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Medicare time!
So it's now official. I will have Medicare starting January 1st 2020! I thought I would sail through this mess of information and forms etc after our first go round earlier this year with M but of course not.
So far the Medicare part has been easy and yesterday our nice insurance brokers set us up with our Medicare supplement which we are happy with. But the social security part was not so easy. I have worked in the US for just over 30 years but only 14 of them were paying into Social Security the other 16 have been with an alternate social security ( it's a government thing) so I knew my s/s would be reduced but the first person I spoke to when signing the forms to claim benefits told me I would be penalised and would get just a very small portion of the amount I had paid in to. She then seemed to have a problem with my identification even though I gave her my SS card, drivers license and I also signed into mysocialsecurity on the screen in front of me. She wanted me to return with my birth certificate and marriage certificate ( husband was sitting next to me with all his proof as well!) A week later I went back and breezed through the whole procedure with another assistant. No need for birth certificate or marriage certificate and he also came up with a higher monthly payment than the previous helper. I even asked him to double check so he had his supervisor check it and they came up with the same amount. Hopefully I have less problems with my claim for my alternate benefit! It's getting real! |
Re: Medicare time!
Sounds like the Windfall Elimination Provision, WEP, they were hitting you with. PS. Congrats on the Medicare! |
Re: Medicare time!
If it is WEP there is a calculator on the SSA web site, this is the online version https://www.ssa.gov/planners/retire/anyPiaWepjs04.html Put your figures into that and it will work it out for you. That way you can double check which one of the "helpers" got it right. If you haven't got the figures for each year, you can get them from your SS account online.
We found SS easier than medicare. Our doctor stopped taking our medicare plan from next year and we have had to sort out a new one. Figuring out all the choices and options was like being on Mastermind. Mrs L has changed her mind 3 times so far. Don't forget to check if you can claim State pension from the UK. |
Re: Medicare time!
Originally Posted by lansbury
(Post 12754900)
If it is WEP there is a calculator on the SSA web site, this is the online version https://www.ssa.gov/planners/retire/anyPiaWepjs04.html Put your figures into that and it will work it out for you. That way you can double check which one of the "helpers" got it right. If you haven't got the figures for each year, you can get them from your SS account online.
We found SS easier than medicare. Our doctor stopped taking our medicare plan from next year and we have had to sort out a new one. Figuring out all the choices and options was like being on Mastermind. Mrs L has changed her mind 3 times so far. I was going to go on the same plan that M has had since August but we found out it is no longer unavailable . So yesterday we started again for both of us and found a plan that our PCP takes and cardiologist and gastroenterologist so we are happy. We also found most of our meds are Tier 1 which also helps. I hope this all works out. It is crazy that the older you get the more complicated life can get! |
Re: Medicare time!
I prefer to stay with regular Medicare and buy a supplement versus going with an Advantage Plan which may be limited on which doctors will accept. You are locked in for a year and if planning to move during that time you could end up outside the area of coverage for an advantage plan. In my case advantage is a non issue as I have a free Medicare supplement from military retirement. |
Re: Medicare time!
Originally Posted by ddsrph
(Post 12754911)
I prefer to stay with regular Medicare and buy a supplement versus going with an Advantage Plan which may be limited on which doctors will accept. You are locked in for a year and if planning to move during that time you could end up outside the area of coverage for an advantage plan. In my case advantage is a non issue as I have a free Medicare supplement from military retirement. |
Re: Medicare time!
Originally Posted by lansbury
(Post 12754900)
Don't forget to check if you can claim State pension from the UK.
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Re: Medicare time!
Originally Posted by ddsrph
(Post 12754911)
I prefer to stay with regular Medicare and buy a supplement versus going with an Advantage Plan which may be limited on which doctors will accept. You are locked in for a year and if planning to move during that time you could end up outside the area of coverage for an advantage plan. In my case advantage is a non issue as I have a free Medicare supplement from military retirement. |
Re: Medicare time!
Having just about got used to Tax Return Season, now facing the new challenge of Medicare Plan Season. :(
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Re: Medicare time!
Originally Posted by Rete
(Post 12754937)
We didn't find that to be true at all. Our Advantage Plan is Aetna Advantage and while it originates in New York State via the union, we use it down here in Mississippi without any problem. We pay for Medicare and separately for Aetna.
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Re: Medicare time!
As it was explained to us, Aetna is sent the medical bills, not medicare, and Aetna pays the bill and then bills medicare. In the 6 years I've had the plan and the 8 years my husband has had the plan, never once have we been billed for a medical service, never have had the charge for a medical service or hospital stay or surgery questioned by Aetna or medicare.
Yes, unfortunately not all healthcare plans are the same. We lucked out and are glad to have the supplemental plan that we have. |
Re: Medicare time!
Originally Posted by ddsrph
(Post 12755225)
... I trust Medicare more that advantage plans right or wrong. Advantage plans receive a yearly fee from govt to pay for ones care. Any money spent to provide that care detracts from their bottom line. That type of incentive does not give me confidence they have my best interest at heart. When the Republicans came up with Advantage plans their reasoning was to save money. The reality is it cost the govt 15 to 20% more for each person than traditional Medicare. Factor out the huge increase in advertising and administrative costs of dozens of plans plus profit and bonuses for executives how much is left over for actual healthcare? This article explains it well - https://www.modernhealthcare.com/art...-reimbursement The CMS pays Medicare Advantage organizations a per member, per month fee to care for seniors enrolled in the plans. Since the 1980s, that payment has been adjusted based on demographic information such as age and sex. But in 2004, the government implemented a new risk-adjustment model that tweaked payment based on demographic information and the health conditions of each member. Each Medicare Advantage beneficiary is assigned a risk score based in part on their health diagnoses. Insurers are supposed to be paid more for sicker members with higher risk scores because they use more resources to care for them, while plans receive a lower payment for healthier-than-average members with lower risk scores. The payment system is designed to prevent health insurers from cherry-picking only healthy members and it has worked to that effect. At the same time the system created strong incentives for health insurers to report as many diagnosis codes as possible because that can lead to higher risk scores and higher payments from the CMS. The annual payment to an Advantage plan for an 84-year-old male patient with diabetes without complications who is not eligible for Medicaid would be $6,765, according to the Medicare Payment Advisory Commission. But tack on a diagnostic code for vascular disease and that same diabetic patient's Medicare payment would jump to $9,796.
Originally Posted by Rete
(Post 12755263)
As it was explained to us, Aetna is sent the medical bills, not medicare, and Aetna pays the bill and then bills medicare. In the 6 years I've had the plan and the 8 years my husband has had the plan, never once have we been billed for a medical service, never have had the charge for a medical service or hospital stay or surgery questioned by Aetna or medicare.
Yes, unfortunately not all healthcare plans are the same. We lucked out and are glad to have the supplemental plan that we have. Despite the potential for problems, however, most people I know choose Medicare Advantage plans and are not unhappy with the result. I think the insurance companies know they are onto a good thing with this arrangement and don't rock the boat by denying service. They just bill medicare a lot of money. My g/f recently turned 65 and chose an MA plan; I'm fast approaching and will also likely choose one. |
Re: Medicare time!
One of the ways advantage plans defraud the govt is inflating risk scores to receive the higher rate.As I understand it the risk score is only calculated once a year and the amount the insurance company gets is paid in a lump sum. |
Re: Medicare time!
Originally Posted by ddsrph
(Post 12755360)
One of the ways advantage plans defraud the govt is inflating risk scores to receive the higher rate.As I understand it the risk score is only calculated once a year and the amount the insurance company gets is paid in a lump sum. |
Re: Medicare time!
In my mind all health insurance companies are crooks until proven otherwise. In my case I could never go on a Advantage plan as I have Tricare for Life thru military retirement. It’s a free supplement to Medicare which also has drug coverage. In the end I pay nothing except Medicare A&B and no copays for any treatment or hospital stays. I heard of a few uniformed cheapskates who decided since they had Tricare they would save money and not enroll in Medicare. A big healthcare expense later they learn they have no insurance at all. |
Re: Medicare time!
Originally Posted by Steerpike
(Post 12755363)
I had the dubious honor of working for a company that was involved in doing 'risk adjustment' for MA plans. The penalties for falsifying / exaggerating the 'scores' are severe. But the great irony is - you don't have to falsify or exaggerate! All you have to do is accurately report the condition of a patient and the score increases. Why? Because the majority of people don't visit their doctor that often, and thus, their score remains stagnant based on their last visit. You said 'the risk score is only calculated once a year...' I think it's more accurate to say, it can only be adjusted 'at most' once a year, but if you don't visit the doctor the score cannot change. So what you do is - look at all the patients who haven't seen a doctor in at least a year, then figure out which ones are likely to have deteriorated over the past year, and then give them a free checkup. Patient gets a free checkup, score naturally increases because ... well ... they are getting older ... and reimbursement goes up. Everyone wins except the government ....
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Re: Medicare time!
I did not realise sick old people were so valuable. This explains why our Medicare Advantage plan provider keeps sending us detailed questionnaires on our health (I binned mine), invitations to "wellness visits", and has now got me wondering what my MA risk score is. I recently admitted to my doctor how much I drink, so that will have bumped up my score quite a bit. Now if I start smoking and put on a few more pounds, perhaps I can request a discount from my MA plan provider. And then I can bring my Mum over, get her RAF coded up, and auction her off to the highest MA plan provider bid.
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Re: Medicare time!
It is a ridulous time of year for those in the Medicare age bracket. In my mail today, there were seven pieces of mail that were Medicare related - three from United Healthcare, my Medicare Advantage provider, and four solicitations from other companies. Other companies want you to change to their plans, your provider deluges you with "Thank You" cards, magazines, proposals to send a nurse to your house for a "wellness visit," etc. etc. This goes on for nearly two moths, so that's hundreds of pieces of junk mail for the wood stove. The only important pieces arrived in the mail a couple of weeks ago. One is Medicare & You 2020, the official government Medicare handbook. It's 122 pages long this year. It basically lists all the hundreds of plans available to folks living in the various counties of New York State. The other is a letter from my provider, United Healthcare, listing changes to my current plan this year. I'll carry on with my present plan for next year, simply because it's the easiest option. I have no idea if it's any good, since I haven't been to the doctor for years. (I do get a free flu shot every year, but that'd be covered whatever Medicare I had.) |
Re: Medicare time!
Originally Posted by robin1234
(Post 12755871)
It is a ridulous time of year for those in the Medicare age bracket. In my mail today, there were seven pieces of mail that were Medicare related - three from United Healthcare, my Medicare Advantage provider, and four solicitations from other companies. Other companies want you to change to their plans, your provider deluges you with "Thank You" cards, magazines, proposals to send a nurse to your house for a "wellness visit," etc. etc. This goes on for nearly two moths, so that's hundreds of pieces of junk mail for the wood stove. The only important pieces arrived in the mail a couple of weeks ago. One is Medicare & You 2020, the official government Medicare handbook. It's 122 pages long this year. It basically lists all the hundreds of plans available to folks living in the various counties of New York State. The other is a letter from my provider, United Healthcare, listing changes to my current plan this year. I'll carry on with my present plan for next year, simply because it's the easiest option. I have no idea if it's any good, since I haven't been to the doctor for years. (I do get a free flu shot every year, but that'd be covered whatever Medicare I had.) |
Re: Medicare time!
Originally Posted by robin1234
(Post 12755871)
It is a ridulous time of year for those in the Medicare age bracket. In my mail today, there were seven pieces of mail that were Medicare related - three from United Healthcare, my Medicare Advantage provider, and four solicitations from other companies. Other companies want you to change to their plans, your provider deluges you with "Thank You" cards, magazines, proposals to send a nurse to your house for a "wellness visit," etc. etc. ... |
Re: Medicare time!
Originally Posted by Steerpike
(Post 12755976)
This could well be the visit that will get 'coded' and will update your risk adjusted score. When I was involved, it had to be a 'nurse practitioner', I believe (didn't have to be a doctor, but had to be more than a 'basic nurse' ... whatever that means!). I will say, in defense of that practice (small defense for a bigger problem), that a lot of genuine problems were found during these visits that would otherwise go undetected. More than once, our nurse practitioners ended up dispatching the patient to the hospital with life threatening conditions that the patient was ignoring.
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Re: Medicare time!
Originally Posted by ddsrph
(Post 12755902)
The above plus TV ads every 5 minutes. All out of the taxpayer’s pocket. This money spent on advertising could pay for a lot of healthcare. Then factor in all the different plans personnel costs and it really gets expensive. |
Re: Medicare time!
Originally Posted by robin1234
(Post 12756318)
Wow, that’s really interesting. Seems to indicate that it’s a common phenomenon to avoid going to the doctor - but to accede to the offer of an annual wellness visit to your home, by a nurse practitioner. I agreed to do it last year. (United Healthcare give you a $15 incentive for the visit.) She was in the house for an hour, and her journey time each way was over an hour ... so it seems to me her visit cost UH quite a bit. It was mostly “happy talk,†a questionnaire, and a fairly superficial examination, but certainly if I’d had some major problem brewing, she’d probably have spotted it. |
Re: Medicare time!
Originally Posted by Steerpike
(Post 12757446)
Did the NP identify herself as working for UHC or for a third party? Just curious ...
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Re: Medicare time!
Originally Posted by Rete
(Post 12754937)
We didn't find that to be true at all. Our Advantage Plan is Aetna Advantage and while it originates in New York State via the union, we use it down here in Mississippi without any problem. We pay for Medicare and separately for Aetna.
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Re: Medicare time!
Originally Posted by Nutmegger
(Post 12760238)
To revisit this Medicare thread, my HI agent has always recommended Medicare Supplement plans as opposed to Advantage plans, but I have just heard from him this week about a zero dollar premium Aetna plan that utilizes the Aetna National PPO network and combines medical, prescription, dental, vision, hearing. He says that there will be more exposure for deductibles and copays, but accounting for premium savings and one's individual situation, it may pay to make the switch. So I am currently reading up on the plan to see if it will work for me. But it is apparently something for Medicare users to look into.
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Re: Medicare time!
Dear Lord, after reading this thread I don't know how you all manage to negotiate healthcare there. I had a headache by the third post.
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Re: Medicare time!
Originally Posted by robin1234
(Post 12760282)
One thing to watch with switching from Medicare + Medicare Supplement to Medicare Advantage, is, if at some time in the future, you choose to switch back to M. supplement, will you be hit by a penalty on the premium for the supplement (as compared with the premium you would have been paying, had you stayed with the supplement plan.) |
Re: Medicare time!
Originally Posted by spouse of scouse
(Post 12760285)
Dear Lord, after reading this thread I don't know how you all manage to negotiate healthcare there. I had a headache by the third post.
Fortunately, they’re over-the-counter, not prescription.. |
Re: Medicare time!
Originally Posted by robin1234
(Post 12760282)
One thing to watch with switching from Medicare + Medicare Supplement to Medicare Advantage, is, if at some time in the future, you choose to switch back to M. supplement, will you be hit by a penalty on the premium for the supplement (as compared with the premium you would have been paying, had you stayed with the supplement plan.) |
Re: Medicare time!
Originally Posted by spouse of scouse
(Post 12760285)
Dear Lord, after reading this thread I don't know how you all manage to negotiate healthcare there. I had a headache by the third post.
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Re: Medicare time!
Originally Posted by vespucci
(Post 12760680)
Or will you be able to switch back at all. If you develop certain medical conditions you may fail "underwriting" and not be able to switch back.
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Re: Medicare time!
Originally Posted by Nutmegger
(Post 12760238)
To revisit this Medicare thread, my HI agent has always recommended Medicare Supplement plans as opposed to Advantage plans, but I have just heard from him this week about a zero dollar premium Aetna plan that utilizes the Aetna National PPO network and combines medical, prescription, dental, vision, hearing. He says that there will be more exposure for deductibles and copays, but accounting for premium savings and one's individual situation, it may pay to make the switch. So I am currently reading up on the plan to see if it will work for me. But it is apparently something for Medicare users to look into.
Originally Posted by robin1234
(Post 12760282)
One thing to watch with switching from Medicare + Medicare Supplement to Medicare Advantage, is, if at some time in the future, you choose to switch back to M. supplement, will you be hit by a penalty on the premium for the supplement (as compared with the premium you would have been paying, had you stayed with the supplement plan.) |
Re: Medicare time!
Originally Posted by Nutmegger
(Post 12764065)
Just wanted to report back on further research on the Aetna plan I cited above. First, unlike some Advantage plans, it would cover any medical services required on a trip to the UK;
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Re: Medicare time!
Taking a look at the Advantage plans on offer here: medicare.gov has an excellent Advantage plan comparison tool. There are really only two companies to choose from in this geographic area. We are currently with the biggest player, but the other guys are clearly making an effort to compete and pull people over. The other company are offering some Dental cover, which is attractive if you have a mouth fitted with British Teeth. Reading the fine print, I see that Dental cover is only available from "in-network" practitioners, as listed in the Provider Directory. So off to their website to check the Dental Provider Directory, and I see it is "Coming Soon". Sigh.
When I signed up with my dentist in the US, he gave me a sales pitch in his sales presentation room which included a spreadsheet displayed on a large LCD screen with all options listed, total $11,000. Having recently arrived from the UK, this was of course a different experience to my NHS dentist. I declined all suggested treatment except for an extraction that I had already been recommended by a dentist in Glasgow earlier that year. A decision I do not regret 10 years later, as my British Fillings have yet to crumble. I should say that as well as a good salesperson, my dentist is also a very good although pricey dentist. I doubt if he will be appearing in the "Coming Soon" Provider Directory. |
Re: Medicare time!
Was truly surprised to see a notice at the eye doctor's yesterday that as of January, 2020 there will be a Medicard deductible of $180. Whoa!
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Re: Medicare time!
So before I even begin this new adventure the Medicare monthly reduction from my SS check will now be $10 more than originally stated!
Retirement date is this Friday! Am i excited..you bet! |
Re: Medicare time!
Originally Posted by Sugarmooma
(Post 12779661)
So before I even begin this new adventure the Medicare monthly reduction from my SS check will now be $10 more than originally stated!
Retirement date is this Friday! Am i excited..you bet! |
Re: Medicare time!
Originally Posted by spouse of scouse
(Post 12760285)
Dear Lord, after reading this thread I don't know how you all manage to negotiate healthcare there. I had a headache by the third post.
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Re: Medicare time!
Originally Posted by ddsrph
(Post 12779847)
Are you still planning to move to different state for retirement? |
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