My Turn to Start Figuring Out Medicare

[BrianGSDTexoma]

I am about a week away before I can start applying for the Medicare stuff. I have heard nothing but bad about advantage stuff. I do have an appointment with Nicole from Morgan Medicare in a few weeks but would like to explore my options ahead of time. Any suggestions? I don't mind paying a bit extra to keep my out of pocket down. I will start in June. I am thinking Part A, B, D and G but I really I dont really know anything at this point.

 

[Newglide]

I'm no help with this but interested to know myself

 

[chef k-dude]

Definitely use the advisor. There are free advisers that can help. I still have some years till I can get on it, but my wife has it and it works pretty well. Her advisor got her set up with a great plan with a tiny out of pocket and cheap compared to the $850 a month I'm paying to have an $8,500 MOP.

 

[SmokinAl]

We have been with several different insurance companies over the last 15 years & all have been advantage plans. No premium, lots of extras, and if you get a PPO, you can go to any Dr, just don’t get a HMO plan. If the person you are seeing can put you in any plan, then that is a good thing. Don’t go to someone who works for just one insurance company. Also make sure that all your doctors are in network, and that your prescriptions are all covered. Most plans pay the total cost for generic drugs. You also get a cap on yearly spending, right now our’s is $4700. So even if I have a $1,000,000 hospital bill ( which I had ). Your out of pocket is capped at $4700. With original Medicare there is no cap. Anyhow, good luck!
Al

 

[Smoke-Chem BBQ]

The advisors are great for helping pick plans. One very cool thing we learned about some/many of the part G plans is that they cover gym memberships with no out of pocket costs whatsoever. That benefit is now called Active Aware, or something similar, but the program was called Silver Sneakers for so long you still hear that term. If you use a gym, it's worth looking for that benefit.

Not all gyms accept it, but you can find a list of those that do. It turns out you can set it up at multiple gyms, and never see a bill from any of them. We have it at a spectacular facility with a full aquatic center, water park, climbing wall, and three gymnasiums that is way across town, and also at the Planet Fitness that is just a few minutes away. Being able to pick based on how much time we have each day is great.

 

[mneeley490]

I'm in this boat, too. I turn 65 in April, and I will be signing up for part A very soon. I have a very good medical benefit plan where I work, so I plan on working until I hit 70, then I'll see what my options are.

 

[ajbert]

I'm still a few years away myself, though my wife has Medicare. She doesn't have any add ons as she has Tricare for life. I'm on Tricare prime but when I get Medicare it will change to Tricare for Life. No co-pays, all prescriptions covered. The only thing not covered is dental. She has dentures and I've been blessed with really good teeth. If anything comes up in that department we will have the funds to cover it. One of the best things about retiring from the Navy for sure.

 

[Elf@shore]

I am about a week away before I can start applying for the Medicare stuff. I have heard nothing but bad about advantage stuff. I do have an appointment with Nicole from Morgan Medicare in a few weeks but would like to explore my options ahead of time. Any suggestions? I don't mind paying a bit extra to keep my out of pocket down. I will start in June. I am thinking Part A, B, D and G but I really I dont really know anything at this point.

Medicare: I am on plan D
What my advisor explained is this:
Advantage plan offer free bees , but @ end of the day, lack serious coverage down the road.
As he called it prepaided healthcare.
Offers more coverage for serious coverage

 

[Gonna Smoke]

We have been with several different insurance companies over the last 15 years & all have been advantage plans. No premium, lots of extras, and if you get a PPO, you can go to any Dr, just don’t get a HMO plan. If the person you are seeing can put you in any plan, then that is a good thing. Don’t go to someone who works for just one insurance company. Also make sure that all your doctors are in network, and that your prescriptions are all covered. Most plans pay the total cost for generic drugs. You also get a cap on yearly spending, right now our’s is $4700. So even if I have a $1,000,000 hospital bill ( which I had ). Your out of pocket is capped at $4700. With original Medicare there is no cap. Anyhow, good luck!
Al

Lots of good advice here, Brian. We've been lucky so far and haven't had to test the limits of our plans and hopefully won't. We use an insurance broker/advisor who has people that only deal with Medicare supplement plans. They look through a bunch of different plans from different companies to get the best coverage for the best price. So as Al recommended, use an advisor that DOES NOT work for a single insurance company...

 

[pineywoods]

I think a lot depends on how healthy you are or think your going to be in the next year. If your healthy a Plan D might work. Somebody with lots of health problems I think Plan G is the way to go. We're both over 65 but the wife gets our insurance through her work when I looked the costs for Part G and a drug plan are right about what we pay for her company insurance.
Those are my guesses after doing a little research but has been said get an advisor to help you.

 

[Elf@shore]

I think a lot depends on how healthy you are or think your going to be in the next year. If your healthy a Plan D might work. Somebody with lots of health problems I think Plan G is the way to go. We're both over 65 but the wife gets our insurance through her work when I looked the costs for Part G and a drug plan are right about what we pay for her company insurance.
Those are my guesses after doing a little research but has been said get an advisor to help you.

Medicare: Beware prices change per states. We are in NJ.
My wife is turning 65 soon.
Just got off the phone with our new advisor, old one retired.
We are going with G plan: $283 deductible. 100% coverage. No Copays .
By law if yur Docs accepts Medicare, yur in !
There is no Network crap.
I am also changing to G Plan. Also the costs are the same, even cheaper than what I have now !
Mutual of Omaha: Told a very solid company. We are going with them !
Cigna is getting a rebranding , Costs will probably increase?
Going to do this very soon.
Scripts are more complicated depending on yur needs ?
I would look up a G Plan with Mutual of Omaha in yur state.

 

[JckDanls 07]

I also am "on the hunt" ... November is 65 for me...

 

[paleoman]

I'm on my second year for myself and my wife. Went to medicare.gov and looked over advantage plans in my area, comparing coverage and benefits. It allows you to enter your prescriptions and then, when comparing plans, you can see the total expected cost per year. You can also enter in all your doctors to see if they are in plan.

I only look at the ones that have no additional cost, as we are both pretty healthy. I've been fine with both PPO and HMO, as our doctors are all in plan.

For dentist, insurance usually pays a specific amount, and our dentist is usually under that amount.

Overally, many companies have similar benefits. Both the one I had last year, and the one this year, have gym membership benefit. Last year's company (Aetna) had a Over The Counter card that they gave you $50/quarter to spend, with a use it or lose it. I don't care for that, and would go online and try to buy items to max out the card each quarter.

This year, the company I have (United HealthCare), does have an OTC card, but they pay pretty generous towards glasses/contacts. Unfortunately, I found that you have to go through them, to get the coverage. :(

YMMV...

 

[dward51]

We navigated this topic a few years back. We had been on the Kaiser HMO through my prior employer retirement plan for decades so we stayed with them in a Kaiser Part C (Medicare Advantage) plan my employer offers. It has much better benefits than the advantage plans on the open market though.

Make sure you sign up for something. You must have a plan that has part D (drug) coverage no matter what. If you don't it will eventually cost you more every year for the rest of your life.

From everything I saw when we signed up, the part G plans were the most comprehensive. Generally they have the required basic medicare part B (hospital) deductible of $283 (for 2026) and covers everything at 100% after that. If you anticipate needing to visit a lot of doctors over your lifetime, this is a must. If you go with a different plan, you can sign up for a part G later, but it will cost you more as it's based on the age when you sign up.

Some of the advantage plans are good, but from what I saw the open market ones were sort of "meh" at best. Be careful and compare the copay or coinsurance costs and deductibles for all plans you are looking at. For example my Kaiser plan (via employee retirement) pays 100% of all durable medical equipment needs. That means in 2024 when I was in the hospital for 2 weeks with sepsis and almost died, they paid 100% for my wheelchair when I came home (super weak for about a month). They would have paid 100% for a electric hospital bed, but I had no issues getting in or out of my normal bed. Most marketplace HMO plans only pay 50% and you have to meet a annual deductible before they pay anything. So make sure you compare the details no matter what type of plan best suits your family.

I would be reluctant to trust the 800 number people you see on TV. Somebody is paying for those commercials that run every 5 minutes for months so they must be making a killing of their plan somewhere.

Another thing about part G is you coverage is the same nationwide, as long as the provider or hospital takes basic medicare (I've never seen anyone who didn't). But some of the other plans are more regional and some of the C plans are basically HMO's where you have to go to a plan facility and doctor for service. Again, research is crucial so you know the facts before deciding.

If it were not for the enhanced C plan my retirement offered, we would have both gone with a G plan. It would be more per month than the $47 each for my Kaiser plan, but once you are locked into a G plan your price is lower if you sign up when first eligible than if you wait. Also make sure your G plan has drug coverage or you will need a part D supplement (I know, it gets confusing).

Another plan is a part N plan. It's like a G, but has a slightly higher cost and more deductible or copay but has the other good part of the G plan.

It's hard to predict what your medical needs will be a month or year from today will be, but if you have pre-existing conditions already, make sure you get the best coverage you can afford. For instance if you sign up for a G plan now, the existing conditions don't matter. But if you go with something else and want a G plan latter, the rules are different.

 

[JckDanls 07]

(I know, it gets confusing).

Need I say anything more ??

 

[BrianGSDTexoma]

Thanks for all the replies. I have had had several people here in Texas tell me stay away from advantage plans now. I probably going with D and G just a matter of which plan. The lady broker I meeting with in a couple weeks suppose to know her stuff. Will see what she says.

 

[Fueling Around]

Do you have your on-line account set up? It is separate from SSA
Medicare.gov explains a lot of the details between Medigap and Advantage.

Before the meeting ask your providers what they accept for coverage with Advantage or Medigap plans without screwing you.
That will set your forward plan coverage objectives when you met with a salesperson (advisor). Remember first and foremost they are sales motivated. They also don't know your providers due to HIPPA
Find more than 1 Insurance advisor to consult. If they push a single plan walk out. Find an advisor that will talk back and forth with MediGap and Advantage and ASK your situation.
Don't be swayed by the cash back offered by the advantage plans. That usually means they are short sheeting your coverage someplace.
I have a lot of friends on Medicare. BCBS is popular both in Advantage and MediGap.

 

[BrianGSDTexoma]

Do you have your on-line account set up? It is separate from SSA
Medicare.gov explains a lot of the details between Medigap and Advantage.

Before the meeting ask your providers what they accept for coverage with Advantage or Medigap plans without screwing you.
That will set your forward plan coverage objectives when you met with a salesperson (advisor). Remember first and foremost they are sales motivated. They also don't know your providers due to HIPPA
Find more than 1 Insurance advisor to consult. If they push a single plan walk out. Find an advisor that will talk back and forth with MediGap and Advantage and ASK your situation.
Don't be swayed by the cash back offered by the advantage plans. That usually means they are short sheeting your coverage someplace.
I have a lot of friends on Medicare. BCBS is popular both in Advantage and MediGap.

I set up this morning. Before I get plan will check with Doctor office. Started searching drug plans and have two meds going to be a problem. i all ready knew about TRIJARDY XR which going to ask doc to change but I surprised to find that tamsulosin used for enlarged prostate is not covered on these plans I have looked at so far.

 

[radioguy]

Get an advisor for the first go around. Check with your county/city see if they offer any senior services. We happen to get a free advisor there met twice or so. Really helped navigate the quagmire.

RG

 

[dward51]

Do you have your on-line account set up? It is separate from SSA
Medicare.gov explains a lot of the details between Medigap and Advantage.

Great Point!

If you don't already have a ID.ME account, I would recommend you sign up for one. This is one of the ways you can officially login to your Social Security, VA, IRS and other government accounts. You will need a smart phone and your drivers license to start setting up an account. It will also take photos of your face. Once it is set up, you can do a lot of stuff online, and it's free.

For those worried about "the man" having you facial recognition, etc.... I worked in guberment for 42 years and was the intel liaison to the FBI/DHS counter-terrorism task force for a State LE agency. Trust me, they already have this and more. You are not giving them anything by setting up an account to access your benefits via ID.ME or LOGIN.GOV (ID.ME is accepted at more sites though - I have both).

The official website is: https://id.me/