Medical Insurance

[BrianGSDTexoma]

I got a call from my Doctor office saying they will not take Market Place ins next year. I turn 65 in June. I will have to get on Medicare as soon as possible. Not even sure if I got to find another doctor, PCP to put on my Market Place application? There nobody around here to get. This Sucks!

 

[Up_In_Smoke]

What date are they calling "next year"?

 

[02ebz06]

Read all the Medicare Enrollment "thoroughly"
You have certain time frame to enroll.
If you don't you get penalized.
Makes no sense, but that's the government.

 

[Fueling Around]

You’re drawing SS, Brian?
Supposedly you are automatically enrolled in Medicare parts A & B when you turn 65 by already being on SS.
I would create an online account as soon as possible
I’m not sure how your marketplace works but can you stay on it until end of year and get a BCBS independent plan for 5 months of 2026?
I was fortunate to get BCBS through marketplace

 

[sandyut]

Seems strange they would not take any marketplace ins. Never heard of an office using that as defining acceptance. I would shop for another provider till you medicare. I have Anthem and their site has a search that gets me started and can search by distance. I get the list then google the docs to see how they are rated.

Also - a broker for medicare is very helpful. I forget the ins and outs when my wife signed up, but there is a choice in coverage type that you can make only once. Im sure someone here on MC can speak to it.

 

[sandyut]

I was fortunate to get BCBS through marketplace

Thats what I thought too...they are pretty much pulling out of Colorado from what I recently read.

 

[BrianGSDTexoma]

What date are they calling "next year"?

Jan 1st

 

[BrianGSDTexoma]

You’re drawing SS, Brian?
Supposedly you are automatically enrolled in Medicare parts A & B when you turn 65 by already being on SS.
I would create an online account as soon as possible
I’m not sure how your marketplace works but can you stay on it until end of year and get a BCBS independent plan for 5 months of 2026?
I was fortunate to get BCBS through marketplace

Yeah I have BCBSTX right now.

 

[processhead]

If you don't turn 65 till June-2026, you will need a few months of coverage from another insurer before you are eligible for medicare. I was in the same boat a couple of years ago.

As mentioned, you may have other insurers that will work with your doctors available to you through the Marketplace. Check them out during open enrollment period. You need to do a bit of research to see what your alternatives are.

 

[BrianGSDTexoma]

I Mainly just need to keep med's going. Probably just have to pay the doc fee and try to get him to keep labs to a minimum. I will still have coverage for other things. Market Place will probably want a doctor listed as PCP.

 

[texomakid]

I'm confused but that's normal for me Brian. I too have BCBSTX and I get it through the Health Insurance Market Place on line. My PCP is at TMC and although I do not endorse this quack I currently have as a PCP they only deal with BCBSTX and me - nothing is done by them through the market place. If you have BCBSTX you can log into their website and find every doctor in their network. You can refine the search by distance or type of doctor, ect........
I hate the Insurance industry as a whole but this sounds like something you can resolve if you're willing to find a different PCP.

Last time I looked, they're were a plethora of doctors in the Sher/Den area. You should have options.

 

[chef k-dude]

Are your meds unaffordable without the insurance? When the ACA first started, it was affordable. Within a few years the price the gave me was literally over $3,000 a month in premiums with a high deductible. I had to go back to uninsured. I didn't stop going to the doctor or taking what meds I was on, I just paid out of pocket. The doctors/providers around here all had an automatic 50% for self-pay, about what they would get with an insurance claim. GoodRX and other discount systems can sometimes slash the price of drugs to lower than the insurance sets them. Harris Teeter (grocery and pharmacy) actually started using a different discounter and saved me even more money. It was more affordable than insurance premiums even before they skyrocketed back then. We dont get a dime in subsidy, so, nothing free for us...

On the medicare thing, definitely get with one of those places that provide guidance. My wife did that and they really helped her navigate the complexities. If you dont have an expert help you, you can end up leaving a heck of a lot on the table. She got an excellent setup and we have never have a problem with services. My employer provides a $300 stipend towards my current policy and takes the rest of my payment out before taxes, so, not a bad deal right now except my deductible and MOOP is high. But that was my choice to keep the premium lower.

 

[processhead]

We have been very happy using an independent insurance broker for selecting a medicare advantage plan. The good brokers ask about your health needs and shop the companies that fit your needs best at least cost.
Not saying an MC advantage plan is best for you, but in our case we are generally happy with our coverage and our health care providers.

 

[whistlepig]

If your doctor informed you about a lapse in your insurance coverage before your insurance provider did your better off finding a different carrier.

 

[Fueling Around]

Yeah I have BCBSTX right now.

That part confuses me. Your primary care provider (PCP) should not see you are on Marketplace plan. They should only see BCBS. Are they dropping BCBS customers?
That also confuses me as BCBS is the gold standard for many providers. It is also the top Medi Gap provider which is something you need to consider next year versus an Advantage (part C) plan.
Talk to an independent broker as others have recommended. If they talk only a Medi Gap and don't talk Advantage, go find another one. If the next one only pushes Advantage, well that sucks, too. Agents are commission based, but they are required by state insurance laws to present all options. However the dollars speak louder unless you push them

...
Also - a broker for medicare is very helpful. I forget the ins and outs when my wife signed up, but there is a choice in coverage type that you can make only once. Im sure someone here on MC can speak to it.

The only one that I remember with a 1 time choice is part D or prescription drug coverage. You can option in or out. But if you option out today and decide to enroll later, there is a penalty.

 

[whistlepig]

Do a web search of Medicare supplemental insurance and give them a call. This is a competitive business right now and they will go out of their way to help you.

 

[Chris_in_SoCal]

Holly F! This thread is totally confusing to read. I understand most of it but I am one of the lucky ones that worked for the feds for 34 years and was able to keep my medical benefits after retirement. I do have to pay a high cost to keep them but as I get older it is definitely worth paying for.

I grew up with Kaiser with my dad as an LAPD cop and when I joined the FBI I made sure to keep that as my primary care. Some might not think it is the best but it has been good for me.

I was able to keep the same coverage after retirement but I have to pay my share that work payed for before. It is a little costly but I do not have to deal with paying up front for medical visits.

At 56 I am not yet ready for medicare.

 

[BrianGSDTexoma]

That part confuses me. Your primary care provider (PCP) should not see you are on Marketplace plan. They should only see BCBS. Are they dropping BCBS customers?
That also confuses me as BCBS is the gold standard for many providers. It is also the top Medi Gap provider which is something you need to consider next year versus an Advantage (part C) plan.
Talk to an independent broker as others have recommended. If they talk only a Medi Gap and don't talk Advantage, go find another one. If the next one only pushes Advantage, well that sucks, too. Agents are commission based, but they are required by state insurance laws to present all options. However the dollars speak louder unless you push them


The only one that I remember with a 1 time choice is part D or prescription drug coverage. You can option in or out. But if you option out today and decide to enroll later, there is a penalty.

They just said not excepting my insurance starting Jan 1. Just figured because it is a Market Place plan. Maybe its just the HMO plan?

 

[BrianGSDTexoma]

Seems strange they would not take any marketplace ins. Never heard of an office using that as defining acceptance. I would shop for another provider till you medicare. I have Anthem and their site has a search that gets me started and can search by distance. I get the list then google the docs to see how they are rated.

Also - a broker for medicare is very helpful. I forget the ins and outs when my wife signed up, but there is a choice in coverage type that you can make only once. Im sure someone here on MC can speak to it.

They just said not excepting my insurance starting Jan 1. Just figured because it is a Market Place plan. Maybe its just the HMO plan? I going to have a new broker this year. I have messaged them

 

[BrianGSDTexoma]

I'm confused but that's normal for me Brian. I too have BCBSTX and I get it through the Health Insurance Market Place on line. My PCP is at TMC and although I do not endorse this quack I currently have as a PCP they only deal with BCBSTX and me - nothing is done by them through the market place. If you have BCBSTX you can log into their website and find every doctor in their network. You can refine the search by distance or type of doctor, ect........
I hate the Insurance industry as a whole but this sounds like something you can resolve if you're willing to find a different PCP.

Last time I looked, they're were a plethora of doctors in the Sher/Den area. You should have options.

Yeah I had a heck of a time finding a doctor that took this plan. If it wasn't for a friends daughter that is my doctors nurse I dont think I would of found anyone. I want to stick with this guy I got but guess will try to find someone temporary. If I could just get him to extend my lab work for a few more months think will be OK.