Health insurance
Thinking of retiring.. will need to get a good insurance company that does not cost a fortune!
Any suggestions?
Thanks!
Jrn My friends have used this, not sure if it will suit your needs.
https://www.medishare.com/
bflat4u If you're not going on Medicare call the ACA and talk to an agent and explain your situation , what you can afford , etc ..
https://www.healthcare.gov/glossary/affordable-care-act/
97XBAM Contact David Becker at Mid Atlantic Business Alliance.
https://www.midatlanticba.com/
Calico696 I do have Medicare part 1… need the coverage for drs, etc.. this is so overwhelming!!
Thanks for the help!!
Jm, just be aware that you must have Medicare Part B before you can get any supplemental plan. I don't think you can get Heathcare.gov coverage if you have Medicare. Part B is now $171 deducted from your SS check every month. Supplementals go from free (Aetna and others) or up to a couple of hundred a month for ones that cover more if hospitalized for a long time, for lower copays or lower yearly deductible limits. Log in to Medicare.gov to see your options before you let an insurance salesman sell you something he gets a commission on.
MK Contact a reputable Medicare consultant. I spent a lot of time on the phone and she helped me wade thru all the options and got me signed up. And she didn’t charge anything
She knew every detail about Part A, part B, C and D. She also sent me comparison tables.
Local Gal I have traditional Medicare and supplemental plan G though United Healthcare . I went for a few years with no supplemental (called Medigap) plan then I incurred hospital costs from treatment for a diabetic foot infection and was very quickly a few thousand dollars in debt .
Medigap plans are listed on page 76 of the 2024 Medicare & You book . Medicare alone worked fine for awhile , but hospital costs quickly mount since that 20% not covered is usually a huge amount . It always gets me how the hospital sends a letter asking for donations after sticking you with a bill for thousands .
BAM… if you had Medicare part A you should have not incurred any bills from the hospital…??
This company https://boomerbenefits.com/about-us/ is very helpful with the healthcare insurance decision making process. They can sign you up for the best products for your needs. Assuming that you are ready to sign up for Part B, they can assist you with that and also can direct you about a gap plan and a drug plan. They provide a free service should you have an issue with any insurance claims that have been processed incorrectly. That service isn’t offered through local brokers. Best of luck.
Darleen I used a medical broker (DAVE SPIELMAN phone and text at: (203) 848-4479) because I was clueless! His name is Dave Spielman and he has been working in the space for abt 15 years; he is licensed in abt 40 states, including NJ. I just asked if it was okay for me to post. His services are FREE to clients. He is paid directly by the insurance companies, and the amount he is paid is generally the same no matter which insurance company he may recommend - so you truly get unbiased advice.
IF YOU HAVE ANY QUESTIONS about your coverage or want to talk in general about Medicare, his services are free to the client.
This is my second year with him - I will continue to contact him during the health care opening every year (Sept. thru Dec. 7) to be sure that I am getting the best coverage for ME, as everyone is different. This year, he went over my list of prescriptions and I changed just the RX plan.
I highly recommend him - he helped me A LOT because I did not know anything when we started! Give him a call - and he will be able to help you!
subaru BAM… if you had Medicare part A you should have not incurred any bills from the hospital…??
I had a 4 day hospital stay , six weeks of antibiotic infusion (41 days straight visiting the hospital infusion center) , an MRI , multiple tests , a home visiting nurse every 3 days to pack the wound , and finally an operation to remove a small bone in the foot so it could heal and ended up owing around 3K or so that traditional Medicare did not cover .
https://www.kiplinger.com/retirement/medicare/601489/7-things-medicare-doesnt-cover
If on standard medicare, I think it's about an 80/20 split where you pay the 20.
For supplementals, its' been awhile, but ..... the one they advertise most are "advantage plans." These plans were developed relatively recently for diverse needs but mostly to offer less payments, more services, than original medicare. IMO, you get what you pay for, so, might include out-of-network hits, local only -- no special travel coverage, etc...but may offer drugs, gym membership, could be bene's that advantage your lifestyle. You have to look. IMO, bottom line, if you are healthier, don't travel, like the extra bene's, could be for you. BUT --- if it looks like a deal, look deeper because I guarantee you get what you pay for. It may cost less, but there;s a reason. Works for many. If I was healthy and expected to continue, I would buy these probably. But I rack up some healthy doctor bills.
Original Medicare let's you travel, etc, without going off-net if you do IF you choose Plan G. There are other plans, by letter, not sure the differences, but G is the most popular. Then you can add supplemental insurance which is third party, like United Health Care (that also offers Advantage packages), and you can add a Part D (drugs) provider which may or may not be the same as your supplemental provider. Here, you can save some money if you look. Initially I have one company for supplemental, another for drugs, but now just United for both because the first guys jerked the price up for one drug I use.
Those are the big differences: original medicare OR medicare advantage.
try this: https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf
Because I travel and don't need any special bene's, I use original Medicare, plus United Healthcare for supplemental and Part D, drugs. Been there for 3 years and still feel I am making money over what I paid being with AT&T, Lucent, etc. so I am not a good one to judge price.
Hope that helps, certainly call free consultation, take with a grain of salt. Their bookish answers may not fit your individual needs. Paid for guys if you really need it. Otherwise, first decision is Original Medicare/supplemental, OR Medicare Advantage. And then you can start picking third party suppliers, but remember, OMed you have to add Part D drug supplier which is probably (need to check) in every Medicare Advantage plan.
babbit The simplest satisfactory coverage (assuming you are Social Security & Medicare eligible) is:
Medicare A plus Medicare B (about $175/mo) and a third party Medicare C/D plan. Many are offered with no monthly premium as they use the Part B prrmium paid to them by Medicare. I use an Aetna plan and am well satisfied.
EVV My United Healthcare drug plan went from 28 to 54 dollars a month . I switched to Wellcare which is 0 dollars a month . Filled the first generic script today for a cost of 0 dollars - so far so good . Of course Comcast raised the cable bill 17 dollars .
97x
Weird, I have Medicare with UHealthcare for supplemental, plan G, and part D drugs which went from 109 per month to 106 per month. I do not pay much for drugs, unless brand/specialty.
But I came here from Express Scripts which was a similar premium, but took a needed brand drug and doubled it, which I caught by pure luck.
So, same company, different story, weird.
I have Humana drug coverage since I started Medicare but the Cost went up to $58 per month. Although the premium is now going down to approx $12/month, I was thinking of changing to another coverage.
Does anyone use Wellcare Value Script for medicare drug coverage? The coverage is approx $2.50 per month which seems like a good deal, and I compared the two coverages (and my yearly cost for my prescriptios would be a lot less) but I don't want to switch and then find out I made a mistake. Anyone have any experience with Well Care - Pros and cons? Thanks for any help.
NOTE TO 97XBAM - I noticed you have Wellcare since Jan '24 - still satisfied with coverage so far??
Thanks for any help!
margaret Margaret
I have WellCare ValueScript and it’s very inexpensive at about $2.30 a month. (Last year it was literally $0 a month)
It’s a good plan if you’re on Tier 1 or 2 meds.
I have had Wellcare for prescription coverage for several years. My monthly premium has been extremely low. But I don't have a lot of medications. One regular and the occasional one if I have a medical issue. I haven't paid more than $15 out-of-pocket for any of them, but again, none of the expensive specialty meds. I use CVS, but I think you can use all the various pharmacies in the area.
Lonesome+Dove margaret
Yes I have to say I've been satisfied with Wellcare so far which is going from 0 a month to 2.30 per month in 2025 on my part D plan .Their website is very good in telling you precisely what the cost of drugs will be at different drug stores . For example one drug I have is 90 dollars for a 90 day supply at 7.5 mg dosage , but for some reason is only 12.50 for a 15 mg dosage - so I had my doctor write a 45 day script at 15 mg and I just cut the pills in half .
Another drug is also 90 dollars for 90 days that I get for half that cost at another pharmacy using an online GoodRx coupon . The downside of Wellcare is a high deductible for brand name drugs with no generic alternative available , but even with that using Wellcare has cut my costs to less than half of what they were before .
Margaret, you need to check out the drugs that the company will cover. I had Wellcare and was very happy with it. When I sat down with an insurance guy he found that it would cost me more for a medication that I am now on, so he changed me to Horizon for the coming year. Last year he changed me to Wellcare from what I had the year before. It all depends on what meds you are on as to which company will be the best for you.
Magpie I not only agree with Magpie but would say that everyone should check the drug formulary on prices. I had one go from $100 per month to like $400 a month for no apparent reason. A quick plan change and I was back to normal.
This year both my drug and medical premiums went down, the medical by 20%. It's AARP United Healthcare with Optum Part D, a medigap plan. Weird, but I like it.
But I was shocked by the formulary change, it was Express Scripts, and all I can figure is some contract deal between them and the pharma house went south or one or the other got pissed and dropped the contract. No one else made this specific drug change. So, pays to check the next year's drug prices on your formulary for changes, strange or logical. You can easily pick another to get the better deal.
Magpie, can you tell me the health advisor you used. I am in need of guidance.
Thanks
Towny Towny, I use Douglas Cartrwright 732-859-9791. This is his cell number. I can't locate his business card right now. If you have medicare plus a medi gap insurance, all you need to give his will be the list of your medications and the dosages. He can also help with the other insurance if needed.
Magpie:
bear in mind you can go medigap or medicare advantage. One difference is that medigap better if you travel, or have some illness. Medicare advantage is often on-net for savings, off-net costs a lot, better for those in relatively good heath and expect that to continue
From the net: "Switching from Medicare Advantage to Original Medicare with a Medigap plan is possible—but you may pay a higher price or be denied coverage. You can switch during the Medicare open enrollment and Medicare Advantage open enrollment periods. Plan switches are also allowed if you qualify for a special enrollment period." Complicated but need to be sure it fits your needs.
"Medigap plans generally have higher premiums than Medicare Advantage plans, but they offer more provider flexibility. Medicare Advantage plans often have lower premiums and include additional benefits like vision, hearing, and dental coverage."
Also may be some geographic constraints for Medigap, if you plan travel.
I would try AARP for consultation before I went private.
Just some general advice.
Stay off Medicare advantage if you possibly can. They’re fraught with problems. They can deny your requests, most of them require you to see dr’s in their network, and if you get seriously ill, you’re in big trouble. This is the briefest explanation I can give.
Personally, I think they’re criminal and should be outlawed.
But, I understand you may need to depending on your financial situation.
If can, opt for a supplemental plan. They look very confusing when you study them, but the important thing to know are:
1. If Medicare covers it, they have to cover it.
2. All plans are standard. That is, all plan D’s must cover the same things. All plan G’s must cover the same things. This makes it much easier to compare costs.
3. There are 3 types of plans. Rates are determined by either age at start of coverage, attained age, or community rates. This is a bit much to explain, so here’s a good link:
https://healthnews.com/medicare/guides/medigap-plans-attained-age-vs-issue-age/
Think not just of your current health, but what you could face in the future.
If you select a Medicare advantage plan when you first enroll, it’s extremely difficult to change to a Medigap plan later. For example, you may be fine for a few years, but then encounter a serious health issue where you need better coverage. It will be hard to change plans and you’ll have to wait until the next open enrollment period. This could greatly impact your care.
Drug coverage isn’t necessarily expensive. Review your medications and see what potential plans cover. I agree with those who are happy with wellcare value plan. Generally it’s very cheap and most of my drugs are free. Premium for 2025 is $2.30/month. Occasionally I run into something that’s pricey (for example, a recent steroid cream), but I use goodRx to get it for less. Most of the pharmacists here are very helpful with this.
Medicare is a great program. It gets ragged quite a bit but it’s actually the best healthcare insurance available. I’m saving over $500/month from my former employer-based plan, with much better coverage.
However, it’s really cruel of the government to make it SO confusing and overwhelming for people to understand and choose. Especially old people, lol.
I used ehealth. They were very good, but I did all my own research and knew what I wanted before I called them. They’re good but still an insurance broker.
Also, if you’re tempted to go through AARP, do your research. I can’t remember about Medicare premiums, but I recently had to purchase dental insurance. Their premiums were $12-15 higher for the exact same plan, than buying directly from the insurer.
Best of luck to you! It’s confusing, but if you make the right choices I think you’ll be very happy with it.
Grayson I agree with Grayson and have said as much, however... Med Advantage may be your best choice IF you like the network AND IF you are relatively healthy and expect to stay that way.
Grayson's point as to IF you get, or are ill, not an advantage, and maybe really bad IF you have to go out of net for quality care. Also not great if you travel and get sick in another state.
Lastly --- Grayson did not note, but be sure you know how to get off Medicare Advantage if you pick that. You may be more STUCK than expected, at minimum having to wait for next enrollment. Same can be true for Supplemental Plan subscribers that decide to switch to advantage.
Pretty simple concept: Medicare Advantage is less expensive; you know they don't make less money, and judging on what they are pushing and how hard they push ---- they are cramming advantage plans down our throats but hardly ever advertise supplemental plans.
FYI: the Plan G which replaced Plan F supplemental plan is the one most people in supplemental plans get. You can look at the others, but not as frequently purchase for sure.
So
step 0: realize that without advantage or supplemental ,you will pay about 20% of everything
step 1: determine whether advantage or supplemental.
step 2: if supplemental, probably plan g, if advantage ---- someone else can help, i am ignorant and find it painful to look :>)
step 3: pick drug plan, does not have to be the same as supplemental provider: check your drugs against the formulary price (list of drugs and prices for coverage) and the plan will probably reveal itself. chances are if will be the same as your supplemental health provider
I use AARP United Health Plan G supplemental with their drug plan which is basically your pharma, I use cvs, or optum for mail order. But the CVS prices are pretty much the same as optum and they don't seem to force you to mail order.
PITA: good luck.
Leave a Reply
To comment on this topic, fill out the form below. If you would like to comment directly to one person, you may click on the envelope next to the posters name if they provided their email.