Sunday, June 16, 2013

I Apply for Medicare, Part I

     My ex-wife is a year older than I am. Last year she turned 65 and applied for Medicare. I remember at one point asking her about the whole process of signing up for Medicare. How do you apply? Is it complicated? How do you know what coverage you're getting?

     She told me not to worry. A few months before you turn 65 you start receiving all kinds of information in the mail. She'd looked over the basics. "Then I was able to sit down with an insurance agent who specializes in Medicare," she told me, "and he explained the whole system to me. He said he gets paid by the insurance companies, so it didn't cost me a thing."

     So I didn't worry. And now this year, in advance of my own 65th birthday, I expected to start receiving lots of literature in the mail, inviting me to join Medicare, showing me how to do it, and explaining all the benefits. I didn't know who it would come from. The government? My insurance company? It wouldn't be from my employer. I no longer have an employer. My company started shedding employees in the 1990s, and got around to shedding me in 2002, so I've been on my own for the last decade.

     The calendar turned over, and the months came and went, but I heard not a word from anybody. Maybe my ex-wife was wrong, I thought. Maybe she got information in the mail, because of where she lives, or because of her insurance company, or because she's a woman. But that doesn't necessarily mean everyone gets information in the mail.

     I started worrying. Maybe, somehow, I've dropped off the the Medicare "membership" list. Maybe my name got lost in the computer. Maybe they forgot about me!?!

     So I finally decided I'd better find out. I realize that for many of you this is "old hat." You've been through all this already. But anyway, like the modern tech-savvy person I am, I typed "How to apply for Medicare" into google. I found lots of general information. There's Part A which is free, and it "helps pay" for inpatient care in a hospital. There's Part B which you pay for, and that "helps pay" for doctor services.

     Well, that's pretty good, I thought, but also pretty vague. I found a link for Medicare Premiums and found out my premium for Part B would be $104.90 a month, as long as my MAGI is $85,000 or less. I know what MAGI means (Modified Adjusted Gross Income), although I'm not sure how to calculate it. But I'm pretty sure my MAGI is less than $85,000 so I'm not going to worry about it.

     This is getting awfully complicated, I realized. And since I really couldn't find out any specifics, I decided to call the Medicare 800 number, which is 1-800-772-1213. I understood what Parts A and B are, at least in theory. They pay for the majority of your doctor and hospital bills. But I wanted to know some of the particulars. Would they pay for my next colonoscopy? What if I needed surgery on my bad knee? Would it make a difference if I went to the hospital, or had it done in the doctor's office? Could I go to a specialist if the specialist wasn't in my medical group?

     Plus, what about Parts C and D? What's the difference between the various Medicare Advantage programs, and the Medigap program?

     I negotiated the Medicare phone tree. I finally got to the option to talk with a real person. Then an automated voice announced the wait would be 10 minutes. Arghh! I must admit, I was too impatient. I didn't want to wait and so I hung up.

     I called my own current medical insurance company. Maybe they could help.

     I negotiated the phone tree and eventually got a very nice lady on the phone. She spoke with a fairly heavy accent, but I understood most of what she was saying. Yes, my insurance company could provide me with a backup plan. There's a PPO plan and an HMO plan. Actually, there are four different PPO plans, and a couple of HMO plans. "What''s your i.d. number?" she began.

     The woman stayed on the phone with me for a good 15 or 20 minutes, trying to explain the basics of the different plans. But I had plenty of questions. How do I find out if my doctor is in the HMO network? She gave me a link on the website. How much would it cost? It depends what plan I picked, and what county I live in. Does the plan cover drugs? One of the plans does; another doesn't. She wasn't sure about the others. Are there any dental benefits? Again, it depends on the plan.

     What if I moved? Like many retirees and pre-retirees, B and I are thinking of moving in a few years, probably to a different state. She told me that their plan was only good in my state. If I moved I'd have to switch plans.

     I confess, I got tired of the conversation before the woman did. She must be used to people asking dumb questions. She finally offered to send me some published materials that would provide me with all the details. It would take about ten days or two weeks to get to me.

     The woman did tell me one concrete and crucial thing. Regardless of what else I did, I should apply for Medicare Plans A and B. And I should do it right away, because if I waited and missed the deadlines, then there are restrictions about when you can apply, and I may be subject to higher rates ... for the rest of my life.

     You can apply by telephone (at the above 800 number), or in person. But I went back on the website where you apply for Medicare. I found the application. I filled it out. It was pretty easy.

     And so as of right now, I await confirmation that I'm accepted into Medicare. And I await some materials in the mail which will presumably inform me what else I need to do to get more than the basic Medicare Parts A and B coverage.

     I'd worried that I'd somehow fallen out of the system, or that it might be hard to sign up for Medicare. Bottom line:  Don't worry, it's easy to sign up. But it is hard to find out exactly what you're signing up for, and to figure out what kind of backup medical insurance you should get.

     More on that in Part II, after I've had a chance to look over those materials.


Olga said...

Hmm, I got a card in the mail telling me I was eligible and enrolled...let us know by returning this card if you don't want part B. My regular insurance notified me that I would no longer be eligible for my health plan, but i could sign up for a Part D plan through them that cost the same as i had been paying. It was all easy enough seeming. i will find out for sure if i get sick.

mxtodis123 said...

I turned 66 in March and plan to retire on July 12th. Fifty years of work is long enough for me. I was signed up for part B because I am still working and will have my insurance until the end of July. I still don't understand the whole thing. I know I will need plan to help offset fees, but I am totally lost.

Dr. Kathy McCoy said...

This is a terrific post -- and a very useful one for someone new to the Medicare system. I've been on Medicare for three years now and love it! I have the plain vanilla Medicare that is $104 a month -- deducted from Social Security. For the Medicare supplement, I have Mutual of Omaha's Plan F, which is pretty comprehensive and pays whatever Medicare doesn't. (It is $304 a month for coverage for both my husband and myself.) Bob and I also have part D program from AARP that is $32 a month. Some of the Medicare Advantage programs offer a great deal. If we were still in California, we would have signed up for one of those with Kaiser Permanente which we had when we were working and liked very much. Full Medicare coverage isn't exactly cheap, but it's a lot less expensive than it would be to self-insure at this age -- assuming one could. We're very grateful to have it!

avenueroo said...

It might be daunting to to navigate all the plans and their addendum’s but it is worth while, just take your time. For several years I had an insurance supplement to medicare A and B and paid for more coverage than I needed so I changed to a less comprehensive and less costly policy. Considering your age and health is important when figuring heath coverage, however look at what you pay out of pocket to health providers and for drugs verses the premiums charged. As I get older and probably less healthy I will most likely increase my coverage but for now I'm not wasting the money that will be needed later to pay for more coverage.

Juhli said...

I am hoping the federal employee pre-retirement seminar we are attending in August will help me navigate this. I'm 64 in Sept. so have to start researching it with the added question of what to do since I will still be covered under my husband's federal employee health insurance as he is 3 years younger and still working. I understand from my brother who has already been through this while his wife was still working and providing health insurance that the medicare website has lots of helpful information if you are patient enough to wade through it. said...

I've had Medicare for six years now, and still don't understand it. I also pay a premium for BC/BS, which covers what Medicare does not, prescription drugs, for example. I just hope my premium does not increase much owing to the new Health Care law. As it is I lay out over $300 per month for the same care I had before I retired. And this does not include the other $300 I lay out for two long-tern care policies.

Re your commnent on my blog. Not everyone in Washington is scoundrel. Medicare is very well run mostly by the private sector.

Linda Myers said...

I turn 65 in September and I'm getting all kinds of mail, including a very large packet from the HMO that has insured me for 20 years. Looks easy enough.

Fortunately. I worried just like you how I would get it all set up.

#1Nana said...

The spouse turned 65 earlier this month. He's been getting mail for months, but did nothing until his birthday. He will continue to work until his Medicare kicks in since we found out only on his birthday that he would no longer be covered on my policy. It is very confusing.

stephen Hayes said...

I just turned 60 so I have a way to go yet, but I appreciate the heads up on this and plan on being prepared when the time comes. Thanks.

DJan said...

I am 70 and tried several different supplements and plans. We moved from one state to another, and the plan that was great in Colorado was awful in Washington state. So it is confusing, but I am now at a medical clinic and pay about $150/month (which includes the Part B coverage) for pretty good, not free, medical insurance. I like my doctor except he looks like he's sixteen. :-)

Douglas said...

I was covered by my company when I retired and that continued until I turned 65. I only worried if Faye would continue to be covered after I reached Medicare age. Turns out she is so all is well. I avoid doctors so I am unsure if my coverage is better or worse. I now have a deductible to meet which I didn't have before but, otherwise, the transition was painless. I joined AARP (which I have decided now was a mistake) and am inundated with with Part B offers every year. I also was overwhelmed with numerous insurance offers even before that... nice to know my old company reimburses me for most of my Part B payment.
Welcome to Senior Citizen status.

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