Medicare Cliff Notes

[Talent312]

I have a High Deductible Plan F and wonder if I will be able to keep it...

I believe that, as long as you're currently enrolled, you'll be fine.
The restriction only applies to folks who become Medicare eligible on or after 1/1/20.
.

 

[simpsontruckdriver]

The ONLY plan being killed is Plan-F. High-Deductible Plan-F (HDF) will continue. Plan-G and HDF are similar, just HDF has a higher deductible.

TS

 

[simpsontruckdriver]

Another issue with Medicare Part-D (prescription drugs) is affording them. If you and/or a loved one are on Medicare and either MedSupp/Part-D or an MAPD, and you have issues paying for medications, there are two steps you can try:

1. Talk to your/their pharmacist and see if the drug maker has any assistance programs.
2. If you/they take brand-name drugs, talk to your/their doctor whether there are any generics available (which are far cheaper).
   
3. If you/they make less than $1500/month, you should apply for Social Security Extra Help (also known as Low-Income Subsidy, or LIS). It's not welfare, it is assistance SSA offers to everyone but many don't know about it. When you apply, they will also forward your information to your state.

As a side note, I worked on United Healthcare's Part-D collections for a few months in 2013. We called people who received under $1000/month who had issues paying premiums. Most did not know about LIS, and were grateful to have that available.

TS

 

[dms11]

My take is this. Medicare Advantage costs a lot less than the combination of traditional Medicare/Supplement/Plan D. IMO the problem with Medicare Advantage is you pretty much have to stay in the plan's network and often have to go through a gatekeeper (your Primary Care Physician) first. If something serious befalls you and you want to go to a Center of Excellence for whatever it is, chances are you can't with an Advantage Plan. My bottom line is this - if you want maximum flexibility and have the money, I'd recommend going the traditional Medicare/Supplement/Plan D route. If cost is an issue, go the Advantage route...

George

This is exactly the type of advice I was looking for. I am new to Medicare beginning in 2020 and could not figure out the difference between Medicare Advantage and Original Medicare + Medigap. This is a great explanation of that difference.

 

[dms11]

Another issue with Medicare Part-D (prescription drugs) is affording them. If you and/or a loved one are on Medicare and either MedSupp/Part-D or an MAPD, and you have issues paying for medications, there are two steps you can try:

1. Talk to your/their pharmacist and see if the drug maker has any assistance programs.
2. If you/they take brand-name drugs, talk to your/their doctor whether there are any generics available (which are far cheaper).
   
3. If you/they make less than $1500/month, you should apply for Social Security Extra Help (also known as Low-Income Subsidy, or LIS). It's not welfare, it is assistance SSA offers to everyone but many don't know about it. When you apply, they will also forward your information to your state.

As a side note, I worked on United Healthcare's Part-D collections for a few months in 2013. We called people who received under $1000/month who had issues paying premiums. Most did not know about LIS, and were grateful to have that available.

TS

Another alternative to Part D: GoodRx app. They have great prices on most prescription drugs and often undercut the prices of generic drugs that are covered by my current health insurance carrier.

 

[dms11]

I have a High Deductible Plan F and wonder if I will be able to keep it...

George

Yes. Anyone currently on Medicare can keep or sign up for High Deductible Plan F.

 

[dms11]

From what I've seen, the majority (at least 75%) are HMOs.

TS

Agreed....that's about right.

 

[simpsontruckdriver]

Another alternative to Part D: GoodRx app.

Not exactly. If you are Medicare-eligible but don't take a Part-D plan, you will be charged a Late Enrollment Penalty when you do take it, and that will not end until either you die or get a Low-Income Subsidy.

Part-D is the best deal. GoodRX only deals with retail prices. Part-D already gives you a significant discount.

TS

 

[WinniWoman]

I can't make head nor tales of the Part D plans. I see the different deductibles and copays, and that is about it. So it looks to me like just sign up for the cheapest one if you are ok with those?

 

[simpsontruckdriver]

Essentially, with Part-D plans, the more premium you pay the less your copays are. And the #1 way to spend the least is generic by mail-order. If you only take a couple generics, take the cheapest Part-D plan and do mail-order (most plans are $2 or less for 90-days of generics). If you take no meds, definitely take the lowest premium plan.

TS

 

[bogey21]

I can't make head nor tales of the Part D plans. I see the different deductibles and copays, and that is about it. So it looks to me like just sign up for the cheapest one if you are ok with those?

I'm not sure you are right about this. My understanding is that the different providers have different Formularies. I think, but I could be wrong, the same drug can be in Tier3 with one provider and Tier4 with another. If I am right and the drug in question is an expensive one, the difference in cost may be significant...

George

 

[simpsontruckdriver]

Correct, some drugs are in different tiers with different plans. But, those are the more expensive brand-name drugs. Again, another reason to have an agent, they can look up your costs under their Part-D plans. An independent agent is preferred, since they can look at multiple companies. Generics are pretty much universal.

TS

 

[WinniWoman]

I am seeing a plan for $14 per mont- $0 copays for generics/

I'm not sure you are right about this. My understanding is that the different providers have different Formularies. I think, but I could be wrong, the same drug can be in Tier3 with one provider and Tier4 with another. If I am right and the drug in question is an expensive one, the difference in cost may be significant...

George

They do have different formularies but just try comparing them on line side by side. Not an issue for my husband as he only takes one drug. I guess my questions is- how can you tell which provider has the best formulary, deductible copays and pharmacies. Not an easy task.

 

[bogey21]

Not an issue for my husband as he only takes one drug.

Unless it is an expensive drug I would consider not going with a Plan D. Check the price for his drug on www.goodrx.com

The drawback to not signing up for Plan D is that when he finally does there may be a penalty to pay but the sum of premiums not paid may be more than penalty. Worth checking out...

George

 

[WinniWoman]

Unless it is an expensive drug I would consider not going with a Plan D. Check the price for his drug on www.goodrx.com

The drawback to not signing up for Plan D is that when he finally does there may be a penalty to pay but the sum of premiums not paid may be more than penalty. Worth checking out...

George

Yes. Right. But I think he should sign up because you never know in the future. His drug is a generic type and right now with his insurance he only pays like $12 for a $90 supply he gets in the mail usually. On Good
RX it is a lot more.

I think there is a plan Part D that it is covered in and the premium is only $14 pr month. Still studying it all. What fun.

 

[Luanne]

Unless it is an expensive drug I would consider not going with a Plan D. Check the price for his drug on www.goodrx.com

The drawback to not signing up for Plan D is that when he finally does there may be a penalty to pay but the sum of premiums not paid may be more than penalty. Worth checking out...

George

A friend of mine gave me this advice. SIGN UP for Part D. You never know what will happen in the future.

 

[simpsontruckdriver]

And there is no MAY BE A PENALTY. Let's say you don't take it in January 2020 when you're first eligible for it. Medicare begins the 1% per month for every month you go without. Then in 120 months, you need drugs and sign up. The cap is 100% of around $35, which means you would be paying that for life - unless you get Low-Income Subsidy, which will stop it. If you are working and your drug plan is comparable to Medicare, you won't be charged. GoodRX and other discount prescription things do not count.

TS

 

[Talent312]

My drug of choice is not covered under any plan:
Claussen Dill Pickles.
No maximum out-of-pocket limit, so I pay in full for each jar.
.

 

[simpsontruckdriver]

heheh

 

[vacationhopeful]

I believe if you take a Medicare Advantage Plan you CAN NOT go back to a 'traditional' Medicare plan.

 

[Luanne]

I believe if you take a Medicare Advantage Plan you CAN NOT go back to a 'traditional' Medicare plan.

According to what I've found you can.

This is from medicare.gov:

If you're already in a Medicare Advantage Plan and want to switch, follow these steps:

• To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. You'll be disenrolled automatically from your old plan when your new plan's coverage begins.
• To switch to Original Medicare, contact your current plan, or call us at 1-800-MEDICARE.

 

[simpsontruckdriver]

Yes, you can disenroll from your MAPD and have "basic" Medicare. By doing that, you're eligible for a Medicare Supplement and PDP, but you can't change your mind until the next Annual Enrollment Period or Special Enrollment Period. Will your MAPD try to get you to change your mind? No, that is illegal.

TS