# Health Insurance



## SensitiveSally (Aug 7, 2017)

Hi everyone. I am new to this. I am 64 and thinking about retirement. I have to figure out how much money I need to survive on and if I can survive without group health insurance. My question is WHAT IS THE BIGGEST OBSTACLE/PROBLEM YOU HAVE FACED in purchasing(or the process of purchasing) health insurance/Medicare???? Thanks in advance.


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## Butterfly (Aug 7, 2017)

Medicare sort of happens by itself when you reach 65.  I have a Medicare Advantage plan that covers pretty much everything Medicare doesn't (after the Medicare deductibles) and I pay no additional premiums for it over the medicare premium (about $109 a month).  I've been extremely happy with  its coverage and service, and the medical care I've received.  I've had no problems at all with it.  Depending on where you live, you should just research what is available to you in your area vis a vis Medicare Advantage and Medicare Supplement plans.  I pay out of pocket a heck of a lot less than I ever did with regular insurance --I had a regular 80/20 plan and couldn't afford to get my hips replaced on that (20% of well north of $150,000 is still a heck of a lot of money).  With Medicare and my advantage plan, I got them both done and had a total out of pocket outlay of around $1,000 for both surgeries together.

I can honestly say I've faced no obstacles at all with my changing to Medicare and my Advantage plan.  Never in a million years would I want to go back to my old insurance.

The only caveat I would have is don't wait past your deadline to signup for Medicare, parts A and B and a drug plan, or you will face monetary penalties that can't be waived.  Do your research on medicare.gov and with insurance carriers for advantage plans and supplements.


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## terry123 (Aug 7, 2017)

What butterfly said!.  I have a medicare advantage plan also and like it as I can have dental also.


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## RustyatMMC (Aug 8, 2017)

*Full disclosure:* I am an insurance broker and am licensed to sell both supplements and advantage plans.  I am not a big fan of advantage plans in my area.  Each year, I have seen them become more expensive and cover less.  I know in some areas of the country, the coverage is different than what it is here in NC.  

I know some here will tell me I don't know what I am talking about and/or how their advantage plan is fantastic!  That's great, however there is a good chance your fantastic plan is not available in the same format as what is available in other parts of the country.  I will use my state as an example later.

If you go with a medicare advantage plan, understand what your out of pocket exposure is if/when you get sick.  A number of times a year, I have people call me wanting to get off of a Medicare advantage plan because they are sick and are starting to get hit with bills.  Most people forget how much you pay when you get sick. 

Here are some items to check when comparing:

- Review how much your premium is?
- Review what your out of pocket is annually?  I have seen one person get sick in November, meet the max out of pocket for that year; then the max out of pocket resets in January, which she hit again early the next year.  
- Do you have to stay in a network?
- Is your doctor in network?
- Does this plan's Part D cover your medicines?
- How are referrals handled?
- Is it an HMO (restricted network) or PPO (you can go outside the network at a higher cost to you)?
 -What does it cost to stay in a hospital each day? (most plans cap it at 6 days, but once you are home for more than 60 days, you have to meet the listed amount again.)  Brochures do not describe the Medicare hospital benefit period in great detail (http://www.aarp.org/health/medicare-insurance/info-08-2010/ask_ms_medicare_question_86__.html)
- Diagnostic costs?  Usually a %
- Make sure you get a plan that has drug coverage unless you have access to VA

Just review what you are responsible for. 

Understand that in most cases, once you are sick; you will *not* be able to simply switch to a Medicare supplement plan for better coverage.  Once you have passed your initial enrollment period (6 months after the day you start Medicare Part B), medicare supplement insurance companies can decline you due to health reasons.  

Medicare advantage plans *replace* coverage that you have with Original Medicare (Part A and Part B).  Medicare supplements fill in the gaps of what you are responsible for with Medicare Part A and Part B.

Here is a link to our NC Dept of Insurance and their SHIIP page.  I would encourage you to look at the plan details to understand what you pay for with Medicare advantage plans here in NC.  It's likely available in your state also, so just google "SHIIP + [insert your state] + department of insurance."  

http://www.ncdoi.com/SHIIP/Medicare_Advantage-Medicare_Health_Plans_(Part_C).aspx 
Simply scroll down and either look by county (Medicare advantage plans can pick and choose what counties they participate in *each year*) or click on "medicare advantage summaries of benefits (2017)" to see each plan offered in NC.  We have some counties that only have one option.

I am a fan of medicare supplement plans because they are don't have so many moving parts.  Their coverage is simple to understand.  They do cost more.  In some areas of the county, the difference isn't that much, in others it is significant (I'm looking at you Florida...).  Check your area.  With supplements, you can have very little out of pocket costs when you get sick.

Just understand what you are getting, because the "rubber meets the road" at claim time.
Good luck
R

PS - If you want a medicare advantage plan, just do your research and don't let someone pressure you into it.  Agents make a lot of money selling these advantage plans (even the $0 plans), so that breeds a lot of misrepresentation of what these plans are and are not.  Medicare (CMS) each year releases marketing guidelines on how agents and companies can market to you.  This year it's 129 pages.  Here are a few things that agents break often...

It's against the law to cold call you for medicare advantage plan
It's against the law to stop by your house without your permission (called "cold knocking")
It's against the law to bait and switch (call from one plan, say dental, but steer the conversation towards an advantage plan)
It's against the law to present a plan to you without a sign scope of appointment 
It's against the law to say a advantage plan is endorsed by Medicare
It's against the law to say an advantage plan is the same as a supplement plan
It's against the law to say this advantage plan is the "best"
It's against the law to say the agent is "with Medicare"
It's against the law to call a referral without getting consent to contact from the referral first (referral has to initial contact)
It's against the law for an agent to edit (ie write, highlight) in any customer material that has been approved by CMS
It's against the law to call former clients
It's against the law to require attendees to provide contact information at a sales presentation
It's against the law to discuss plan details at educational presentations
It's against the law to have a sales presentation and not inform CMS (Medicare) you are having it.

https://www.cms.gov/Medicare/Health...Medicare-Marketing-Guidelines_Final072017.pdf 

Funny how all these rules only get followed by the agents who want to do the right thing.  Those that don't follow the rules to start, will not follow rules no matter how many regulations are added. Every year, I have clients tell me someone contacted them in a way that was a violation of one or more of these regulations.


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## Ken N Tx (Aug 8, 2017)

RustyatMMC said:


> *Full disclosure:* I am an insurance broker and am licensed to sell both supplements and advantage plans.  I am not a big fan of advantage plans in my area.  Each year, I have seen them become more expensive and cover less.  I know in some areas of the country, the coverage is different than what it is here in NC.
> 
> I know some here will tell me I don't know what I am talking about and/or how their advantage plan is fantastic!  That's great, however there is a good chance your fantastic plan is not available in the same format as what is available in other parts of the country.  I will use my state as an example later.
> 
> ...



Great informative post!! Thank you.....Remember to do the research!!!


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## Trade (Aug 8, 2017)

RustyatMMC said:


> *Full disclosure:* I am an insurance broker and am licensed to sell both supplements and advantage plans.  I am not a big fan of advantage plans in my area.  Each year, I have seen them become more expensive and cover less.  I know in some areas of the country, the coverage is different than what it is here in NC.
> 
> I know some here will tell me I don't know what I am talking about and/or how their advantage plan is fantastic!  That's great, however there is a good chance your fantastic plan is not available in the same format as what is available in other parts of the country.  I will use my state as an example later.
> 
> ...



Around the time I turned 65 I must have gotten enough Medicare Advantage Plan junk mail to fill up a Dempsey dumpster. And that's where all of it ended up. I signed up for Traditional Medicare. I researched Advantage Plans and I wouldn't touch one with a ten foot pole.


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