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Old 05-15-2020, 11:58 AM
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My wife qualifies for medicare /medicaid in July she has pre existing condition ( stroke , high blood pressure ,type 2 diabetes etc) I was talking to a social security rep and he was from another country and was not very clear apparently what happens is that social security will with hold $145.00 per month for their product but then people start talking about paying extra for pills etc which you have to buy from another insurance company who then puts you on HMO plan?? One agent tells me for an additional $245.00 per month her plan covers every thing including PPO ?? Anybody know the true ins & outs on this deal.
Old 05-15-2020, 12:11 PM
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United Healthcare/AARP Plan G, covers all deductibles no out of pocket.
Old 05-15-2020, 12:16 PM
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Originally Posted by THT MOD 14 View Post
United Healthcare/AARP Plan G, covers all deductibles no out of pocket.
^^^^ this is what I have

This company helped me out in deciding. https://medicare.selectquote.com/
Old 05-15-2020, 12:28 PM
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A couple things I ‘think’, no claim to be expert.
1. If collecting SS, you automatically enroll in Medicare at 65.
2. They will deduct $145 for Medicare from your SS.
3. You can get additional coverages from almost any healthcare provider - aarp, usaa, ...
4. No reason to talk with anyone in another country.
5. Does your or her employer offer any supplemental coverage?
I spent days trying to proactively set up a plan for my wife’s transition to Medicare and got nowhere until she turned 65. Then was simple. Applied for SS online, couldn’t have been easier.
Good luck
Old 05-15-2020, 12:45 PM
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Nothing run by the government is as simple as it should be.

You can get a prescription supplemental policy, I think that is Part D BUT--each company's policy has their own "formulary"--drugs they will pay for. Make sure the drugs she is taking (or most of them anyway) are in the formulary of the company you choose. And, they can change the formulary too.
Old 05-15-2020, 01:22 PM
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I just went through this head ache for both me and my wife.

Do yourself a favor and solicit the help of an insurance broker that reps MANY insurance companies and plans. This type of broker wont's steer you to one or another plan, they get paid the same regardless. Do not engage a health care insurance provider as they will only quote you their product, unless of course you want to.

The short rundown
Medicare Part A 80% of inpatient/hospital costs No premiums 20% copay
Medicare Part B 80% of out patient/doctor costs As of 2020 premium 146.60 per month. 20% copay
Medicare Part C Medicare Advantage covers expenses not covered in above. If you go this route you might be subject to in network providers. Usually provided by the big name health care providers. United/Aetna etc. There are many plans and deductible structures etc
Medicare Part D RX Coverage, apply online at medicare.gov after receiving approval of medicare coverage. Create account, choose mail order or retail or both to get quotes after entering any meds you might be taking. For my area there were 26 plans to choose from YMMV.
Medicare Part F is phased out in 2020
Medicare Part G Supplemental to cover copays of Part A and Part B after any deductibles. The plan we selected is good anywhere we might go. No network provider requirement.

I think that covers it............................maybe............... .........how I understood it. LOL

Last edited by usernamewastaken; 05-15-2020 at 01:31 PM.
Old 05-15-2020, 01:28 PM
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FYI...Humana offers an Advantage plan that is a PPO, at least in Florida and I do not know about other areas, no premium and includes Rx . Not all Advantage plans are HMO's
Old 05-15-2020, 01:50 PM
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Humana advantage was a bust for my wife and I. One the big issues was that they changed approved providers all during the contract period. It was a total nightmare.
I suggest you use Medicare as the primary and find a Suplemental policy to help you with the balance after medicare. Basically all care providers accept Medicare so your list of doctors stays full. We have BCBS Plan F as supplimemtal to the tune of about 250 per month for us and we're pretty well satisfied - with the exception of the fact that my previous employer paid close to100% before this obamashit started.
Old 05-15-2020, 07:55 PM
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The "parts" are A-D. Part C is whatever supplemental plan you add That will be plan G or the other less inclusive ones but G is the Cadillac plan. Plan F was the Rolls Royce plan but it is gone for new subscribers.

Advantage plans are a whole nother thing. They take the part B premium plus what Medicare budgets for you and they cover everything like a regular insurance plan. You are not using regular medicare.Put that card away, nobody wants to see it. They may also want more per month from you but it usually covers drugs.You might actually pay zero per month for everything.
If you are fairly healthy and the providers are good in your area, it can be attractive. There will be co-pays for most things. You really need to do your homework on that one. For me, the AARP/UHC PPO Advantage plan works great. They cover both medical conglomerates that dominate our area so I can go anywhere. My Co-pays are not anywhere near the price for a regular medicare plan. My wife isn't all that healthy and when she is up next year, I think we will put her on Plan G.
Old 05-15-2020, 08:01 PM
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I got supplemental plan F. If still available look at it. No copay. No overages. Any provider accepting Medicare. No shitty networks or silly waits or referrals.
Old 05-15-2020, 08:02 PM
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F no longer available replaced by G.
Old 05-15-2020, 08:12 PM
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I’m 5 years out. Will not need any of it, DAV but good info. My care is covered by VA.
Old 05-15-2020, 08:21 PM
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Originally Posted by Still Stoked View Post
I got supplemental plan F. If still available look at it. No copay. No overages. Any provider accepting Medicare. No shitty networks or silly waits or referrals.
plan g covers it all but initial deductible buying f costs more than paying deductible plus cost of g plan

Last edited by donald/tri-again; 05-15-2020 at 08:32 PM.
Old 05-15-2020, 08:31 PM
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Medicare c turns your care over to a private insurer .usually no cost besides what govt charges for part b . Who now plays God with your life. Limiting what tests procedures they will qualify you for . They make pot look sweet by throwing in some freebies and limited drug coverage.
you can try it for the first year and still be able to switch to regular Medicare a,b, plus buy plan g medigap and part d Rx coverage without health review. After your first year on “c” your stuck if you want to change to regular a,b, and medigap policy you have to go thru medical underwriting! If you developed something extreme during that first year your premiums will skyrocket trying to change to real Medicare. And if you stay on c plan you may not get care needed .
A is free . B you pay then buy medigap and part d plans so sometimes it’s cheaper to stay on employer plan or keep spouse on employer plan !
Cheapest plan may have big price increases after first year , have to look at yr to yr comparison of rate hikes too.
boomerbendfits.com has good videos to explain it all and show the pitfalls.
or. https://www.remedigap.com/

Last edited by donald/tri-again; 05-15-2020 at 08:41 PM.
Old 05-15-2020, 08:58 PM
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Originally Posted by donald/tri-again View Post
Medicare c turns your care over to a private insurer .usually no cost besides what govt charges for part b . Who now plays God with your life. Limiting what tests procedures they will qualify you for . They make pot look sweet by throwing in some freebies and limited drug coverage.
you can try it for the first year and still be able to switch to regular Medicare a,b, plus buy plan g medigap and part d Rx coverage without health review. After your first year on “c” your stuck if you want to change to regular a,b, and medigap policy you have to go thru medical underwriting! If you developed something extreme during that first year your premiums will skyrocket trying to change to real Medicare. And if you stay on c plan you may not get care needed .
A is free . B you pay then buy medigap and part d plans so sometimes it’s cheaper to stay on employer plan or keep spouse on employer plan !
Cheapest plan may have big price increases after first year , have to look at yr to yr comparison of rate hikes too.
boomerbendfits.com has good videos to explain it all and show the pitfalls.
or. https://www.remedigap.com/
I don't find this to be true at all....far from it.
Old 05-15-2020, 11:05 PM
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Going with Plan G in August when I hit 65. $229/month and I’m covered. Wife has Plan F, but they stopped it 1 Jan 2020, replaced by G; she’s grandfathered in for F.
Old 05-16-2020, 05:24 AM
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Originally Posted by THT MOD 14 View Post
United Healthcare/AARP Plan G, covers all deductibles no out of pocket.

This is what most of my clients have that want good coverage. Worth the extra if you ask me
Old 05-16-2020, 06:40 AM
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Avoid medicare advantage plans at all costs!!
Old 05-16-2020, 07:03 AM
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If your wife qualifies for Medicare in July, she can apply for her Medicare now. Medicare coverage will not begin until she is age 65. If your wife already receives a Social Security benefit, the Medicare premium will be deducted from her monthly SS benefit. If she is not receiving SS, she will receive a bill for Medicare premiums every 3 months.
https://www.ssa.gov/benefits/medicare/

If your wife is covered by medical insurance through her current employer or yours, talk to someone in the benefits department to learn what you should do. Most employer-provided plans want a covered individual to apply for Medicare coverage to begin when the person turns age 65. The employer may also offer a Medicare Supplemental or Advantage plan and the benefits department can also advise on that. In the cases of my and my wife's employer insurance, the company-sponsored Advantage plans can be a better deal than similar plans on the open market, because the employer often pays part of the premium. My Advantage plan is administered by Aetna, costs me $92/month and I get one Explanation of Benefits statement for each medical visit.
Old 05-16-2020, 07:08 AM
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Originally Posted by usernamewastaken View Post
I just went through this head ache for both me and my wife.

Do yourself a favor and solicit the help of an insurance broker that reps MANY insurance companies and plans. This type of broker wont's steer you to one or another plan, they get paid the same regardless. Do not engage a health care insurance provider as they will only quote you their product, unless of course you want to.

The short rundown
Medicare Part A 80% of inpatient/hospital costs No premiums 20% copay
Medicare Part B 80% of out patient/doctor costs As of 2020 premium 146.60 per month. 20% copay
Medicare Part C Medicare Advantage covers expenses not covered in above. If you go this route you might be subject to in network providers. Usually provided by the big name health care providers. United/Aetna etc. There are many plans and deductible structures etc
Medicare Part D RX Coverage, apply online at medicare.gov after receiving approval of medicare coverage. Create account, choose mail order or retail or both to get quotes after entering any meds you might be taking. For my area there were 26 plans to choose from YMMV.
Medicare Part F is phased out in 2020
Medicare Part G Supplemental to cover copays of Part A and Part B after any deductibles. The plan we selected is good anywhere we might go. No network provider requirement.

I think that covers it............................maybe............... .........how I understood it. LOL
Up here I went through this dance. What I learned was
You have to enroll part A @ age 65
Part B you have to enroll in and they will deduct that cost from your SS and as I understood it (I could be wrong) you only get this option once, you can opt for it but defer it if you are working I believe but if you decline it you can't go back later and select to take it.

It gets crazy after that, The medicare advantage plans (up here anyway) were cost free but had huge deductibles (3000) and max out of pocket (6000) and didn't cover many things and had a network . They even had "gym reimbursement".

I opted for Plan G which I pay $130 for a month and covers what "A and B" doesn't. And then I opted for a plan D which covers rx's for $20 some bucks a month. I opted for one that would make CVS my "primary" pharmacy .

I haven't really used any of this all that much as I am in real good health and work hard to stay that way but when I did, so far, the costs to me were almost nothing ($5 once I think for an RX)
I ended up using "Senior healthcare direct" to find my plans , and they were actually telling me I really didn't need the "G" due to my good health but it would be a wise choice. He also told me all the plans have to offer the same coverage .

Anyway that's my .02 and what I ended up doing. I'm happy so far and haven't really had to put any of this to a real test.

Last edited by Eastport205; 05-16-2020 at 12:16 PM.

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