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DiscussionRoadblock to Medical Care? Medicare Advantage Plans
Just Want to Talk | Last Active: Sep 28 9:46pm | Replies (21)Comment receiving replies
Replies to "Any input advice appreciated. Open enrollment coming up. I will be 64 in 13 days. This..."
@mdk1960 Since you will be turning 65 next year you will likely be inundated with mailings from a number of companies that sell supplemental plans such as United Health Care, Omaha of Nebraska to name a few. I certainly was.
By “straight” Medicare I’m wondering if you mean Original or Traditional Medicare? That’s where you sign up for Parts A and B, choose a supplemental plan to “fill in the gap” after your Part B pays 80% of your outpatient bills, and then also choose Part D which is your prescription plan.
I chose Original Medicare. I have Part A (no cost to any of us), Part B (we do pay for this $174.70 per month) although this amount can be higher depending on your income as filed with the IRS), Part G (I chose Transamerica Insurance and I pay $165 per month) and Part D (I chose WellCare, I do not have a premium). With all of this I can go anywhere I choose in the U.S. that takes Medicare. I do not need pre-authorization as no private insurance companies are involved. This is why I chose Original Medicare because I did not want to be in a provider network that limited where I go for my medical care.
On occasion I pay for a lab test (a blood test) that Medicare does not cover. At times my co-pay for my prescriptions has been over $100 which irks me but that’s the way the drug companies work.
Can you switch to Original Medicare? I don’t know the answer to that. It is very confusing. I do know that when a person first enrolls in Medicare at age 65 one cannot be refused any health care plan, including the Supplemental Plans based on prior diagnoses. If a person chooses a Medicare Advantage Plan at age 65 and then later wants to switch to Original Medicare with a Supplement I believe the insurance companies can deny based on prior health history. But you should get more clarification on that by carefully reading the policy descriptions for the Supplemental Plans.
What’s Medicare Supplemental Insurance?
— https://www.medicare.gov/health-drug-plans/medigap
Does this help?
I'm unsure what you mean when you say "Do I switch to straight medicare,? "
As far as I know, unless you have End Stage Renal failure, and maybe a few other diseases, you cannot sign up for Medicare until the month when you turn 65. For you that would be October 2025.
Here is what I suggest - find an INDEPENDENT - not tied to one company - insurance agent who specializes in Medicare or Health insurance. Start looking now, reading and asking questions of friends, neighbors and family members. Then, next year about 6 months ahead of your birthday, sit down with that person and find out what your options are, and the costs for each one.
In the mean time figure out what you need in an insurance policy
1) whether you have specific doctors you want to continue seeing,
2) whether you travel or plan to and will need coverage while away from home,
3) whether you have conditions that may worsen with age and require surgery or expensive care
4) what you can afford to pay for premiums and copays.
Sometimes the "zero premium" policies end up costing far more than one with a monthly premium. For example, if you need a joint replacement followed by a short rehab stay and then PT - if there is a $1000 hospital copy, then $50 copays each for physical 12 therapy sessions, and $200/day copays for a week in rehab, your out-of-pocket expenses for that one procedure are $3000. But if theses costs are all (or mostly) covered by a policy that costs $250 per month and gives you good coverage the rest of the year, you are way ahead.
My friend showed this calculation to a group of seniors in our winter community and they were amazed.
Do you live in/near a town or city where you can find a good agent?