I will be starting Medicare in a couple of months. I am at a loss as to what I need. I am hesitant to talk to anyone because they all want to sell a policy. My UHI retirement policy becomes secondary and Medicare primary. My prescriptions are covered so I don't need part D. I have no need or practical way to use "silver Sneakers" or other gym benefits so they mean nothing to me. Would an advantage plan have any benefit at all for me?
Am I correct that you are talking about an American style of Medicare ??? I am in Canada and our system is different...
When you sign up for Medicare you will be mailed "The Official U.S. Government Handbook". In the back there are listed all the health plans in your area. There are a lot to choose from, so I only looked into those that have a local connection. I'm now part of a local health care system with clinics and hospitals and it works for me. If you are not happy with your choice after the first year, you can change to another during the fall enrollment period.
Medicare A covers hospitalization, and part B covers doctors. You are not charged for part A, but you are charged for part B. Most people also get either a Medicare supplement or a Medicare advantage plan that picks up whatever the part B does not cover. We have had an insurance agent for the past 3-4 years, and I think that it really helps out. He goes over the available plans with us to decide which plans are best for us, and what company offered the best plan for those coverages. So, yes, an agent will want to sell you a plan, but if you are going to get a Medicare supplement plan anyway, it really helps to have an agent that you trust to explain what each plan covers. Each year, our agent reviews the plans and we decide on which coverage is the best for us out of what is available. We have an Advantage plan, and really like it because it covers more things than just a Medicare supplement covers, like eye exams, glasses, and dental work. it gives us an OTC allowance each month (mine is $100 a month) for things like vitamins, first aid, medical equipment, etc. Since we use that Silver Sneakers membership, that is important to us; but if you are not close enough to a fitness center to use the SS membership, then it would not make sense to have that be part of your plan.
Then, there are those military Vets that have both Medicare A/B, VA Medical and a Supplement. I have all three. My left rotator cuff surgery/rehab, cataract surgery and a trip to ER last August were all taken care of by both Medicare B and Supplement. My main doctor is thru local VA and my medications all come from the VA. I will use my wife's doctor as my secondary doctor. Both of us have regular Medicare A and B with a Supplement.
I too was pretty confused at first until we got an insurance agent who spelled things out for us. One thing Yvonne forgot to include about the advantage plan was that with her insurance company, United Health Care, she gets points for health related activities and gets a nice little check every now and then. Everything is tied in with our watches and phones so the activities are tracked. The one item about medicare that still throws me is the insistence that we veterans have a Civilian primary health doctor as opposed to simply listing our VA doctor. I’ll have to check into it, but the present administration pushed through a new VA bill that allows us to go to a civilian doctor / hospital should we need one so maybe that might have some influence on overall billing for Part B medicare for vets. I’m not particularly worried about it because having an advantage plan already covers that for me but it’s a curiosity nonetheless.
Generally speaking, if you have secondary coverage (as a retirement benefit, etc.), you do NOT need an advantage plan. We have Aetna through our previous employer and when we went on Medicare in April, the Aetna coverage changed from primary to secondary. You probably need to get the ball rolling since you'll need to sign up for Medicare in advance of your birthday month. Your Medicare premium will be deducted from your SS if you are getting it.
Bobby, I haven't got a civilian doctor and never had.........thru the VA that is. My primary doctor is at the VA. One thing I did learn, it's up to the VA if they pay for medical services or not. After visiting a non-VA Medical, a Vet submits a form to the VA and they decide "pay or not". I was going to give up my Medicare A/B when we moved here, but the closest VA Hospital to me is in Cheyenne, Wyoming. That's some 50+ miles north of us. When I fell out of the bathtub last August, I went to local hospital ER and the entire cost of the visit was taken care of by Medicare and Supplement. And, since I'm a Diabetic II, Medicare will pay for a vision test for me each year. VA Clinics aren't open on weekends, so, if I didn't have Medicare and Supplement, I'd have to pay for all of a ER bill. The VA Hospital in Cheyenne has the closest ER for Vets around here.
Yep, I was thinking I didn't need an Advantage plan. I have no teeth,and the vision coverage is minscule at best. I have never used the VA. I did sign up because I am under the Camp Lejeune contaminated water program. Our county agent is not the best so I really am not sure what my cost for services would be. Supposedly the earnings cap is removed for my class, but I think that is for the specific related ailments.
Dunno what you mean by..”through the VA”. A civilian doctor is a civilian doctor and a VA doctor is a VA doctor and it seems that neither one particularly likes the other one. That said, on my medicare form it asked what primary health care doctor I had and when I tried to list my VA doctor it was rejected so I had to find a civilian doctor. We’re both about the same age so I do not know why it would be different. Now, about the cross referencing from one to the other’s services. All you have to do is call the VA clinic or hospital (triage) closest to you and explain why you are going to the hospital or to another doctor and it will be approved at that time. If you’re damaged and can’t call, your wife can do that whilst you’re checking in at the ER. I do not know what the mean ceiling is any longer but as of 5 or 6 years ago, if you make 12K or less, all VA emergency services are pretty much free of charge and the same thing applies to hospital services (new law) if there isn’t a VA hospital or clinic close by or you can’t get a timely appointment with the VA.
Which plan would be the best idea is highly individual because it has to do with your particular needs, as far as medication, specialists, out-of-area coverage, and so on. One thing to keep in mind is that you can change your plan every year if you want to, and there are some circumstances that allow you to make a change even before the year is up. I started out with a Supplement, then changed to an Advantage plan. I have a plan that only covers me in Maine and New Hampshire because I rarely leave the state and, when I do, the only coverage I'd need is for emergencies, and my plan does provide emergency coverage out of state. For that matter, if I were to move, moving is one of the conditions that would allow me to make a change before the enrollment year is up. My wife has something different because she sees a lot of specialists and takes a whole lot more medication than I do. You probably don't need to sweat the decision quite as much as you think you do because, as I said, you can change it next year if it doesn't work out as well as you'd like. In most cases, the guy you talk to will represent more than one plan so s/he'll be able to show you the differences between the various plans. I have had two different plans and my wife has had three, but we've used the same agent for all of them. The Medicare website is supposed to have an interactive thing where you can compare different plans in your area, although I've never looked at it.
Well I am all set. I received a benefit package from our carrier Saturday. We have pretty much the Cadillac of plans. Of course we pay about 400 per month for it. I will sign up for parts A&B. I am automatically enrolled in our plans part D. The plan will reimburse me the part b premiums, and the part D is a qualifying plan so that I can change next year if I am not happy.
What I was explaining, Bobby, I've never had a civilian doctor as a primary doctor, when using the VA Medical. My primary doctor is my VA doctor. I'm planning on having a civilian doctor, as a secondary primary doctor, when I have my first visit with my wife's primary doctor. The reason we have to pay a co-pay is because my wife was making over 50k and VA Medical goes by a couples (household) income. Because she made so much, we knew a VA Means Test would show that income and we'd still have to pay a co-pay for VA visits and meds. So, we didn't do a Means Test. When using my Medicare and Supplement, I have no worry about being charged for medical services, once my Medicare and Supplement yearly deductible is paid. Now, if I didn't have Medicare or my Supplement, I'd have to use VA Medical completely.
Okay, I am being bombarded with mailings and emails about selecting the best supplemental plan for Medicare because I will be turning 65 next year. My question is how will I know when I receive a mailing from Medicare? I know that I have to sign up 3 months before my birthday which is not far away. Help (in my small wee voice)