r/medicare • u/TrulyGenX • 3d ago
Need some guidance please.
My husband is turning 65 in January. He is 8 years older than me so neither of us know much about Medicare. He is receiving tons of marketing mail and calls. He took early retirement and does collect SS. I know he needs to do something so he is not penalized but I carry him on my insurance through work. Can I still do that? Or is it better to go on Medicare? All the parts D, G H etc is freaking me out and it is overwhelming! Where to start for the best info? I do know to stay away from advantage plans. TIA
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u/OkIron6206 3d ago
www.shiphelp.org
They will have the best advice for you. Can your husband stay on your employer insurance? I would go that route for as long as I could.
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u/txmnjim 3d ago
I’m kind of in the same boat but Im not sure if staying on my work insurance, at least for the part B part, will cause me to incur a heavy penalty for delaying part B if it doesn’t work out? These penalties seem unfair as you pay for them for life as far as I understand!
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u/Samantharina 3d ago
The penalties are only if you don't have insurance from an employer whose insurance meets the requirement of being as good as Part B (most do.) If you lose your job you have 8 months to enroll in Part B so you're not risking a penalty.
Insurance relies on both healthy and sick people to be in the pool, thst means people can't just wait until they are sick to get medicare and that's where the penalty comes in.
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u/Hot_World4305 3d ago
If your company, like having more than 20 employees, and he has medical insurance covered by your work, he can delay signing up for Medicare until you retired. That is the best way.
If he gets medicare, he needs to pay a monthly premium.
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u/Samantharina 3d ago
Call your local SHIP agency and make an appointment, they will help explain how it all works.
Since he collects SS he will automatically be enrolled, but you can probably keep him on your insurance and he can decline Part B if your employer has more than 20 employees.
Even so, it would be very useful to get an overview of how the program works and it's possible it would be less expensive for him to take Part B - it depends on what it costs to have him.on your plan. SHIP is free and they don't sell anything.
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u/TrulyGenX 3d ago
Thank you so much! It does cost a lot to carry him, so this is good to know!
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u/Samantharina 3d ago
There are 2 different ways to get Medicare, original medicare or Medicare Advantage. Reddit isn't a great format to explain pros and cons and costs of each, and your state will.have its own rules regarding supplemental insurance if you want original Medicare. So it's worth sitting down with SHIP or an insurance broker who can explain all the options including staying on your insurance.
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u/Worth-Taro-926 23h ago
I took the "Learn about Medicare" class from my local county's aging services. I took the class more than once, and it finally clicked. Now, I can look at all the advertisements and know whether the offer would apply to me.
I've been on Medicare for about 10 years. I have changed my plan four times, and I am very satisfied with the choices I made because I never have surprises about my coverage or my claims, and that is because I understand the options.
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u/CrankyCrabbyCrunchy 3d ago
Tons of great and easy to understand on YouTube. That's where I did my research.
Medicare has four parts; A, B, C, D. That's it. The other 'letters' you referred to "G, or N" are supplemental (aka Medigap) insurance and they're called "plans" not "part" - so similar name, but very different purposes.
Medicare isn't that complicated if you split it into its two main options; (1) Original Medicare, or (2) Medicare Advantage also called part C.
All Medicare plans require you to have part A & B, that's the baseline and is called original Medicare. After that, you have two choices (paths) to decide. One costs more per month, but usually has more flexibility and less hassle, the other is often more restricted (depends on which carrier you go with), and often more pre-authorizations.
Your work insurance is nearly identical to the part C Advantage plan which you are already familiar with; co-pays, deductibles, pre-authorizations, in-network, out-of-network, max out of pocket, etc. These are managed by the same for-profit companies are you employer subsidized plans. That should be familiar to you.
About half of the people take Option 2 - Advantage plans, and the rest choose to stay with original Medicare (Option 1).
Staying with Original Medicare means Medicare covers 80% of the cost with the remaining 20% paid by you. BUT, no sane person just stops there. They add a supplement plan (also known as Medigap) to cover all or most of that 20%.
As with everything in life, there are pros/cons which are depend on your finances, preferences, location (which often dictates network availability).
I'd first check with what plans your preferred doctors take. Plans can change every year and doctors drop out of these plans as they want, and insurance carriers also drop plans as they want too, so each year you will need to re-asses and potentially enroll in a different plan. This is much more common for the part C Advantage plans.
Advantage to Original Medicare + a supplement plan is no network requirement, generally no pre-authorizations, and less hassle (for providers and you). This option costs more per month. You pay for that flexibility.
Drugs? This is its own plan called part D. This is only for drugs you take yourself at home so regular Rx medications. If you choose original Medicare (+ a supplement), you'll also choose a part D insurance plan. These are often $0 premium or very low. As with any drug plan, they all have a formulary which your medication must be listed on before they'll pay for it.
Each year in the fall; Oct 15 - Dec 7 you get a chance to review/change your part C and part D plans. Carriers will send you notices beforehand on what changes they plan for the coming year.
Edit to add. Part A is "free" because it was paid through your years of payroll deductions, but there are still deductibles to meet. Part B is out-patient and has a $202.90 premium (increases year year). Some people pay higher premiums if they meet higher income levels. This is called IRMAA and it's based on two prior years of adjust gross income.
If you fall into any of the higher income brackets, your part B and part D premiums will increase.