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Post by lesserknownpea on May 17, 2022 7:12:46 GMT
Well I’ll be turning 65 soon, and that makes me the most sought after princess at the ball.
every day I get materials in the mail purporting to help me through this process. I qualify for extra help, whatever that means, and was sent a form to apply for drug help, and it seems there’s all the letters of the alphabet to figure out, and the charts to “help” me make my eyes cross and my brain shut off.
and if I don’t figure this out right, I won’t get to continue with my primary, who I love, but I also should be on original Medicare because they cover the clinic and hospital that I need for my particular heart situation.
what helped you get all signed up and sure you chose wisely?
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Post by peasapie on May 17, 2022 10:55:45 GMT
There are lots of insurance agencies that help folks free with this process. They seem to get some sort of compensation directly from Medicare,because they charged me nothing. They go through the list of meds you take and also which doctors you use and tell you the best plans for you.
If you qualify for extra help, we’re you previously receiving Medicaid?
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Post by mikklynn on May 17, 2022 10:58:30 GMT
I used a broker called Breitendeldt Group. There are plenty of brokers out there. They do not charge you a fee. They will ask you for access to your medical records and medications, so they can determine which supplemental policy is the best fit for you.
They also help with regular medical insurance, too. DH was on Medicare, I am not until next year.
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Post by lisae on May 17, 2022 11:43:29 GMT
I think your big choice is whether to choose a traditional Medicare supplement or a Medicare Advantage plan. For DH, we choose a traditional supplement. It's the more expensive option but his supplement pays for everything. You can no longer get his specific plan and today he would have to have a deductible but after that would have full coverage. The only bill we have ever had even after surgeries and procedures was for about $80 after his last hip replacement. We could never get a detailed bill from the hospital so we finally just paid it.
I have a cousin who tried a Medicare Advantage plan but had so much trouble with procedures being denied that he changed over to a traditional supplement.
For Part D prescription coverage, Medicare.gov has a calculator where you put in your medications and preferred pharmacies and they present you with the plans in order by cost. This changes every year so it is wise to revisit at open enrollment in the fall to be sure your plan hasn't shot up in cost. The drug plan is easy to change. The medicare supplement plan man not be so easy so choose that one wisely.
I agree with others, on the medical plan go to an insurance agent to discuss your options.
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Post by karenlou on May 17, 2022 11:51:12 GMT
OMG, I feel your pain.....This whole medicare/retirement thing is not for the faint of heart. I am STILL getting things in the mail 2 years later. My only advice to you is be sure to sign up for a prescription drug plan...I did not as I wasn't taking any prescription drugs....Well, one gets penalized for not signing up whether or not you need it!!!! It was all so confusing.... I totally agree with lisae, I chose a supplement, and pay for it, but WELL worth the $$ My DH chose the latter and I am not happy about his choice. Good Luck to you as you move through this process!!!
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Post by revirdsuba99 on May 17, 2022 12:09:48 GMT
karenlouTell me about it!! Retired 10 years and still get piles of Medicare promotions. Sorry you got jammed on the Drug plan.. I know someone that is paying Medicare penalties EVERY year!
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QueenoftheSloths
Drama Llama
Member Since January 2004, 2,698 forum posts PeaNut Number: 122614 PeaBoard Title: StuckOnPeas
Posts: 5,955
Jun 26, 2014 0:29:24 GMT
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Post by QueenoftheSloths on May 17, 2022 13:23:47 GMT
I would strongly urge you to go to an insurance broker for professional help. As stated above, there is no charge to you and with the huge number of options and all the terminology, it's way too easy to make a costly mistake if you are on your own.
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Post by allison1954 on May 17, 2022 13:56:24 GMT
Make sure your Dr takes the supplement you choose.
Just because they take BC/BS for example doesn’t mean they take a specific supplant
I am in FL and my GP takes many but not all.
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Post by **GypsyGirl** on May 17, 2022 15:00:24 GMT
Make sure your Dr takes the supplement you choose. Just because they take BC/BS for example doesn’t mean they take a specific supplant Also verify with the doctor's office that they are accepting new patients with the plan you are looking at. A friend went on Medicare in January and really did her homework last fall when getting signed up. After her Medicare coverage kicked in this year, the medical system she was in said they were no longer accepting patients that plan when she tried to schedule appointments. It seems they will continue to see the previously signed up patients, but not accepting new ones on the same plan. So just because their website states they take a plan, verify that they will accept a new patient with that plan. After almost 20 years, she is out looking for new doctors who do take her plan.
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Post by librarylady on May 17, 2022 15:08:14 GMT
It is further complicated because each state has different plans and rules and guidelines.
BEWARE, BEWARE OF MEDICARE ADVANTAGE PLANS!!! Many physicians will not accept the plan.
DH is 9 years older than I am and we waded through everything about 20 years ago. Finally we picked BCBS. It turned out to be a good plan. He had prostate cancer and the two insurance plans (Medicare and BCBS) paid everything--including his 50+ radiation treatments.
I used the teacher insurance supplement when I reached the magic age. 3 years ago the teacher retirement went to Medicare Advantage. I was in fear, but so far, all our physicians will accept it.
(I have no idea if this is true or not) One office worker told me the reason many physicians won't accept Medicare Advantage is that most plans make the physician wait very long times to be paid. In Texas, the Advantage plan is paid promptly so that has affected who will accept it in a positive way.
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Post by revirdsuba99 on May 17, 2022 15:18:46 GMT
Whatever you decide, if you have not choosen your plan by 65, sign up for original Medicare with drug plan!!! You MUST have something immediately or there are penalties
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Post by jcm28 on May 17, 2022 15:24:02 GMT
Our PCP actually sent us a letter basically stated that if we chose a Medicare Advantage Plan, they wouldn’t see us any more.
Janet
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pinklady
Drama Llama
Posts: 5,513
Nov 14, 2016 23:47:03 GMT
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Post by pinklady on May 17, 2022 15:44:01 GMT
One word of advice. If you use a broker/agent, make sure they WORK FOR YOU and truly help you with answering questions and giving you options before during and after enrollment. These agents make $800 commission for your initial enrollment into a medicare plan and $400 each year you stay on your plan. Yes, everything is free for you as the enrollee but they do get paid A LOT for your enrollment so they WORK FOR YOU!
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Post by katlady on May 17, 2022 16:09:59 GMT
I am still a few years away, but I am curious about one thing. With my Company, retirees still get group insurance. When we turn 65, we have to sign up for Medicare and then my Company offers a supplemental group insurance. If we have that supplement, do we still need supplemental insurance through Medicare? This all sounds so confusing reading the posts. Not looking forward to having to go through all this paperwork.
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Post by ntsf on May 17, 2022 16:15:54 GMT
katlady, you should call hr and ask them about it.
I signed up for aarp united healthcare, as I had used united in the past with good results. I had to change my meds plan to a more expensive one after the cheap one I chose would not cover my basic asthma medicine. if your income is high, you pay more for the supplemental and meds plan.
there are lots of people to help you choose for your situation.
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Post by airforcemomof1 on May 17, 2022 16:37:41 GMT
Our certified elder law attorney calls advantage plans DISADVANTAGE plans! I have regular Medicare and a supplement. He warns me to never change to an advantage plan. I also pay a penalty because I did not take a drug plan when it was first available to me because I did not take any medicine at that time.
My husband suffered a traumatic brain injury in 2016. He has been in a nursing home ever since and is in and out of hospital quite often. When his insurance thru his employer changed to a Humana advantage plan it has been nothing but a headache. They constantly deny services and claims that were always paid in full when he had Medicare and a supplement. Our attorney, hospital and the nursing home say stay away from Humana and I couldn’t agree more!
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Post by revirdsuba99 on May 17, 2022 16:42:45 GMT
I am still a few years away, but I am curious about one thing. With my Company, retirees still get group insurance. When we turn 65, we have to sign up for Medicare and then my Company offers a supplemental group insurance. If we have that supplement, do we still need supplemental insurance through Medicare? This all sounds so confusing reading the posts. Not looking forward to having to go through all this paperwork. Retired. I have employer paid medical. I have regular Medicare and am reimbursed for the monthly payments by my former employer, they also carry, pay for, my secondary coverage which is BCBS. I am also on the drug plan. I get papers every year to keep for proof of ongoing coverage. If I give up any part, I cannot go back on to the employer covered plans. I do not have hearing aids or routine eye exams etc. I do see an opthalmologist, visits covered. I had cataract surgery while still employed, but still get medical eye checks.
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pinklady
Drama Llama
Posts: 5,513
Nov 14, 2016 23:47:03 GMT
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Post by pinklady on May 17, 2022 16:43:24 GMT
Our attorney, hospital and the nursing home say stay away from Humana and I couldn’t agree more! I would tend to agree with this. They are just robots who don't think. I'd stay away from Blue Shield, LA Care, Clover, Health Net, WellCare and Anthem as well. These companies are run by incompetent people who don't know their ass from a hole in the ground.
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Post by librarylady on May 17, 2022 16:58:06 GMT
I am still a few years away, but I am curious about one thing. With my Company, retirees still get group insurance. When we turn 65, we have to sign up for Medicare and then my Company offers a supplemental group insurance. If we have that supplement, do we still need supplemental insurance through Medicare? This all sounds so confusing reading the posts. Not looking forward to having to go through all this paperwork. Only one supplemental policy needed. You would need Medicare and your retirement policy through your company. Usually those are comprehensive and cover your Rx as well as other medical costs.
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Post by lesserknownpea on May 17, 2022 20:14:56 GMT
Thank you to everyone for all the tips. I will be staying away from the advantage plans!
This affirms how important it is that I get this right.
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Post by revirdsuba99 on May 17, 2022 20:17:52 GMT
Thank you to everyone for all the tips. I will be staying away from the advantage plans! This affirms how important it is that I get this right. Thing is that you can go with original Medicare IF you need the time to do more research. I do think you also need drug coverage, basic at least to start.
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moodyblue
Drama Llama
Posts: 6,173
Location: Western Illinois
Site Supporter
Jun 26, 2014 21:07:23 GMT
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Post by moodyblue on May 17, 2022 21:36:04 GMT
I watched a webinar on the basics of Medicare, given by insurance brokers. I understood more about the basics after that. I was also recommended a great local broker who many people I know found to be very helpful and knowledgable. I ended up not seeing him since I was choosing between two plans offered by the state for retired teachers.
There are, I think, huge differences between states as far as Medicare Advantage goes. My retired teacher options (if I wanted to stick with the subsidized-by-the-state choices) were only for Medicare Advantage choices, and so far, it has been pretty decent. The plans in my area are widely accepted, and they seem to be paying claims pretty quickly. It is more difficult to go back to traditional Medicare from an Advantage Plan than it is to do the reverse.
Do you have someone you know locally who has gone through the process recently? That can be a huge help.
I also recommend starting as soon as you are eligible. I found I could only go so far online because I had to file under my late husband's account as I did not pay into the system as a teacher. I had to complete the process through a phone call and it was many weeks before I could do that; that was while Social Security offices were still mostly closed - it might be different and faster now.
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Post by lindamh on May 18, 2022 0:08:50 GMT
My husband is turning 65 this year and I'll be following next year. I'll add 2 things we've learned to the wealth of information above. 1. Check out Boomer Benefits at boomerbenefits.com They are a broker that represents a large number of companies. From what we've learned they have great reviews, they'll work with you to find your best options and they continue to work with you over the years and will help you solve any problems you run across with Medicare - they'll find out why you were turned down for a procedure, they'll check your bills is you think there's a problem, etc. They've also got a Facebook page where they answer all sorts of questions. 2. Find and contact your local SHIIP representative. (Senior Health Insurance Information Program) This is a free service in most, if not all states, that is staffed by trained volunteers who will help you find the best choice for you. They do not represent any particular insurance and they get no reimbursement for helping you so they have no reason to steer you towards any particular company. Good Luck!
PS - we'll be making an appointment with our local SHIIP person to get their perspective and then we'll be getting in touch with Boomer Benefits to make our final choice and sign up with them.
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peaname
Pearl Clutcher
Posts: 3,389
Aug 16, 2014 23:15:53 GMT
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Post by peaname on May 18, 2022 0:36:40 GMT
Please keep a healthy amount of skepticism. Nothing is free and any insurance company that wants to “help” you select a plan is likely getting paid by reducing the cost of your care.
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Post by mollycoddle on May 18, 2022 1:14:14 GMT
I watched a webinar on the basics of Medicare, given by insurance brokers. I understood more about the basics after that. I was also recommended a great local broker who many people I know found to be very helpful and knowledgable. I ended up not seeing him since I was choosing between two plans offered by the state for retired teachers. There are, I think, huge differences between states as far as Medicare Advantage goes. My retired teacher options (if I wanted to stick with the subsidized-by-the-state choices) were only for Medicare Advantage choices, and so far, it has been pretty decent. The plans in my area are widely accepted, and they seem to be paying claims pretty quickly. It is more difficult to go back to traditional Medicare from an Advantage Plan than it is to do the reverse. Do you have someone you know locally who has gone through the process recently? That can be a huge help. I also recommend starting as soon as you are eligible. I found I could only go so far online because I had to file under my late husband's account as I did not pay into the system as a teacher. I had to complete the process through a phone call and it was many weeks before I could do that; that was while Social Security offices were still mostly closed - it might be different and faster now. Same. Our Advantage plan is run by our state teachers’ retirement system, and so far, so good. Do they let you switch from Advantage to Original, or vice versa? I should probably know that, but I don’t.
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Post by Fidget on May 18, 2022 12:19:04 GMT
I too am navigating these muddy waters! Here is what I've learned that has not yet been mentioned in this thread.
In regards to switching from an Advantage plan to a supplemental plan and vice versa, yes you can switch during open enrollment every year.
What you need to know though is that during your initial enrollment period a supplemental plan cannot deny you coverage due to pre-existing conditions, however if you choose an Advantage plan during your initial enrollment and decide the next year to switch to a supplemental plan, you CAN be denied based on pre-existing conditions. You only have that first enrollment opportunity to enroll without any regard to your health history. I have a friend who cannot switch to supplemental because of a diagnosis (neuropathy) and will have to stay with an advantage plan forever.
Your out of pocket with a supplemental plan is $233 every year ( but you do pay a monthly premium - (for me it will be $113.00) and that does not cover pharmacy - I will pay an additional 13.00 per month for pharmacy coverage.
The other thing to remember is that an advantage plan is typically a plan that is based in your community, whereas a straight Medicare with supplemental you will have coverage nation wide. A supplemental plan (by law) has to be accepted anywhere that Medicare is accepted.
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Post by revirdsuba99 on May 18, 2022 14:13:49 GMT
Just remember you MUST sign up for Medicare at 65, regardless what plan/s you choose!! Otherwise there are penalties which go up every day ...
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Post by **GypsyGirl** on May 18, 2022 14:37:44 GMT
Just remember you MUST sign up for Medicare at 65, regardless what plan/s you choose!! As with everything, there are exceptions to that rule. If you are still employed full-time and covered by your employer's health insurance you can delay Medicare and do not have to sign up at 65. Once you quit working (or are no longer covered) you then have an 8 month period to sign up.
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pilcas
Pearl Clutcher
Posts: 2,913
Aug 14, 2015 21:47:17 GMT
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Post by pilcas on May 18, 2022 14:55:54 GMT
I am still a few years away, but I am curious about one thing. With my Company, retirees still get group insurance. When we turn 65, we have to sign up for Medicare and then my Company offers a supplemental group insurance. If we have that supplement, do we still need supplemental insurance through Medicare? This all sounds so confusing reading the posts. Not looking forward to having to go through all this paperwork. Medicare doesn’t offer supplementary insurance. If your company has the supplementary then you are good. Probably you will need drug coverage.
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Post by revirdsuba99 on May 18, 2022 15:06:48 GMT
Just remember you MUST sign up for Medicare at 65, regardless what plan/s you choose!! As with everything, there are exceptions to that rule. If you are still employed full-time and covered by your employer's health insurance you can delay Medicare and do not have to sign up at 65. Once you quit working (or are no longer covered) you then have an 8 month period to sign up. you must sign up, you do not have to use it or pay the premiums.
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