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Medicare: What Are The Options?

Huntn

Huntn

macrumors Penryn
Original poster
May 5, 2008
24,779
27,859
The Misty Mountains
I'm 3 months away from going on Medicare. I have a stack of information sent to me from various companies offering Medicare supplemental insurance. Today, I start making phone calls. If you are familiar and want to discuss it, I'd be interested in benefiting from any insight you might have.

This is not a thread meant to argue about the merits of the Medicare program. That's why it's in the Community Forum, not PRSI.

I know:
Part A: Hospital Insurance- inpatient Hospital care.
Part B: Medical Insurance- Outpatient care from doctors and health care providers.
Part C: Run by Medicare-approved private insurance companies that follow rules set by Medicare. Includes Part A, B, and usually D.
Part D: Prescription Drug Coverage
Supplemental Coverage vs Advantage

I assume C is what I want to include D. I'm wondering how much variety there is in services offered and pricing. These are described as supplemental plans, so I assume the price will be substantially lower that what I'm currently paying for my Health Insurance approximated $500 per month (individual).

I assume some companies for Part C are better than others.
I'll report back on any revelations I discover. Any good advice appreciated! :)
 
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must be done; start the thread off:

partA,B,D come with 4free
partC is the supplemental for cost

when looking for supplemental mediCare; what is the typical shopping list, what do we need?

by the way care starts at 65 but
Medicare. You can receive Medicare at any age if you have been receiving Social Security disability benefits for two years.
 
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jeyf said:
must be done; start the thread off:

partA,B,D come with 4free
partC is the supplemental for cost

when looking for supplemental mediCare; what is the typical shopping list, what do we need?

by the way care starts at 65 but
Medicare. You can receive Medicare at any age if you have been receiving Social Security disability benefits for two years.
Click to expand...

So I should use the label Supplemental for Part C, sound good?
What do I need or want? A,B, and D. :)
 
Coverage and cost for supplemental plans vary by state, they also tend to change almost annually ---some medical groups are in one plan but not others.
If you have a doctor you like , make sure he is in the plan you choose.
Some physicians do not accept Medi-Care. It can become confusing.
 
what is everyone looking for when buying the supplemental plan? The major stuff.
dont care whatever state you live

i do not need to keep the doctor i have been going to last few years
 
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I made a unpleasant discovery yesterday. With my employer I retired from, I'm still covered by the insurance they offer through UHC. As it is right now I'm paying approximately $1000 per month for insurance for me and my spouse. I had assumed (look out!) that when I retired, my wife could stay on the companies insurance till she is 65. She has 5 years to go. I could drop off insurance, convert to Medicare and save some money...WRONG.

  • If my wife says on company insurance her rate doubles to $1000, all by her self.
  • If I wanted to stay on our insurance with her, our policy would jump to $1400 a month for the two of us.
  • The market place of the Affordable Care Act, might be an option, but I make over $50k in retirement so I would not get a subsidy and the price would be just as high as the $1000 a month that would cover my wife through the company.

I spoke with a medicare broker yesterday who technically works for United Health Care, but can sell polices with any of the companies out there. The rates here apply to Texas. I scribbled a lot of notes and some of this may not be 100% accurate, but it should be ball park. I discovered:

  • Medicare A and B have to be signed up for. Medicare Part B is $134 a month. Both A and B have unlimited risk. In other words there are no limits on catastrophic illnesses, you pay the % of what ever the final bill is. A $200K bill might be $20k to you.
  • There are two options to control the financial risk- Supplemental and Advantage.
  • Supplemental costs $200-300 per month in premiums. If I understand this correctly hospital bills are free, but you are paying $2400-3600 a year in premiums.
  • Advantage costs $37 a month ($444 a year), and when you go into the hospital you pay $395 per day for 4 days ($1580), and then the rest is picked up by the plan. In addition, it's a PPO (preferred provider) plan, but, there is no penalty if you go outside of network with the UHC plan. Some plans, Etna and Humana out of network, the charge is 40-50% of the doctors bill.
  • Both the Supplemental and Advantage plans cover prescription drugs. With the advantage plan, I believe Tier 1 and 2 drugs are free for a 90 day supply. Tier 3 and 4, if I recall correctly are $20-45 for a 3 month supply.
I'm basically a healthy person, so the Advantage Program is a slam dunk. The premiums for Part B would be automatically removed from my Social Security payment, and I assume, I pay the $37 a month premium to the company directly.

Because my wife's premiums go up, this means that instead of saving money, my expenses will increase $137+ $37 a month over current costs.
 
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Huntn said:
I made a unpleasant discovery yesterday. With my employer I retired from, I'm still covered by the insurance they offer through UHC. As it is right now I'm paying approximately $1000 per month for insurance for me and my spouse. I had assumed (look out!) that when I retired, my wife could stay on the companies insurance till she is 65. She has 5 years to go. I could drop off insurance, convert to Medicare and save some money...WRONG.

  • If my wife says on company insurance her rate doubles to $1000, all by her self.
  • If I wanted to stay on our insurance with her, our policy would jump to $1400 a month for the two of us.
  • The market place of the Affordable Care Act, might be an option, but I make over $50k in retirement so I would not get a subsidy and the price would be just as high as the $1000 a month that would cover my wife through the company.
...
Click to expand...

Do you make a lot more than $50K per year, and is that your household income?

If you're a household of two with an income of $50K, you're below 400% of the federal poverty line. So you may qualify for a premium subsidy. The household income cap (for a household of two in the lower 48 states) would be around $64K. Below that level and above around $48K, your share of annual premiums for the benchmark silver level plan would be less than 10% of your annual income. At $50K it would be around $400 a month. At $60K it would still be less than $500 a month.

The coverage provided by a silver level plan might not be as good as that provided by the plan you have through your former employer. But you can get the same amount of premium subsidy if you buy a better plan through the exchanges. If the benchmark silver level plan costs $1,200 a month and your share is capped at $400, then you get an $800 per month subsidy even if you enroll in a more expensive plan.
 
Carnegie said:
Do you make a lot more than $50K per year, and is that your household income?

If you're a household of two with an income of $50K, you're below 400% of the federal poverty line. So you may qualify for a premium subsidy. The household income cap (for a household of two in the lower 48 states) would be around $64K. Below that level and above around $48K, your share of annual premiums for the benchmark silver level plan would be less than 10% of your annual income. At $50K it would be around $400 a month. At $60K it would still be less than $500 a month.

The coverage provided by a silver level plan might not be as good as that provided by the plan you have through your former employer. But you can get the same amount of premium subsidy if you buy a better plan through the exchanges. If the benchmark silver level plan costs $1,200 a month and your share is capped at $400, then you get an $800 per month subsidy even if you enroll in a more expensive plan.
Click to expand...
Thanks, I’ll look into this, but I’m above $70k annual. Do they look at your tax return net income? What about money that comes out of your 401k?
 
Huntn said:
Thanks, I’ll look into this, but I’m above $70k annual. Do they look at your tax return net income? What about money that comes out of your 401k?
Click to expand...

It's based on modified adjusted gross income.

At $70K your income would be a little too high, at least in the lower 48 states. The poverty levels for Alaska and Hawaii are higher. And the subsidy isn't just graduated down above 400% of the poverty level, it's a subsidy cliff of sorts. At 400% you can qualify for a large subsidy - whatever the annual premium cost is minus 9.56% (for 2018) of your income. At 401% you don't qualify for any subsidy.

For reference, the 2017 federal poverty level (which is used for 2018) for a household of two is $16,240. So 400% of that is $64,960.
 
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Huntn said:
Thanks, I’ll look into this, but I’m above $70k annual. Do they look at your tax return net income? What about money that comes out of your 401k?
Click to expand...

Unfortunately, they look at all income including 401K.

If you want the subsidy, you will have to keep all money received under the cap.

I highly recommend that you spend some money and get some expert advice. People here are helpful but it's too important for you not to get some expert advice for the state you live in.
[doublepost=1515592719][/doublepost]
Carnegie said:
It's based on modified adjusted gross income.

At $70K your income would be a little too high, at least in the lower 48 states. The poverty levels for Alaska and Hawaii are higher. And the subsidy isn't just graduated down above 400% of the poverty level, it's a subsidy cliff of sorts. At 400% you can qualify for a large subsidy - whatever the annual premium cost is minus 9.56% (for 2018) of your income. At 401% you don't qualify for any subsidy.

For reference, the 2017 federal poverty level (which is used for 2018) for a household of two is $16,240. So 400% of that is $64,960.
Click to expand...

Good explanation. It is a cliff.

People who are working and are close to the cap can put money into an IRA to get below the cap.

Unfortunately, the money you put into the IRA is limited by what you earn while working during the year. This means that while you are retired or out of work, you can't put money into an IRA for that time.
 
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I spoke with my union yesterday (unions do serve a purpose :D) and they mentioned a bronze retirement plan that the company offers that my wife may qualify for at half the monthly premium. Yes there are trade offs , but up front despite having a $3000 deductible, and paying $6000 in annual premiums, it’s cheaper than having $12000 in annual premiums. With the latter you pay $12k before you ever see a doctor. I’ll report back as I learn more.
 
Huntn said:
I spoke with my union yesterday (unions do serve a purpose :D) and they mentioned a bronze retirement plan that the company offers that my wife may qualify for at half the monthly premium. Yes there are trade offs , but up front despite having a $3000 deductible, and paying $6000 in annual premiums, it’s cheaper than having $12000 in annual premiums. With the latter you pay $12k before you ever see a doctor. I’ll report back as I learn more.
Click to expand...

I would still recommend seeing a financial expert on retirement healthcare.
 
jeyf said:
must be done; start the thread off:

partA,B,D come with 4free
partC is the supplemental for cost

when looking for supplemental mediCare; what is the typical shopping list, what do we need?

by the way care starts at 65 but
Medicare. You can receive Medicare at any age if you have been receiving Social Security disability benefits for two years.
Click to expand...
Part B premium for most new enrollment costs $134/mo which is deducted from your SSA benefits.
 
I was increasingly nervous as I approached retirement, about 12 years ago. I was a university professor in NY state and was in the state employees health plan, which was free to me apart from copays. When I retired I went to Part B, paid my Medicare out of Social Security (but NY State reimbursed it), and went on my union's plan for dental and vision. I was using an HMO and in practical terms, day-to-day, nothing changed.

Then I moved here, where there's a shortage of doctors (a serious one, on my island). I could have stayed on the NY State plan but without a personal physician it wasn't practical, so I signed up with Kaiser. I still pay my Part B out of my Social Security, and I pay Kaiser around $200/month for a Medicare Advantage plan, plus nearly-useless dental and vision. I've been happy with Kaiser.

Every state seems different -- and I totally agree with others who suggest not paying a lot of attention to amateur advice-givers -- but Huntn, does TX have HMOs that you could join? You might get a better deal.
 
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Plutonius said:
I would still recommend seeing a financial expert on retirement healthcare.
Click to expand...
I’m also speaking with a broker who has been in the industry and doing this for 20 years.
[doublepost=1515610435][/doublepost]
monokakata said:
I was increasingly nervous as I approached retirement, about 12 years ago. I was a university professor in NY state and was in the state employees health plan, which was free to me apart from copays. When I retired I went to Part B, paid my Medicare out of Social Security (but NY State reimbursed it), and went on my union's plan for dental and vision. I was using an HMO and in practical terms, day-to-day, nothing changed.

Then I moved here, where there's a shortage of doctors (a serious one, on my island). I could have stayed on the NY State plan but without a personal physician it wasn't practical, so I signed up with Kaiser. I still pay my Part B out of my Social Security, and I pay Kaiser around $200/month for a Medicare Advantage plan, plus nearly-useless dental and vision. I've been happy with Kaiser.

Every state seems different -- and I totally agree with others who suggest not paying a lot of attention to amateur advice-givers -- but Huntn, does TX have HMOs that you could join? You might get a better deal.
Click to expand...
They may. I think they were mentioned as part of Supplemental plans, the more expensive side, as compared to the Advantage plans. The broker Intalked to described them as a fork in the road, with Supplemental plans on one side and Advantage plans on other.
 
My husband went on Medicare this month. (Lucky guy will retire in April!) But because he will remain on his employer's medical plan until he retires, he could not choose his Part D options. He has chosen a free BC/BS option that's available here in AL and administer by United Healthcare. The states all seem to vary widely.
 
Huntn said:
I’m also speaking with a broker who has been in the industry and doing this for 20 years.
Click to expand...

Is he a specialist in retirement finances ?

Another thing to find out is what effect your passing would have on your wife's healthcare. It's not a fun topic but it needs to be discussed.

Have you or are you planning to set up a revocable trust ?
 
Plutonius said:
Is he a specialist in retirement finances ?

Another thing to find out is what effect your passing would have on your wife's healthcare. It's not a fun topic but it needs to be discussed.

Have you or are you planning to set up a revocable trust ?
Click to expand...
My plan is to set up a living trust.
 
My husband retired early but was still on my company insurance plan, where my insurance was 100% covered and his portion was $100/month. Only good bene this company gives.

Then my company insurance told him that our prescription plan didn’t meet Medicare requirements when he was 65, so he dropped off my company plan, went to the regular PartB Medicare that is paid out of the SS check, and enrolled in an Advantage plan through Health Net, which covered prescriptions plus some additional medical (Here its called Violet Option 2). In Oregon the Health Net plan started out free, but is now $25/ month. So he has pretty good coverage for $134 medicare + $25 Health Net, and my company still covers me for $0. Havent had to hit the govt plans which would be a bad thing for us.
 
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Huntn said:
So I should use the label Supplemental for Part C, sound good?
What do I need or want? A,B, and D. :)
Click to expand...

Part A is free.....sign up for it
Part B is optional.....but you want to buy it

the alternative to the above two plans is;
Part C, or what's called "Medicare Advantage"....these are private insurance plans that have received approval from Medicare. They package plans that provide your Part A and Part B, and sometimes Part D. The specifics of the plans Advantage vary, for some you may have to pay for your Part B on your own

Part D is optional and covers prescriptions. You buy these plans from private companies.

Then there are the supplemental plans......Part A and Part B have limits to their total coverage, so the idea is to buy supplemental coverage that picks up where medicare leaves off. Medicare specifics the coverage offered in a series of plans which are then sold by private insurance companies

And if the job where you used to work offers any healthcare insurance as part of your retirement benefits (yes there are still employers that offer such things along with pensions and other benefits for retirees)......it'll all be confused by what they offer

Good Luck
 
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all very informative for me!
i might add:
Part B; if your income >certain amount, can it more expensive than the standard $134 ?
 
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