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To all the 'experts' (aka seniors) here.

With three months to go, I am earnestly researching my Medicare options and have had conversations with a few friends. I'm looking for confirmation that the route I'm thinking of choosing makes sense for me.

We currently still have private health insurance through H's employer. We're not quite sure how long that company will be around, but we also know that if anything happened, we would immediately qualify to enroll in the health insurance pension plan through his former employer, a very large company that he worked almost 30 years for - we absolutely have full trust that that their plan will be available to us forever, no matter his employment status. In fact, every year during open enrollment time, we get a notice from them offering to sign on to their option. We always assumed what we were getting through his current employer was cheaper, so we never made the switch. But after looking at Medicare options this week, we looked at what our portion of his current health care plan is vs. the plan available through his pension plan, and it ends up the pension plan actually would have cost us less. So if things continue as they are (he is still working for his current company this coming November) , we will probably switch to the pension plan option. He will not be 65 for another year.

Again, if his employment were to end tomorrow, we would immediately be eligible for the pension plan medical coverage. Both plans are relatively decent insurance plans (comparatively speaking of course). We are only interested in PPO plans (vs. HMO), and both plans offer that.

I was talking to a good friend this past weekend who recently became eligible for Medicare, and who used to manage a medical practice. When I mentioned my Medicare research, she asked me why I was signing up for Part B given we have private insurance. When I told her what our cost would be monthly to either stay on his current plan, or switch over to the pension plan in November, she said that was a steal compared to what Medicare will cost us. IIRC, the pension plan option will cost around $800/month for both of us. She said Medicare will probably cost us between $300-500/month per person, and that doesn't include prescription drug benefits, which we'd have to enroll separately and pay extra for. FWIW, I am on quite a few prescription medications.

Obviously I have to sign up for Medicare Part A. But am I missing some reason as to why I would choose Medicare Part B, given our other options?

I'm not sure how Medicare Part B is priced for new retirees, but we each pay $185/month from our Social Security checks. I think that's the standard premium for most Medicare Part B customers. Part B is necessary for us because our insurance coverage for most things comes in only after Medicare reimbursement. (We can go to docs who have opted out of Medicare and get 80% or 60% reimbursement (in-network vs. out of network).

Company insurance jumped 15% for me this year. As I say, it covers some things that Medicare won't, but I expect we'll switch to a Medigap policy next year.

My reco is to stay away from Medicare 'Advantage'; it's just too easy for MA companies to wrongly deny benefits that they promise.

Find out if you can find a relatively objective consultant. There are lots of options available, and I found it impossible to keep all the pluses and minuses straight. You've got to consider things like how Medigap compares to employer plans, how they're priced (by insured's age - less expensive at first, more expensive later - or by community - the opposite), strength of the company, etc., etc., etc.

And do it pretty quickly. You've got +/- 3 months from the month you turn 65 for guaranteed acceptance. After that, a company can reject you or charge a higher premium if they think you have higher risk to them.

Part B is necessary for us because our insurance coverage for most things comes in only after Medicare reimbursement. (We can go to docs who have opted out of Medicare and get 80% or 60% reimbursement (in-network vs. out of network).

Yup, now that I looked further, it appears if H loses his current health insurance and we go to the retiree benefit plan, we have to do this. Bummer.

And, according to the Medicare website, if a company has less than 20 employees (which H's current company has less than 10), I have to choose Medicare.

And from the Medicare website:
If you (or your spouse) have health insurance from a job:

If you or your spouse are still working, you may be able to wait to sign up for Medicare without paying a late enrollment penalty.

Where you have group health insurance that’s available to everyone at the company.

If you don’t have to pay a premium for Part A (Hospital Insurance), you can choose to sign up when you turn 65 (or anytime later). Do I qualify?
You can wait until you (or your spouse) stop working (or lose your health insurance, if that happens first) to sign up for Part B (Medical Insurance), and you won’t pay a late enrollment penalty.

Once you stop working (or lose your health insurance, if that happens first) you have an 8-month Special Enrollment Period (SEP) when you can sign up for Medicare (or add Part B to existing Part A coverage). The SEP starts when you stop working (or lose insurance), even if you choose COBRA or other coverage that’s not Medicare.

Ask the employer that provides your health insurance if you need to sign up for Part A (Hospital Insurance) and Part B (Medical Insurance) when you turn 65. If you don’t sign up for Part A and Part B, your job-based insurance might not cover the costs for services you get.

This makes it sound like I might no longer be eligible for the current company plan, but I've asked H to put a call into the person who handles this stuff.

Your state's office of insurance commissioner should have a site for Statewide Health Insurance Benefits Advisors (SHIBA) volunteers. They can help answer your questions and walk you through some of this.

I found it beneficial to have an unbiased (as much as someone can be when they receive commissions) health insurance consult.

One thing my acquaintance who sells insurance advised me of was Irma and Medicare adjusted gross income—basically that Medicare premiums are now variable based on income. Apparently people are getting letters with their income-adjusted Medicare premium amounts. For some people the amounts are shocking. The income-adjusted premium anmounts are posted online.

It can seemingly get complicated. From what I understood if Fiancé and I marry and we are getting tricare for retirees and spouse we would be required to keep Medicare. This appears to be the case for him even if he is eligible for VA..

Ugh

One thing my acquaintance who sells insurance advised me of was Irma and Medicare adjusted gross income—basically that Medicare premiums are now variable based on income. Apparently people are getting letters with their income-adjusted Medicare premium amounts.

Yes, that's why my friend told me it'd be cheaper to go with our employer health plan for Part B because Medicare premium will be income-adjusted.

Your state's office of insurance commissioner should have a site for Statewide Health Insurance Benefits Advisors (SHIBA) volunteers. They can help answer your questions and walk you through some of this./quote]

Yes, I was looking for how to find information for this earlier. I will have to dig deeper. I really don't want to go to someone who makes money off of selling me insurance if it's possible my best option is to utilize what current or former employer may offer.

So in the state of MA, these volunteers are called SHINE (Statewide Health Insurance Benefits Advisors). In our area of MA there are three locations where I can access one, and damned if I'm floored that one of them is ten minutes from where I live!! I've now got their contact information and will be reaching out to them tomorrow!

This is all ridiculously complicated!!

My H worked for an advantage plan that was actually good. Their customer service was unbelievably good.

Good luck sorting this out and making your decision.

Best wishes on finding the right fit for you at an affordable cost. I will say that I have received great advice from a couple of ethical principled people who sell a variety of Medicare products. You do not have to buy what they offer. But the ones I spoke with regarding my future needs/planning were ethical. Both sold more than just advantage plans.

I learned about the premium issue and also that certain products require medical underwriting so are basically for getting when people are healthy…

One thing that came up for us unexpectedly was access to top tier medical facilities (think places like Mayo Clinic). So we are taking that into account as well because we might need or want that level of care in the future.

I also learned about special needs plans in certain states for certain conditions. I could not be happier with my plan. But I am truly blessed by having been in the right state at the right time and having the right advice.

"This is all ridiculously complicated!!"

I hear you zebra. It is complicated.

That is why I benefitted from advice from a great licensed agent who studied these things. But I am sure that not all agents are equal in their knowledge or ethics. For me it even matters greatly where I live county to county and state to state in terms of what is available and what networks the insurance is in…

Seeking advice from a trusted person in the business is really good idea.

Every state has a SHIP program that is free and accessible by all and not driven by reimbursements from specific companies. Search State Health Insurance Program and your state you should get a website and a phone number. They can help you navigate these questions and best options. If you use a broker they often get incentives from specific programs and whether it makes sense or not will push you toward it.

So I have an appt with a SHINE volunteer at the end of the month. Am feeling a lot better about this, but am really starting to think I'm going to have to elect Medicare Part B from the get-go.

Another friend of mine has said I will likely end up picking Plan G. So I'm hoping this volunteer will be able to help me decide which of those will be best for me that are available for my area.

Good luck! They're called WSHIP in our state, so I hope anybody else reading this thread will know that there are different terms for the same thing.

My ex-BIL is in an urban area where Medicare C (Medicare Advantage) plans work well. Where I live, not so much.

You can also talk to the billing office of you PCP to find out how the plan pays. Also, talk to your pharmacist about the formulary that works best for you.

Do you track your medical expenses? The decision is likely to be a lot easier if you know what you spent on docs, tests, drugs (and which drugs), medical equipment, etc.

I do not, but I keep all receipts (going back seven years).

When you say track, how do you mean it? What I have to pay out of pocket, like co-pays? As far as my meds go, right now I take eight different medications each day. I just ordered another 90-day supply of them all via Amazon Pharmacy which cost me around $90. I feel like that is a steal. Other than a couple of them that have been around forever and are more like $4 per 90 days, I don't know what the others cost. With current insurance, we are required to do mail order for all meds for chronic conditions, getting 90 days each mail order. I find that enormously convenient. It allows me to set up four weeks of meds at a time, three different times to get me through those meds. I don't know if Medicare will allow me to order 90-day supplies at a time. I sure hope so.

My therapist, my H's therapist, and our couple's therapist are all currently out-of-network and don't take Medicare, so we will have to continue paying them as we do now. I am not interested in changing any of these therapists, especially given how difficult it is these days to find experienced therapists who are taking new patients.

As for the rest of expenses, some years I really rack them up, like 2023 when I had breast cancer, and this year with my skin cancer. Ten years ago it was endometrial cancer with a subsequent hospitalization for and infection and sepsis. Then there are years where I just have your average doctors' visits. No medical equipment at this time. I see an eye doctor once a year, and have some upcoming dental issues in the next couple of years that will be expensive.

Receipts are great.

What I'll be doing soon is separating the services we get that are covered by Medicare and the services that aren't covered. A medigap G policy will cover our part of the covered services, and we'll lose the insurance for uncovered services. (For example, my current insurance covers 80% of the cost hearing aids; Medicare doesn't.)

Then I'll compare out-of-pocket expenses with each option and check my work with a consultant who's been recommended to me.

Medicare IS confusing! When I became eligible, I spent hours looking at all the plans, and my head was swimming. After 2 years, I've finally settled into Medicare A & B (because I want to choose my doctors), part D for prescriptions, and a Medigap plan for everything else. One HUGE mistake I made was my failure to get a Medigap plan from the get-go. Once you've passed 6 months from taking Medicare, if you want a Medigap plan, you have to answer all kinds of medical questions. As a former smoker with COPD, the best Medigap plan was completely unaffordable. So, I think I settled on Plan N, which was affordable for me.

I have a friend that has gone through HELL with her different Advantage plans with all the pre-approval nonsense, and has had a terrible time finding doctors that accept her plan. For me, I'm pro Medicare because I want to choose my own doctors.