What to Know When Choosing a Medicare Plan

Beebs had a great question on another Blog post: "Does anyone have high deductible plan G and if so, do you like it?" Anybody else care to chime in?
Your editor has a Hi-F plan, which I like. The premiums are reasonable. Had some major medical issues so I did use up my deductible this year. Most years I never use up the deductible but never pay too much out of pocket, don't seem to ever have copays. I am a snowbird so I never have to worry about going out of network as long as they take Medicare.

In regard to the Hi-F plan, do you buy that in Connecticut? I have the regular Plan F but there is no Hi-F offered. I am in CT. If you buy that in CT what company offers it? I am with AARP United Health Care.

What is a G plan or a Hi- F plan?

Cam, Hi-F is Medigap Plan F but has a higher deductible thus costing less than Regular Plan F.
Here are the Medigap Plans: https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies

I have the High Deductible F plan in Connecticut with Globe Life. I know it is no longer offered but there is another plan, I thing G that has a high deductible.
I pay $561 a year and have never reached the $2000+ necessary for the plan to kick in, luckily. No plan covers my medically necessary contact lenses, which are my biggest medical expense. The plan covers regular eye exams, dr visits, etc. partially.
I hope this helps

https://portal.ct.gov/-/media/CID/1_LifeHealth/Medicare_Supplement_Insurance_Rates.pdf?la=en
I tried replying but am not sure where I posted.

We picked the G plan because it's the only one that pays "excess charges," which could throw you into bankruptcy. We had had United Healthcare for years and it has been great. We have paid nothing in copays so far. The extra tab with Medicare is little for the security it provides.

I have had Medi-gap Plan N. I just make sure that all my doctors participate with Medicare fully and I have not had any excess charges. I also pay a $20,00 copay for office visits once my deductible has been met and there is a $50.00 charge for ER Visits unless I am admitted to the hospital--then the $50.00 is waived. All else is covered and I have been happy with this plan, especially since the premiums rise much more slowly than Plan G or F (which I could have also chosen since I turned 65 in September of 2019, but chose not to since older and sicker patients will force up the premiums). Plan G will also raise their premiums higher as those who are not able to qualify for Part F usually want Part G.I did not want to pay high premiums since I am relatively healthy.

I need help deciding what is best. I am 64 1/2 now. I have been diagnosed with a serious blood disorder and have been hospitalized 4 times since August. I think my bills are already over $300,000.00. I have ESRD on dialysis and have been told that I will qualify for Medicare early because of it. Right now, I have Christian Healthcare Ministries and they are being very good about the high expenses. The chemo drugs will cost alot. My husband is 68 and has a BCBS Advantage plan. I don't think that would be good for me, however as my expenses will be ongoing and expensive. Anyone have any experience with high medical bills and drug costs on Medicare?

Question? Am I being shadowbanned? I used to be a prolific poster about several different topics on this website, but was wondering why there have been no reponses to my posts for a long time . Please let me know.....I will have to get answers elsewhere. Sad, if true. Retirement shouldn't be so divisive, unless you want to exclude half the population. This makes me very sad since I led a very healthy lifestyle and was diagnosed with a fatal disease 2 months ago. So much for retirememt.........

Caps
I used Christian Healthcare Ministries from the time I turned 63.5 until I qualified for Medicare in Sept of 2019. At the time they were a wonderful solution since I had lost my full-time job and benefits due to ageism in the workplace. I could not find another full-time or part-time job at my age that gave me the benefits I had lost. I could not afford private insurance either. They were a Godsend! I loved their operation and used them until I turned 65 in Sept. 2019. I, too was very healthy until I acquired a virus that threw me into A-Fib and a week in ICU with oxygen!! I have been on medication since then (November 2019), and may have long haulers syndrome.
At 65,I chose traditional Medicare and then used AARP United Healthcare Medigap Part N as my secondary, although I could have used Christian Healthcare Ministries as my secondary. Go to Boomer Benefits.com and watch a few of their YouTube Videos. They are brokers with world class service and they can help you navigate choices and it is all for free as they are paid by the insurance
company that you choose. (Beware that Advantage Plans do cap what they will pay for chemotherapy and even Pet scans and MRI's each year.)
I am so very sorry for your diagnosis. Do not be discouraged. A fatal diagnosis is very serious, however with proper treatment, one can live a long time. I look forward to your posts.

Caps,
This article may help you understand the Donut Hole and the different stages of how drug coverage works: https://www.tuftsmedicarepreferred.org/sites/default/files/downloads/2021_THP_Documents/2021_thp_donut_hole.pdf
My husband and I have Plan F Medicare supplement which pays the most but many people choose Plan G or N which cover a lot too. Plan F is no longer a choice for new people to Medicare but Plans G and N are. Plus, some companies offer a high deductible plan where you pay more out of pocket but the premiums are less.
Here is a website that might help you sort out supplemental plans:
https://www.medisupps.com/medicare-supplement-plans/medicare-supplement-plans-2022/

Caps, I’m sorry to hear about your disease and all the expense. Speaking for myself, I did not respond initially because I don’t have an answer. I heard from family last year that Medicare advantage plan F required prior approval for MRI and thus delayed their testing. They have switched back to Medicare advantage plan G at higher premiums but with tests done as ordered.
Caps, I look forward to hearing from you. Top Retirement blogs are very informative. Thank you to all.

Thank you Jennifer and Maryann. At least I know that I am not being censored, as I suspected. It is surprising how much your life can change overnite. My FIL told us to do the things ....like travel etc. right after we retired because "you never know how long your health will allow it!" HOw profetic! Being at doctor appointments 4 days a week was something I could never even imagine.....yet it's now our life, at least for several more months. My husband has to drive me, cuz I am not strong enough, so this really is taking up his life too....and he is my caregiver. I suppose without him, they would put me in a nursing home. Does anyone know if there are nursing homes that provide dialysis?

What state do you live in? I do not believe that any long-term care facilities provide kidney dialysis. Here in DC, Virginia, and Maryland where I was a nurse, the Kidney dialysis facilities were separate from any type of nursing home situation. Maybe in your state, you can find one with the assistance of your doctor or social services.
.

Google “nursing home with dialysis on-site” and you should see the list of specific nursing homes near you. In NY there are several.

Maryann, I actually did try that after I posted the question. We retired near Chattanooga. I found out that most care facilities provide transportation for medical services that they themselves do not provide.

I am curious. Does anyone out there have a Medicare Advantage plan, and what do you think about it? Many of my friends have them and are pleased. In terms of popularity, Medicare Advantage plans are more popular than traditional Medigap, mainly because they offer zero or very low premiums.
BTW, I found this fact about maximum out of pocket costs for Medicare Advantage plans:
Since 2011, federal regulation has required Medicare Advantage plans to provide an out-of-pocket limit for services covered under Parts A and B. In 2021, the out-of-pocket limit may not exceed $7,550 for in-network services and $11,300 for in-network and out-of-network services combined.

Let’s say you get a major medical illness in the month of December and are hospitalized at an ‘in network’ facility that uses ‘out of network’ physicians, labs, and various other medical services, etc. Let us say that illness extends into the month of January. You could potentially have a bill of $22,600 with Advantage plans by the time you are recovered. As a nurse I have seen patients hospitalized in this type of scenario. You also will not know that the facility uses out of network medical services until the bill arrives. Be very careful with Advantage plans.

Hello Caps, I worked as a dialysis nurse for many years and some of that time as a ‘home dialysis’ nurse. I don’t know your situation but has anyone ever discussed with you the option of doing dialysis at home? When I retired from nursing there were two types of dialysis, peritoneal and hemodialysis. Both forms of dialysis requires training, hemodialysis more so than peritoneal dialysis. With hemodialysis you need a caregiver that will be the one to provide the treatment. With peritoneal you can be trained to do the treatment yourself or a caregiver can do it for you. Go to You Tube and look for these types of dialysis to see if it is something that you would be interested in doing at home, and of course, if you qualify for it per your nephrologist. Keep in mind, both of these require a good storage area (like a clean basement), to store boxes of supplies. Best of luck.

Thanks Colette;
Thank you for your post. Yes, I have been to the first consultation for the home dialysis and was told about those 2 options. It sounds like a good option down the road a bit, however my case is a little too complicated and they need to keep closer tabs on my numbers for at least another month or so as I am also on Chemotherapy right now.

Caps, I am so sorry to hear about your diagnosis. Have you checked with Alexian Brothers on Signal Mountain? Also, I believe their is another assisted living/independent living facility in Ooltewah. Both are nice facilities. Hopefully, they will have what you are looking for.

Thanks for the info Lisa. No, I hadn't heard of either place. I will check them out. Thank you everyone for all the advice and help.

I just noticed your post above Louise. I have really been enjoying all of your posts for a very long time. You are very wise and such a helpful addition to this website.
For the poster asking about Medicare advantage......that is what DH has from BCBS. It has been good for him for the 3 years he has been on it. It has helped pay for hearing aids, glasses and dental work, with no additional premiums. He takes no medications, so I cannot vouch for that. Oh, he has also been to see his doctor, but never to the emergency room or hospital. I believe they paid for the doctor bill in full.

Thanks for the compliment Caps!
I just wanted to point out this article about underwriting. If you choose traditional Medicare and want to sign up for a supplemental plan, it seems you will not be subjected to underwriting when you first join. But I think this is the only time you can slip thru the cracks. If you wait a year and decided you want a supplemental plan, underwriting will scrutinize your health and if they decide you are going to cost them too much money, they will deny you coverage.
This is what is says:
Your Medigap Open Enrollment Period starts on the month that your Medicare Part B begins, and lasts for six months. For instance, if you start Medicare in July, your MOEP would end in December. Most carriers will also let you apply for the plan that you want six months before your Part B start date so that your Medicare Supplement plan will be active the moment your Medicare coverage begins. During this time, you’ll be able to sign up for a plan with any provider with no health questions. This is the only time most people can avoid underwriting, so it’s critical you take advantage of it.
Please read this article: https://www.gomedigap.com/medicare-answers/enrollment/medical-underwriting/
My husband already had prostate surgery when he was eligible for Medicare and a supplemental plan. He signed up for Plan F and there was no health questions involved. After he was on Medicare and Plan F, about 4 months later he needed radiation. That would have cost us a small fortune had we not signed him up for Plan F.

That was a good choice Louise and her husband made in choosing Plan F under Original Medicare for him. If someone becomes quite ill and has a Medicare Advantage plan, MA plans have an annual maximum out-of-pocket (MOOP) limit, while Original Medicare does not. This puts a limit on what a MA recipient must spend for medical care each year, even if they decide to go out-of-network. This also means if you have Original Medicare, there's no limit to how much you might spend in a calendar year. For example, my $0 premium plan has an annual MOOP cost limit of $3100 for in-network and $5400 for in-network and out of network services charged. Again, it pays to look at the details of any plan being considered, as well as seek the services of an independent insurance professional.

Really interesting article by NextAvenue: "The Truth About Those Medicare Commercials You See on TV". Not everything they say is completely true, so keep your eyes and ears open. Still, the author quotes a study that says most people are satisfied with their traditional Medicare or Medicare Advantage plans.

Our MA plan through UHC (partially subsidized by my former employer) has a MOOP limit of $500 for each of us--and a VERY wide network. We are very happy with it; it has included spinal surgery for my wife at very reasonable cost.

JoeG, that’s a very good MOOP limit. The ones I’ve seen are more like $3000-5000 annually. I think mine is $3400. Maybe your lower limit comes about because of your former employer still being involved.

I have the high deductible Plan F from Blue Shield. The MOOP is $2400, which is much lower than the MOOP for most of the Medicare Advantage plans I have seen. They advertise no premium, adding back money into your social security, dental and vision, but they have $5,000 ++ annual MOOPs. I would rather have a lower MOOP and take care of dental, vision and hearing expenses and forego an extra $100/mo. In the long run, I think the MOOP is the most important figure.

When it came time for me to transition from a partially subsidized employer insurance plan to Medicare, I carefully researched both Medicare Advantage and Medicare Supplement plans as well as Part D Prescription Drug plans. In the end, I went with- and have stayed with, AARP UNITED Health Care Plan
G. It has been a very wise choice. Although I am generally very healthy individual, I did find myself facing extensive foot and ankle surgery after a tendon rupture. My surgery and PT bills came to over $35,000 including x-rays, durable medical equipment, all doctor visits and all hospital charges. I paid nothing out of pocket. I have never needed a referral, can choose any doctor who accepts Medicare, have never paid a co-pay or a deductible or a co-insurance. My monthly premium may be a little more than some
other plans but overall it is less than many annual out-of-pocket limits. When you add up the co-pays and other out-of-pocket costs many people incur over the course of a year with Advantage plans, I think I have made a good choice for the long term. My prescription drug plan is reasonable as I don’t take much for medicine. I would simply urge people to look carefully at overall costs- not just the monthly premium. Add up the co-pays, the deductibles, and calculate the real costs prior to making such an impactful decision.

Barb, I completely agree with you. The MA plan we started with didn't want to pay for my heart surgery after a mild heart attack because we had traveled to the next state. Only active intervention by the exceptional coronary team got them to cover the $300K+ costs.
Fortunately for us, my previous employer changed their medical insurance management (rather unusual circumstance) and the next option period we were able to change to Medicare Plan F. (Now closed and getting more exposure with age, but outstanding coverage.). Since then 3 major knee surgeries were covered without question and our copays have been minimal despite traveling all around the country with some severe and unusual conditions. MA covered us while we were healthy and in-state. It's truly frightening to think of the potential exposures had we not had the opportunity and made the change to regular Medicare

Plan F above is getting more"expensive " as the closed pool dwindles. Still preferable at 74 to Medicare Advantage.

Medicare Part B going up, up, up!
https://www.cnn.com/2021/11/12/health/medicare-premium-hike/index.html

This inflation is out of control. The Medicare Part B is going up almost 15%! They say this is due to Covid expenses. The SS COLA is only going up 5.9%. My plan F and D is also going up. I would do better on the Health Care exchange at this point. Are we locked into being on Medicare?

Further in the article I posted above, it mentions Medicare is anticipating the high cost of a new Alzheimer's drug that will cost each qualified patient $56,000 a year. Of that, Medicare only pays 80%, patient pays 20%.
This is what it says:
CMS said part of the increase for 2022 was because of uncertainty over how much the agency will end up paying to treat beneficiaries to be treated with Aduhelm, an Alzheimer's drug approved by the US Food and Drug Administration in June over the objections of its advisers. Some experts estimate it will cost $56,000 a year. Medicare is deciding whether to pay for it now on a case-by-case basis.
Because Aduhelm is administered in physicians' offices, it should be covered under Medicare Part B, not Part D plans, which pay for medications bought at pharmacies. Traditional Medicare enrollees have to pick up 20% of the cost of most Part B medications, which would translate into about $11,500 in out-of-pocket costs for those prescribed Aduhelm.

Thanks Louise for the headsup on the 2022 Part B premiums. See this new article for more on what those premiums will be. https://www.topretirements.com/blog/health-issues/medicare-part-b-premiums-increase-over-14-in-2022.html/

Hi All,
Thank you all for sharing all this important information. It is SO helpful. We'll be moving back from Canada and trying to figure out what our monthly expenses will be is very difficult.
Thank you Admin for that article/link regarding the 14% increase in Part B. Does anyone know what line item number Medicare uses to determine your "yearly income" on the 1040? Is that adjusted gross income? I guess we must assume that the supplemental insurance and prescription drug insurance rates will go up by similar amounts? YIKES!!!

Do we have to be on Medicare if we could do better on the Health Care Exchange?

Maimi, this article may answer your question.
https://aginginplace.org/can-i-use-private-insurance-instead-of-medicare/#:~:text=The%20only%20exception%20is%20if%20you%20are%20paying,you%20can%20purchase%20a%20Marketplace%20plan%20then%2C%20too.

If someone is eligible for Medicare, they cannot use the ACA to buy a policy instead. In other words, if you could buy a Medicare policy, then you could not use the ACA instead. Nearly all US citizens 65 or over are eligible for Medicare. If you currently have a Medicare policy, you couldn’t switch to the Health Care Exchange because you are obviously eligible for Medicare. Nearly all ACA policies are local HMOs, requiring in-network providers only, and the network is usually only in the state where you live. Medicare is much more expansive in the availability of providers than the ACA. Its deductibles, premiums and overall cost are almost always higher than Medicare.

Unless you work for an employer with 20 or more employees and have comparable employer insurance, in most cases, you do have to take Medicare when you are eligible. It is true that the exchange has some very good deals and usually the prescription drugs are less too. You can call your local SHINE/SHIP counselors and talk to them about it.

Thanks, Roberta. With Part B, D. and F and my Dental all going up, Medicare is getting very expensive.

Cam, Social Security determines if you pay the higher Medicare premiums. It is called your modified adjusted gross income and is not a line item on tax forms. Social Security takes your adjusted gross income, Line 11 on the Form 1040, and adds tax exempt interest income. It is based on 2 year old tax returns so your 2021 premium was based on your 2020 return which is for tax year 2019.
https://www.ssa.gov/benefits/medicare/medicare-premiums.html

Thank you Mike!

Just be careful! The MOOP on some MA plans is 10K or more. With high deductible F, there is a $2350 deductible and no MOOP at the back end. The MOOP is at the back end, charges per year. I am relatively healthy and very active. My monthly premium at 74 years old is $96/month. I do not have a drug plan as I go to a naturopathic doctor. If the need arises and it makes financial sense, I will buy a Plan D for drugs.

Having Plan F with a high deductible was a big money saver for me 5 years ago. I was running in a park near my house and I tripped and fell, breaking my right arm near the shoulder. I had surgery as a titanium plate was necessary. I spent 3 days only in the hospital. It was a Providence hospital. The total bill was over $35,000, including surgery, hospital and incidentals. If I had MA I might have had a MOOP of 10K or more. As it was, I had a deductible of $2,050 at that time, and after that no further out of pocket. All physical therapy and follow-up visits had no out of pocket cost either, except Medicare limits the amount of physical therapy and anything additional is strictly on your own. The physical therapy allowed in my case was all I needed.

Thanks all for sharing. I feel that Plan F is the way to go for us.

The well-respected Center for Retirement Research at Boston College yesterday published a good article on Medicare plans and options. If you haven’t chosen yet, or are not sure if the plan you picked for 2022 is right, this may be very helpful. Last day to enroll for 2022 coverage is December 7.
https://squaredawayblog.bc.edu/squared-away/need-help-choosing-your-medicare-options/

Thanks for posting that link, Clyde. Medicare Medical Savings Accounts were mentioned......Does anyone know anything about that? First I've ever heard of it!

https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-medical-savings-account-msa-plans

CAM, Plan F is not open to new enrollees, you have to be Medicare eligible before January 1, 2020 to get Plan F. https://medicare.com/medicare-supplement/is-medicare-supplement-plan-f-going-away/
Plan G is similar to Plan F, the difference is Plan G doesn’t cover the Part B deductible which will be $233 in 2022. Plan G also covers "excess charges" if you use a provider that does not except the Medicare approved amount as full payment.
https://www.medicareadvantage.com/costs/part-b-excess-charges

Thanks danno;
So I checked out the link. It looks to me like the MSA is an alternative plan to Medigap or Advantage plans. I was hoping that a senior could set aside a tax free savings account to use for furture medical expenses, like long term care etc., even though they had another supplement plan.