I'm nearing the magic age of 65..... please share your Medicare knowledge and experiences

[groundloop]

I've been doing research online trying to learn as much as possible about my options before my birthday later this year, and while I feel like I understand Medicare a little bit better than before I also have a lot more questions.

Given that insurance companies manage Medicare Advantage plans I had initially vowed to avoid that and stick with traditional Medicare. However, I'd really like to have vision and dental coverage so maybe I need to go ahead and find a Medicare Advantage plan which offers those and (hopefully) with an insurance company which isn't too difficult to deal with.

So I'd love to hear from anyone that's already on Medicare and what your experiences have been.

[Taraman]

1. Go see a certified Medicare counselor

The visit is free. They aren't allowed to favor one provider over another. They are tuned into the local insurance situation and medical providers.

I did it at 65 (7 years ago) under advice from my HR department. Glad I did.

[Lettuce Be]

13. This - I have a local agent. They show you plans & options

You'll need a supplement to cover what Medicare does not. Don't try to wade through it on your own, just call or visit an agent. The supplement is what saves you from big bills so seriously do not think you can get by without.

Our agent told my husband to stay on his current plan as it's no longer offered and he's grandfathered in (proving they are not being paid to just sell you something). But he elected not to get the supplement for RX coverage to save $78 a month despite my saying at his age he maybe should reconsider (he's 78). Two weeks ago he had a brain bleed (stroke) spent 11 days in ICU, now is home but still in rough shape. The first medication they said he "had" to take every 4 hours for the next 16 days was $2300 (hospital's pharmacy price). We elected to try to use GoodRX and after a few days of back-n-forth and no one had the drug in stock the doctor took another look at his chart and decided he could do without that drug. O.M.G.

Medications cost a fortune and yes, being a healthy man currently taking no medications could lead one to believe they'd be fine but if something happens, it can bankrupt you. My sister's cancer drugs were at one point $16000 a month (she did have insurance), but if she hadn't had that RX coverage she'd never have gotten those meds (not that they saved her tho).

Not try to scare anyone, I just think the RX benefit is worth the cost (obviously just my opinion) and totally depends on your situation. Worth taking a look.

Not sure what this sudden thing against Medicare Advantage is about. It's through AARP. It does not replace Medicare, it's the supplement.

[DuaneT]

32. Medicare Advantage certainly does your original Medicare and most include Part D prescriptions.

Medicare Advantage is Part C. Although it replaces A and B you are still have to pay for Part B.

One that does not purchase a Part D prescription drug plan when eligible will be penalized 1% per month for every month they did not get it.

AARP does not sell a Medicare Advantage or supplement, they shill for United Health Care.

[Lulu KC]

19. CANNOT AGREE MORE!

Don't do Advantage.
Do get a supplemental.
We haven't found dental or vision that's worthwhile, but we're still looking.

The Medicare counselor we used hosted a seminar that made a world of difference. It was about two hours long, held at the public library. I STILL consult the notes at the end of each year when it's time to think about seeking a new Rx provider.

And oh yeah--the prescription supplement. Depending on what you take, but sure to examine the formulary carefully. The first year, the advisor does that for you (worth its weight in gold) but if you change meds, you need to reexamine annually. So far, that's the only ongoing challenge for me.

[groundloop]

29. How does one find a Medicare Counselor?

I live in semi-rural Alabama (the only reason I stay is that I'm on a lake) so there's not a lot around here. I searched online and all I can find are what looks to me like insurance sales people.

[DuaneT]

33. Find your state SHIP office. Call them and normally someone can come to you.

[randr]

2. Eat well, exercise

and find the CBD product that works best for you.

[piddyprints]

3. Apply 3 months before your birthday.

Or 3 months before your eligibility date (which is the first of the month following your birthday) — can’t remember which. That way, all your ducks are in a row and you’ll be all set. I think also that you have to pay the first 3 months in advance and then can go monthly and have it taken right out of your checking account.

[ciao_bella]

4. Stay away from Medicare Advantage

https://www.democraticunderground.com/1017732643

[JustABozoOnThisBus]

20. Some have great success with their advantage plan

My Long-term Medicare advisor recommends a few advantage plans that have good national coverage. He recommended plain Medicare for me, and recommended the company and plan for medigap. So far, so good.

So, as mentioned earlier in the thread, find a good local medicare advisor.

[Alice Kramden]

5. I'm on regular Medicare

Also have a dental/vision supplement which is $35 per month and works well for me so far

[jmbar2]

7. What supplement do you have?

[Alice Kramden]

26. It's called

Manhattan Life.

[jmbar2]

27. Thanks - I'll check it out.

[Alice Kramden]

30. I found good information and assistance

From an organization called Boomer Benefits - I think it's an insurance broker. I am not affiliated with them - just a recommendation. There are some YouTube videos they have with good info

[jmbar2]

6. None of the dental plans are worth a darn

according to my trusted dentist.

The amount they pay doesn't cover much of the cost, compared to the premiums. Plus they have a lot of waiting periods, deductibles, etc.

Dental care as you get older is a major expense. Set up a special retirement fund just for these expenses. Estimate worst case scenario - getting crowns replaced, dentures, implants, and budget for it ahead of time.

In my case, I spent $5,000 on a root canal and crown replacement - one tooth! The insurance would not have covered it.

[DURHAM D]

10. My dentist (my friend) advised me that the dental supplemental was not worth the cost.

You are right. Last year I had to get a full bottom denture. They removed my remaining teeth. Then I had bone grafts. Then the implants (4) and finally the snap-in. Cost $12,000. Insurance would have covered zip.

[jmbar2]

23. WOW! That's really high

I wouldn't have been able to afford it. Scary....

[DURHAM D]

24. Now started on the uppers.

It will cost $28,000 - $30,000 to complete it. It will not snap in - it will be fixed. Snap-ins would cost a few thousand dollars less.

jftr - First my parents and then myself spent a fortune trying to keep my own teeth. It started with fillings in all my baby teeth. Not sure they still do that. When I started on this replacement journey last year I was looking at some x-rays with my dentist and I noticed one tooth looked very different than all the others. I asked him why? He laughed and said "It is the only one without a crown or a veneer". Also, almost every tooth had a root canal. Got my first root canal in 1962 - remember it well. Just so you know how old I am, I was born during WWII.

It is scary. That is one of the reasons I am willing to talk about it. It is beyond frightening.

What do other countries do?

[jmbar2]

28. Not sure about other countries

Very good question. I know that dental care in the UK is not all that great. I sure wish that the proposal to extend medicare to cover dental would have passed.

I have been fanatical about dental care since I was young. Ultimately, it's really a social class signifier and can affect your employability a lot. If you have missing teeth, your status bumps down pretty fast. That's why I'm terrified of future dental problems.

My brother had all his teeth pulled, and didn't have enough money to even get dentures. He was only mid 60s when that happened. He has adjusted, but it makes him look much older and scruffier than he would have with a nice set of pearlies. He would probably never be able to get a job except maybe at an adult store.

You are blessed to have the resources to get all that work done. You planned well. Good on 'ya.

[wolfie001]

43. The running joke in the 1st Austin Power's movies was that....

....the British had bad teeth. Here I am 64 with three root canals and two more caps. Flossing every night, brush, brush, brush just hoping to avoid any more big dental bills. At this point, I'm just gonna say, "Pull it!"

[KarenS]

8. I'm traditional Medicare

and have a supplement insurance plus Part D which is for meds,,,, this is why talking with an independent medicare insurance advisor is important, they have access to all kinds of information that can help you decide which is best for you. And you should talk to them every year because things can change in the industries and with your health.

I love my Medicare,,,,

[wolfie001]

44. Just curious: what state are you from and are you north or south of $400 total per month?

[KarenS]

45. answer,,, Arizona

and it's about $530 for a plan F supplemental and Part D


but seriously an independent Medicare insurance agent is the way to go

[wolfie001]

46. With my retirement, that may be problematic

I'm in Maryland and plan on discussing this with a SHIP. With the premium going up X dollars every year, yipers. Thanks for the info though. Appreciate it.

[Ritabert]

9. I pay for a Medicare supplement plan

It's a bit costly but was well worth it when my husband spent 5 days in the hospital with a bleeding ulcer. All we got billed was the $203 yearly Medicare deductible which is standard with every plan.

[DURHAM D]

11. Seems like Advantage can jump up and bite your ass.

Three years ago I was at a gathering of seniors and in advance the host forbid the guests from discussing bill shock re: Advantage. I have been at a couple of gatherings where couples are arguing with each other and with other friends because they received bills they did not expect. However, sometimes they brag about not getting a bill. Mostly they are just confused. Pretty much none of the Advantage people know they are with a private insurance company and not the government.

[Triloon]

12. have been on medicare for 6 years

with chronic ailments and I have nothing good to say about it at all. Nothing at all. It's pauper care with service far worse than Medicaid. I can't afford the Medicare Advantage and so I'm losing teeth one at a time with considerable untreated pain and I haven't had a new pair of glasses in ten years. Be prepared for neglect and disrespect.
If you can afford the 'Advantage' you might as well do it. But they are fleecing you. They find every mode possible to pry the last few dollars out of a pensioners hand.
Sorry I dont have anything encouraging to say, just the facts as I'm experiencing them. For instance, last week I spent $33 copay to see my Dr for a simple prescription refill authorization. The prescriptions cost me $700, all out of my pathetic $1100 Social Security check. And the dentist wants $540 to pull this molar that's swelling its way out of my head. I guess it's my own fault for being a blue collar construction worker all my life. Enough of my anecdotes - If you can afford it then do it. If you can't - then welcome to capitalist America where if you're poor you pay more.

[MOMFUDSKI]

14. My medicare advantage plan

includes dentist and $150/YEAR towards eye glasses or contacts. I get 2 cleanings/year and 1 xray/year and 1 filling/year. Other work done at my dentist allows me a discount on their listed prices. My primary doc appts are free as is my blood work. You can afford Med Advantage. Call an insurance broker and have him/her come to your home and check it out.

[groundloop]

15. So it sounds like you're generally satisfied with your Advantage plan?

Can we ask which insurance company you're with?

[snowybirdie]

16. Please read last week's

analysis of Advantage plans done by a government agency. It details how often customers are denied coverage for doctor ordered tests and treatment. They also can void your contract annually if your care costs too much. We studied both Advantage and Traditional and found traditional was our way to go. Much depends on your health and needs as you sign up for it. A big decision for sure. Good luck!

[DuaneT]

34. So much disinformation

Medicare Advantage Cannot void or cancel your plan every year because of claims, only if they scrap that plan or pull out of a county.

[snowybirdie]

37. Not really

https://askmedicaremike.com/can-amedicare-advantage-company-cancel-my-coverage/#:~:text=Medicare%20Advantage%20plans%20are%20not%20guaranteed%20renewable.%20So,single%20you%20out%20and%20cancel%20just%20your%20policy.


And they can surely deny procedures and tests ordered by a doctor.

[Voltaire2]

42. Which they can do. They can also change any of

the plans features, change their provider network, etc. As these are for profit operations, they have all the problems inherent in private health insurance: their motivation is to deny you service and underpay service providers. How people still don’t understand this is amazing.

[Midnight Writer]

17. Be wary of networks if you go Medicare Advantage. Not all doctors/facilities accept all plans.

It can get complicated if you have surgery and the doctor accepts one plan, the hospital may not accept the plan, the lab that does the bloodwork and testing may not, the anesthesiologist may not. You might end up with a hodge-podge of bills, some of them unexpected.

You may also have issues if you travel and need medical care away from home.

[Auggie]

18. This

I'm going with a Medigap supplement. It'll cost more, but, well, you get what you pay for.

I'm applying this week.

[Voltaire2]

21. Medicare part D is stunningly horrible.

[mahina]

39. How so please?

Thank you

[Voltaire2]

40. For starters you have to predict your

medications for the next year when you sign up for a plan. If your prescriptions change you can be out lots of money. Just figuring which plan is best for you is absurdly complicated.

[mahina]

41. Wow! I am finding it crazy that we'd be expected to predict our meds.

I am also finding it complicated.

[LetMyPeopleVote]

22. I just turned 65 back in December

A number of my law partners are over 65 and I used a consultant who is a member of my temple. I got Schedule G plan plus a drug plan. It seems to working and is one-third of the cost of coverage under my firm's insurance

[dflprincess]

25. I'm still working so I only signed up for Medicare A

I'm still working and am on my employers' plan. As long as you have other "credible" coverage you do not need to sign up for Part B. When you do though, get someone to help you navigate it. In my opionion this has been made needlessly complicated.

[DuaneT]

35. You do not have to sign up for Part B if the group is 20 or more employee's.

Otherwise, if under 20 will get penalized if and when you sign up for Part B.

[PoindexterOglethorpe]

31. I have an Advantage plan, and it has been very good to me.

Shall I start with the nearly $80,000 hospital bill when I had a heart attack in 2020 that I paid $800? Shall I continue with prescriptions that I pay about $10.00 for? Shall I do on with other doctor visits that cost nothing at all or very little?

I don't understand why people here trash Advantage plans. They would not be right for everyone, but they are very right for some people. I have been very happy with mine.

A few days ago I got a notice that I was being refunded $95.00 from some sort of overcharge for something medical. Not enough information was included for me to have any clue exactly what was being refunded. Sigh.

About a decade ago I got a check for a refund for something medical, and I spent time trying to figure out what was going on. I didn't want to cash a check I wasn't entitled to. Eventually I learned that a copay from when I'd broken my arm more than a year earlier, should not have been charge to me, and so I happily cashed the check. The most interesting thing was that the people I contacted were utterly astonished that I was questioning the refund. Honestly, I didn't want to accept a refund I wasn't entitled to. Although it was quite nice to get it.

[DuaneT]

36. I think people trash it because their friends have a supplement that pays for everything.

But what they don't realize you're paying up front premium's monthly and not using it all that much and with Advantage it's pay as you go. Most look at Advantage plans as an HMO and don't look at PPO's which many really have in network coverage across most of the U.S.

I have been on Advantage 8 years now and have saved over $27,000 in premium's if I had purchased a supplement and Part D. My max out of pocket is $4800 on medical and 4 years ago after a 2 week over $100,000 hospital stay and all the ct's I had that year what I paid out of pocket was $2200.

I had surgery 3 weeks ago and the hospital stay was $88,000 one day stay I owe the hospital $295 for that stay. A few surgeon visits will cost me $45 co pay. After the 3rd visit I will be released. My drugs total $15.00 per month.

[BlackSkimmer]

38. Same here! Glad I found this thread.