Health Care Prior to Medicare?

[dmccarty]

A google search found this answer.....(No, you don't need to have creditable insurance coverage before you can get Medicare coverage)

Yep, I think that is correct.

I should have said, "yes, one needs to have "creditable coverage" on some insurance plans before getting into Medicare Part D drug plan.." At least that is the one I know about.

To make this more confusing/interesting for me, is that I have a bit of retirement money from my employer that can be applied to health care after retirement. The money was a very small token amount the company gave to some employees when they did away with a defined pension, and more importantly, the retirement health care benefit. The bit of money might last one year prior to Medicare and can only be used on health plans provided by the company. One of the requirements to keep the money, is to maintain health care coverage.

 

[Bendboater]

A Medicare supplement is not the same as a Medicare Part D drug plan. A supplement pays the 20% part B expenses that Medicare doesn't cover and (in most plans) the part A deductible ($1675 per benefit period in 2025).
A Part D (drug) plan helps pay for the cost of prescriptions.
Our Part D plan did not ask if we had prior insurance coverage. Only the Medicare Supplement asked (and required proof).

The alternative to having Medicare, plus a Medicare Supplement, plus a Drug plan would be to get a Medicare Advantage (Part C) plan. These plans, offered by companies such as United Health Care (aka, AARP), take care of it all and are essentially "privatized Medicare" (you don't deal with Medicare at all). I do not know if Part C plans require insurance coverage. There are significant pro's and con's to either approach.

Some folks also choose to only have Medicare (no supplement or Advantage plan).

It's complicated and there are a lot of moving pieces in the health insurance puzzle that can have lasting ramifications if not done correctly the first time out of the gate. It's also different for everyone....there is no "one size fits all". So, as before, I encourage you to seek professional assistance with these decisions.

Back to installing a Summit Front and Rear hydraulic kit on my tractor.

 

[dmccarty]

...
It's complicated and there are a lot of moving pieces in the health insurance puzzle that can have lasting ramifications if not done correctly the first time out of the gate. It's also different for everyone....there is no "one size fits all". So, as before, I encourage you to seek professional assistance with these decisions...

Yes it is complicated. My company benefits documentation specifically mentions which plans it offers are, and are not, creditable coverage for Medicare drug coverage.

As part of the retirement process I will be talking to professionals. However, I want to know this stuff before I talked to them. The HR people use to be company employee but they were outsourced eons ago. I suspect they will know what they are talking about but I will be the one paying the piper if I get the wrong information. At this point Medicare is not possible but I do what to plan things so we don't pay more than we have too for Medicare coverage.

 

[gsganzer]

I was $1700/mo. for a BCBS family of 4. I swapped to a plan on the healthcare exchange last year for $1100/mo. It's interesting that many practices won't accept plans from the healthcare exchange. I'm still looking for a better option.

Don't even get me started on our broken healthcare system. I'll be considering political candidates that intend to fix the problem, rather than continue to kick the can down the road.

 

[dmccarty]

I was $1700/mo. for a BCBS family of 4. I swapped to a plan on the healthcare exchange last year for $1100/mo. It's interesting that many practices won't accept plans from the healthcare exchange. I'm still looking for a better option.

Don't even get me started on our broken healthcare system. I'll be considering political candidates that intend to fix the problem, rather than continue to kick the can down the road.

Yeah, making sure one's doctors will take your insurance is another issue to deal with when picking a provider. Looking at the ObamaCare plans in our area, I did not even look at one insurance company because I have heard so many problems with them being accepted by the providers.

The US system is messed up that is for sure but at least it is not like the health care systems in Ireland and the UK. Prior to the pandemic Ireland had a 12-18 month waiting period for "elective" surgeries. After the pandemic it was up to 18-24 months. The UK was about six month behind Ireland. People are treated and left in gurneys in the halls because they do not have enough beds. Pay for doctors and nurses is not good so they go to other countries to live and work which lowers the quality of care.

The first step in the US to fix this mess is to stop giving businesses a tax break for providing health care and to give the money the company is paying for health care to the employee. If people knew how much they were REALLY paying for health care, it would be far more difficult for the politicians to let this mess continue.

 

[ericm979]

The UK's system used to be good but in the last couple decades the politicians have been trying to kill it by underfunding it.

The US could start by beefing up oversight of insurance companies and banning PBMs. They're just a middleman there to siphon off money. With three dominant insurance companies that are also PBMs and own the big pharmacy chains, the free market is only an illusion in the retail drug industry. Pretty much every other segment of the medical industry has the same problem.

 

[gsganzer]

The US system is messed up that is for sure but at least it is not like the health care systems in Ireland and the UK. Prior to the pandemic Ireland had a 12-18 month waiting period for "elective" surgeries. After the pandemic it was up to 18-24 months. The UK was about six month behind Ireland. People are treated and left in gurneys in the halls because they do not have enough beds. Pay for doctors and nurses is not good so they go to other countries to live and work which lowers the quality of care.

The first step in the US to fix this mess is to stop giving businesses a tax break for providing health care and to give the money the company is paying for health care to the employee. If people knew how much they were REALLY paying for health care, it would be far more difficult for the politicians to let this mess continue.

That's the scare tactics that the politicians and the healthcare industry lobbyists use to keep the status quo of a broken system. "Look at how messed up country X's system is!" How about looking at the other dozen or so that work well?

I agree completely on the issues of how we currently pay for healthcare. There's virtually zero visibility of actual costs for the end user. Obviously, there are many, many, many more contributing factors to our high costs that also need addressed.

 

[dmccarty]

That's the scare tactics that the politicians and the healthcare industry lobbyists use to keep the status quo of a broken system. "Look at how messed up country X's system is!" How about looking at the other dozen or so that work well?
...

In the US, I always hear people using the UK health system, NHS, as an example of a well run system and what the US should emulate. We should NOT emulate the NHS at all.

 

[dmccarty]

The UK's system used to be good but in the last couple decades the politicians have been trying to kill it by underfunding it.

The US could start by beefing up oversight of insurance companies and banning PBMs. They're just a middleman there to siphon off money. With three dominant insurance companies that are also PBMs and own the big pharmacy chains, the free market is only an illusion in the retail drug industry. Pretty much every other segment of the medical industry has the same problem.

Yep, and the number of providers has gotten worse due to mergers which I think were done in some ways to deal with the cost of regulation and administration. My area has gone from five hospital systems to three spread across three counties. Now, there is only one hospital system in each county, where as there used to be two in two of the counties.

 

[wilso]

I haven't retired but I noticed that COBRA is expensive. Some friends have opted for Obama Care, which can be more affordable depending on your income. Others just go without coverage, but that’s risky. A lot of planning is required before retiring early. I also reached out to enhance health customer service recently, and they provided great guidance on different health plan options. I should say, it's good to have resources when navigating this transition.

 

[CloverKnollFarms]

I tried to get Affordable Care Act insurance. However, since I match my income to my spending in retirement, I didn't earn enough to qualify for that either. So they forced me into Medicaid.

I would have paid, but they said no.

 

[gsganzer]

I pay $1100/mo on the market place. However, I have some inherited IRA disbursements in the coming years that will make it become a roller coaster ride, trying to keep up with the discounts. The bottom line is the ACA plans are kind of crappy too. Many places won't take them and then you just get nickel and dimed with additional payments from the doctor.

I'm likely to go back to just finding coverage outside of the ACA. I was paying $1700/mo (family of 4) before I swapped.

 

[dmccarty]

I pay $1100/mo on the market place. However, I have some inherited IRA disbursements in the coming years that will make it become a roller coaster ride, trying to keep up with the discounts. The bottom line is the ACA plans are kind of crappy too. Many places won't take them and then you just get nickel and dimed with additional payments from the doctor.

I'm likely to go back to just finding coverage outside of the ACA. I was paying $1700/mo (family of 4) before I swapped.

From what I was reading, certain insurance companies were to be avoided like the plague, an ACA plan could be a problem, but at least in my state, it was the company to avoid. Maybe other companies ACA plans had problems but I was really picking up on avoiding some companies.

I figured if we went down the ACA route, then I would call our current service providers and get their opinion.

We have a high deductible plan now so we have to pay for some health care but we are covered for the major, financial destroying illnesses, which is really my big concern. Having said that, we have had family members who suffered through cancer. One died from the cancer but held it off for years, but was only existing not living. The other "survived" the cancer but the destruction of mind and body caused by the pain, chemo, radiation and surgery was extensive. They two really only existed. The wife is adamant she won't suffer through cancer treatment. I am pretty sure I won't either. Maybe if the cancer and treatment is not so bad.

Of course there are other illnesses that can be expensive but hopefully with proper diet and exercise, those can be avoided. It really is all about risk management, and to some extent, a roll of the dice.

 

[CloverKnollFarms]

The ACA plans, at least in Indiana, tell you who takes them, and who does not. They also included customer reviews of each plan and carrier. So one should never be surprised about who takes them.

I just needed catastrophic coverage. I don't need insurance to pay for every visit, and we don't have prescriptions. Most dental plans cost more than the care they cover.

But, we were deemed too poor to pay $100/mo for ACA coverage. Since we don't have to take disbursements, we just earn what we must, and sit on our retirement funds. Being completely debt free, makes our required income awfully low.

 

[ericm979]

The ACA plans, at least in Indiana, tell you who takes them, and who does not. They also included customer reviews of each plan and carrier. So one should never be surprised about who takes them.

"should", but here's some of the things we have seen personally:

Some insurers play games where they will cover Dr X at office A but not if they see you at their other office B. If you don't check you only find out when you get the bill. So you have to check every provider at every office. The doctor's insurance claim person was surprised at that one, said it's new to her too.

They remove providers from their list often, and there's usually no notice. Except when you get the bill. It may happen in the middle of, say, cancer treatment.

Or a new one on us, retroactively denying things they approved and paid for years ago. That one was an employer plan. The time period covers most of my wife's two cancers and the amount is heart stopping. We're hoping we have that one beat but won't know for a while.

My wife's been having nightmares lately, about insurance. But the reality is a nightmare.

 

[part-time-Farmer-NC]

That's scary and sounds like it could be defeated in court. Unfortunately it could take years. I think they count on that as well, hoping people will give up the fight and cost of the fight...

Would that be a battle for the insurance commissioner in your state?

 

[dmccarty]

That's scary and sounds like it could be defeated in court. Unfortunately it could take years. I think they count on that as well, hoping people will give up the fight and cost of the fight...

Would that be a battle for the insurance commissioner in your state?

Yes, I think a talk to the insurance commissioner would be helpful. Decades ago, after we had a few serious hurricanes blow through, an insurance company canceled a coworkers house coverage. I suggested he talk to the insurance commission and his coverage was reinstated. He had had no claims, not is a flood zone, etc. They just wanted to cancel for some reason.

We talked with the NC Insurance commission and they have been very helpful. Once you get to the right person.