October 28, 2018 at 6:07 pm #1111Dannys32Participant
I am turning 65 soon and wanted to sign up for Medicare. The more research I do, the more confusing it gets. Can others share their experience in the best way to research and navigate the system?
ThanksOctober 29, 2018 at 7:14 pm #1114CaseyStantaParticipant
Danny32, every year I do the “which Medicare option?” dance. It is daunting, for sure.
The first choice you must make is whether you want original Medicare (usually you have a 20% co-payment for most services and you can choose any doctor/hospital that accepts Medicare) with, if needed, a separate drug coverage policy; a Medicap policy that you buy in addition to original Medicare that covers some (but not all) of Medicare’s coverage “gaps,” again with your choice of providers; or a Medicare Advantage plan INSTEAD OF original Medicare, which covers everything Medicare covers and then some, usually at reasonable rates, but restricts your provider choices only to the plan’s member providers (whom you may or may not like).
Oh, and if you are a veteran, the VA has several tiers of medical coverage it offers, as well.
The bottom line is that you have some homework to do.
I suggest you first make a comprehensive list of what YOU need and expect in your health insurance plan. Include all your anticipated needs for physician visits, specialist visits, medical equipment, medications, medical transportation and anything else you can think of, for at least the coming year (because after your first sign-up Medicare changes can be made only once per year, October through mid-December).
Second, look up the definitions of original Medicare, Medigap, and Medicare Advantage to make sure you understand the differences. Considering your own list of needs, make a preliminary determination of which type(s) of plan make the most sense in your own case.
Third, check the availability in your area for types of plans that interest you. Medicare serves the entire nation, and many (most?) Medigap policies are offered by major national brand insurers. But Medicare Advantage plans are local. Google “Medicare Advantage plans available in 90x0x” to see what’s offered in your zip code, and do a comparison.
Here’s what I did: I signed up with original Medicare when I became eligible. I did not sign up for the optional Part D (prescription drug coverage). I soon realized that my co-pays and Rx outlays were way more than I was comfortable with, and as I had no particular favorite doctor, I looked into less costly options for the following year. I have been with a Medicare Advantage plan for several years because it is the simplest and least costly. However, i have had trouble finding doctors I like within the plan.
It’s a very personal decision, so resolve to take whatever time you need to figure out what’s best for you. And if you make a mistake the first year, no biggie. You can always change next October after you’ve had plenty of time to ask around and you know better exactly what you want your plan to do for you. Best wishes.October 30, 2018 at 8:44 am #1124victorjParticipant
The one thing I like about regular Medicare is you never have to get permission to see a specialist. Just pick the doctor you want and call to make an appointment. Few in my experience have ever said they don’t take Medicare. Some even have never charged me the 20% co-pay. Even better when it comes to the co-pay, this is a real example, when a hospital billed Medicare $17,000 or an ER visit, Medicare said the services were only worth $730, and made the hospital write off $16,270. My part of the co-pay was less than $200. So, no matter what the provider bills, I’ve you pay 20% or less of what Medicare says the service is really worth. It is true though that you can buy different levels of Medicare plans from Insurers other than the government. I still kinda don’t foresee big expenses down the road except the inevitable slip and fall. And luckily my primary of 15 years takes Medicare.October 31, 2018 at 5:25 pm #1141Dannys32Participant
Thanks to all for the great info and insights.
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