This post is about Medicare and the experiences I've had with it. Let me state right here that I'm not an expert on the subject so I encourage you to get the official word on how things are supposed to work at the federal government Medicare website and the CMS website. CMS is the outfit that actually handles the processing of bills under Medicare. What follows here is my view of how Medicare works and what that meant to my wife and me.
I'm older than my wife so I reached the magic Medicare age before she did. That caused some interesting developments that I'm sure most couples who reach our age go through. Here's how it worked out for us.
When I retired one of the benefits I got from the company I had worked for was health insurance for my wife and myself. It wasn't free. In fact I had to pay more for it every year. The cost eventually got so high that the only plan we could afford had such a high deductible that it was sort of like catastrophic illness insurance, but at least we did have some choice of plans. When I reached 65 things changed. Instead of the choices I previously had for health insurance plans to cover both my wife and me, I had no choice but to enroll in Medicare and had several choices of insurance plans for supplemental insurance to cover what Medicare did not cover for me and a completely separate health insurance for my wife.
At this point I should tell you a little bit about Medicare. It's coverage is composed of several different “parts”. Part A covers hospital costs and is free. The majority of folks will also need part B, which covers doctor bills, outpatient costs and some other things that Part A doesn't cover. It's not free. For most people Part B costs around $100 per month. The good news is that the deductible is pretty small and, for the things that Medicare covers (more on that later), it pays 80% and you pay the other 20%. There is also a Medicare Part D, which covers drug costs. There is a separate charge for that too, but with some insurance packages a Medicare Part D equivalent drug plan is included. With some it is not.
Before I enrolled in Medicare I was already paying monthly fees for dental and eye care insurance in addition to a monthly fee for health insurance for my wife and me. After I enrolled in Medicare I still paid the monthly fees for dental and eye care. In addition the government began deducting about $100 out of my social security check to pay for Medicare Part B.
The company from which I retired offered several different types of health insurance plans to cover costs which Medicare does not pay and several plans for health care insurance for the spouses of retirees. From conversations I have had with other retirees they appear to me to be pretty typical for retirees on Medicare who can still get health insurance for themselves and their spouses through the company from which they retired.
I'll get into the types of plans that are typically available below, but to complete my story, the plan that my wife and I were able to afford gave me what I think of as catastrophic illness insurance in that it only pays something when I have laid out a fairly high out of pocket expense. That would be made up of my 20% of Medicare-eligible costs and 100% of any medical costs I incur which the good folks at Medicare don't want to pay for. The insurance I was able to get for my wife amounts to a PPO with a lower deductible than we had before I went on Medicare. For both of us that also includes a Medicare Part D equivalent drug plan. That's the good news. The bad news is that when you add up what we are paying per month for our dental, eye care and health insurance, plus the money that the federal government deducts from my Social Security check to pay for Medicare Part B, it comes out to somewhere between two and a half to three times the monthly payment we were paying before I was forced to get on Medicare. Oh, by the way, Medicare doesn't cover a lot of the preventive medical costs that our previous insurance did, so we are getting less service for our increased cost. To be fair I should point out that Medicare's deductible is a lot lower than the deductible we had before I got on Medicare so, at least for me, we probably pay out less out of pocket money over and above the monthly cost of insurance, but we end up paying out more money in years where we don't have large medical expenses than we would have with our old plan.
After all this whining I have to point something else out: My old girl and I are lucky that we are able to get health insurance through the company from which I retired for both her and me. People who are not in that position (that is, those who are on Medicare but are married to someone who is too young to be on it and who are not able to provide health insurance for the younger spouse through a group plan from the company that the older spouse retired from) have to find some other way to provide health insurance for the younger spouse.
One way to get insurance for the younger spouse is for that person to go to work at a company that provides health insurance. Not all companies do that these days, but when I worked part time for awhile at a big box store that shall remain nameless, I met a lot of people who were working there mostly because the company had a health insurance plan. I know people who are doing this because they are in just the situation described above. Unless you do something like that about the only other alternative is to find some affordable health insurance that you can pay for in its entirety, and that is hard to do if you are retired.
Even if you are fortunate enough to have the ability to provide health insurance for your younger spouse through the group insurance plan of the company you retired from, you have several options for insurance that will supplement Medicare. The two basic ways to get Medicare and integrate it with a supplemental insurance plan are Original Medicare and Medicare Advantage plans. I'm not going to go into all the differences here because I'd probably get something wrong and you can get all that info on the Medicare web sites. As I see it, however, the difference is this: In Original Medicare you get Part A for free and pay a hundred bucks or so for Part B. Then, unless you want to cover all of the cost of drugs and the 20% that Medicare doesn't pay for, as well as 100% of the things that Medicare doesn't cover at all, you need to find some kind of supplemental insurance to pay for some or all of those things. In a Medicare Advantage plan (sometimes also called Medicare Part C) you pay a monthly fee to the insurance provider who covers all of the Medicare Part A and B things (and usually also Part D if you elect to pay more for that) and you don't have money deducted from your social security by the government to pay for Part B. There will almost certainly be differences in the doctors you can go to between these alternatives. With Original Medicare you can usually go to any doctor that takes Medicare. The catch is that there will be some (maybe even many) doctors who take Medicare that will only accept it for existing patients. That is, they aren't interested in accepting new Medicare patients. That can be a real problem. The doctors you can go to under a Medicare Advantage plan will be doctors that have signed up with that plan. There may be fewer of them but you probably have a better chance of going to them as a new patient.
So if you or your spouse is about to turn 65 the bottom line as I see it is as follows. It would be a good idea to check to make sure that your spouse can still be covered through the group insurance plan from the company from which you retired. If they are, you can probably expect to pay a higher overall cost for health insurance for the two of you than you are paying now, so it would be a good idea to plan for that. It would also be a good idea to check the Medicare web sites to see what is covered to ensure that you will be able to get the same physicals you have been getting or that other procedures you anticipate getting will be covered. Definitely check into the two alternative ways to get Medicare, pick the one you think works best for your situation and make sure that, if you choose that option, you won't get yourself in a position where you are no longer covered through the group insurance plan of the company you retired from. This is probably not likely but you will get offered a lot of alternatives from many insurance companies and you may be tempted to take one that is not offered through the company from which you retired. That's a big step to take so research it thoroughly before you do that.
Good luck and welcome to the quagmire.
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