WSJ - Big mistakes people make in Medicare

[Chuckanut]

Many states allow people to switch from Medicare Advantage back to regular Medicare during an open enrollment period. However, one other issue remains. Can you you then buy a Medigap policy to fill in the holes in Medicare coverage? I have heard stories of sick people being unable to get the gap coverage, but I am not certain as to their veracity. It’s certainly something to consider. Remember, the rules can vary by state.

 

[zl55lz]

turning 65 in Nov and working thru this. Being Fed Employee with FEHB's I am going to keep my BCBS Standard and sign up for B too.

Using Consumer Checkbook.org (site only has FEHB coverage plans) You are able to compare coverage etc. The big thing I'm seeing comparing Standard with Basic BCBS is that basic gets a $800 rebate? It costs more, why would they get a rebate?

Standard might cost more than Basic because it appears to have better Rx coinsurance overall, and it also offers to cover 10 additional days of Skilled Nursing days (SNF) after the Medicare initial 20 which are covered in full by Medicare. Also, Standard apparently covers some out of network providers. Basic at this point does not offer any SNF days, no out of network (except when required by law). The $800 reimbursement is nice through Basic.

I would also read the advice at Consumers' Checkbook--they have info on how to save money by switching to a different FEHB plan to combine with Medicare A and B. When on A&B, the FEHB becomes secondary coverage and covers the approx 20% after Medicare pays. The FEHB plan works differently when on A&B than when on FEHB only while working.

We are both on Medicare A&B and switched to Aetna Direct which saves us approx $300 per month in premiums, and also gives us $1800 as a fund to cover Rx, etc., and covers 40 extra SNF days after the Medicare initial 20. Other plans mentioned frequently to pair with A&B are NALC High and GEHA Standard.

I try to review the FEHB brochures each year to see if there have been any changes, and especially the sections on Rx (5) and Coordination with Medicare (Section 9).

However, different people have different needs for network providers, Rx, etc.

 

[misanman]

Friend of ours has a leg infection that persists. The doctors think hyperbaric therapy might help cure the infection and avoid amputation. But the treatment has to be reviewed and approved by his MA plan. I think the review has been going on for ten days or so and he is in increasing danger of losing his leg.

 

[HGTVFanatic]

There is no way insurance is going to cause me to lose my leg. Pay up and submit later.

 

[Luvtoride]

IMO, all poles should include 'I like bacon" as one of the possible responses.

How about “I like Dryer sheets”[emoji1787]

 

[ncbill]

How about “I like Dryer sheets”[emoji1787]

Vinegar in the rinse cycle & wool balls in the dryer are the frugal alternative.

 

[stedmakr]

turning 65 in Nov and working thru this. Being Fed Employee with FEHB's I am going to keep my BCBS Standard and sign up for B too.

Using Consumer Checkbook.org (site only has FEHB coverage plans) You are able to compare coverage etc. The big thing I'm seeing comparing Standard with Basic BCBS is that basic gets a $800 rebate? It costs more, why would they get a rebate?

To be cost competitive. But first...

The standard plan is significantly more expensive that the basic plan. The dollar difference is more significant for the Self +1 plan than the Self plan. The main benefit of having the standard plan is that you can go to out of network doctors. However the BCBS basic plan has an extremely large network. I think it is something like 95% of all doctors that take Medicare take BCBS basic.

OPM suggests that individuals consider obtaining a lower price plan when enrolling in Medicare. In this case that would mean changing from the standard to a basic plan. Of course you should verify that all your doctors are in the basic plan before changing. (Go to the OPM website to find this reference).

Both of the BCBS plans provide comprehensive coverage. Medicare also provides comprehensive coverage. Why do you need two sets of comprehensive coverage (BCBS and Medicare)? BCBS addresses this and attempts to keep you as a beneficiary if you enroll in Medicare by acting like a Medigap plan and providing additional benefits.

BCBS also attempts to keep you as a customer by reducing costs in the basic plan with the $800 rebate. If you enroll in Medicare it becomes the primay payer and BCBS is a secondary payer for your health care (in most or all cases you will not have a copay). Medicare Part B pays 80% of your claims and BCBS pays the remaining 20%. Your health care claims to BCBS are less if you take Medicare and BCBS can still make a profit with the rebate. The purpose of the rebate is to keep you as a customer.

I know this response is a little disjointed but I am time constrained today. Go to the fepblue.org site then get into the Medicare section to get more information. The 2024 checkbook guide is not out yet. Since you are just starting Medicare it would be worthwhile to review it prior to making a decision.

 

[5Miler]

I have always been LBYM so always on the alert to save a dime if it makes sense. One thing I haven't and won't scrimp on is my health insurance.

I appear to be an outlier here as I receive my primary care via the Veteran's Administration where I pay a small copay ($15) to see my PCP and a bit larger copay ($50) to see any specialist. I am still enrolled in Medicare part A and B and have a "G" Medigap plan via United Health Care. I do not currently have a Part D plan as the VA counts as creditable coverage. Since Wellcare is offering a part D plan in my area for $0.50 per month, I am going to enroll in it this year.

Guess it's the belt and suspenders approach even though I am a pretty light user of medical services. I get an annual physical which by the way is more involved than an annual "Wellness Check" from Medicare. Actually, it's more like every 9 months these days and they give me the choice of every 6 months if I would prefer. I don't prefer. Full labs every time.

I keep Medicare enrollment at Part A and B in case some future President decides my classification group no longer qualifies for care at the VA. It's been done before as I am only class 7 in a range of 1 to 8. Obama made 7 and 8 eligible again during his term around the time I retired so good timing on that. I could enroll in Medicare Advantage with zero premiums to avoid future penalties in that event but I have been on Kaiser many years and would prefer to pay up then deal with an HMO. VA healthcare coverage counts as creditable coverage for Part D but not Part B and Medigap.

One of our friends is 64 and was using her retirement benefit from her last job to have health coverage at Kaiser which she has used most of her working career. Last year she opted to drop it to save money and went on some screwy health care discount plan even though she had experienced a stroke the year before. All to save a dime. Two months ago she fell down her stairs and just got hit with a $17K hospital bill for her shoulder injury. She managed to negotiate it down to $7K but still a major blow their retirement budget. Twice a week PT is $100 per session. I believe she is going on Part B and a "G" plan at Blue Cross when she turns 65 next May and an ACA plan in January to have coverage until then. Lesson learned.

 

[jimmyz]

I have a crazy good Aetna Advantage plan through my retirement plan. A PPO and I can see basically any doctor anywhere in the country. Co pay is 10 dollars. Heck my hip replacement did not cost me a cent.I was refunded 60 dollars at end of the year for co pays I paid. I get up to 250 back of co pays. Why can't all of us have what I get. We should as a nation we put men on the moon. We can cover all of us with healthcare.

 

[Teacher Terry]

Luckily my retiree benefits include 195/month towards my premiums. That really helps as in total I pay 325/month before the benefits and my income is not that high so it makes a real difference for me.

 

[Buckeye]

I know 2 people that are still alive only because they could seek treatment anywhere in the country. One was told your cancer is too advanced and there’s nothing that can be done and gave her 6 months. MD Anderson in Texas said differently and many years later she is still alive.

The ability to travel anywhere in the country for the best care for a particular medical issue is why I will be purchasing traditional Medicare and a supplement plan.

 

[Midpack]

I hear such horror stories all the time from some friends. It seems to me like the government should provide well trained/certified facilitators to help guide folks through the maze of options and pros and cons on a case by case basis and with "fiduciary" like responsibilities. Maybe they do, and I just don't know about them.

That’s what Boomer Benefits and others like them do for free. Maybe your friends should have done a little research - on a critical topic like their health care? Medicare is headed toward insolvency (though Congress will presumably course correct later rather than sooner), they don’t need the added expense of “well trained/certified facilitators to help guide folks.”

 

[Duke of Sands]

I hit the paywall now- does ur share have limited time?
"Free link of referenced article: https://www.wsj.com/health/healthcar...hare_permalink"

 

[FIREd_2015]

I hit the paywall now- does ur share have limited time?
"Free link of referenced article: https://www.wsj.com/health/healthcar...hare_permalink"

Try this:

https://www.wsj.com/health/healthca...mf6ydcvtae9&reflink=desktopwebshare_permalink

 

[Gearhead Jim]

Free link of referenced article: https://www.wsj.com/health/healthca...dofhrld0r4b&reflink=desktopwebshare_permalink

(OP, hit share to get the free link next time)

I'll summarize the article:

- Medicare advantage plans may have really limited networks
- Advantage plans commercials and sales tactics are just that
- Get medigap right away when you sign up for medicare

When I retired 18 years ago, my former employer had a "typical" retirement health insurance plan since I was under Medicare age.
Five years later, I aged into Medicare and the supplement from my former employer.
Five years ago, the former employer switched all of their retirees who were Medicare age, from the various plans into an Aetna Medicare Advantage Plan. Our premiums went down slightly, and after the initial paperwork shuffle I can't tell any difference in coverage or services. I'm sure there are some doctors outside of our network, but I haven't found one yet.
Of course, Aetna probably has many Advantage plans and some may be bad, but ours is just fine.

 

[MissMolly]

When I retired 18 years ago, my former employer had a "typical" retirement health insurance plan since I was under Medicare age.
Five years later, I aged into Medicare and the supplement from my former employer.
Five years ago, the former employer switched all of their retirees who were Medicare age, from the various plans into an Aetna Medicare Advantage Plan. Our premiums went down slightly, and after the initial paperwork shuffle I can't tell any difference in coverage or services. I'm sure there are some doctors outside of our network, but I haven't found one yet.
Of course, Aetna probably has many Advantage plans and some may be bad, but ours is just fine.

Yes. I also have an employer sponsored Medicare Advantage plan and it's been great. In fact, much better for me since they cover my single medication which costs over $14,000/month. Plan D will only pay 80% leaving me to pay over $2,800/month. Under my Advantage plan some months I pay $55 and other months $110. In an entire year I pay less for this medication than I would pay in a single month on Plan D. I grow tired of everyone painting Advantage plans with same broad brush. There are huge differences in them.

 

[Duke of Sands]

Try this:

https://www.wsj.com/health/healthca...mf6ydcvtae9&reflink=desktopwebshare_permalink

Got it thanks! Good article!

 

[Dtail]

Yes. I also have an employer sponsored Medicare Advantage plan and it's been great. In fact, much better for me since they cover my single medication which costs over $14,000/month. Plan D will only pay 80% leaving me to pay over $2,800/month. Under my Advantage plan some months I pay $55 and other months $110. In an entire year I pay less for this medication than I would pay in a single month on Plan D. I grow tired of everyone painting Advantage plans with same broad brush. There are huge differences in them.

Agree.
One key negative always pointed out is the acceptance of the MA plans by doctors in one's area. Not an issue at all in our area.

 

[RetMD21]

Yes. I also have an employer sponsored Medicare Advantage plan and it's been great. In fact, much better for me since they cover my single medication which costs over $14,000/month. Plan D will only pay 80% leaving me to pay over $2,800/month. Under my Advantage plan some months I pay $55 and other months $110. In an entire year I pay less for this medication than I would pay in a single month on Plan D. I grow tired of everyone painting Advantage plans with same broad brush. There are huge differences in them.

Wow, that's fortunate for you. MA plans work out well for some people and many are not affected by the network restrictions.

The situation of the person waiting for a MA plan to possibly approve treatment to save his leg is rare.

 

[JoeWras]

Maybe a better take away from the article is: do your homework.


Don't assume any old plan, no matter the flavor, will work for you. Check the network, the the restrictions, check the costs. The cheaper plan is sometimes best, sometimes worst.

Like all insurance, this is also a regional problem. Some people can't believe that the entire world doesn't get free glass replacement on their auto insurance. It is regional, just like doctor networks are regional.

 

[RetMD21]

Maybe a better take away from the article is: do your homework.


Don't assume any old plan, no matter the flavor, will work for you. Check the network, the the restrictions, check the costs. The cheaper plan is sometimes best, sometimes worst.

Like all insurance, this is also a regional problem. Some people can't believe that the entire world doesn't get free glass replacement on their auto insurance. It is regional, just like doctor networks are regional.

How would that work for Teacher Terry's friend with cancer who attributes her survival with cancer to getting on a plane and going to MD Anderson. Do the online reviews of MA plans tell you that they will authorize out of network treatment if you have this specific condition with scans showing that specific finding and the local doctor makes a particular recommendation?

 

[misanman]

The situation of the person waiting for a MA plan to possibly approve treatment to save his leg is rare.

Update: the treatment was eventually approved and treatment has started. Five treatments a week for eight weeks. Hoping that success isn't jeopardized by the delay.

 

[sturge]

Maybe a better take away from the article is: do your homework.


Don't assume any old plan, no matter the flavor, will work for you. Check the network, the the restrictions, check the costs. The cheaper plan is sometimes best, sometimes worst.

Like all insurance, this is also a regional problem. Some people can't believe that the entire world doesn't get free glass replacement on their auto insurance. It is regional, just like doctor networks are regional.

BINGO...being retired, one thing most of us have is MORE TIME to dig into things. This is a great link to provide timely information regarding types of plans, potential problems, changes in plans, changes in laws, etc. Countless video's loaded with factual information to help you figure what's best for you.

https://www.medicareschool.com/

 

[Joylush]

I have always been LBYM so always on the alert to save a dime if it makes sense. One thing I haven't and won't scrimp on is my health insurance.

I appear to be an outlier here as I receive my primary care via the Veteran's Administration where I pay a small copay ($15) to see my PCP and a bit larger copay ($50) to see any specialist. I am still enrolled in Medicare part A and B and have a "G" Medigap plan via United Health Care. I do not currently have a Part D plan as the VA counts as creditable coverage. Since Wellcare is offering a part D plan in my area for $0.50 per month, I am going to enroll in it this year.

Guess it's the belt and suspenders approach even though I am a pretty light user of medical services. I get an annual physical which by the way is more involved than an annual "Wellness Check" from Medicare. Actually, it's more like every 9 months these days and they give me the choice of every 6 months if I would prefer. I don't prefer. Full labs every time.

I keep Medicare enrollment at Part A and B in case some future President decides my classification group no longer qualifies for care at the VA. It's been done before as I am only class 7 in a range of 1 to 8. Obama made 7 and 8 eligible again during his term around the time I retired so good timing on that. I could enroll in Medicare Advantage with zero premiums to avoid future penalties in that event but I have been on Kaiser many years and would prefer to pay up then deal with an HMO. VA healthcare coverage counts as creditable coverage for Part D but not Part B and Medigap.

One of our friends is 64 and was using her retirement benefit from her last job to have health coverage at Kaiser which she has used most of her working career. Last year she opted to drop it to save money and went on some screwy health care discount plan even though she had experienced a stroke the year before. All to save a dime. Two months ago she fell down her stairs and just got hit with a $17K hospital bill for her shoulder injury. She managed to negotiate it down to $7K but still a major blow their retirement budget. Twice a week PT is $100 per session. I believe she is going on Part B and a "G" plan at Blue Cross when she turns 65 next May and an ACA plan in January to have coverage until then. Lesson learned.

Can you explain a bit further? I too am enrolled in the VA health care system but planned to get Medicare when eligible as well as a supplement plan. Are you saying because I’m enrolled in the VA health care system I am not required to purchase a part D prescription drug plan? I take no drugs and can always get them through the VA system if needed so nit having to pay for another plan I don’t need would be great. I was not aware of this.

 

[Buckeye]

Can you explain a bit further? I too am enrolled in the VA health care system but planned to get Medicare when eligible as well as a supplement plan. Are you saying because I’m enrolled in the VA health care system I am not required to purchase a part D prescription drug plan? I take no drugs and can always get them through the VA system if needed so nit having to pay for another plan I don’t need would be great. I was not aware of this.

If you are enrolled in VA healthcare, you will start getting an annual letter from the VA telling you that your enrollment counts as Part D creditable coverage. But be careful. Your VA doctor has to prescribe the medication that you want, i.e. the medication that has been prescribed by your civilian doctor. Maybe the VA doctor will be willing to prescribe the drug and maybe not. You can't take a prescription written by a civilian doctor to the VA pharmacy to be filled. Because there are some very low cost Part D plans available (mine is $0 premium, this year) I still purchase a Part D plan. And, always check the GoodRx price of any prescription.