Would appreciate some answers to my Medicare options.

Oct 9, 2018

  1. CC1975
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    CC1975 Expert

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    I turned 65 and signed up Medicare Part B and have been billed $402 .00 for 3 months of coverage. I have not paid any of the premium because I have been trying to decide whether to buy a Medicare Supplement or a Medicare Advantage plan. So far it's my understanding....

    1) one of the main differences in the Supplements vs Advantage plans is the Advantage plans seem to be limited in their coverage if you have to go out of your local care area if you have a need for specialized treatment. Is this true? I live the Dallas area and have local access to major hospitals. I'm thinking because of this an Advantage plan would be ok because of my access olcally and the chance I have to travel to get treatment is lower than if I lived in a rural area.

    2) Aren't the extra dental, vision, workout plans on Advantages plans really just "teasers" that can't pay out much because of very limited calendar year limits?

    3) If I make a decision to go with a Advantage or straight Supplement, I won't need to pay the $133 monthly premium for Part B, correct? Because the Advantage and/or Supplement plan replaces Part B and along with it the $133.00 premium?

    4) I am healthy, athletic, run and cycle several times a week, presently take no medications, no diagnosed diseases other than recommended cataract surgery. However, I am way overdue for a through physical exam and plan to have this done in a few months when I have made my decisions and have coverage in place. If you were me, what plan would you go with? I'm leaning towards an Advantage plan , because
    1) there are o premum plans in my area, 2) with a large amount of local access, seems the negative about Advantage plans not have the same coverage nationally is negated 3) If my health changes and/or I in the future, needed medications on a daily basis, can't I change each open enrollment period to another plan that covers out of pocket drugs?

    Any corrections, comment and answers would be very much appreciated. Thanks!

    PS If I sign up for an Advantage or Supplement in a week or so... do I still need to pay the $402 premium for Part B?
     
    CC1975, Oct 9, 2018
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  2. ICACharleston
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    ICACharleston Expert

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    You need part B to enroll in either plan. Some MA plans will give you back your Part B premium. You have nothing to lose and lots to gain by engaging with a local agent you can look in the eye.
     
  3. CC1975
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    CC1975 Expert

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    I'm a P & C agent also licensed to write L&H, so I'm also looking to contract and write this type of business as well. Thanks for your input.
     
    CC1975, Oct 9, 2018
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  4. Hopes
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    Hopes Super Genius

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    Just a few things to clarify.

    1. The premium for Medicare Part B is non-negotiable. If do not pay it or if you discontinue payment. It will go away. If this happens you may have to pay a penalty later.

    2. You have to have Medicare Part B to enroll in a Medicare Supplement or a Medicare Advantage Plan. This is non-negotiable. The Medicare Supplement "supplements" the 20% Part B does not cover. The Medicare Advantage administers Parts A & B but in exchange for doing so, they receive a portion of the Part B premium you pay. If you do not take Part B or you let it go, you will lose the Medsupp or MA plan.

    3. You are in a unique position to choose any plan you want without underwriting. If you choose a Medsupp you will not be charged higher rates due to your health. If you choose a MA and later want to enroll in a Medsupp after getting sick, you will go through U/W and may pay a higher premium or be denied coverage. They work very differently.

    I'm sure there are probably some things I missed but this is for starters.
     
    Hopes, Oct 9, 2018
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  5. JJ2713
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    JJ2713 Super Genius

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    Sir,

    You don't understand the consequences of your actions.

    By not paying the Part B premium, you are at risk of missing your initial enrollment period to enroll in Medicare. You have to sign-up AND PAY the premium. If you don't, you'll have to wait to enroll again and be without coverage until July 1 (with only Part A coverage - inpatient), you will lose your Part B coverage.

    You are at risk of losing your Medicare Part B (outpatient) coverage once 3 months after your birth month pass. The initial enrollment period is your birth month + 3 months before and 3 months after (unless your bday is on the 1st of the month, then the main month is the month before your bday month, 3 months before and 3 months after).

    You won't be able to enroll again until January - March, with the effective date being July 1. This means you won't have Medicare Part B coverage until July 1.

    Also, you won't be able to have either a Supplement Plan or Advantage Plan until July 1 as well, with the ability to sign up during April - June, with a July 1 effective date.

    You will just have Part A until July 1. With no more coverage. And you wont be able to get more coverage because you're on Medicare.

    An Advantage Plan doesn't replace the premium you have to pay for Part B. Part B premium has to be paid with a Supplement Plan or Advantage Plan.

    Pay the $402 you owe to Medicare for Part B RIGHT NOW.

    After you pay Part B, then research your two choices...
    1) Original Medicare (Part A & B) + Supplement Plan + Drug Plan
    2) Medicare Advantage Plan with drugs included (called a Medicare Advantage Prescription Drug Plan)
     
    Last edited: Oct 9, 2018
    JJ2713, Oct 9, 2018
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  6. CC1975
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    CC1975 Expert

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    Thanks for your input. Yes, I was thinking I had to pay the Part B premium before the 3 months are up. I'm still trying to get an answer whether after the initial 3 months, does one have to still pay for Part B, if one signs up for a Advantage or Supplement plan? I thought the Advantage and/or Supplement replaced Part B therefore you would pay whatever your monthly premium for that coverage?
     
    CC1975, Oct 9, 2018
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  7. Hopes
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    Hopes Super Genius

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    This was answered in two posts.

    If you want a Medsupp or MA, you have to have Part B. Again, this is non-negotiable.

    In other words, NO Part B = NO potential Medsupp or MA. You can not have one without the other.
     
    Hopes, Oct 9, 2018
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  8. russelltw
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    russelltw Guru

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    You have to have Medicare Part A and Part B to enroll in a Medicare Supplement or a Medicare Advantage Plan.
     
  9. StephanieCJ
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    StephanieCJ Expert

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    To clarify, you must have both parts A and B in addition to continuing to pay the part B premium. On top of the part B premium would be the premium for either the Med Supp & Part D plan or the Medicare Advantage plan.
     
  10. JJ2713
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    JJ2713 Super Genius

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    The Part B premium is separate from Supplement Plans, Drug Plans, and Advantage Plans.

    Pay it now. Don't be cavalier about it.

    Original Medicare (Part A & B) + Supplement Plan + Drug Plan
    Part A = no premium if you/spouse worked 10 years
    Part B = premium
    Supplement Plan = premium
    Drug Plan = premium

    Advantage Plan with drugs
    Part A = no premium if you/spouse worked 10 years
    Part B = premium
    Plan = may or may not have premium
     
    JJ2713, Oct 9, 2018
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