It's that time of year when celebrity spokespeople are pitching Medicare Advantage Plans (Part C) on TV. I'm still working full time with good health coverage, but Medicare is not so very far off for me. Here is a good article that discusses some of the problems with these plans:

https://www.nbcnews.com/health (Click on,'Deny, deny, deny': By rejecting claims, Medicare Advantage plans threaten rural hospitals and patients, CEOs say)

(Sorry, I wish I could post the direct link, but something about it is upsetting the filter.)

Apparently, the plans are fighting hospitals tooth and nail over treatment of patients. After reading this article, I'm left with the impression that Part C patients are often receiving sub-standard care. The hospitals do their best to stand up to the private companies, but as the article points out, rural hospitals seldom have the resources to do that, and many are having severe financial problems, and may close as a result.

Just something to think about as you make your yearly selection. I know that for many people, Part C may be your only realistic and viable option. But it's best to be aware.

I HATE all those pressure ads this time of year.

I don't do Advantage Plans myself.

The health care system in the USA is a complete and utter mess, mostly designed to funnel profits to billionaires.

Between insurance companies, pharma companies, health care companies and politicians, I don't know which are more frustrating.

dagny Wrote:
-------------------------------------------------------
> The health care system in the USA is a complete
> and utter mess, mostly designed to funnel profits
> to billionaires.

Yes, it is. But in all areas of medicine, Big Pharma is the winner these days and makes vast profits. You don't want to go with the British system either, which is a total mess just now. You have to wait two years or more for some non-emergency assessments there and their buildings are crumbling.

I have a Medicare supplemental vs an advantage plan. I’ve had 0 issues getting bills paid. In 2020 my hysterectomy was free. So far this year I’ve had rotator cuff surgery and 6 months of PT with the only cost being pain killers after my surgery.

My niece who is a hospital social worker hates advantage plans. She recommends supplemental and separate part D if you can afford it.

What supplemental do you go with, sbg? I've heard good things about Aetna's supplementals, but would love to hear about your first-hand experience.

The overall cost of Medicare (Part A, Part B, and Supplemental) is one of the reasons that I'll probably put in an extra year or two of work in order to boost my pension.



Edited 1 time(s). Last edit at 10/31/2023 07:34PM by summer.

Do you get to choose when you start taking your social security? If so, what are the options and costs/benefits?

--Asking for a clueless friend (no, not that clueless friend)

Within limits, yes you can choose. You can start collecting social security at 62, but with a 30% lower monthly benefit.
That can be avoided by waiying until full retirement age which is 66 or 67 depending on when you were born.

If you wait until age 70, your benefit will increase by 8% pr year from full retirement age until 70. there is no increased benefit if you wait until after 70.

https://www.ssa.gov/pubs/EN-05-10035.pdf

Regarding Medicare (from the above link)


"If you’re not already receiving benefits, you should contact
us about three months before your 65th birthday to sign up
for Medicare. You should sign up for Medicare even if you
don’t plan to retire at age 65 to avoid the late enrollment
penalty.

If you don’t enroll in Part B or Part D when you’re first
eligible, you may have to pay a late enrollment penalty for
as long as you have Part B or Part D coverage. Also, you
may have to wait to enroll, which will delay coverage."

So you should sign up for Medicare when you turn 25 to avoid paying more per month for the rest of your life. There is an exception to the penalty if you still have group health insurance.

25? Did you mean 65?

Yes.

Whew! For a minute there I thought I'd missed the boat!

;-)

Good post. When to take SS can be different for everybody. My recommendation is if you need the money or have questionable health, take it at 62. In the end it all depends on how long you live, the break even point for taking SS at 62 or 70 is somewhere around 78-79 (if I remember correctly).

My mom took SS at age 62, and then lived to be 79 (within four months of 80.) I think in her case it was a bad decision to take it early. One of the things that hurt her was inflation over the years. SS, even with COLAs, couldn't keep up. It was the worst in her last few years, at ages 77-79. Her investments also hurt her -- she put most of her savings in bonds (a bond mutual fund,) and CDs. The bond mutual fund dropped in value, and the CDs could not keep up with inflation. IMO a mellow balanced fund with some stocks and bonds would have been a better choice. Finally, she had sold her home and rented towards the end of her life. If she had a paid-off home, that would have made a difference as well.

My advice would be to try to take SS at your full retirement age (i.e. 66.5 or 67) if you are able.

You are correct, inflation does not keep up. So, what should have done with her money, stock market?

In all due respect, your Mom was not invested well. My mother did the same thing until my father died and I took over.

Rent or paid off home, you still have expenses. i.e. taxes, insurance, maintenance. Were there stairs in the house?

I agree 66 or 67 is the age you take it... if you can.

With the benefit of hindsight, I would have put her into a well-managed balanced mutual fund. The stocks in the portfolio would have provided enough growth to keep up with inflation, and the bonds would have provided a balancing influence. My mom did not understand investments, and allowed herself to be influenced by a stockbroker that sold her an all-bond fund with a high load. I've always liked the Dodge & Cox family of funds, but I also would have looked at Vanguard, T. Rowe Price, and Fidelity no-load options.

In regard to owning a home, a paid-off home beats renting. She sold a condo and moved to a less expensive rented condo. Again, with the benefit of hindsight, I wish that she had bought a less expensive condo. I know for myself, taxes, insurance, and maintenance will be far less than paying my mortgage (my condo will be paid off next spring.) Plus, if you rent, rents get jacked up every year, especially in desirable areas.



Edited 1 time(s). Last edit at 11/01/2023 11:47AM by summer.

I had my Mom in Dodge and Cox and Vanguard, which worked out well for her. I see the situation your Mom was in all the time. People put their trust in the wrong people and then don't audit their accounts. I can't tell you how many people near retirement are letting the foxes in the hen house.

I tell everybody that wants to listen, ok, keep your high priced investment advisor but at least audit your account balance every money and keep track on a spread sheet. The data never lies.

Here's what I recommend.

Before the time comes, open a Social Security account on the official government site. Check and monitor everything. It's easy to make decisions about your SS there.

Also open an account on the official Medicare government site. Everything you need to know and sign up for is there, without as much BS from insurance companies. At first it is confusing because there is A B C and D.

Most people sign up for A and B, since that is the basic hospital and Medicare health insurance. That's basically the required minimum.

Then they confuse you about C, which is where all the weird Advantage stuff enters. That is where "optional" insurance companies have plans and send you non stop spam trying to get you to sign up for "additional" coverage. I never got sucked into any of that since what little Medicare doesn't cover, I can cover myself (from investing all the money not spent on insurance!). That's where a lot of consultation enters depending on your personal circumstances. Meanwhile, insurance companies might also offer "supplemental" policies that are not linked to Medicare C like the Advantage plans.

Medicare D is all about prescriptions. It is not required. I don't have any prescriptions so I didn't sign up for it when I signed up for A and B. There is a catch though. If you do not sign up for it when you are first eligible, there is a small penalty cost for all the years you didn't have D. If you decide later to sign up, like I did this year, you can during the open enrollment period and you can pay the penalty. Then you have to go through the list of D prescription plans (a list of all the insurance companies that qualify) to see which ones have what you think you might need. You can do it all on your Medicare account on the Medicare site. If you have a prescription or provider you need to have, you can pick one that covers your situation. The only reason I signed up is because apparently you need part D to get the Medicare prices that the government has negotiated (like cheap insulin). I hope I never have to go any deeper into all that convoluted stuff.

Disclaimer: This is only my understanding, process and experience. I've only had one major medical issue maybe 5 years ago involving a fracture and surgery. I didn't have any issues with Medicare.

I could go on, but you get the idea.

I have Blue Cross/Blue Shield of MN. Aetna was the other one I considered. I ended up with Blue Cross because they cover almost every doctor and hospital in MN.

While it is more expensive, I’m getting what I’m paying for.

I actually switched while I was still working. The cost difference more than offset the 5K deductible and 20% after that of my company’s horrid insurance.

Thanks, sbg. I'll look into Blue Cross as well. A friend of mine lives in Minnesota, and I understand that the state has its own way of doing things when it comes to health coverage.

Prostate cancer, gall bladder removal and a some intricate pieces of glued-together lawn hose replacing my aorta...  $100 bucks each time for the hospital.

All under normal MediCare.

The calls and letters regarding switching to an Advantage plan are surprising.  I don't recall this pressure in years past.

Can someone provide a brief explanation regarding this apparent surge?

My understanding is they are losing participants to supplement plans that offer better coverage. I’m getting more ads this year the 4 years ago when I became eligible. My recycle bin is getting a workout.

My experience with my mother in the hospital, the hospital copay or part A coverage is separate from every damn doctor, phlebotomist, imaging, radiologist, everything. Part A only pays so much, my mom was in for 8 weeks with sepsis. So in addition to the mountain of hospital bills uncovered by part A, I got bills from the infectious medicine specialist, the pulmonology specialist, the conglomerate that provides the hospitalists, the labs, etc.

Medicare is a nightmare.

Unrelated, but I'll just add this here. When politicians promote medicare for all, I think it's intellectually dishonest. Unless you've had to deal with medicare or deal with a loved one's medicare, it's easy to think it's interchangeable with medicaid, but it's not.

Yes, the slew of bills is a nasty wake up call for those who are hospitalized, or who even pass through a ER. The bill from the hospital is just one piece of the puzzle. When I broke my leg and ankle, I got a bill from an ER doc whom my insurance company deemed "out of network," even though I have excellent medical insurance (a BC/BS company.) I rolled my eyes and paid it. Who penalizes someone who needs emergency care? Only in America, folks.

Since I'm still married by law, I just let him take care of all of it. It just stresses me out. So far I haven't had any issues. All my meds are paid for except Lantus, which I pay $35 a month for. I have 6 or 7 meds as I also have depression and anxiety besides diabetes. I guess I'm a ticking time bomb in some ways, but I must not be too bad if I do as much as I do.

When I get all this stuff in the mail about other plans, I just throw them away. I hate all the stuff you get back from the doctor like a statement of your meds every month I believe. I used to read them. I ask questions of the people who signed us up to find out which medications are tier 1, etc., and so far it has been okay.

As far as taking early SS. I had just been working at Sam's Club--that lovely period of my life--and I had just found another transcription job, so 2 months before I turned 62 (4 years ago) I quit Sam's and I signed up for SS as soon as I could.

I figured out what my payout would be if I took it at 62 instead of whenever it is. I'd have to ask. I don't think about it. If I live to age 76, the age my parents both died, I will get the same amount less $4 for starting at 62. It helped me get out of working at Sam's.

But my "husband" does take care of that stuff as he is much better with financial stuff and we have a deal that he pays for everything since I paid for it all for many years and paid for all the kids' stuff. Otherwise, I divorce him finally and take half the pension.

I'm not concerned. I know where the pension money is and how much and I just want it to go to my kids and I know it will.

I'd say being on SS makes me feel older. Financially it has been fine.

What I find strange is realizing that all the stuff I made, quilts, afghans, put together photo albums, wrote in journals. Just as well burn the journals. things I've saved over the years, I have started seeing things in the point of view of should I keep this or is it something the kids would appreciate I throw it out. I've sent a lot of stuff to the DI. I find it strange to be 66.

I will take any advice you can give me.

I am in the must enroll 6 month window for Medicare. I am still employed, have a great plan through my Employer for Medical, Prescription, and Dental. I have no intention of dropping any of it while I am employed, since I also carry my wife on the policy and she is younger. I plan on continuing working for another 3 to 5 years depending on how long I can put up with young bosses and ageism.

For you who have gone through the setup, Give me any advice you can, I can use all I can get.

The AARP article linked above explains it nicely. Basically as long as your employer has twenty or more employees, you can keep your employer's plan if you wish for as long as you are working. That's what I opted to do. There are a bunch of small, clarifying points that the article goes into, so do read it thoroughly.

My honest advice for you is to consult a medicare specialist. You can be connected with one via your city/county's office on aging, or you can go to an elder/senior attorney. You can also speak to your benefits manager/HR at your job.

Medicare is confusing, and you don't want more than you need or less than you need.

I'm not qualified to give you accurate advice because this isn't something I've had to deal with in my mom's medicare issues, but I have cousins in your position. In some cases, their company moved them to an equal benefits medicare plan. Others use their company insurance as the primary and medicare as the supplemental.

What I can tell you is that there is a late enrollment penalty for part A and part B. It shouldn't apply to you since you are covered by insurance, but you might want to check for sure: https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties

I don't know why you Americans are so in love with this system. It has the worst features of both commercial and socialized medicine, because you end up paying twice for the care. Also if you want a model for healthcare look to France, Germany or Japan, not the UK whose system barely functions these days... but no medical system covered itself in glory in 2020 or 2021.

Medicare is an insult to the elderly, it should be no different than medicaid.

The US has the advantage of many viable health plans around the world that it could study to come up with a system that suits its needs. The very discussion here underlines the complicated and convoluted nature of the current Medicare system.

Personally, I want to know why SS deducts 40% of my small UK SS from my US SS when I paid into the UK systen (and susequently made voluntary contributions) long before I ever set foot in the US. There's probably an equally convoluted system to explain that.

If you never need a Dr. and you never travel or go to a dr outisde your network an advantage plan would be great.

Whether or not to retire early [in the US] is more complicated than most people realize.

If your goal is to have the maximum amount of lifetime income possible, keep working until age 70, or even don't ever retire. Die with your boots on. This is not the common choice.

If your goal is to extract as much money as possible from SS, then early retirement may be the way to go, especially if you are in poor or questionable health. If you are in good to excellent health, working until 70, and then filing for SS, and living into your 90s, you will make out like a bandit. You will make out like a bigger bandit if you do that, and also keep working after age 70.

At age 62, can you keep working, and file for SS? Yes, but that is almost certainly a terrible idea. The main problem is that there are earned income caps until you reach full retirement age (66 or 67) and if you exceed those caps, SS takes back part of your SS for that year.

As I understand it [translation: I barely understand it] if SS claws back part of their money because you earned too much, it will go back into your basis when you do reach full retirement age, so you don't actually lose that money, it is just delayed.

Once you do reach full retirement age, it doesn't matter how much extra money you earn, you get to keep all your SS for the year. However, the more income other than SS you have, the more of your SS gets taxed as income. That is true regardless of whether you have reached full retirement age or not.


Now, suppose you get laid off before your full retirement age. Should you file for SS immediately, or should you wait, and live off your savings for one or more years, until you reach full retirement age, or until your savings get dangerously low?

In other words, how many years does it take before the 8% per year increase in benefits for the rest of your life make up for the 100% loss of benefit for the year if you don't file for SS that year?

If you delay retirement for one year, it will take 12.5 years to make up for not receiving any SS benefits for that year : 100%/8%/yr = 12.5 yr. It is not quite that simple, but it is surprisingly close. After the 12.5 years, you will clear an extra 8% for the rest of your life, but keep in mind that you will be at least in your mid 70s by then, maybe late 70s. You might be dead, you might have ten or fifteen more years. Maybe more, but not likely.

OK, how about if you delay retirement two years? That's better, right? It won't still take 12.5 years to make up for the money you didn't receive those first two years when you didn't retire, right?

Unfortunately, the break-even point is still 12.5 years from the time you retire (give or take a small amount). Sorry about that. There is some good news. Once you get past that 12.5 year window to reach break-even, for all the ensuing years, you don't get 8% extra money for the rest of your life, you get 16%. And if you delay 3 years, you will get 24% after your 12.5 year break even window. Etc.

Of course if you die in less than 12.5 years after you retire, you will end up having received less SS than if you had retired earlier.


One more complication - when you retire, your expenses often change. Commuting costs may go way down. Wardrobe costs may go down. However, and this is a big "however", health insurance costs may go up until you qualify for Medicare. That is wildly variable between people depending on how much your employer charged for health insurance (often the employee is fully covered, the family coverage is paid all or mostly by the employee). Also, you may qualify for subsidy under Obamacare, or your spouse may be able to add you to their coverage. Like I said, the cost of health insurance is highly variable.

If you are going to have high health insurance costs if you retire early, then that 12.5 years to break even on SS for not retiring early gets shorter. You don't have to make up 100% of SS you didn't get by not retiring early. You were going to lose 20% or 30% of your SS anyhow in health insurance premiums, so the break even point might be something like 8 years.

And one last complication - if you don't retire early, you get the extra income from your job, and the health insurance from you job, for another year for each year you delay. That is generally the most important consideration, and the simplest one to understand. Of course it only applies if you have a job.



And I don't even try to do a cost-benefit analysis of Medicare in all its flavors.

Oh, and I have been retired 12.5 years. Coincidence.

Back to the Topic of Medicare: You have to apply for Medicare with, I believe it is 60 to 90 days of your 65th Birthday, regardless of when you apply to take Social Security. They are 2 separate things.

And definitely do not sign up for a Medicare "Advantage" plan, purchase a Supplement Plan instead. Medicare Advantage sounds good, but they will deny every medical thing you go for.

Please, definitely READ THE ARTICLE the OP recommends.
https://www.nbcnews.com/health/

Then look for Title of the article "'Deny, deny, deny': By rejecting claims, Medicare Advantage plans threaten rural hospitals and patients, say CEOs"

An Insurance person I know told me of people he knows who had "Advantage" Plans who were stuck with thousands of dollars in bills they owe out of pocket.


You need to be able to go to any specialist and not require a referral. Your health is not something to try to skimp on.

Not all advantage plans are like that, my mother has AARP united advantage PPO and she never needs referrals, sees specialists, gets treatments, and everything else. A HMO or an EPO would be terrible. She's never had a prior auth denied, either.

I got my mother supplemental (part C) last year. It's an AARP/United plan in maryland.

My mother is financially vulnerable (my father spent her inheritance decades ago, she didn't work till she was in her 40's and it was mostly low paid work, she has no savings and is now disabled and unable to work, the disability coincided with the first year she could get her (paltry) social security and medicare), and prior to getting this plan, I spent years paying the 20 co-insurance on her medical bills. It's "only" 20%, but 20% of, say 2k lab work is still a lot. She has multiple medical conditions which require seeing 4 specialists and her GP every 6 months.

I was finally able to get her "federal helping hand" which covers her part D premium and reduces her meds to $5 and $11 (which is much better than multiple copays of 120, 60 and 30 on the 14 medications she takes monthly).

Between the advantage plan and the helping hand, I was able to quit my 3rd job!

She hasn't had problems yet when it comes to getting care, but we're not rural, we're in montgomery county MD. She is less limited in the care she can get now than she was before, because I often wasn't able to afford the 20% co insurance for some major procedures, even with 3 jobs (her net social security, so minus part B, she qualifies for medicaid w medicare, but they only go by gross, and the gross is like $70 too much). Advantage also covers vision and dental.

TL;DR if you NEED advantage, get it. If you have other means, don't. Just do research, make sure the plan covers all your meds and all of your doctors take the plan. IF you are financially vulnerable look into the assistance your state/the fed gov provides. For instance, there's a type of medicaid, SLMB, that covers your part B premium, there's the federal helping hand for part D, and there's medicaid you can use as a primary/secondary insurance on top of medicare. If you qualify, of course. But if you're struggling, it's worthwhile to find out what you qualify for. You might not qualify for the above, but qualify for a free advantage plan.
(I'm kinda passionate about physically and financially vulnerable elderly)

>> TL;DR if you NEED advantage, get it. If you have other means, don't.

I agree with that. It sounds your mom is exactly the sort of person that Medicare Advantage (Part C) was made for. Living in Montgomery County, she likely has the advantage of having wealthy hospitals that will go to bat for her, if needed, against United Healthcare. Just keep a sharp eye on the more impactful decisions regarding her health care. The providers are on her side. United Healthcare's Advantage plan might not be.

summer Wrote:
-------------------------------------------------------
> >> TL;DR if you NEED advantage, get it. If you
> have other means, don't.
>
> I agree with that. It sounds your mom is exactly
> the sort of person that Medicare Advantage (Part
> C) was made for. Living in Montgomery County, she
> likely has the advantage of having wealthy
> hospitals that will go to bat for her, if needed,
> against United Healthcare. Just keep a sharp eye
> on the more impactful decisions regarding her
> health care. The providers are on her side. United
> Healthcare's Advantage plan might not be.

Thank you for this. What kinds of things should I look out for. So far, the only issue I've run into is having to pay the specialist's copay, and then the charge over medicare assignment.I think I might be able to fight that, but I have no more energy to fight I'll pay the extra $20. I'm so exhausted, managing her healthcare, doling out the meds, messaging doctors, it's a full time job.

I always check the EOBs, there are always extra charges, but again, energy.

She hasn't been denied any requests so far, for instance, she was unable to get her heart rate down for a CTA at johns hopkins in bethesda, so she had to go to johns hopkins hospital to get it. It was approved. Next week she's having an endoscopy in the hospital instead of a surgery center because the doctor wants her to be in the hospital since she has copd and heart issues. That was approved.

I am constantly waiting for the other shoe to drop, this takes up most of my mind, thoughts... even contributes to my OCD. I want to care for her as best as possible. Do you have suggestions to look out for or ways to mitigate the down sides? I'd hate for her healthcare to be based on her income and the value of her insurance.

I'm not sure about the wealth of MoCo hospitals, my only experience has been with shady grove (and some studies at NIH). I'm sure you're right about suburban hospital.

I'm sorry to take so long to respond. I would ask her physicians (either inpatient or outpatient) to notify you if United Healthcare turns her down for anything that regular Medicare would normally approve. That's what you need to stay on top of. Any or most of the Montgomery County hospitals will have the resources to fight any battles that come up with United Healthcare (the problem is mainly with the smaller, economically weaker rural hospitals,) but it's best to be aware.