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After doing some research on the topic for my wife, we decided that my wife would go on Medicare B and not on company medical insurance when she started with the company last December (2015). Actually, I found out (research) that many companies are very happy to see an employee go on Medicare. That way a company medical insurance company doesn't have to mess with a employee's complaints about any medical stuff (Service/Billing).
Since I was already collecting SS/Early Retirement, when I turned 65, I was automatically signed up for Medicare B. I could have refused it, but I wanted another medical besides VA Medical. Because I signed up when I did, and there was no COLA for this year, my monthly premium stayed at $104.90 per month. My wife pays $121 per month, due to her salary at work. Our yearly Deductible did go up from $147 to $166.
We both also have: Florida Blue (BCBS) as our Supplement and Humana Walmart Rx Plan for prescriptions. We picked Florida Blue b/c it will pay our upfront cost to be admitted into a hospital........when that is needed.
Now, for me, I'm continuing to use my VA Medical, but also have Medicare and my Supplement and Rx Plan as a backup.
I am cursed with three medical insurance plans.
1. Insurance through my wife's employer.
2. Medicare.
3. Tricare.
At least twice a year, I get a form from each of them wanting me to tell them about the OHI (Other Health Insurance) that I have. Then there is a discussion about who is primary and who is secondary. Tricare is never primary or secondary, so they rarely pay anything (so much for the "free medical care for life" that I was promised back in 1959). However, we did recently get a surprise, a $13 check from Tricare!
At the present time, the employer insurance is primary, Medicare is secondary.
I am cursed with three medical insurance plans.
1. Insurance through my wife's employer.
2. Medicare.
3. Tricare.
At least twice a year, I get a form from each of them wanting me to tell them about the OHI (Other Health Insurance) that I have. Then there is a discussion about who is primary and who is secondary. Tricare is never primary or secondary, so they rarely pay anything (so much for the "free medical care for life" that I was promised back in 1959).
Just wait a while. You'll be happy for the Tricare when wife no longer works. The paperwork may be a PITA now, but it's worth it. I know a former RN who is on Medicare/Tricare through her husband's military service and quite pleased they don't need to navigate the Medigap/Advantage issues. She had very expensive and extensive abdominal surgery two years ago. Between Medicare and Tricare, there was very little out-of-pocket. Biggest issue was Medicare disallowed one portion of the surgery, but later approved it.
Last edited by Ariadne22; 04-26-2016 at 12:03 PM..
I've had straight Medicare, no supplement, no gap no nothing. I take care of my health with supplements MOSTLY and no insurance pay for these. I deal with my copays for the few docs I see if and when I see them. I went thru a hip replacement in 2010 and medicare came thru big time and I made co payments to the docs involved...
Do you recall your cost including rehab? Last I read Medicare reimbursement for hip replacement was either $30k, or $12k - not sure which is correct. Even if $30k, your share would be $6k or the cost of a supplement for several years. If you incur that cost once in five years, you're ahead. Many Advantage plans have max out-of-pockets of $5-$7k - so, even on Advantage you might have hit that figure between copays for hospital and rehab.
Quote:
Originally Posted by jaminhealth
Sometimes I think the less insurance one has the more we can count on the system to help us. Personally, I cannot afford a supplement which runs $200-$300 month and keeps increasing so I just carry straight medicare and keep myself healthy on my own.
If and when anything could or would happen, I'll deal with it as best I can. THEY can't get blood from a turnip. I've had straight Medicare for going on 13 yrs. No prescription D as my few meds are low priced. I stay away from the high priced drugs. But this is ME.
I see you are in California. Kaiser Medicare Advantage in California (LA area) has been quite satisfactory for one CD member - a retired teacher. He loves it and the medical care he has received. Like you, he's generally healthy. No premium, minuscule copays. Should the time come your health changes, you might want to look into Kaiser. Because Kaiser owns its own facilities and employs its own doctors, many of the negatives attached to some of the for-profit Advantage insurers don't exist - although Kaiser would require you use its doctors/facilities.
Also, consider a Medicare Medical Savings Account if they are offered in California. MSA's are a form of Advantage, zero premium - and, best of all, without networks, oversight or preapprovals. You can see any Medicare doctor anywhere. The plan has a deductible of $4-$5k, which is offset by a $1,500-$2,000 deposit into Medical Savings Account depending on deductible. Balance in the MSA carries forward to the next year if not used. In time, you could build up your entire deductible. You are responsible for first dollar Medicare expenses up to $5k (net cost to you $3k), after which Medicare pays 100%. These plans have been offered in WI for two years, I joined an MSA this year and used mine recently for laser eye procedure. Medicare cost for doc/hospital/procedure totalled $1,594 which I paid out of the MSA deposit. Had I not had the MSA, my Medicare out of pocket would have been $452. So, I'm ahead for now, and with money left over for other medical costs.
Last edited by Ariadne22; 04-26-2016 at 12:51 PM..
Also, consider a Medicare Medical Savings Account if they are offered in California. MSA's are a form of Advantage, zero premium - and, best of all, without networks, oversight or preapprovals. You can see any Medicare doctor anywhere. The plan has a deductible of $4-$5k, which is offset by a $1,500-$2,000 deposit into Medical Savings Account depending on deductible. Balance in the MSA carries forward to the next year if not used. In time, you could build up your entire deductible. You are responsible for first dollar Medicare expenses up to $5k (net cost to you $3k), after which Medicare pays 100%. These plans have been offered in WI for two years, I joined an MSA this year and used mine recently for laser eye procedure. Medicare cost for doc/hospital/procedure totalled $1,594 which I paid out of the MSA deposit. Had I not had the MSA, my Medicare out of pocket would have been $452. So, I'm ahead for now, and with money left over for other medical costs.
You are thinking of an HSA - Health Savings Account - into which YOU and/or your employer deposit pre-tax money and which is a different animal than a Medicare MSA. Further, there is no age cut-off on an HSA provided one is NOT enrolled in Medicare. I worked until almost age 68 and did have and contributed to an HSA for almost two years. My employer did not offer an HSA until I was 66 y/o. Since, I was not enrolled in Medicare, I began an HSA and maxed it out for as long as I worked because of the tax benefits.
Otoh, the Medicare MSA - Medical Savings Account - deposit is made by Medicare/MSA insurer, not me, so there are no tax issues. Medicare MSAs are available in WI from two insurers. Medicare MSA's for your state can be found with the Advantage plans on Medicare.gov - by your zipcode. Not all states have MSA's. This is the company/plan I have:
NetworkHealth is 50% owned by Froedtert, a very large hospital system in our county. Other MSA in WI is offered through the Marshfield Clinic under the name Security Health - smaller deductible, smaller deposit. I chose NetworkHealth because of its Froedtert affiliation - which hospital campus is two miles from my house, although, as I said, I can use any Medicare provider. As it happened, my eye surgery was done through the Aurora Health System with an Aurora doc at an Aurora facility which accepted and processed the procedure through NetworkHealth without any issue. That said, if I lived in the Marshfield area upstate, I would probably have chosen Marshfield's plan. Marshfield has an excellent reputation, fwiw.
Last edited by Ariadne22; 04-26-2016 at 09:06 PM..
I've had straight Medicare for going on 13 yrs....... No prescription D as my few meds are low priced. I stay away from the high priced drugs. But this is ME.
I guess from this statement that you started Medicare in 2003. As I understand it, you don't have Medicare Advantage, or an employer-provided plan for medications and you didn't take Part D when it came along in 2006.
If that's true, then you've been racking up financial penalties for non-enrollment in Medicare Part D without any creditable coverage.
The penalty is 1% higher premium when you do enroll for every MONTH that you delayed enrollment. If it's been 10 years of no drug coverage, then if you enroll in Medicare Part D, you'll be paying 1% x 12 months x 10 years = 120% more premium per month than someone who enrolled when they were first eligible for Part D.
Depending on your income in retirement, you could also face some pretty steep out-of-pocket costs for your medications each year through Medicare Part D.
Perhaps this is the best decision for you.
For others reading this, keep in mind that delaying enrollment in Medicare Parts B and D without "creditable coverage" will cause you to incur on-going premium penalties which you'll have to pay for the rest of your life. Know what the penalties are before you decide to go that route. Going without prescription drug coverage doesn't just save you the cost of the premium, it can substantially increase your premium costs later in life.
I'm about to turn 65 and received a Medicare enrollment form in the mail. I've done quite a bit of research, but the more I read, the more confused I get.
My wife is working and we currently have health coverage through her job. It's a pretty good comprehensive package that includes medical, dental and vision insurance. The upcharge to have me on her plan is around $75/month. We're both pretty healthy, although last year I had a surgical procedure and we ended up paying the full out-of-pocket maximum of just over $13,000. This was a big hit to our budget, but we have resources available to cover it annually if need be.
My question is whether or not to enroll in Medicare vs. staying on my wife's plan. She expects to keep working for at least another 3-5 years. I would have to pay quite a bit more monthly for Medicare that we pay now. If I keep her plan coverage, what do I need to do about the Medicare coverage? I believe there's a penalty for not signing up when I turn 65. Does that apply if I have other insurance? Do I need to notify them if I won't enroll? Are there any compelling reasons to take Medicare coverage?
Thanks for any insight.
Enroll in Medicare Part A now. It's free. If you don't sign up for Part A now, you can be penalized for it later!
Medicare Part B is the hard question since it will cost you about $120 a month now, but it will cover 80% of your non-hospital costs except prescriptions which is Part D and separate. I am not sure how much having Medicare Part A & B would have cut your $13k bill. It's possible that Medicare B would have paid 80% of that $13k or that Medicare would have paid 80% for the operation and your wife's insurance would have covered the rest.
The first thing to do is to have your wife contact her HR office and find out if the employer HI pays before Medicare or vice-versa. Then you need to take that information along with information on your wife's HI policy and what it covers, to a Medicare/senior life/aging services counselor. This will cost you some bucks (I paid $60 for an hour's consultation), but a counselor can help you make your decision. You can find them through whatever agency handles various programs for seniors or even through a local assisted living/senior housing facility.
If you don't sign up for Part A now, you can be penalized for it later!
This is not correct. There is NO penalty attached to Part A. Part A enrollment can be delayed until one begins SS benefits - and does not need to occur at age 65. If one delays SS benefits, one can also delay enrollment in Medicare Part A.
There is a late enrollment penalty for Part B which is waived as long as OP is covered by creditable coverage (wife's employer's coverage is creditable), which issue has been covered upthread by several posters.
Quote:
Originally Posted by Linda_d
The first thing to do is to have your wife contact her HR office and find out if the employer HI pays before Medicare or vice-versa.
Apparently, you missed this:
Quote:
Originally Posted by JonahWicky
Thanks for all the excellent advice and suggestions. I'll contact HR and go from there.
You are thinking of an HSA - Health Savings Account - into which YOU and/or your employer deposit pre-tax money and which is a different animal than a Medicare MSA. Further, there is no age cut-off on an HSA provided one is NOT enrolled in Medicare. I worked until almost age 68 and did have and contributed to an HSA for almost two years. My employer did not offer an HSA until I was 66 y/o. Since, I was not enrolled in Medicare, I began an HSA and maxed it out for as long as I worked because of the tax benefits.
Otoh, the Medicare MSA - Medical Savings Account - deposit is made by Medicare/MSA insurer, not me, so there are no tax issues. Medicare MSAs are available in WI from two insurers. Medicare MSA's for your state can be found with the Advantage plans on Medicare.gov - by your zipcode. Not all states have MSA's. This is the company/plan I have:
NetworkHealth is 50% owned by Froedtert, a very large hospital system in our county. Other MSA in WI is offered through the Marshfield Clinic under the name Security Health - smaller deductible, smaller deposit. I chose NetworkHealth because of its Froedtert affiliation - which hospital campus is two miles from my house, although, as I said, I can use any Medicare provider. As it happened, my eye surgery was done through the Aurora Health System with an Aurora doc at an Aurora facility which accepted and processed the procedure through NetworkHealth without any issue. That said, if I lived in the Marshfield area upstate, I would probably have chosen Marshfield's plan. Marshfield has an excellent reputation, fwiw.
Thank You!
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