quote:

Originally posted by Fly-Sig:

You probably have dozens of Medigap plans available in your zip code

Whichever Medigap plan you choose, the coverage is exactly the same, no matter what company you enroll with. Same coverage, but not necessarily same cost. Since there is no difference in coverage, go with the company that offers the lowest cost for the plan that you choose.

NOTE: I am talking about Medigap (tradional Medicare supplement plans) not Medicare disavantage.

quote:

Originally posted by gjgalligan:
I am 74 and have a plan through my retirement and while it covers a lot the best I can see out there is to be poor and and get medicare & medicaid. My brother (now deceased) and one of my wife's friends is on it and they have the best of care and pay nothing.

My late sister was on Medicaid in Utah. They purchased a Medicare Advantage plan for her that was pretty good. A few of the copays or deductibles were expensive (e.g. ambulance), considering she was on disability for many decades and only brought in $855 per month with that. I and my other siblings paid the very large majority of her expenses.

The local hospital provided outstanding care in every way whenever she was sent to the ER or was inpatient. Being poor is not an impediment to top notch care in this country.

My brother (now deceased) and one of my wife's friends is on it and they have the best of care and pay nothing.
^^^^^^
Where I live the combination of Medicare and Medicaid leads to lower tier care. The rates paid to physicians is lower than any other insurance plan and does not attract the best doctors. Sadly, the average patient does not know if they are getting top tier care. Medicaid shifts the burden of payment to the taxpayer. It is one step closer to Socialism.

quote:

Originally posted by Rey HRH:


Wait for the Part D Open Enrollment period which is from October 15 to December 7 each year.

Cool...I don't have to deal with this crap for almost 2 weeks.

quote:

Originally posted by pace40:
Thanks all. Anybody using a good Part D plan for really expensive drugs?

I don't take any expensive drugs, but my Part D plan is under Wellcare which is really cheap for me. Worth looking into. Good luck!

Thanks for all the input, guys. Much appreciated!

quote:

Originally posted by gjgalligan:
…..be poor and and get medicare & medicaid……

Terrific strategy.

Medicare Advantage and Medicare Supplement are two very different ways to get your healthcare coverage — each with its own strengths and trade-offs. The key is finding which one best fits your needs, budget, and peace of mind.

My best advice: work with a trusted, independent insurance agent who can guide you through the maze. Independent agents aren’t tied to one company, so they can compare multiple plans and help you make an informed choice that truly works for you.

Full disclosure: I’m an independent agent licensed in 12 states. I’m not here to pitch my services, but to share what I’ve learned — both Medicare Supplement and Medicare Advantage plans can offer excellent coverage when matched with the right situation and the right person.

I have several conditions, cardiac, urological,dermatologist and a couple different orthopedic issues.

I went to an Advsntage plan when I turned 67 ad the supplement plans I had jumped astronomically those first two years (2017/2018) I was on it. My drug coverage was an additional forty dollars a month on top of the mid year jump in monthly premiums.

Our advisor got me into the Advantage Plans once they came available around here despite my reluctance. I have two medications that I’d have to pay for regardless but it’s like fifty two dollars for a 90 day supply. The other seven are zero copay. My copays are forty five dollars for any of the doctors (all are specialists, my Cardiologist functions as my PCP but I’m happy to pay that to see him) and no referrals necessary. Healthy food allowance benefit every three months, only eighty dollars a quarter next year though. Silver Sneakers gym membership too. Just found out I need to start aquatic therapy for my muscle/nerve pain in my hip,as that’s now gym related those sessions will be covered too.

My wife has minimal doctor contacts. For us, Advantage plans work out the best.

My wife has minimal doctor contacts. For us, Advantage plans work out the best.
^^^^^^^^^^^^
Rates are going up for MA plans and they can discontinue coverage when they are not making enough money.Glad that it works for you.

I never understood why Biden (his junta anyway) tried to get rid of Advantage plans. They are the only part of Medicare that can control costs which will otherwise bankrupt us. Of course they vary widely; but my wife and I are in the Kaiser Senior Advantage plan by choice; our coverage—within the very large Kaiser Permanente organization, of course—cannot be beat as far as our out-of-pocket costs are concerned. Costs are controlled because the physicians are on salary. Yet their quality of outcomes, as far as one can measure, are outstanding. A major reason for us not to leave California.

quote:

Rates are going up for MA plans and they can discontinue coverage when they are not making enough money

While that’s somewhat true, it’s important to remember that Medicare Advantage plans are annual contracts, running from January 1 through December 31 each year.

In practice, it’s extremely rare for a plan to change or discontinue benefits midyear. (One recent example of a discontinued benefit happened when a well-known Continuous Glucose Monitor provider went out of business. Thankfully, other CGMs were — and still are — available, so it was more of a change in benefit rather than a loss of one.) However, if a plan were to become insolvent or terminate coverage during the year, Medicare would immediately create a Special Enrollment Period. That would allow you to switch to another Medicare Advantage plan or even move to a Medicare Supplement plan with Guaranteed Issue rights, meaning no health questions or underwriting.

So while the concern is understandable, there are strong protections in place to make sure you’re never left without coverage.

MA plan members locally were informed by a note on the door of the hospital on January First that MA plans would not be accepted. They are also using AI to do prior authorizations. If you can afford it original Medicare and a Medigap supplement is best.
I don't want the plan Joe Namath reccomends. All that free stuff like rides to the doctor you pay for. They pick you up a seven am and are back to get you at the doctors office around five. A bonus is you may make friends with the other riders.

The Joe Namath commercials do share some accurate information — but it’s presented in a very misleading way. Yes, there are plans that offer some of the generous benefits Mr. Namath mentions, but limited to a very specific geographic area or income level. However, those ads are mainly designed to collect your name, phone number, and permission to contact you.

By law, an insurance agent can’t discuss any Medicare plan details without having your written or electronic permission on file for at least 48 hours. The ads sound so appealing that many people call to learn more — not realizing that calling the toll-free number automatically gives permission for agents to contact you. Unfortunately, your information is often sold to multiple agents, which can lead to a flood of unwanted calls.

This year, many of the calls about Medicare are coming from overseas call centers. Often, the callers have strong accents that can make it difficult to understand them. Unfortunately, many of these calls originate from countries that don’t follow U.S. telemarketing laws, which is why they can be so persistent.

Well...I decided to go with regular Medicare and a supplemental Part D and a Plan G medigap. I'm sure my docs will be glad not to have to do the constant pre-auths. Applications all in and waiting for cards. Premiums are certainly more but I should make up most of it not having all the imaging copays.

quote:

Originally posted by ZSMICHAEL:
MA plan members locally were informed by a note on the door of the hospital on January First that MA plans would not be accepted.

Yea, this kind of thing pushed me over the edge to regular Medicare. There was a sign posted at check-in at the cancer center that an insurance company had dropped the center from their network. Don't know what I would do if that happened to me. Saw one really upset couple.

I was reading this thread a few days ago. Since then my experiences with a MA plan, FWIW. If you’re squeamish you might skip ahead to the end.

A week ago Monday I went in the ER, kidney stone. Was there 18 hours, bladder stent until it could be broken up with a laser, next month. Released that evening.

Tuesday evening SHTF. Went to the ER due to heartburn. Yep, you know where this is going, straining to relieve myself early in the day, it got better that afternoon but apparently I knocked some plaque loose. Yep, you guessed it, M.I.

Interhospital transfer via “bus” Code 3 straight to Cath Lab, bypassed the ER. Two stents, Three days CICU, two days Cardiac Unit but out of ICU. Called my insurance broker who we’ve worked with for eight years. The MA plan we have has our out of pocket at a bit over 5k. This also includes cardiac rehab that I start next week covered 100%, four months IIRC. My prescriptions coverage, part of the plan, covered the majority of my maintenance scripts 100% prior, well I had about a $180 copay for new meds at 60-90 day supply, we’ll see what gets modified as time goes by.

We did have some additional coverage above the MA plan coverage, a nominal price per month we have to pay out of pocket for this. This coverage pays $300 per day each day I’m hospitalized so depending how it’s determined either four or five days. We took that coverage on the advice of our broker. I will admit that I wondered if it was worth it, glad I kept it up.

My only advice is that if you are going to look at MA plans, go through a broker, one that represents many insurers and plans. When I first went on Medicare I had a United Healthcare plan from a agent representing only them but in fairness I was outside the geographical area that was offering them in 2017 and I had what I felt was excessive co-pays not to mention constant fights over covered medications with the drug plan I was on.

And yes, I’m doing ok. Tired, scared, (I’ll admit that!) weak, but still fighting and being positive. I’m not housebound, I can drive. My part time work (LGS) has been supportive too, I’m going to miss part of the busy season, the owner said they will work with me. That meant a lot, the car dealer I was working at prior to my retirement, I have no faith that my manager would have been as supportive.

Thanks to all.

quote:

Originally posted by Fly-Sig:
"Prepare for Medicare" by Matt Feret is an excellent book that clearly and simply explains how all of the options work. He doesn't advocate for or against Advantage or Supplement. He also explains how and when to select Part D, or switch from Supplement to Advantage.

Fly-Sig: I bought that book on your recommendation and it is very helpful. Unfortunately he really doesn't address TriCare for Life as a supplemental very much in the book, just says to reach out to an agent who may be more well versed in it. He also kind of conflates veteran services and TriCare for Life but it's only cursory so no harm really there.

It's a good book that he updates every year that would be helpful for folks getting ready to start Medicare.

On a side note, I've heard radio adds for MediShare plans for 65+, has anybody considered this option?

Thanks

quote:

Originally posted by Sigfan Roy:

Fly-Sig: I bought that book on your recommendation and it is very helpful. Unfortunately he really doesn't address TriCare for Life as a supplemental very much in the book, just says to reach out to an agent who may be more well versed in it. He also kind of conflates veteran services and TriCare for Life but it's only cursory so no harm really there.

It's a good book that he updates every year that would be helpful for folks getting ready to start Medicare.

On a side note, I've heard radio adds for MediShare plans for 65+, has anybody considered this option?

Thanks

Thanks for the additional detail about the book which will help people with TriCare.

I am, for the time being anyway, keeping Christian Healthcare Ministries for seniors. It is similar to Medishare. It isn't insurance and it isn't a sanctioned Supplement plan. I also am carrying a Supplement Plan G (with high deductible for 3 years, then reverts to low deductible).

The main thing I'm still mulling is what happens if CHM ends this program. It is inexpensive and it has a $500 deductible per event, so it is quite superior to the Plan G unless I have a lot of events. I would be happy with it forever, as we have been quite pleased with CHM for the past 5 years.

In the future, acceptance into a Supplement plan is not guaranteed, and premiums would be based on my health at that time if they do take me. I am not enthusiastic at all about Advantage plans, but they would be required to accept me.

So it is a gamble if I drop the Supplement that I might get stuck on an Advantage plan in the future. That's really the only downside to choosing CHM (or perhaps Medishare) over a Supplement.

With the high deductible plan, CHM will pay off if I have significant expenses into the Supplement's deductible.

If you're not already on CHM, and presumably the same applies to Medishare, there is a 2 year period of no coverage for pre-existing conditions.

(I wish I could just stay on regular CHM rather than all this Medicare rigamarole. It is a lot cheaper and a lot better).

Well… I have read all the threads here and thanks to all who have contributed.

I have been on my wife’s company health plan for the last 30 years and it has been very good to us. However, in the last 5 years or so the costs have skyrocketed now to the point that Medicare, for me, is actually cheaper out of pocket.

I am very fortunate in that one of my sisters has been an executive in the health care insurance field for over 30 years. Her insight was tremendously helpful in figuring out what particular plan is best for me.

In a nutshell since we travel quite a bit a MA PPO plan is best for me. I am only taking one generic prescription drug and my cost is $0/ yr. All my doctors including my primary, eye and dentist are all in network locally so the basics are covered. If I need emergency room help while traveling it’s something like $350. The daily cost for hospitalization is like $450/day for the first 8 days then completely covered.

My total out of pocket expense maximum is $6900/ yr which all in is less than I am paying in my wife’s coverage. My part B is projected to be $206/ mo I believe and I was paying $380/ mo to my wife’s insurance carrier.

Hopefully this works out for me!!

Thread revival from last July - November. Just posting feedback for anybody who might be interested.

Went with straight up Medicare and TriCare for Life for 2025. It was fine, nothing out of pocket except the Medicare premiums due to the secondary coverage of TriCare for Life.

I submitted SSA Form 44 to inform them that my income was going to be significantly reduced due to my retirement in Aug 2025. That dropped my IRMAA bracket one level.

The only slight hitch was the doctor filed a claim the month after I retired for my implanted heart monitor with the old work insurance and it got kicked back. I let them know and they sent it to Medicare and it got paid.


This year I am trying a Medicare Advantage plan from Humana endorsed by USAA. It pays $65 each month of my Medicare premium and includes dental and vision coverage. It does not include Part D drug coverage, but the TriCare for Life does cover me for drugs and of course acts as a Supplemental Plan to limit my out of pocket expenses, normally zero other than the Medicare premium.

TriCare for Life does have a $13 copay for my meds if I use the 3 month supply via the mail with Express Scripts. With my company insurance before I retired those had zero copays.

Both my cardiologists and my primary care doctor take the plan and I haven't had issues one month into it. The transition with the monthly heart monitor bill has been smooth.

I will see how the year goes with this plan and then decide to keep with it or switch back to standard Medicare. Either way, I am covered by TriCare for Life for my Supplemental plan equivalent and Part D drug coverage.

I will report back if I have any issues getting coverage as the year goes by.