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Medicare Annual Enrollment Period coming up!

bogey21

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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
 

VacationForever

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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.
 

Rolltydr

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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

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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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Unfortunately.....yes.
 

Steve Fatula

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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.
 

VacationForever

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

SmithOp

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

b2bailey

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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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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
 

WinniWoman

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@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.
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. :crash:
 
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VacationForever

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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 drawn down our money.

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

VacationForever

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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.
 

WinniWoman

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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.
 

VacationForever

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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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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
 

WinniWoman

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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.
 

VacationForever

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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.
 

WinniWoman

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...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

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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

 

bogey21

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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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