How do some retirees handle this with Medicare???

[Omaha Steve]

Marta turned 65 in November. She signed up for Medicare before November first. It took until two weeks ago to get her Medicare # so she could sign up for prescription coverage. She was signed up for the medical supplement without a #.

Now through no fault of our own they want SEVEN months premiums. November and December are billed at last years rate. All totaled that is $1,147.50. Marta is still working and we can afford it. What do seniors that don't have it do when this happens to them?

OS

[SheltieLover]

1. Easy answer: no rx coverage.

Kroger has a great rx discount plan for $36/yr. Others likely do, to.

90 days most meds cost $12.

Likely lots not included but the same is true of Part D's.

[ampm]

14. I agree

I have a smiths' which is part of Krogers and my meds are manageable. Just too much against us. Medicare takes such a huge chunk of what they gave us in this. It wiped it out all but 7 extra dollars. This government has to do better period

[SheltieLover]

15. Yup!

[Ms. Toad]

17. Bad idea.

If you do not enroll in a medicare drug plan when you are first eligible, you are required to pay a penalty for the rest of your life.

While Kroger has decent coverage - when you need the specialty drugs (e.g. biologics, cancer drugs, etc.), you will need Part D. When you sign up late, you will pay not only the premium, but an add-on penalty.

Instead sign up for the cheapest Part D plan you can, then price your drugs and buy them wherever they are cheaper (Kroger, Costco, GoodRx)

My spouse buys 5 of 8 drugs through Costco; I buy 3 of 5. (The others are cheaper through our respective plans. The two I'm "buying" through insurance are $0. They likely cost you $12 at Kroger).

[piddyprints]

2. My husband signed up 3 months before he was eligible.

Then he immediately signed up for an advantage plan, for no extra premium. He had to pay only 3 months in advance and now he’s on auto-pay. He still works, so no biggie. He actually made out well because his portion of his employer’s plan was huge. So now he gets to keep that money as well as what his employer used to pay.

I don’t understand the 7 months in advance thing. How far in advance of November 1 did she sign up?

[Omaha Steve]

9. Middle of October

Now she is paid up through June first.

[piddyprints]

12. I'm glad she's paid up.

And I don't remember how we knew to sign up 3 months early. Someone must have told us, I guess.

Yeah, there is something to be said for being paid up that far in advance!

[ret5hd]

3. A related question (who will soon need this info)

Where, what publications/brochures/websites have good solid info on this subject so this does not happen to others?

It all seems very confusing to me.

[edhopper]

11. Try here

https://www.medicarerights.org/

[Ms. Toad]

18. It is incredibly confusing.

I have not found really good resources - I patched several together and spend about 200 hour on it.

The Medicare & You 2022 (or whatever year) official government book is a good placet to start. Kaiser Family Foundation has some good info: https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/

One big decision you must make during your initial enrollment (7 months including your 65th birthday) or your special enrollment period is whether you EVER want traditional Medicare. You have a one-time opportunity at a guaranteed issue supplemental plan. (You can always switch later to Medicare Advantage during open enrollment. You CANNOT necessarily switch to traditional Medicare later - if you need a supplemental plan to cover the costs not covered by Medicare. These supplemental plans can deny you coverage - OR - charge you more later.

The second big choice, if you are doing traditional Medicare, is which plan (N, G, etc.) and which insurance company. Absent a later switch to Medicare Advantage (or the luck of good health) you are stuck wth this choice for the rest of your life. (No other insurer has to accept you - AND - they are not required to allow you to switch betwen the various plans.)

We made the choice for traditional Medicare - which allows us to change our minds later if we want Medicare Advantage. (I don't see doing that - unless we run out of hospital coverage under traditional Medicare). Each of us pays a $233 deductible, and about $280 for premiums (Medicare + plan G + Drug) and an average of $300/year for meds. ~$3900. That is our total cost for all of our medical care for the year. No copays, no coinsurance.

With Medicare Advantage it would likely be similar for now. We'd lose the ~$120/month premium for the supplemental plans - BUT - we would pick up copays for office visits and coinsurance for imaging, hospitalization, ER, etc. The resesarch indicates that as you age (and pick up more ailments), traditional Medicare is cheaper because - with the right plan - you don't have coinsurance or copays (or the copays are more expensive).

If you travel - traditional Medicare is better, since most Medicare Advantage plans are state-specific. So you will be paying more (or out of pocket) if you need medical care while in another state or country.

When you get ready to make a choice, feel free to reach out.

[LiberalArkie]

4. I do not get the 7 payments. I have never had a problem (I am 74 now). I would call them and find

out why they want 7 months. Is this part A, B D ? or did they combine all of them and that is what they are requesting. I use Arkansas Blue Cross for all my medicare and Part G. I would rather have a higher monthly payment that I can budget and a bg hospital bill happen all of a sudden. I have never had any out of pocket expense after several hospital stays and surgeries. That is what I am concerned about.

[Omaha Steve]

8. Part B only

Last edited Fri Feb 11, 2022, 06:38 PM - Edit history (1)

Edit: The payment was for part B only, since part A is free.

[stopdiggin]

13. Medicare B is standard (everybody should have A and B)

currently costs (~ $170) and prior to drawing SS comes out of pocket. It sounds like here wife is being billed for 5 months in 2022, two months in 2021. (if she's paid up through June, this might be about right)

[Ms. Toad]

19. Yup. Just paid my first bill.

It was for 5 months. Since I didn't have Medicare the last two months of 2021, it was only 5 months.

ETA: Not everyone needs both parts immediatley.

My wife was covered under my employment insurance from 65 - 69.5 and only needed Part A (which is free). Now that I no longer have work insurance, she also needs Medicare. Because she had creditable coverage, there is no penalty for signing up at 69.

BUT- all of the information available about signing up for Part B assumes you are signing up for both simultaneously, so it is very hard to find out how to sign up for it separately years after you sign up for Part A.

[stopdiggin]

21. I can remember feeling a certain sense of relief ...

(damned glad it was there for me - and glad to have it taken care of and out of the way)
(and I honestly have to say that I didn't have that much difficulty with sign up/enrollment, what-have-you)

[Ms. Toad]

24. If you sign up for both simultaneously -

it's a piece of cake.

It is only when you sign up for Part A (because you have to at 65, or face late enrollment penalties), and then sign up separately for Part B that the fun begins.

[stopdiggin]

22. you are correct. JUST part A is a possibility

and a sound choice for a sub-sector. And I wouldn't mean to misinform.

[Faux pas]

5. I've

never heard of anything like that! Maybe it's a short staffing problem because of covid? Best of luck!

[fightforfreedom]

6. I went through this crap with my wife.

They sent her a bill for the entire quarter when she signed up. I called them and one person told me not to pay, it would come out of her SS payment. Another person I talked to told me to pay it. This was about Medicare part B. Pick your poison.

[milestogo]

7. Medicare bills me for 6 months at a time.

I thought that was normal.

[Ms. Toad]

20. Pretty sure after the 1st payment mine shifts to monthly. n/t

[ProfessorGAC]

31. Normal? Don't Know. Universal, No.

I went Medicare in September. Everything has been monthly, the whole time.
There was no point that I ever had to pay more than 1 month for Parts A&B, my D plan & my supplemental.
Weird that it's not identical for everybody.

[milestogo]

32. It is weird.

[MineralMan]

10. Although it won't help you at this point, it's important to sign up for

Medicare three months before you are eligible, just to prevent situations like yours. If you do, and you also sign up for any Advantage or supplement plans at the same time, choose autopay deductions from your bank account, you won't get a big bill for months of coverage.

If you wait until you are actually eligible, things can get confusing pretty quickly.

If, like many people, you started receiving Social Security payments early, it can be even more complicated. Health insurance paid for by an employer can also complicate things, since Part B premiums are deducted from your monthly SS benefits.

[Ms. Toad]

23. There is generally no point in having both health insurance by an employer AND Part B.

(Unless your employee insurance is free).

If you are paying for both, you may be throwing money away, since work insurance (except for companies< 20 employees or if you have a disability) is the primary and Medicare pays a portion of what is left - and probalby not enough to justify the $171 monthly premium.

[MineralMan]

25. That's true, but it can be confusing for some people.

I've always been self-employed, though, so signing up for Medicare was a breeze. However, I opted out of Part D, since the meds I was taking were really cheap anyhow. A few years later, though, I added Part D to my new Advantage plan. So, now, I pay a penalty each month for the time I was not on Part D. My mistake. It's not a big deal, but I should have understood that better.

However, at the time I went on Medicare (pre ACA), I immediately saved over $500 per month, compared to the individual BCBS policy I had. It was a major boost in available money for me. Same story for my wife, when she left her BCBS individual plan for Medicare. She has always been self-employed, as well. Medicare made a huge difference for both of us.

Everyone's situation is unique, of course. Medicare can be complicated, for sure, but it works very well and often offers better coverage than private insurance for most people.

[Ms. Toad]

26. I'm not disparaging Medicare -

we will be saving considerable money.

But there are way too many trap doors, ill-informed government employees (state and federal), self-interested insurance agent, and penalties if you get the enrollment wrong.

The mechanics of the process - especially if you sign up for Part A and Part B separately are (1) not clearly explained, (2) not understood by state insurance folks (SHIP), most Medicare reps (I spoke with at least six, and none was right), and most people who sell supplemental insurance policies.

In addition - I know way too many people paying fines for Part D because the implications of not signing up right away are not publicized. There was a splash when the fines were enacted, but by now you have to go search it out.

Especially with the bombardment of Medicare Advantage advertising, there isn't a clear neutral location I could find which explained in 10th grade language to counter the advertising. Specifically - the critical details which took me quite a while to ferret out (and I am still arguing about wtih a colleague with similar education and experience who still doesn't get it)

(1) If you choose Medicare Advantage, you may not ever be able to switch to traditional Medicare. There are at most two guarantee issue times (open enrollment; special enrollment). Beyond that, your ability to acquire a supplemental plan is at the whim of the insurance companies - and they are not going to accept you once your annual medical costs are too high under Medicare Advantage that you decide regular Medicare might be better.

(2) If you choose traditional Medicare, choose your supplement carefully because you may be stuck with your choice for the rest of your life. You are not guaranteed the opportunity to switch either plan type (N, G, F, J, etc.) OR insurance company. (When I did my reserch, some plans were 3 times as expensive for the exact same coverage. If you later discover you chose unwisely, you have missed your guarantee issue period. They may or may not issue you a policy. They may or may not allow you to switch between plan types.

(3) All supplement plans are sold by insurance agents (some are ONLY through agents). Those agents are paid only if you buy their plan (higher priced plans typically reward their agents more fully) AND - they may only be able to sell a limited selection of the plans available.

I spent approximately 200 hours making this choice. I have bachelor's degee, a master's degree, and a JD - and I still disovered, at the last minute, one quirk which nearly cost me coverage during the month of January: Even if you are eligible to enroll under a special enrollment period, if you are still in your initial enrollment period you cannot. Two Medicare reps, the state SHIP rep, and my insurance agent ALL got that wrong.

It was only when I called to check why my appliation hadn't been acted on, weeks after my spouse's had, that I was told that it was denied because I was in the overlapping period. (I still have not received a denial, except over the phone).

Once I understood the problem, and read the regulation, I knew I could force coverage in January - BUT all of government and other literature interpreting the regulations said I could not have coverage until February. I had to twist the arm of my insurance agent to apply for the supplemental coverage in December (mandatory to get coverage starting 1/1), because she believed that I needed approval from Medicare before she could apply. It was only when I threatened to apply without her that she submitted my applications.

During this period - several of my similarly educated friends (incluidng one heavily involved on the receiving end of Medicare) had similar challenges which I helped them work through. (They might well have managed signing up - BUT - the nuances about how important this choices is had never occurred to them. While drug coverage is a once-a-year thing; picking a supplemental plan is - generally - a lifetime choice and needs far more thought than many are aware of.)

[fightforfreedom]

35. I have insurance from work.

When I sign up for medicare part A,B, medicare becomes my primary and my work insurance covers whatever medicare does not pay. My work insurance becomes the supplemental. I could drop my work insurance and go fully on medicare but it is really hard to figure out if it will be cheaper. So I am keeping my work insurance. When I sign up for medicare A,B, I will be covered 100%.

We are all being screwed by our health care system one way or another.

[Ms. Toad]

36. Genearlly it doesn't become primary.

Disability and employers of fewer than 20 people are the exception.

Even it it becomes primary, you will likely still have deductibles and out-of-pocket expenses before your work insurance picks up 100%.

[Ms. Toad]

16. Signing up for Medicare is a nightmare.

I was a bit shocked at the 6-month premium I received ($800+). Like you, I can afford it. We got a double hit - because both my spouse and I enrolled in Medicare at the same time.

It may be different if you are paying via withdrawal from SS account - my guess is that the guaranteed payment may let them bill it for one month at a time.

But I signed up for Medicare Part A when I turned 65 in September and declined part B. At that point I expected to be working for about 7 more years. But a month later when they trounced all over my boss, slammed his leadership abilities, and bounced him back to the classroom, he got really pissed and fired one of the few he could (i.e. me).

So I was still in my initial enrollment period AND qualified for an overlapping special enrollment period when my work insurance ended 12/31. That is a nightmare, and nearly everyone I spoke with insisted I would be without insurance for the month of January becase you cannot use the special enrollment period (which entitles you to immediate coverage) while still in the initial enrollment period (which delays coverage for at least 2 months.) I researched the law - the people who do this for a living were wrong in their assumption that if I enrolled in January (special enrollment) it would be active in February at the earliest.

I had to wait out the initial enrollment period (which, luckily, ended 12/31 and then apply in January and ask them to make sure I was covered for the month of January. I received notice by the second week in January that Part B was effective 1/1.

Fortunately, I had a Part A number (which doesn't change when you add Part B) and was able to line up a supplemental policy and drug coverage to start 1/1/2022.


. . . and then the real fun begins! If CVS Caremark is the back end for your wife's drug plan (and was involved in her plan before) be very careful. We are purchasing more than half of our meds through Costco without insurance (it's dramaticallly cheaper). CVS Caremark (my work insurance provider) transferred ****without notice or consent**** not only all of our medications, but also our credit card information to the new drug insurer (which also uses CVS Caremark as the back end).

One drug shipped (and was charged to the credit card we never gave the new insurance company) before we had a chance to gather and set up our new prescriptions. I thought we were done with nasty surprises and then on Monday, my medicare insurance (different company than my spouse's) did the exact same thing. AND Costco discovered I had a Medicare policy (even though I had not provided them with the information - and had checked "do not bill insurance.&quot and billed my insurance company for the meds.

It's a nightmare. I'm ultimately OK with Costco (although they should have warned me). They checked the list available to all pharmacies, found it was a few dollars cheaper through my medicare plan, and used my insurance. (It was a med I had not planned to continue, so I hadn't price checked it as thoroughly as the rest - but my doctor had other ideas so I priced it quickly and must have messed up as to which was cheaper)

Not at all comfortable with Aetna, Wellcare, or CVS Caremark.

Bottom line - I now know as much or more about Medicare and supplemental health and drug coverage than most of the people working with it for a living (and have already helped a half-dozen others through the process). . . Do I sense a potential new career?

[JustABozoOnThisBus]

27. If Marta is still working, does she have an employer health care plan?

If so, there's no need to sign up for parts B or D, just part A.

[Omaha Steve]

29. The employer plan is expensive and high deductable

My birthday is January 23rd. So we lost MY good retiree health plan on January first.

[JustABozoOnThisBus]

30. Was she covered by your retiree health plan until Jan 1?

If so, she should be able to get a letter from your Personnel (human resources?) stating that fact, and she would be eligible for a "late" start to Medicare with no penalty.

I started Medicare (B,D) when I was 69, because I was carried on my wife's employer insurance. So there was no penalty for starting "late".

[Omaha Steve]

33. Yes she was

She was told she had to start her coverage on November 1 by a Medicare phone representative.

[JustABozoOnThisBus]

34. Maybe she had to start Medicare Part A by November, that's normal.

Parts B and D can be deferred without penalty if she's under a spouse's employer's plan. It sounds like you need some kind of Medicare advocate, and I'm not sure where to find one.

Medicare should not be charging for parts B or D while she was under your plan. See if your congressman's office can recommend an advocate, or maybe go to bat for her.

I see shenanigans.

[Raftergirl]

28. I signed up for Medicare 3 months before my 65th b'day which is in November.

I received my Medicare card in less than a week after signing up. I don’t understand how it took the person in the OP so long to get her Medicare #.

I only signed up for Part A and B as my supplemental insurance and drug plan is covered by my husband’s retirement benefits from New York State.

I get billed by Medicare quarterly. I am not taking SS yet so pay directly. My first payment was due by Oct. 31 with my coverage staring Nov. 1.

I am fortunate that his State retirement benefit also pays for Medicare Part A & B. They reimburse the amount paid to Medicare in his pension check. Supplemental insurance and prescription premium is also free for us.