Don’t Make These 5 Costly Medicare Mistakes

Category: Health Issues

July 28, 2015 — There is at least one good thing about getting to the ripe old age of 65 – you are eligible for Medicare! It pretty much removes the worry of finding health and drug insurance coverage, and you get this benefit at a very low cost. But if you make some of these common mistakes, you might not be eligible for it when you want it, or it might cost you more money than it should.

We think this article will be useful for people who have not yet signed up for Medicare as well as those who are already in the program. It is part of our series on Medicare and health care insurance. See the bottom of this page for links to the rest of the series.

But before we launch into the worst Medicare mistakes, here is a tiny background about Medicare:

What is Medicare, and who is eligible?
Medicare is health insurance for people 65 years or older, under age 65 with certain disabilities, and any age with end-stage renal disease (ESRD) or Lou Gehrig’s disease. Medicare has four parts — Part A, which is hospital insurance, Part B, which is medical insurance, Part C, which is Medicare Advantage Plans, and Part D, which is Prescription Drug Coverage. You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years.

What is the difference between Medicare and Medicaid?
Medicare is a health insurance program that is available to eligible people over 65 and a few other individuals suffering from special illnesses. Most people qualified for the program by paying Social Security and Medicare payroll taxes. Medicaid is a joint Federal and State program that helps pay medical costs for some people, irrespective of age, with limited incomes and resources. Most of your health care costs are covered if you have Medicare and Medicaid. Medicaid programs vary from state to state.

Biggest Medicare Mistakes

1. Not signing up for Medicare at age 65 if you are not already enrolled in Social Security or still actively working.
If you are receiving Social Security benefits you will automatically be enrolled in Medicare. But if you decide not to apply for SS by age 65, you have 7 months to enroll in Medicare (3 months prior to your 65th birthday, your birthday month, and 3 months later). The only valid excuse for not signing up at age 65 is when you are actively working and have coverage in a group plan. If your spouse is covered in the group plan, he or she can also delay signing up for Part B.

The penalties for not signing up on time for Part B are severe. For one, there is a 10% lifetime penalty for every 12 months you delay Part B enrollment (e.g.; a 3 year delay equals 30% penalty). Another major penalty is that if you don’t sign up and then need major medical care, you might not be able to get coverage for a long time. First you must wait for the Jan-March signup period, and even after that the coverage will not start until the following July. In the case of a catastrophic illness, the consequences of not having coverage could be very serious.

2. Not understanding the various kinds of plans, or choosing the wrong kind of plan.
First you have to understand the various Medicare plans (Parts A, B, C, and D), and then choose the right one among them. Part A (hospitals) enrollment is automatic and free for most people. But making the choice between Part B (medical care from doctors, etc.) or C (Medical Advantage) is more complex. Part B generally gives you more hospitals and doctors to choose from, but at a higher cost. Part C offers lower costs and deductibles but more limited choices. For a retired snowbird the choice might be easy – the Part C network choices are probably not available in both your winter and summer locations, so you have to go with Part B. For others it is a decision that will require some thought.

If you are choosing a Medigap policy, which will help you reduce your out of pocket costs, you need to pick the right one. For example some plans might make you pay extra for certain pre-existing conditions, while others do not. It is important to compare different plans against your situation.

3. Missing the deadline signup for Medicare after leaving your job.
As we mentioned you do not have to sign up for Medicare if you are actively working at age 65. But when you leave that job, you have 8 months to do so. Penalties will apply if you do not.

4. Not reviewing your plan choice every year during the open enrollment periods.
Every year you need to review your situation against your coverage. And the time to do that is during the open enrollment period, which starts on October 15 and runs through December 7. For example, is Part C still a good choice for your situation, or is Part B better? Maybe you have moved and the doctor network that covers you is not nearby. Perhaps the cost factor between B and C plans has narrowed. Maybe you can get a lot better deal on your Medigap insurance, or you need to step up coverage because of your changed medical situation. Failure to review your situation could mean that you don’t have the access or the coverage that you need. See our article on “Open Enrollment“.

5. Not reviewing Part D every year.
Part D plans (prescription drug coverage), also offered by private insurance companies, can be be very volatile. Prices and availabilities are largely driven by what drugs you take, or what you might need in the future. The experts caution against putting your Part D plan on autopilot, because if you do you might find yourself paying a lot for drugs you don’t take any longer, or not covered for some you do need.


Medicare videos – a great resource:

We recommend you invest 5 minutes to watch this informative video with Medicare trainer Andy Tartella “The ABCD’s of Medicare.” It is part of a series produced by the Centers for Medicare and Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Another good video is one produced by Kiplingers, “5 Common Medicare Mistakes“. Lastly, this article from the Squaredaway blog has even more Medicare videos worth watching. Spend a few minutes, you’ll be an expert!

Bottom line
Medicare is a great plan and a comfort to millions of Americans over 65. But if you don’t insure you get enrolled on time, or take it for granted down the road, you could jeopardize that piece of mind.

For further reading
FAQ feature at Medicare.gov
So You’re Turning 65: Your Medicare 101 Guide
Topretirements Survey Report: We Like Medicare, Please Keep it Working!“, reports on the results of our recent member survey on Medicare.
What to Do About Health Insurance If You Retire Before Age 65“.



Posted by Admin on July 27th, 2015

64 Comments »

  1. You do not have to sign up for Part B or C if you leave employment after age 65 if you are covered by your spouse’s medical insurance. You can sign up, without penalty, once your spouse leaves employment.

    by LS — July 28, 2015

  2. I struggled with which plan to enroll in – Medicare Advantage (through Medicare) or Medicare Supplement (through a private insurer). Hopefully, I have the names correct because information relating to these two different choices often uses different names for these plans which adds to the confusion in trying to decide which plan/program to choose. After reading the Medicare Handbook from cover to cover, I was still confused. I contacted an agent for Humana. His advice was if you are in relatively good health, go with a plan through a private insurer for lower costs and adequate coverage. If you have health problems, go with a plan through Medicare for wider coverage but more costs. I went with a private insurer based on his advice (even though he was making a commission on my choice, I felt he was sincere in what he told me.) Recently, I listened to a seminar on line in which the speaker was recommending going through Medicare for a plan because there were no limits as to what doctors that you could use (provided they accepted Medicare). So, I am again unsure which way to go. I hope the videos suggested in the article will clarify it for me.

    by Wallace Hardy — July 29, 2015

  3. John thank you for sharing great information

    by Skip — July 29, 2015

  4. If you have questions about Medicare, help is available. There is a ombudsman -type person at Medicare who will answer your case specific question. In the case of Medicare vs Medicare advantage, we chose Medicare Part B as it allows us the most freedom to choose a doctor or specialist anywhere in the country. P.s. I would caution about using an agent from any insurer as they have a vested interest in your selection. Medicare is the best place to go for advice.

    by Sheila Bryan — July 29, 2015

  5. FYI, the Mayo Clinic, one of the best hospitals in the world, does not take Medicare Advantage.

    by Chuck — July 29, 2015

  6. Not yet being of Medicare age, though it looms closer on the horizon than I care to admit, I am very interested in the wisdom that will be shared in these comments.

    Thanks in advance.

    by JCarol — July 29, 2015

  7. I too am very interested in a discussion of Medicare Part B with then having to choose Medicare Part D – drug coverage VS a Medicare Advantage Plan. My employment offers a Medicare Advantage plan for its retirees. It would include drug coverage, vision and dental. My husband’s employment currently only offers a Medicare Part B and D company plan. So, we will have to choose which employer we wish to carry our insurance through… and it scares me to know that I will be making this decision on the available facts on the day we sign papers. Then there is no going back. My husband’s company could also move its retirees into a Medicare Advantage Plan and then…which one would be better?
    I am very interested in anyone’s experience with the Medicare Advantage. It seems it is the future for many employers to cut costs. But, as Chuck posted above, I also have heard that many notable hospitals and physicians are not signing up for Medicare Advantage.
    Many are stating that it is already very difficult to move and get a new physician if you are already on medicare. This seems to only complicate matters more.

    by Marsha K — July 29, 2015

  8. It is true that the Mayo Clinic will not take Medicare with Medicare Advantage as the supplement BUT will take Medicare with a Medicare supplement other than Medicare Advantage. We did not ask about the private insurance supplement option.

    by Sue Cook — July 29, 2015

  9. Two observations.
    (1) If you have an employee-sponsored retiree plan ( mainly for those who worked for city, county, state, etc.), and you plan on leaving it for an HMO or MAP, be aware you may not be able to re-enroll later.
    (2) If you are in a hospital, make sure you are formally admitted as an inpatient, not merely “under observation”. “Under the rules, Medicare picks up the whole tab for the first 20 days in an approved skilled nursing facility for rehab or other care, but only if someone has spent at least three full days in the hospital as an admitted patient. If instead a patient has been under observation — for all or part of that time — he or she is responsible for the entire cost of rehab.” Google “medicare-inpatient-vs-outpatient-under-observation” for details.

    by OldNassau — July 29, 2015

  10. OldNassau is correct on the three full days in the hospital as an admitted patient to qualify for a stint in rehab. However, you cannot demand to be an admitted patient. My Mom was in the hospital and they WOULD NOT admit her as an admitted patient and put her in under observation status. They couldn’t pin point what her problem was. She was scheduled for an endoscopy but they didn’t want to keep her till the next day because they would have had to ‘admit’ her. She was in pain and it was totally wrong because they sent her home without diagnosing her problem. It turned out she had an ulcer on her esophagus from radiation treatments which we found out several days later after the endoscopy. I found the social workers not to be compassionate at all and it seemed their mission to evict my Mom as fast as they could. It is a very ugly process and you will never know how horrible it is till you go through it or witness a loved one suffer with an unknown health problem and be kicked to the curb. Mom had Medicare as her primary and State of CT health insurance as her secondary and she still couldn’t stay according to the social workers.

    by Louise — July 30, 2015

  11. We chose a medicare supplement plan instead of a Medicare advantage plan because we travel a lot and live 3-4 months in Florida and the rest of the year in Indiana. The Advantage option seemed more like an HMO type plan and was limited to the area we live in most of the year. With the supplement option, we are free to use medical facilities wherever they accept Medicare. I have been on the AARP supplemental type N plan for year and a half now and have no complaints. Something like $145 annual deductible and $125 monthly premiums.

    As far as Plan D, I chose one that had free generics for mailorder prescriptions, as I am on several drugs for congestive heart failure. I pay $12/month and haven’t paid a dime more for any prescriptions mailorder.

    Keep in mind that whatever you sign up for, if you are not happy with the coverage, you can always change plans during the annual election period.

    by Bill — July 30, 2015

  12. I have recently been informed I have been dropped bynmedicaid and Medicare. I called Medicare who suggested calling Medicaid. Then I was told to register online. I. Am having such a traumatic experience due to the overwhelming choices and suggestions, explanations, limitations as well as cost. Please help. I am receiving disability benefits (no health coverage). I have a family of 4, one in college. My husband works part time due to handicap.

    by Brenda — July 30, 2015

  13. Re: Mayo Clinic in Jacksonville : hospital does not take Medicare and providers do not take Medicare. Therefore, they can charge up to 15% more of the cost . Some medigap plans will pay nothing if you are not treated at a Medicare participating hospital or by a Medicare provider.

    by Sue Rath — July 30, 2015

  14. Our first 3 years on Medicare my husband and I went with Advantage Plans that were like PPO’s where we paid a co-pay but in general all the hospitals and doctors in our area (Fort Myers, FL) seemed to take the plan (AARP Advantage United Health Care). Then we started receiving letters that in 2014 one by one our doctors AND major hospital in the area were no longer on the plan! We quickly changed to another Advantage Plan with Blue Cross that was regional to our area. That worked for 2014. The more we thought about it though as we are getting older and see other friends getting hit with major medical expenses that it was time to go back to regular Medicare and we did that for 2015 and have Plan “F” – this is the all encompassing plan with no restrictions on doctors, hospitals and we can use anywhere in the US and with some limitations when we travel. So far in 2015 we have experienced no out of pocket expenses and my husband had two surgeries. It is peace of mind to have this type of insurance. One caveat – it will cost you considerably more than the Advantage Plans.

    by Terri — July 30, 2015

  15. Each county in every state has a Department of Aging to help seniors become more informed about Medicare and supplement programs. In Baltimore County, MD, there are Senior Health Insurance Program (SHIP) seminars in the public libraries various times of the year which help clarify the choices that are out there. I attended one of them several years ago and got lots of handouts even though I was not at the age to choose a supplemental plan. The Older Americans Act requires counties to provide this information to seniors and the public. Please contact your county Dept. of Aging office to find out when and where these health insurance sessions are taking place to get an idea well before you need to. It is very informative.

    by JoyceR — July 31, 2015

  16. Terri, can you give an example of what is ‘considerably more’? Can you tell us what one cost over the other? Right now Hub and I are on the Affordable Care Act (Obama care) and it is pretty costly. We are getting the subsidy of $1011.00 per month and it still costs us $495.30 a month plus copays ($30 for general practitioner and $50 for specialists) . Have not had anything major like surgeries so I can’t comment on what those costs would be.

    Hub will go on Medicare in about 1 1/2 years. Another slippery slope to navigate.

    by Louise — July 31, 2015

  17. Louise:

    By considerably more, I meant that the Advantage Plans we were under the first few years we paid zero additional premium. Remember Part B comes out of your Social Security check so I am not including that in these figures. We are paying monthly for Plan F $206.00 for my husband who is 70 and $190.00 for me and I am 68. As I mentioned, there is no co-pay for doctor visits. All the doctors/hospital bill Medicare first and then Blue Cross/Blue Shield gets that information, determines their portion and we get statements from them quarterly. At times there is “an amount you may be billed” showing after Medicare and BC/BS pay but we have never been billed for these amounts because our hospitals and doctors here all accept payment from these two sources as payment in full. Even if we did have to pay the “difference’ most of the time it is so minor I wouldn’t even question it. Hope this information helps!

    by Terri — July 31, 2015

  18. Yes, Terri, very helpful information. So between what is taken out of your SS check (Plan B) for Medicare and what you pay in Plan F it is quite costly too! I have been whining about what I pay but I see that down the road when we are both on Medicare it will be costly too.

    This insurance stuff is very scary and it never goes down in price! I cannot see how future generations will ever be able to afford it in retirement.

    I am so thankful we qualify for the subsidy or we’d never be able to afford insurance!

    by Louise — July 31, 2015

  19. Keep the info coming regarding Advantage Plans VS Supplement. As I said above, my state employment only includes a Medicare Advantage Plan which looks great on paper as long as we don’t move and our doctors/hospital accept it. I am reading more and more doctors and hospitals do not accept it as Terri reported above. My husband is employed by a utility and as of now, they offer their retirees a company plan Medicare Supplement which is the same plan offered to employees less vision and dental. The cost seems comparable to what I am reading can be purchased privately or through Medicare. We will have to choose which employer we wish to be insured with and it is not changeable down the line.

    But…so many unknowns. We could choose my husband’s plan, pay more to have a supplement instead of a Medicare Advantage Plan and then….his plan change and also move to a Medicare Advantage Plan. We would have to go with that OR change to a Medicare supplement..and also, never go back to the employee plan.

    So many “ifs” and “whats” involved. We really want to make the best choice and then know that we will have to be flexible as life changes.

    Appreciate everyone’s comments and experiences. It always answers questions and also creates more that I should be asking!

    by Marsha K — July 31, 2015

  20. Yes the cost of insurance even when your on Medicare is higher than I expected. For a Plan F through Mutual of Omaha our cost per month is $147.00 for me and $132.00 for my wife. In addition we have plan D policies through Silverscript costing $68..00 for each of us. Also have to include $104.90 per month coming out of SS for Part B. Am thankful that I have the Plan F as I had a heart attack in March and haven’t paid a dime out of pocket.

    by Jim C — July 31, 2015

  21. I have read the article several times and some of it is sinking into my head.

    Part A (Hospital) is free for most people who have worked 10 years.
    Part B (Doctors, medical care). More costly. More availability than Part C but higher cost.
    Part C Medical Advantage (Doctors, medical care). Lower cost and deductibles but limited choices.
    Part D (Prescription drug coverage)

    I have questions. There is no mention of Plan F in the article above. What is Plan F? Is it Medigap insurance? How do you get information on Plan F? Does information come in the mail from Medicare? Does this come out of the SS check or do you have to pay this bill directly to an insurance company?

    Part A you get automatically if you already receive SS and is free, Part B or C is deducted from your SS check. How do you sign up for Part D? Does information come in the mail from Medicare? Does this get deducted from your SS check or do you have to pay this bill directly to an insurance company?

    Thanks!

    by Louise — August 1, 2015

  22. Great info and real specific examples! Keep it coming and thank you Louise for digesting it all – so confusing! My question is which of the costs are the same in all states, and which vary by location? Thanks all!

    by SandyZ — August 1, 2015

  23. I recently went through the process of deciding what Medicare plans to choose.

    I had heard it was confusing so I visited the local senior health care advocate. I believe every state has this and it is free. In FL it is called SHINE. The lady gave me a booklet issued by Medicare called Medicare and You. She went through the book and explained the basics. Having someone that could answer my questions was very helpful. She also went on the net and showed me how to use Medicare web site to get info on the various plans. She also put my prescriptions in the Medicare web site to show how to price out the Part D plans.

    I found the Advantage plans to be cheaper but decided to go with traditional part A and B plus Medigap. As others stated previously, it seems like less Dr. are participating in Advantage plus I found out that the ACA changed the reimbursement formula resulting in less reimbursement for these plans (the Feds give the Advanrage private insurers $ based on a formula, the intent being to equal what Medicare would typically pay to cover the person under part A and B). Many people who analyzed the new formula said it would make the Advantage plans unaffordable once fully implemented. In 2014 Pres. Obama signed an executive order stopping the cuts to Advantage plans but this could be rescinded at any time with the stroke of the pen. So I decided the cost savings was not worth the risk of the potential future cost increase.

    The Medicare web site has cost info. on the various Medigap policies but it is just listed as a range in cost along with a list of insurers. It is left to the individual to call the companies to find out their cost. After several frustrating attempts at this I found a company on the web that said they had the cost info. by company already compiled. It really burned me up to have to pay $99 for thus info but I’m glad I did because I found a high deductible plan F for only $55 a month, which saved me about $30 a month on the cheapest that I had found in my own. The web site is Weiss Ratings. Note that Medigap policies are all standardized by the Feds so all you are comparing is price. You’ll also want to consider if the Medigap policy is issue age rated or attained age rated because this has an effect on how fast the company may raise its prices in the future. (Issue age rated is better)

    Part D can be researched to completion on the Medicare web site. You can put your prescriptions in the site and it will tell how much your annual cost will be vs. the provider. I choose the Humana Walmart plan for $15.70 monthly.

    One concern I had was: it looks to me like you get one chance to sign up for a plan without having to go through underwriting (can be declined coverage due to current health problems) and without restrictions based in preexisting conditions. This time is during initial enrollment. So it was important to me to pick what I thought was something I could go with for the long haul.

    by RTB — August 1, 2015

  24. It’s so important to stay as healthy as possible so even if paying for health insurance and having Medicare, I need to use it as little as possible. It will be even more expensive if I have to use it. I’m in good health, but I’m taking steps to get in better health because this is the one critical variable, even more than money, that will determine the quality of my retirement. Eat healthy, eat less, be physically and mentally active, laugh lots.

    by Elaine Cubbins — August 1, 2015

  25. Louise,

    I believe the “Plan F” being referred to is Medigap insurance – it is offered via AARP. You can go to their website and get information on the cost per plan which is based on the area you live in.
    https://www.aarpmedicaresupplement.com/medicare-insurance/find-a-plan-download.html

    Plan F was the recommended plan for us by our Financial Advisor.
    When we reviewed the plans, we definitely agreed this was the best plan for us.

    You can either pay the Medigap insurance via payment booklet coupons (and personal check), or
    you can save $2 monthly by having them deduct it from your checking account automatically on a date you choose.

    Part D you can sign up from on the medicare site – you can input the medications you take to get a quote of what it will cost you. You also pick, the carrier for your Part D.
    https://www.medicare.gov/part-d/

    Part D, once you sign up, is also deducted directly from your SS check. The earlier you sign up for the Medicare plans, the easier it is to have it all work seamlessly. (3 months in advance)

    Hope this helps.

    by Linda — August 1, 2015

  26. Another perspective – I am 64, have been enrolled in Medicare for ten years because of disability (multiple sclerosis) and I carry Plan F through United Healthcare as a Supplement to Medicare. I currently pay $235.40 per month plus I pay for Medicare Part B and Part D. Since leaving my (very good) job, I have lived in four states and the premiums for Plan F did vary by state. California was the most reasonable (San Diego County) followed by Massachusetts. Arizona was higher and the current state (Alabama, my wife’s home state) is the most expensive for Plan F and the state with the fewest options for a medicare recipient. When my wife finishes her teaching work, we will probably settle in a northern state that provides good access and quality healthcare.

    by Thom — August 1, 2015

  27. Louise, Plan F is a Medigap policy sold by private insurers. There are many other letters assigned to other plans with different levels of coverage (Plan A,B,N more) but Plan F is the best (and most expensive). But I have no co-pays or deductibles for doctors and hospitals and the freedom to choose any doctor or hospital that accepts Medicare assignment (that is the rub, because if a facility like Mayo Clinic does NOT accept Medicare payments because they are too low, then you need to plan in advance what you will do). I do know that Plan F for me covers ‘excess medical’ but I am not sure if that would mean that they pay the extra billing that would come from a place like Mayo Clinic.

    by Thom — August 1, 2015

  28. Louise and Sandy,

    You are correct, Part A is the hospitalization and that is no cost to those on SS or those who have worked at least 10 years.

    Part B is the medical portion, ie, doctor’s visits, lab work, radiology, etc. You pay for that on a scale based on your income but for under I believe it is $88,000 per year, it is $104.00 per month. This can be taken out of your SS monthly check or if not on SS yet, you can be billed or have it debited from you account. I believe the cost for this is identical nationwide.

    Part C is medicare advantage. It generally provides more coverage than Part B but limited choices relative to your doctors etc. Not all that familiar with it as I opted to go with B.

    The Plans (whatever letters are utilized including F & G) are medigap insurance and piggyback the Part B in that it will pay the 20$ deductible of all Part B bills, some will pay the $147.00 annual Part B deductible, some will pick up what Part B was paying when those benefits are exhausted, and it also pays the Hospital deductible of Part A. The costs vary from state to state as do the benefits of each plan. The better the coverage, the higher the cost. You should do your research carefully by requesting info from insurance carries such as AARP, Cigna, Anthem, Bankers Life, et al) or from the independent insurance brokers themselves. If you are approaching 65 I expect you would be inundated with phone calls and promo literature from them. You pay the insurance companies direct.

    Part D is the Medicare Prescription Drug Plan. I found this to be the most confusing and aggravating. Again, insurance carriers have the Part D so you should get the info from them as to what they cover. Each one is different as is the cost and I expect again it would vary from state to state. Research carefully relative to the deductibles, how much they pay for a drug and check to see if your drugs are on the formulary. My research shows a lot of brand name drugs are not included and thus will cost you out of pocket. It’s the gov’t’s attempt to put everyone on generics. You pay the insurance company direct either via credit card deduction or automatic withdrawal from your checking account or monthly check.

    Hope this helps. Good luck!!!

    by Susan — August 1, 2015

  29. Seems like A, B, and D plus purchasing C from the government or E/F — private medigap coverage) are necessary for full coverage of hospitalization, doctors and medicine. Whew. Got it. I’m still in early 60s, and trying to develop a retirement budget. I can figure out A & B. I’m concerned that C won’t meet my needs, so I anticipate wanting to buy E/F Medigap coverage plus D from a private insurer. It’s very difficult to find any info about actual costs of policies for budget planning. I appreciate the info that is being shared very much.

    by Kate — August 2, 2015

  30. Kate, you can call insurance companies (AARP, Anthem, Cigna, Bankers, etc) and ask for a medigap package (the Part B supplement) or go online to any of their websites. Costs are zip code based and even though the benefits for the Plans are identical across all insurance companies, the cost will also vary depending on which insurance company you go with. Also some insurance companies do not offer all the Plans. Rates will go up each year and some go up more than others so factor increases in. Rate of increase can’t be determined but the way it’s going I’d expect it to be substantial. You can also ask for packages on their Advantage Programs if they offer it and their Part D plans if they offer that. I would give a bogus birth date as not sure they will provide the information if you are not close to 65. Good luck.

    by susan — August 2, 2015

  31. This information was very helpful and thanks to all who contributed!

    Very good information to newbies trying to prepare for the next phase of retirement!

    My question is if you don’t buy Part D (prescriptions), does Part B or Plan F pay anything towards prescriptions through their plans?

    It would be nice if the article above was revised to compile some of the comments here to help clarify what is written in the article. The commenters have really helped me understand this so much better than the original article!

    by Louise — August 2, 2015

  32. Louise,
    My Plan F policy through Mutual of Omaha did not include plan D drug coverage so I purchased a separate policy from Silverscript. I’m not sure if Plan F policies through other insurance companies include plan D drug coverage. From what I’ve gathered all Medicare Advantage and Medigap plans must meet certain criteria established by the government.

    by Jim C — August 2, 2015

  33. I heard that there is a $2500 cap on prescription plans – is this true?

    by Patty W — August 3, 2015

  34. Just to clear a few things up,

    Part A covers 100% of hospital insurance.
    Part B covers 80% of such things as Doctor visits, procedures, and outpatient services.
    Part D covers medications and prescriptions.
    Part C is called Medicare Advantage which encompasses Part B and Part D. Also can include things like dental and vision, but limited in geographic area and specific doctors. If you pick this policy, you do not pick Part D or part B medigap insurance.
    Medigap insurance covers the 20% of Part B that is not covered above.
    Depending on your area code, there are multiple TYPES available, type A,B,C,D,F,G,K,L,M,N. Each of these have different types of monthly premium and deductible. Each type is offered by multiple insurance company.

    Something else to keep in mind. You and your spouse do not have to take the same type of Medigap insurance. If you have ailments that require more care, you might pick a policy that pays more with a higher premium. If your spouse does not need much ongoing care, she might pick a higher deductible with low monthly premiums.

    by Bill — August 3, 2015

  35. Very interesting article and articulated to where it’s easy to follow and understandable. Really great follow-up comments likewise!!

    My question specifically regards Medicaid. The article points out that Medicaid programs vary from state to state. Does anyone know which states have more favorable Medicaid programs, and which states have the less desirable plans? I’m sure there are parameters and certain requirements that must be fulfilled first, but I wish there was a good resource, or article, that addressed this topic and exactly what the alternatives will be, depending upon state of residence. I’m asking about this on account of my 92 year old mother who has no long-term care insurance and very limited assets. If anyone could steer me in the right direction, it sure would be appreciated!

    by Jody G — August 3, 2015

  36. This whole Medicare thing is so extremely stressful. I’m not there yet, but will be sooner than I’d like. I’ve been worried about this since I was in my 30s. LOL I hate not having choices and being limited in my health-care decisions and forced to get care from what I believe are inferior providers. Not one doctor I currently see takes Medicare patients, which means no Medicare plan or supplement will be of any use to me. Yet, I have to pay for it. I don’t get the advantage really. Being forced into a program that is limited at a time when our medical needs may be increasing seems crazy. Also, being thrust into a confusing system at this time of our lives almost seems cruel. Right now, the only ailment I have is Medicare, but that could lead to more. I read here trying to understand, but everything I read just tells me that I’m screwed. Looking for a Medicare consultant (fee for service) to help me navigate the waters. If you know of any, please share. Thank you and sorry for the rant, but this is so distressing and I’m scared of it.

    by Ginger — August 4, 2015

  37. Ginger,

    I have used this person to help me make a choice with various Medigap plans. Unsure if that will be helpful to you, but at least you can speak with her, no charge. She did save me money by putting me in a different Medigap plan.
    I live in Greenville SC and we also had to make numerous calls before I could locate a PCP who accepts Medicare. Hang in there and don’t give up!

    Policy Services
    United Medicare Advisors
    866-282-5797 ext. 2008 (desk) | (888) 977-9410
    kara.cook@unitedmedicareadvisors.com

    http://www.UnitedMedicareAdvisors.com

    by Fionna — August 5, 2015

  38. Any insurance company that sells supplemental insurance will have people that can help.

    by Carol — August 5, 2015

  39. Just ran the numbers from lots of research for my husband who turns 65 this year and me in two years. Took me several days – all day. Between the Part B premiums, Part D prescription plan, and a supplemental Humana Part F plan to cover copays and dental and vision needs, the monthly costs to us would be $660 per month! This is at today’s dollars – a modest cost increase would be 5% per year., so by the time I enter the Medicare system, it will be 10% more! We are budgeting $800.00 per month in our retirement budget – the highest monthly cost in the budget. Very disappointing!

    by SandyZ — August 5, 2015

  40. Ginger,
    I’ve been on Medicare for about 6 months and generally feel more secure now than when I was on regular insurance. The monthly cost is less than what I was paying for insurance through my job. In addition it can’t be taken from you like it could if you lost your job. Granted you could get cobra coverage at a very high cost. I had a heart attack about one month after getting on Medicare. I haven’t paid a dime in out of pocket expenses. Don’t think that would have happened under regular insurance.

    by Jim C — August 5, 2015

  41. Well, if the whole mega-vat of worms that is health care administration in the United States weren’t so ludicrously Byzantine (the rules of Calvin ball got nothin’ to match this) the amount of problems such as this article suggests (and countless other similar issues) would be diminished by an incalculable, but very significant, margin.

    The whole system is broke, and each attempt to fix it breaks it more.

    by George Corrigan — August 5, 2015

  42. What everyone needs to understand is the following:

    Advantage is good ONLY in the state you live in. Repeat – ONLY good in state you live in. PERIOD. If you get sick out-of-state; like on vacation ~ All Expenses Come Out Of YOUR Pocket. ALL of Them. Advantage providers, in each state Write their own Drug Formulary which you can NOT research ahead of time. Advantage drug formulary can also change the pricing at any time. If you find this hard to believe; call MAYO or Sloan-Kettering; Stanford Med Center; Mass General;. Tell them you want a 2nd opinion and that you have Name of State ADVANTAGE thru Blue Cross; Humana; Pres. and listen to what they tell you. You are welcome to come; and all expenses are yours personally to pay. Advantage is Fake Medicare. And ADVANTAGE is under the direction of Your State so it is Different in all 50 States.

    I live in NM. 3 years ago i qualified for Disability as I have Blood Cancer. Federal Gov’t said I qualified for Medicare. State NM said no. I was under 65. Federal Law specifically says must be 65. So all i could get was Lovelace Advantage which was bought out by Blue Cross. NIGHTMARE. The games the state plays and the Advantage providers play is a disgrace.

    I am now old enough to get R~E~A~L U.S. Gov’t Medicare and I bought Plan G. All i have is a $147.oo deductible and all other charges are paid. This combination is ACCEPTED at all major facilities across the country. Since I have blood cancer I want a Major Facility like Mayo or Stanford.

    There is no STATE requirement to put up ONE website, that tells state residents the Insurance Companies that provide Supplemental Ins. plans, i guess E thru N.in your home state. This is also a nightmare. Lots of insurance companies got into the Supplemental Plan business and have dropped out; been bought out, etc etc etc. The only way to go since this is your health, is to go with an A+ Rated Carrier, like Mutual of Omaha. You can google “A Rated Medicare Supplement Name of Your State.”

    Plan D – Meds was a snap. The U.S. Gov’t control this on the Medicare website. When I plugged in New Mexico, i had 6 choices. you may have more depending on state you live in. But this was easy; controlled; clear; no bogus info.

    The plans, or Supplements need to also be controlled so we are not wading thru tons of paper; fielding hundreds of calls [seems everyone knows when you turn 65].

    Yes – someone posted earlier; lots of independent docs will not take Medicare. All hospitals associated with a Medical School; all State Hospitals; and the MAJOR facilities do take Medicare. I would love to go see a doc at Mayo in PHX or MDAndersen in TX.

    No one knows when they will get sick. And how sick you can get. And how much high profile meds; like for Parkinson; Cancer; Stroke; etc – what these drugs Cost/per month. Better to have more insurance and not need it; than buy too little and be told you can get the $250,000 treatment ~ but all will be your personal expense. Even 20% of some of these cancer treatments, specifically , in hundreds of thousands of dollars. If you sign up for a lower Supplement and do learn you have Parkinson; Stroke; any form cancer; and you decide THEN ~ you want to upgrade your supplement to F or G; any carrier can deny your application to upgrade. If you are accepted, you know you will have a very expensive premium and/or large deductible. I could not get health insurance because of pre-existing conditions. I was considered indigent and only facility i could go to was the hospital associated with the NM Medical School. I know what i am talking about when it comes to health care – both a lack of; pre-existing conditions; monthly premiums no one could pay and also pay for doc visits; treatments; chemo meds; food; rent; utilities;

    And when you want a 2nd opinion or Surgery by one of the best in the country – you H~A~V~E to have Medicare With Supplement F or G. If you have Advantage, you are stuck with the “best doc” in your State. Think about it…

    by Arlo — August 5, 2015

  43. This Comment came in from Daniel:

    Sandy yes, we were very disappointed when we ran the numbers and took care of parts B and D additional coverage for copay etc and prescriptions through an insurance in my wife’s school system and we will pay $544 each per month for the coverage. Under the other plans you never know what you are paying for and can not depend on what drug you will be able to have covered. I used the “calculators” and in many cases got strange results requiring a phone call to the system to tell them that their calculator told me that my wife’s annual cost for prescriptions was coming out as $ 108,000. A few twerks later it was between $3,500 and $ 8,000 depending on how each company calculated the monthly plan costs and how they handled your specific prescriptions etc. We went with the school’s plan because there was far less guessing as to what one would get based on your needs as you grow older. We hope we made the correct decision because it starts in September for us. We will see what it all looks like in the world of retirement health care next year!

    by Admin — August 6, 2015

  44. We can spend hours calculating, but sadly things can change both our health and insurance itself. This blog is great. I figure as much research as possible helps, but tomorrow is another day. Life can be a challenge.

    My Medicare plan is through my prior employer (state of NC)and I had a choice of Humana or United Healthcare advantage plans. Prices were the same for out of state as in state for either plan, but are still an advantage plan. I presently live in VA. But like anything else, it can change. Just got a card in the mail watch for enrollment material…so who knows what that will bring. Right now I do not take any prescrip…that’s the good news. But the bad news is I am planning for a pig in a poke. Trying my best to stay healthy, but tomorrow can bring anything.

    by elaine — August 7, 2015

  45. Thank you Jim and Fionna for the information! I plan to read this whole string and make notes to move forward on this. Again, many thanks.

    by Ginger — August 8, 2015

  46. Elaine- I too am a state worker but worse…Illinois. my plan offered is also an advantage plan. It says in or out of state but retirees are telling me that it is very difficult to find a dr that will take medicare advantage out of the state issued and still difficult to find a dr who will take new Medicare patients period if you move…

    by Marsha kerschke — August 9, 2015

  47. Marsha, that is my fear. Of course, in VA, I have not yet had any trouble with NC insurance. Maybe I just cannot go that far. I wanted to retire to NC, but so far that is not happening.

    by elaine — August 9, 2015

  48. I just began using A, B, and Humana Advantage PPO. Not wanting to change my primary care physician was the deciding factor due to Humana Advantage being the ONLY MEDICARE plan honored by his office. Hospitals also figured into my choices. Yes, the scenarios are confusing, but, feedback from friends, the Doctor’s staff and a recommended agent, were great assets.

    by CM — August 12, 2015

  49. My employer insurance is $1400 family plan with BCBS with a co pay of 20% all around. This does not include ER physician charges. Now I am reading that $600-800 per person a month for medical expenses when I retire, higher than while working! This will be a major factor on relocation for us as we didn’t plan it was so high priced. Thanks for the facts Arlo.

    by DeyErmand — September 10, 2015

  50. Thought this would help others:
    1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,180 deductible before it covers anything.
    2. Plan K has an “Out-of-Pocket” yearly limit of $4,940 (in 2015). After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
    3. Plan L has an “Out-of-Pocket” yearly limit of $2,470 (in 2015). After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
    4. Plan N pays 100% of the Part B co-insurance, except for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that don’t result in an inpatient admission.

    by DeyErmand — September 10, 2015

  51. Also this was informative for me.
    Medigap plans are standardized in all but three states. (Massachusetts, Minnesota, and Wisconsin have different options.)

    There are 10 standardized Medigap plan options currently available for purchase in most states. Each option is referred to by a different letter: A, B, C, D, F, G, K, L, M, and N. Every plan with the same letter has the same benefits, no matter which company you buy from. That means Plan A from one insurance company includes the exact same benefits as Plan A from a different insurance company. The only difference is price and who is providing the coverage.

    by DeyErmand — September 10, 2015

  52. DeyErmand,
    Both my wife and I have a plan F through Mutual of Omaha. Total cost for both of us per month is $279.00. This plan does not have Part D so we pay an additional $136.00 for Silverscript. Lastly is the $210.00 that comes out of SS every month for Part B. Total cost per month for the two of us is $625.00 per month.

    Actually the Plan F has very little deductable. I had a heart attack in March 2015 and spent 2 days in ICU. I did not have any out of pocket expenses but total billing to Medicare was over 50 thousand dollars. Follow up office visits to the Cardiologist had zero copays as well.

    by Jim C — September 11, 2015

  53. Ginger
    I don’t know what state you live in I am in NJ and have all the same Drs. At a great hospital Morristown they all take Medicare..
    I don’t have the Advantage Plan not a fan of HMO’s…I keep hearing this some states I believe like Fl.
    Joy

    by Joy — September 12, 2015

  54. Got to talk with the MIL today. She says she pays out $104 each month from her check, then she has 20% co pay if she is admitted to the hospital. She goes to a Catholic hospital that will let her write off so much if not all of the 20% co pay by income. All the hospitals have this she says and base it on your income and set up payments. They do not pay for Ambulance and she has a $10 co pay for her family doctor. She has a $500 co pay for a new specialist first visit, then it is $45 every visit after that. She has AARP/United Health Care complete PPO and can use it out of state only at the ER. Her prescriptions cost her around $4 each. Generic, full price if not. She has even checked into assisted living/nursing home coverage. The minute she would move to one of these facility, she can change her medical insurance to cover it all. So she says there is no need to pay for what she doesn’t yet need. She picked what would cover in home health care, and at home rehab, should something arise. She has a separate checking account and deposits $204 each month into it, and only uses it for medical bills/pharmacy.

    by DeyErmand — September 12, 2015

  55. Joanne sent in this question:
    Have any of your readers mentioned having problems with Medicare coverage if they are living in two states (snowbirds)? I have been hearing stories that “NJ won’t take Florida Medicare” etc. thank you!

    by Admin — November 11, 2015

  56. Good question, because I had a relative go from Ohio to Tenn where his daughter lives, just this past summer, and they stabilized him in the ER but didn’t admit him because of his Medicare and Medicaid insurance. He thinks it is because it is a HMO not a PPO policy.

    by DeyErmand — November 12, 2015

  57. As far as I could find out all Medicare Advantage programs (part C) are only valid within the state you reside. Supplemental Part B programs are valid along with the rest of Medicare Part A & B in any state.
    Another thing to keep in mind is Any Medicare is not valid outside the US. If you travel abroad or on cruises to the Caribbean, ALWAYS get travel insurance that has medical coverage.

    by Bill — November 13, 2015

  58. I have an employer retirement advantage plan and the location is not a problmem so far. But finding a doc that accepts new Medicare patients can be a challenge in places like FL and I guess elsewhere

    by elaine — November 13, 2015

  59. Kathleen sent in this comment: My older sister took care of our mother for 9 years (she had a Alzheimers). My sister was on a waiting list for respite care for years. 9 months before our mother passed, she was put on hospice and, ironically, that was the same time her turn came for respite care. I highly recommend you check out with the local organizations, and ask her doctor, since she can’t leave the house, to put her on Hospice. My sister still took care of her in her home while she was on hospice until she fell and broke her hip. (At that time she couldn’t lift her to care for her… then she went into a care facility.) But with hospice my sister did go on vacation. Where she is located in Northern Indiana, they have a full bed & care facility so that family can take time off, up to a week at a time. My sister had been basically locked in with Mom for 8 of those years… (the rest of us live out of state and across country from her). She desperately needed some time away. I don’t know if you have support or not, but this is an option. Many people don’t know that these things are available.
    Each state is different, but you can be put on as a family member care giver and be paid… at least in California. Again, I highly recommend you contact local agencies – with Medicare she should have a case worker – she should know some avenues to pursue.

    by Admin — February 24, 2016

  60. These recent comments were moved from a different Blog for further discussion:

    This is for Kate. My mother cannot be left alone and she doesn’t qualify for Medicaid so I can’t really work you see. Even if I could find a job at my age I would have to pay for her receiving care and I wouldn’t be able to save any money for my retirement. She owns her own home so we are planning on selling it or doing a reverse mortgage. I am the only other family member and we don’t belong to any churches anymore. She is not able to leave the house so I can’t utilize Adult day care either. I am doing the best that I can and try to make her as comfortable during this time in her life. It just gets frustrating sometimes because my husband wants us to be able to have more time for ourselves. Thanks for responding back…

    by MaryJane — February 23, 2016 | Edit This

    MaryJane – I do suggest that you talk to your state and local elder care agencies, including any Alzheimers groups. They may be able to point you to resources to make things easier for you. If her condition is so advanced that she can’t leave the house, you have additional concerns about getting her medical care. She may qualify for hospice, which would be particularly helpful since that will help pay for her Depends and other care products. (It is a myth that patients have to be at end of life for hospice care. Yes, they have to be evaluated every few months to confirm that they are terminal, but advanced Alzheimers patients can qualify even if they aren’t expected to die within 6 months or so). I am assuming that you have a power of attorney to sell her home or do a reverse mortgage. I’d suggest spending a few hundred dollars on legal advice. Divesting your Mom’s assets at this point can be tricky, even if you are the only family member and assets are being used solely for her care. You may also be able to pay yourself as a caregiver, but there are rules about how to it. (I can’t provide legal advice online – have to add this disclaimer.) My heart goes out to you. Women who are caregivers of Alzheimers’ patients may each have a different story, but we’re all sisters of the heart..

    by Kate — February 24, 2016 | Edit This

    Mary Jane,
    I agree with Kate. My older sister took care of our mother for 9 years (she had a Alzheimers). My sister was on a waiting list for respite care for years. 9 months before our mother passed, she was put on hospice and, ironically, that was the same time her turn came for respite care. I highly recommend you check out with the local organizations, and ask her doctor, since she can’t leave the house, to put her on Hospice. My sister still took care of her in her home while she was on hospice until she fell and broke her hip. (At that time she couldn’t lift her to care for her… then she went into a care facility.) But with hospice my sister did go on vacation. Where she is located in Northern Indiana, they have a full bed & care facility so that family can take time off, up to a week at a time. My sister had been basically locked in with Mom for 8 of those years… (the rest of us live out of state and across country from her). She desperately needed some time away. I don’t know if you have support or not, but this is an option. Many people don’t know that these things are available.

    Each state is different, but you can be put on as a family member care giver and be paid… at least in California. Again, I highly recommend you contact local agencies – with Medicare she should have a case worker – she should know some avenues to pursue.

    by Kathleen Osborne — February 24, 2016 | Edit This

    by Jane at Topretirements — February 25, 2016

  61. I just turned 65 live in Indiana. I took out a plan G with Aetna-Continental Life of Brentwood Tennessee for approx. $12 less than Mutual of Omaha. I just hope I made right decision. It’s hard to know when you have no idea from year to year what your premiums will raise to. Does anyone have any good advice about either of these companies. Thanks.

    by F — March 4, 2016

  62. F – I’ve had a Plan F from Mutual of Omaha for a couple of years. Had two heart attacks last year and had zero out of pocket expenses even with hospital costs exceeding $200M. My monthly cost for this plan is $158.00. The plan does not include Part D prescription drug coverage so have to pay an additional $68.00 per month for that.

    by Jim C — March 5, 2016

  63. After trying the umbrella PPO Medicare insurance for a few years with zero premium and all the aggravations that go with this type of plan (doctors and hospitals and drugs constantly being cancelled, changed, etc.) we went with Plan F through Blue Cross/Blue Shield in Jan. 2015. Have not had a single issue with the plan – zero out of pocket – and my husband has been through 2 operations during that time. Every doctor and hospital in our area (Fort Myers, FL) takes this plan. Not as pleased with having to deal with a separate drug plan but that is manageable at $70 a month. Monthly cost varies with $210 for my husband and $197 for myself for Plan F.

    by Toni — March 6, 2016

  64. My husband is retiring in 4 years. When he leaves his job at age 70, we will both need to be insured. I am 13 years younger than my hubby and am in good health. He has type I diabetes, but keeps it under control. I am wondering if it would be better for me to secure my own plan until I turn 65. I am guessing that if I go under his SS benefits he will be charged double? I do like what is being shared about using Parts A & B and getting a Plan F and a prescription drug plan like Silverscripts. I assume you don’t have to pay for Parts C & D in that scenario? I’ve just begun the research process and it is daunting. I appreciate all the info. being shared!

    by Katie — March 9, 2016

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