Medicare + Part D + Medigap...or Medicare Advantage?

Medicare options are really confusing. For one thing, you need to actually read the Medicare booklet that comes... There are certain choices you have to make almost immediately (prescription coverage, for example). Seriously - If you don't sign up for some things within 6 months of becoming eligible for Medicare, you either can't sign up or they hit you with a penalty percentage - forever!

"Basic Medicare" is the plan you will have if you don't opt for Medigap or Medicare Advantage with an insurance company. You would submit claims to Medicare and deal directly with them. The coverage would be very basic, and you would still have to purchase dental and/or prescription coverage from a company. Insurance companies buffer you from having to deal directly, and take care of all the paperwork, etc. What people may not realize is that Medicare is paying those insurance companies for your basic coverage (at least with Advantage plans. I'm not as familiar with Medigap programs)... You are paying a premium to the insurance company which adds some benefits to the basic Medicare coverage, and is also more convenient. However, you will still hear the constant refrain of coverage “within Medicare guidelines”.

Medigap and Medicare Advantage are very different, and you cannot by law have both at the same time! Make sure which coverage you want, because otherwise you might not be able to change without penalty or at all. (If I remember correctly, Medigap insurance can be purchased when you first become eligible for Medicare, with no restrictions. But if you wait a certain period of time, it changes to whether they want to cover you – whether you meet certain standards/qualifications – and you can be denied coverage.

Next, all Medicare Advantage plans are not the same... Some offer low to zero premiums every month - and you think you're in heaven... That is, until you need coverage, and then you pay - and pay - and pay! Read the fine print of the policy! There are also hidden issues. Example: The first year I was eligible I chose a company MODA (don't know whether they're available generally or only in my area?) Their monthly premiums were higher than some other companies/options, but the coverage was better. Ever since I started dealing with my Mom's ongoing issues I've seen a counselor, until recently every week. My co-pay with MODA was $30 for mental health visits... AARP/United Health was constantly advertising and being touted as best, so the second year I switched to them. "0" copay for primary doc, $25 for Specialists... and, also I quickly found out - $45 copay for mental health visits (which certainly wasn't prominently disclosed). I ended up paying $60/month more for my counseling with AARP/United Healthcare. Besides that, they were much harder to deal with in general, and their pharmacy plan wasn't as good. I've switched back to MODA and am much happier.

Dental insurance is another issue... You can opt to add dental coverage to your Advantage plan... (MODA uses Delta Dental, which has been a really good plan) AARP's plan was different, and was actually a "rider" of sorts... With dental insurance, the kicker is that you HAVE TO KEEP IT CONTINUOUSLY - even when switching companies - or you are severely penalized for a long period, during which they won't cover most major issues. (Again, I had trouble with AARP because they couldn't/wouldn't give me proof of dental coverage to pass along when I went back to MODA. It took me 3 months, and a threat to go to the Insurance Commission, to get the needed proof from them.)

Bottom line: shop around, read the fine print, READ the Medicare booklet (pain in the fanny, but...), ask questions, and don't let some insurance salesman steer you into a plan you don't understand, need, or want. If you talk with Insurance company salesmen, understand they are pushing specific plans they offer, and get a commission for. Purchase Prescription coverage (Part D) right away, don't wait until later!

Ahmijoy, some more thoughts here. All of your options require you to pay your Medicare premiums AND the premium for the plan you select --- Advantage or medigap. Then you pay for medicare D in addition to that. Dental would be separate and an additional premium. For me, the big issue is the out of pocket maximum I would have to pay. Medicare alone does NOT have an out of pocket Max (OOP). So-o I would encourage you to pay attention to that item.
Your good historic medical care needs is not an indication of future needs. Especially, if you are unable to get needed care due to caregiving responsibility.
Every state has SHIP counselors (state health insurance plan). They provide (for free) assistance in choosing appropriate coverage. And they explain the choices available to you. I'd suggest you contact them to assist you in understanding all of your options.

Im in the same boat as I turn 65 in October. My brother who was a Doctor is 67 and he says he really likes Medicare and he picked Mutual of Omaha for his advantage. I am also confused a bit, so I looked up SHIP in our state and there are consuling sessions I plan to go to in August. Our city Senior center has once a month sessions to go to to learn, so I think this would be best to go and meet with an expert. I too use to be healthy but one day at work my colon ruptured and it was a life threating event and have been cautious since. Having an ostomy opened up my eyes that good health can change almost instantly, so having good insurance is critical to keep from loosing your savings overnight.

Think of it this way--if you are paying money for insurance you are "not using", it's probably a sign that you are remaining healthy. I'm 66 and in excellent health, but I realize there will come a day on which I need care whether it's at age 69 or 89. I chose the Medigap plan G because it is very comprehensive.

My major beef with Medicare is that, as the defacto Medical Insurance Plan for older people - and it's not a freebie! - a great many providers don't accept it, and don't have to! Just try to find mental health providers with Medicare? Good luck! I think there should be a requirement that every practice/clinic, etc., set aside a certain percentage of the practice to accept Medicare patients. By spreading that universally across all providers, the "pain" of lower payments providers receive from Medicare (the excuse they give for not accepting M. patients) would be mitigated/shared across the board. What good is "insurance" if no one wants to accept it? Or - if the only docs who do are potentially just desperate for patients?

Contact your local Council on Aging and see if there is a SHINE (Serving the Health Insurance Needs of Everyone) program.  They have people trained to review what your insurance needs are and what plans might best fit those needs.  It is a free service.

I had no idea what Medicare was all about when I spent two years taking care of my parents. I (they) never got a medical bill during those years, which included multiple trips to the ER, cancer surgery, pneumonia, re-hab, and hospice care with skilled nursing.

When I turned 65, I decided it was worth it to have the kind of coverage they had. I figure I'll probably be too frail some day, as were my parents, and my caregiver(s) would have one less headache without having to worry about Medicare. I also figured I might end up with a chronic condition (who knows what the future holds?) that requires multiple hospitalizations -and I don't want to be fretting about whether to get needed medical attention because of money worries.

So I opted for Original Medicare, parts A & B, and a supplemental (Medigap) plan. I chose supplemental (Medigap) Plan F (which is just like Medigap Plan G - only G has a small deductible and F has no co-pay or deductible). I chose United Healthcare as the underwriter - through AARP - for my Plan F supplement. Every healthcare provider I've been to immediately recognizes my coverage (Plan F is the most popular medigap plan) and knows the bill will be paid for. They never ask for copay S or deductibles (or full payment) upfront.

I opted against Medicare Advantage plans because their networks, copay, deductibles, etc, change too frequently.

For Part D prescription coverage, I kept my retiree benefit plan, as it's certified under Medicare. I still pay co-pays for several drugs. Without that retiree coverage, I'd probably have to evaluate Part D plans every year to find the least expensive in terms of the particular drugs I take.

Always plan with the future in mind, knowing health issues tend to get worse as we age. A more inexpensive plan now may not work in the future and the "open window" to get the best insurance for future needs will be closed by then.

Just my thoughts. Good luck!

Issues with Plan C--the Advantage Plan-- (1) you typically can't get a Medigap or Plan F if you decide some day to switch to Original Medicare. That caveat could leave great financial liability as you would have to pay the 20% that Original Medicare doesn't pay for (Plan F pays for what isn't covered by Original Medicare---and for expensive health issues that is important), (2) they have limited physician/lab/extended care networks (whereas Original Medicare allows to you go to any doctor, lab or facility that accepts Medicare---there are no "door-keepers to seeing specialists either (make sure you check out your local physician network with any Advantage Plan) and (3) some extended care facilities (i.e., ALF, nursing homes, etc. will not accept Advantage Plan members---this is frightening). Don't choose which Medicare Plan based on how healthy you are because you never know what might happen in the future!

Hello! Licensed Social Worker that counsels older adults on Medicare choices on a daily basis.  I suggest anyone struggling with making any Medicare decisions contact their local Area Office on Aging, their states SHIP (Senior Health Information Program) and/or Senior Center.  They are a wealth of impartial information about Medicare/Medicaid and the differences of Supplement and Advantage plans.  I have found some agents will strongly encourage folks to take Advantage plans which may not be the best one for you and then run into problems when the plan will not cover all of the costs of care or medications.  Make sure you do a benefits check-up every year because plans do change medications they will cover.  I am in Ohio and we have one of the best SHIP Programs in the country,  I am partial of course! While it may seem like your "pouring money down the toilet" with a Medicare Supplement, you will have very few costs later.  With a Medicare Advantage you have co-pays all along the way.  I refer to them as Pay it Now or Pay it Later.  It all depends on your own financial situation.  We all are used to paying for insurance we may never need, think about the insurances you have on your house, car, etc.  I hope my house never burns down but am glad I pay for it up front, same for car insurance, I hope I do not get in a wreck, but am glad I have had it for the times I have needed it. Good luck with your decision but remember you can always change it every year if it the one you chose does not work for you.

Our supplementary is free for my husband and I and we have a 50.00 deductible and no co-pays. But before I got married I had advantage and it was a disaster for me because of the drug coverage I had to accept. The formularies are very restrictive and I was paying over $800.00 a month for prescriptions. I had a United Healthcare Advantage plan. Glad that nightmare is over.