Medicare Experience

KennyG · Jan 16, 2017

I'm not trying to start a rant here but just retired and have had some interesting experiences with Medicare. I'm wondering if this is typical.

I have a Medicare Supplement plan and a Part D plan from a private insurance company and it's been a very positive experience. They provided very clear information on the options. When I call them I get someone on the phone right away. When there has been some problem, they just fixed it, and sent me something for a confirmatory form for signature.

Medicare itself has been different. The people are very courteous but they can't directly do anything. They can only fill out forms or refer you someone else. The first problem was they set Medicare to start a month early, before I retired. Although the form I filed showed the correct date of retirement, they automatically start the coverage the month after the form is signed. I gather this happens all the time but nothing tells you this. Additional forms have to be filed to appeal the original start date. After a month I'm still waiting to see if this is corrected. My next step will be appealing my "high income" surcharge based on 2015. The website suggests making an appointment when visiting the local office. However, the voice mail system at the local office has no way to reach a real person unless you know their name or phone extension. Fortunately, the first time I went in the wait was less than 45 minutes. It will be interesting to see if that is typical. I'm hoping everything will be on autopilot once I get the signup issues resolved, but it's not encouraging.

Bird · Jan 16, 2017

Of course, I "retired" before I was old enough for Medicare, but when I signed up, and later my wife signed up, I don't remember any problems. My only complaint would be with the cost of the Medicare Supplements we have, and especially the Part D cost when it doesn't even pay for everything.

k0ua · Jan 16, 2017

KennyG said:
I'm not trying to start a rant here but just retired and have had some interesting experiences with Medicare. I'm wondering if this is typical.

I have a Medicare Supplement plan and a Part D plan from a private insurance company and it's been a very positive experience. They provided very clear information on the options. When I call them I get someone on the phone right away. When there has been some problem, they just fixed it, and sent me something for a confirmatory form for signature.

Medicare itself has been different. The people are very courteous but they can't directly do anything. They can only fill out forms or refer you someone else. The first problem was they set Medicare to start a month early, before I retired. Although the form I filed showed the correct date of retirement, they automatically start the coverage the month after the form is signed. I gather this happens all the time but nothing tells you this. Additional forms have to be filed to appeal the original start date. After a month I'm still waiting to see if this is corrected. My next step will be appealing my "high income" surcharge based on 2015. The website suggests making an appointment when visiting the local office. However, the voice mail system at the local office has no way to reach a real person unless you know their name or phone extension. Fortunately, the first time I went in the wait was less than 45 minutes. It will be interesting to see if that is typical. I'm hoping everything will be on autopilot once I get the signup issues resolved, but it's not encouraging.

Kenny normally Medicare starts the 1st of the month that you are eligible. For example if your birthday was Nov 27th your medicare would start on Nov 1st. Unless you birthdate is Nov 1st then it would start on Oct 1st. You are free to apply for Medicare 3 months prior to your birth month, your birth month and 3 months after your birth month. You do not want to wait until your birth month to sign up or the 3 months post birth month, because this will delay your eligibility date. Those first 3 months before your birth month is when you want to sign up.

I am glad to see you have your supplement and Part D all worked out, as that is something you DO NOT want to delay or miss. Especially if you have any kind of Medical conditions. During your initial enrollment you can be near death and the insurance company must take you without questions asked, but after you miss that period than you will have to go thru medical underwriting unless you have a special enrollment period which can be invoked by too many things to list here. There are hundreds more rules...at least!

Yes, the whole Medicare thing is very complicated and many of the rules seem arbitrary and capricious to me, but then again no one asked me.!

By the way all questions can be answered at Medicare.gov,

When will my coverage start? | Medicare.gov

rekees4300 · Jan 16, 2017

KennyG said:
I'm hoping everything will be on autopilot once I get the signup issues resolved, but it's not encouraging.

Yes once the bureaucrats get all your info they will be happy campers and the system will work without intervention.

brown40 · Jan 17, 2017

You have joined up with the single largest health insurer in the world. Where most insurance companies will look at the specific details of their business to earn more customers, improve the member service experience, shore up expenditures, attempt to prevent illnesses, and negotiate rates on medications, DME, and services, Medicare is an insurer that looks at things in broad strokes, and has a captive enrollment regardless of performance.
Federally funded medical insurance initiates many of the ripples that cause prices to go up everywhere when they adjust their fee schedules. Rates for Aetna, BCBS, Humana, etc. are adjusted to follow suit within the calendar year, and ensure the Feds are getting the "best" deal come cost-report season.
More dangerous is changes to State Medicaid funding: generally by law their rate must be "break-even", and is the basement of rates charged. When those rates change, the ripples go everywhere. In some cases, companies are left scrambling to spend money, so they don't have to repay a aggregated lump sum or get their rate reduced and lose it the next year.
Medicare IS the very best health insurance going. Not that they cover the most, or pay the best, but they do pay, and even pay self-imposed penalties to providers if the do not process timely.

GaryM · Jan 17, 2017

I'm 70 and have been retired on Medicare for 6 years. I have an Advantage PPO plan for which I pay about $120 a month. I have a $20 copay for my primary care doctor. I have no supplement plan or anything like that. I'm very happy with my coverage.

My BiL has Medicare with a supplement plan for which he pays almost $800 per quarter. I believe his supplement takes care of his copays, but unless you go to the Dr. several times a month I don't believe he's got a good thing going.

KennyG · Jan 17, 2017

If you are reasonably healthy and don't mind being restricted to a PPO, the Advantage Plans seem to be a better deal than the Supplement Plans. However, my employer subsidizes a Supplemental plan for retirees, so it was a obvious choice for me.

k0ua · Jan 17, 2017

KennyG said:
If you are reasonably healthy and don't mind being restricted to a PPO, the Advantage Plans seem to be a better deal than the Supplement Plans. However, my employer subsidizes a Supplemental plan for retirees, so it was a obvious choice for me.

The key word is "seems". And the qualifier, "if you are healthy" is absolutely true. So if you are healthy, it IS a better deal. So when are you going to be non healthy?. That's the rub. I sell both. And I recommend supplements if you can afford them. AND I make more money selling advantage plans instead of supplements. If you have an advantage plan and you become seriously ill, you need to pay attention to that yearly total out of pocket, because that is what you are going to be paying each year. If you never become seriously ill or never need a surgery or hospital stay, then you are going to come out ahead of the game with an advantage plan. If a person knew when they would die and how sick they would become along the way all of these decisions would be ridiculously simple.

k0ua · Jan 17, 2017

GaryM said:
I'm 70 and have been retired on Medicare for 6 years. I have an Advantage PPO plan for which I pay about $120 a month. I have a $20 copay for my primary care doctor. I have no supplement plan or anything like that. I'm very happy with my coverage.

My BiL has Medicare with a supplement plan for which he pays almost $800 per quarter. I believe his supplement takes care of his copays, but unless you go to the Dr. several times a month I don't believe he's got a good thing going.

That seems like a very high monthly premium for an advantage plan. What is your total yearly out of pocket, and what is your daily hospital stay expenses. Many advantage plans range from $0 to around $36 per month. Our most popular one is the $0 monthly premium as you would imagine. For a male at 65 in Missouri in his initial enrollment period a G plan is $147.75 from one large A rated carrier. This pays everything but your part B annual deductible of $183.00