The Top 5 Confusions About Deciding on Medicare

I’m not an expert, just (I hope) a better communicator. Trust but verify.

1. The overarching choice you must make is “Advantage or DIY.”
   DIY (do-it-yourself) is my way of referring to getting traditional Medicare and almost always adding a Supplemental plan and drug coverage. If you go “Advantage,” that means putting your trust in an HMO company, but it can save you $200–300 per month when you’re healthy. Supposedly the Advantage plans aren’t as draconian as they used to be. (High praise, eh?) And it’s worth mentioning that — from personal experience — phone support for Medicare has been excellent. Medicare itself is still a behemoth, but the help has been surprising. The purpose of this particular article isn’t to get into the details beyond that, so let’s move on.
2. There’s no such thing as “open” enrollment…
   … except the very first time you sign up. Changing after your initial signup means you’ll have to answer a lot of detailed questions about your health… like, for instance your systolic and diastolic blood pressure. When you first sign up, you have to answer just the most basic questions like smoking… so you won’t even understand what the longer list of questions is. I finally found the longer list (several pages) when my 92-year-old mother wanted to change plans because her doctor changed, and she got denied. Answering this longer list of questions almost certainly is what is referred to as “going through underwriting.” So the yearly “open” nonsense isn’t open at all… it’s simply the industry word for “the plan year is about to change… do you want to try to change plans?” What’s your blood pressure again???
3. “Supplemental” only covers ALREADY-COVERED procedures!
   What? What do you mean? Supplemental covers three insurance payment limits (deductibles, copays, and co-insurance) on procedures and other bills that are “Medicare covered.” [[[Deductible: dollar amount per year; Copay: dollar amount per event; Co-insurance: percentage of bill per event.]]] So one of your first surprises if you go DIY and get a bill for something that isn’t covered is: “Why isn’t my supplemental covering this?!” And the answer will be “The item was not a “Medicare covered” item. So there was no deductible/copay/coinsurance (that Medicare deferred to you) because Medicare deferred the ENTIRE item to you! It was not a Medicare item, so the private company that takes your $50–150 per month for Supplemental says “Go - yourself. Thank you for your business. It’s right in the chart for plans G through N… can’t you read… we only pay the insurance gaps, not the coverage gaps.”
4. It’s “one-year term” insurance.
   Go shop for a life insurance policy and see if they’ll sell you a term policy for one year. I honestly don’t know if they will, but I’m guessing not. (Someone will sell almost anything if the price is right, but wanting only one year makes it seem like you’re planning to die.) Why does this matter??? Because a one-year insurance policy, even for doctors’ bills, is worthless. If you’re at their mercy to renew each year, they’ll kill you with the increasing risk of getting sick, as you age… right? Yes, right. So you need to understand the urgency of item #2, above: you are guaranteed to stay in a plan once you’re in (although rate increases and limits on them are regulated in by law). So if you stay in a plan, it’s endless (not one-year term!) insurance; if you switch, it’s “Let’s see how bad a risk you are. Stand on this scale, bend over, cough, and give me your wallet.” If it weren’t one-year term, we would all choose the lowest price, possibly Medicare B and NO SUPPLEMENTAL, and sign up when we start getting more feeble.
5. With DIY Medicare (and drug coverage) there are two penalties for not signing up (a.k.a., “PAYING IN”) immediately when you first qualify and they are both FOR LIFE!
   You really have to read the details on these, but essentially, if you delay getting Medicare (Part B, doctor visits) and later want to sign up for it, you pay a higher rate forever. Similarly, if you delay getting Part D (drug coverage) and later want to sign up for it, you pay a higher rate forever. When I say “immediately,” that’s for emphasis; educate yourself about the exact startup deadlines. (For Medicare B, they describe the penalty in annual terms [10% higher rate for each year of lateness]; for Drug, they describe the penalty per month… whatever. My father didn’t get Drug immediately and had to pay the penalty, which is 1% higher premium for each MONTH of lateness.) Not sure how these penalties interact with Advantage, such as if you start out on an Advantage plan and try to move back to DIY… but I already explained to you there’s no such thing as “open” enrollment, right?

Trust me… you now have a deeper understanding about Medicare than 99.9% of people.

Can’t get enough of this? Here’s the complete story: https://medium.com/@jackbellis/medicare-at-a-glance-3b3691327554