course costs far more than the maximum out of pocket. And, say, I don't have the cash, I live check to check or have early retirement. So, I have to take money out of retirement to pay for it. Taking the money out, raises my income! Now that my income is raised, I don't qualify for the subsidy and I now owe the full premium for the entire year (which is a massive amount), and, I have to take even more out of retirement, which then raises my income further or bankrupts me. This is an actual example though, not theoretical. So, by having a medical problem, your income goes up (even though you have less money in reality). Still it is taxable, so I get it but it also doesn't make sense. There are ways around this, but you can see it can get semi complex.


Good point. It does suck to make around 400% of poverty line.  The year that I was on ACA, we had very little interests and dividends and no other income.  We did draw on a chunk of taxable savings to live on and as a result not put us into a higher income bracket.  With silver plans, if you get both premium and cost sharing subsidies but you end up with higher income when you file your tax returns, IRS will only ask you to pay back some or all of the premium subsidy but not the cost sharing (max out of pocket) subsidy.


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## Steve Fatula (Nov 7, 2019)

VacationForever said:


> Self employed folks are no different from an employee working for an employer who does not provide health insurance coverage.
> 
> Low income folks who get 100% subsidy fall under Medicaid and have $0 copay for dr visit and prescriptions.  If you fall under 400% of poverty level, you get premium subsidy which can be very good.  The trick is to buy a silver plan as only silver plans get cost sharing subsidy in addition to premium subsidy.  I paid only $161 per month in premium and max out of pocket of $850.  There are many articles out there which explain that ACA is actually helping alot of early retirees because it only uses income to determine affordability and ignores assets.



Yes, this can be true. Where I live, it is not possible to have $161/mo and max oop of $850. It all depends. Point is, for people like Fred as an outsider looking in, it can get complicated to try and understand. There are winners, and losers. I can certainly see how it can help early retirees, at least in lower expense states. In higher expense states, perhaps not.


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## Steve Fatula (Nov 7, 2019)

VacationForever said:


> Good point. It does suck to make around 400% of poverty line.  The year that I was on ACA, we had very little interests and dividends and no other income.  We did draw on a chunk of taxable savings to live on and as a result not put us into a higher income bracket.  With silver plans, if you get both premium and cost sharing subsidies but you end up with higher income when you file your tax returns, IRS will only ask you to pay back some or all of the premium subsidy but not the cost sharing (max out of pocket) subsidy.



Yes, since it's an immediate cutoff, make $1 more and you're in big trouble! If you are near the 400% line, better to at least try and HSA plan if one exists as then withdrawing more to pay a medical bill can be offset by putting it into the HSA first, then paying it.


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## WinniWoman (Nov 7, 2019)

Fredflintstone said:


> Question?
> 
> Why is the health care insurance system so complex in the US? Part A, B, C, medigap, Medicare, Medicaid, COBRA, etc.
> 
> ...




Exactly! It is so convoluted! I for one wish we had a health care system similar to Canada's. I am for simplicity and affordability, of which we do not have in the USA. Some people in the US always point out the flaws in the Canadian system as if our system has none. SMH....

PS- you forgot to mention Medicare Advantage, ACA plans- Bronze, Silver, Gold, Platinum, and Part D drug plans- more craziness....


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## WinniWoman (Nov 7, 2019)

Fredflintstone said:


> Yes, I’m not trying to be critical of the US system, I am just confused on its complexity.
> 
> Couldn’t money still be made with a simple process? For example:
> 
> ...




The other issue in the USA is that each state is it's own entity with it's own laws in regard to health insurance, so you add in the profit making insurance companies (some are non for profit on paper btw) and things get very complicated.


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## WinniWoman (Nov 7, 2019)

I remember a few years ago my husband and I were sitting outside at a winery in Vermont, sipping our wine and enjoying the scenery.(This winery is also a farm.) The owner - late middle - came out and sat down with a pile of mail. She threw it down on the table, but holding an envelope from Blue Cross/Blue Shield and gasping. She said life was so easy when she lived in Canada (before she married this Vermont farmer). True- she had an apartment there, but she did not have all these bills and her life was simple, she said. She was so frustrated and particularly about having to pay the health insurance premiums. That always stuck with me.


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## bogey21 (Nov 7, 2019)

Fredflintstone said:


> Thank you.
> 
> So, as I understand this, you pay 1500 a month for health care? I assume you pay nothing when you qualify for Medicare at 65? So Medicare covers 80 percent of any health care cost and then you either pay the other 20 percent out of pocket or have added insurance? Medicare is state issued right? Medicaid is Federal? Do Medicaid get the same coverage as Medicare?



Medicare can be relatively cost free if one signs up for a Medicare Advantage Program.  Many of these have tight networks and require referrals to see specialists.  To maximize the benefits of Traditional Medicare where one can use any doctor or hospital accepting Medicare costs more.  You need to buy a Medicare Supplement Policy and a Prescription Drug Program.  Depending on your income this can be somewhat costly.  You have it backward vis-a-vis Medicare and Medicaid.  Medicare is Federal and Medicaid is State.  Medicaid is inferior to Medicare.  A major problem with Medicaid is that many Doctors will not accept Medicaid patients due to low reimbursement rates...

George


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## VacationForever (Nov 7, 2019)

Steve Fatula said:


> Yes, this can be true. Where I live, it is not possible to have $161/mo and max oop of $850. It all depends. Point is, for people like Fred as an outsider looking in, it can get complicated to try and understand. There are winners, and losers. I can certainly see how it can help early retirees, at least in lower expense states. In higher expense states, perhaps not.


I just priced it out at your location... at $27k annual income, 0 premium for Blue Preferred Silver PPO 201.  $150 deductible, max OOP $2700.  Estimated annual cost $871 for average doctor visits.

It works for early retirees with enough but not too much taxable investments to get by without drawing on their IRA.


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## Rolltydr (Nov 7, 2019)

I think we have sufficiently proven fredflintstone’s contention that the US healthcare/insurance system is indeed complex and it almost has to be intentional so as to confuse individuals and enrich healthcare providers and insurers. Read back through this thread and tell me how any of it makes sense if health and care are the primary objective.


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## Ewiike (Nov 7, 2019)

Rolltydr said:


> Because in the USA, medical care is part of the free enterprise system and profit is the motive, not healthcare. If that statement runs afoul of the TUG rules, sorry. I’m just trying to answer the gentleman’s question.
> 
> 
> Sent from my iPad using Tapatalk


Unfortunately.....yes.


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## Steve Fatula (Nov 7, 2019)

VacationForever said:


> I just priced it out at your location... at $27k annual income, 0 premium for Blue Preferred Silver PPO 201.  $150 deductible, max OOP $2700.  Estimated annual cost $871 for average doctor visits.
> 
> It works for early retirees with enough but not too much taxable investments to get by without drawing on their IRA.



Well, sure, if you only made 27k. They do silver loading in my zip code. As always, it depends on your income or the amount of money you have to withdraw from retirement that is taxable to live and vacation on, pay MF, etc. Of course, I am doing exactly as you say, using after tax money for some of the expenses so as to not withdraw too much until I get to medicare age. If you make more than the minimum and don't get the extra subsidy (forgot the term), that plan is actually still $0/month, but, $8,150 max OOP with $1,100 deductible and 50% co-pay beyond the deductible. But sure, if you could live on 27k, it is as you say. Depends if you own your home, and all sorts of factors. But as you can see, no sub $1,000 max oop here.


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## VacationForever (Nov 7, 2019)

Steve Fatula said:


> Well, sure, if you only made 27k. They do silver loading in my zip code. As always, it depends on your income or the amount of money you have to withdraw from retirement that is taxable to live and vacation on, pay MF, etc. Of course, I am doing exactly as you say, using after tax money for some of the expenses so as to not withdraw too much until I get to medicare age. If you make more than the minimum and don't get the extra subsidy (forgot the term), that plan is actually still $0/month, but, $8,150 max OOP with $1,100 deductible and 50% co-pay beyond the deductible. But sure, if you could live on 27k, it is as you say. Depends if you own your home, and all sorts of factors. But as you can see, no sub $1,000 max oop here.


We were able to make use of the premium and cost sharing subsidy for one year when we were not pulling anything from IRA and we had no SS income.


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## MULTIZ321 (Nov 8, 2019)

Medicare's outpatient 'Part B' premium going up to $144.60.


https://apnews.com/b1f404c7e8df4aefad6d5f8fe1349f0c.


Richard


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## MULTIZ321 (Nov 9, 2019)

Medicare Part B premium 2020: Rates and deductibles rising 7% for outpatient care.


https://www.usatoday.com/story/mone...0-deductibles-premiums-increasing/2541901001/


Richard


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## DrQ (Nov 9, 2019)

I just turned 64.5 and if I NEVER hear from another Medicare jeezer on the phone, I will be happy.


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## SmithOp (Nov 9, 2019)

DrQ said:


> I just turned 64.5 and if I NEVER hear from another Medicare jeezer on the phone, I will be happy.



I’m a year older than my wife (FRA 66 next month), we’ve had calls and junk mail for two solid years now with no sign of relief.


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## simpsontruckdriver (Nov 9, 2019)

Under CMS ("Medicare") regulations, no one is allowed to call you cold-contact. Insurers are allowed to put up ads on radio/TV and send you USPS or e-mail, because you can simply throw them out or change the channel. But some get around the "word-of-mouth" allowance by having a call center have a non-event call and ask if one of their agents can contact you.

 Since DrQ said he is 64.5 years old, this will all repeat when he (or any one else) hits 64 yrs 9 months.

TS


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## b2bailey (Nov 10, 2019)

I have taken the time to read every post in one gulp this morning. I've had a supplement plan that works for me, so no interest in changing.

BUT... I have been dissatisfied with my Prescription Drug plan (which was chosen for me by agent) It's something called Humans Wal-Mart -- which is confusing to me because there isn't a Wal-Mart in my zip code.

Anyhow, I pay a monthly premium, and then pay $10 per month for my thyroid meds. The frustration is because I used to pay less at Costco, with no insurance.

I'm ready to make a change and saw reference to "lowest cost" prescription plan. How do I go about switching plans?


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## simpsontruckdriver (Nov 10, 2019)

I'm not sure about your area (I am in Florida), but for 2020, Humana is rolling out a revised "WalMart" PDP. You can call Humana directly, an agent can get you set up on a less-expensive plan. The whole "WalMart" is just a saying, that it is usually the least expensive plan. *In addition*, you can save more by signing up for the Humana mail-order pharmacy (does not include specialty or narcotics), where 3 month generics are less than $5.00. Humana can point you in the right direction on both.

TS


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## WinniWoman (Nov 12, 2019)

VacationForever said:


> @mpumilia You can get around the ACA system to get 2019 rates by indicating that you have change of life events and it will let you proceed to get current rates. 2020 rates will be available starting in Nov.  You may be eligible for premium and share of cost subsidies next year since you will both not be working.  Your income will be calculated using your mother's IRA RMD inheritance, interests and dividends from your taxable accounts and whatever amount you want to withdraw from IRA and roll into ROTH.
> 
> If you are eligible for subsidies then ACA is likely to be cheaper than COBRA and private individual health insurance.  If you are not eligible, you are most likely going to find private individual health insurance cheaper and better than ACA.  ACA rates without subsidies are always going to be most expensive and have the worst coverage, because the rates are averaged out with the healthy and the private market-rejected very sick group of people.  Without ACA subsidies, you will need to compare oranges to oranges between COBRA rates and coverages and those in the private individual market.  Insurance brokers don't get commission from ACA plans so you will first need to find out whether you will get subsidies or not using the ACA site.  If you are not going to be eligible ffor ACA subsidies, then you need to connect with broker(s) to find all available private individual market plans.
> 
> ...



I spoke with our Financial Advisor today. Mind you, he was the one that told me back in April- before this whole moving thing occurred- that staying on my husband's employer's health plan was probably the easiest option until I become eligible for Medicare.

Then today out of nowhere he starts talking about exploring the NH exchange when we move. Telling me to make an appt with a navigator- of which I do not see if NH has them anymore since the Trump Administration sliced funding for it.

I went on line and they have inexpensive silver ($87-$207) and gold plans ($345), some with low deductibles- but still copays- of which I could get a subsidy for - and a cost sharing reduction) since we will have little income as we will be living on cash for the first year mostly- unless I do not go on an exchange, then we would be withdrawing from IRA's and doing some Roth conversions out of hubby's account.

But all the plans are EPO's and HMO's. No out of network care. Only emergency coverage out of state- and that is subjective. HMO's need referrals for specialists. Not liking it. Then there is the fact that I don't even know who my doctors would be in NH! So I would have no idea if the ones I would want would be in the network! I would have to choose from their list only.

At least my Cobra would be a PPO and nationwide, so out of network care is available.

I could explore a private insurance plan in NH after I move amongst the hundred thousand other things I have to do!

Anyway- the FA wants to meet with us in January to revamp his plan for us- I guess in case I went on the exchange because that would affect how we draw down our money.

Frankly- I am so sick of thinking and analyzing this stuff.


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## VacationForever (Nov 12, 2019)

mpumilia said:


> I spoke with our Financial Advisor today. Mind you, he was the one that told me back in April- before this whole moving thing occurred- that staying on my husband's employer's health plan was probably the easiest option until I become eligible for Medicare.
> 
> Then today out of nowhere he starts talking about exploring the NH exchange when we move. Telling me to make an appt with a navigator- of which I do not see if NH has them anymore since the Trump Administration sliced funding for it.
> 
> ...


EPO plans are pretty good and do not require doctor referrals but are only local to the state unless in an emergency.  My plan is technically an EPO plan and the best specialists take it.


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## simpsontruckdriver (Nov 12, 2019)

Essentially, an EPO is an HMO without referrals. Where a PPO allows you to see any doctor, an EPO says you must go to a doctor who accepts your insurance. But, unlike HMO and PPO, EPO isn't standardized. For instance, Humana has plans in certain areas that are listed as HMO but they are like the EPO.

TS


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## VacationForever (Nov 12, 2019)

simpsontruckdriver said:


> Essentially, an EPO is an HMO without referrals. Where a PPO allows you to see any doctor, an EPO says you must go to a doctor who accepts your insurance. But, unlike HMO and PPO, EPO isn't standardized. For instance, Humana has plans in certain areas that are listed as HMO but they are like the EPO.
> 
> TS


The thing is where we are, HMO plans are crappy and only crappy specialists accept them.  When we went to EPO in 2018 it was night and day.  The best specialists accept our EPO plan.  I switched out of a couple of bad specialists immediately.


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## WinniWoman (Nov 19, 2019)

VacationForever said:


> It is called estimated income.  You look at how much interests and dividends from taxable accounts that you have been getting each year and adjust for changes in withdrawal of principal or deposits.  There is a table for inherited IRA RMD, percentages based on your age, and you can estimate 2019 year end balance in the IRA account.  You will need to decide how much you want to rollover from IRA to Roth.
> 
> The nice thing is if you underestimate and get subsidies for both premiums and share of cost, you will need to make up additional premium payment only and not share of cost when you file 2020 IRS returns.



So in NY, it looks like for me, if I did not do Cobra, I would get a subsidy and cost sharing with ACA, but the issue is all the plans are EPOs or HMO's and we will be moving sometime in the first half of the year. I mentioned this before, I know. No PPO's in NY, which is a state plan.

So then I would have to switch to a NH plan- which is Federal- right away- would have 60 days. No PPO's there either and, of course, I do not have a network of doctors there yet so I have no idea how to pick a plan based on that.

For NY, I put in $35,000 per year income (anything under they throw me on Medicaid- no thanks). In NH, it is an $25,000. Rates in NH are cheaper than in NY.

I, for the life of me, cannot figure out how to find the network of doctors in any of the ACA plans. The other thing is, I am concerned about coverage as we go back and forth from NH to NY for awhile until the final move. I know emergencies are supposedly covered with the ACA plans, but that is subjective and up to the insurance company to determine what constitutes an emergency. You know how that goes!  Emergency room only- maybe- depending on why you went to the emergency room. But what about anything else that possibly pops up? I guess I could pay out of pocket- depending on what the issue would be- but again- it could end up being costly if something does happen 

So back to should I just take the COBRA PPO- high deductible plan we have now, which is also good in NH, and stop racking my brains?

Or maybe take the COBRA for now until our final move? Seems the NY ACA Silver plan will save me about $267 per month over the COBRA. But again- an HMO or EPO. A little more savings in NH.

Is it worth it for all the rigamarole I would  have to go through- dealing with the government and all the regulations and tax BS? Just for 18 months? I don't know. I am probably overthinking this, but they don't make it easy.

I guess if I wasn't moving I would probably go on the ACA plan and take my chances with the network and all that. Take out travel insurance for my timeshares in NH and VT- which I do anyway. But with the move it just seems like too crazy.


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## VacationForever (Nov 19, 2019)

I cannot offer you any help.  You just have to go with what feels right for you.  My experience with EPO is wonderful but I am in a different state.  I bought an EPO plan from off exchange starting in 2018 and the best specialists take it.  I have not found a doctor who is not in the EPO.  If you are concerned with commuting between the 2 states, you need to ask yourself how much time are you really spending in each state at a time.  If I am not mistaken, it is mainly the walkthroughs, closing and completing the move. It is not as though you will be living out of 2 states for any extended period of time.  The part that you should call and ask the NH exchange is that if you go on COBRA, whether you will be precluded from moving into an ACA plan.  It was a huge problem when ACA was first set up where someone who accepted COBRA could not take up an ACA plan until COBRA period ran out.  I THINK they fixed it a year or so ago which allowed switching only during Open Enrollment.  If so, I also don't know if it includes moving out of state.  You need to find out.


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## simpsontruckdriver (Nov 19, 2019)

The ACA and Medicare share the same enrollment period definitions. You can't change/enroll until annual enrollment, change in address, switching jobs (I believe losing COBRA counts), and some others.

TS


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## WinniWoman (Nov 19, 2019)

simpsontruckdriver said:


> The ACA and Medicare share the same enrollment period definitions. You can't change/enroll until annual enrollment, change in address, switching jobs (I believe losing COBRA counts), and some others.
> 
> TS



Yes. So I think moving to another state when on Cobra I could then change to ACA.


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## VacationForever (Nov 19, 2019)

mpumilia said:


> Yes. So I think moving to another state when on Cobra I could then change to ACA.


...and you may just want to go with COBRA in NY and then after your move, you can evaluate doctors in the EPO network in NH to see if you want to go on ACA to get subsidies.


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## WinniWoman (Nov 19, 2019)

VacationForever said:


> ...and you may just want to go with COBRA in NY and then after your move, you can evaluate doctors in the EPO network in NH to see if you want to go on ACA to get subsidies.



I am thinking maybe that. I would have 60 days from the date we move to do so if I go that route.

Plus, we meet with the Financial Advisor in January to fine tune things so will have a better idea of what we are doing. It's just so much all at once. Worse comes to worse, I pay the Cobra for 18 months.

I am not sure how quickly we will be moving after we close on the house. We will need to get the heat on and a security system in it until we live there permanently. We might even get an air mattress so we can stay in it while we take care of a few things.

This is why I really needed to work until age 65m though I doubt I would have made it.


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## easyrider (Nov 19, 2019)

The subject of medicare supplemental policies came up the other day. I still have a ways to go but many of my friends are there. It seems that these policies are almost a scam for most people after watching this doctor explain it. Is this guy wrong ?

Bill


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## bogey21 (Nov 20, 2019)

If you are relatively healthy and don't have multiple expensive prescriptions, I think he is right.   In my mind it is like HO or Auto Insurance which I carry and hope I never need.  If money were tight, I'd probably opt for a zero premium Medicare Advantage HMO plan.  But money isn't tight for me so I carry a high deductible Plan F and a relatively low cost prescription Part D Plan for flexibility and peace of mind...

George


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## Talent312 (Nov 20, 2019)

b2bailey said:


> I have been dissatisfied with my Prescription Drug plan (which was chosen for me by agent) It's something called Humana Walmart ... I'm ready to make a change and saw reference to "lowest cost" prescription plan. How do I go about switching plans?



Go to medicare.gov. Create account or sign-in. Click on "Find 2020 Health and Drug Plans."
Select for Drug Plans only and record your meds and preferred pharmacies.
The plan finder creates a sortable list. Sort by Total Cost, compare 3-4 and look at Details.

You will also see a button to enroll. It really could not be any simpler.
The system will terminate your current plan & enroll you in the new one as of January 1st.
You will get a notice from your old plan and a drug-card from your new plan in 2-3 weeks.
.


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## WinniWoman (Nov 20, 2019)

Who is this guy? An insurance salesman? (for Advantage plans?)

Most insurance is a scam if you ask me.


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## simpsontruckdriver (Nov 20, 2019)

Insurance as a whole is a good thing. The problem is not insurance, but health providers. Costs for drugs, hospitals, etc have skyrocketed faster than inflation, which means someone has to pay for that $700 Epi-Pen. Insurance's goal is to spread out loss (pregnancy, injury, sickness, disability, cancer, etc) over all their members. Essentially, everyone who pays a premium is paying for it.

Medicare is the same. Everyone who pays Medicare taxes (FICA) is paying for their opportunity at 65, as well as healthcare losses of retirees. Those who take Part-B and Part-D are paying for all retirees' healthcare costs.

Is insurance a scam? No. But providers FAR overcharging for their drugs are.

TS


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## simpsontruckdriver (Nov 20, 2019)

And about using Medicare to estimate drug costs... as of now, their estimator gives faulty numbers. DO NOT use it. Talk to an insurance agent who is independent (affiliated with several providers), they have more reliable information.

TS


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## Brett (Nov 20, 2019)

mpumilia said:


> Who is this guy? An insurance salesman? (for Advantage plans?)
> 
> Most insurance is a scam if you ask me.



the poster certainly sounds like an insurance agent !

But I don't believe most insurance is a "scam" -  insurance is useful in many situations - home, car   .... and health


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## Luanne (Nov 20, 2019)

Brett said:


> the poster certainly sounds like an insurance agent !
> 
> But I don't believe most insurance is a "scam" -  insurance is useful in many situations - home, car   .... and health


You never know what will happen.  I consider myself to be healthy.  I generally only go to the doctor once a year, and only take medication for high blood pressure. Then bam! a few months ago I start having some issues catching a deep breath.  Go in for my physical.  A trip to the ER, a cardiac catheterization (no problems with heart), two scans, three sets of blood test, and an echo cardiagram later, the source of the problem has been detected.  No bill (so far) for any of this.  Without insurance, or with a lesser Medicare supplement plan, I don't want to think what it might have been.

Dh went in for back pains and he is now scheduled for his fourth procedure to try to pinpoint the cause.  

I think we'll stick with health insurance, in our cases a Medicare Supplement.


----------



## glenmore (Nov 20, 2019)

Insurance is not a scam. Retired 14 years now and have had 2 hip and 1 knee replacements in 9 years due to arthritis 

Can’t imagine our cost if we had not had a good Medicare Supplement Plan


----------



## easyrider (Nov 20, 2019)

mpumilia said:


> Who is this guy? An insurance salesman? (for Advantage plans?)
> 
> Most insurance is a scam if you ask me.



The man in the video is Dr. David Belk. This is one of his websites. Basically, for most people on Medicare, the supplemental insurance is not needed and the premium costs are more than the deductibles on Medicare is how I read this.

Bill

http://truecostofhealthcare.org/

http://truecostofhealthcare.org/medicare-supplemental-insurance/


----------



## VacationForever (Nov 20, 2019)

glenmore said:


> Insurance is not a scam. Retired 14 years now and have had 2 hip and 1 knee replacements in 9 years due to arthritis
> 
> Can’t imagine our cost if we had not had a good Medicare Supplement Plan


If you had bought an Advantage PPO plan you would not pay a fortune either as every plan has its maximum out of pocket, and using Medicare negotiated rate.  My husband's current Advantage PPO plan has max out of pocket of something like $5K per year.


----------



## Steve Fatula (Nov 20, 2019)

easyrider said:


> The man in the video is Dr. David Belk. This is one of his websites. Basically, for most people on Medicare, the supplemental insurance is not needed and the premium costs are more than the deductibles on Medicare is how I read this.



Sure, premiums are higher than the deductible, but for many including us, not the deductible + copays. Humana paid more out for my wife than she paid in. And it was a non sick year as well. That's not even considering the $30 per month savings from the included Silver Sneakers membership (we'd be paying gym otherwise).


----------



## easyrider (Nov 20, 2019)

glenmore said:


> Insurance is not a scam. Retired 14 years now and have had 2 hip and 1 knee replacements in 9 years due to arthritis
> 
> Can’t imagine our cost if we had not had a good Medicare Supplement Plan



I wonder how much the supplemental insurance paid that wasn't covered under regular Medicare ? When I bought supplemental insurance for my inlaws it did seem like Medicare actually covered everything. The supplemental we had for my mother in law didn't help with her perscription costs as the drug she was on was new, it didn't help with nursing home stay to recover and it didn't pay for hospice.

For my father in law the supplemental insurance didn't really pay for anything either and he had multiple heart issues that included 7 bypasses in 1 operation that had a 25 day hospitial stay, 90 day nursing home stay and continued care.

These were Humana Plans. 

Bill


----------



## easyrider (Nov 20, 2019)

Steve Fatula said:


> Sure, premiums are higher than the deductible, but for many including us, not the deductible + copays. Humana paid more out for my wife than she paid in. And it was a non sick year as well. That's not even considering the $30 per month savings from the included Silver Sneakers membership (we'd be paying gym otherwise).



I wonder how much of the amount paid out was not covered under regular Medicare ? 

Bill


----------



## VacationForever (Nov 20, 2019)

easyrider said:


> I wonder how much the supplemental insurance paid that wasn't covered under regular Medicare ? When I bought supplemental insurance for my inlaws it did seem like Medicare actually covered everything. The supplemental we had for my mother in law didn't help with her perscription costs as the drug she was on was new, it didn't help with nursing home stay to recover and it didn't pay for hospice.
> 
> For my father in law the supplemental insurance didn't really pay for anything either and he had multiple heart issues that included 7 bypasses in 1 operation that had a 25 day hospitial stay, 90 day nursing home stay and continued care.
> 
> ...


Procedures that are typically not covered - Lasiks when having cataract surgeries and stem cell treatments for joints - knees and elbows.  I don"t know if it covers stem cell transplant for lymphoma.


----------



## WinniWoman (Nov 20, 2019)

easyrider said:


> I wonder how much the supplemental insurance paid that wasn't covered under regular Medicare ? When I bought supplemental insurance for my inlaws it did seem like Medicare actually covered everything. The supplemental we had for my mother in law didn't help with her perscription costs as the drug she was on was new, it didn't help with nursing home stay to recover and it didn't pay for hospice.
> 
> For my father in law the supplemental insurance didn't really pay for anything either and he had multiple heart issues that included 7 bypasses in 1 operation that had a 25 day hospitial stay, 90 day nursing home stay and continued care.
> 
> ...



All the supplement plans are different, so just because they were all Humana, doesn't mean anything. If they were all Part N, or Part C or Part G or Part F- that is what matters. You have to compare apples to apples.

A Part G plan is not the same as a Part N plan, for example, but can be issued by the same insurance company.


----------



## WinniWoman (Nov 20, 2019)

I just signed my husband up for Part F and a cheap Part D prescription plan where his drug is covered for $0 with mail order or a preferred pharmacy. With moving and everything did not want to rack my brains anymore. When we get to the new state I will call VIA benefits in the 60 day window for him to see about new plans or whatever- mainly because part D I know you have to change as they are localized and also because he maybe can get a cheaper rate for Medigap. We shall see. I know he can keep the same plan by just calling Empire and giving them the new address and asking for the new rate, but this stupid VIA benefits co. insists we have to call them to keep our HRA contribution. I still don't get that one if we are able to keep the same plan they already sold us.

I am going to sign up for the expensive COBRA Aetna POS Choice II High deductible and decide about the ACA coverage when we move in the 60 day window allowed.

Sick of the whole thing. Like the doc in the video said- this country's health system needs a major overhaul.


----------



## VacationForever (Nov 20, 2019)

mpumilia said:


> When we get to the new state I will call VIA benefits in the 60 day window for him to see about new plans or whatever- mainly because part D I know you have to change as they are localized and also because he maybe can get a cheaper rate for Medigap. We shall see. I know he can keep the same plan by just calling Empire and giving them the new address and asking for the new rate, but this stupid VIA benefits co. insists we have to call them to keep our HRA contribution. I still don't get that one if we are able to keep the same plan they already sold us.


It is called their ability to continue to be paid commission.


----------



## bogey21 (Nov 20, 2019)

mpumilia said:


> For NY, I put in $35,000 per year income (anything under they throw me on Medicaid- no thanks). In NH, it is an $25,000. Rates in NH are cheaper than in NY.



You just put in anything you want!!!  Don't they verify your income...

George


----------



## VacationForever (Nov 20, 2019)

bogey21 said:


> You just put in anything you want!!!  Don't they verify your income...
> 
> George


Yes.  Once approved, it will ask for supporting document, like retirement letter or unemployment letter, bank account interest information etc.  It is not painful.


----------



## WinniWoman (Nov 20, 2019)

bogey21 said:


> You just put in anything you want!!!  Don't they verify your income...
> 
> George




Just to get rates you can put in anything you want on the website. No way can you verify your income for 2020 when it hasn't happened yet. I guess when you file your taxes at the end of the year, that is when they see what it is? I have no idea. I suppose you can tell them retired and no SS for next year? I really don't know and this stuff is one reason why I hate to get involved with this type of plan.


----------



## WinniWoman (Nov 20, 2019)

VacationForever said:


> It is called their ability to continue to be paid commission.



But if you are not changing plans or the insurance company- just the rate is changing? I don't understand.


----------



## Steve Fatula (Nov 20, 2019)

easyrider said:


> I wonder how much of the amount paid out was not covered under regular Medicare ?
> 
> Bill



Zero. Medicare only pays 80% and our 20% was the amount that the supplement paid. If she had any hospitalization, which she did not, then, the Part A deductible by itself is more than we pay yearly for the supplement. And then you add copays.

I don't believe the supplement covers anything that Medicare does not cover.


----------



## VacationForever (Nov 20, 2019)

mpumilia said:


> But if you are not changing plans or the insurance company- just the rate is changing? I don't understand.


Yes.  If you make direct contact to change anything without going through the broker, the broker gets dropped from their system.


----------



## WinniWoman (Nov 20, 2019)

VacationForever said:


> Yes.  If you make direct contact to change anything without going through the broker, the broker gets dropped from their system.




Aahh... I see. So- yes- I do have to call them first  if we want that HRA money. Thanks.


----------



## Brett (Nov 20, 2019)

mpumilia said:


> Just to get rates you can put in anything you want on the website. No way can you verify your income for 2020 when it hasn't happened yet. I guess when you file your taxes at the end of the year, that is when they see what it is? I have no idea. I suppose you can tell them retired and no SS for next year? I really don't know and this stuff is one reason why I hate to get involved with this type of plan.



yes, that's what you do.   "Obamacare" health insurance premiums are based on income and if your income is more than what you initially submitted online then you pay more taxes next year.


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## simpsontruckdriver (Dec 2, 2019)

FYI, Annual Enrollment ends in less than a week! Then comes Open Enrollment between January 1 - March 31. During that time, you can change to a different MAPD once, but if you have Medicare + Part-D you can not change. You can change a Medicare Supplement, but the plan *may* deny Pre-Existing Conditions (aka underwriting - if you have no chronic conditions you have nothing to worry about). Insurers and agents will not advertise plans during OE, that is against CMS regulations. We can say the time of it (it is also listed on Medicare's website), but that is about it.

TS


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## bogey21 (Dec 2, 2019)

If peace of mind, not cost, is your primary concern, insure to the maximum.  This will generally be traditional Medicare + a Supplement + Plan D.  If cost is an impediment, improvise and take your chances...

George


----------



## simpsontruckdriver (Dec 2, 2019)

bogey21 said:


> If peace of mind, not cost, is your primary concern, insure to the maximum.



Not only does this apply to Medicare, this also applies to both Life Insurance and Auto (Property and Casualty) Insurance. If you just get the absolute minimum, then file a claim (doctor, car accident, death), there will be unpaid bills.

TS


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## DancingWaters (Dec 2, 2019)

Luanne, do you have plan F or G for a supplemental?
I went on my state teachers retirement supplemental and it seems like I’m getting little bills here and there.  No major problems, just regular visits etc.
We put my husband on Plan G with Anthem so he could have the Silver Sneakers, but if Plan F is better I want it switched


----------



## simpsontruckdriver (Dec 2, 2019)

Here is the policy with Medicare Supplement Part-F. When they say "new people with Medicare", they mean anyone who is newly eligible (65+ or disabled-for-24-months in late 2019). But the last sentence "may be eligible" means you should call Anthem BCBS to find out. Essentially, those who are on Medicare Supplements (like Part-G) who want Plan-F for 2020 is up to the insurer. On the other hand, "Silver Sneakers" may be available on other MedSupp plans, and most MAPD HMO (and some PPO) plans offer it. Personally, I suggest sticking with Part-G, since your premiums will go up if you are able to switch. An agent will let you know, since issue/attained age will determine your premiums 

This post is so long (nothing wrong with that with all the info posted here) that I don't know if this was posted before 

TS


----------



## simpsontruckdriver (Jan 25, 2020)

UPDATE! Currently, there are special enrollment periods if you want to change your Medicare plans. Between 01/01/20 - 03/31/20 you can make ONE change to your Medicare Advantage plan. It's like if you looked over your plan but disliked it, or if your doctor dropped the insurer, you can make a single change for the rest of the year. If you have only Part-A and you wish to join Part-B, and you're past your initial enrollment period, this enrollment period is also for it, but Part-B won't be effective until July. If you have Medicare Supplement, you can change, but you're subject to underwriting, and you're liable to lose pre-existing conditions. If you have Medicare PFFS and a Part-D plan, you are simply out of luck - unless you qualify for another special enrollment period.

As I mentioned before, if you're turning 65 this year, you have 3 months before your birth month, your birth month, and 3 months after your birth month, to sign up. Everyone should sign up for Medicare Part-A at 65, Part-B and Part-D can wait if you have Medicare-compliant group health insurance. There are plenty of other Special Enrollment Periods, if you think you may qualify, talk to an agent. I work in Florida, but I may be able to refer you to a local agent in your state, for enrollment questions or setting you up. If you live in Massachusetts, I am eligible to become an agent, but because it's expensive to become an agent up there, I would ask for a guaranteed sale (don't ask for me to become an agent, then go to another agent to sign up).

TS


----------



## Sugarcubesea (Jan 25, 2020)

Thanks, your a wealth of knowledge and I wish you serviced MI as I would sign up through you.  I’m 6 years away from 65.   The goal is that I will retire In December of my 65th year and then move to FL for retirement.

Since I will still be working when I turn 65 I will know to sign up for part A.


----------



## Sugarcubesea (Jan 25, 2020)

DancingWaters said:


> Luanne, do you have plan F or G for a supplemental?
> I went on my state teachers retirement supplemental and it seems like I’m getting little bills here and there.  No major problems, just regular visits etc.
> We put my husband on Plan G with Anthem so he could have the Silver Sneakers, but if Plan F is better I want it switched



What is Silver Sneakers?


----------



## simpsontruckdriver (Jan 25, 2020)

Silver Sneakers is a Medicare-paid gym membership (aka $0 for members).

TS


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## Sugarcubesea (Jan 25, 2020)

simpsontruckdriver said:


> Silver Sneakers is a Medicare-paid gym membership (aka $0 for members)
> 
> TS



Wow, that’s a nice benefit


----------



## Luanne (Jan 25, 2020)

DancingWaters said:


> Luanne, do you have plan F or G for a supplemental?
> I went on my state teachers retirement supplemental and it seems like I’m getting little bills here and there.  No major problems, just regular visits etc.
> We put my husband on Plan G with Anthem so he could have the Silver Sneakers, but if Plan F is better I want it switched


Plan F

I don't know much, or really anything, about Silver Sneakers.  But, I thought it was only available with some Medicare Advantage plans, not with a Medicare Supplement.  It doesn't even look like Silver Sneakers is available where I live.  I do know the gym I go to is "covered" by some Medicare Advantage plans.


----------



## artringwald (Jan 25, 2020)

We had a Blue Cross Medicare Cost plan when we first signed up for Medicare and when they got rid of the Cost plan a year ago, we signed up for a Blue Cross Medicare Supplement plan. Both plans had Silver and Fit or Silver Sneakers, which include free gym membership. I like Silver Sneakers better because you don't have to commit to any one gym. There's a plethora of gyms supported in our area, so we can go to which ever one we want on any given day.


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## simpsontruckdriver (Jan 25, 2020)

Essentially, some MedSupp plans are throwing in Silver Sneakers plans, while most Medicare Advantage HMOs have that benefit. As an insurance agent, we never say "free", because someone always pays. In this case, Medicare plans pay it


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## Luanne (Jan 25, 2020)

simpsontruckdriver said:


> Essentially, some MedSupp plans are throwing in Silver Sneakers plans, while most Medicare Advantage HMOs have that benefit. As an insurance agent, we never say "free", because someone always pays. In this case, Medicare plans pay it


Thanks for the info. As I said in my earlier post looks like Silver Sneakers isn't available in my area, so for me it's a non-issue.


----------



## DancingWaters (Jan 25, 2020)

I have really enjoyed my silver sneakers membership.  I go to the YMCA and take an aquacise class on Mondays, and I take an aqua Zumba class on Tuesday.  I feel so good after both classes it’s amazing.  With my silver sneakers card I don’t pay anything for the Y membership or the classes.  Other facilities accept silver sneakers also like Planet Fitness, Anytime Fitness, Senior Centers


----------



## simpsontruckdriver (Jan 28, 2020)

FYI, I finally was able to get some information where I am licensed and ready to sell products. Not only am I licensed in Florida, I am licensed in North Carolina and Washington (state). If you live in either of the 3 states, I can assist. In all other states, I can see if I can refer you to an agent in the area (no guarantees).

TS


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## simpsontruckdriver (Jan 29, 2020)

I am not sure it was covered in the mounds of information in this post, but there is another federal health insurance that many may take: TriCare. If you are a vet and you're eligible for it, you can take it instead of Medicare without penalty (if you choose to take Medicare later in retirement). I know nothing about the benefits of taking TriCare over Medicare, but you can compare the two to see which one is better.

TS


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## simpsontruckdriver (Apr 27, 2020)

It's been a few months and we're officially out of any enrollment periods. But there are always exceptions, which I may have mentioned in one of the 9 other pages.

Delayed Part-B = if you delayed taking Part-B at 65, then you sign up in January (Part-B), you can sign up for a Medicare Advantage plan in May for a July 1 effective date (coinciding with Part-B effective date).
Losing coverage = if you delayed taking full Medicare while you have a Group Policy (work), but you quit that plan, you can join a Medicare plan.
Moving = if you move from one zip code to another, you should switch plans, since your plan in one zip code may not be in your new zip code
Institutional = if you move into/out of a nursing home or jail, you can switch plans
Low-Income = if you receive assistance from the state and/or Social Security, you can switch plans once per quarter
Medicare Supplements have their own enrollment periods, and most likely you'll be subject to pre-existing conditions. I'm not sure about other states, but in Florida, those who are disabled or have End-Stage Renal Disease (kidney failure that requires transplant) must take a supplement as soon as they get Medicare, after the 7-month enrollment period (Guarantee Issue) they can not sign up for a supplement until they turn 65.
If you live in or moving to FL, NC, or WA, I can help you personally (Send me a private message). But, I suggest going through the previous 216 messages to see if your question is answered there. *PLUS*, thanks to Coronavirus, I can sign you up for any Medicare Advantage plan online, all insurers highly suggest not meeting face-to-face to sign up.

TS


----------



## simpsontruckdriver (May 14, 2020)

*UPDATE*
Trying to figure out licensing in other states (aka non-resident health insurance licensing) is a HUGE pain! No state is the same, and MA is the most expensive. So, I don't want to get a license in another state without a guaranteed customer. It costs you nothing (Medicare pays our commissions).

If you have or will get Medicare in 2020, and you want me to be your agent (I can offer you Aetna, AARP United Healthcare, or Humana) send me a message. There is no guarantee I can become an agent in your state as I was licensed in most states in 2012 and they all expired (expired usually means the agent must start at the beginning).

TS


----------



## Polly Metallic (May 14, 2020)

I read the first few pages then skipped to the end since there's so much information it's overwhelming. Here's my situation. My husband (59) and I currently have insurance through Independent Health via the NYS Marketplace. The last few years, due to our income level, our heath insurance premiums were refunded once we filed our income tax. I turn 65 this year in mid July. Since I started drawing Social Security at 62, the info I received from S.S. says I will be automatically enrolled in Parts A and B. I assume my present Independent Health coverage will overlap Medicare for the remainder of 2020, then I'll just have Medicare next year. I see no need for an Advantage Plan, and I'd like to avoid unnecessary Medicare supplement plans, considering we've been getting our insurance essentially free from NYS Marketplace. Can I just coast along on Parts A and B for the next few years? Aside from arthritis, I have no health issues that I'm aware of, and I'm not on any medications.


----------



## simpsontruckdriver (May 14, 2020)

Polly Metallic said:


> Can I just coast along on Parts A and B for the next few years? Aside from arthritis, I have no health issues that I'm aware of, and I'm not on any medications.


Not exactly. As soon as you turn 65, if you do not have comparable medical coverage, you must sign up for Parts A + B ($144/month) + D (premiums between $15-$35 per month for drugs). Or, to save money, get a $0 premium Medicare Advantage with Prescription Drugs (MAPD) plan. In that case, you would pay the Part-B premium ($144) only, with full medical benefits. If you take ONLY Parts A & B, no Part-D, you will begin accruing a Late Enrollment Penalty, which Medicare will bill you as soon as you sign up for a drug plan. That is 1% of the average premium for every month you do not take it, maxing out around $35/month.

For example, my dad took Medicare Parts A & B when he turned 65 in 1999. In 2005, Part-D was introduced (created and signed by Republicans), but he never took it. A couple years ago, he signed up for an MAPD, and Medicare tacked on around $35/month Late Enrollment Period until he dies or qualifies for a Low-Income Subsidy (LIS).

TS


----------



## Talent312 (May 14, 2020)

As a SS recipient, I was automatically enrolled in Parts A+B eff. the month I turned 65.
I received my Medicare card in the mail about 2-3 months before my start date.
I then set about looking for a Medigap (Supplement) + Drug plan on my own.
_... BTW, your state's insurance agency may list company premiums._

*Existing Insurance*... which does not convert itself to a Medicare plan:
*1)* May be secondary to Medicare anyway. It won't pay what Medicare would have.
*2)* Won't flow thru or work w-Medicare, so separate claims will be needed.
*3)* Not enrolling in a plan within the initial period may result in higher premiums
_.... (unless you qualify for a special enrollment period)._
*4)* If Medicare thinks you have other insurance in force, it may deny claims.
... We had to show that DW's policy had been cancelled to get her 1st claim paid.

IOW, it is not a good substitute for a Medigap+Drug (or Advantage) plan.
Relying on it as such is beset with issues.  I urge you to research the heck out of it.


----------



## Polly Metallic (May 14, 2020)

Talent312 said:


> As a SS recipient, I was automatically enrolled in Parts A+B eff. the month I turned 65.
> In fact, I received my Medicare card in the mail about 2-3 months before my start date.
> _... Perhaps to make sure that I didn't go out and do it myself._
> 
> ...



I have the card for parts A and B, and the info stated there’s nothing I need to do, I will be automatically enrolled when I turn 65. Personally, I’d rather skip Medicare and keep my present insurance plan, but from what you’re saying, that’s not an option, right? We’re all forced to have a government mandated Medicare plan whether we want it or not.


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## simpsontruckdriver (May 14, 2020)

It is an option. But, Medicare Advantage only costs around $144 per month with full benefits and no/low deductibles. So, do your own math. Since they say you are automatically enrolled in Parts A & B, that means you're going to pay $144/month out of your SS check. I assume your NYS plan is equal to Medicare, and since you said you get it for free, you can do either. Either way (MAPD or NYS), you will be paying $144/month for healthcare.

TS


----------



## Luanne (May 14, 2020)

simpsontruckdriver said:


> It is an option. But, Medicare Advantage only costs around $144 per month with full benefits and no/low deductibles. So, do your own math. Since they say you are automatically enrolled in Parts A & B, that means you're going to pay $144/month out of your SS check. I assume your NYS plan is equal to Medicare, and since you said you get it for free, you can do either. Either way (MAPD or NYS), you will be paying $144/month for healthcare.
> 
> TS


Doesn't the monthly cost for a Medicare Advantage plan depend on a few things.  Like where you live, who the carrier is, what the plan is?  We opted for Supplemental Plans rather than Medicare Advantage.  We felt it would give us more flexibility.


----------



## simpsontruckdriver (May 14, 2020)

Supplements do give a lot of flexibility but with higher premiums. In most areas, you can get a PPO (Preferred Provider Organization) that allows you to choose your doctors, but ones that do not take your MAPD are slightly higher copays.

In another post, I gave a major reason to sign up for an MAPD from either Humana or United Healthcare: $0 copays for primary care doctors, mental health, and telemedicine for the rest of 2020. Supplements' copays are unchanged. Blue Cross Blue Shield is waiving copays only for telemedicine for 2020. Aetna is only waiving for Coronavirus diagnosis.

TS


----------



## Steve Fatula (May 14, 2020)

Luanne said:


> Doesn't the monthly cost for a Medicare Advantage plan depend on a few things.  Like where you live, who the carrier is, what the plan is?  We opted for Supplemental Plans rather than Medicare Advantage.  We felt it would give us more flexibility.



It can greatly depend on where you live. In some states, people complain they are limited to what doctors they can use. Here in Oklahoma, my wife had a plan which allowed her to use any doctor via an advantage plan (PFFS). In Ohio where my sister lives, most Advantage plans cost $0 extra. Here, none did (at the time), they all cost extra.


----------



## Luanne (May 14, 2020)

simpsontruckdriver said:


> Supplements do give a lot of flexibility but with higher premiums. In most areas, you can get a PPO (Preferred Provider Organization) that allows you to choose your doctors, but ones that do not take your MAPD are slightly higher copays.
> 
> In another post, I gave a major reason to sign up for an MAPD from either Humana or United Healthcare: $0 copays for primary care doctors, mental health, and telemedicine for the rest of 2020. Supplements' copays are unchanged. Blue Cross Blue Shield is waiving copays only for telemedicine for 2020. Aetna is only waiving for Coronavirus diagnosis.
> 
> TS


So where did the $144/month come from?

My monthly premium for a supplement is less than that.


----------



## simpsontruckdriver (May 14, 2020)

$144/month is Part-B premium. MAPD premiums are as low as $0.

TS


----------



## Luanne (May 14, 2020)

simpsontruckdriver said:


> $144/month is Part-B premium. MAPD premiums are as low as $0.
> 
> TS


Thanks.  I must have mis-read your post.


----------



## simpsontruckdriver (May 14, 2020)

No problem, there are over 200 posts and people can get bleary-eyed 

TS


----------



## topmom101 (May 22, 2020)

I AM bleary eyed and completely overwhelmed. I have read so much material and spent hours and hours watching you-tube videos. I turn 65 in June and just signed up for an AARP Medicare Advantage plan #1. It all sounded so good on the phone but now I am having doubts. I live in South Carolina. My husband works for Lowe’s and both of us are covered under their health plan. I need to make decisions, but, frankly, I am so confused. 

What are your thoughts on the advantage plans? One of the things that is bothering me and the insurance broker did not tell me is that I will not be covered out of state unless it’s an emergency. My daughter lives in NY and I visit her one week every month. What would happen is I were to get sick or take a fall? 

Also, as I mentioned above, I signed up over the phone for this plan (the only one he told me about) 2 days ago with a broker from United Healthcare.  Am I locked into it or can I still cancel? The plan would be effective as of June 1st.

I welcome your advice.


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## simpsontruckdriver (May 22, 2020)

As a former agent for AARP/United Healthcare (I would need to be re-appointed), I am familiar with those plans. The way most Medicare Advantage plans work is yes, you're only covered for ER/Hospital stays out of state or dialysis. But, there is one feature the salesman did not mention: travel. If you need non-emergency care in another area (let's say you get a throat infection, so urgent care is better than ER), you can call UHC and they can point you to an in-network provider and switch your network to that area. This is a PDF about the plan. You can call UHC customer service and find out if your plan is eligible. And this applies to ******ALL****** AARP/UnitedHealthCare Medicare Advantage with Prescription Drug subscribers, call UHC to see if your plan has that benefit. Humana also allows the same, switch to the new area by calling customer service.

If your plan does not, you MAY be able to switch to one that does by calling customer service. If not, you would have to wait until Annual Enrollment Period (AEP). Usually, when you first sign up, you're stuck with that plan until you switch during AEP, but customer service may be able to find a way (no guarantees).

TS


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## dago (May 22, 2020)

WinniWoman said:


> From what I have read from other people, always check your Part D plan coverage- even if it is the same plan because suddenly you could be paying a lot more next year for the drugs you are on. So don't automatically renew before you check this out.
> 
> I have also read some things about Humana renewing people into another plan and also trying to coerce people into Medicare Advantage plans. Be aware.


Exactly - I have Humana Part D. Just before open enrollment they notified me that my plan was changed and my premium about tripled. I started looking around for other options and found that I could get the  same coverage from Humana for even less than I paid last year. The only difference was some of the RX I need moved to a different tier. All things being equal, my out of pocket costs was still way less than the plan they were going to put me in. I told a friend of mine who had the same plan that I had in 2019 to be aware of what was going on. He ended up waiting too long to take any action and it was beyond the open enrollment date, so he couldn't change. However, when he talked to Humana in person, the Rep did try to coerce him into Medicare Advantage plans.


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## dago (May 22, 2020)

simpsontruckdriver said:


> Regarding Part-D... if you're not going to take an MAPD (either not taking Part-B or you're taking a MediGap plan), and you're healthy, talk to an agent to get the least expensive PDP. Why pay $30+/month when you can get one as low as $15/month?
> 
> TS


That's what I did. Premium is $13.20


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## pittle (May 22, 2020)

We are"grandfathered" in for UHC Plan F, so do not worry about the $144 Part B and plan to keep it for as long as it is available to us.  We do not take any prescription meds, so we have the $13.30 Humana Walmart Plan D for each of us.


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## topmom101 (May 22, 2020)

TS, you saved the day!!! Your advice was exactly what I needed to hear. I called UHC and confirmed that my plan does indeed qualify for the Passport benefit. That solves my problem of being uninsured while visiting my daughter in NY. Funny, though.... before seeing your reply earlier today, I had called UHC to confirm something else and spoke to a different agent who also failed to mention this benefit.  After reading your reply, I called a third time and spoke to a woman who confirmed the Passport benefit and explained it thoroughly.  I am in excellent health and have decided to stay with the advantage plan. TS, I can’t thank you enough.


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## dago (May 22, 2020)

WinniWoman said:


> I cannot remember where I read it. I have been reading so much about this these past few days I am going loony.


You are correct you can downgrade(F to G). You basically cannot upgrade, but you may be able to, but you would be subject to the previous conditions situation.
I can feel your frustration and anger. Getting medicare insurance is overwhelming. I remember when I was 65(10 years ago) and was going through the process. Felt just like you. It should not be that complicated, IMO.


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## simpsontruckdriver (May 22, 2020)

For those who feel they're overwhelmed with Medicare, get an agent. I am more than willing, but you can find someone who lives in your area. We're not here to make money off of your Medicare, we're here for you to "pick our brains". Commissions (paid by Medicare) are a bonus.

Todd S
Aetna & Humana
Licensed in Florida, North Carolina, and Washington (but eligible in most other states).


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## dago (May 22, 2020)

WinniWoman said:


> My husband's health is good right now thankfully. The only difference with G is the Part B deductible $185  outlay, but the premiums are similar. Hey- $185 is $185. I am just not sure what to do because people keep saying that the F premiums are going to rise over time and so forth.
> 
> G premium is $210 per month and F is $230. Both Empire. I guess either way- the F you lay out $20 more per month for the premium. With G you lay out up to about $15 per month for the deductible IF you use it.
> 
> Then again, I assume the Part B deductible can go up?


Yes Part B deductible can and will increase. Also, my understanding of Plan G is in  addition to the Part B deductible one needs to pay one also has co-pays to docs and ER.


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## dago (May 22, 2020)

simpsontruckdriver said:


> I'm not sure about your area (I am in Florida), but for 2020, Humana is rolling out a revised "WalMart" PDP. You can call Humana directly, an agent can get you set up on a less-expensive plan. The whole "WalMart" is just a saying, that it is usually the least expensive plan. *In addition*, you can save more by signing up for the Humana mail-order pharmacy (does not include specialty or narcotics), where 3 month generics are less than $5.00. Humana can point you in the right direction on both.
> 
> TS


Exactly - That's the plan I have (I'm in Ohio) The premium is $13.20/month


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## dago (May 22, 2020)

easyrider said:


> I wonder how much the supplemental insurance paid that wasn't covered under regular Medicare ? When I bought supplemental insurance for my inlaws it did seem like Medicare actually covered everything. The supplemental we had for my mother in law didn't help with her perscription costs as the drug she was on was new, it didn't help with nursing home stay to recover and it didn't pay for hospice.
> 
> For my father in law the supplemental insurance didn't really pay for anything either and he had multiple heart issues that included 7 bypasses in 1 operation that had a 25 day hospitial stay, 90 day nursing home stay and continued care.
> 
> ...


I could be wrong, but I don't believe Medicare Advantage plans pay for Nursing home stays either. My FIL was in a nursing home for a short period of time before he passed and his MA plan didn't cover the expenses.


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## simpsontruckdriver (May 22, 2020)

Most Medicare Advantage plans (at least Humana, Aetna, and AARP/United Healthcare) pay for up to 150 days of Skilled Nursing (aka nursing home). The first few days are usually $0 copay, then the rest are a certain rate per day. All MAPD, Medigap, and Medicare PFFS (aka "basic") will end at 150 days or if the patient does not improve (whichever comes first).

TS


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## Talent312 (May 22, 2020)

Last year, Aetna sold DW's drug plan to Wellcare. The renewal premium increased.
We found another Wellcare plan thru the Medicare website for much less ($13.20).
It was another Wellcare plan. This confused them, but we called and worked it out.


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## dago (May 22, 2020)

DancingWaters said:


> Luanne, do you have plan F or G for a supplemental?
> I went on my state teachers retirement supplemental and it seems like I’m getting little bills here and there.  No major problems, just regular visits etc.
> We put my husband on Plan G with Anthem so he could have the Silver Sneakers, but if Plan F is better I want it switched


The difference between Plan G and plan F is Plan F pays all deductibles and co-pays. With Plan G you pay the Part B deductible and I$20 co-pays to the doctor and $50 co-pay for ER. The premiums for plan G are substantially lower. You need to estimate how many times you think you will see a doctor and how many times you think you might go to ER, and compare all your out-of-pocket costs between the 2 Plans. I looked into it, and for me although the the total out-of-pocket for Plan G was less than Part F, it was not enough for me to make the change., so I stayed with Plan F. I have had Plan F for 10 years and,other than the premiums I have never paid a dime for any health services. I just feel more comfortable with not having to worry about co-pays when I go to the doctor. For 2020 they are not offering Plan F anymore, so this may be a moot point.


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## dago (May 22, 2020)

Luanne said:


> Plan F
> 
> I don't know much, or really anything, about Silver Sneakers.  But, I thought it was only available with some Medicare Advantage plans, not with a Medicare Supplement.  It doesn't even look like Silver Sneakers is available where I live.  I do know the gym I go to is "covered" by some Medicare Advantage plans.


I thought the same thing. But I have Plan F from UHC(AARP discount)  and I DID have Silver Sneakers, but they took it away last year.


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## simpsontruckdriver (May 26, 2020)

FYI, for 2021, MAPDs (and possibly PDP) will offer a Diabetes plan. For a higher premium, you'll get Insulin for $35. It will be a whole new plan, you will not automatically get the Diabetes benefit. Insurance agents like myself won't know anything until September for plans offered in Annual Enrollment.

Todd S


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## topmom101 (May 27, 2020)

Todd S., thank you for that information. My brother has a Medicare Advantage plan thru UHC and is diabetic.  I know he pays over $150/month for his insulin. He’ll be happy to hear this news. 

I am so glad to be a part of this knowledgeable group of people.


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## simpsontruckdriver (May 27, 2020)

Like I said, I have no idea what the premiums will be, but I have a feeling they will save $$$ overall. That is the premise of insurance, spreading loss over all members.

Todd S



topmom101 said:


> Todd S., thank you for that information. My brother has a Medicare Advantage plan thru UHC and is diabetic.  I know he pays over $150/month for his insulin. He’ll be happy to hear this news.
> 
> I am so glad to be a part of this knowledgeable group of people.


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## Talent312 (May 27, 2020)

topmom101 said:


> Todd S., thank you for that information. My brother has a Medicare Advantage plan thru UHC and is diabetic.  I know he pays over $150/month for his insulin. He’ll be happy to hear this news.



Good news for insulin users.
OTOH, there are a lot us diabetics using alternative brand-name drugs (Jardiance) who will pay thru the nose.  I'll have to cover my deductible ($485) each year with very first refill, yet the annual cost will be less than "better" drug plans.


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## simpsontruckdriver (May 27, 2020)

As I said before, most Insulin-based products will be $35 or less with the new plans. The big question is premiums. It's similar to when President GW Bush signed the Part-D law, it is not run by the government, it is regulated by CMS. CMS is telling insurers like UHC, Humana, etc to create Diabetes-specific MAPD and PDP plans that significantly cut Insulin copays.

TS


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## simpsontruckdriver (Jun 12, 2020)

FYI, for anyone on Humana Medicare Advantage plans - or considering it - they are sending out health test kits. The page talks about calling them, but in a week, they're sending them out proactively. Their take is, get it done and find out if something is going wrong, that way they can be treated before it gets bad.

As always, I can sign you up if you're turning 65, or later this year for AEP.

TS


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## Brett (Jun 12, 2020)

simpsontruckdriver said:


> FYI, for anyone on Humana Medicare Advantage plans - or considering it - they are sending out health test kits. The page talks about calling them, but in a week, they're sending them out proactively. Their take is, get it done and find out if something is going wrong, that way they can be treated before it gets bad.
> 
> As always, I can sign you up if you're turning 65, or later this year for AEP.
> 
> TS




interesting, I have a Human supplement plan


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## Luanne (Jun 12, 2020)

Brett said:


> interesting, I have a *Human* supplement plan


Well, I would hope you would have a Human plan.


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## clifffaith (Jun 12, 2020)

simpsontruckdriver said:


> FYI, for anyone on Humana Medicare Advantage plans - or considering it - they are sending out health test kits. The page talks about calling them, but in a week, they're sending them out proactively. Their take is, get it done and find out if something is going wrong, that way they can be treated before it gets bad.
> 
> As always, I can sign you up if you're turning 65, or later this year for AEP.
> 
> TS



What is AEP? The robo sharks started circling last week and at least once a day we get another Medicare call (and inexplicably Cliff feels he needs to track me down to talk to/hang up on the caller) -- I turn 65 in December.


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## simpsontruckdriver (Jun 12, 2020)

See page 1 

AEP = Annual Enrollment Period, 10/15 - 12/07 yearly when everyone can change their plans. Or keep it. As I mentioned somewhere, you can enroll between September 1 and March 30 (Initial Enrollment Period).

TS

PS. THe "See page 1" is a joke seeing as the site is chock full of information in around 10 pages


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## Brett (Jun 12, 2020)

Luanne said:


> Well, I would hope you would have a Human plan.



I have a human plan   ... and Humana !


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## simpsontruckdriver (Jun 25, 2020)

Even though this is from a year ago, Kaiser lays out much of the data with Medicare Advantage Plan subscriptions.

TS


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## Talent312 (Jun 25, 2020)

I just started Medicare with a Supplement (Plan G) in March.
I like how at the doc's check-out desk, I don't have to pull out
a CC anymore this year (having met the nominal deductible).

But the Drug Plan's $435 deductible for brand-Rx's was a pain.
I paid in full with my first refill of the drug, but I was prepared.
.


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## simpsontruckdriver (Jun 25, 2020)

In some cases, generics can save $$$ but only if they are available. For instance, my dad is on a certain Brand-Name drug that does not have a generic yet. Or, the other option is in AEP, add up your year of both premiums and drug costs, then talk to an agent (like myself) and we could see if another PDP will save money.

TS


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## dago (Jul 11, 2020)

simpsontruckdriver said:


> I'm not sure about your area (I am in Florida), but for 2020, Humana is rolling out a revised "WalMart" PDP. You can call Humana directly, an agent can get you set up on a less-expensive plan. The whole "WalMart" is just a saying, that it is usually the least expensive plan. *In addition*, you can save more by signing up for the Humana mail-order pharmacy (does not include specialty or narcotics), where 3 month generics are less than $5.00. Humana can point you in the right direction on both.
> 
> TS


It's called Humana Walmart Value RX Plan(PDP). Here in Ohio the premium is $13.20/month and my thyroid meds are $1.00 for 30 day supply or $3.00 for a 90 day supply.


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## Talent312 (Jul 11, 2020)

dago said:


> It's called Humana Walmart Value RX Plan(PDP). Here in Ohio the premium is $13.20/month...



We used to have the "Walmart" plan, but switched to WellCare Wellness ($13.20/month).
Even though we had to pay a deductible+copay for my brand-name, it was equivalent.
It offered Publix as a preferred pharmacy, which was more convenient to us.

.


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## isisdave (Jul 11, 2020)

We did the same as the Walmart plan was going from $15 to $29 for some reason. But the WellCare plan was 13.20, covered all the same things, and the preferred local pharmacy was a small local Ralphs that is a lot easier to use. (California)


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## dago (Jul 11, 2020)

isisdave said:


> We did the same as the Walmart plan was going from $15 to $29 for some reason. But the WellCare plan was 13.20, covered all the same things, and the preferred local pharmacy was a small local Ralphs that is a lot easier to use. (California)


So my plan is basically the same. Walmart is within walking distance from my home, so very convenient, but I generally use the Humana mail-order, which is even more convenient


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## simpsontruckdriver (Jul 14, 2020)

I may have mentioned it somewhere in all my posts, but earlier this year, Humana raised the price on their original "WalMart" PDP. That was so they could create a NEW "WalMart" PDP. If you're in the hunt for an inexpensive PDP, Humana's low-cost PDP (they use "WalMart" more for marketing, but WalMart is one of their preferred pharmacies) is available to those who can switch.

Personally, I do not suggest WellCare, but if you find their plans are better than Humana/Aetna/AARP United Healthcare/BCBS, go ahead and enroll or stay with them. Essentially, a couple years ago, my dad (who just turned 86) was hospitalized a couple times due to severe infections. After the second stay, WellCare denied his stay (ICU for a week, then regular hospital for a week, then a week in rehab) because they claimed he did not follow doctor's orders. The family appealed, and are obviously not paying more than the Medicare deductible. Once he got out of rehab, I changed him to Humana, he has no complaints other than denying a doctor-prescribed Rx (I let him know how to appeal that). So for me, I won't, but if you still want it, be ready to appeal of any denials.

TS


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## simpsontruckdriver (Aug 5, 2020)

(Message removed)  Sorry--advertising is not allowed in the discussion forums.


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## simpsontruckdriver (Aug 17, 2020)

Anyway, in October (if you have Medicare currently), you may want to look into switching Medicare Advantage plans. I've looked into the 2021 plans, they are all cheaper! Low/no premiums, lower copays, etc. I doubt Medicare Supplements are going down in price since they're regulated by your state. And for Diabetics, like I mentioned before, many PDPs and Medicare Advantage plans have Diabetes-specific plans that will cut Insulin prices to a maximum $35 as I mentioned before.

TS


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## linsj (Aug 18, 2020)

simpsontruckdriver said:


> Anyway, in October (if you have Medicare currently), you may want to look into switching Medicare Advantage plans. I've looked into the 2021 plans, they are all cheaper! Low/no premiums, lower copays, etc.



I've had a PPO Advantage plan since I started on Medicare, first with Blue Cross, then with Humana. The premium is affordable, and the extra benefits help a lot. The $0 premium plans are all HMOs, which I would never choose. Both companies are much less expensive than supplement plans and include prescriptions. The PPO plans include every hospital in the Chicago area and a huge list of doctors. 

I can't say enough good things about the Humana plan. After the first year, the copays went down and the quarterly OTC amount went up. This year it's waving the $5 copay for primary docs. My plan also comes with $200 vision/year, dental (not a lot because my dentist isn't in network, but it helps), and gift-card payments for wellness exams like mammograms, blood tests, flu shots, etc. Plus the three prescriptions I take are free through its mail-order pharmacy. I've had to pay some for X-rays, but I'm still way ahead financially compared with a supplement plan.


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## Talent312 (Aug 18, 2020)

linsj said:


> I've had a PPO Advantage plan since I started on Medicare, first with Blue Cross, then with Humana....



We like our Supplement plans (F+G) 'cuz after the deductible, everything is -0-.
We don't miss the extra premium. But hey, whatever floats your boat.
Supplement and Advantage plans have been debated here since time began.
.


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## simpsontruckdriver (Sep 1, 2020)

MORE CHANGES FOR 01/01/2021!

Medicare will now allow people with Stage-4 Kidney Disease (ESRD) to join/change MAPD plans.

TS


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## Brett (Sep 1, 2020)

I have supplemental plan F


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## simpsontruckdriver (Sep 3, 2020)

More news from Medicare... up until 2020, if you had End-Stage Renal Disease (aka kidney failure), you could not join a Medicare Advantage plan. It is the only pre-existing condition, meaning you could only get a supplement (which can be expensive). Until now. Starting in 2021, Medicare will allow anyone with ESRD to join an MAPD.

TS


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## simpsontruckdriver (Oct 1, 2020)

If you are on a Humana MAPD, and you were diagnosed with ESRD (Kidney failure  - producing less than 15% and requiring Dialysis), DaVita is no longer in-network effective January 1. If you are going now, you can continue until the end of the year *unless* they work out an agreement.

TS


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## Talent312 (Oct 1, 2020)

Given the advent of "Open Season" on Medicare clients,
perhaps it's time to start a new Medicare '21  thread.
.


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## pittle (Oct 1, 2020)

We have the lower cost Humana Walmart plan, but neither of us takes any meds.  We are thinking about changing to the $6.60 per month SilverScript SmartRX.   Since we have to have a plan or there is a penalty, this could be a fit for us. 

If something costs too much, we will try GoodRX.  I did that for a prescription cream the dermatologist prescribed last month and saved 66%. That was the first prescription I have had to fill in 9 years.

If something changes and we do start taking prescription meds, we can change again next year.

We have UHC Plan F for Healthcare.  It works great.


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## Luanne (Oct 1, 2020)

pittle said:


> We have the lower cost Humana Walmart plan, but neither of us takes any meds.  We are thinking about changing to the $6.60 per month SilverScript SmartRX.   Since we have to have a plan or there is a penalty, this could be a fit for us.
> 
> If something costs too much, we will try GoodRX.  I did that for a prescription cream the dermatologist prescribed last month and saved 66%. That was the first prescription I have had to fill in 9 years.
> 
> ...


I have compared pricing through GoodRX and the one Martin Sheen advertises for (can't remember the name) and found in both cases we did better with our part D plan.  We have SilverScript, which had been affiliated with CVS, now it's being done by Aetna.  They promise no changes.  And we are paying more than the $6.60/month you are quoting.


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## mjm1 (Oct 1, 2020)

Well, I just applied for social security (1 year and 4 months early) and Medicare as I turn 65 in January. I told my DW that she is officially married to an old guy.  Thankfully neither of us feel our age. We also have UHC Medicare PPO and Express Scripps through the company from which I retired. As far as I know all of our doctors accept our coverages, so we won’t have to make changes there.

One thing we will need to explore is vision coverage. We have used EyeMed, but will have to pay the entire premium starting next year. Both of us wear glasses. Any suggestions regarding other good coverage options would be appreciated.

Best regards.

Mike


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## Luanne (Oct 1, 2020)

mjm1 said:


> Well, I just applied for social security (1 year and 4 months early) and Medicare as I turn 65 in January. I told my DW that she is officially married to an old guy.  Thankfully neither of us feel our age. We also have UHC Medicare PPO and Express Scripps through the company from which I retired. As far as I know all of our doctors accept our coverages, so we won’t have to make changes there.
> 
> One thing we will need to explore is vision coverage. We have used EyeMed, but will have to pay the entire premium starting next year. Both of us wear glasses. Any suggestions regarding other good coverage options would be appreciated.
> 
> ...


We have VSP for vision care.  I get it as a retiree through my company.  You can get private coverage through them as well.  We like it much better than EyeMed.


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## pittle (Oct 1, 2020)

Luanne said:


> I have compared pricing through GoodRX and the one Martin Sheen advertises for (can't remember the name) and found in both cases we did better with our part D plan.  We have SilverScript, which had been affiliated with CVS, now it's being done by Aetna.  They promise no changes.  And we are paying more than the $6.60/month you are quoting.


That was the price I saw on the Medicare Preview today.


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## Luanne (Oct 1, 2020)

pittle said:


> That was the price I saw on the Medicare Preview today.


I'm not disputing that amount.  I'm guessing rates very state by state, who you get tne plan through and what is covered.  The plan we have and the one you are looking at may be different.  I'm just jealous you found prescription coverage for such a low price.


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