Medicare choices
Hail fellow expats!
Sorry to start my first post on a depressing note, but I just lost my job, and with it health insurance for me and her indoors. The insurance broker that my ex-company uses has advised that we will be "termed" at the end of the month, which leaves me just a few days to sort out new health insurance. The one bit of good news is that I scraped in with 40 quarters of social security contributions, so we qualify for free Medicare part A (otherwise we would be on a plane home now). I have just about got to grips with the concepts of Medicare Parts A and B, now moving on to parts C and D is doing my head in. I am working through various plan details, but with not much time left to maintain coverage, I would appreciate any thoughts and experiences when it comes to choosing Medicare plans. Obviously a lot comes down to our personal circumstances, but if anyone has thoughts on eg. Medigap vs Advantage, it might help while I work through the 33 plans available in my state. I am aware of the medicare.gov plan finder. Thanks in advance for any responses. |
Re: Medicare choices
If either of your are prescribed medication you need to check that whatever plan you choose covers the drugs you are prescribed.
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Re: Medicare choices
As someone who works in the industry, I would council anyone against Medicare Advantage plans. With traditional Medicare, you are guaranteed benefits if you need them. With an Advantage plan, not so much.
Example: You fall and hurt yourself, spend 3 nights in the hospital, then go to a Nursing Facility for rehab to help you regain your walking skills after they repair your hip. With traditional Medicare, as long as you meet the guidelines for treatment (ie making progress, being seen as an inpatient at least 5 sessions a week) you are entitled to a maximum of 100 days. No fuss, no issues. It's a guaranteed benefit. With Medicare Advantage, you are at the whim of your insurer. The second that they see you have refused treatment one time (maybe because you were in pain that day) or they see that you didn't meet your goals for that week, they are cutting you off and denying further treatment, irregardless of if you really need it or not. There is one singular advantage to 'Advantage' plans, and that's that they often provide prescription coverage, where as you have to get Medicare Part D Coverage to cover it if you have traditional A/B. These plans usually cost $20-$50 per month, so for those on a limited income I understand why it seems appealing, but you need to understand that C plans have serious drawbacks. |
Re: Medicare choices
Originally Posted by civilservant
(Post 12675979)
As someone who works in the industry, I would council anyone against Medicare Advantage plans. With traditional Medicare, you are guaranteed benefits if you need them. With an Advantage plan, not so much.
Example: You fall and hurt yourself, spend 3 nights in the hospital, then go to a Nursing Facility for rehab to help you regain your walking skills after they repair your hip. With traditional Medicare, as long as you meet the guidelines for treatment (ie making progress, being seen as an inpatient at least 5 sessions a week) you are entitled to a maximum of 100 days. No fuss, no issues. It's a guaranteed benefit. With Medicare Advantage, you are at the whim of your insurer. The second that they see you have refused treatment one time (maybe because you were in pain that day) or they see that you didn't meet your goals for that week, they are cutting you off and denying further treatment, irregardless of if you really need it or not. There is one singular advantage to 'Advantage' plans, and that's that they often provide prescription coverage, where as you have to get Medicare Part D Coverage to cover it if you have traditional A/B. These plans usually cost $20-$50 per month, so for those on a limited income I understand why it seems appealing, but you need to understand that C plans have serious drawbacks. |
Re: Medicare choices
I don't consider then to be significantly higher than Medicare, in fact the co-pay rates for Hospital and Nursing Home stays are identical to Medicares in most cases, and in some cases actually lower - but this only normally applys to former State/Federal employees on the State Health Benefit Plans.
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Re: Medicare choices
Originally Posted by sid nv
(Post 12675875)
Hail fellow expats!
Sorry to start my first post on a depressing note, but I just lost my job, and with it health insurance for me and her indoors. The insurance broker that my ex-company uses has advised that we will be "termed" at the end of the month, which leaves me just a few days to sort out new health insurance. The one bit of good news is that I scraped in with 40 quarters of social security contributions, so we qualify for free Medicare part A (otherwise we would be on a plane home now). I have just about got to grips with the concepts of Medicare Parts A and B, now moving on to parts C and D is doing my head in. I am working through various plan details, but with not much time left to maintain coverage, I would appreciate any thoughts and experiences when it comes to choosing Medicare plans. Obviously a lot comes down to our personal circumstances, but if anyone has thoughts on eg. Medigap vs Advantage, it might help while I work through the 33 plans available in my state. I am aware of the medicare.gov plan finder. Thanks in advance for any responses. |
Re: Medicare choices
No one has asked, so I will. Are you both 65 or older? It doesn't matter that you have worked 40 quarters. That and your ages are what determines if you qualify for medicare.
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Re: Medicare choices
Originally Posted by lansbury
(Post 12675893)
If either of your are prescribed medication you need to check that whatever plan you choose covers the drugs you are prescribed.
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Re: Medicare choices
Originally Posted by civilservant
(Post 12675979)
As someone who works in the industry, I would council anyone against Medicare Advantage plans. With traditional Medicare, you are guaranteed benefits if you need them. With an Advantage plan, not so much.
Example: You fall and hurt yourself, spend 3 nights in the hospital, then go to a Nursing Facility for rehab to help you regain your walking skills after they repair your hip. With traditional Medicare, as long as you meet the guidelines for treatment (ie making progress, being seen as an inpatient at least 5 sessions a week) you are entitled to a maximum of 100 days. No fuss, no issues. It's a guaranteed benefit. With Medicare Advantage, you are at the whim of your insurer. The second that they see you have refused treatment one time (maybe because you were in pain that day) or they see that you didn't meet your goals for that week, they are cutting you off and denying further treatment, irregardless of if you really need it or not. There is one singular advantage to 'Advantage' plans, and that's that they often provide prescription coverage, where as you have to get Medicare Part D Coverage to cover it if you have traditional A/B. These plans usually cost $20-$50 per month, so for those on a limited income I understand why it seems appealing, but you need to understand that C plans have serious drawbacks. It did not occur to me that an Advantage plan might refuse to pay out. Although, having had some dental claims denied in the past, I probably should know better. My wife happened to come back from her Senior Center bingo session yesterday with a copy of AARP magazine, so I will look at their recommended Supplement Insurance plan - same as "Medigap". I think. |
Re: Medicare choices
Originally Posted by MidAtlantic
(Post 12676005)
Surely another factor is the deductibles and co-pays, which are far higher with traditional Medicare?
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Re: Medicare choices
Originally Posted by civilservant
(Post 12676017)
I don't consider then to be significantly higher than Medicare, in fact the co-pay rates for Hospital and Nursing Home stays are identical to Medicares in most cases, and in some cases actually lower - but this only normally applys to former State/Federal employees on the State Health Benefit Plans.
Original Medicare deductible = $1,340 Advantage plan = 5 days @ $275 = $1,375 So yes, about the same. But the 20% copays for Original Medicare look daunting. |
Re: Medicare choices
Originally Posted by Nutmegger
(Post 12676038)
You will be eligible for COBRA to extend your current insurance, which means you can take a bit more time looking for your new coverage. I presume you are of an appropriate age to be able to sign up for Medicare? And another vote for traditional Medicare/Medigap, as opposed to Advantage.
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Re: Medicare choices
Yes, we are both age over 65, so eligible. Less than 40 quarters means I would have to pay for part A.
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Re: Medicare choices
There are 20% co-pays for Advantage plans too.
With respect to stays in Hospital and Nursing Homes, there is a per diem rate set at the federal level each year for co-insurance rates after the days at 100%. For Nursing Homes it's $170.50 per day. This increases each year, but is covered in full by a Medigap policy. For most services under Part B, the 20% applies, but again would be covered by the right Medigap policy. AARP is a good one, insured by UHC. That is very interesting. So far, I have only been looking at the Advantage plans, which have attractive zero-dollar options. The main downside I see to Advantage is they do not provide out-of-network cover, so I can envisage situations where we inadvertently use out-of network services. |
Re: Medicare choices
Originally Posted by sid nv
(Post 12676135)
For hospital, I see:
Original Medicare deductible = $1,340 Advantage plan = 5 days @ $275 = $1,375 So yes, about the same. But the 20% copays for Original Medicare look daunting. |
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