Medicare – Turning 65

by Marie on October 21, 2013 · 5 comments

It seems that every insurance agent in the country knows I’m turning 65 this year and each and every one of them is sending me mail to ‘help me out’ with the open enrollment period.

What a pain. I have perfectly good insurance right now at a reasonable rate. But along comes age 65 and suddenly my insurance might become secondary and medicare primary and I have to spend my valuable time researching a government program so that my negative impacts are as small as possible.

There are multiple parts (A,B,C and D) as well as multiple kinds of plans (original Medicare, Medicare Advantage, Medigap and so forth). What a nuisance. I’d love to just keep my current insurance and not have to worry about all the government rules and regulations! I believe that I will end up just paying more for the same or lower coverage, even if I keep our current insurance and add the Medicare. What a great deal for me!

Come with me on my journey!

Question: Do I have to enroll in Medicare?

In general, no, you aren’t forced to enroll.  However, if you worked, you were probably forced to pay the taxes for Part A.

For me, the answer is probably YES – at least for Part A (hospital services).

I understand that because I paid into Medicare for more than 10 years while working – I am eligible for the ‘free’ Part A benefits of Medicare – which include hospital services coverage of some sort.

For me, the answer is probably YES – also for Part B (professional services). Although I don’t HAVE to buy this coverage, it seems to be recommended.  But, at least we have a choice.  Since our insurance is through the Federal Employee Heath Benefits program, we can choose to NOT enroll in part B and retain coverage through our current insurer.  However, I can’t seem to get a straight answer on whether the coverage would be the same as it is now – overall.

Question: Do I pay extra for Medicare?

For me, the answer is YES. Since Medicare will become my primary insurer under our current health insurance policy rules if I   enroll in Part B.  There is a monthly  premium of around $100 each (this year anyway). So there goes an extra $1200 out the door with no extra benefit. I’m 90% sure that our current insurance premium will NOT go down because I will have Medicare as a primary insurer (unless we change our plan options).

Why do I think this? For years, when I was working, my spouse carried family insurance to cover all of us. After the kids left home he kept this coverage – top of the line – pays for most stuff. All the while I was working, my employer covered me at no cost. Therefore my company insurance became my primary insurer, with my husbands policy becoming secondary. Our premiums were not reduced. The only benefit I saw was that my deductibles were paid by his insurance. Of course, if my employer insurance wouldn’t cover something, it was submitted to the secondary – but most of the time the primary insurer paid. That may be different with Medicare – the government program is probably of way lower quality than my employer insurance was.

So, guess what. If you do sign up for Part B, and the more income you have, the more you pay for the privilege of carrying Part B. Great. Not only do you have more of your Social Security benefit taxed, you also pay more for Medicare ‘benefits’. See – these programs will survive, they will give you benefits, but then Uncle Sam will take the money away through a back door of some sort. That way, the populace doesn’t get angry and the government still gets their money.

Since I’m not taking early Social Security (my full retirement age is 66), I have to sign myself up for the program. If I had taken benefits at age 62, I WOULD BE AUTOMATICALLY ENROLLED! Great.

According to Kiplinger article Survive the Medicare Enrollment Maze:

“You need to sign up yourself for Parts A and B if you have not started Social Security benefits by the time you turn 65. You should enroll in Medicare when you’re first eligible during your seven-month “initial enrollment period,” which begins three months before the month you turn 65 and ends three months after your birthday month.”

If you don’t and then later decide to sign up, you pay more… and more … 10% penalty for each year you delay signing up!

Question: What parts of Medicare do I have to get (or should I get)?

Part A.

Since we have paid into Medicare for more than 10 years, Part A – Hospital Services is a no brainer and probably will be required by our current insurance company anyway.

Part B – covering things like ambulance service, mental health (yes Medicare may just drive me crazy so I might need this one!), second opinions on medical treatments and more.

Who decides what is covered? Lawmakers (ugh!) and Federal and state medicare administrators! Great. I wonder if any doctors have a say in it?

Since we have good insurance and I want to keep it that way, I will probably end up paying the extra premiums of $104 a month. The only benefit I get that I can see is that my insurer will pay “100% of covered hospital and medical expenses after Medicare. You pay no deductible or co-pays for hospital and medical benefits” (from their website).

Part C – otherwise known as Medicare Advantage.

According to the Social Security site

Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee. You must have both Parts A and B to enroll in Part C.”

I will need to look into this more but don’t think it is something I will need. It sounds like it pertains to HMOs.

Part D – Prescription drug coverage.

Since our current insurance has ‘Creditable coverage’ for drugs, I won’t be paying extra for this one! According to United Health Care’s site:

“Medicare beneficiaries who have other sources of drug coverage – through a current or former employer or union, for example – may stay in that plan and choose not to enroll in the Medicare drug plan. If their other coverage is at least as good as the new Medicare drug benefit (and therefore considered “creditable coverage”), then beneficiaries may continue to get the high quality care they have now as well as avoid higher payments later if they sign up for the Medicare drug benefit. Eligible members who forego Part D enrollment when first available and who do not have creditable prescription drug coverage for any period of 63 days or longer will likely have to pay a higher Part D premium of one percent (1%) per month for late enrollment.”

Question: Will my doctors still provide care for me under Medicare?

I’ve hear that some doctors are refusing to serve people with Medicare. I wonder what effect this will have on me now and in the future.

It seems to be a real possibility and an issue that will most likely get bigger as more doctors go to different service models and the boomers fall into Medicare. According to Forbes article What To Do If Your Doctor Won’t Take Medicare: 

 “Medicare officials say the number of doctors who don’t accept Medicare is very small. According to their figures, only about 4% of U.S. doctors don’t participate and most beneficiaries (as patients are called in Medicare lingo) can see the doctors they want. Still, a 2013 annual report by the Medicare Payment Advisory Commission, an independent congressional agency, shows that 28% of beneficiaries seeking a new primary-care physician last year had trouble finding one who accepted Medicare.”

I don’t really fault the doctors. They spend hundreds of thousands of their dollars on getting educated, trained and on equipment, malpractice insurance and more. Why should they give their services away.

So, if I want to continue good quality health care, I may have to pay my own medical bills to a doctor who won’t accept the knock downs in price that accepting medicare insurance requires of them. The Medicare site even lets you do a look up to see which doctors DO take Medicare.

Who came up with this wonderful Medicare program! Can you tell it wasn’t me! More later as I seek my answers.

What are your family’s Medicare experiences?

Disclaimer:  I’m obviously not an expert and just as obviously biased against this program, so don’t rely on what I’m saying here to make your decisions on Medicare!

 

{ 5 comments… read them below or add one }

1 Sarah M October 22, 2013 at 1:40 pm

If you don’t want Medicare coverage right now (and I view it was a program plainly not designed for people who aren’t retired), just don’t enroll. I’m not sure why this is hard, or why educating yourself on your insurance options is in any way a negative. Most of us don’t really understand how our insurance plans work as well as we should.

As for experience, I can speak to my father’s, who retired a year ago and began both Medicare and Social Security when he exited the workforce (again, I think this is the point of the program, so I don’t entirely understand your central complaint – most likely Medicare isn’t for you yet. OK! Nobody can force you to read more things!). Once he completed the sign-up, which like signing up for anything is a process, I can tell you he’s paid more, not less, attention to his health. There was a required physical after he started, which alerted him to some minor chlolesterol and fitness issues he’d been ignoring for awhile, and he’s now healthier and has a relationship with a physician he didn’t have before (who’s treating him quite happily, I really do think the ‘inability to find a doctor’ who deals with Medicare patients is something of a boogeyman).

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2 Sarah M October 22, 2013 at 1:41 pm

*are retired, rather

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3 Marie at Family Money Values October 22, 2013 at 6:55 pm

Actually, I have been retired for 3.5 years (yeah!). The complication occurs when trying to understand how our current plan fits in with what medicare part b offers and whether or not it would be beneficial for us to enroll and pay an extra $109 a month for the medicare, on top of our current premium.

Thanks for sharing your Dad’s experience.

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4 hey wayne October 24, 2013 at 1:25 am

Ouch! I’ve read your blogs for some time and have usually found them interesting and/or educational but this article reeks of poor research and will surely confuse anyone contemplating their Medicare options for themselves or for a friend or family member. You do excuse yourself on your disclaimer but I think your facts should be more accurate and more articulate before publishing an article that confuses or misinforms potential or current Medicare beneficiaries.

I am a SHIP Medicare Counselor with only a couple of years experience so far, but some of your information could or should be clarified. I am 73, retired for three years who retained my employers coverage until I fully retired. At that point, I enrolled in Part B, Part D, a supplement plan without any financial or eligibility penalty.

First, the issue of signing up for Medicare while you are still employed is more complicated if you have insurance coverage that will continue as long as you remain employed. If that coverage is equal or better than Medicare Part B medical or Part D drug benefits (“creditable coverage”) you can delay signing up for Part B or Part D without any penalty unless you delay signing up once the “creditable coverage” ends. If you are a federal employee, you have options less costly than the rest of us for healthcare benefits under Medicare.

Some employers plans will not cover you with the same coverage once you reach 65 forcing you to enroll in Part B and D plans. Check carefully with your employer’s (or union’s) coverages.

Some employer and union plans for retirees are often better than Medicare options but rising premiums, copays and deductibles are causing patients to search out better prices with Medicare Supplement and Part D Drug plans. Sometimes, they are successful but you must check out the fine print in the employer/union plans because once you enroll in another insurance plan, all benefits in the union plan may cease and are cannot be reinstated.

All insurance companies, not just Medicare, determine what is covered and what is not under their various plans. Some are much more restrictive than Medicare.

Finding doctors who will accept “new” Medicare patients is becoming an issue according to some my acquaintances although all of mine, some just recently started, are all still accepting me.

Original Medicare is often the least restrictive of any type of insurance plan regarding which doctors and facilities may be used without penalty. The HMO and PPO models are the reigning models for most insurances which usually are restrictive on allowable providers. Many of the Medicare Advantage Plans (Part C) are also similarly restrictive.

I could go on and on and on. The Medicare web site (Medicare.com) has tons of detailed information on options and rules for Medicare beneficiaries and when your situation seems unsuitable for the web, call Medicare at 1-800-MEDICARE.

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5 hey wayne October 24, 2013 at 1:34 am

Please correct the Medicare website to medicare.gov

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