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Medicare choices

Medicare choices

Old Apr 26th 2019, 2:53 am
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Default 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.
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Old Apr 26th 2019, 5:53 am
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Default 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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Old Apr 26th 2019, 11:28 am
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Default 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.
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Old Apr 26th 2019, 12:19 pm
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Default Re: Medicare choices

Originally Posted by civilservant View Post
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.
Surely another factor is the deductibles and co-pays, which are far higher with traditional Medicare?
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Old Apr 26th 2019, 12:40 pm
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Default 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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Old Apr 26th 2019, 1:19 pm
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Default Re: Medicare choices

Originally Posted by sid nv View Post
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.
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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Old Apr 26th 2019, 2:03 pm
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Default 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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Old Apr 26th 2019, 4:44 pm
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Default Re: Medicare choices

Originally Posted by lansbury View Post
If either of your are prescribed medication you need to check that whatever plan you choose covers the drugs you are prescribed.
Yes, we are both on "meds". The medicare.gov website indicates for the Advantage plan I am looking at, the cost of my wife's Rx will increase for months 7 - 12 of the year by a factor of x12, due to something called Coverage Gap, or "Donut Hole". I have no idea at the moment if there is any way to avoid this Donut Hole.
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Old Apr 26th 2019, 4:45 pm
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Default Re: Medicare choices

Originally Posted by civilservant View Post
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.
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.

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.
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Old Apr 26th 2019, 4:46 pm
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Default Re: Medicare choices

Originally Posted by MidAtlantic View Post
Surely another factor is the deductibles and co-pays, which are far higher with traditional Medicare?
Yes, at first sight Original Medicare vs Medicare Advantage seems a no-brainer.
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Old Apr 26th 2019, 4:47 pm
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Default Re: Medicare choices

Originally Posted by civilservant View Post
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.
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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Old Apr 26th 2019, 4:47 pm
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Default Re: Medicare choices

Originally Posted by Nutmegger View Post
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.
COBRA has not been mentioned, and I don't think it applies to small companies (less than 20 employees?)
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Old Apr 26th 2019, 4:48 pm
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Default 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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Old Apr 26th 2019, 4:48 pm
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Default 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.
Depending on your location, this can hurt your choices. As an example, no provider I am aware of in this immediate area has a contract with Aetna. This might be worth checking around your local providers, especially any you currently use, before making a selection.

Last edited by civilservant; Apr 26th 2019 at 4:54 pm.
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Old Apr 26th 2019, 4:57 pm
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Default Re: Medicare choices

Originally Posted by sid nv View Post
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.
Also check the Out of Pocket Maximum. Advantage Plans vary by state but here in GA Advantage plan maximums are around $6k pa, whereas with traditional Medicare there is no limit.
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