OT: Medicare research ARRRGH

I have "a guy". A bunch of my friends used him so I met with him too. Went through all the plan options and found the best plan for me that helped pay for zytiga. You probably have a guy like that where you live. Ask your locals.

halbert - It is really good to do this in summer/fall before the annual renewals start up and everyone is busy with the mass confusion. Only problem is you do it again in a few months. Insurance brokers can help a lot if you are getting too lost in the process. Been a couple years now, but a few items come to mind:

The first thing is to both sign up for a Social Security account if you have not already. This can be done any time and helps keep the account safe. Then sign up for Medicare when you hit 65. Social Security and Medicare are linked but managed separately except for the part where they automatically subtract the Medicare monthly payments from your Social Security payments when you elect to receive them.

Yes, there is a trial period when you first enroll. No idea of the details anymore. Some states have special laws covering changes to plans.

Yes, there can be a small discount with some insurance plans for couples. We do not have that with our BCBS Supplement.

Yes, I believe you are correct about the HSA contribution limitations.

HSA vs. HRA - You own the HSA and the HRA is a company plan. You will have to discuss with company to see what the provisions are for retirement.

If you go with a Supplement and Part D drug plan, the only spreadsheet needed can be done on the Medicare website where you enter your drugs and see how the various drug plans shake out. The problem is anticipating what your future drugs may be but you can change your Part D plan every year. The Medicare supplement plans seem to be very close for the same coverage, say N or G in our area, within $10/mo.

My Wellcare Part D plan is $7.50/month. Great for standard meds, terrible for more expensive meds. We pay cash from some meds as it is cheaper that way than with insurance.

If you go with an Advantage plan, good luck figuring them out. They range from $0/mo to as much as a Supplement + Part D plan. I decided to go with BCBS supplement (no deductibles back then) and have never seen a medical bill since 2018, same for wife since 2019. Drugs are another issue which is my crusade but will be limited to $2,000 out of pocket in 2025 so not such a big deal.

Good luck

Hal, the Medicare.gov is a great website.
https://www.medicare.gov/plan-compare/#/?year=2023&lang=en

First, just know that Medicare Advantage plans generally speaking are great, until you get sick. They have networks you need to stay in, and they have pre-authorizations for a lot of common procedures. My opinion, stay away, ignore the hype.

beyond that, before going any further, aren’t you still working? You can stay in your employers group insurance, and only sign up for Medicare Part A (hospital) which is free of charge.

Jack (JNF) is our resident expert he knows more about the rules than I do I’m sure he’ll respond soon. In the meantime feel,free to email,or call me if you want to talk. Keep in mind every state is different.

Hal, your first decision is whether to use traditional Medicare parts A and B as primary plus a supplement to cover deductibles and copays and Part D for rx drugs; or to opt out of Medicare and use C Medicare Advantage through a commercial insurer. Pros and cons each way and we can provide you with the issues to consider. In a nutshell the major differences are: Advantage plan premiums are generally lower than Supplement plan premiums, Advantage deductibles and copays are generally higher than Supplement plans, maximum out of pocket expenses are much higher with Advantage plans, Advantage plans have local based networks that can be restrictive whereas Supplement plans allow you to go anywhere as there are no restrictive networks, Advantage plans may impose referral restrictions and more onerous pre-approvals as compared to supplement plans where you do not need a referral to see a specialist. There are more differences, but these are the main ones that first come to mind. Advantage plan benefits can vary widely when comparing one geographic area to another, where all Supplement plans must provide the same coverage regardless of geographic location.

If you go the supplement route, the best plan is N. Since we lost F a couple of years ago, G is now the default for guaranteed issue and can expect to have the highest rate of future premium increases. Both G and N have you pay the yearly B deductible and the N charges a $20 copay on some, but not all doctors visits. In the last year we have spent less than $100 on copays but we saved more than $1,200 in premium using N versus G. Our experience is that N premium is about 40% less than G premium, so some real savings. Over the last decade studies show that G premium increases have been about double that of N, so that can be a real factor in the future, which is why we switched. Most companies I am aware of offer significant “couples discount” when both use the same insurer. Our discount is, as I recollect, 12%. I am not aware of such discounts for Medicare Advantage plans.

As far as switching in and out of Medicare, there are three basic times you can enter a supplement plan without potential restrictions. First, when you become eligible for B, second within one year of first choosing a Medicare Advantage plan and third any time you physically relocate from one Medicare administration area to another. Another rare time is if your Medicare Advantage insurer cancels your coverage and offers no other C plans to you, then you can choose to return to Medicare and buy a supplement plan without restriction.

You can go to a supplement plan or change a supplement plan at any time by meeting the insurer’s requirements. Your health will determine the availability and premium. For instance, last year we switched from G to N to save money and thankfully qualified for the best rate. Neither of our cancer histories were against us as we are no longer being treated and have no other significant issues. If we were diabetic or had other significant issues, we may not have been able to do so. However, once you have a Supplement plan, you can not be cancelled unless your company cancels everyone and then you can go to another company on a guaranteed issue basis.

You can choose a Medicare advantage plan at your first eligibility, age 65, or each year during the normal enrollment period, basically October through part of December. At that time you can change plans or companies and there are no restrictions placed on the eligibility due to health or age. Unless there is a life changing event or your insurer cancels you, you can not make any changes during the year either by changing plans or insurers.

The use of a very good agent is suggested and does not cost you more as all Advantage plans and Supplement plans are sold through an agent and earns the same regulated rate of commission. One of the highest compensated agents is AARP as they make more than a billion a year from their insurance commissions selling Medicare oriented plans. One reason Medicare Advantage plans are pushed so hard is because there is more commission money available compared to supplement plans. In my opinion, the agent should be independent and be able to represent all companies and plans in your area. They should be able to make an objective assessment about your situation and suggest the best method between traditional Medicare and a supplement versus opting out of Medicare and using an Advantage plan; and providing multiple companies for your consideration.

Hope this helps, keep the questions coming.

Advantage plan also known by many as Disadvantage plan. If you can't afford anything else then get the Advantage plan.

The reason we are doing the transition is this: While I am still working, my BCBS is provided by my previous long time employee, and since we parted ways when I was 58, I am considered retired by them--and the BCBS ends on my 65th birthday in September.

JNF: thanks for the insight about G vs N, we will look at the premium difference as quoted today. At this point, I'm staying away from Advantage plans, in part because our plans for the future include spending summers in Maine, not PA, and hopefully more than a little international travel.

Retirement plan is to retire a year from now, anyway.

Ken, regarding the Part B excess charge issue, I don’t find it a concern for several reasons.

The amount is limited to 15% of the Medicare approval amount, so they are limited and usually not an excessive amount. They are easily identified before you contract the service so you can decide whether to go forward, so they would not be a surprise. According to a Kaiser foundation report from 2020 they found 98% of Medicare accepting providers are “participating” meaning they can not charge the excess. So the excess charges were possible in less than 2% of cases and were found to be primarily mental health treatments, so they are not common. Most providers including surgeons must contract with hospitals and institutions and most all of these are “participating”, thus can not charge the excess. Several states, including New York either disallow or limit the practice. New York limits the charge to 5%. If a provider does not accept Medicare you know that right up front before you contract for the procedure and make an informed decision to pay whatever it takes for that provider, so that is not a Medicare “excess charge” issue nor a surprise. Medicare Advantage plans have no provision to pay them. Twenty-six million Medicare beneficiaries (42%) use Medicare Advantage plans. So, if this was a real problem, we would see it reported daily and things would change.

So, if you need a surgery that Medicare reimburses at $1,000 and you narrow to two surgeons and one says the 15% excess charge applies, then you have a $150 decision to make and could use it as a negotiating tool. Or if you have a GP or specialist that you see several times a year that charges the excess, then you either find the provider worth 15% extra, or move on to someone else.

And a caution, these “excess charges” should not be confused with the “surprise billing” issue where during a procedure a non-network provider is used without the insured’s knowledge or approval and then the insured gets hit with a big surprise out-of-network copay. This can not happen with traditional Medicare and supplement as the network simply means providers that accept Medicare payments and assignments. These surprise billings are only applicable to non-Medicare insured’s and potentially some Medicare Advantage insureds that have restrictive provider networks.

Jackthat is great information, thank you.

have an HRA. Every month my Medicare B and D premium is deducted from my social security and reimbursed as a deposit to my bank account. My medigap plan is paid directly from the HRA.

You can use your HSA anytime for reimbursement of medical expenses. You can use your HSA to pay for some Medicare expenses including your Medicare Part B, Part D and Medicare Advantage plan premiums, deductibles, copays and coinsurance. You may not be reimbursed for of Medigap premiums from an HSA.