Some Medicare info for those who are nearing Medicare recipient age

In talking to several friends who are a year or two away from Medicare,  I'm discovering a surprising lack of knowledge about how it works.  So if you're one of the knowledgable ones just disregard this thread.  This is for the ones who aren't clear on it.

When you enroll in Medicare you enroll in what's called Medicare Part B.
Medicare Part B pays only 80% of your medical bills.

So unless you want to have to cough up the other 20%,  you will want to supplement Medicare with something else to cover that other 20%.

You have two options.

1.  A medicare supplement policy,  also called a "Medigap" policy.  That's a private insurance policy purchased from the private insurance companies (Blue Cross,  Humana,  etc).  
The premium amount generally runs from about $100/month to over $200/month depending on the size of your copays and the extent of the coverage.

2.  Medicare Advantage.  This is an alternative to being enrolled in Medicare.  In other words,  it takes the place of Medicare.  You won't even use a Medicare card.  Instead you will present your Medicare Advantage card.
With Medicare Advantage,  the government gives a lump sum per person (about $10,000 annually)  to the insurance company who sells you your policy.  And then the insurance company has to provide medicare like coverage and still make a profit.
Most Medicare Advantage plans are PPO's.  But it's not a disadvantage (excuse the pun) in our area because the Blue Cross Medicare Advantage plan includes all the local hospitals and 95% of the local doctors in the PPO network.
Most Medicare Advantage plans have either zero premiums you'll have to pay or premiums of no more than $20-30/month.

The main difference between having  a Medicare Advantage policy and a Medigap policy is the Medicare Advantage policy comes with copays and the Medigap policy does not.  BUT to eliminate the copays will mean higher montly premiums with the Medigap.

Between October and November of every year,  you will have an opportunity to choose between Medicare Advantage and Medigap.  And if you don't like your choice you can change to the other during the next year's "enrollment period" between October and November.
So if you make a choice you're not happy with,   you're only stuck with it for a year and then you can change it.

Any questions?

So this means that even after paying taxes all these years to a Medicare fund those slimy insurance companies still weaseled a way to squeeze more from us...yea figures..fear factor.

TEOTWAWKI wrote:So this means that even after paying taxes all these years to a Medicare fund those slimy insurance companies still weaseled a way to squeeze more from us...yea figures..fear factor.

Yes that is true for the 20% of your medical bills not covered by Medicare part B (essentially the first 80%).
The private insurance companies are still the go-between on that last 20%.

"Medicare Advantage" first became an option in 1997.  The reasoning behind it was that the private for-profit insurance companies could provide health care more efficiently than the government bureaucracy can.  SO,  it took the form of the government paying one lump sum (per geezer) every year to the private sector and then letting the private sector deliver the health care.  It was thought that by doing so the insurance companies could spend that money more efficiently than the government could.

Although I should qualify that last post.  The fact is that the government has mandated what the Medicare Advantage benefits and coverages and prices will be.  In other words,  regardless of which insurance company is selling the Advantage policy,  they are all complying with the same government mandate and regulations.  So, in other words,  every Advantage policy by government dictate delivers essentially the same coverages and services regardless of which insurance company it is you're buying it from.

About the only real difference between the different insurance companies' Advantage policies is the makeup of that policy's PPO. Different Advantage PPO's have different hospitals and doctors in their networks.
But as I said earlier, in our area the Blue Cross version includes about all of the local providers in the network anyway so it really doesn't matter.

Bob wrote:In talking to several friends who are a year or two away from Medicare,  I'm discovering a surprising lack of knowledge about how it works.  So if you're one of the knowledgable ones just disregard this thread.  This is for the ones who aren't clear on it.

When you enroll in Medicare you enroll in what's called Medicare Part B.
Medicare Part B pays only 80% of your medical bills.

So unless you want to have to cough up the other 20%,  you will want to supplement Medicare with something else to cover that other 20%.

You have two options.

1.  A medicare supplement policy,  also called a "Medigap" policy.  That's a private insurance policy purchased from the private insurance companies (Blue Cross,  Humana,  etc).  
The premium amount generally runs from about $100/month to over $200/month depending on the size of your copays and the extent of the coverage.

2.  Medicare Advantage.  This is an alternative to being enrolled in Medicare.  In other words,  it takes the place of Medicare.  You won't even use a Medicare card.  Instead you will present your Medicare Advantage card.
With Medicare Advantage,  the government gives a lump sum per person (about $10,000 annually)  to the insurance company who sells you your policy.  And then the insurance company has to provide medicare like coverage and still make a profit.
Most Medicare Advantage plans are PPO's.  But it's not a disadvantage (excuse the pun) in our area because the Blue Cross Medicare Advantage plan includes all the local hospitals and 95% of the local doctors in the PPO network.
Most Medicare Advantage plans have either zero premiums you'll have to pay or premiums of no more than $20-30/month.

The main difference between having  a Medicare Advantage policy and a Medigap policy is the Medicare Advantage policy comes with copays and the Medigap policy does not.  BUT to eliminate the copays will mean higher montly premiums with the Medigap.

Between October and November of every year,  you will have an opportunity to choose between Medicare Advantage and Medigap.  And if you don't like your choice you can change to the other during the next year's "enrollment period" between October and November.
So if you make a choice you're not happy with,   you're only stuck with it for a year and then you can change it.

Any questions?

Damn with a little more training I could hire you. One thing there is no annual election period for Medicare Supplements (medigap) you can do anytime. The AEP for Med Advantage is Oct 15 - Dec 7th. But otherwise you have this shit down better than a lot of agents I know.

Informative thread. Thanks!

doubtingthomas wrote:

Damn with a little more training I could hire you. One thing there is no annual election period for Medicare Supplements (medigap) you can do anytime. The AEP for Med Advantage is Oct 15 - Dec 7th. But otherwise you have this shit down better than a lot of agents I know.

I am available for a paid assistant position and I'll work cheap. lol

p.s.  can you take a guess what an obamacare policy is going to cost me for the month of january?  And i mean just a ballpark figure?

Also here's another question for you,  TG.
I have a friend whose 65th birthday is in July of next year.  He asked me a question I have no answer for.  
He has no health insurance now.  He is wanting to know if he will have to pay a fine/fee if he chooses not to buy an Obamacare policy for the coming year and instead just waits to get on Medicare in July.
How does that work?  Who exactly will be required to pay the fine/fee when they choose not to buy obamacare?

[quote="Bob"]

doubtingthomas wrote:

Damn with a little more training I could hire you. One thing there is no annual election period for Medicare Supplements (medigap) you can do anytime. The AEP for Med Advantage is Oct 15 - Dec 7th. But otherwise you have this shit down better than a lot of agents I know.

I am available for a paid assistant position and I'll work cheap. lol

p.s.  can you take a guess what an obamacare policy is going to cost me for the month of january?  And i mean just a ballpark figure?[/quote

No guessing for one month yet. I know you can't pay more than 3 times what a younger person has to pay and I don't know those figures yet. But if you have smoked I believe 4 months leading up to when you sign up and answer it yes, you will probably be charged 50% more than a non smoker.

Bob wrote:Also here's another question for you,  TG.
I have a friend whose 65th birthday is in July of next year.  He asked me a question I have no answer for.  
He has no health insurance now.  He is wanting to know if he will have to pay a fine/fee if he chooses not to buy an Obamacare policy for the coming year and instead just waits to get on Medicare in July.
How does that work?  Who exactly will be required to pay the fine/fee when they choose not to buy obamacare?

Yes he will have to pay a penalty in 2015 that would be deducted from any refund. If he is single for 2014 the penalty is $95.00 or 1% of his income for 6 months not the whole year. I call it obamacare for lack of words, it's insurance company plans set forth by the obama law lol, so it's obamacare. lol:P You'll have to pay one month because I don't believe mega is considered minimum essential coverage under the law. But if it is not don't be surprised if pretty soon you receive a letter that they are canceling it on Jan 1. In either scenario I wouldn't worry about it.

Bob wrote:Also here's another question for you,  TG.
I have a friend whose 65th birthday is in July of next year.  He asked me a question I have no answer for.  
He has no health insurance now.  He is wanting to know if he will have to pay a fine/fee if he chooses not to buy an Obamacare policy for the coming year and instead just waits to get on Medicare in July.
How does that work?  Who exactly will be required to pay the fine/fee when they choose not to buy obamacare?

Everyone will pay the penalty that is not already on a plan with minimum essential coverage. What is bad is if you are enrolled with VA you cannot get a health plan. I know several that are enrolled with small disabilities that never use the VA and want a plan, but they would have to disenroll with the VA, but not lose their monthly VA check, also anyone else already on any government health insurance won't have to pay or can enroll on an individual plan, tricare, medicare, etc.

TEOTWAWKI wrote:So this means that even after paying taxes all these years to a Medicare fund those slimy insurance companies still weaseled a way to squeeze more from us...yea figures..fear factor.

Actually even though it started in 97 under Clinton it really went no where until Bush signed the Medicare act of 2003. They figured if they let private insurance do it the savings would keep the Medicare fund a float, but instead has cost the government 13% more than if everyone had just stayed on original Medicare. This was the government's idea.

I hope everyone else reading this thread will be able to appreciate your last few posts.

Dudes (and dudettes), I have never had the motivation to endorse anything in the 20 years I've been participating in social media. But I make an exception just this one time. I can now recommend an insurance agent for you fellow geezers needing to buy backup insurance for Medicare. You will get the best person in Pensacola and I guarantee it and I don't get paid a dime for saying it. Fuck Fred Thompson and the Fonz who are getting paid millions to pimp for somebody. I would rather be able to do it because I fucking believe it.
So PM me if you want to know how to contact him.

By the way, for anyone who's followed my crazy story with insurance and medical bills, and might have read the post in another thread that I was kinda hoping I could get lawyers to go after that Mega Life and Health which has fucked me ten different ways to Sunday for 30 years and still has it's dick up my ass...

I talked to the lawyer in California today who is the Mike Papantonio of health insurance fraud.

Bottom line: If I had got the bad Lymphoma and rung up another $40-50k in bills before Medicare takes over, I woulda been able to do a lawsuit.
But now that I only have the $15-20k in melanoma bills, the lawyers aint got a big enough prize to get interested.

doubtingthomas wrote:

Bob wrote:

doubtingthomas wrote:

Damn with a little more training I could hire you. One thing there is no annual election period for Medicare Supplements (medigap) you can do anytime. The AEP for Med Advantage is Oct 15 - Dec 7th. But otherwise you have this shit down better than a lot of agents I know.

I am available for a paid assistant position and I'll work cheap. lol

p.s.  can you take a guess what an obamacare policy is going to cost me for the month of january?  And i mean just a ballpark figure?[/quote

No guessing for one month yet. I know you can't pay more than 3 times what a younger person has to pay and I don't know those figures yet. But if you have smoked I believe 4 months leading up to when you sign up and answer it yes, you will probably be charged 50% more than a non smoker.

Since government stupidly mandated that insurance companies cannot charge their most expensive customers more than three times a younger person, the younger person is going to get screwed and not even kissed. Since they won't do that, they will pay the fine which puts ObamaCare even deeper in the hole.

I had an HMO I was very happy with for many years before reaching the age of Medicare. I opted for Medicare Advantage and the switch was seamless. I just don't write a check to them each month. Same doctor, great service.

Medicare already has a massive unfunded liability plus the unfunded liability for Prescription drugs. This will simply pile more and more debt on top of debt. We don't have the money, the rich don't have the money, the insurance companies don't have the money and the young don't have the money.

Markle wrote: the younger person is going to get screwed and not even kissed.  

I've been predicting for some time that young Americans are like the "sleeping giant who is about to wake up" which Admiral Yamamoto referred to following Pearl Harbor. And when they wake up, they're going to be looking out for their generation, not ours.

Well here is that younger generation starting to wake up. It comes in the form of an Evan Feinberg who is one of the spokespeople for young America.

Don't get distracted by this being the "obamamania media" as Hannity calls it. The beginning of this report is just a background story so you can skip that if you wish and start watching the interview beginning at the 2:42 mark on the time counter. Pay particular attention to Feinberg because he has the same perspective on obamacare that you do.

http://www.pbs.org/newshour/bb/health/july-dec13/health_07-23.html

Yup I think the Jewish kid nailed it. Pay the damned fine and find their own insurance. I would be livid if I were a young person having to foot the bill for us old farts.

Thanks Bob.

In the scenario of the 21 yr old get going to college and working pt: I doubt he's making anywhere close to $18,000 a year, but if his parents are not dead and he is being claimed on their taxes because he is in college he would almost have to go on their health insurance, because in this scenario of his parents claiming him he could not get a subsidy if purchased on his own. Didn't read the whole article but anyone under 30, american indians and anyone that can prove real financial hardship can buy a catastrophic plan. But true, for 2014 the penalty will be cheaper than purchasing health insurance.

I had a kid yesterday 25 that his premium is right now on an individual plan he purchased a few years ago $225 a month and a grandfathered plan, which doesn't have to be changed. He works ft and only make's $18,000 a yr. I told him he could keep that it and explained grandfathered, I also told him he could change it and showed him one for $134 and explained that if he changed it was no longer grandfathered and this new one would be changed next year. Then told him to come back in Octboer and we'd figure how much subsidy he would receive. Well he had originally come in to pay his bill and I said think about it a couple of day, if he wanted to change now to save almost $100 a month. He left with the intention of probably changing, I heard him back in office an hour later. He called his dad and his dad told him to pay the premium on the plan he had and keep it. I asked him if his dad was helping him pay and he said no. So maybe there will be more responsible young people like him, but I doubt it. Oh he had only used the plan once for a cold in the past 4 years.

doubtingthomas wrote:Thanks Bob.

In the scenario of the 21 yr old get going to college and working pt: I doubt he's making anywhere close to $18,000 a year, but if his parents are not dead and he is being claimed on their taxes because he is in college he would almost have to go on their health insurance, because in this scenario of his parents claiming him he could not get a subsidy if purchased on his own. Didn't read the whole article but anyone under 30, american indians and anyone that can prove real financial hardship can buy a catastrophic plan. But true, for 2014 the penalty will be cheaper than purchasing health insurance.

I had a kid yesterday 25 that his premium is right now on an individual plan he purchased a few years ago $225 a month and a grandfathered plan, which doesn't have to be changed. He works ft and only make's $18,000 a yr. I told him he could keep that it and explained grandfathered, I also told him he could change it and showed him one for $134 and explained that if he changed it was no longer grandfathered and this new one would be changed next year. Then told him to come back in Octboer and we'd figure how much subsidy he would receive. Well he had originally come in to pay his bill and I said think about it a couple of day, if he wanted to change now to save almost $100 a month. He left with the intention of probably changing, I heard him back in office an hour later. He called his dad and his dad told him to pay the premium on the plan he had and keep it. I asked him if his dad was helping him pay and he said no. So maybe there will be more responsible young people like him, but I doubt it.  Oh he had only used the plan once for a cold in the past 4 years.

Too bad he has a dumb Dad. Dad is probably a republican.

Too bad he has a dumb Dad. Dad is probably a republican.



 

I have my doubts his dad was a republican, dreams, considering it's Pensacola and his racial makeup. But his dad may be smart. Yes, this kid with his income could probably get a pretty good plan for very low premiums with a subsidy, but the plan he is currently on is/was the best plan. If people are going to allowed after 2014 to keep a grandfathered plan and they are in perfectly good health that is the way to go. It is expected by actuary's that only the healthy will stay on those plans, less claims and less rate increases. Only time will tell.

Thanks for sharing this. This is very informative thread. I think I am one of the guilty individuals whose knowledge about medicare coverage is very few.

doubtingthomas wrote:I have my doubts his dad was a republican, dreams, considering it's Pensacola and his racial makeup. But his dad may be smart. Yes, this kid with his income could probably get a pretty good plan for very low premiums with a subsidy, but the plan he is currently on is/was the best plan. If people are going to allowed after 2014 to keep a grandfathered plan and they are in perfectly good health that is the way to go. It is expected by actuary's that only the healthy will stay on those plans, less claims and less rate increases.  Only time will tell.

The subsidy would have paid the whole plan premium. How do you figure paying $225 a month on an $18000 salary vs. free when you hardly use it is a good choice?

What make's you think he can get it for free? There is a possibility if he chose the worse plan in the exchange he could get it for free, but not one like he has with the same benefits. Now it is very possible he could get a decent plan and have to pay less than $100 a month out of his own pocket.

If you're trying to figure things out by the online calculators it may not necessarily work. The subsidy is figured once it goes thru IRS, HHS, SS, DHS, DOL, HBO, MM, SOB, PBS and then signed off by Obama and Michelle.