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Medicare Annual Enrollment Period coming up!

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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
 

VacationForever

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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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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.
 

Luanne

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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.
 

Fredflintstone

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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....


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Luanne

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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....


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

Rolltydr

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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....


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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.


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Fredflintstone

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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.


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That’s a fair comment.


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VacationForever

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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....


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

Fredflintstone

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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...






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VacationForever

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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...

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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.
 

Fredflintstone

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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.
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?




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VacationForever

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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?

You still have to pay a small premium, $135.50 per month but if you have high income, higher tiers for higher income up to about $600, called Medicare IRMAA.

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?

Both Medicare and Medicaid are federal but states can be more liberal with Medicaid qualifier. Medicaid dollars go directly to the state which give them leeway on the implementation.

Yes. Other insurance is to cover the 20 percent.

Do Medicaid get the same coverage as Medicare?

Two separate programs. One can spend his entire life on Medicaid and when this person reaches 65, they are on Medi-Medi, both Medicaid and Medicare. Whatever Medicare does not cover, Medicaid picks up the tab.

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?

They should go on ACA Health Exchange and get lots of subsidies. It is very painless so the government keeps reminding people to sign up and renew.

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

One gets older, premiums go up as an older person gets more illness. $1000 is an arbitrary number for a 64 year old but it is probably very close to the real health premium
. The inefficiencies of individual insurance market drives the cost up higher than Medicare negotiated reimbursements. This is my analysis, not found in any article out there.

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

Medigap = Supplement. Yes. But many flavors are sold with varying deductibles and premiums.

Advantage plans do the same.


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

Covered = pay premiums. They need to enroll and pay premiums unless they are on Medicaid.

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

Below 65, Medicaid. 65 and above, they get on Medi-Medi.

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See reply in message.
 

Ewiike

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


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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

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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.
 

VacationForever

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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.
 

Steve Fatula

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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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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.
 

WinniWoman

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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....


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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....:ponder:

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

WinniWoman

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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...






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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.
 

WinniWoman

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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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