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Medical Insurance

Discussion in 'TUG Lounge' started by clifffaith, Feb 6, 2019.

  1. mpumilia

    mpumilia TUG Review Crew: Veteran TUG Member

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    Right. Unless you are covered by an employers plan. Then you can apply for Medicare when that coverage ends with no underwriting or penalties.
     
  2. VacationForever

    VacationForever Tug Review Crew: Rookie TUG Member

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    It is a good question. We know that all plans cover medical emergencies, i.e. urgent care and ER including hospitalization in a different state. But if you are a snowbird and spend 6 months here and 6 months there, Supplement plans are the way to go.

    I would emphasize again that when picking an Advantage plan, make sure you pick a PPO one instead of a HMO one. Where we are Aetna Medicare HMO and Choice PPO have $0 premium. We go with Aetna Medicare Select PPO which costs $67 per month in 2019, it was $96 per month in 2018.
     
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  3. Luanne

    Luanne TUG Review Crew: Veteran TUG Member

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    Not sure I follow this. When I became Medicare eligible my coverage ended with my employer plan. So there was no underwriting or penalties. Are you saying your employer plan is going to last longer than when you turn 65?
     
  4. simpsontruckdriver

    simpsontruckdriver Guest

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    With travel, I would suggest United Healthcare MAPD. If you go somewhere for a few months, call them and they will move your network to your new location. Then, when you return, call UHC to put it back. Others may do it with a few extra steps.
     
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  5. mpumilia

    mpumilia TUG Review Crew: Veteran TUG Member

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    My husband turns 65 in April. He applied for the free Medicare Part A. You can apply 3 months before or 3 months after your 65th birthday. Being he is still working full time and will be covered under his employer (a "qualified" plan), he can keep his employer insurance and does not have to apply for Medicare Part B and D and a supplement or advantage plan until he leaves his job. There will be no penalty at that time as long as he applies for them within a certain time period- I believe it is 8 months. Of course, he would apply right away when he leaves his job.
     
  6. Talent312

    Talent312 Tug Review Crew: Rookie TUG Member

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    Some do (like Mary Ann's husband). Those folks get a Special Enrollment Period ("SEP") w-no penalties/underwriting. Others become secondary to Medicare and you get an option to take their Supplement or cancel. I suggest that you read the fine print of your policy or talk to HR about it.

    My employer's plan (state gov't) dealt with me and DW (spouse coverage) differently: At age 65, my coverage will become secondary to Medicare and I'll get the option, but DW's coverage under my policy stayed primary, even after she turned 65 (long before me). I think it was becuz they don't track spouses ages, just the employee's. :shrug:

    .
     
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  7. Timeshare Von

    Timeshare Von TUG Review Crew: Expert TUG Member

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    I too am anxiously awaiting 65 and Medicare! Currently my silver level ACA compliant plan is $1,055/month and my DH's is $1,000/month. Our individual deductible is $4,600 and max out of pocket is $7,800 each. So not a "rich plan" by any stretch. Copays for doctors' appointments are high too ($50 regular and $100 specialists) . . . with 70/30 co-insurance on labs (and after the deductible has been met for other services).

    Last year we got our coverage through the exchange and the premiums were even higher for the same coverage with the same company. Mine was $1,180 and DH was $1,100. New plans were made possible through a deal where Wisconsin worked with the Federal government to essentially do a back stop on benefits paid over a certain amount to save the insurance company from huge catastrophic claims/losses.
     
  8. rapmarks

    rapmarks TUG Review Crew: Elite TUG Member

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    Those numbers are astonishing
    Last year I had my knee replaced and also went through sleep apnea testing.
    The bills were $189,000 my insurance paid 17000 and I paid 1800. So ten percent of the charged amount was allowable. Yes insurance companies charge astronomical amounts.
     
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  9. Luanne

    Luanne TUG Review Crew: Veteran TUG Member

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    I may have been too hasty with my question. I retired at 62 and was still covered by my employer plan. My dh was also covered by my employer after he turned 65 while I was still working. I think once I retired he had to get his own Medicare Supplement. When I turned 65 I also had to get my own Medicare Supplement. We do have a company we can go through, and if we go through them we get an HRA which more than offsets the cost of the premiums.
     
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  10. geekette

    geekette Guest

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    It's a good thing that Medicare for me is over a decade away - this stuff is confusing!!!

    I am nearly certain that there won't be continued employer coverage unless I COBRA and I can't imagine that being a good deal.
     
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  11. mpumilia

    mpumilia TUG Review Crew: Veteran TUG Member

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    I might add this all depends on the size of your employer as well. In other words, I think under 20 employees, Medicare is primary. Over 20 employees- the employer plan is primary.
     
  12. Miss Marty

    Miss Marty TUG Member

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    To Qualify for Medicare

    3.05: MEDICARE & MEDICAID

    Both Medicare and Medicaid are large federal healthcare programs. They’re maintained by the Centers for Medicare and Medicaid Services (CMS). More than 80 million Americans today use Medicare and Medicaid as their primary payer, making them two of the most important bodies in the healthcare industry.

    Video
    https://www.medicalbillingandcoding.org/medicare-medicaid/
     
  13. b2bailey

    b2bailey TUG Member

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    Ouch! (That was me feeling your pain.)
     
  14. Brett

    Brett Guest

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    hospitals and surgeons charge an astronomical amounts -- I'm not sure what would be a reasonable charge for a knee replacement.
     
    Last edited: Feb 18, 2019 at 7:44 AM
  15. DancingWaters

    DancingWaters TUG Member

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    I turn 65 in June and have been bombarded with insurance agents trying to sell me a supplemental. At this point it sounds like if I have the option of getting a supplemental through an employer group that would be better. Anyone on a STRS supplemental?
     
  16. Luanne

    Luanne TUG Review Crew: Veteran TUG Member

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    Not sure what an STRS supplemental is, but both dh and I have supplemental plan F. The advice I was given by several people is, if you're going with a medicare supplemental plan, find the cheapest one. Coverage is the same whoever you get it through and the prices can be really different. What makes the employer group plan sound "better" to you?
     
  17. VacationForever

    VacationForever Tug Review Crew: Rookie TUG Member

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    STRS - State Teachers Retirement System.
     
  18. DancingWaters

    DancingWaters TUG Member

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    I went to a Medicare meeting at the senior citizens center and they told me it’s always better to go with a former employer plan. It’s State Teachers Retirement Service in Ohio.
    It is a Medicare advantage plan with a PPO,but it does cover out of state which I thought I read somewhere that advantage plans aren’t the best. Confused
     
  19. Luanne

    Luanne TUG Review Crew: Veteran TUG Member

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    Do your research. Advantage plans work very well for some people, not so well for others. The disadvantage I can see with an Advantage plan is that it's more like a HMO. You have a network of doctors you can use. I don't know what happens if you travel out of state. The advantages are you usually get dental (maybe?), vision and prescription drugs included, and many times the premiums are less than with a supplemental plan. You have to look at which advantage plans are available in your area, what they cover, and what doctors are in their network. Dh and I both decided to go with a supplemental plan, we felt it gave us more flexibility.
     
  20. rapmarks

    rapmarks TUG Review Crew: Elite TUG Member

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    I am on a state retirement system plan, it is Medicare advantage but has same copay for network and out of network.
     
    Last edited: Feb 19, 2019 at 8:34 AM
  21. DancingWaters

    DancingWaters TUG Member

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    Rap marks
    I went back and read your posts about your cost and procedures they paid for. Your monthly premium is higher than what I was quoted. I only got 23 years in teaching. I have friends in the same plan and they think it’s wonderful, but they also had full retirement and were born with silver spoons in their mouths. I guess I can gain good info from them but my income is not what theirs is. Will they cover you when you travel, how about to Mexico etc?
     
  22. Luanne

    Luanne TUG Review Crew: Veteran TUG Member

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    I found these answers, but again, you need to look at the plans available to YOU in your area.

    Do Medicare Advantage plans cover you out of state?
    Most doctors and hospitals take Original Medicare. If you have a Medicare Advantage Plan, your plan may or may not cover care outside of its service area. Some plans may cover providers that are out-of-network or out of your service area, but with higher cost-sharing (copayments, coinsurances).
    Traveling with Medicare - Medicare Interactive

    https://www.medicareinteractive.org/.../medicare-covered.../medicare-coverage.../traveli...

    Search for: Do Medicare Advantage plans cover you out of state?
    Do Medicare Advantage plans cover international travel?
    Another Medicare plan option for overseas travel coverage. ... They may cover some of the “gaps” in Medicare coverage by providing standardized benefits in most states. Six Medicare Supplement plans, labeled plans C, D, F, G, M and N, may cover some of your out-of-pocket covered emergency care costs during overseas travel.Sep 15, 2018
     
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  23. MULTIZ321

    MULTIZ321 TUG Member

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  24. ilene13

    ilene13 TUG Member

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    I worked for 43 years in the Buffalo Public Schools, as a high school teacher and then assistant principal. Via our union contract I never paid for health insurance. As a retiree I pay $400 a quarter for the same coverage I had when I worked. When I turned 65 it became my supplemental policy and we ( my husband and I) had to go on Medicare. Our deductibles are low. My husband still works and I have a substantial retirement. Because of our income we pay $1200 a month for Medicare. It is definitely not a free ride or an entitlement as some would say.
     
  25. VacationForever

    VacationForever Tug Review Crew: Rookie TUG Member

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    Ah... but to pay the max IRMAA which is what your numbers are telling us, we are looking at more than $500K in income per year. Most of us would love to have the "problem" of having to pay $1200 a month for Medicare for 2.

    I would also gladly pay $600 per month if Medicare for all goes through for those before turning 65.
     

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