quote:

Originally posted by Flash-LB:
Do yourself a big favor and get a PPO, not an HMO. You get a lot bigger selection of Doctors and you don't need a referral to go to one.

Been on the Advantage plan for 15 years and referrals have never been and issue. If on my own, I find a specialist, say and orthopedic guy, I simply call my PCP and ask them to send a referral.

Lastly, I wouldn't even consider anything but a supplement plan. That way if you decide later to travel a lot, you're set.

Yes, we've established travel is an issue with Advantage. If you have medical conditions and want to travel, then Advantage is not for you. I personally would be hesitant to travel if I was in poor health or had life threatening conditions. Of course things happen to seemingly healthy people. When your in your elder years, every day is somewhat a gamble.

Part D drug plan, permanent penalty if you don't sign up when you are first eligible.

Could be an extra $30 a month or more every month.

https://www.medicare.gov/drug-...e-enrollment-penalty

I went with the plan G low deductible. I'm VERY happy with the coverage.
I have had a few physicals, 3 cataract surgeries (yes 3)two at the Cleveland Clinic ( to repair damage done by another DR.) and two others at a Chicago area hospital and Doctors( That botched the surgery).
Other than my yearly deductible I have not had to shell out one cent.

You sign up for Medicare with Social Security. That includes both part A and part B. If you are already collecting SSA benefits prior to age 65, you will be enrolled in Medicare (both parts) automatically. Nothing for you to do. If you haven't applied yet and are applying for SSA benefits at age 65, you can enroll in Medicare at the same time you apply for SSA benefits. If you don't plan on collecting SSA benefits until after age 65, you still contact SSA to file for Medicare parts A and B only. I strongly urge you to make an appointment to file. Call 1-800-772-1213 to make an appointment. Hours are 8 a.m. and 7 p.m.

Once you sign up for Medicare with SSA, any issues with Medicare are Medicare jurisdiction, not SSA jurisdiction. Some obvious issues:

If you go with original Medicare, in Original Medicare, you generally pay some of the costs for approved services. Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private company that helps pay your share of costs. This is a link to a Medicare site that allows you to research Medigap policies in your area. You key in you zip code and it lists all of the Medigap policies sold in your area. It lists prices, deductibles, coverage etc. It's very good. https://www.medicare.gov/medig.../m?lang=en&year=2022

Medigap policies don't usually cover prescription drugs. That's part D. Here is more information about that: https://www.medicare.gov/drug-coverage-part-d

Medicare Advantage Plans is another option. Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. Here is a link that explains more about this. It's also from Medicare. https://www.medicare.gov/sign-...care-advantage-plans

I haven't seen anything in this thread that I would disagree with. People have made different choices here based upon their differing individual choices and circumstances. Does all of this seem confusing and overwhelming? You bet. You can consult with an insurance agent that sells health insurance plans for help. But I would, however, strongly urge you to spend a little time doing some of your own research first so you will go into the conversation armed with a basic understanding of the issues.

I would suggest calling your local SSA office rather than the central SSA.
My experience was that I would wait on hold for an hour and then get dropped by the central office.
After that happened three times, I called my local office and got through in minutes.
They even told me it's better to call them instead of the national number.

quote:

Originally posted by WaterburyBob:
I would suggest calling your local SSA office rather than the central SSA.
My experience was that I would wait on hold for an hour and then get dropped by the central office.
After that happened three times, I called my local office and got through in minutes.
They even told me it's better to call them instead of the national number.

Absolutely correct - if you can get the local office number. It most places it isn't published so you have to contact the national 800 number.
Call the 800 number only during the second half of the month, and then only on Wednesdays, Thursdays, and Fridays before 10:00 AM or after 3PM. This recommendation will help you avoid the times when the 800 number is most heavily used.
The appointment system is a national database, so any office anywhere in the US can make an appointment for you at your local SSA office.

Thank you. Much appreciated.

I don't understand the poster who said that one had to apply for Medicare before age 65. I was still employed with good medical benefits until I was 67, at which time I applied for SS and Medicare Parts A and B. I had to get Part B to be eligible for Tricare For Life (military retirement benefit). TFL and Medicare Part A don't have premiums, but Part B does. Only military retirees are eligible for TFL, but it's good coverage--includes good prescription benefits and essentially pays for all costs not fully covered by Medicare A and B.

Have the rules changed about when one may get Medicare?

flashguy

quote:

Originally posted by Warhorse:
Think about supplemental insurance to cover that which medicare doesn't pick up.

I second this big time. Medicare itself leaves considerable deductibles and co-pays (they pay 80% of most services, and the 20% is left for you, or your supplement).
 
One thing not widely publicized is that you have a six month grace period from the time you turn 65 and join Medicare to purchase a supplemental policy, with NO actuarial factors being figured in. IOW, they are required to sell you the supplement at the going rate in your state without regard to things like pre-existing conditions.

The various supplements' benefits are defined by Medicare. These plans are sometimes called Medigap plans, as they fill in for what Medicare does not pay.
 
Go to Medigap Supplemental Insurance Plans and click on the link that says "See benefits of each plan". A chart will slide over and show you just what each plan covers. Plan F, for example, covers everything domestic that Medicare does not pay, and would you leave you with no out of pocket expenses for Medicare-approved services. It is also the most expensive. You can tailor your needs/costs based on how much out of pocket you are willing to pay.
 
But if you are going the Medigap route, please remember the six month grace period and take advantage of that.

Wife is a volunteer in Florida and Indiana for the "Shine" type programs. Every state has a Federally funded program that has people like my wife who can help you examine the options. Other states may call the SHIP or SMP. I do know from talking to her that it's VERY important to get it right initially. There are some options that once you pass on, you can't change your mind and go back to select. I do know she's not much a fan of the Advantage plans unless you never plan to leave your base location AND that plan is super solid in addressing your needs.

This is one you REALLY need to get right. Find the program in your area and use them. They are NOT associated with any company or involved with the sale of any product.

quote:

Originally posted by flashguy:
I don't understand the poster who said that one had to apply for Medicare before age 65. I was still employed with good medical benefits until I was 67, at which time I applied for SS and Medicare Parts A and B. I had to get Part B to be eligible for Tricare For Life (military retirement benefit). TFL and Medicare Part A don't have premiums, but Part B does. Only military retirees are eligible for TFL, but it's good coverage--includes good prescription benefits and essentially pays for all costs not fully covered by Medicare A and B.

Have the rules changed about when one may get Medicare?

flashguy

No, if you’re covered by a qualified medical plan and are still working, you can delay starting both Medicare and Part D drug plans with no penalty until after you stop working. That said, there’s no financial downside to starting Medicare A asap since you don’t pay for that, but do check any work policies for coordination of coverage before doing so.

And, I disagree with the poster who said medigap G was the only option; we have N which is less expensive than G by requiring a $20 copayment for doctor visits (something I’d had for years as part of my work medical policy). And that $20 doesn’t increase, so with a few more years of inflation it’ll probably equal the cost of a fast food burger! Whatever medigap policy someone decides on, check how they are allowed to increase costs annually. It can be based on your age or the average age of the entire insured group; the latter can slow premium increase as younger people join the group. I think there’s a 3rd approach to medigap annual increases but I don’t recall what it is offhand.

 
One other thing I thought of. If you do go with traditional Medicare, be very wary if you are ever asked to sign an ABN (advanced benefit notification). This generally means that Medicare may not/probably won't pay for that service.
 
It could be something as simple as the incorrect charge code being used. For example, I am being monitored for a Vitamin E deficiency. When the nurse ordered the blood test, she simply ordered a Vitamin E test charge code, and an ABN was spit out by the computer. I balked, of course. She went back and found the correct charge code for the Vitamin E test associated with the Vitamin E deficiency, and all was good. Do not sign an ABN blindly, or you could be stuck with charges that Medicare does not cover.

There are quite a few procedures that Medicare will not cover hence the need for an ABN. Cosmetic procedures are one example. The physician many times does not have knowledge of whether the procedure will be covered. It is not all a coding error.

quote:

Originally posted by ZSMICHAEL:

It is not all a coding error.

No, not always a coding error, but unfortunately, coding errors are too common.

Example: Lab test for PSA. I got hit with a bill because of a coding error.

For men who have not had prostate cancer, there is a limit on how frequently the PSA test can be done on Medicare's nickel. In my case, I had the radiation series, and the doc could theoretically order a PSA test every day, at no cost to me.

Medicare does have a rule that if you’re told it’s covered by Medicare, and you think it is, the POS can’t bill you. At least not for the Medicare covered part. Don’t know about the other 20%.

quote:

Originally posted by Pyker:
If you are applying for SS, they will automatically sign you up for Medicare at the same time. If you are not, call SSA.gov and have them do it separately. In either case, they will answer your questions surprisingly efficiently.

HA That is the nowhere near the experience I have had.
Tried to enroll my mother at the beginning of September online. Filled everything out online and clicked submit and was told she must sign up in person.
After hours on hold and numerous calls we finally have a PHONE appointment for February 22.
That’s right a phone appointment more than 6 months after trying to sign up.
Covid is their explanation.

quote:

No, not always a coding error, but unfortunately, coding errors are too common.

^^^^^^^^^^^^^^^^^^^^
Less than Burger King wages is part of the problem. The other is the coding system itself. Convulted and complicated.

quote:

Medicare does have a rule that if you’re told it’s covered by Medicare, and you think it is, the POS can’t bill you. At least not for the Medicare covered part. Don’t know about the other 20%.

^^^^^^^^^^^^^^
You sound angry.

quote:

Originally posted by ZSMICHAEL:

quote:

No, not always a coding error, but unfortunately, coding errors are too common.

^^^^^^^^^^^^^^^^^^^^
Less than Burger King wages is part of the problem. The other is the coding system itself. Convoluted and complicated.

Fortunately for me, Mrs. Flash spent 10 years doing Medical billing for a County Hospital so any errors we get she gets fixed immediately.

It helps when you know the codes and the words. When they hear her talk, they know she knows the business and things happen.