Medicare + Part D + Medigap...or Medicare Advantage?

Medicare A, B, D, and UHC/AARP Plan F (F will only be available to new enrollees through the end of 2019 and then grandfathered to those with it, but not available to new members. At that time, Plan G will be the 2nd best.

Avoid Medicare Advantage.

Think of it this way--if you are paying money for insurance you are "not using", it's probably a sign that you are remaining healthy. I'm 66 and in excellent health, but I realize there will come a day on which I need care whether it's at age 69 or 89. I chose the Medigap plan G because it is very comprehensive.

RayLin: Thank you!

Sorry, didn't read everyones responses but want to put my 2cents.

Thankfully husbands former employer handles our supplimental, DH paying a small fee for me. We have BC/BS. Neither husband or I have any health problems. Most years we don't even meet the deductable. By the time we do, its almost the next year, We also have a "share" amount we r responsible for.

Medicare pays 80% of what they consider reasonable leaving 20% you are responsible for. This s/b picked up by ur supplimental. With me and my Mom (AARP United Health Medigap) that 20% was split in half, I am responsible for the other half. When I had to look for a supplimental for Mom, the state of NJ only had 3 that I could chose from. Medicare Advantages used to be HMOs. I think now they are PPOs. Meaning that you probably can keep ur doctor but will get lower deductibles and copays if you stay within their network (their doctors and services).

You really have to weigh the cost of the insurance plus deductables and copays to determine if having the insurance will save you anything. Find out what your doctor excepts and hospitals in ur area.

By the way, if you are already getting SS, Medicare is automatic.

Hello! Licensed Social Worker that counsels older adults on Medicare choices on a daily basis.  I suggest anyone struggling with making any Medicare decisions contact their local Area Office on Aging, their states SHIP (Senior Health Information Program) and/or Senior Center.  They are a wealth of impartial information about Medicare/Medicaid and the differences of Supplement and Advantage plans.  I have found some agents will strongly encourage folks to take Advantage plans which may not be the best one for you and then run into problems when the plan will not cover all of the costs of care or medications.  Make sure you do a benefits check-up every year because plans do change medications they will cover.  I am in Ohio and we have one of the best SHIP Programs in the country,  I am partial of course! While it may seem like your "pouring money down the toilet" with a Medicare Supplement, you will have very few costs later.  With a Medicare Advantage you have co-pays all along the way.  I refer to them as Pay it Now or Pay it Later.  It all depends on your own financial situation.  We all are used to paying for insurance we may never need, think about the insurances you have on your house, car, etc.  I hope my house never burns down but am glad I pay for it up front, same for car insurance, I hope I do not get in a wreck, but am glad I have had it for the times I have needed it. Good luck with your decision but remember you can always change it every year if it the one you chose does not work for you.

Istucany, hubby has Medicare, AARP, (which I think is United Healthcare). He has dental and eye through his union.

Jacobsonbob, his finger looked very bad. We have seen the Urgent Care doctor before and I trust him. I believe he got to see the specialist sooner because he did go by ambulance. I also think the doctor thought I would take him home and not go to the ER because I complained about the long wait time the last time I was there. Remember this was a table saw accident and the doctor thought nerves and tendons were damaged.

This is from my cell phone I hope it gets through ok.

Ah: You;re welcome!

I was rereading my post,
I realized that I wasn't clear. It sounded like I haven't had any health issues. That is not true. I meant the insurance companies have paid off with no problem.

Ahmijoy one major illness can cost thousands. My husband cut his finger badly on a table saw recently. We went to urgent care. The doctor said he needed a hand surgeon and insisted be go by ambulance to the hospital about 1/2 mile away. It cost $1,400. Just for ambulance. Insurance covered all. Haven't seen anything from urgent care , ER or doctor.

As Llamalover47 says, use an agent.

I went to the Medicare site when it was time for me to carry insurance and it even states there, get an agent.

You don't pay the agent - they earn small commissions. An Advantage Plan will cost you more money and still has limits. My DH had a "oldie but goodie" plan that is no longer offered so we kept it. No limits on it back then.

I opted for a policy that I pay the deductible because it saved me more than the deductible in paying the premiums. A good agent will give you the time to figure it all out - have a calculator and pen & paper handy. It took me a few minutes to see that paying the deductible out of pocket really did save me money over the premiums.

I never met my agent - talk to friends and family, that's how I found my agent. He has me call him every November to see if there is a better plan for me. He's changed my insurance companies twice and my drug plan twice. Since I take no drugs, I can always get the cheapest plan he can find. Same with the Health Insurance, I've never been hospitalized for anything.

You would be wise to use a qualified insurance agent when you sign up for Medicare Supplemental as it can be difficult to understand which plan letter to sign up for, assuming you're going purchase Medicare Supplemental. What also comes into the decision in your own health history.

Issues with Plan C--the Advantage Plan-- (1) you typically can't get a Medigap or Plan F if you decide some day to switch to Original Medicare. That caveat could leave great financial liability as you would have to pay the 20% that Original Medicare doesn't pay for (Plan F pays for what isn't covered by Original Medicare---and for expensive health issues that is important), (2) they have limited physician/lab/extended care networks (whereas Original Medicare allows to you go to any doctor, lab or facility that accepts Medicare---there are no "door-keepers to seeing specialists either (make sure you check out your local physician network with any Advantage Plan) and (3) some extended care facilities (i.e., ALF, nursing homes, etc. will not accept Advantage Plan members---this is frightening). Don't choose which Medicare Plan based on how healthy you are because you never know what might happen in the future!

I wish I could offer some good advice. I have heard that Advantage plans are not good. I have no experience. I was such an innocent. When I was eligible for Medicare, I didn't even know I had to get it. I just happened into the Social Security Office for another matter. That was in May, I turned 65 in June, this was 19 years ago. Just pure luck on my part. So, I went with Medicare and my regular insurance which is GEHA (Government Employees Health Association). I also get their dental program. I have never had a problem other than a couple of blood tests that weren't covered. My daughter who is on Medical, went with Kaiser. She likes it, but a lot of people don't. I do pay a lot, but since it is a PPO. I can go to any doctor without a referral. To me that alone is worth the money. As one doctor told me. "Dear, you are golden, you can go anywhere." Too, I don't have to wait for my family doctor to give me a referral. If I ever get really down on my finances, I will switch to a HMO, but as long as I am the least bit able I will stay where I am. I have no co-pay when I go to the doctor.

Good timing for this subject! I turn 65 in November, so can call the 1st of August to sign up..... for what, I am with everyone else in the "unsure boat".

I had no idea what Medicare was all about when I spent two years taking care of my parents. I (they) never got a medical bill during those years, which included multiple trips to the ER, cancer surgery, pneumonia, re-hab, and hospice care with skilled nursing.

When I turned 65, I decided it was worth it to have the kind of coverage they had. I figure I'll probably be too frail some day, as were my parents, and my caregiver(s) would have one less headache without having to worry about Medicare. I also figured I might end up with a chronic condition (who knows what the future holds?) that requires multiple hospitalizations -and I don't want to be fretting about whether to get needed medical attention because of money worries.

So I opted for Original Medicare, parts A & B, and a supplemental (Medigap) plan. I chose supplemental (Medigap) Plan F (which is just like Medigap Plan G - only G has a small deductible and F has no co-pay or deductible). I chose United Healthcare as the underwriter - through AARP - for my Plan F supplement. Every healthcare provider I've been to immediately recognizes my coverage (Plan F is the most popular medigap plan) and knows the bill will be paid for. They never ask for copay S or deductibles (or full payment) upfront.

I opted against Medicare Advantage plans because their networks, copay, deductibles, etc, change too frequently.

For Part D prescription coverage, I kept my retiree benefit plan, as it's certified under Medicare. I still pay co-pays for several drugs. Without that retiree coverage, I'd probably have to evaluate Part D plans every year to find the least expensive in terms of the particular drugs I take.

Always plan with the future in mind, knowing health issues tend to get worse as we age. A more inexpensive plan now may not work in the future and the "open window" to get the best insurance for future needs will be closed by then.

Just my thoughts. Good luck!

Contact your local Council on Aging and see if there is a SHINE (Serving the Health Insurance Needs of Everyone) program.  They have people trained to review what your insurance needs are and what plans might best fit those needs.  It is a free service.

I don't recall if I'm allowed to mention specific names, but I went with Boomer Benefits and have been very happy with them. They clearly provided information about all the options and the advantages and disadvantages of each company and plan, and I ended up getting a MediGap Plan G which should cover most costs and allows consultation and treatment essentially anywhere, with even a bit of overseas coverage. I believe in insuring against disasters rather than inconveniences--a charge of $500 isn't comparable to one of $150,000--so I wanted to have a plan that would minimize the possibility of a major out-of-pocket expense if my health should fail or I get into an accident.

Husband and I opted for only Medicare Part B, $134/mo. There is a deductible, and a 20% copay; BUT Medicare controls the amount providers can charge, so you may be surprised that (actual example) a doctor visit billed at $108 is adjusted down by Medicare to $74.55. Medicare paid $59.66 of that, so the visit only cost about $15.
My husband had the same surgery twice--once before Medicare for about $8000 with cash discount, once now on Medicare for about $600 our cost.
Most PCPs and specialists accept Medicare assignment, so they have to accept this. I'm unsure about mental health professionals, but my inclination would be to ask them for their cash discount rate and pay as I go.
We are mostly healthy, and our drugs are only $40 a year each at Walmart, so we didn't get part D. Yes, there's a premium increase if you need to sign up for it later, but we figured we could take that small risk to save the monthly premiums now.
The advantage plans tell you they are 0 cost, but you still have to pay the $134/mo. for Part B. And, they are PPOs, so not so good if you're snowbirds.
We are members of a health-care sharing ministry also, which will help us with possible catastrophic expenses. Medi-share is one that offers a reduced cost for Medicare-covered members. We belong to Samaritan Ministries, and they covered our pre-Medicare surgery. We didn't even submit the Medicare-covered one for reimbursement.
I still get the marketing phone calls, too. What a pain!

Try to find a Medicare specialist insurance broker. They do not sell companies because they only work with Medicare.

You will have deductibles no matter which way you go. My dad has a 183.50 annual deductible which is all used on his prescription copays. From my understanding, this is the deductible that everyone pays.

Advantage plans have a 4,000.00 deductible, co-pays and co-insurance amounts and once you go this route, you CAN NOT switch to a supplemental plan, ever! Unless, you move to a different state and they cancel you.

There are many tiers of supplemental plans, ie plan A, plan b, etc. When I read all of the information and looked at coverage, copays etc. I choose plan g, it pays everything that Medicare does not. I used a different company for drug coverage, you can have the agent input all of your meds and compare copays, which for my dad are all because of the 183.50 annual deductible. After June he gets all of his meds for free. (No additional charges I should say, as he pays 27.00 monthly for the insurance.)

He had an advantage plan and because of his medical condition thought it was great, 10.00 monthly for scripts, 10.00 in network dr visit, then he traveled and ended up with a 100k hospital bill that they would not pay one red cent for, out of network = no insurance coverage. Oy vey.

I was fortunate that the hospital social workers supervisor was kind enough to give me a card for a Medicare specialist. I highly recommend this route.

My dad pays monthly premiums on top of Medicare but as of today he has never had to pay anything beyond the 183.50 deductible and he has been in the ER 2xs, 1 heart surgery, 2 hospital stays and monthly visits to a cardiologist and a nephrologist not to mention the PCP, labs and tests. He would have already, this year, paid more out of pocket expenses on an advantage plan then his entire year premiums for his supplemental insurance will cost him.

Please look carefully at everything each offers and ask lots of questions. Nobody ever told my dad that he could not go to a supplemental once he opted for an advantage plan.

Let us know what you find out.😁

Im in the same boat as I turn 65 in October. My brother who was a Doctor is 67 and he says he really likes Medicare and he picked Mutual of Omaha for his advantage. I am also confused a bit, so I looked up SHIP in our state and there are consuling sessions I plan to go to in August. Our city Senior center has once a month sessions to go to to learn, so I think this would be best to go and meet with an expert. I too use to be healthy but one day at work my colon ruptured and it was a life threating event and have been cautious since. Having an ostomy opened up my eyes that good health can change almost instantly, so having good insurance is critical to keep from loosing your savings overnight.

Ahmijoy, some more thoughts here. All of your options require you to pay your Medicare premiums AND the premium for the plan you select --- Advantage or medigap. Then you pay for medicare D in addition to that. Dental would be separate and an additional premium. For me, the big issue is the out of pocket maximum I would have to pay. Medicare alone does NOT have an out of pocket Max (OOP). So-o I would encourage you to pay attention to that item.
Your good historic medical care needs is not an indication of future needs. Especially, if you are unable to get needed care due to caregiving responsibility.
Every state has SHIP counselors (state health insurance plan). They provide (for free) assistance in choosing appropriate coverage. And they explain the choices available to you. I'd suggest you contact them to assist you in understanding all of your options.

My major beef with Medicare is that, as the defacto Medical Insurance Plan for older people - and it's not a freebie! - a great many providers don't accept it, and don't have to! Just try to find mental health providers with Medicare? Good luck! I think there should be a requirement that every practice/clinic, etc., set aside a certain percentage of the practice to accept Medicare patients. By spreading that universally across all providers, the "pain" of lower payments providers receive from Medicare (the excuse they give for not accepting M. patients) would be mitigated/shared across the board. What good is "insurance" if no one wants to accept it? Or - if the only docs who do are potentially just desperate for patients?

Medicare options are really confusing. For one thing, you need to actually read the Medicare booklet that comes... There are certain choices you have to make almost immediately (prescription coverage, for example). Seriously - If you don't sign up for some things within 6 months of becoming eligible for Medicare, you either can't sign up or they hit you with a penalty percentage - forever!

"Basic Medicare" is the plan you will have if you don't opt for Medigap or Medicare Advantage with an insurance company. You would submit claims to Medicare and deal directly with them. The coverage would be very basic, and you would still have to purchase dental and/or prescription coverage from a company. Insurance companies buffer you from having to deal directly, and take care of all the paperwork, etc. What people may not realize is that Medicare is paying those insurance companies for your basic coverage (at least with Advantage plans. I'm not as familiar with Medigap programs)... You are paying a premium to the insurance company which adds some benefits to the basic Medicare coverage, and is also more convenient. However, you will still hear the constant refrain of coverage “within Medicare guidelines”.

Medigap and Medicare Advantage are very different, and you cannot by law have both at the same time! Make sure which coverage you want, because otherwise you might not be able to change without penalty or at all. (If I remember correctly, Medigap insurance can be purchased when you first become eligible for Medicare, with no restrictions. But if you wait a certain period of time, it changes to whether they want to cover you – whether you meet certain standards/qualifications – and you can be denied coverage.

Next, all Medicare Advantage plans are not the same... Some offer low to zero premiums every month - and you think you're in heaven... That is, until you need coverage, and then you pay - and pay - and pay! Read the fine print of the policy! There are also hidden issues. Example: The first year I was eligible I chose a company MODA (don't know whether they're available generally or only in my area?) Their monthly premiums were higher than some other companies/options, but the coverage was better. Ever since I started dealing with my Mom's ongoing issues I've seen a counselor, until recently every week. My co-pay with MODA was $30 for mental health visits... AARP/United Health was constantly advertising and being touted as best, so the second year I switched to them. "0" copay for primary doc, $25 for Specialists... and, also I quickly found out - $45 copay for mental health visits (which certainly wasn't prominently disclosed). I ended up paying $60/month more for my counseling with AARP/United Healthcare. Besides that, they were much harder to deal with in general, and their pharmacy plan wasn't as good. I've switched back to MODA and am much happier.

Dental insurance is another issue... You can opt to add dental coverage to your Advantage plan... (MODA uses Delta Dental, which has been a really good plan) AARP's plan was different, and was actually a "rider" of sorts... With dental insurance, the kicker is that you HAVE TO KEEP IT CONTINUOUSLY - even when switching companies - or you are severely penalized for a long period, during which they won't cover most major issues. (Again, I had trouble with AARP because they couldn't/wouldn't give me proof of dental coverage to pass along when I went back to MODA. It took me 3 months, and a threat to go to the Insurance Commission, to get the needed proof from them.)

Bottom line: shop around, read the fine print, READ the Medicare booklet (pain in the fanny, but...), ask questions, and don't let some insurance salesman steer you into a plan you don't understand, need, or want. If you talk with Insurance company salesmen, understand they are pushing specific plans they offer, and get a commission for. Purchase Prescription coverage (Part D) right away, don't wait until later!

Our supplementary is free for my husband and I and we have a 50.00 deductible and no co-pays. But before I got married I had advantage and it was a disaster for me because of the drug coverage I had to accept. The formularies are very restrictive and I was paying over $800.00 a month for prescriptions. I had a United Healthcare Advantage plan. Glad that nightmare is over.

You better check Medicare Advantages again. When they started they were HMOs, now I think they are PPOs. Yes, you pick your own doctor but if you use the "in network" doctor you save money. Then, you have to where you will get the best deductables. Some have deductables you will never meet if you don't use a doctor regularly. Then, can you use the supplimental out of state. Medigap does not have prescription plans. But, you can travel out of state and be covered. My husbands employer allows us supplimental thru them for a small deduction from his pension. But we have to share costs. As did my Mom with United Health thru AARP. This means that after the 80% Medicare pays there is 20% that the supplimental may pick up. Lets say Medicare pd $80 out of hundred leaving $20. The supplimental pays $10 my "share" being $10. The bigger the deductable the less you pay for the insurance. It takes a lot of research looking for the ones that meet your needs cheaply.

I’m in the same place you are. I turn 65 in September and frankly, Medicare does not impress me one bit. I too do everything I can to stay out of the hospital, including suffering all weekend waiting for Monday morning so I can see my doctor, rather than go to the ER. The last hospitalization I had was in 2000. But you never know when you’ll need it (insurance) because my last illness came on suddenly and I had to pay some deductibles for tests, procedures, etc. I’m going to miss my current insurance because even if I didn’t use it much I had it in emergencies.

The best thing about Advantage is you can see whatever doctor you want where you want. My doctors are across a state line and the doctors in my state are quacks. So I’ll be going to ‘off limits’ doctors if I don’t figure this out. To sign up is confusing!

So I feel for you. That’s my story.
So Medicaire Advantage should be the one for me.