Just a reminder; the annual Medicare Open Enrollment period ends on December 7th.
During this period people can switch, without penalty, between Medicare Advantage and traditional, fee for service Medicare or vice versa.
People can switch, without penalty, between Medicare Advantage plans.
People can switch, without penalty, between their Prescription Drug plans.
People may face penalties and underwriting if they switch their Medicare supplemental plan.
Decisions need to be made and signed by the end of the week.
Look for your helpers as insurance is a complex choice set.
Ohio Mom
After reviewing both my Plans B and D, I’m happy with the choices I (okay, the family numbers guy, Ohio Dad) made last spring (when I joined the Medicare ranks).
Do I have to do anything to reconfirm these choices or will they continue on their own?
I’ll repeat my eternal rhetorical question, How do elderly people who have begun losing their marbles navigate this Byzantine mess?
Nelle
Why, as my brain cells gallop over the horizon, do I have to sort through ever complex choices? When I moved to another state, I was told that I couldn’t qualify for a policy in my new state because of a suspected TIA in Jan 2019 (I had a weird incident with no evidence of a TIA but I got the full work up because, I suspect, of Medicare ka-ching!). I was told to wait until Jan of 2021. I talked to a broker who said, wait till January and ignore the open enrollment period. I’m calling another broker today to get a second opinion. I just want the experience I had on National Health care in NZ. This does not feel like freedom to me.
Cross posted with the above. It does feel diabolical and exploitive to demand that we spend remaining days puzzling this. Who profits? Right, someone fills their pockets out of an overly complex system.
satby
Yeah, every time a Bernbot screeches “Medicare for all” I want to slug them with a 2 x 4. It’s insurance, it’s partially underwritten by the government so it’s affordable; and it’s just as ridiculously complex as navigating all the choices from before I was eligible. I’m glad I have it, but I’m not any better off than I was on the ACA with the CSR.
raven
@Ohio Mom: We have a council on aging here that provides support for folks. I met with them before I retired and we talked about how difficult it is for people in their 80’s and 90’s.
Ohio Mom
I am thinking of my parents’ generation, in my family, all gone now. They remembered life before Medicare, and so must have been thrilled with its advent. The idea that you were covered for life, no matter what, must have seemed miraculous. And maybe it seemed that it was always being improved: let’s add Advantage plans, let’s add a drug benefit!
For me, I think of what I hear about coverage in other industrialized nations and I am beyond underwhelmed with Medicare. But better than nothing.
Ken
I’m not eligible yet, so the only thing this means to me is that the horrible TV ads will vanish for ten months.
Ohio Mom
Raven:
Yeah, over the weekend I found my notes from last spring with the contact info on the Ohio volunteer Medicare advisory group. On my list to call them today but thought as long as David was here, I’d ask him. But maybe this was a post and run for him this morning?
Ohio Mom
Ken:
One day you will be old enough, and if things remain the same, you will be deluged with robocalls from Medicare providers — every single day, multiple times — in addition to the TV commercials. So enjoy the quiet while you have it!
David Anderson
Contact the area volunteer Medicare advisory group; I am 97% sure you default to your current choices but I am not 100% and I don’t want to fuck this up on that 3% chance.
satby
@Ohio Mom: I think I was told in a previous post on this topic that you can just stand pat on the choices you made and they roll over into the new year. Because I also just went through choosing my coverage last spring and don’t feel like going through it all again.
satby
@David Anderson: ok, thanks. And UGH!
cope
@raven: Florida actually manages to do a decent job on this as well because, well, old people.
Before the virus, our local library had a representative from the state group once a month. I went there twice when things started to swirl around too fast in my little pea brain. I left that last meeting having been told that the coverage my wife and I each have is perfect.
I might be able to shop around for lower payments but since I can afford what we have and it’s what we need, I don’t want to deal with making any changes until I/we have to.
wvng
My wife and I are on traditional Medicare, with no D or supplemental. We are betting that our current good health (he says while knocking furiously on wood) will continue, which is an unknown. As others have noted above, it’s a crazy complex system for anyone to navigate, but for a population where many have declining mental resources it is problematic.
ALurkSupreme
David, my wife turns 65 in September 2021. Is there anything we need to do about her Medicare right now? From what we’ve read, we think the answer is clearly no, but as others have said, it’s a complex system.
Thanks in advance.
JanieM
Just chiming in to agree that you couldn’t have designed a more Kafka-esque mess if you had tried for a hundred years. My sister and I were almost in despair trying to help our mom navigate the system in her last years. But at least our involvement with her had a sort of silver lining in that it alerted me to how much education I needed before going on Medicare myself a couple of years later.
My local “Senior Spectrum” gives helpful prep classes in how to choose plans. For me, that was adequate education for choosing among Part B plans. Since so far I’m taking no drugs, I just chose a cheap “placeholder” for Part D. But I just went through my first open enrollment period and changed to a different Part D plan, because of course the original one doubled its premium this year. And that was my reminder that Part D is the essence of the opaque nightmare that is the Medicare choice process.
I’m grateful to have coverage, for sure, but I’m with Satby. Everyone time someone says “Medicare for All” I wonder if they know a single thing about Medicare. I certainly didn’t as recently as 3 or 4 years ago. I know it isn’t going to happen, because the vested interests will prevent it, but I’d like to just scrap the whole steaming pile and start from scratch with something sane and simple. I sometimes wonder what the loss in productivity in the US is because of all the time people have to spend trying to cope with the health insurance system. It’s staggering, I’m sure.
*****
@Ohio Mom:
Yes on both counts. I have a couple of friends who’ve told stories of needing medical care while traveling in Europe. They show who they are, they pay a modest bill, they leave. (One involved a broken rib from a fall, I forget what the other one was.)
I’m not sure whether health insurance or guns should take pride of place as a more fitting symbol of our national shadow side.
Ohio Mom
wvng:
I believe there may be life-long financial penalties for signing up for Part B late — oh well, nothing to do about it now.
When you are absolutely broke, there is Medicaid. Based on my experience with Ohio Son (who has Medicaid because of his disability), it’s a lot easier to navigate, but maybe that’s just Ohio (each state administers Medicaid a little differently, unlike Medicare which is administered federally).
David Anderson:
Thanks, will do this afternoon. I don’t make non-urgent calls Monday mornings on the theory that anyone who MUST make a call first thing at the beginning of the week can go before me.
JanieM
@Ohio Mom:
@wvng:
I’m pretty sure that’s right, a quick google search suggests so, and it’s definitely true for Part D.
Plus, Part A’s coverage has huge holes in it in certain situations. I took a similar calculated risk (to wvng’s) with my health coverage when I was self-employed — I had a Blue Cross policy with a huge deductible. And it came out okay. But I decided to rebalance the calculation after I retired and went on Medicare given how much less predictable good health is with aging.
Of course, the magnitude of the downside of only having Part A depends on the personal financial resources available for covering the shortfall if it becomes necessary.
Again…who does it serve to have the system be so complicated…?
Ohio Mom
ALurkSupreme:
There is a six month window around the Medicare participant’s birthday in which you can sign up: three months before and three months after. Wait any longer, and your premiums will be higher the rest of your life.
If you sign up early, coverage will start on the first of the birthday month (for example, if your birthday is September 30, coverage starts on September 1).
As mentioned above, there are counselors who can help. Contact your area Council on Aging for info on this.
Your big choice is between: Traditional Medicare (Part A), supplemented with a Part B plan and a Part D (drug plan), OR
a Medicare Advantage Plan (all inclusive).
There are pluses and minuses for each.
cope
@Ohio Mom: Yes, and I pay that penalty because when I retired, my work insurance carried over to the end of the year so I thought I could defer signing up for B. My bad. It costs me some $6-8 extra a month.
OzarkHillbilly
@satby: I am not so sure. Just got my new card but at the bottom it says, “Enrollment in any Humana plan depends on contract renewal.”
Now I am screaming at phone menus.
Luciamia
I, for one, will not miss the endless tv commercials.
JanieM
@cope: That’s depressing. I thought you didn’t have to pay the penalty if you had some other “creditable coverage” (?).
I worked until I was almost seventy, with good health insurance from work, and I didn’t end up having to pay any penalties. But the system is so complicated, I suppose there’s some quirk or complication that made our situations different.
David Anderson
@ALurkSupreme: Nope, you are all good.
You’ll get deluged with information next summer.
JanieM
For the record, this page shows one of the downsides of only having Part A.
E.g. for inpatient hospital care there’s this:
Well, the benefit period is sixty days (although it’s not even that simple; hover the cursor over the phrase for an explanation). I have a relative of a relative with serious health problems, no money, and no ability to work (she is mentally disabled, it’s as if she has Alzheimer’s). She had two hospital episodes within a few months and was charged the deductible for both of them.
O. Felix Culpa
@Ohio Mom: Isn’t today Tuesday? :)
Ohio Mom
O. Felix Culpa:
OMG, you are right! To the phone!
ALurkSupreme
Ohio Mom and David: Sincere thanks for your help!
Your information is consistent with what I thought I knew, but I try to triple- and quadruple-check when it comes to health insurance.
Cheryl from Maryland
Dear David — I would like some reassurance from an expert. I’ve been reading Medicare information for several months now in preparation for my husband turning 65 next June. His health and pharmacy needs are very complex, but he’s also an ex-fed, so he has BC/BS FEHB as his secondary insurance. Everything I have read indicates that all he needs to do is sign up for Medicare A & B with BC/BS FEHB as his secondary (which is guaranteed by his retirement) and avoid Medicare Part D because it won’t save him any money or help him in any way. This would be a big relief as we’ve conquered BC/BS to accept his doctors’ scrips. If this isn’t in your realm of expertise, that’s fine. Feel free to contact me off-blog. Thanks so much.
JanieM
@JanieM: Maybe it’s only Part D that does the creditable coverage thing….aaarrrgh.
Nelle
It would help to get straight answers. Just spent half an hour with a broker who, it turns out, only sells Advantage and kept trying to talk me into that. I’m willing to pay more to skip all the deductible, copays, percentage of hospital stay business. Nothing like a surprise six day hospitalization for what was supposed to be an overnight stay to know I dont have enough brain cells left to become a nearly full time, voluntary worker for my own care. Nor the interest. I resent the usurpation of my time enough as is.
Delk
From the Medicare & You 2021 handbook :
‘Plan coverage and costs can change each year. If you already have a Medicare plan, look at your plan’s 2021 coverage and compare it with other plans. If you’ve compared different plans and decide to stay with the plan you have, you don’t have to do anything.’
section 11 page 117
edited to add: I have an Aetna Premiere PPO and have been happy with it. Going to keep it.
WV Blondie
Every time you post on this, David, you get inundated with questions … So here are mine :-)
I could ask another dozen questions, but I know you’ve got a slew of ’em already …
Ohio Mom
For anyone considering a Plan D:
There is a handy-dandy Medicare site to help you. You type in your Zip code and all your current medications and it tells you which plan is the cheapest in your area.
What? It’s the middle of the Plan year and your doctor prescribed something new, that needless to say, wasn’t on the list you typed in? It isn’t on your current plan’s formulary?
This hasn’t (yet) happened to me so I don’t know what the options are in this case. Just another fun kink in the system.
JanieM
@Ohio Mom:
I’m pretty sure at that point you’re screwed until the next enrollment period, but I would love to be proven wrong.
I had this happen to me in a minor way for a medication I need only rarely, and ad hoc, but when I need it I need it badly. It wasn’t covered by my plan, but my pharmacist was helpful enough to tell me I didn’t have to buy all the pills my doc prescribed, I could just buy a few to have on hand just in case. Which I did, paying about $40 instead of over $200.
Kelly
I’ll be 65 June 2021. Mrs Kelly will remain on Obamacare for several years. The premium after subsidy for the plan we’ve been on for the last few years will be $260 a month more for Mrs Kelly alone than the premium for the two of us plus whatever I end up paying for Medicare. My aging into Medicare may cost us around $500 a month. Not a financial disaster but very weird.
wvng
@Ohio Mom: when I said basic Medicare, I was including Part B, because that seemed basic to me. It’s Advantage, D and supplemental policies I was talking about. Sorry for any confusion.
WhatsMyNym
@wvng: I recommend checking the Medicare website for a basic Advantage plan. They can be a real cost saver as you get older. With 2 of you, the odds are high one will need it.
TomatoQueen
I turn 65 on 12/31. I still work and plan to continue until I drop. I have AETNA for federal employees which just forked out for my titanium-enhanced backside to the tune of over $40K and oh do I feel better except for when I don’t. It’s a nice plan but sort of screwy in the formulary dept (odd things about diabetes supplies coverage for example). I don’t want to pay any more than I’m paying now but we’re being told that of course premiums are going up. A lot of gibbering and no decisions here.
Scout211
@WhatsMyNym:
Definitely check because some counties do not have any providers that accept Medicare Advantage, like my rural county in California. One of my neighbors actually keeps an apartment in a nearby county so they can use Kaiser for their Medicare Advantage coverage and they use that address and live there the required days per week to qualify.
All of our healthcare providers are in that nearby county as well. But we have regular Medicare plus Tricare for Life. Both are accepted anywhere.
You definitely have to study the plans that your county allows. HiCap is the free advisory agency here in California. It is very helpful and has all the latest on policies for 2021.
2liberal
is there a free advisory agency for AZ? I’m on Part A however now I need to add on the other parts as my company is moving forwards with off-shoring tech support starting Jan 1. I found MedicareWire, is that one of many ? They partner with HealthPlanOne which sells policies.
David Anderson
@WV Blondie:
A– you have a 1 time window to buy a supplement during your initial eligibility that is not underwritten
https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap
B — the marketing e-mail system on Healthcare.gov is unlikely to be tightly tied to future eligibility determination system. It is cheaper for Healthcare.gov to spam you and everyone else who has a current plan but has not renewed their plan than to clean the list mid-year
C: Given the Public Health Emergency, Medicaid is not conducting redetermination of eligibility right now, so even (hopefully) your income has increased since your husband became eligible, he is still eligible even if he was not in normal times. This rule is in effect for at least as long as the public health emergency. Loss of Medicaid coverage in March 2021 (or later) would trigger a Special Enrollment Period for your husband to sign up on HC.Gov. He should do nothing right now.
David Anderson
@Cheryl from Maryland: I’m not sure… Part D regulation is beyond my ken
Scout211
@2liberal:
https://www.shiptacenter.org/about-medicare/regional-ship-location/arizona
It looks like this is the agency for Arizona.
2liberal
@Scout211: thanks, I think this is for financial assistance with medical. I’m not looking for that and don’t expect to be. I’m just looking for guidance with enrolling in, and using Medicare, which I think is different.
JanieM
For @2liberal:
https://des.az.gov/services/older-adults/medicare-assistance
ETA: The free class I took, complete with someone who helped me sign up the first time, was under SHIP’s umbrella in Maine. And sorry for the haste, I’m in a hurry because I’m overdue for a meeting.
Scout211
@2liberal:
According to the national SHIP site, the Arizona SHIP site is supposed to have counselors that give advice on plans.
https://www.seniorsresourceguide.com/directories/National/SHIP/
Scout211
@JanieM:
And JanieM got there first. :)
Another Scott
@Scout211:
[Boggle!]
I had no idea people did things like that. Wow.
Our system is broken in so many ways. :-(
Cheers,
Scott.
satby
@wvng: The trouble with Advantage plans is that they tend to be networks tied to your location, and traveling puts you out of network. I chose a supplemental plan, because if something serious happens to me I’m heading out of South Bend to Chicago. Two hours away but not in any networks I’m aware of in my area.
JanieM
@Nelle:
and @satby:’s entire comment —
I chose Medigap rather than Advantage for these reasons, and I’m just grateful I can afford the premiums (which aren’t too bad, really).
I had really good coverage when I was working, but even so the network restrictions were frustrating and at times maddeningly limiting. I toss barrels full of Advantage junk mail in the fall at this time of year. It seems to me that they wouldn’t push them so hard if they weren’t making a lot of money off them, and the money is (surely? David?) made off the backs of people who have a lot fewer degrees of freedom under those plans.
Scout211
@JanieM:
It really does depend on where you live. Before I was retired and on Medicare myself, we helped my father get enrolled in Kaiser and he was extremely happy with their Medicare Advantage plan. But he pretty much never left the county he lived in here in California.
Then he decided to move to Florida to live near my sister. My sister could not convince him that there was nothing in her county anything like Kaiser and he needed to enroll in regular Medicare. He refused to pay the extra money for regular Medicare and a supplement, plus Part D. So she was forced to take time off work and then drive him all over the county every time he had a doctor’s appointment because there were so few healthcare offices that accepted his enrolled plan. It was very cheap up front but there were very few providers in the entire county that accepted it. She was a hospital social worker and knew all of this but he just saw the costs and refused to believe her.
The end of the story is she finally changed him to regular Medicare when he moved to assisted living so he could actually use the medical providers who came to the facility. Otherwise, she would have had to remove him from assisted living (not easy with his dementia at that time) and drive him all over the county to see the providers who accepted his Advantage Plan.
So yeah, check the plan and check the providers near you who will accept the plan and then check the portability of the plan.
JanieM
@Scout211: All good points.
The complications of having a parent in a nursing home, and all the bureaucracy and paperwork around both Medicare and Medicaid, are mind-boggling. Kudos to your sister for doing the work of navigating it for him — I too have such a sister, and thank heavens she lives near where my mother was in her last year of life.
Cheryl from Maryland
@David Anderson: Thanks for replying anyway.