Lesson #12 – Medicare …. WAIT!! Isn’t this for OLD people?



Medicare!  Nothing is simple until you actually understand it all.

At the age of 64 we start receiving lots and lots of mail from every health insurance company known to man.  It is unbelievable how the insurance industry really wants YOU.  And they know you are 64.  They want not just YOU but your money each and every month.  Health insurance companies that you, perhaps, have never heard from.  Lots and lots of mail.

This happened to me.  I wondered why I was getting all of this unwarranted attention.  I was covered by my husband’s health insurance and I was very happy.  I am sometimes not quick to the draw.  Actually, a lot. Dawning of a new day begins. It’s a shock to the system.

Reaching the real retirement age of 65!  Woo Hoo.  Medicare!  At 65  we are eligible.  Not really something to be thrilled about…this getting older business… but a lot of attention and time must be spent figuring out what works best for you in the health care department.

You can enroll in Medicare prior to turning 65.  I would suggest doing your homework, deciding what plan works for you and enrolling before your 65th so that when you turn 65 you are off and running.  I’m unsure why I found this process so complicated and, believe me, I spent hours reading and thinking about it all.  I mean, I used to take care of choosing the best health plan for my employers, reviewing insurance claims, policies, etc. for them.  I took care of all the attorneys’ claims….can you imagine?  YES, I understand because it is paperwork and WHO in their right mind wants to fill out paperwork?  Everything ‘in the old days’ was completed by hand and mailed.  Glad those days are behind me.

There are two directions you may go.  Enroll in the government Medicare or a private health insurance company also called a Medicare Advantage Plan (much like a HMO or PPO)  It’s important to know what Medicare covers.  I am not writing details but this is an overview only.

The original Medicare covers Hospital-Part A and Medical Insurance-Part B.   The Advantage plan is PART C and it combines Part A, Part B and USUALLY PART D (drugs). Decide whether you want government Medicare or a private insurance Advantage plan.  The Advantage Plans are offered by insurance companies in your area.  You will receive information from AARP, Humana, BCBS, etc. etc. Find out what these insurance companies cover for you.  This is the beginning and Decision 1.  Once I understood it all I chose to be on Medicare.  It was simple once I got it.  With Medicare you can go to any doctor that takes Medicare anywhere in the United States.  So you can be in California and become ill and all you have to do is find a doctor/hospital that takes Medicare.  Most do. It’s more complicated with the Advantage plans.   Some are only taken by doctors in your area zip code or your State.  A plan may be accepted in another State but not all and you  have to find a doctor that takes that insurance plan.  I don’t have the patience.  When we travel I want the peace of mind knowing I can go to a doctor that takes Medicare.  This doesn’t work overseas and that is another story.

Second decision. Drugs. If you choose a Medicare Advantage Plan, find out if the plan includes drug coverage.  Part D.  Most of the Advantage Plans do include the prescription drugs plan.  If the plan does not include drug coverage, check if you may add it.  Some people may like the complete package with everything included.  It all depends on the drugs that you are prescribed.

A drug plan is necessary to purchase if you choose to go the Medicare route like I did.  It is called Part D.  If you don’t take drugs, you don’t need this.  You may sign up next year during open enrollment if your drug usage changes.  Search by price.  I was told that all drug plans are the same and it is regulated.  True?  I think so. So, shop by price but just make sure the drug plan does cover your drug.  If you can take or may switch to a generic you may save money in the long run. Find out how much the drug coverage company charges for your drugs.  If you move, you will have to do this again.  Go cheap..  I pay $0 for one drug per month and the other is not much more.  Your monthly premium with different companies is all over the board.

Now, this is IMPORTANT.  Third decision. Again, if you choose to go the government Medicare route.  You only have one opportunity to choose to take the Medicare Supplement Insurance plan (MEDIGAP) which means you don’t have to pay any out-of-pocket expenses for anything or significantly less depending on which plan you choose.  You do, however, have a deductible.  If you don’t take a plan when you sign up, you will never NEVER never have any other opportunity to sign up for it.  NEVER.  I decided to take the plan because I may not need it now but in the future I might.  I don’t want to pay out-of-pocket for anything including copays, etc.  Don’t miss this.  It is so important.  I feel it is better to pay now for something I may need later.  If you don’t agree then don’t get the MEDIGAP policy.

There are ten MEDIGAP plans to choose from.  Some or all will be offered in your State.  Some of these plans cover 100% of the gap left between Medicare and you.  If you don’t buy into the Gap plans you will have to pay out-of-pocket for care that Medicare does not cover with both Part A and Part B Medicare.  Hence, the name MediGAP.  Some of these ten plans pay most and one pays ALL of that gap so you NEVER have to pay out-of-pocket.  I chose a plan that has a deductible of $147/year.  Paying for the plan that covers 100% of all of the gap was more than what I would pay for the deductible.  That worked for me.

With the Advantage plans Medigap may not be sold to you.  This was a negative for me.  The Advantage plans may gear their coverage to cover gaps so no worries there but to be honest I am unsure.  Ask those insurance companies about this.

Medicare is taken out of the Social Security checks automatically so you will be getting paid less every month.  Easy.  You will have to pay each month for your drug plan and your supplement plan.  I just set it up with my bank to send every month just like any other bill. Every year the premium may increase and it is a good bet the premiums WILL increase every year.  Just accept it and pay.

If you move you have to let the plans know about it to see if they can cover you in your new zip code.  The premium will change for that also.  Accept that too and pay.  Nothing we can do about it.

When there is a move, however, you have a certain number of days to ‘shop’ again.

Easy to sign up.  Call Social Security or medicare.gov.  You can enroll in the Advantage plans, of course, by calling that insurance company.   Either way call several months prior to your 65th birthday.  You will receive the Medicare card/drug prescription card/Medigap card in the mail.  Carry them all with you as normal.

So far I am happy with my choice of Medicare, the supplement and the drug plan.  I have found most of my doctors take Medicare.  Not so with my GYN.  She decided not to take it because the amount of paperwork and the wait time to be reimbursed by the government is lengthy.  I was going to her for over 20 years and I was sad to say goodbye.  She may be getting ready to retire since she is my age.  My deductible has been met this year and I don’t pay anything to anybody for doctor visits.  Nice.

Contacts to remember:

http://www.medicare.gov/find-a-plan for information

1-800-633-4227 Ask for agent.  Help is there.

Most States (Georgia and North Carolina) have people to help.  I can’t speak for other States but imagine there is help. Georgia has great help ‘GeorgiaCares’ 1-866-552-4464.  One on one help.  Invaluable to me.

If you have any questions call the numbers above.  Good luck with this!!  I have made this as simple as possible.  Let me know if I have forgotten anything.  I would appreciate it.



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