Why does Medicare have to be so danged complicated?

[ShazzieB]

Mr. B recently got laid off from his job (he should have retired a long time ago, but decided to keep on working as long as he felt able, because we needed the money... but that's a whole separate story). The health insurance from his now ex-employer will only cover us till the end of this month, and we have got to get our Medicare ducks in a row by then. We already both have parts A and B, but as we all know, that will only get us so far. We need to add a Medigap/Medicare Supplent plan plus Part D for prescription coverage.

(Before anyone mentions Medicare Advantage, we've already ruled that out. I've read too many posts here at DU about the pitfalls and decided to steer clear.)

So like I said, if I understand correctly, we need Medigap and Part D. But (again, if I understand correctly), we have to get those from a private insurance company (or maybe 2 different companies?) and that's when my brain shuts down. There are so darned many insurance companies and so many different types of plans, and I can't figure out where to start. If we really have to wade through all these websites to figure out what will work best for us, I'm afraid we may end up flipping a coin or something equally random by the time it's all said and done. It all sounds so complicated, and neither of us has the kind of brain that's good at processing this kind of information and keeping it all straight.

I'm extremely leery about talking to any insurance people on the phone while were in this frame of mind. I'm sure they'd all just tell us how great their plan is and try to sell us on it, and that's the last thing we need right now.

I'm curious to hear abut how others have navigated this process, and whether anyone has any pointers to share. Right now, I feel as lost as if I was trying to find a couple of needles in a haystack the size of Mt. Rainier.

[bullimiami]

1. Thanks. Watching because this is me next year.

[ShazzieB]

24. I hope some of these replies help you as much as they're helping me! 😉

Seriously, I'm really glad I posted this. Things are already starting to make more sense.

[Raven123]

2. Go to the government website.

https://www.medicare.gov/

[ShazzieB]

33. Will do.

I've also got the print handbook that they send in the mail every year.

Thanks for the suggestion.

[ShazzieB]

34. Will do.

I've also got the print handbook that they send in the mail every year.

Thanks for the suggestion.

[cbabe]

3. Sounds like you're in Washington state. If so,

help is at hand.

Call SHIBA. They are an excellent service.

https://www.insurance.wa.gov › about-shiba-services

About SHIBA services | Washington state Office of the Insurance ...

Washington state's SHIBA provides free, unbiased and confidential help with Medicare to people of all ages and backgrounds. Our volunteer advisors, located around the state, can help you: Assess your health care coverage needs. Determine your general eligibility for health care coverage programs. Evaluate and compare Medicare plans and programs.

[underpants]

16. Great advice.

[ShazzieB]

25. I'm actually in Illinois, but I'm pretty sure we have something like that here.

Last edited Sat Sep 23, 2023, 11:50 PM - Edit history (2)

I'm adding that to my list of things to look into.

Edited to add: Yes, we have something in Illinois called Senior Health Insurance Program (SHIP), "a free statewide health insurance counseling service for Medicare beneficiaries and their caregivers."

I'm looking at their website right now, and it kooks really helpful!

[emulatorloo]

4. Check with your local social security office, they can talk you through it.

[ShazzieB]

26. Someone my husband knows told him the same thing.

But when he tried calling, they were like, "Uh, no, we don't do that." Weird!

[emulatorloo]

42. I guess call them back and ask them who does do that. They should be able to point you in the right

direction. Fingers crossed!

Edit: I see below someone recs Medicare Marketplace, that is a good suggestion!

[ProfessorGAC]

5. I Looked At The 3 Biggest Providers...

...of supplemental plan in Illinois.
As there was no meaningful difference in price amongst them we went with BCBS for everything, including part D.
We did go through a broker who did plan price comparisons for us and presented them.
The same company also set up an annuity with 40% of our retirement money, so it was one stop shopping for us.
There are LOCAL insurance firms willing to do this and it costs nothing. The insurers pay them a cut for drumming up business. Might greatly simplify things to just let an expert do the details & just make recommendations to you.

[ShazzieB]

27. Thanks for this.

I did know about local brokers but hadn't investigated that yet for some reason. I think my brain was tied up in knots for a while there. These replies are helping to shake things loose, thank goodness!

[Voltaire2]

6. Because insurance lobbies have blocked reform

And improvement, and instead successfully modified the system to steer people into for profit private advantage plans.

But really what we need is universal comprehensive healthcare for everyone.

[MOMFUDSKI]

10. Totally agree.

I always think of the quite deaf widower without a computer struggling to navigate the System. I know my agent stops by these folks’ houses to help them. It shouldn’t have to be this way.

[ShazzieB]

35. I know what you mean.

Sometimes I forget how lucky I am to be somewhat computer savvy and have access to the internet. I don't know I'd ever survive without it.

[ShazzieB]

28. Pretty much what I figured about the insurance companies.

I'll bet they welcome the confusion, because it probably makes it easier for them to sell their Medicare Advantage plans (which I understand are much more profitable for them). I would have probably gone that route myself, if not for some of the posts I've read about it here at DU.

[Silent Type]

7. It is complicated. Main reason is that Congress has to add coverage/programs

on a piecemeal basis, fixing one thing, patching coverage holes, etc. They’ve never done a comprehensive overhead. Doubt they will anytime soon.

MediGap coverage is pretty much the same no matter what company you get, as long as you get the same plan designation. Plan G offers pretty much same coverage no matter what insurance company you use. Plan G also covers the most of deductibles and coinsurance. Therefore, go for cheapest.

Plan D is different. You can see what plans you want based upon medications you take now, or can reasonably expect to take in future.

If it were me, I’d call a few LOCAL insurance brokers who represent many insurance companies. Tell them upfront you don’t want Medicare Advantage. They’ll find options for several MediGap and drug plans.

While I agree MA has disadvantages, it’s all some people can afford. About 50% of Medicare beneficiaries choose it. I’d start out like you suggested on traditional Medicare and MediGap and drug plan. You’ll have more flexibility in most states in choosing coverage in future.

Good luck. Not an expert, just my opinion after 10 years.

[ShazzieB]

29. Thanks for helping sort out some of the confusion.

I fully understand the appeal of Medicare Adantage for a lot of people, but I don’t want to lose the flexibility of "regular" Medicare.

[Deuxcents]

8. I'm losing my employer sponsored health benefits

So after 40 years, I’m on my own as they’re cutting off the retirees if we don’t want United Heathcare Advantage. So..since I’ve had Florida Blue forever, I’m working directly with an agent there. I called them and they gave me their billing information and I’ve spoken a couple of times with them now. If you don’t want to go to an agent/broker, call directly to the company you are going to go with work with them. It never used to be this complicated but I think the competition among the companies to get us Boomers is making it so. Best wishes

[ShazzieB]

30. Sounds like you are in good hands.

I am going to look into brokers as several people here have mentioned those.

Thanks for the input!

[Deuxcents]

32. I can only hope to make the best decision..

There are so many choices but I went directly to BC because of the scams and they’re even scarier!

[ShazzieB]

36. Funny yould should mention BC!

The plan we've been on and are about to lose is BC. I thought about calling them, and still might. If they're scary, I'll just have to deal somehow.

Monday is the deadline I've given myself for taking some kind of action. Mr. B and I are both terrible procrastinators and have a tendency to put things off too long, if we let ourselves. I am not going to let that happen with this.

[Deuxcents]

38. I know! And I think there's penalties if we're late.

Im just staying with what I’ve had for all these years. I may have to change plans but BC has never given me a reason to change. Good luck and post how you’ve made out.

[ShazzieB]

39. Thanks!

I will definitely post an update!

[tblue37]

9. I had to get a lawyer friend to help me figure it out. There are free government run

seminars to help you figure it all out, I think.

[MoonlightHillFarm]

11. Medicare Marketplace

Look up and call Medicare Marketplace. They will do everything. They’ll find you the best supplemental plan in your area, the the best prescription plan based on the coverage of the meds you are taking.

They provide a service, no charge.

I’ve found them to be responsive and accurate in their information. It’s really a one-stop-shop

Good luck.

[underpants]

15. Great advice.

[ShazzieB]

37. I will, check that out, thanks.

[Rebl2]

12. My parents

always had United Healthcare through AARP. They had an expensive plan though. My Mom has Medicare RX through them as well. It’s actually going to go down in price next year. They had pretty good luck with them. My husband and I have BC&BS federal plan through his retirement from PO. It’s kind of expensive, but I take some medications these other plans from other companies either won’t pay for or we would have to pay a lot of pocket that we couldn’t afford. BC&BS has been pretty good, especially since we have been on Medicare.

[SlimJimmy]

20. I have Medicare part A and B, and then kept my government health

coverage at the same rate I was paying when I worked. Primarily because I can keep my wife as a plus one when she retires in April. I recently had a quadruple bypass, and so far, Medicare is covering 80% and my government plan is taking up the slack on the 20%. I keep getting EOBs that say zero owed for hospital stays, surgery and all manner of doctors who dropped by while I was in the hospital. I told my wife the other day to keep those coming. Since my government plan covers medicines, I think I'll be in good shape going forward.

[mike_c]

13. my union and pension provider (CalPERS) navigated this for us

We have free-to-me platinum Anthem-Blue Cross gap coverage and an OptimRX plan for prescriptions. We also have vision and dental plans, which we pay a little extra for. I'm not that happy with OptimRX, but that's what we've got and it keeps the pill bottles full. I have no complaints about Anthem-BC although I don't usually pay attention to who pays what, as long as it's not me. I get that this isn't your situation, just sharing what works for us. Good luck!

[Diamond_Dog]

14. It is waaaay too complicated for mere mortals to understand, I agree.

Do you have Insurance Navigators where you live? I cannot recommend talking to one highly enough. They know all the facts about all the plans out there so you don’t have to drive yourself crazy trying to figure it out. Plus, their service is free.

[cbabe]

17. Forgot to mention in my earlier post, SHIBA is free.

[KarenS]

18. See if you can find an independent insurance broker that is for Seniors and

knows about your State,,,, we used one and it worked for us,,,,

This is also the first time Husband & I don't have the same insurance company,,,, it just worked out that way.

Good luck to you!!

[slightlv]

19. I'm glad it worked for you, Karen...

but it was a broker who tricked me onto Medicare Advantage. He was *suppose* to be independent. Afterwards, finding out what he'd done, I'd swear he was bought and paid for by Aetna. After that, even pleading my case as to what happened and how, he made out like a bandit (no doubt) and I basically cut out of the Medigap program by cost... simply because I'd *already* been on Medicare Advantage. For like one day.

I say Medicare for All, and make it a thorough health program (NOT an insurance program) that covers not only your torso, but also your eyes and ears, and all the parts in between!

[KarenS]

21. oh that's terrible,,,,

There are "bad players' everywhere. We were fortunate.

I agree with you on the Medicare for all and making it a Health Program that covers everything.

Good luck.

[ShazzieB]

31. Wow, I'm so sorry to hear that happened to you.

I will be super vigilant if we talk to any brokers. I know they're not all like thst, but it's good to be aware of the possible pitfalls.

Amen to Medicare for all, for everything! This piecemeal garbage is for the birds.

[LetMyPeopleVote]

22. When I turned 65, I talked to a consultant who is a member of my temple

Several of my law partners are over 65 and this man has advised one of my partners. As a partner, I pay my own insurance and I am saving a great deal by being on Medicare. I have a schedule G supplement and a prescription plan with my coverage. I am paying about one-third of the amount that I was paying as a partner.

[Deuxcents]

40. I've been considering plan G

I have N now. I’m so thankful for Medicare and want to keep Original Medicare as I’ve worked too long to give it over to a private health company. When I was younger and looked over my pay stubb, I chimed in with the others about my money going to SS and Medicare and squawked about never gonna see it because I wasn’t gonna live that long! Omg…now, I wish if I had known I’d live this long, I’d have taken better care of myself. Ain’t life great?!

[LetMyPeopleVote]

41. I am not going to do a Medicare advantage plan

[llmart]

43. I have AARP's United Healthcare Supplement Plan G

I am so glad I opted to pay the higher premium because you rarely have to worry about anything. I can't think of a scenario where you'd end up with a huge bill for medical care unless you had some terrible health problems that required extensive, lifelong assistance. I've never looked into those types of scenarios. I pay $192 a month for Plan G and am 74 years old. When I was 69 I vacillated between waiting until I was the magic number of 70 to change to Plan G, but instead I did it at 69 and boy, was I glad I did because my dry macular degeneration turned to wet in one eye and I needed monthly injections for one year. The cost would have been $2000 per injection. The retinal specialist's charges not included. I never paid a penny after I met my deductible which that year was about $138.

I take no meds, have no underlying conditions, have been fit and healthy my entire adult life, but you never know what can happen once you get older. I do know that very few get into their senior years without something. Just this summer I had major surgery for a rare type of tumor that is benign but still had to be removed. I've just now received all the bills and what I owe. All the charges added up to about $60,000 and I didn't pay a penny. It was all covered by Medicare (80%) and UHC picked up the rest.

I also have my Part D prescription plan with them and it's the lowest one they offer because I take no meds. I needed one antibiotic post surgery and that cost me about $9. I pay approximately $28 per month for the plan.

I can afford the higher premium for my Plan G and I understand there are a lot of people who that might be scary to fit into their budgets, but my experience shows that the higher premium is much easier to stomach if you think about the cost of any major health issue if and when that happens.

Also, I don't care what any of the celebrities say who hawk Advantage plans. Not for me. I need the security of knowing that any odd thing that may crop up in my health will be covered.

[Deuxcents]

45. Sounds like you have the right plan for you

Pleased that you are healthy and at 74, that makes a good quality of life. I’m a couple of years older but I take thyroid meds but I’m fortunate to be otherwise healthy. I should exercise more, tho. I’m keeping my Original Medicare and staying with BC as I’ve been with them for many years. I have a phone consultation next week as enrollment is right around the corner. Best wishes for your continued good health 😊

[llmart]

46. Oh, I hope you don't think I was trying to encourage you to leave BC.

I responded because you said you were considering switching from Plan N to Plan G. It's been a few years, but I believe Plan G was the top tier you could still get into (Plan F was phased out unless you were already in it and that was the top tier supplement plan prior to when it was phased out for new people).

[Deuxcents]

47. O, no. We're good 👍

[llmart]

44. I posted a reply to another DU'er but the info might help you also.

I agree that it is complicated at first. It doesn't have to be. It's sort of like trying to decide how to invest retirement money. If you are risk averse as I am, you stick with uncomplicated and more security. You need those two things as you get older. My oldest sister is 83 and she has a saying that none of us is getting out of this world without some health issues that require medical care (outside of if you get hit by a bus crossing a street and kick the bucket - LOL).

[trof]

48. Check out a Medicare Advantage plan.

Some people bad mouth it, but we have been very happy with it.
NO monthly premiums.
Zero co-pay for your family doctor.
$25 co-pay for each specialist visit.
Drug, dental, and vision coverage.
Walk-in clinic/urgent care covered.
$90 co-pay for ER visit.

No monthly premium has saved us thou$ands.

[Random Boomer]

49. Warning! There's no going back

Once you opt for an Advantage plan, you can never go back to traditional supplemental.

[ShazzieB]

51. Yeah, I ruled those out early on.

Don't want to get painted into a corner we can't get out of,

[trof]

52. Not true

If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.

https://www.google.com/search?q=can+I+go+from+Medicare+Advantage+back+to+a+standard+plan&gs_ivs=1#tts=0

[Random Boomer]

50. State Farm bundled supplemental plan G with my other policies

I retired a few months ago, and got supplemental Medicare at a discount by bundling with my State Farm home & auto insurance policies. Even if I move on to another insurance company later, this was an easy way to get started.