The Medicare Thread

[schindlerpiste]

I will be 65 in July. My wife is 8 years younger than me, working, and her employer pays for 80% of our ins. premium. I'm not 100% sure, but I think that I have the option of not registering for Medicare at 65 (w/out penalty) and staying insured under her BC/BS Regent plan until she retires, or is no longer eligible. Is this true? If so, should I forego Medicare until she retires/is no longer eligible for ins. thru her employer?

[Cisco Kid]

Both retired and have OK but not great medical insurance paid by my wife's former employer AND Medicare. I don't know who pays for what but her new knee was free to us. I had to pay out of pocked for my $2000 dental bill

[Nobody Famous]

Medicare does not pay for long term care, so I don’t understand why you are questioning your strategy. It sounds like you are on the correct track.


Sent from my island using TGR Forums

I knew Medicare does not pay for long term care. Am asking if there are any unique or special options, add-ons etc. one should choose, signup for, opt out of, etc. to not overlap with LTC insurance.

Edit: To answer to my own question, no! Reference: Page 56 in this 130 page document, Medicare and You Handbook 2024.

[half-fast]

I will be 65 in July. My wife is 8 years younger than me, working, and her employer pays for 80% of our ins. premium. I'm not 100% sure, but I think that I have the option of not registering for Medicare at 65 (w/out penalty) and staying insured under her BC/BS Regent plan until she retires, or is no longer eligible. Is this true? If so, should I forego Medicare until she retires/is no longer eligible for ins. thru her employer?

Pretty sure you should register, at 65, you don't have to take any coverage if you're covered by your wife's insurance.

[fomofo]

In most important news, the Aetna Advantage plans near me include a 1200 fitness benefit that can be used on a Ski Pass!

Wait, I thought you were a strong proponent of traditional Medicare? As nice as it would be to have someone else pay for a ski pass, from the big picture view of serious healthcare costs and considerations isn't that just another shiny object in the "bells and whistles" category?

[Cono Este]

Wait, I thought you were a strong proponent of traditional Medicare? As nice as it would be to have someone else pay for a ski pass, from the big picture view of serious healthcare costs and considerations isn't that just another shiny object in the "bells and whistles" category?

I am a strong proponent of people knowing what they are doing and why they are doing it.

[Cono Este]

Both retired and have OK but not great medical insurance paid by my wife's former employer AND Medicare. I don't know who pays for what but her new knee was free to us. I had to pay out of pocked for my $2000 dental bill

Keeping that comes down to how much you pay for it. If it’s less than 200 per month, then it’s safe to keep, Mainly because you can defer your medicare open enrollment for ever. So if you decide to drop out of the group plan you will always have a special enrollment period to enroll to buy a supplement without health questions.

[Cono Este]

I will be 65 in July. My wife is 8 years younger than me, working, and her employer pays for 80% of our ins. premium. I'm not 100% sure, but I think that I have the option of not registering for Medicare at 65 (w/out penalty) and staying insured under her BC/BS Regent plan until she retires, or is no longer eligible. Is this true? If so, should I forego Medicare until she retires/is no longer eligible for ins. thru her employer?

You should at least get part a, it’s free. Can help you traveling etc.

The decision to keep your spouses insurance vs getting part b, and buying a supplement, comes down to cost. Not just monthly premium, but out of pocket in your wife’s plan.

When I find retirees like this, if they are paying less than 150-200 for their wife’s plan, I leave them alone.

Drug costs are also important. If someone has a crazy expensive drug it can some times be cheaper on the group plan.


You can a,ways defer your part b, keep other coverage, its when you do drop it, don’t forget you need a cms L564 form for the employer to sign so you don’t pay a late part b penalty. You turn it in with part b application which is the form 40b.

[4matic]

It’s protected article but the crux is not surprising:

“Internal documents show that a UnitedHealth subsidiary called NaviHealth set a target for 2023 to keep rehab stays of patients in Medicare Advantage plans within 1% of the days projected by the algorithm. Former employees said missing the target for patients under their watch meant exposing themselves to discipline, including possible termination, regardless of whether the additional days were justified under Medicare coverage rules.”

https://www.statnews.com/2023/11/14/...investigation/

[TBS]

^^^Our regional hospital system will not accept United Healthcare Advantage plans after 1/1/24. The hospital system said they are too hard to deal with.

[fomofo]

Wait, I thought you were a strong proponent of traditional Medicare? As nice as it would be to have someone else pay for a ski pass, from the big picture view of serious healthcare costs and considerations isn't that just another shiny object in the "bells and whistles" category?

I am a strong proponent of people knowing what they are doing and why they are doing it.

Didn't mean that as a swipe. You have posted lots of good info throughout this thread, and I appreciate that (and I believe others do as well). It's just at this point I can't figure who Medicare Advantage would be good for. It seems nice on the face of it, but unless you never have to use it for something serious it seems like maybe not such a good deal.

Maybe someone who just doesn't have the money to pay Medicare Part B and Supplement/Medigap premiums, but that someone might qualify for Medicaid.

It’s protected article but the crux is not surprising:

“Internal documents show that a UnitedHealth subsidiary called NaviHealth set a target for 2023 to keep rehab stays of patients in Medicare Advantage plans within 1% of the days projected by the algorithm. Former employees said missing the target for patients under their watch meant exposing themselves to discipline, including possible termination, regardless of whether the additional days were justified under Medicare coverage rules.”

https://www.statnews.com/2023/11/14/...investigation/

^^^Our regional hospital system will not accept United Healthcare Advantage plans after 1/1/24. The hospital system said they are too hard to deal with.

There seems to be a lot of negatives being reported...

https://news.cornell.edu/stories/202...e-provide-less

[fomofo]

The country spends about $4.3trn a year on keeping citizens in good nick. That is equivalent to 17% of GDP, twice as much as the average in other rich economies. And yet American adults live shorter lives and American infants die more often than in similarly affluent places. Pharmaceutical firms and hospitals attract much of the public ire for the inflated costs. Much less attention is paid to a small number of middlemen who extract far bigger rents from the system’s complexity.

Who profits most from America’s baffling health-care system?

[liv2ski]

I turn 65 in January. Based on everything CE has ever posted I blew off the Advantage plan my wife has and went with standard Medicare for A & B. Have dental coverage for $35 a month, picked up a cheap prescription plan ($15 a month) as I don't need any legal drugs and went with part G coverage that kicks in after I pay around $2,500 a year for cheap ($150 per month) from Mutual of Omaha. After paying close to $1,100 a month for the last 2 years for similar coverage I am stoked.
Now when is this going to be the default coverage for all in this dumb ass country.

[fomofo]

Good question. If you were to design a healthcare system from scratch you'd have patients on one end and providers on the other, with as little in between as possible. That's clearly quite different from the insane mess we have at this point, but the only way to change it is to first get rid of of the corrupt politicians in both parties, and then legislate something better. And don't forget the unintended consequences of the many employed in the current bloated system, (think bulk of the rank and file, not the thick slab of fat cats at the top), losing their jobs. (A lot may lose them anyway, thanks to the wonders of AI.)

Hmm, AI could easily make monkeys fly out of my butt. Maybe this is the moment to push hard again for universal healthcare? Just put AI in the black box in between, and, problems solved! Yea, that's the ticket!

Back to reality, liv2ski, I guess you're paying $175/month, (or will be soon in 2024) for Part B premium, plus $200 month for the other pieces, for a total of $375/month for complete coverage. That does seem pretty damn good in comparison.

Just out of curiosity, what dental plan did you go with? And, related question, when is dental gonna get into basic healthcare coverage fer chrissake?

[4matic]

Dental insurance is always a ruse. A couple free cleanings and a deductible for procedures. I just buy the half baked plan my dentist sells which prepays cleanings at 50% and discounts procedures 50%. Dental insurance max benefits are never more than $2k and I doubt you get that with a part G rider

[Bunion 2020]

Unless someone else is paying the premiums most dental plans are shit.

[riser4]

Not on medicare yet. I have dental coverage that I contribute to through my employer and the coverage sucks.

[XXX-er]

Good question. If you were to design a healthcare system from scratch you'd have patients on one end and providers on the other, with as little in between as possible. That's clearly quite different from the insane mess we have at this point, but the only way to change it is to first get rid of of the corrupt politicians in both parties, and then legislate something better. And don't forget the unintended consequences of the many employed in the current bloated system, (think bulk of the rank and file, not the thick slab of fat cats at the top), losing their jobs. (A lot may lose them anyway, thanks to the wonders of AI.)

Hmm, AI could easily make monkeys fly out of my butt. Maybe this is the moment to push hard again for universal healthcare? Just put AI in the black box in between, and, problems solved! Yea, that's the ticket!

I don't think a lot of Americans really understand the word " universal " they might want their HC to be cheaper but they don't wana pay for those fat fucks in the south

[Cono Este]

Unless someone else is paying the premiums most dental plans are shit.

100%. No one reads their policies, especially when through work. Better off betting red\black once a yr for $500

I tell everyone that, and I get paid to sell that shit.

When I roll out Mutual of Cono, it will be a dental plan.

[Cono Este]

I turn 65 in January. Based on everything CE has ever posted I blew off the Advantage plan my wife has and went with standard Medicare for A & B. Have dental coverage for $35 a month, picked up a cheap prescription plan ($15 a month) as I don't need any legal drugs and went with part G coverage that kicks in after I pay around $2,500 a year for cheap ($150 per month) from Mutual of Omaha. After paying close to $1,100 a month for the last 2 years for similar coverage I am stoked.
Now when is this going to be the default coverage for all in this dumb ass country.

This is the way to think. If you are going from $1100 a month, to about $350, with a $200 deductible, and no network, and no insurance company bullshit, you should be in heaven.

Why cheap out another 150 and hand it all back to the insurance co?

Unless of course you get a free ski pass! Those advantage plans are speaking our language. Kidding, I think.

* also, if you start on a supplement, then switch to advantage, you get a 1 yr trial where your old supplemental company has to take you back. You also get that trial period if you Join advantage when 65 and first Eligible for medicare.

Realize, I’ve never had a complaint, never will have one, because I recommend the conservative route, even though advantage pays me 2-3x as much. Plus I’ve got a sick mother and seen it work, on both plans. When she got sick, and I moved her back from Maui, the law said I could get her back on a supplement. She’s constant,y in the hospital and I’ve never seen a bill nor do we give a fuck about gym memberships at that point. Unfortunately, we all end up there,

[Bunion 2020]

^^^ A lot of depressing truth in those last 2 sentences.

I guess it is natural to think about death as you age. From 0-45 it comes from trauma, bad luck or poor decisions. 45-65 those and early onset disease. 65+ all of those and the simple wearing out of the parts until your brain goes blue screen and then you are fucked but don't really know it.

[riser4]

^^^ A lot of depressing truth in those last 2 sentences.

I guess it is natural to think about death as you age. From 0-45 it comes from trauma, bad luck or poor decisions. 45-65 those and early onset disease. 65+ all of those and the simple wearing out of the parts until your brain goes blue screen and then you are fucked but don't really know it.

BSOD.

[Nobody Famous]

A client once told be that sounded like the “conservative” choice. And it is, because in most cases, you won’t get another chance to do that without answering health questions, and Medicare Advantage takes everyone. So what’s the hurry?

However, if you feel you understand what the differences are , and know you really don’t want to pay for a supplement, or may cancel it if it goes up, (and it will), then advantage plans have a lot of free shit. And who doesn’t like free shit.

I've been reading, and re-reading, this thread and the Medicare and You handbook. A few points are still not not clear to me:

- The Medigap/Supplement plans are available in different variants, "A" through "M", (page 76 of the 2024 handbook). Are there any rules or implications or limitations if one were to start out a "G" plan (at age 65), and then say 2 or 5 10 years later switch to one of the lower cost variants?

- Still focusing on the Medigap variants, some show coverage for "Skilled nursing facility care coinsurance." How do I poke around for some details to figure out if this overlaps an existing LTC policy?

[Nobody Famous]

...Are there any rules or implications or limitations if one were to start out a "G" plan (at age 65), and then say 2 or 5 10 years later switch to one of the lower cost variants?

I've partially answered my own question.

Yes there are definite implications in choosing a Medigap Supplement plan. The big ones are 1-It's going to be complicated or maybe impossible to switch as the years advance, 2-The "G" plan in particular will be subject to price increases each year driven by several factors (guaranteed issue driving more unhealthy people into it), and 3-It's a gamble picking a plan now that will be the best fit cost vs. benefit wise for the next 5, 10 ... 20 years of life.

Reference for this is one helpful reddit thread, one YT video and one state's insurance commission website with a few helpful tips.

Experience with Mutual of Omaha part G-Medigap Plan
Plan G vs. Plan N

[mcski]

I don’t think you’ve answered anything in a useful way lol.

Also LTC policies don’t kick in until Medicare coverage has been used up.