The Medicare Thread

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Originally Posted by mcski

I don’t think you’ve answered anything in a useful way lol.

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Disagree, I had assumed jumping back and forth between the Medigap plans is allowed or hopefully, is easy or encouraged. Answer is: Bad assumption. Jumping is allowed with conditions some of which might not be attainable (underwriting, etc.). So definitely not easy. And, no guarantee ten years from now same rules will apply, or even same plans will be offered. Big question answered is you want to choose a plan that will work for you for the remainder of your life.

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Originally Posted by mcski

Also LTC policies don’t kick in until Medicare coverage has been used up.

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That the common perception. Some retired 'Med Mal' attorneys I know claim the cutoff/kick in point is not so black and white.

I don’t think any LTC policy will start until Medicare/supplement is extinguished. That max is 100’days but getting to that number requires continuous improvement.

More disgraceful behavior!

https://www.youtube.com/watch?v=sKLCK8pR0TM

https://www.cbsnews.com/news/a-new-m...greed-to-blame

I don't know if it will be the case with this hospital but a lot of the time when a hospital screws up regulators impose a fine--which in a situation like this just makes things worse. I wouldn't be sruprised if the outcome is this hospital closing, Maybe it deserves to be closed but it would further reduce the availability of care.

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Originally Posted by fomofo

More disgraceful behavior!

https://www.youtube.com/watch?v=sKLCK8pR0TM

https://www.cbsnews.com/news/a-new-m...greed-to-blame

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What does this have to do with Medicare ?


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Originally Posted by Harry

What does this have to do with Medicare ?

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Take control, then systematically trim staff, underfund operations, and sell off assets, with a focus on maximizing profit. That model applied to healthcare not only undermines the quality of care, but also potentially availability of care. When community hospitals close that can be particularly hard on Medicare and Medicaid patients, and also possibly push people away from traditional Medicare to the private (Advantage) alternative.

Went in to my Tax preparer yesterday. She told me about IRMAA.

If you are still working and exceed $103K AGI your Medicare premium doubles.

SS counts as a part of your AGI. The more you know......

https://secure.ssa.gov/poms.nsf/lnx/0601101020

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Originally Posted by Bunion 2020

Went in to my Tax preparer yesterday. She told me about IRMAA.

If you are still working and exceed $103K AGI your Medicare premium doubles.

SS counts as a part of your AGI. The more you know......

https://secure.ssa.gov/poms.nsf/lnx/0601101020

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Regarding IRMAA this is mentioned in the ssa.gov doc linked above, but is definitely worth keeping in mind...

IRMAA is determined by income from your income tax returns two years prior. This means that for your 2024 Medicare premiums, your 2022 income tax return was used.

https://www.medicareresources.org/me...d-amount-irmaa

If you're getting Medicare coverage and normally have a modest annual income (Soc Sec or otherwise) below where IRMAA kicks in, but have a year where you have a one time long term capital gain, say, sell a second home, you could easily become subject to the IRMAA premium increases.

Also...

Unfortunately, even if you enroll in a Medicare Advantage plan, you are still subject to the Medicare Part B premium plus any IRMAA surcharges.

You might find an Advantage program in your area that does not charge an additional premium (known as zero-premium plans) above your Part B premium/IRMAA surcharge, I told the reader. But Advantage plans require you to use their network of health care providers, often require pre-approval for specialists and are usually restricted to care in a specific geographic region. While Medicare Advantage programs are becoming increasingly popular as a low-cost way to receive health care in retirement, they do involve trade-offs that may not be appropriate for people who are wedded to their doctors or who travel extensively.

No escaping IRMAAs by switching to Medicare Advantage

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Originally Posted by fomofo

Unfortunately, even if you enroll in a Medicare Advantage plan, you are still subject to the Medicare Part B premium plus any IRMAA surcharges.

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I realize you're quoting an actual article by somebody there, but I'm pretty sure Medicare Advantage is an alternative to Medicare A+B+D, and so Part B premiums should not be an issue for Medicare Advantage (as they are with Medicare Supplement plans). But whatever; anyone with enough income to be concerned about IRMAA charges (which do seem to apply regardless) shouldn't be considering Medicare Advantage's inferior coverage.

That, and Medicare premiums doubled is still pocket change compared to what private insurance costs previous to qualifying for Medicare.

In the spirit of Bunion above "The more you know......"

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Originally Posted by bobz

I realize you're quoting an actual article by somebody there, but I'm pretty sure Medicare Advantage is an alternative to Medicare A+B+D, and so Part B premiums should not be an issue for Medicare Advantage (as they are with Medicare Supplement plans).

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Medicare Advantage Plan (Part C):

You must keep paying your Part B premium to stay in your plan.

https://www.medicare.gov/basics/get-...-medicare-cost

(The Advantage plan may pay for all or part of the Part B premium.)

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Originally Posted by bobz

But whatever; anyone with enough income to be concerned about IRMAA charges (which do seem to apply regardless) shouldn't be considering Medicare Advantage's inferior coverage.

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I suspect there are lots of people of different income levels who have signed up for an Advantage plan without understanding exactly what they're getting (into, and perhaps giving up).

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Originally Posted by bobz

That, and Medicare premiums doubled is still pocket change compared to what private insurance costs previous to qualifying for Medicare.

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Sadly can't really argue that.

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Originally Posted by fomofo

Medicare Advantage Plan (Part C):

You must keep paying your Part B premium to stay in your plan.

https://www.medicare.gov/basics/get-...-medicare-cost

(The Advantage plan may pay for all or part of the Part B premium.)

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Huh. Okay. So even though one is opting out of the benefits of Medicare A+B, they still (depending on the Advantage plan) need to pay the Part B monthly. So, Medicare Advantage is an even worse deal than it had seemed.

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Originally Posted by fomofo

I suspect there are lots of people of different income levels who have signed up for an Advantage plan without understanding exactly what they're getting (into, and perhaps giving up).

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Ah yes, marketing! Can't dispute that. What I said was that people who can swing the very modest monthly expense of Medicare + Medigap "shouldn't be considering Medicare Advantage's inferior coverage", not that they couldn't ignorantly be led to choosing inferior coverage anyway.

Cono has kindly shared a wealth of information, but it's interspersed in posts spread all throughout the thread. I've though about going back through those posts and pulling out the juicy bits to stuff into a reference doc, but ... I think about doing a lot of shit that I never get around to.

Short of that this is a good reference manual...

https://www.medicare.gov/medicare-and-you

You can download a PDF from that page.

I posted something in the Older Parents-WWYD? thread this morning I thought might be useful for folks wrestling with that kind of situation. Included therein was some general info about changes this year in the Medi-Cal (California Medicaid) program that could possibly be useful for someone in Cali trying to work out healthcare coverage.

FWIW...

Medi-Cal Asset Elimination FAQ

Medi-Cal (for People with Medicare)

Ways to Lower or Stop your Medi-Cal Share of Cost

In sum, this bill will create an annual open enrollment opportunity for Medicare beneficiaries to choose a Medigap policy during the same time frame as the Medicare Advantage Open Enrollment Period, which is January 1st to March 31st each year. This bill creates more parity with the rights of Medicare beneficiaries to move from one Medicare Advantage (MA) plan to another each year, or leave an MA plan by creating the same right to choose a Medigap plan. Medicare beneficiaries will be able to choose the most appropriate Medigap or MA coverage each year without being rejected for a health condition.

New Medigap Bill Would Create an Annual Enrollment opportunity with no health screenings

Bill Text: California Senate Bill 1236

Note that this would only apply to California.

This is a worthwhile listen. (And sadly yes to the above.)

Seniors choosing Medicare Advantage plans for the first time often don't realize they might get locked out of traditional Medicare for good. But changing this problem must be done state by state.

California tried to fix a major Medicare loophole for seniors

According to the piece the insurance companies lobbied the legislators and apparently killed the bill, although I do not see that reflected when I check the bill's current status in different places online, like this...

https://fastdemocracy.com/bill-searc...ls/CAB00032304

Medicare Advantage plans were designed to bankrupt Medicare by neocons. It was all part of the push to privatize Social Security and Medicare.


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Yep ^ And not to get all polyass but none of that is gonna exist if they get to institute project 2025. They will nuke it all.

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Originally Posted by MagnificentUnicorn

Medicare Advantage plans were designed to bankrupt Medicare by neocons. It was all part of the push to privatize Social Security and Medicare.


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Fact.

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Originally Posted by MagnificentUnicorn

Medicare Advantage plans were designed to bankrupt Medicare by neocons. It was all part of the push to privatize Social Security and Medicare.


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This is true, costs the medicare fund about 15% per beneficiary, per yr. more.

On a side note, the industry is worried. The inflation reduction act is capping out of pocket drug costs at $2000 per yr., so they will shift costs. Expect higher monthly premiums for part d plans, and med adv to get worse. They also instituted a plan to spread out drug deductables and costs, etc throughout the yr., but, a united health care rep I deal says they may not get paid back if the beneficiary drops the plan and there is a balance remaining.


Pay attention this fall.

Worth a read, and not just this section.

https://static.project2025.org/2025_...CHAPTER-14.pdf

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2025 Presidential Transition Project
1.
Make Medicare Advantage the default enrollment option.
2. Give beneficiaries direct control of how they spend Medicare dollars.
3. Remove burdensome policies that micromanage MA plans.
4. Replace the complex formula-based payment model with a competitive
bidding model.
5. Reconfigure the current risk adjustment model.
6. Remove restrictions on key benefits and services, including those related
to prescription drugs, hospice care, and medical savings account plans.26

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Check yoir NOC. I’m getting the 2025 apps and the advantage plans are cutting their extra benefits like otc benefits, dental etc. this was expected as part D out of pocket is now capped at 2500 for the yr.

My Aetna plan dropped the added 1200 you could use for a ski pass. And cut the dental in half.

Nothing terrible, but as I said before, never join an advantage plan for dental or dumb stuff, that comes and goes.and know if you do, your giving up your guaranteed right to a supplement if you had stayed on original medicare.

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Originally Posted by Cono Este

.....and know if you do, you're giving up your guaranteed right to a supplement if you had stayed on original medicare.

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For me, the one take away from the entire thread is this very point.

When you reach sign up age you are answering "choose how would you like to access, manage and pay for your healthcare for the rest of your life. With no easy way to change the decision*." Yet they never narrow it down to just these words.

*unless you live in a GI/Guaranteed Issue state.

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Originally Posted by Nobody Famous

For me, the one take away from the entire thread is this very point.

When you reach sign up age you are answering "choose how would you like to access, manage and pay for your healthcare for the rest of your life. With no easy way to change the decision*." Yet they never narrow it down to just these words.

*unless you live in a GI/Guaranteed Issue state.

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According https://www.medicare.gov/basics/get-...joining-a-plan you can switch during the open enrollement period every year, or am I not understanding this correctly? I never gave it much thought--when I retired from Kaiser i got enrolled in Senior Advantage for no premium (and they reimburse my Medicare premiums. Talk about the best benefits go to those who need them the least, but Kaiser tries to incentivize docs to retire--it's cheaper than paying them twice as much to work half as hard as young docs.) There is an alternate plan but I like Kaiser.

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Originally Posted by old goat

According https://www.medicare.gov/basics/get-...joining-a-plan you can switch during the open enrollement period every year, or am I not understanding this correctly? I never gave it much thought--when I retired from Kaiser i got enrolled in Senior Advantage for no premium (and they reimburse my Medicare premiums. Talk about the best benefits go to those who need them the least, but Kaiser tries to incentivize docs to retire--it's cheaper than paying them twice as much to work half as hard as young docs.) There is an alternate plan but I like Kaiser.

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That section you linked is referring to Medicare Advantage (MA) plans only, not Medigap (Supplement) plans which are totally different. MA Plans are intended to do annual signups as that section says. That's the Joe Nameth TV commercials around this time of year.

For Medigap (Supplement) plans it's different. And that's the basis of my rant and related to the point Cono Este made: The plan you pick at initial signup is the plan you should be prepared to stay with for the remainder of your life. My rant, and pet peeve, is it's never stated as such with these exact words and in such a short way***.

The entire system for Medigap (Supplement) plans is designed to prevent switching plans, ever, over one's lifetime. Footnote: Switching becomes slightly less complicated if you live seven of the states listed below, or in an 8th state, IL, and started with a specific insurer:

- CT, MA, ME, NY have year-round GI, but all premiums are higher because of this. For NY plans are higher by a factor of 200 to 300% vs. a neighboring non-GI state.
- CA, OR have birthday month GI rules.
- MO has an anniversary month GI rule.
- IL, if you signed up with Blue Cross Blue Shield of Illinois and Health Alliance, you get ongoing GI rights. Other Medigap (Supplement) carriers in IL do not offer this, ad IL does not mandate it. BCBS is being benevolent and probably has higher rates to make it work.

Reference for this state-by-state breakdown: https://www.kff.org/medicare/issue-b...across-states/

Another very helpful KFF writeup, for 2024 annual signups: https://www.kff.org/medicare/issue-brief/what-to-know-about-the-medicare-open-enrollment-period-and-medicare-coverage-options/

*** Edit to add: I already got through the Medicare initial signup. Yet it still pisses me off, wherever and whenever it comes up, that I had to spend hours and hours getting to understand this very point. Maybe I was just dump or numb to all the noise in medicare signups, but this point was one detail that never fully registered with me until I was well into the initial open enrollment period.