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Medicare Part A? B? D? HSA? What the?

Krteczech

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So hubby's open enrollment period for 2019 is coming up at his job and we have to make some decisions.

He turns 65 in April. Not retiring. He has always contributed (the max) to an HSA since he has a high deductible plan, but if he applies for Medicare in 2019 he will no longer be able to do so.

If he does not apply for Medicare, and decides to retire April of 2020- when he turns 66- he will have had to stop contributing to his HSA 7 months BEFORE that date-around October 2019- or face tax penalties. Then he is going to have to immediately apply for Medicare when he turns 66 upon retirement.

So- my question is: Should he apply for Medicare Part A in January 2019 or should he wait until he retires in 2020 (or whenever he does retire)? What about Part B? Should he apply for that also or wait? He would be keeping his health insurance through his job no matter what. His employer is a large one so the insurance would be primary over Medicare.(I am also covered under that plan.) I heard sometimes it is a hassle to apply for Part B later on when you do retire- it takes a while to take effect and you could have a gap in insurance coverage(?).

And- what about D then? How does that come into play? Since he has employer insurance with drug coverage I assume we can forgo that- or can we?- there are so many rules my head spins. Will it be an issue later on when he no longer has employer heath insurance and need drug coverage through Medicare? Yikes.

My thinking is that Part A is free anyway. His insurance is high deductible and Medicare, though it has a deductible also, could pick up for anything his insurance does not should something happen medically before he retires. With Part B, since he would not be contributing to his HSA, he could divert some of that money for the Part B premium. (He does not pay a premium for his insurance at his job- at least up until now his company pays for him in full. We do pay a premium for me). Then Part B could also pick up for things his insurance does not pay for as well. My husband could also divert some of the money he would normally have put in the HSA into his 401K, which he recently had to cut contributions because of my job loss. Or honestly we could use some of the extra money in our household budget so it wouldn't be so tight.

Know that we have been healthy so far. We get preventative care. Hubby is on blood pressure meds (cheap through his employer prescription plan) and has to visit the doc every 6 months and have lab work. Have to lay out for colonoscopies because we have both had polyps in the past.

So the downside is that he could not contribute to the HSA (well he could for the first 3 months of the year, but why even bother- the tax advantage would be minimal) if he goes on Medicare and if he doesn't he still cannot contribute to the HSA for the entire 2020 year either, though he can get a chunk of money in there- again- not worth the hassle and tax advantage I would think (our income in 2019 will be lower than this year, since I am no longer working).

I contacted his HR dept and the reps there were useless. I finally was directed to a retirement specialist at the company (even though hubby is not retiring) and she was somewhat helpful but couldn't help me on this particular issue. She then directed me to another company called Via Benefits which supposedly handles his company's employees in transition when they are eligible for Medicare and retire and so forth. That rep also said she could not assist me because my husband was not Medicare eligible yet and would be getting a card in the mail from SS in January and at that time I could call back and ask questions. She said their advisors were sales reps. and could not answer these questions at this time. Huh? I tried calling Medicare and was on hold so long I hung up. Then I tried the local SHIP office via phone and they were not there. OMG...

How can someone plan and make decisions without the proper information? I don't get it.

Anyway, hoping someone here has some insight into this.
So hubby's open enrollment period for 2019 is coming up at his job and we have to make some decisions.

He turns 65 in April. Not retiring. He has always contributed (the max) to an HSA since he has a high deductible plan, but if he applies for Medicare in 2019 he will no longer be able to do so.

If he does not apply for Medicare, and decides to retire April of 2020- when he turns 66- he will have had to stop contributing to his HSA 7 months BEFORE that date-around October 2019- or face tax penalties. Then he is going to have to immediately apply for Medicare when he turns 66 upon retirement.

So- my question is: Should he apply for Medicare Part A in January 2019 or should he wait until he retires in 2020 (or whenever he does retire)? What about Part B? Should he apply for that also or wait? He would be keeping his health insurance through his job no matter what. His employer is a large one so the insurance would be primary over Medicare.(I am also covered under that plan.) I heard sometimes it is a hassle to apply for Part B later on when you do retire- it takes a while to take effect and you could have a gap in insurance coverage(?).

And- what about D then? How does that come into play? Since he has employer insurance with drug coverage I assume we can forgo that- or can we?- there are so many rules my head spins. Will it be an issue later on when he no longer has employer heath insurance and need drug coverage through Medicare? Yikes.

My thinking is that Part A is free anyway. His insurance is high deductible and Medicare, though it has a deductible also, could pick up for anything his insurance does not should something happen medically before he retires. With Part B, since he would not be contributing to his HSA, he could divert some of that money for the Part B premium. (He does not pay a premium for his insurance at his job- at least up until now his company pays for him in full. We do pay a premium for me). Then Part B could also pick up for things his insurance does not pay for as well. My husband could also divert some of the money he would normally have put in the HSA into his 401K, which he recently had to cut contributions because of my job loss. Or honestly we could use some of the extra money in our household budget so it wouldn't be so tight.

Know that we have been healthy so far. We get preventative care. Hubby is on blood pressure meds (cheap through his employer prescription plan) and has to visit the doc every 6 months and have lab work. Have to lay out for colonoscopies because we have both had polyps in the past.

So the downside is that he could not contribute to the HSA (well he could for the first 3 months of the year, but why even bother- the tax advantage would be minimal) if he goes on Medicare and if he doesn't he still cannot contribute to the HSA for the entire 2020 year either, though he can get a chunk of money in there- again- not worth the hassle and tax advantage I would think (our income in 2019 will be lower than this year, since I am no longer working).

I contacted his HR dept and the reps there were useless. I finally was directed to a retirement specialist at the company (even though hubby is not retiring) and she was somewhat helpful but couldn't help me on this particular issue. She then directed me to another company called Via Benefits which supposedly handles his company's employees in transition when they are eligible for Medicare and retire and so forth. That rep also said she could not assist me because my husband was not Medicare eligible yet and would be getting a card in the mail from SS in January and at that time I could call back and ask questions. She said their advisors were sales reps. and could not answer these questions at this time. Huh? I tried calling Medicare and was on hold so long I hung up. Then I tried the local SHIP office via phone and they were not there. OMG...

How can someone plan and make decisions without the proper information? I don't get it.

Anyway, hoping someone here has some insight into this.
My recent experience- I didn’t apply for Medicare A when I turned 65 and neither did my husband. Reason? I was working and contributing to HSA account. Our health insurance was from my employer. I discontinued contributing 7 months before planned retirement date. Two months before retirement I applied for Medicare A and B effective following my retirement month. I paid for Medicare out of pocket until I started to collect SS benefits after New Year. When filing taxes I had to withdraw some $$ from my HSA because I went over limit.
 

Jan M.

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Both of us got Medicare part A when we each turned 65 but didn't take part B until my husband retired as we were still covered under his employer's healthcare p!an. My husband retired on February 2nd of this year and at that time he was 68 and I was 66. His employee health care continued through the end of February and our Medicare coverage began March 1. We did not apply months in advance either.

You must submit the form completed by the employer stating that you both were covered under their health care plan. You want to make sure that you have prescription coverage too and that information is also supplied as you will be charged a higher rate of you didn't have prescription coverage.
 
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Sugarcubesea

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My recent experience- I didn’t apply for Medicare A when I turned 65 and neither did my husband. Reason? I was working and contributing to HSA account. Our health insurance was from my employer. I discontinued contributing 7 months before planned retirement date. Two months before retirement I applied for Medicare A and B effective following my retirement month. I paid for Medicare out of pocket until I started to collect SS benefits after New Year. When filing taxes I had to withdraw some $$ from my HSA because I went over limit.

This is good information for me to know. In my budget plan I was going to contribute my max to my HSA till age 65 and then retire, so I wonder if I can contribute the max early in the year and then stop 7 months out from retirement? Wow, so much to consider and think about...
 

Krteczech

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This is good information for me to know. In my budget plan I was going to contribute my max to my HSA till age 65 and then retire, so I wonder if I can contribute the max early in the year and then stop 7 months out from retirement? Wow, so much to consider and think about...
I contributed max in January and February, retire in October, started Medicare A,B effective 11/1 and SS 1/1. As mentioned earlier, I went over limit on HSA and had to withdraw 2/12 of my contribution.
 

Krteczech

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Both of us got Medicare part A when we each turned 65 but didn't take part B until my husband retired as we were still covered under his employer's healthcare p!an. My husband retired on February 2nd of this year and at that time he was 68 and I was 66. His employee health care continued through end end of February and our Medicare coverage began March 1. We did not apply months in advance either.

You must submit the form completed by the employer stating that you both were covered under their health care plan. You want to make sure that you have prescription coverage too and that information is also supplied as you will be charged a higher rate of you didn't have prescription coverage.
Correct, the form from your employer had to be submitted when you delay application past 65th birthday.
 

WinniWoman

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This is good information for me to know. In my budget plan I was going to contribute my max to my HSA till age 65 and then retire, so I wonder if I can contribute the max early in the year and then stop 7 months out from retirement? Wow, so much to consider and think about...


No. I do not believe (but can't find info. on it) that you can contribute the max all in the beginning of the year. It is prorated. Otherwise you will have to take the money out that is over what is allowed and also pay a penalties and taxes.

And- just to add to all the complications, look at #4 ( and #7) in the link below. I would be interested to know how that works.

https://www.benstrat.com/downloads/HSA-GPS_HSAs-and-Medicare.pdf
 

WinniWoman

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Found this also:http://www.hsaforamerica.com/faq-contributions.htm

"The contribution limit is determined by the IRS and is based on the Consumer Price Index. If you do not keep your coverage for at least 12 months, the contribution limit will be pro-rated based on the number of months in which your HSA-eligible health insurance was in effect. For example, if your coverage begins on March 1 and is in effect only through December, you will only be allowed to deposit 10/12 of the annual contribution limit."

"Individuals can contribute their entire contribution at the beginning of the year, up to the applicable contribution limit. They might, however, have to make a corrective distribution later in the year if the individual's eligibility status changes during the year (for instance, if they become covered under another non-qualifying plan, or if their HDHP coverage ends)."
 

Krteczech

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No. I do not believe (but can't find info. on it) that you can contribute the max all in the beginning of the year. It is prorated. Otherwise you will have to take the money out that is over what is allowed and also pay a penalties and taxes.

And- just to add to all the complications, look at #4 ( and #7) in the link below. I would be interested to know how that works.

https://www.benstrat.com/downloads/HSA-GPS_HSAs-and-Medicare.pdf
I contributed the max in first two months of year and started Medicare in November. I had to withdraw my prorated contribution for two months. Not difficult to do.
 

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I just spoke to my husband's employer yet again and the rep. said when it comes time for open enrollment (can you believe they still don't know when it will be?) that there will be specific instructions with qualifications my husband must meet in order to enroll in the HSA. Bottom line is I don't think they will let him enroll to put in $ past March as she said he has to call in February to stop them- even if he is not enrolling in Medicare.. She alluded to the fact that most people forget to stop contributions when they need to and then they- and the company- have too many problems. So- I guess I will find out more once open enrollment starts with his employer, as they have their own rules.
 
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Krteczech

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I just spoke to my husband's employer yet again and the rep. said when it comes time for open enrollment (can you believe they still don't know when it will be?) that there will be specific instructions with quantification my husband must meet in order to enroll in the HSA. Bottom line is I don't think they will let him enroll to put in $ past March as she said he has to call in February to stop them- even if he is not enrolling in Medicare.. She alluded to the fact that most people forget to stop contributions when they need to and then they- and the company- have too many problems. So- I guess I will find out more once open enrollment starts with his employer, as they have their own rules.
I believe it is the employee who set the payroll deduction, not his employer. My employer would allow me to contribute in just one payroll deduction in January, but my salary was not enywhere near the family limit.
 

WinniWoman

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I believe it is the employee who set the payroll deduction, not his employer. My employer would allow me to contribute in just one payroll deduction in January, but my salary was not enywhere near the family limit.


Right- but I mean- who has like a $7000 monthly paycheck? LOL!
 

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Right- but I mean- who has like a $7000 monthly paycheck? LOL!
That would be $84,000/year. I know many people who make, or have made, that amount.
 

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That would be $84,000/year. I know many people who make, or have made, that amount.
True, but most employers pay twice a month, which cuts 7k in half and one has to pay taxes. Sad but true, my paycheck was not in that category.
 

WinniWoman

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That would be $84,000/year. I know many people who make, or have made, that amount.


LOL! I wasn't thinking. Of course! LOL! I was thinking take home pay!
 

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I'm thinking that the year before I turn 65, I 'm going to have to find a medicare expert to help navigate me through all of this... I want to ensure I make the right decisions and not pay any penalty's. My budgeted plan had me contributing the max to my HSA till the end of my 65th year. My birthday is in July and I wanted to work that full year, so I was thinking I would retire that following January or February
 

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Just to confuse, or clarify, things more I found the letter sent to me by the company that administers retiree health benefits for the company I worked for. The big banner headline is: Medicare Open Enrollment starts October 15th.

Body of the letter (I've left some details out just so this doesn't become too long):
It's almost time to renew your Medicare coverage for 2019.

Open Enrollment is the time when you have an opportunity to review your plan and coverage details.
  • If you're happy with your coverage and it's available in 2019 there is nothing you need to do. Your policies will automatically renew.
  • 2019 plans will be available on October 1st.
 

Talent312

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Open Enrollment:
For keeping original Medicare, a Medigap policy, and a drug plan...
Open enrollment is less than it seems.
About all you can do is switch drug plans (or go for an Advantage plan).

Changing Medigap plans is not a part of O-E (it's done anytime).
With some exceptions, there is no guaranteed issue or premium limit.
So, even if they issue it, you're the premium is unlikely to be cheaper.
 

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Planning and making decisions without proper information is a big risk. As different Medicare plans include different terms and condition, it is will be beneficial for you to seek the advice of a real insurance agent from a Medicare-approved firm like https://www.thehealthexchangeagency.com. This is so because you can gain knowledge about the pros and cons of each plan through them which can help you in signing up with the proper plan in future. Hope this can help you. Good luck.
 

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My take from the peanut gallery -- If you have or are worried about getting hit with a serious medical problem, choose Regular Medicare and a Supplement. If you are in relatively good health and have no inkling that you may be hit with some serious medical problem down the road, go with an Advantage Plan which is less costly. The benefit of sticking with Regular Medicare is that you have so many more choices of where to be treated than with most Advantage Plans which have tight networks...

George
 

WinniWoman

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My take from the peanut gallery -- If you have or are worried about getting hit with a serious medical problem, choose Regular Medicare and a Supplement. If you are in relatively good health and have no inkling that you may be hit with some serious medical problem down the road, go with an Advantage Plan which is less costly. The benefit of sticking with Regular Medicare is that you have so many more choices of where to be treated than with most Advantage Plans which have tight networks...

George


I think you are right about this. Though there are "Out of Network" benefits with Advantage plans. The regular Medicare plans are very expensive I hear.

Then there is the issue of traveling- care needed if something were to happen when you are away. I guess something to also look into with Advantage plans.

Plus, if you want to switch from Advantage to regular down the line, you would be subjected to pre-existing conditions and all that. Is that correct?
 

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Here's what I found...
Medicare Advantage plans are required to cover the same pre-existing conditions or disabilities as original Medicare they replace so they can be approved as a Part C plan. However, there are two criticisms: (1) narrow networks, and (2) poor service for seniors who are chronically ill or with serious medical conditions...

"The plans have denied such charges, but academic research has found patterns of sicker seniors switching out of MA plans into basic Medicare." -- "We found that a high proportion of beneficiaries with nursing home or home health care use choose to exit the Medicare Advantage program by the start of the next plan year."

-- Sources: http://time.com/money/4347183/medicare-advantage-risks/
-- https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.0272

Also... For certain chronic illnesses, there are Chronic-Condition Special Needs Plans (C-SNP): These plans serve beneficiaries with certain severe or disabling chronic conditions, such as cancer, chronic health failure, or HIV/AIDS. Chronic-Condition Special Needs Plans may target a single chronic condition or more than one condition. Some SNP's offer a larger network of providers that specialize in treating a condition or have formularies tailored to cover drugs prescribed for the illness.
-- Source: https://www.ehealthmedicare.com/medicare-advantage-articles/medicare-advantage-special-needs-plans/

---------------------

As for me, before I enroll in anything, in ~18 months, I'm going to seek advice from a SHINE volunteer... A program sponsored by the state's Department of Elder Affairs.
.
 
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VacationForever

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I think you are right about this. Though there are "Out of Network" benefits with Advantage plans. The regular Medicare plans are very expensive I hear.

Then there is the issue of traveling- care needed if something were to happen when you are away. I guess something to also look into with Advantage plans.

Plus, if you want to switch from Advantage to regular down the line, you would be subjected to pre-existing conditions and all that. Is that correct?
Not all Advantage plans are made the same. The most restrictive of networks are typically called HMOs. When we looked at various plans, we decided on Aetna Medicare Advantage Select PPO for my husband. Every imaginable doctor that he may wish to see is on the PPO list. We have yet to find the best specialists that we know of that are not on it. It is very flexible. We love his plan and his cost for his plan is $96 per month. In fact it is dropping to $67 per month in 2019. It does cover out of state and out of country medical care.

With Medigap/Medicare Supplement plans, there is no pre-existing condition consideration in the first 2 years of Medicare eligibility, i.e. 65 to 67. They must take you if you apply for it during the first 2 years. If you decide to switch from an Advantage plan to a Supplement plan plan after the first 2 years, then they will screen you for pre-existing conditions. They can then decline coverage or accept coverage and charge the applicant Tier 1 or Tier 2 costs. Tier 1 premium is the cheapest and Tier 2 is around double.

After experiencing a Medicare Advantage HMO plan for 1 year and then switching to a Medicare Advantage PPO plan, the experience is night and day. We are finding that my husband's PPO is absolutely perfect - lower premiums than a Supplement Plan but having direct access to any doctor that he wants to see. No restrictive doctor list and bs of a HMO plan.

One more thing to add, if there is a doctor that is not on the PPO list of doctors, the patient can see out of network doctors and incur a higher copay.

Many of the Advantage Plans also include a Drug Plan for no additional cost.
 
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Medicare Open Enrollment: A 5-Point Check List
By Ken Moraif, CFP/ Retirement/ Kiplinger/ kiplinger.com

"Managing retirement money often includes managing health care costs. If you’re on Medicare, we suggest you take a look at those costs: from Oct. 15 through Dec. 7 you can enroll* or make changes to your plans.


It’s important to be aware of the time limitation so that you don’t miss your opportunity and have to wait until next year to make any changes. It’s also important to consider your plans carefully. This Medicare open enrollment checklist can help you to do just that...."

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Richard
 
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