Medicare for all would be even better
Monday January 22nd 2024, 10:43 pm
Filed under: Friends,Life

I was talking to a friend on Sunday. She was wearing a mask due to her husband’s health, which meant my hearing had to depend on my ears only but we did our best.

But one of the things she said was that, like us, her husband hadn’t signed up for Medicare because he had coverage through his work.

He was hospitalized. He had turned 65. His insurance refused to cover the hospital part of the bill on the grounds that Medicare should be covering it.

But nobody tells you that! I wanted to protest.

She also said that if there is a gap in your healthcare coverage and then you sign up for Medicare, you pay a fine–and she emphasized this–every single month for the rest of your life for that.

Medicare was insisting they had had a gap of two weeks.

They had not. But they had to prove it, and she spent hours each time waiting in line at the Social Security office and then the IRS office and then back to the SS one. She had to show them physical proof.

You know those medical cards you get every year from your insurance company? she asked me. SAVE THOSE. They are your proof that you had continuous coverage. Get an envelope, keep them in there, put it in a safe place, but never throw those away and never lose them.

After she got home she emailed me this link. Because nobody knows what they’re doing when they suddenly have to decide on what to choose among the bajillion Medicare plans out there while insurance agencies cold-call and spam you mercilessly.

I started trying last year (not too persistently, because it was so discouraging and because I thought the work coverage was fine) to find out what the difference is between Medicare Advantage and Medigap plans and why one would want one or the other and what the difference in costs would be. That site has the point of the whole thing right there front and center: one makes you use a doctor from their plan, while the other lets you go to any Medicare entity whatsoever. That’s Original Medicare. You then pay a Medigap policy not to have to deal with the 20% co-pay bills nor (assuming you choose a good plan) the paperwork.

There are far more details than that but I’m just getting started.

Basically, for the first time in all these months I feel like I have a good source of information. Medicare’s own site was definitely less helpful as far as I was concerned.

So I thought I’d pass the good word on for those coming up on this soon.

6 Comments so far
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The big kicker is that if you had high earnings before you apply for Part B, they charge you extra for Medicare coverage, and they want it up front. My deposit in February will be a whopping $3.50 (recouping the extra I owe from the January). Fortunately, you can appeal these things. I just sent a “life changing event” form and hubby’s end of employment letter to our local office. We have funds to cover things for now, but it would be nice to have everything resolved.

Comment by Anne 01.23.24 @ 2:24 am

Happy Boomerbenefits client here.

The only issue you may have with them is, they’re located in Texas and thus you have to interface with them via phone.

They have a lot of YouTube videos explaining the basics.

Here’s how Medicare Advantage works: instead of the government paying your medical costs, they pay an insurance company a premium every month to insure you. Some of the insurance companies may be nonprofit, but there has to be a lot of money going to them for the amount of commercials they run during open enrollment. Probably no premium to you, but you could be subject to delays and preapproval for services. Plus the network issues.

The big caveat is that once you go Advantage, if you want to go back to Original Medicare+Supplement (Plan G), you will be subject to underwriting and may be denied or charged a higher price.

My mom and aunts all had a supplement, and never paid anything (other than drugs, but that’s a whole nother can of worms). Margie had lung cancer, and had chemo on and off for five years. Never paid a cent. Alice had a lot of falls in her last three years, was hospitalized 4 or five times, two stints in Rehab post hospitalization, at least 8 CT scans and ambulance runs from assisted living because she fell & hit her head, and it was all covered. My mom just had a lot of doctor visits, until she had a massive stroke and never awoke from the surgery; she died 4 days later (there are a lot of worse ways to go when you’re 91; she was driving the day before). Never paid anything. Never had to get preapprovals.

I figure as long as I can afford the premium I’m going with Supplemental insurance. If at some time in the future I can’t afford it I’ll deal with the advantage plans then.

It is very confusing. The government does not make it easy. And the slogan “Medicare for all” is not as comprehensive as people think. Plus the Part vs Plan gets confusing. Part is Medicare, Plan is various supplements.

Comment by Debby 01.23.24 @ 2:38 am

Doing the research and trying to make a decision is beyond daunting! I can’t, for the life of me, figure out why they make it so confusing! Debby has it right. I did this dance years ago and we went supplemental and so glad we did. Fortunately we have decent retirement income and can afford the premiums. Just my two cents.

Comment by Jayleen Hatmaker 01.23.24 @ 7:38 am

While not every single thing is covered, I am so glad I live in Canada.

Comment by Chris+S+in+Canada 01.23.24 @ 8:31 am

Thank you for the link and all the info, in the comments as well. After months of research last year, we got my husband on Medicare Part B, a gap plan, and a Rx plan. It was a big adjustment as our family doctor for 38 years retired, so we had to move to a new medical group anyway. Seems to be working so far, we haven’t had any unexpected costs for him. I’ve got a few years until it’s my turn. My mom likes Kaiser and they went with the Kaiser Advantage. While it seems everything is covered, she waits a long time for appointments, but that could be Kaiser in her area.

Comment by DebbieR 01.23.24 @ 11:00 am

Such a good PSA! I’m going to start saving those cards!

Why is insurance so complicated?!

Comment by NGS 01.24.24 @ 8:55 am

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