Would you please help us with stop gap insurance and medicare issues/questions

[Paula Sims]

Hello all,
My husband and I need some DU help and knowledge. We have researched this issue and have spoken to "experts" and of course we're getting conflicting information. Would you please help? Background: I am 56, husband is 67, I carry him on my insurance so he currently only has Medicare Part A.

I am changing jobs and it's best if I "retire" from my old job rather than resign/quit. I will get insurance for us in the new job but it won't be effective until Jan 1. That said, what do we do in the gap between resignation (say Oct 29) and start of new insurance? Our options are:

1. I go on the employee retiree and he goes on Medicare & supplement
2. We get COBRA for the 2 months and hope for the best

HOWEVER, at some point I will retire from this new job (hopefully not for 10 years) so what does my husband do then? Can you jump from Medicare to Medicare?

One insurance company told us that "getting back in" would require a physical. And they said there's no difference between an Advantage plan and a Supplement plan other than the cost.

As time is running out, can you please help?

Yes, I too would prefer Medicare for all but that's not an option for us now.

Thanks!!

Paula

[left-of-center2012]

1. A question about your husband's insurance

Why does he not get a Medicare advantage HMO which should cover Medicare a and B and prescriptions.

I have for the past few years used Blue Cross Blue shield Medicare advantage HMO which cost me nothing but a few co-pays when I go to specialists.

[rsdsharp]

2. There is a difference between an Advantage plan and a supplemental plan.

The Advantage plan is not Medicare per se. The insurance company administers the plan and is paid by Medicare. Once you opt for an Advantage plan, you can not go back to Medicare. You can switch plans, but not go back to Medicare and a supplement. You can switch from Medicare to an Advantage plan, however.

We opted for Advantage plans. We pay $58 per month, compared to nearly $600 if we went with supplemental plans and Part D prescription plans. We could have gotten slightly different plans for no additional cost. In some cases, it may also offer additional benefits over Medicare, depending on where you live. You do need to check that your doctors, dentists and prescriptions are covered by the plan.

[SheltieLover]

3. Advantage plans are private ins & I've read a physical may be required

if the person wants regular Medicare.


Personally, I wouldn't touch those.

[Desert grandma]

4. Hi Paula.

There is a BIG difference between an Advantage plan and a supplement plan. Original Medicare and a supplement plan can cover almost all of the medical costs. The supplement plans have difference costs and co pays depending on the one you select. We have plan G which covers everything except the plan B deductible which is about $183. So we pay the first $183 in costs for the year and everything else is paid for. In addition we can go to ANY physician or facility that accepts Medicare, including the Mayo clinic. Advantage plans usually have provider networks you have to use. If I was in your position, I would have your husband get on original Medicare and choose a supplement in your area. Most of those supplements are "age attained" rated, which means that they will increase every year on your birthday and can also increase due to medical inflation costs. "Age Issue" rated is a plan that stays the same price even as you age. It will increase only due to medical inflation costs. The other is called "community rated". Everyone is charged the same, regardless of age. It can go up because of inflation as well. Most supplement plans are age attained rated. The only community rated one that I know of is AARP. We have an "issued age" rated policy which has only increased maybe $7-8 in the 8 years we have had it. The sooner he gets on an issued age policy, the better. In our state, there were only 2 companies. We went with Trans America, because they responded while the other company did not. Your husband should be able to get on Medicare and a supplement now. If he does not, he may have to go through underwriting in the future. Pre-existing conditions can affect the cost of supplement plans if you do not get on one when first available. You can go on Medicare when you retire and have your own supplement plan then. You will each have your own Medicare and supplement plan, whichever plan you choose. I hope this has been helpful to you.

[Freddie]

5. He can start Medicare Part B or a supplement anytime

Pretty sure you will need a letter from your employer verifying that he will no longer be covered by your employer plan. Check the Medicare site. I plan on doing the same, I’m 65 but only took Part A as I’m going to stay on DH’s plan til he retires.
As far as a stopgap measure, can you get an Obamacare plan short-term?

[GoodRaisin]

6. Not an expert, but on Medicare

If it was just you it would be an easy call, pay COBRA rate for a couple of months until your new job insurance kicks in.

But since your husband is on your current insurance he wouldn’t have full coverage for those months unless he goes on part B (and D for prescriptions).

If it were me and wanted to keep spouse covered on company insurance, I would try to arrange to start the new insurance the day after I retire from the old company. But if unable to do that, then I would think it would be time to move spouse to full Medicare and you do the COBRA on your own in the gap.

[lark]

7. Bad information, sorry.

Medicare Advantage Plans are NOTHING LIKE Medicare Supplement plans. The first is an HMO and covers prescriptions, office visits and hospital with generally just a co-pay and there generally is no deductible. You don't have to do any type of application, you just sign up.
There is a limited network and you can only go to doctors they contract with. You have a primary care dr. and they have to issue the referrals to any specialist or testing - this process can be slow & confusing and the length of wait is one reason not to use HMO's. Your primary care docs office needs to be on the ball or this part can doom you. There are usually limited out of pocket max's too which is super important if anything big happens.

With a supplement - prescriptions are not included. You have to buy a separate rx plan and they all have the donut provisions. When I had a supplement 3 years ago, the cheapest I could find was $140/mo. The supplement covered most Medicare out of pocket costs, but of course I was super healthy that year and it wasn't used. I still paid the same whether it was used or not. Because I got aggravated at paying so much for the policy and drug policy I dropped it. You have to take this when you first get Medicare, otherwise you have to fill out forms about previous medical history and will be denied if you have ever had cancer, any heart problems, diabetes, etc. etc. If you drop it and want it back, again, it's the medical review required and only if you are in tip top health will they take you. The best part of this is no referalls or auths required so you can quickly get the care you need.

So it depends on your health, the meds you take, how much risk you can tolerate, if the HMO network has your docs or docs you want to go to, and your financial ability to pay. Good luck with the decision!

[Paula Sims]

8. thank you all for the DU love. You are the best!!!

[Liberal In Texas]

9. Advantage plans are just private insurance with a patina of the Medicare name on top.

If possible just stay with real Medicare run by the government. It's excellent. It doesn't have bells and whistles like gym memberships or dental and vision but it also isn't an HMO and allows you to go to any doctor you want. And if you get really sick and need really good insurance it will be there. Not so sure about the private Advantage plans.

And shop for a medi-gap plan which is private insurance. It will pay some of what Medicare doesn't. Your employer may allow you to continue medical coverage after you retire as a medi-gap policy which is what I have done.