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Question for the R&E Braintrust (off topic)

Posted by CE0802 on July 5, 2025, 7:46 am

My wife and I are both 64.

We're both collecting our Social Security.

We file our taxes jointly.

Next year we'll start on Medicare.

We exceed none of the income limits for basic Medicare coverage.

If we have Medicare coverage, with Dental, Vision, and Prescription Drug coverage, about how much can we expect to pay as a monthly premium?

I've tried to research this on-line, and it's mostly all Greek to me.

I believe it's income based and state oriented

Posted by Trish on July 5, 2025, 7:41 pm, in reply to "Question for the R&E Braintrust (off topic)"

in NY the standard is $185

I think (I have to preface everything with "I think") the $185 is the same everywhere.

Posted by CE0802 on July 6, 2025, 4:14 am, in reply to "I believe it's income based and state oriented"

It's the Advantage Plans that differ depending on where you live.

We live in the MCV/VCU (Medical College of Virginia/Virginia Commonwealth University) area, so we've had a ton of different options for Doctors and Specialists and Hospitals and Clinics.

Hopefully we'll also have a ton of options when it comes to Advantage Plans.

I'm sure this will all gradually come into better focus.

It's confusing at first (I was like, say what? at first), but it will eventually 'click' with you.

Posted by Dancing Digits on July 6, 2025, 7:56 am, in reply to "I think (I have to preface everything with "I think") the $185 is the same everywhere."

I've traded a few emails with my previous employer's HR Department.

Posted by CE0802 on July 7, 2025, 8:28 am, in reply to "It's confusing at first (I was like, say what? at first), but it will eventually 'click' with you. "

My previous employer will provide Medigap Plan G and pay part of the premium, and also Dental at around $50 a month for both of us.

So with what we'll pay for Part B and for Part D, we should be around $660 a month, or exactly what we're paying now.

And with Medigap, we'll have no co-pays, which are now usually 50 bucks a pop.

We would just have to add Vision, if we wanted it.

Sounds like it is working out for you. Good!

Posted by Dancing Digits on July 7, 2025, 8:32 am, in reply to "I've traded a few emails with my previous employer's HR Department."

My husband and I are both on Medicare.

Posted by Dancing Digits on July 5, 2025, 3:44 pm, in reply to "Question for the R&E Braintrust (off topic)"

It's not the greatest.

First, you have a window of opportunity for enrollment - 3 months before the month you turn 65, and 3 months after the month you turn 65. Once you select a plan and enroll, stay on top of it. Don't assume the paper work will be processed in a timely fashion. My husband and I enrolled at the exact same time (months ahead of our individual deadlines) - his application was processed, mine wasn't. I had to chase them and my application still wasn't processed until one day before my deadline.

If you have enough work credits (which I imagine you do), Part A/Hospital has no premium charge.

Part B coverage is for medical/doctors. You have to pay for Part B. My husband and I are each charged $179.00 per month. Premium rate is based on income (which you made mention of in your post). It doesn't pay for medications, dental, vision. Also, be aware that each year, premiums have risen. When we first signed up for Medicare, our premium was $140.00 each month. Yes, once you collect Social Security, you will get COLA/cost of living adjustment each year. That is typically swallowed up by the rise in the Medicare premium. If there is anything left of your COLA after Medicare gets its hands on it, it generally will only buy you a cup of coffee and a buttered bagel.

You can choose either Original Medicare or Medicare Advantage. (I don't know if there are any other options other than these two routes).

Original Medicare only pays a percentage of the total charge (and that charge is what is considered a 'reasonable charge' if I understand correctly) - I think something like 80% (but don't quote me on this). Many people select to supplement Medicare with a medigap insurance policy, such as United Health Care. If you want drug coverage, you need to also sign up for Part D. If you don't want to sign up for Part D, you can select to sign up for it at a future date but be forewarned - if you don't sign up for it when you first sign up for Medicare, you will be charged a fine. That fine/charge will remain with you until you are no longer on Medicare - that is, until you die. The fine, to the best of my knowledge, is based on the length of time you went without drug coverage - the longer the time frame, the higher the fine.

Original Medicare with a Medigap insurance plus Part D is the more expensive way to go. My mother had it. It offered the best coverage, but believe me she paid for it.

The other plan you can select is Medicare Advantage Plan. (I think its called Part C.) It is essentially Medicare that is 'enhanced' by an outside insurance carrier plan. Its somewhat better coverage. We currently have this plan as we couldn't afford Original Medicare with Medigap and Drug Coverage, though we wanted it. If you opt for an Advantage plan, you may not add a medigap policy to it. The Advantage plan you select will determine what your drug coverage will be - it is, to the best of my knowledge, included.

Some Advantage plans do not charge an additional premium (the rock bottom plan quite often), but then the coverage is rather limited. The next step up from the bottom, so to speak, is the Advantage plan my husband and I selected. It comes with better medical/doctor coverage, drug coverage, and some meager coverage for dental and vision (and I do mean meager). Not all plans offer the same coverage, so you have to do comparison shopping.

Advantage plans are not without problems. Generally speaking, they do not pay for any medical problems you may encounter while traveling out of your 'area'. They only cover emergency services (and sometimes they limit that). The Advantage HMO plans will only pay for in-network providers. They will pay nothing for out of network, so you are on your own with that. We selected a PPO plan, which pays in-network providers and a rather reduced amount for out of net-work. I could be wrong, but I think the PPO requires a referral to see a specialist. I always ask for a referral to shut the insurance company up before it even thinks of opening its mouth. Again, all of the is dependent on the plans offered by the insurance carrier you go with.

We each pay $70.00 per month for the Advantage coverage. So, between the both of us, our Medicare Advantage plan is costing us $498.00. Since this isn't enough coverage, my husband (who still works full time), has taken out additional coverage with his company for dental, but we still end up paying a hefty bill if we need work beyond the typical routine care.

I always use in-network providers and generic drugs whenever possible. My husband avoids doctors at all costs. Drugs are assigned 'tiers'. The higher the tier the drug has been assigned to, the less the plan will pay for it. So make sure you know what tier your scripts (if you take any) are assigned to and how much you will be responsible for paying before you sign up for a plan.

Not all plans are the same - coverage varies according to the plan you select, the area you live in, your income, and the insurance carrier you sign up with (for either the Advantage Plan or the Medigap insurance).

It's complicated, and to add on top of it, plans change. Insurance companies are notorious for changing coverage. Our original plan was discontinued. My husband and I had to not only find a new plan but a plan that had in-network providers in our area. It takes me 1 1/2 month to see my primary, specialists can take anyway from 3-12 months.

Finding in-network providers has become a problem around here. Medicare pays around 30-50% less than what private insurance policies pay. More and more providers are dropping out of network. Providers that are still in the network quite often no longer take new patients as their practice is over-flowing with patients. The problem continues to get worse around here.

Each year there is an open enrollment period, when you can switch plans. There are also rules that apply to switching plans, so make sure you are familiar with them too.

When we originally signed up, we did all the work ourselves. When our Advantage insurance carrier discontinued our plan, we used an insurance agent to help us navigate the new waters and find a plan. So far, our plan 'will do'. It could be better. I've already been denied coverage for a drug I need. I appealed it, but as I suspected, it was a wasted endeavor. I can't afford the drug, so I go without. Also, be aware that I have heard claim of Advantage plans being sued for refusing coverage on claims that they should have. I think United Health Care has also been hit with law suits, but I don't know the details as we are not insured through them. Such is the state of healthcare today - access to care is crappy if you are someone of limited financial means.

I am not an insurance agent, nor am I an expert on this. What I wrote is based on my personal experience and understanding. Policies and coverage can change yearly, so my advice is to be on your toes with this and start planning well in advance.

Good luck!!

Fantastic outline

Posted by Sr. DanO on July 6, 2025, 7:01 am, in reply to "My husband and I are both on Medicare."

Thank you.

Thank you . . . and you're welcome.

Posted by Dancing Digits on July 6, 2025, 7:57 am, in reply to "Fantastic outline"

I spent hours and hours on the phone

Posted by Trish on July 5, 2025, 7:53 pm, in reply to "My husband and I are both on Medicare."

ironing out what I needed to do. At one point, I was told I qualified for a program, only to get another application, not once, but twice. I called to make sure everything was okay, but damn.

So I have IHA as the hub, so to speak. They help with med admin. All approvals and bills must pass through Medicare before Medicaid.

Make sure your provider has all the right billing information. One tried to charge me $280 when I owed nothing (and there were other similar instances)

I feel bad for those who are elderly and have no advocate to help them with red tape.

I may have to actually BUY "Medicare fo Dummies". The copy I have...

Posted by CE0802 on July 6, 2025, 4:22 am, in reply to "I spent hours and hours on the phone"

...is the new edition for 2025 from the Library. I'm the first one to have signed it out.

One thing it talks about is the frustration of calling these government programs and getting different answers to the same question.

I admit not knowing the qualification of the Author of the book. But it seems like a pretty thorough reference guide that I may need on the shelf going forward.

Updated info is essential. There are website you can visit too. Here is one:

Posted by Dancing Digits on July 6, 2025, 8:02 am, in reply to "I may have to actually BUY "Medicare fo Dummies". The copy I have..."

https://www.medicare.gov/basics/costs/medicare-costs

Those For Dummies books can be really good (at least, some of them). I have a few myself on different topics.

It's completely insane and it shouldn't be.

Posted by Dancing Digits on July 5, 2025, 8:11 pm, in reply to "I spent hours and hours on the phone"

I've called Medicare more than once with the same question, getting different answers depending on how knowledgeable the rep was. The same thing happened with my insurance carrier - same with SS.

I like to, whenever possible, do my own research and wade through the websites, books, forms, whatever I need to get the information I need. Sometimes it is the impossible. But I try.

THAT was awesome! Thank you!

Posted by CE0802 on July 5, 2025, 7:01 pm, in reply to "My husband and I are both on Medicare."

I've been reading "Medicare for Dummies".

So what you wrote makes more sense to me now than it would have yesterday.

My next door neighbor gave me the number of an Insurer that they used. Supposedly he'll be able to give us some good direction.

My wife and I already get our Social Security, so when we turn 65 (her, next May; me, next June) we'll be automatically enrolled, I guess in Parts A & B.

I assume we'll go with a Part C Advantage Plan of some kind.

Right now we pay $660 a month for everything, including vision and dental.

I'm hoping we can get pretty much the same coverage for that much or less.

Thanks again. That was great. Very helpful.

Glad to be of help.

Posted by Dancing Digits on July 5, 2025, 7:57 pm, in reply to "THAT was awesome! Thank you!"

My husband and I are the same age. We signed up for Medicare first. It was a while before we started to collect SS (we waited until FRA), so I can't tell you if you are automatically signed up for Medicare if you are already collecting SS. I urge you to check everything out carefully - mistakes can be costly and difficult to fix.

I can tell you that once we started getting our SS checks, the Medicare Part B premium of $140.00 (back then) which is now $185.00 (again apologies for giving you last year's premium) was automatically deducted out of our SS checks before ever seeing a dime of it.

We pay the remaining premium of $70.00 directly to our insurance carrier. I have no idea why the premium is split like that, as Mugwumps is right - Advantage plans are through private insurance carriers. The correct amount we pay, together, monthly is $510.00. (I hate automatic payments as ours is set up - its too easy to lose track). There are more expensive Advantage Plans than the one we selected, and they have better coverage on certain things. It all depends on what you health is and what your needs are.

Mugwumps is also correct as far as being careful with Advantage Plans - they sound initially great, but one must keep in mind what they pay for if, in the future, you end up with long-term care needs or serious health problems.

We also have Aflac. It's not an insurance plan per say and is more like a savings account that pays a certain amount for certain things, depending on what you sign up for.

I urge you to talk to a professional as I am not one. Everyone deserves healthcare and deserves to understand in full what they are paying for before they sign up for it.

Very glad to help. Thanks for the compliment.

I hadn't thought about AFLAC. I know nothing about it, really.

Posted by CE0802 on July 6, 2025, 4:18 am, in reply to "Glad to be of help."

Thankfully, my wife and I are both in pretty good shape "for people our age".

A friend of ours scared us when we first brought this up. His wife has had some condition - Muscular Distrophy, I think - so they've had to add some additional Plans that cost WAY more than any of the more common plans.

If we could get our same level of coverage for $600 a month, I'd be ecstatic.

We have hospital-stay coverage and cancer coverage with Aflac for

Posted by Dancing Digits on July 6, 2025, 8:10 am, in reply to "I hadn't thought about AFLAC. I know nothing about it, really."

$227 (and some odd cents) per month. It doesn't pay a huge amount, but every little bit helps.

We are in OK health for our age (69). But of course, the more you age, the greater the chance is that something is going to develop.

I told my family I don't want to be a burden to anyone and I don't want to be in a nursing home. (I've toured some of them as part of my education program. They are so sad.)

Just shoot me!! LOL!

In some cases you may also qualify for Medicaid

Posted by Trish on July 5, 2025, 7:47 pm, in reply to "THAT was awesome! Thank you!"

if so, they help with out of pocket

The income limits for Medicaid seem really low, so thankfully...

Posted by CE0802 on July 6, 2025, 4:10 am, in reply to "In some cases you may also qualify for Medicaid"

...I don't think we qualify. lol

Thanks! I'm glad I'm about a year ahead of all of this.

They are very low.

Posted by Dancing Digits on July 6, 2025, 8:22 am, in reply to "The income limits for Medicaid seem really low, so thankfully..."

I have no idea who came up with those limits but in today's world they are close to delusional. Our government is totally out of touch with living in the real world for the Middle Class.

If you file your taxes jointly with your wife, the limit is $212,000.00 annually to qualify for the $185.00 Part B premium. Anything over that and the premium rises. Income of $212,000.01 to $266,000.00 equates to a premium of $259.00 (individually). I don't know what the Part D limits are as we are Part C people. This is in accordance with the website I posted elsewhere:

https://www.medicare.gov/basics/costs/medicare-costs

Is my terminology wrong?

Posted by Mugwump on July 5, 2025, 4:10 pm, in reply to "My husband and I are both on Medicare."

I thought "Advantage" referred to medicare plans run by Private insurance Companies.
BTW, after the Proselytizing thread, I don't give a rat's ass
what them peanut gallery thinks. The answer is Monaco.

Nope, you are correct.

Posted by Dancing Digits on July 5, 2025, 4:47 pm, in reply to "Is my terminology wrong?"

It is very possible I was not clear in my post.

Medicare is a federal program run by the government. The government is the plan's administrator, but not the insurance carrier. The Feds negotiate with private insurance carriers for the terms of coverage offered which is then offered by Medicare. Private insurance carriers offer additional plans of their own that provides for added coverage. It can get confusing and its all very expensive. I am not sure I am explaining it well. There are still co-pays for some plans and for many plans, out of pocket costs. To add on top of that, many things are simply not covered. And coverage keeps changing.

Advantage Plans (gotta love that name . . . geeez!) can be thought of as a Medicare plan that has additional coverage which is provided by a private insurance carrier. Advantage plans are not suppose to refuse to cover what Medicare does. We use CDPHP - the best pick out of a bad lot.

When I present my insurance card, I present my CDPHP issued card provided by the private insurer. If I present my red, white and blue Medicare card, I will only get the insurance coverage offered by Medicare without the additional coverage CDPHP offers.

And then I have a dental insurance card (Delta), vision cards, I use to have a separate drug card but that is now part of my CDPHP card . . . . its all very ridiculous.

I navigated all of this crap with my Mom during her declining years - my parents lived with us (Mom died at home in her own bed). My Dad, even in his declining years, was pretty savvy even close to the end of his life. I was pretty much spared fighting with the insurance companies on his behalf (he loved a good fight!).

As to the proselytizing thread. . . I use to try to approach every one with civility, even if I felt they didn't deserve it. I wanted to be able to look at myself in the mirror, and not be disappointed in the person that looked back. Some felt I was being too tolerant and tolerating disrespect.

After reading that proselytizing thread, I've had second thoughts. There is a certain value to fighting fire with fire. If the attitude taken here (by some) continues along the path it does, I don't see why I should have to be the 'adult' and civil while some others can say anything they want and treat other posters as they want without thought or consideration to the fact that that is a feeling human being they are insulting and not just words on a page they are responding to.

I don't see why I must be held to a standard that some others here feel they are free of. IOW. . . .

Screw it!

Beware of "Advantage" plans

Posted by Mugwump on July 5, 2025, 2:04 pm, in reply to "Question for the R&E Braintrust (off topic)"

They often offer benefits that are very tempting, but if you run into a serious situation involving, say, home care, and need an extension of hours per day or toatl weeks, the decision on the appeal is made by an insurance company concerned with its bottom line.
This information comes from an independent patient advocate who deals daily with complex situations and knows the systems thoroughly.
One should also note the lawsuits that developed when the Adams administration in NYC decided it wanted to switch all its retirees from traditional Medicare to an "Advantage plan."

$231/month-for-medicare-b-@-at-65y/o

Posted by scott on July 5, 2025, 10:49 am, in reply to "Question for the R&E Braintrust (off topic)"

I’m paying $400.00 per month.

Posted by GOG on July 6, 2025, 9:54 am, in reply to "$231/month-for-medicare-b-@-at-65y/o"

Subsidizing the invaders.

You're right its $185.00 typically.

Posted by Dancing Digits on July 5, 2025, 6:20 pm, in reply to "$231/month-for-medicare-b-@-at-65y/o"

I gave you last year's premium. Sorry - brain got a bit lost in numbers. This site spells it out pretty clearly:

https://www.medicare.gov/basics/costs/medicare-costs

Belong's under CE0802's post

Posted by Dancing Digits on July 5, 2025, 6:21 pm, in reply to "You're right its $185.00 typically."

I thought it was only $185 a month, unless you were wealthy.

Posted by CE0802 on July 5, 2025, 12:17 pm, in reply to "$231/month-for-medicare-b-@-at-65y/o"

Just picked up "Medicare for Dummies" at the Library.

Should be exciting reading while watching the Mets game. lol

Sorry, I'm in Canada

Posted by Moishe on July 5, 2025, 9:27 am, in reply to "Question for the R&E Braintrust (off topic)"

We don't need to learn "Greek".

I remember golfing in Arizona with a couple of guys near retirement from Minnesota. Post-round discussion turned to the same topic, health care insurance.

All I could do was listen in amazement, realizing that they were talking about an annual cost equivalent to FIVE years of my golf membership in Canada.

I feel sorry for what the average US citizens are now faced with in arranging health care. And it will get worse when Trumps' BB bill takes full effect.

What burns me. . .

Posted by Dancing Digits on July 5, 2025, 3:54 pm, in reply to "Sorry, I'm in Canada"

The US calls itself the leader of the free world and the defender of human rights. And yet, we are unable to provide basic medical care for our citizens the way other western world countries can.

Healthcare is NOT a human right here - it is a profit seeking business. It really is based on money. That leaves healthcare providers and patients the close to impossible task of navigating muddy waters.

I can tell you about case after case of citizens who have worked and supported the 'system' all of their lives through paying taxes. Those same people are ones who are denied care that they need . . and why? . . . because they can't afford it. So, like many, they go without.

Defender of human rights? What a joke.

Well, I have to say that...

Posted by CE0802 on July 5, 2025, 10:05 am, in reply to "Sorry, I'm in Canada"

...just one of the things I've disagreed with my President on is the way he's treated Canada.

Totally unnecessary.

[don't tell any Libs that a MAGA disagrees with the President on something - it'll ruin their delusional idea of what a MAGA is. lol]

Re: Question for the R&E Braintrust (off topic)

Posted by Deanna on July 5, 2025, 8:08 am, in reply to "Question for the R&E Braintrust (off topic)"

IF, you have United Health Care's Medicare Advantage....that is what you want....! And I believe it is after you have spent over $4000 in medical expenses you pay no more...I believe that incudes your medicines too.... I know, there must be others that are on top of it more than I.....as we have just joined Medicare Advantage after paying $300 for me and $400/ month for my husband for medical/hospital insurance and it was going up every year...and we had to pay the cost of our medicines...prior!

That is just a sketch for you above...as, that is off the top of my head....

But, check Medicare Advantage by United Health Care...I think it is....

Thanks! Should it be this confusing? lol

Posted by CE0802 on July 5, 2025, 8:23 am, in reply to "Re: Question for the R&E Braintrust (off topic)"

I see:

- Part A, which costs nothing
- Part B, which costs $185 a month (for each of us, I assume)
- Part C, which adds Dental and Vision and Prescriptions, I think. That's the one that varies depending on provider?

So if you add Part C, the cost is in addition to the Part B cost?

I'm heading to the Library to check out "Medicare for Dummies". lol

LOL No! It Should NOT Be!!!

Posted by Deanna on July 6, 2025, 9:30 am, in reply to "Thanks! Should it be this confusing? lol"

Getting into it this past year and starting this year was something else...and then there are a bunch of nasty people that surreptiously represent themselves as being with United Health afteer you are into it...so, you have to figure that one out too.....

But, so far, I've been able to manage figuring it all out.... PHEW!!

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