Health insurance when retiring

[RunThru]

Quick question (or not so). I am planning on retiring next summer. I have pretty good health insurance which reduces my hospital and pharmaceutical costs. Once retired, I want similar care, and so I am looking at Medicare. I am taking Zytiga, pretty expensive; and who knows what the future holds. What Medicare options are the best for this kind of care; plan A, B, D? All the above? Explanations? Thanks for your input.

[Kentucky1]

First, I would advise you to talk to an agent in your town that deals with Medicare supplemental insurance exclusively, the choices are varied and can be confusing. They can steer you in the right direction choosing the plans that are best for your particular situation. I became eligible this year and so far I am extremely pleased with my group of plans. Medicare A and B are pretty much automatic. If you have elected to draw SS you will be automatically enrolled when you become eligible. From there you generally have two pathways to choose. Medicare Advantage plans closely resemble traditional insurance like HMO or PPO plans. They usually lock you into a network of providers in your area and provide services that cover the entire spectrum of healthcare coverage. They do limit choice, but are usually less expensive than your second choice. The second route involves choosing a Medicare D plan for your prescription needs and a Medicare supplemental (Plan F,G, Etc). A supplemental plan is necessary to cover expenses that part B doesn't fully cover, i.e. the 20% not paid for hospitals and such. Without the supplemental you will have to pay the 20% plus potentially some extra charges from your medical providers in certain situations. You must also choose the D plans in a timely manner or be subject to higher rates for postponing your decision. I went with a supplemental plan G, a plan D for Rx's, in addition to the standard A and B coverage. This way I was not limited to any specific network of doctors or hospitals like an Advantage plan would. Rates vary according to age and location, but I am paying $28 a month for Part D and $139 a month for Part G. The part D has a $445 yearly deductible and operates with a formulary system much like regular insurance. My Abiraterone was about $275 month one, $225 month two, and now since the deductible has been met, it will be about $115 a month going forward. That's a huge saving from the 25% of the inflated $6800 cost I was paying through my previous Obamacare plan. Once again I would urge you to contact a qualified agent to help you sort your way through all your choices. What's right for me may not be best for you. Good Luck in your search and welcome to old age.

[dentaltwin in reply to Kentucky1]

I agree with everything you said--except that you must sign up for part B. You are automatically eligible for part A IF you have enough years of employment in, paying FICA. The situation with participating providers may differ significantly from place to place. I strongly suggest getting a supplemental plan (what was originally called "Medigap"); Medicare Advantage is managed care. If you are going to take that route make sure your doctors and good local hospitals are on the panel. The particulars of the different part D and supplemental plans may differ a bit from state to state (as will the costs). The supplemental plans are given a letter designation. The most expensive is F; AFAIK you can still get it in NY, but I opted for G, because the only difference is the part B deductible, and the difference in premium over a year is more than the deductible.

The enrollment periods are pretty tricky, and yes--if you wait too long to enroll it increases the premiums--for life. Yes, it's confusing, and having a good insurance broker can ease the process.

[JuliesHusband]

Kentucky1 has it pretty well covered. I wasn't aware that F an G are still available.

I am on Medicare and searched out a PPO Medicare Advantage plan. I changed the MA plan when I was diagnosed with cancer.

My first plan had a $10,000 annual out of pocket for out of network providers, the new plan is $4,000 max including both in and out of network providers. Premiums on the new plan are $120/mo, a $50 increase over the old plan. Coverage is almost identical otherwise.

I do miss my corporate insurance, but that is a bit steep for retirement.

[Kentucky1 in reply to JuliesHusband]

I think plan F is not open to new members, but G is still an option, at least in my area.

[bethdavis in reply to Kentucky1]

It depends on age. To get Plan F, you had to be eligible for Medicare prior to Jan 1, 2020.

[Muffin2019]

I have AARP United Healthcare advantage plan with no issues, my abi cost is about the same as yours, no supplement as they do not help with the medicine cost, 4 years on the plan. My mom also had them and was very satisfied with them.

[bethdavis]

I am definitely going to go with a Supplement, especially because of my husband’s Ca. I have done a lot of research, and also helped my older brother, also with prostate cancer, choose his. An Advantage program limits your choice, and we want to be able to go wherever we need to go. Plus, with a Plan G Supplement, you pay a $203 annual deductible and that’s it. Shop wisely for your Med D plan, too.

I am going through a broker named Boomer Benefits when I retire next year. They help find the least cost plan for my situation.

You will only be able to choose a Supplement in your one year enrollment period. After that, it’s subject to underwriting, and with cancer, you would not be accepted.

With a supplement, it might cost more but there are no surprises.

[MyDad76 in reply to bethdavis]

Hi, as I'm not from US, I was just wondering. How much do you pay monthly for a health insurance if you want low annual deductibles?

I'm from Slovenia, Europe. In Slovenia we have state health care system. It does give access to everyone, but we are very limited in treatment and doctor choices. How much you pay depends on how much you earn - it is defined by law that we pay a certain % of wage for healthcare. Only those who are employed pay, but everyone is insured. So the more you earn, the more you pay, we also have the same coverage, so the unemployed at top earners have the same service, private sector is very limited.

[bethdavis in reply to MyDad76]

We have so many choices, depending on what type of coverage we want. My employer has 8-10 different plans. I believe that for my husband and myself, we pay around $450 a month. We have the most comprehensive plan my company offers. After I retire, we will be on Medicare. We will each pay $148.50 for a premium, plus a surcharge on top of that called IRMAA because we are higher earners. Then the supplemental insurance on top of that, which might range $150-$250 per person. I am going to use my employer prescription plan, because it has an annual cap, unlike Medicare D. It’s $236 for that. I believe it will be around $1200 per month for healthcare when I retire. One reason I am still working!

One good thing I just learned is that because I also have a small business, I can deduct all those premiums from my gross income, before adjusted gross income is calculated. This will help avoid tax on that amount, and might help to keep us in a lower IRMAA group.

It’s expensive but everything is paid and we can go to top notch centers for care.

[MyDad76 in reply to bethdavis]

Thank you for taking the time and sharing information. Honestly I thought it is more expensive. In Slovenia if you are on minimal wage, than out of your salary 210 USD go to health insurance. Due to heavy tax and social contributions, salarys that are above average, but nothing extreme - well the difference between gross and net salary is 50%. Out of my salary every single month over 650 USD for health insurance alone. What we get is not even decent, let aline close to western standards, no matter how they try to convince people that “we should be so happy that everyone has access to health system”.

[monte1111 in reply to MyDad76]

Two sentences to describe the health care system. Wow. None of this A, B,........Z S!!! Everyone gets the same health care. Everyone pays the same. What a great idea. Where is Slovenia? Close to Russia?

[Hidden in reply to monte1111]

I have a flight credit...ill get a one-way ticket for you...let me know when you want to leave

[monte1111 in reply to Hidden]

Are you kidding? I'm getting too much stimulation.

[MyDad76 in reply to Hidden]

I’m an only child and will take care of my father till his last breath. I do often wish though, that I would leave immediatelly after completing studies. I could easily move, no borders in EU and I could find a job easily.

[JuliesHusband in reply to monte1111]

Note the comment on the level of treatments and providers available. State run medicine often does not provide the choices we have. My Aussie relatives find private insurance is often a better option to state medicine.

[monte1111 in reply to JuliesHusband]

I agree. Private insurance is always the best.

[MyDad76 in reply to JuliesHusband]

Perhaps state run medicine works in mature democracies like Germany, Austria etc. In young countries it is a synonym for corruption, poor service and zero accountability. I will give example of prostate cancer, as we all know the field. Diagnosis: no MR before biopsy, so blind biopsy only. Treatment: my dad, Gleason 4+3=7, diagnosed after TURP just after turning 74, excellent health, 0 comorbidities. They calculate average life expectancy: if below 10 years, they do not like to proceed with surgery or radiation. The cheapest drug: so first casodex (bicalutamide), when it stops working you are switched to Eligard. No referral to oncologist until not castrate resistant or mets. Second line treatment like Zytiga or chemo only once you are castrate resistant and distant mets. No scans of new generation, no genetic testing, no clinical trials, no proton available. In our system you not get anywhere without referral, only to GP, dentist, pediatrician and gynecologist. For all the rest you need a referral by GP or later specialist. Since we are a small country (2 million), private sector is extremely limited - just some outpatient checks, but we have no single private general hospital. Waiting lines are ridiculous - one year for rheumatologist. Yes, one year. No private practice in the whole country. So either you go abroad or wait. Or, if you know anyone at the rheumatology clinic, you will skip all the lines (happens on a daily basis). And for this i pay over 650 USD every single month. Night mare. That is all I can say. I do not see any change in the near future: they keep telling us, yes, the system is not perfect, but at least everyone has access. They often use US system as example: where poor people can not afford treatment. There are is no out of pocket cost in our system. What you pay depends on your salary, but everyone has the access to the system, so either you pay 0 or 1.000 USD per month, you have the same rights. It sounds good, but it is for sure not working in Slovenia. Ah, add thing. Doctors salary is the same regardless of how many patients he has per day or how good he/she is. We can not contact our doctor (except GP) by phone or email. You just get to talk to them when you have official appointment. And they decide when you need it, there are no “in betweens”, because you would like to clarify stuff. And there is no firm rule, how fast you should receive test results, but if you get it before than in 2 weeks, you should consider yourself very lucky!

[JuliesHusband in reply to MyDad76]

MyDad76 Insurance companies and Medicare here also often require blind biopsy before imaging. This is backwards and needs to be changed.

Also, many of our physicians operate under the USPSTF and CDC guidelines which do not do much to encourage prostate cancer screening overall and discourage screening men under 55, over 70 or who have less than ten years life expectancy per actuarial tables.

This is why I see so many men in their 50s or 80s who are living with the pain of the cancer in their bones. I recently watched as one member of a support group considered euthanasia, discovered prostate cancer in his spine, became paralyzed from chest down and within about two months died.

I was diagnosed because I am able to self refer (PPO insurance) and went to a urologist rather than my primary care physician (PCP). When I told my PCP that I'd been diagnosed he seemed to think he'd done his job because he went by the CDC recommendations and at age 75 I would be dying of something else before the prostate cancer became fatal.

This totally disregards the fact that in those 10 years predicted by insurance tables I could develop painful metastasis. CDC and the PCP don't give a damn. It also ignores the fact that I might be outside the numbers on the actuarial tables and live beyond 10 years. Since my family typically lives into their 90s I plan to live much longer than the accountants predict. I plan to outlive the PCP.

The upside is that with self referral and plenty of research and input from support groups like this one we can make decisions not controlled by the accountants.

[MyDad76 in reply to JuliesHusband]

Self referral in Slovenia is limited to those areas, where we have private outpatient ambulants'. As for prostate cancer, unlike with breast cancer, there are no programs of prostate screening unless one presents with problems. So no, no one measures PSA of men regardless their age unless they develop problems. They even have the guts to say it, that false positive PSA make more harm than good, disregarding the lives of men that could be saves by a simple test.

I could not agree more with you when you say: "This totally disregards the fact that in those 10 years predicted by insurance tables I could develop painful metastasis."

They also totally disregard that many men could live longer, as they have no comorbidities. Now as my father's cancer seems to have reached seminal vesicle, they are discussing radiation. Only after I have used all my connections of course. Had I not had them, he would even not have this option. And they kept telling him, radiation carries risk of side effects etc. Like hormone therapy is a joke / walk in a park.

I'm glad you self referred! All the best to you.

[JuliesHusband in reply to MyDad76]

That attitude towards prostate cancer and testing is the same as our CDC. Same lame stuff.

Modern radiation is definitely not as bad as cancer.

Men don't see hormone therapy as a walk in the park. We are not accustomed to having the menopausal symptoms it brings. And I am experiencing what may be after effects, but would go the same route again.

[MyDad76 in reply to monte1111]

It sounds great, but in practice it is a crap. For some of us, a very expensive crap. Slovenia was once part of Yugoslavia, it borders Italy, Austria, Hungary and Croatia.

[monte1111 in reply to MyDad76]

You are right. Theory and reality can be a whole lot different. I did google Slovenia. The close to Russia was a feeble attempt at a joke.

[MyDad76 in reply to monte1111]

Sorry, I did not get it :-/. I guess topic of health insurance is so painful for me, that my brain is not even able to perceive a joke :-/. Our system does sound like the old Soviet school, so I just thought it is a logical conclusion for someone to position us in/near Russia. To be honest, I traveled Russia for work and have colleagues there; they have a very good private healthcare in large cities. Of course they also have a state system and hospitals, but they have also a choice of good private system.

[JuliesHusband in reply to MyDad76]

I was paying $78/month for the $10,000 max out of pocket, am now paying $120 /month for the $4,000 max out of pocket. Medical is currently contributing something like an additional $114 per month.

[MyDad76 in reply to JuliesHusband]

From where I stand, this is cheap. And the choices you have are on a totally different level as ours.

[Concerned-wife]

I agree a broker can help. Just make sure to ask whether they sell both supplement and M Advantage plans so you know they are being objective. Medicare.gov has very good tools to help you. As someone mentioned, it is important to make the right decision the first time.

[JPnSD]

Watch out for the 24 month catch 22 in Medicare. If you sign up for an Advantage Program....and then later wish to switch to regular Medicare....DO NOT go beyond 24 months after you initially sign up for benefits. You CANNOT buy a Medicare Supplemental Insurance Plan to cover uncovered Regular Medicare costs after that 24 month period....without having to move either to a new state...or totally out of you present service area. Totally SUCKS!

[Break60]

Original Medicare is best if you have a chronic disease imho. With it you get Part A ( hospitalization) covered 100%, and Part B (outpatient care) covered 80% . You need a medigap private plan to cover the remaining 20%. Part D, prescriptions, are covered by a private plan you select. So you have three premiums to pay: Medicare Part A and B, Medigap, and Part D.

All Medigap plans are the same but premiums may differ.

Consult with an expert.

[ChicagoJ]

Another place to possibly find help is your state’s senior health insurance program (SHIP). They have volunteer counselors who can answer Medicare questions.

[NotAlwaysSunshine]

I'm a broker. I'm in Ohio. Find someone close to you that you can talk to in their office rather than a random agent in your state. Things to do - as mentioned above. Sign up for Part B. If I were you, in your situation, I would sign up for Part G Supplement and then find a Part D plan on Medicare.gov by submitting all of your drugs in the search. Good luck to you and happy retirement!

[Canoehead]

Medicare is a minefield. You get part A (hospitalization) automatically. Part B (doctor bills, office calls, etc) is mandatory unless you have some other private insurance still in effect. There is a penalty for failing to sign up for Part B when required. Part B can also be quite expensive if you are still working or have significant investment income, as it has an income based surcharge. Part D (drugs) is voluntary and has to be purchased through a private vendor. Part D plans are quite variable in terms of cost and coverage. The whole system is not streamlined or easy to navigate, and it can get pretty expensive.