which insurance plan to chose ?

[kenmac]

I turn 65 next mo.
I have recieved millions of calls from people wanting to help me sign up for an insurance plan.
One an Advantage plan, the other a suplement plan.

I realize everyone's situation is different, but any advice on which plan one would chose over the other, would be appreciated ?

 

[Torvy]

No specifics, but be very careful. Many times what you are being offered is a scam or will cost you more for the same service.

 

[KennyG]

If you can afford it, supplement plans have more flexibility and less potential red tape. Most of those TV ads you see are for advantage plans and are very misleading on cost and coverage. (i.e. don't trust Joe Namath or the Good Times actor.) If you know a trusted insurance professional talk to them. Some of the choices you make when you first sign up will restrict or eliminate your options to change later.

 

[RustyA]

I'm going through the exact thing right now. I chose a medigap policy plus an inexpensive drug policy as I don't presently take any medications. The way my advisor explained it to me is your initial enrollment there is no refusal for pre-existing conditions. If you choose medigap you can never be refused or denied coverage in the future even if you change insurance company that writes the policy. With advantage plans if you get sick the company can nonrenew you during open enrollment and you might have trouble getting affordable coverage due to your condition.
The other reason I chose medicare plus a medigap coverage is it is accepted anywhere Medicare is. Advantage plans may involve networks, HMO, and sketchy coverage when traveling. Some advantage plans are regional or limited to your home state. Talk to someone you trust like an insurance agent or financial planner to make sure you make the right choice for you.

 

[ljjhouser]

Well, this is about an hour-long topic. I will attempt to shorten it with a few suggestions.

1. Medicare is separated into 4 parts. You must choose where you want to get your insurance. Part C - the advantage plans -- OR -- Original Medicare -- OR -- Original Medicare with a Supplement plan (Medigap). This choice should be made relying on what you feel your needs are, your health in the future, and who you trust to cover those needs. And how much you want to contribute to health care cost if you need help. Examples: Advantage plans will include a drug plan, and cover much of your health needs. Most items in these plans have a copay and Max out of pocket. But the plan can be low cost with no monthly premium. If you choose a Part C advantage plan, you will not use Original Medicare (even though you must have it to enroll in Advantage). You will be dealing with the insurance company you choose, NOT Medicare. Most all Advantage plan features change every year, including the Max out of pocket. But you can change every year if you choose.
If you choose Original Medicare, you can switch adding an Advantage Plan or Part Drug Plan if you choose (you can change to be on Advantage or Original Medicare).
Original Medicare with a Pt D drug Plan. Original Medicare is a fee for service insurance. If you go to the hospital (part A) you will have a copay of about $1300 if you are admitted. That copay includes 60 days if you need to return again. Medical in OM has an annual deductible of about $190 and 20% copay on all medical services. That is 20% of the MEDICARE APPROVED PAYMENT, not the billed payment amount.

Only you can assess your needs and the costs you choose to incur.
Facts to remember,
At age 65, you enter the IEP - Initial enrollment period of Medicare. You can sign up for ANY medicare product. AFTER the IEP ends, you may not be able to make changes. For example, If you select Advantage and later decide to get a supplement, you may not be permitted after the first 12 mos. (with a SEP - Special Enrollment period).

You CANNOT have both an Advantage Plan and a Supplement (Medigap) plan at the same time.
There are free counseling services in most states and enrollment presentations. Good place to get info.
If you choose supplement, Plan G is very good, BUT look at Plan N. N covers most major costs and leave affordable copays for you. G pays everything (except the annual Medical (Pt B deductible).

Medicare is VERY good insurance at an affordable cost. It is the best insurance I have ever had. Choose wisely to best fit your health care needs.
Best wishes.

 

[duffer]

I won't give you advice, but I can provide some pros & cons of each plan.

Traditional (A+B)+(Medigap) Supplement policy will provide you the greatest flexibility, especially if you travel within the US. There is no set network you have to use, you can see a specialist without a referral if you want. So there is no doubt you can keep your current Dr and hospital you like for treatment. There are multiple Medigap policies (supplement policies) to choose from. Essentially you pick how much financial risk you want to take with each type of plan available in your state. The premium cost for each plan is different, as well as the deductibles. So..if you decide you want a Medigap policy "N", it will cost you $x. If you want policy "G" it will cost you $y. Now....all the different insurance companies in your state will offer the same plans, with the same deductibles and benefits. You need to decide which "plan" fits your needs, and then shop it around among the different insurance companies because the premiums you have to pay will differ. Wife and I had plan N, and it cost us about $300 a month for both of us combined. You'll also have to buy a Rx drug plan (D) separately to cover drugs. And pay deductibles and co-pays for each.

Advantage (Adv) plans are also specific by state. They are a little more complex to compare "apples to apples". Some offer HMO coverage, some offer PPO coverage, and some might offer open type coverage with no networks at all. (depends on your state). Essentially Adv plans combine Medicare part A & B into one, (technically called "C"). Most Adv plans cover the 20% you would normally owe for medical services from Traditional Medicare (which your extra Medigap policy you bought above, would pay for). So using an Adv plan would normally eliminate the need for buying a Medigap Supplemental policy. And Adv plans usually provide for Rx coverage (at least for generics), plus some dental, plus some eye care, and in our state even provide for a gym membership to get you in shape. Depending on your residence location, you might even get back some or all of your Part B premium that is deducted from your SocSec check. (although I think is rare) The downside to Adv plans is that they are not "portable". So if you travel, or have residences in multiple states, you won't be able to use the Adv plan in state #2 unless you go to the ER.

We started with Trad Medicare A+B at 65, because we refused to give up our primary Dr. Recently, he became available under Adv Plans. So we switched this year to an Adv plan (ours is a PPO). My drug costs have gone to $0. I use the gym membership several times a week. Went to an Ophthalmologist with $0 co-pay, and we're saving the $300/month for not having a Medigap policy to pay for. We do not have any restrictions we can't live with easily. The hospital network we want is also available under our Adv plan. You just need to do a little research with your Dr. & hospital to see if they're part of the Adv plan you want, AND from the Insurance company you intend to use. My Dr. has a sign up in the check-in window that says he does NOT take (1 particular insurance co.) Adv plans, but he does for most of the others. So you would be wise to verify with your own Dr. if he'll take your plan & insurance company....if you choose to use an Adv plan at all.

Good luck! Let us know how you come out.

 

[ljjhouser]

I turn 65 next mo.
I have recieved millions of calls from people wanting to help me sign up for an insurance plan.
One an Advantage plan, the other a suplement plan.

I realize everyone's situation is different, but any advice on which plan one would chose over the other, would be appreciated ?

About those calls. It is against Medicare licensing policies for an agent to contact you via phone or in person UNLESS you have contacted them first. They MAY loose their license if documented and sent to Medicare.

If you go to a store - grocery or the like, and there is a Medicare information table to discuss Medicare, they will ask you to complete a short contact card. If you do that, then that information you supply them is the first contact. They may call or knock on your door. Some do get away with calling anyway.

 

[Torvy]

I am truly sorry that Medicare is the best insurance you have had. I've seen what my parents go through. Fortunately, dad is a DAV and gets most of his Healthcare at the VA (his local is one of the better VA hospitals)

 

[ljjhouser]

No need to be sorry about my insurance. I just wish your father had the same insurance as I. I have Original Medicare and a F Medigap. I pay nothing but the Medigap monthly premium. It pays EVERYTHING else.

I am glad that that the VA has worked well for him. The VA has an excellent drug program.

 

[2manyrocks]

It is very difficult to understand the options and actual premium costs without consulting an independent agent who specializes in medicare supplement plans. There's a heck of a lot of marketing for advantage plans being affordable or not costing anything, but when you need or want medical care, those plans act like gatekeepers and you may not get the medical services you'd pick for yourself if you had that option.

If you carefully compare coverage and premiums among plans and various companies, there are some significant differences in coverage cost between them.

Give yourself adequate time to research and understand your options. Find a good agent. They deal with this stuff on a daily basis.

 

[Tinhack]

I dislike HMOs. I wouldn't go that route again. I had a bad experience with just a cut on my hand. I'm on straight Medicare A&B. My drug costs are about $50 a month for my arthritis. The quote I got from BCBS was around $3600 a year with a $3000 per year deductible. A few years ago, I had a bleeding stomach ulcer and a heart attack. Spent 11 days in a well-known premium hospital. I paid $400 extra for the ride to the ER there in an ambulance (long distance). I came out with a repaired stomach and a replaced aortic heart valve. My total portion with Medicare was about $3600 for the ulcer and open-heart surgery. That was in 2018. I've been banking that BCBS premium and living the life since. As has been mentioned on the board before, I hope the last check I write bounces.

 

[Snobdds]

If you can afford it, get a supplement with plan G.

If you start off with a lower coverage plan, if you ever want the better plan, they would have to underwrite you to get into it. You can always go down in coverage, but it's hard to go up in coverage.

I would stay away from advantage plans.

 

[mjonesnh]

Like you we had lots of questions. We contacted a local agent that I had previous business with. He spent considerable time with us explaining all the different choices available. In the end we chose a medigap plan G with a plan D for our prescriptions. After our part B deductible is paid everything else is covered, so no surprises. No networks to worry about, covers any doctor that accepts medicare

 

[Oaktree]

It is very difficult to understand the options and actual premium costs without consulting an independent agent who specializes in medicare supplement plans. There's a heck of a lot of marketing for advantage plans being affordable or not costing anything, but when you need or want medical care, those plans act like gatekeepers and you may not get the medical services you'd pick for yourself if you had that option.

If you carefully compare coverage and premiums among plans and various companies, there are some significant differences in coverage cost between them.

Well, that could go down as the understatement of the week.

Plain old Medicare's big advantage is that it's accepted pretty much everywhere. IMHO that's about all it's got going for it. Lots of things aren't covered. Most part D (prescription) premiums cost more per month than what the few prescriptions we have would, especially if you use GoodRx or something similar.
Both my wife and I are in reasonably good health (and there are few health problems on either side of our families), and can't see paying $$$ for a policy that pays for things we don't need. Obviously, if you DO have health problems that's probably not the best solution.
We decided to go the advantage route. The only downside we've seen is sometimes limited providers that are part of the plan. I agree that finding the right plan is enough to make your head explode. Our previous plan was discontinued at the end of 2022 and we had to shop for a new one. Man! was that confusing. Widely varying prices for what looked like similar coverage.
I've personally not had good experiences with independent insurance agents, regardless of what it's for.

 

[2manyrocks]

Without a medicare supplement of some sort, there is the risk of running into some very substantial medical bills. An advantage plan is better than no supplement plan at all.

Insurance agents are like anything else. Some good. Some bad. There are agents who specialize in medicare supplement plans who aren't captive to one particular company. They don't really care which plan you pick because they are working with so many people that they probably make a good living regardless. They can't afford to be tied to one company, either, because the company that offers the better deal today may try to more than make up their losses with a large premium increase next year, forcing a change in coverage to another company assuming one isn't stuck in a plan because of a pre-existing condition.

The OP needs to understand that there is no initial underwriting when going into a supplement plan at 65, but if the OP has or develops a serious condition by the time of the next enrollment period, changing plans may require an underwriting evaluation and payment of a potentially higher premium. So don't start off in any plan thinking you can just change it next year because an unexpected illness or accident can change your situation.

One thing that concerns me about the OP's situation is that the OP says he turns 65 next month leaving not much time to figure out what he really needs to do. I spent a few months trying to get answers on my own, but then realized that the supplement companies don't want you to comparison shop and don't make it easy. They just spew out a lot of fluff marketing trying to get you signed up on their plan regardless of whether it actually makes sense in your particular situation. That's when I decided to consult an independent agent who deals with supplements every day. I was able to quickly narrow my choices and make a decision. I don't think I could have done it on my own, and especially not in such a short time frame as the OP is evidently facing.

 

[ljjhouser]

Just a short note. The Medicare IEP - initial enrollment period begins three months before the 1st day of the 65th birthday month, includes the month of the 65 birthday, and ends three months after the month of the 65th birthday. A total of 7 months. Unless the 65 birthday is on the 1st day of the month.

 

[2manyrocks]

If whatever coverage the OP has ends at age 65 and no supplement is in place when that happens, there is a potential gap in coverage that you really don't want to have happen.

Another thing is to compare the premiums at varying ages between different companies offering competing plans. Future premiums are subject to change, but some companies will charge a lower initial rate at age 65 to get people enrolled in their plan, but try to make it up later with larger premiums at older ages.

 

[kenmac]

Just to clairfy, I turn 65 mid month, so I have been studding the different plans on medicare.gov.
I'm not able to get an F plan which appears have zero out of pocket expense. Looks like I quality for two pretty good plans.. G and N as a sumplement, or zero cost Advantage plan.

Appears from medicare.gov site, that plan G has $226.00 deductable and zero co-pays at a cost (in my area) of $144.00 per mo.

Plan N on the otherhand, has the same #226.00 deductable, co- pays are $20.00 office visits, $50.00 emergency room visit which isn't charged if admitted. at a cost (in my area) of $94.00 per mo.
I'm in pretty good health as is, so this may be a pretty good plan for the monthly preminum, with low out of pocket expense

I have a friend that is on an Advantage plan and he says they can,and do deny some test, such as MRI, CT, etc,.
That doesn't sound very good even though it is at zero preminum.

As someone already mentioned, Advantage is probably better than just plain medicare as it only covers 80%.

Currently, I'm just paying for a private insurance plan, so I don't think I'm going to be kicked off a plan if it takes a little longer to decide. But I have about a month and a half to decide, so I should be good.

I'll probably try to talk to someone that isn't trying to push one brand, like an Independent insurance company. I use an independent with Homeowners, and vehicles.

 

[2manyrocks]

My private medical insurance carrier would have let me stay on their plan at 65, but the premium was through the roof. I think they thought I'd just sign up for their medicare supplement plan, but it became apparent that another company beat them on premiums and offering a greater lifetime maximum benefit, not to mention having better customer service ratings.

Please don't guess at when your present coverage ends or what it might cost.

I suggest speaking with at least two independent agents so you can compare advice to see if they seem to be telling you the same thing or causes you to feel you need to investigate further.

 

[ljjhouser]

Just to clairfy, I turn 65 mid month, so I have been studding the different plans on medicare.gov.
I'm not able to get an F plan which appears have zero out of pocket expense. Looks like I quality for two pretty good plans.. G and N as a sumplement, or zero cost Advantage plan.

Appears from medicare.gov site, that plan G has $226.00 deductable and zero co-pays at a cost (in my area) of $144.00 per mo.

Plan N on the otherhand, has the same #226.00 deductable, co- pays are $20.00 office visits, $50.00 emergency room visit which isn't charged if admitted. at a cost (in my area) of $94.00 per mo.
I'm in pretty good health as is, so this may be a pretty good plan for the monthly preminum, with low out of pocket expense

I have a friend that is on an Advantage plan and he says they can,and do deny some test, such as MRI, CT, etc,.
That doesn't sound very good even though it is at zero preminum.

As someone already mentioned, Advantage is probably better than just plain medicare as it only covers 80%.

Currently, I'm just paying for a private insurance plan, so I don't think I'm going to be kicked off a plan if it takes a little longer to decide. But I have about a month and a half to decide, so I should be good.

I'll probably try to talk to someone that isn't trying to push one brand, like an Independent insurance company. I use an independent with Homeowners, and vehicles.

Good, you are coming along well. Good review of choices. I will add a few comments and notes.
1. You become eligible for Medicare on the first day of the month of your birthday---Unless your birthday is on the first day of the month.
2. When you are in the IEP, you qualify for ALL medicare products. Any supplement, Pt D drug plan or Advantage offered can be purchased.
3, Per an act of Congress, all Medigap F plans were grandfathered in if previously purchased and Plan F was removed from the market. Same is true of Plan C. That is because those two plans paid the Part B (Medical) annual deductible. This changed in JUNE. of 2010.
4. BE AWARE - IF YOU KEEP YOUR COMPANY.INSURANCE PAST THE IEP, YOU BECOME THE "WORKING AGED." WHEN YOU DROP YOUR INSURANCE PLAN AND ENROLL IN PART B, YOU HAVE ENROLLMENT RIGHTS. THAT IS A SEP (SPECIAL ENROLLMENT PERIOD). YOU WILL HAVE EIGHT MONTHS TO ENROLL IN PART B (I THINK) AFTER ENDING YOUR COMPANY PLAN, BUT YOU WILL HAVE ONLY 63 DAYS TO ENROLL IN A SUPPLEMENT PLAN. YOUR CHOICE AND PLAN N WILL NOT BE OFFERED. YOU CANNOT CHOOSE PLAN N AFTER USING YOUR CO PLAN AND ENROLLING IN PT B LATE.

You may want to check this out if you are looking at an N plan (a good choice, in my opinion.)

5. If your company ins. is provided by a co with 20 or less employees, you will want to enroll in Pt B during your IEP. This is because Medicare will be primary payer and your co ins secondary. If you do not have MC Pt B, then Medicare will not pay, and as secondary, your secondary ins may pay little or none of the bill when they find you are eligible for MC.

6. If more than 20, you may delay part B and you ins will pay their commitment. UNLESS you are disabled --then the number is 100 emploees.

Sorry to take so long, just want to caution you about the options relating to working insurance past 65 and Plan N.