Moving from ACA to Medicare (medical, plan, hospital, surgery)
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My DH and I are on an ACA plan, but he will be 65 the end of October. I am wondering if he can start his Medicare January 1st (within the 3 month initial sign up after he turns 65) or is he going to be instantly put on Medicare when he turns 65 and thrown off the ACA. The reason for this is I am very concerned that if we try to take him off sooner somehow the system will screw up and cancel the entire plan and leave me uninsured. We are both together on the same plan and signed up that way with me as the primary and him as secondary. I don't turn 65 until next July.
I read somewhere that you can keep your ACA plan along with Medicare, but you will lose any subsidies and have to pay full price, which we absolutely cannot afford. It's going to be a bit "iffy" as it is with the newly increased Medicare fee plus a Medigap and Prescription plan as he isn't taking his SS until he turns 66. I was just going to wait it out until January 1st when the ACA application would only have me instead of him, but now I'm concerned about what I read. Or maybe I'm misunderstanding everything.
I am not a stupid person (BS degree in Medical Technology) but all of this extremely frustrating. Don't know how it got so complicated in the last 10-15 years. I don't ever remembering my parents having this much trouble with Medicare.
Yes, he can sign up for both Parts A & B, effective January 2017 and still be within the Initial Open Enrollment Period. Because he is not collecting SS benefits, he will need to pay his Part B premiums directly to SS. They now allow for ACH withdrawals, I believe.
Because Medicare Part B premiums are paid in advance, hubby should start this process relatively soon, as his first Part B payment for January 2017 will need to be made in December 2016.
Thanks Ariadne, I appreciate it. That's what I thought but DH wasn't sure and we didn't want to get hit with the higher ACA for 2 months.
What would you suggest as his latest date to sign up? And if we signed up in the next month would the payment still not be due until December? We are in a bit of a cash crunch right now.
What would you suggest as his latest date to sign up? And if we signed up in the next month would the payment still not be due until December? We are in a bit of a cash crunch right now.
Get the process going next month, or October latest. I would try to get to an SS office to begin the application - I'm a big believer in doing things face-to-face. SS isn't going to want payment any earlier than December and will send you a notice, which you can confirm with the SS rep when you apply. With this much lead time, you should be able to schedule an online payment in December for January Part B.
I'm going to have to move to Medicare as well from ACA - problem is: from research so far (Medicare starts 12/1 because of disability) - it's going to cost MORE than my current ACA (I'll need a supplement) - NOT happy as I'm VERY limited as to funds.
I'm going to have to move to Medicare as well from ACA - problem is: from research so far (Medicare starts 12/1 because of disability) - it's going to cost MORE than my current ACA (I'll need a supplement) - NOT happy as I'm VERY limited as to funds.
Are you sure you couldn't be a dual eligible - Medicare/Medicaid? Medicaid would pay the Medicare Part B premium and pick up what Medicare doesn't, similar to a supplement - and provide drug coverage. Otherwise, yes, Medigaps are costly - unless you can find an Advantage plan that would work for you. Many people here on limited income have found satisfactory Advantage plans - maybe the first one doesn't work out too well, but then they try another and find success.
You may want to consult with a Medicare insurance broker and/or with the SHIP people in your state:
Be aware that in some parts of the country, such as the Wash, DC. area, waits at the Social Security offices are horrendous, over 4 hours on occasion, so doing things in person may not be worth the bother, since some things can be done online quite easily.
You need not fear initial sign up for Medicare, for example. Or try phone. You wait a long time, but at least the wait is at home.
Are you sure you couldn't be a dual eligible - Medicare/Medicaid? Medicaid would pay the Medicare Part B premium and pick up what Medicare doesn't, similar to a supplement - and provide drug coverage. Otherwise, yes, Medigaps are costly - unless you can find an Advantage plan that would work for you. Many people here on limited income have found satisfactory Advantage plans - maybe the first one doesn't work out too well, but then they try another and find success.
You may want to consult with a Medicare insurance broker and/or with the SHIP people in your state:
Actually Medicaid does not pick up the part B premium. My mom just started on Medicaid August 1st (she has been in an ALF for several years). They (the state) allowed us to keep her supplemental plan at $311 a month. I also work in SNFs as an OT, and have never had a billing situation where Medicare paid for part A costs and Medicaid part B. Medicaid will pay for a bit of therapy and other things part B pays for, but it is much more restricted and the reimbursement is so low compared to medicare Part B that many medical services that bill part B won't even accept you as a patient.
Also remember all Medicaid plans are state specific, some states may be somewhat better than others.
Just be very careful with the Advantage plans. They are usually great when you're healthy, but awful if you get sick. Therapy and other services are much more limited (Advantage plans have gatekeepers, Medicare does not). My mother used to have a Blue Cross Advantage plan and she thought it was great, until she went to the hospital and rehab for 3 weeks and ended up with $5000.00 in co-pays, on top of being booted out (by the Advantage plan gatekeepers) before she was really healthy enough to leave.
When I got POA, I changed her to regular as soon as open enrollment came that year (with her knowledge). Since then (3-4 years) she has been in the hospital at least half a dozen times, she is now there every few months (chronic LE cellulitis) and although we have paid $300 a month for her supplemental, she is FAR ahead than if I hadn't switched her. She has had zero co-pays. If she had kept her Advantage plan she would have owed thousands and her "spend down" money would have gone to hospitals instead of using it to buy what she needs.
Point is, go by your health. If either of you have potential to be a frequent flier in terms of hospitals or have a chronic illness, IMO you really should do whatever you can to afford straight Medicare with a supplemental. You will pay much more on the back end if you're not careful.
When my mom had her Advantage plan, I couldn't even get her into the rehab I worked in, because they don't want to deal with Advantage plans and so don't accept them as patients (due to the PITA gatekeepers and lower reimbursement).
Actually Medicaid does not pick up the part B premium.
My mom just started on Medicaid August 1st (she has been in an ALF for several years). They (the state) allowed us to keep her supplemental plan at $311 a month. I also work in SNFs as an OT, and have never had a billing situation where Medicare paid for part A costs and Medicaid part B. Medicaid will pay for a bit of therapy and other things part B pays for, but it is much more restricted and the reimbursement is so low compared to medicare Part B that many medical services that bill part B won't even accept you as a patient.
Also remember all Medicaid plans are state specific, some states may be somewhat better than others.
As I recall your mom was in PA and then moved to NJ which is where you are?? You are correct Medicaid is state specific with different income criteria. I am well-acquainted with a 75 y/o woman right here in WI who has been on SSDI/Medicaid/Medicare since age 57 and, then, at age 65, moved to SS and SSI. Medicaid does, in fact, pay her Part B premium. Her income is about $800/mo. between SS and SSI, there is no deduction for Part B. Her medical costs are pretty much zero.
On Medicaid here, she has recently had kidney stone surgery and overnight hospitalization three times and in our very best teaching hospital, Froedtert, which, btw, has been excluded by the regular ACA plan networks because it won't accept ACA rates. She has better coverage than those who actually buy insurance. She pays virtually nothing for anything. When I talk about Medicare insurance with her she has no concept of the costs/issues people outside her situation could incur.
Her medical options under Medicaid in her current state of health are superior to those with ACA plans, by far, and some Advantage plans. Not all MA's around here include Froedtert in their networks, either.
Quote:
Originally Posted by ocnjgirl
Just be very careful with the Advantage plans. They are usually great when you're healthy, but awful if you get sick. Therapy and other services are much more limited (Advantage plans have gatekeepers, Medicare does not). My mother used to have a Blue Cross Advantage plan and she thought it was great, until she went to the hospital and rehab for 3 weeks and ended up with $5000.00 in co-pays, on top of being booted out (by the Advantage plan gatekeepers) before she was really healthy enough to leave.
When I got POA, I changed her to regular as soon as open enrollment came that year (with her knowledge). Since then (3-4 years) she has been in the hospital at least half a dozen times, she is now there every few months (chronic LE cellulitis) and although we have paid $300 a month for her supplemental, she is FAR ahead than if I hadn't switched her. She has had zero co-pays. If she had kept her Advantage plan she would have owed thousands and her "spend down" money would have gone to hospitals instead of using it to buy what she needs.
Point is, go by your health. If either of you have potential to be a frequent flier in terms of hospitals or have a chronic illness, IMO you really should do whatever you can to afford straight Medicare with a supplemental. You will pay much more on the back end if you're not careful.
When my mom had her Advantage plan, I couldn't even get her into the rehab I worked in, because they don't want to deal with Advantage plans and so don't accept them as patients (due to the PITA gatekeepers and lower reimbursement).
LOL - fwiw - I've cited your posts often when discussing the disadvantages of Advantage plans. There are, indeed, pitfalls. Medigap is preferable, if at all financially doable. That said, we've heard from several people on CD who also disagree strongly, have always had MA's, just love their MA's, and believe comments on the drawbacks of an MA paint an inaccurate picture. They've had good experiences with their MA's and believe everyone does - which is not true. Performance is very much a plan issue - and one's health can alter that picture considerably.
Are you sure you couldn't be a dual eligible - Medicare/Medicaid? Medicaid would pay the Medicare Part B premium and pick up what Medicare doesn't, similar to a supplement - and provide drug coverage. Otherwise, yes, Medigaps are costly - unless you can find an Advantage plan that would work for you. Many people here on limited income have found satisfactory Advantage plans - maybe the first one doesn't work out too well, but then they try another and find success.
You may want to consult with a Medicare insurance broker and/or with the SHIP people in your state:
Thanks Ariadne - I'll have to check into finding a broker to navigate. I'm actually pretty (very) happy w/my current plan, wish I could just keep it until I turn "real" Medicare age and then deal w/it then, LOL.
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LOL - fwiw - I've cited your posts often when discussing the disadvantages of Advantage plans. There are, indeed, pitfalls. Medigap is preferable, if at all financially doable. That said, we've heard from several people on CD who also disagree strongly, have always had MA's, just love their MA's, and believe comments on the drawbacks of an MA paint an inaccurate picture. They've had good experiences with their MA's and believe everyone does - which is not true. Performance is very much a plan issue - and one's health can alter that picture considerably.
