I am trying to navigate the insane labyrinth of the alleged healthcare as I will be 65 in January.
I have paid into a system my entire effin’ life.
And, I have to buy insurance, still.
Thank you, you right wings jerks.
And the system wants to take nearly all my retirement money.
And people wonder why I have anxiety issues.
All I can do is shake my head.
So, I am eligible for Medicare?
I wasn’t sure what to do when I turned 65. I kept getting letters in the mail from privateers who were anxious to “guide me through the process” of getting on Medicare (which I assumed meant reaching into my pockets in the usual middle-man tradition).
I finally called my county’s Dept of Aging for advice, and someone there sent me a list of options.
I ended up with a Medicare Advantage plan. No monthly payments. But now I’m worrying, because I keep hearing people call Medicare Advantage a scheme to destroy Medicare.
So I don’t know if I did the right thing. But I knew I wasn’t going to take advice from any “for profit” people. The person at the Dept. of Aging wasn’t looking to profit from anything I decided, which made me less uncomfortable.
Make an appointment at your local Social Security office and they will walk you through it.
I am not a big fan of Medicare Advantage, but I know people that love it. Having all your Doctors & records at one provider is a BIG advantage and saves a LOT of administrative hassles. When I turned 65 I last November, I left Kaiser (Colorado) after 30+ years. I have spent the year finding new doctors for each specialty, and dealing with administrative “stuff” from multiple medical practices. It ain’t fun.
I have Medicare because I was disabled by a stroke 16 years ago. Never had any problems getting Medicare, but can’t recommend a stroke as a means to get it, though some of the other patients in the rehab hospital were very nearly driven to having strokes by their insurance companies.
Officially, I gather, I could be wrong, it’s as confusing as possible (and I have a PhD dammit), it works like this:
Eligible for Medicare at 65. Enroll any time during the first six months after turning 65. (After that, there are Rules.)
Medicare Part A is the big hospital insurance thing and is free, but covers only 80% (?) of hospital costs.
Medicare Part B fills in some of the gaps in A and is not free, but costs way less than the usual insurance bills we see.
Part C is all the “Advantage” plans private companies keep trying to get you to buy. They work a lot like below-65 insurance in the US: doctors must be in-network, there are deductibles and co-pays, procedures have to be approved beforehand, and the whole shebang. They tend to cost very little to start with and while you’re healthy.
Part D is prescription drug coverage. Whether that’s worth it or not depends on how many seriously expensive prescription drugs you require. OTC drugs are not covered.
Then there’s “Supplemental” plans, also called Medigap, E, F, G, and most of the rest of the alphabet. They fill in more gaps that Plan B doesn’t. These are stringently regulated to be similar to Medicare itself and do work if you need the kind of coverage they provide.
One wrinkle is that if you do not sign up in the first 6 months after turning 65, you can only sign up for Plan B Jan 1 -March 31 (exact dates not sure) at the beginning of each year. You can then sign up for Medigap plans after you get B.
Another wrinkle is that you can only sign up for Plan D, drug coverage, if you didn’t initially, from Oct 1 to Dec 7 (exact dates not sure) in any given year. That is also the only period when you can sign up for Plan C = “Advantage” = private corp insurance plans. Hence the blizzard of “Let Us Help You” emails from the sharks around now.
Medicare.gov has some quite useful interactive decision tree kind of things to see which plans do what and for how much.
If you go with traditional Medicare, you absolutely must sign up for a Gap plan (I use the AARP’s version). This is because there’s no cap on your Part B expenses.
So you go to the doctor and it’s $200 and you think, okay, I have a 20% copay, I can swing $40. But then something goes horribly wrong with your body and the bill is a gazillion dollars and you can’t swing 20% of a gazillion. The Gap plan makes it possible for you to cover your co-pay; it covers that gap created by the Rube Goldberg structure of traditional Medicare.
Another snag is if you wait too long to sign up for a Gap plan, they can hold your pre-existing conditions against you, and either charge you an obscene amount or decline to cover you at all! The law requires them not to hold your preexisting conditions against you during the initial sign-up period.
If this is all making Medicare Advantage look good, remember that they are basically managed care plans with a set group of doctors. So if you acquire a weird medical condition and the world’s expert just happens to be in in your town but isn’t in your group of doctors, oh well.
Or maybe it’s your beloved PCP of the last few decades who isn’t included. Which is why you might want to run your choices past their billing staff.
TL/dr: People who shout “Medicare for All” are too young to have dealt with Medicare. Traditional Medicaid is much better but no one thinks advocating for poor people’s coverage is an easy sell.
I may have Parts A and B mixed up as far as the co-pays go—I did all the research six years ago and I’m sticking with Traditional Medicare, so my memory of the co-pay details may be a little off.
But I stand by the rest. Whatever you choose, it’s a disappointment after dreaming about the day you enter the world of (partially) socialized medicine.
Medicare Advantage is good if you can’t afford anything else. It’s like an HMO, but you don’t get hit with the additional costs until you have a major illness. And I believe they have the right to deny you coverage over certain amounts.