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Old 03-28-2016, 07:47 PM
 
1,763 posts, read 1,297,804 times
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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.
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Old 03-28-2016, 07:59 PM
 
Location: DFW - Coppell / Las Colinas
36,790 posts, read 40,953,283 times
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I'm 63 so not quite there yet but everything I've read you must sign up at 65 or there are long term penalties.

Many policies also become secondary when you turn 65. I don't think you have a choice.

YOu might ask this over in the Retirement section.
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Old 03-28-2016, 11:50 PM
 
484 posts, read 452,066 times
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Quote:
Originally Posted by JonahWicky View Post
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.
Yes, you might have a choice.

It all hinges on whether your wife's coverage is "creditable" with Medicare Part B and Medicare Part D. Call Human Resources and ask them "Is our health insurance coverage "creditable" with Medicare Part B?" Then ask "Is it creditable for Medicare Part D?"

Part B pays for outpatient care. Part D pays for drugs. Some employer plans are creditable with both, some with one or the other, and some with neither.

If the answer is that the plan is creditable with neither, then you need to sign up for both Medicare B and D when it's first offered.

If it's creditable only for Part B, then you can delay signing up for Part B, but must enroll with Medicare Part D. Penalty for delaying enrollment in Medicare Part D without employer-provided "creditable" coverage: Your premium for Part D coverage is permanently increased by 1% for every month that you delay signing up. No appeal, no rollback, permanently higher.

If it's creditable only for Part D, then you can delay signing up for Part D, but must enroll with Medicare Part B. Penalty for delaying enrollment in Medicare Part B without employer-provided "creditable" coverage: Your premium for Part B coverage is permanently increased by 10% for every 12 months you delay signing up. No appeal, no rollback, permanently higher.

If your wife's coverage is "creditable" as outlined above, you'll be able to delay signing up until her coverage ends. At that point you will qualify for an 8 month special enrollment window. At the end of that 8 months, you'll need to have signed up with both B and D.

An added note for veterans: VA benefits are "creditable" coverage for Medicare Part D BUT NOT for Medicare Part B.

BTW, totally recommend checking out the website of the Medicare Rights Center, which is a non-profit organization that is neither funded nor affiliated with Medicare. They advocate for the rights of people on Medicare, and they have some of the clearest writing about Medicare benefits, eligibility, etc. Medicare Rights Center (800-333-4114) Or: Medicare Rights Center

You also need information about buying a Medicare Supplemental policy, but I'm going to ask my fellow CD insurance posters to help you with that issue.
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Old 03-29-2016, 02:30 AM
 
Location: Wisconsin
23,573 posts, read 50,242,219 times
Reputation: 18231
Quote:
Originally Posted by Rakin View Post
I'm 63 so not quite there yet but everything I've read you must sign up at 65 or there are long term penalties. Many policies also become secondary when you turn 65. I don't think you have a choice.
No penalty and, yes, he has a choice as long as wife's coverage is creditable. It's possible employer plan may become secondary for a spouse who is Medicare-eligible, which means then OP must enroll in Part B. He needs to check w/wife's employer on that.

Quote:
Originally Posted by Rakin View Post
YOu might ask this over in the Retirement section.
No, he shouldn't do that. CD has a very large link at top of Retirement Forum which says:
"Health Insurance Medicare forum link."
Posts on Retirement dealing with Medicare are moved to Health Insurance.

Quote:
Originally Posted by JonahWicky View Post
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?
Your don't need to notify Medicare if you choose not to enroll at this time. You should check w/wife's employer as to whether her plan requires you (spouse) enroll in Medicare at age 65. Her policy may or may not remain primary for you if you are Medicare-eligible.

If you go on Medicare at a cost of $122/mo., Part D at a cost of about $40/mo. plus drug copays, and buy a good Medigap policy with cost varying between $140-$175 mo., depending on your state - it is unlikely you'll ever again experience a $13,000 OOPs - unless your drug costs are out of sight. For most people, Medicare and Medigap premiums are pretty much the extent of their medical costs. Exception being if you encounter services not covered by Medicare. It happens, but we hear little about that issue, here.

If you don't want to take on the approximately $300/mo. insurance costs, for now you can stay on wife's policy and switch to Medicare without penalty when she retires, provided wife's policy is creditable. Most employer plans are. You can check with her HR people on that and whether her company requires you enroll in Part B, as I said above. When I retired, my firm gave me a statement on creditable re medical and drugs which I took to SS when I enrolled in Part B at age 67-1/2. No problem. I was covered under Medicare the following month.

Fyi - when the time comes, know that there are other less expensive alternatives to a full Medigap - such as a high-deductible Medigap F or a Medicare Medical Savings Account (MSA) both of which have complete provider flexibility - or an Advantage plan with restricted provider networks. We've had discussions on those plans elsewhere on CD.
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Old 03-29-2016, 04:54 AM
 
3,613 posts, read 3,428,666 times
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I agree, your first step is to call HR at your wife's company and see if they allow you to stay on the plan after age 65. Then you need to do the math, $75/month pays for a good portion of a good Supplement plan which would give you zero out of pocket, or close to it, in the event you need more medical care, especially expensive medical care. Then factor in plan changes, price increases, etc. for your wife's plan. The approximate costs for your Medicare plus supplement plan works out to about 3.5 years of paying for that for each time you max your out of pocket on your wife's plan, assuming your costs/premium stays the same over the next 4 plan years. Down side, make sure your physicians accept Medicare/assignment.
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Old 03-29-2016, 07:08 PM
 
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Thanks for all the excellent advice and suggestions. I'll contact HR and go from there.
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Old 04-25-2016, 08:34 PM
 
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OP here. I've pretty much decided to go for Medicare rather than continue the employer's coverage. Now I'm trying to decide on a Medigap supplemental plan or a Medicare Advantage plan. My head is spinning from all the reading I've done. Can anyone do a basic pro/con summary of one vs. the other? At the moment, I think I'm leaning toward a Humana Gold Plus advantage plan
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Old 04-25-2016, 08:45 PM
 
Location: Wisconsin
23,573 posts, read 50,242,219 times
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Quote:
Originally Posted by JonahWicky View Post
Now I'm trying to decide on a Medigap supplemental plan or a Medicare Advantage plan.

Can anyone do a basic pro/con summary of one vs. the other? At the moment, I think I'm leaning toward a Humana Gold Plus advantage plan
My basic response to this Q:

We've had many discussions on this forum on the pros and cons of either a Medigap + Part D, or an Advantage plan which includes drugs. A quick search should turn up many threads.

You need to evaluate these four criteria -
  1. your health
  2. your need/desire for doctor/provider flexibility
  3. your ability to pay Medigap (and Part D) premiums
  4. carrier reliability (especially true for Advantage and some Part D plans)
If you have a lot of chronic health issues or foresee serious issues - and can afford it - then a Medigap G or F - provides the most flexible, worry-free, and trouble-free choice. You can see any provider anywhere in the country who accepts Medicare, no gatekeepers on treatment approval, no provider networks. Bills go to Medicare and your Medigap.

Generally, with a Medigap F/G, your Medicare-approved expenses will be paid 100%. For the most part, medical expenses are pretty much limited to Medigap premium (and Part D premium and copays if you take medication).

There are less expensive (premium) cost-sharing Medigap plans available, as well, but often these prove to be a false economy when managing chronic illness or worse. Copays and hospital deductibles can eat up any premium savings in short order.

If you are reasonably healthy and can afford some premium and the very low 20% not paid by Medicare the few times you doctor - then a high-deductible Medigap F, which, again, provides the most provider flexibility and caps your annual max out-of-pocket (your 20%) at $2,180, worst case scenario, all at one-half to one-third the cost of a regular Medigap F. Bills go to Medicare and your Medigap. Medicare pays its 80%, you pay 20% up to a maximum of $2,180. Thereafter, the Medigap pays 100%.

If you're healthy, over a period of years, you'll probably be much further ahead financially with an hd-F. (If you haven't done so, as yet, strongly recommend you read this: Help - In Texas: Thinking Original Medicare and hi-D Plan F - thoughts?

If you are cost-conscious, then an Advantage (aka Medicare health plan) (if you're healthy - or, even if you're sick - depending on plan) can be an appropriate choice, as it bundles docs and drugs, for a low or zero premium. Pay close attention to:
  1. copays and max out-of-pockets, especially if you're sick or anticipate health issues.
  2. restricted networks - an issue if you need specialty care or if you travel a lot.
  3. drug formulary (tiers and copays).
For the chronically ill, annual Advantage copays could exceed twice the cost of a Medigap F, as max out-of-pockets can be set at $5-$7k, or more.

If you travel a lot or snowbird, unless it is a PPO with out-of-network coverage, Advantage is not an appropriate choice.

If you choose Advantage, know that you are divorcing yourself from Medicare and putting the decisions for treatments, benefits, and payment in the hands of the PRIVATE (this means for-profit) Advantage insurer. Some are good actors, others are not. Common bad behaviors by MA's are denials of mandated Medicare benefits, onerous oversight on long-term therapies and preapprovals, etc., slow pays, denials they've received the provider claims, customer-service run-around, and more.

Check with network providers and providers' billing people on ease of use, timely payment, preapprovals, insistence on use of generic drugs, verify with the provider that provider is, in fact, in that network - insurance reps and websites often are wrong - and talk to people you know who have the same plan.

Unless you are in a guaranteed issue state, know that once past the Initial Open Enrollment, you will not be able to switch to a Medigap without undergoing health underwriting, although you can move from one Advantage plan to another Advantage plan during Annual Open Enrollment.

So, choose carefully, because there may not be a do-over if you decide later you prefer a Medigap.


Last edited by Ariadne22; 04-25-2016 at 09:00 PM..
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Old 04-25-2016, 09:21 PM
 
1,763 posts, read 1,297,804 times
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Wow, very helpful and informative Ariadne22! This speaks to exactly the dilemma I mentioned...much confusion from reading. I'll do some more research on Medigap policies. Fortunately, my health is generally pretty good at the moment (although that's always subject to change without notice).
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Old 04-26-2016, 01:13 AM
 
Location: Southern California
28,796 posts, read 11,633,938 times
Reputation: 18462
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...

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.
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