You are correct - if you’re still working and have employee coverage through work you don’t have to take Medicare and you don’t get a penalty.
I am pretty sure buying a non-work related plan does not count like a work related plan, and so if that’s all you had you would have to pay the penalty if you later choose Part B. I have federal retiree insurance, and if I don’t take Medicare part B at 65 I will have to pay the penalty if I want to take it.
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It depends on where you live. It’s true that in some states medical underwriting is required if you later want to switch from an advantage plan to a medicare supplement. However, that’s not the case everywhere - eg in Massachusetts where you can change your plan during open enrollment each year. I think there are also other circumstances where you can change to a supplement eg if you move to a different state. It is complicated and the details are important. I recommend reading as much as possible and some of the info begins to fall into place! Also, if Medicare sign up is imminent for you, much of the best advice comes from the volunteers at the state SHIP or SHINE programs who are well trained and continually updated about the process and rules and plans available. Private insurance advisors don’t necessarily know about/provide all the options.
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Best what? Regular Medicare is regular Medicare and is the same part A and B for everyone. And AFAIK, you can switch supplements during open enrollment any year. Someone else can verify this.
As noted, some states and some plans do allow you to switch from Medicare Advantage to regular Medicare (and vice versa) without underwriting.
I just got done signing up for Medicare last year. Mine began November 1st. Everyone’s situation is different so it’s difficult to give advice. You are eligible to sign up for Medicare when you turn 65, however, the process should be begun a few months ahead of time. You’ll begin your Medicare plan on the first day of the month of your birthday. Medicare part A cost nothing and is for hospitalization. It has it’s own deductibles and co-pays. Medicare part B is for doctors visit and out patient care. There is a fee for this. Usually around $175 per month. It can vary based on your income and will change from year to year. This will be taken out of your social security check if you receive social security. It also includes its own deductibles and co-pays. Medicare part D is your drug plan. It’s best to enter the drugs you are currently taking and compare plans. You must sign up for a drug plan when you sign up for Medicare or will pay a penalty (forever I believe). Medicare does not cover dental, or vision. You will have to cover those on your own.
From there you have two options. One is a Supplement or Gap plan that covers the deductibles and co-pays and the additional costs physicians can charge beyond what medicare will cover. So long as Medicare covers it the Supplement will cover the gaps. You can choose your Supplement plan. The best (Plan G) covers everything except for your Plan B deductible (I think around $275 for 2024). You can go to any doctor that takes Medicare anywhere in the US. You can sign up initially without a medical backround check. Once that initial period passes you will likely be required to apply to be accepted into the plan.
The second option is a Medicare Advantage plan. Essentially Medicare will pay an insurance company to manage your healthcare. They are usually HMOs or PPOs and have their own deductibles and co-pays. They will typically have max out of pockets so long as you are within their network. A challenge can be a doctor or hospital not being in their network and it can be very expensive. They can have some dental and vision coverage within their plan and many Advantage plans have no fees as they are paid by Medicare. It’s easy to switch from a Supplement to an Advantage but more challenging to switch from an Advantage to a Supplement.
None of what I’ve said takes into account those who continue working and are covered by insurance. I was not in that situation so I don’t know all the ins and outs. I went to a company that advised me on my Medicare options. They were free and very helpful. Good luck to all.
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If this is all accurate, this post should be pinned! Explains the “parts” quite well.
Only thing I’m unclear on is … I thought part A was free and then I would pay for part B and D (drugs) - I thought B was the supplement/gap - you’re saying you need a third? (G)
The comment about ‘not qualifying’ I believe the writer meant that if you sign up when initially eligible (when you have other insurance, and then are initial enrollment for Medicare B and supplement) the supplement takes you at the age/rate they have set, w/o ‘qualifying’ with a physical.
IDK if switching from Medicare Advantage to regular Medicare can be w/o ‘qualifying’ - with the plan deciding if they will take you based on your physical.
One has to be very careful on the selection. A Medicare Advantage plan may work great in an area where you live. We chose ‘traditional’ Medicare with supplement and separate drug plan, as we like wider flexibility of services with US travel. We can also purchase a separate rider when we go overseas.
Yes Medicare B doesn’t pay everything as addition to Medicare A. Some people choose not to do a supplement, but one can face pretty high medical bills that way.
And some people who never have paid in do have to pay for Medicare A, but I don’t know of any specific cases.
So Medicare B payment (if not a high income earner) is $174.70 a month in 2024 for each participant.
We have Blue Cross Blue Shield of AL C+ (which is essentially the ‘G’) - initially it was $176/month at age 65, with quoted age 66 - 69 at $194/month, and age 70+ at $215/month at that time. Currently we pay $199/month for each of us at age 67. Last year we paid $190/month each.
DH and I each pay a separate drug plan which saves money as we choose the plan which fits our prescriptions. This year, neither of us has a plan deductible, we each pay a monthly amount, and some of our prescriptions have additional payments due when filling the prescription. Medicare on-line has a good service where you plug in your location, pharmacy preferences, your medications, and they have choices come out with lowest to highest cost plans. This year I did not change plans, but DH has had different plans each year for cost savings.
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The G plan is one of the Medigap plans. They have several, designated A through N, I think. Many different companies offer Medigap plans, and a G plan at one company offers the same benefits as a G plan at another company. There can be big differences in the premiums that different insurance companies charge for the same coverage, so be sure you compare Medigap plans with the same letter (for example, compare Plan G from one company with Plan G from another company).
Here’s a chart of the different “alphabet” plans - I hope the link works.
https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits
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This page has a nice explanation.
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When I was trying to decide whether to keep my work sponsored health plan or Medicare, once both my husband and I were eligible, I had to make a spreadsheet to compare cost. While Medicare premiums were cheaper, due to IRMAA, the monthly payments would be much higher than my work health plan. Then I had to add my supplement and drug plan. BUT, when one figures in the deductibles for the plan at work, if we had any health events more than we had the previous year, Medicare would be cheaper or a break even, as everything was covered after the deductible.
We are smart people, and I deal with health insurance daily at work and my husband was a physician, so we know how this works. You should have seen my spreadsheet and charts, it looked like I was a mathematician looks for the next discovery! It took a few weeks to compare and make sure we were calculating correctly. We commented, how do normal people do this?
When on Medicare, do compare cost yearly for your supplement and drug plan. While we chose a cheap drug plan last year, it was a big $11.50/month, this year that same plan is $.50/month. I was able to switch my mother to the same plan as she was paying $110/month for her drug plan. On this plan, 3 of her 5 medications are considered maintenance medications, so are free, one is $5/month, and only her inhalers will cost more, and it still isn’t expensive. She is going to save over $1200 this year assuming she doesn’t need too many addition medications.
I always compare self pay cost when filling a prescription, as at times that is cheaper than the negotiated drug plan cost.
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Why isn’t everyone using a broker? My BIL and SIL have one they love.
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We used a no-fee broker (referred by our FP) who explained everything very clearly and helped us choose appropriate gap (G) and drug (D) plans. Because we were already collecting SS before 65, we were automatically enrolled in Medicare A (hospital) and B (doctors), but she explained that because we split our time between two states, a nationwide supplemental (G) plan would be better for us than an Advantage plan, most of which have network limitations that don’t carry well across states. You can easily change supplemental and drug plans during open enrollment each year if you wish.
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That shows the Gap plans very well.
No plan B is doctor and out patient care. Plan A is hospitalization. You are not required to get a Supplement (see Patsmom’s chart) plan but if you don’t get a supplement or an advantage plan the deductibles and co-pays can get expensive if you use your medicare.
I did use a broker once I decided to go with Medicare, but I still did the research on my supplement and drug plans in advance. I already knew of a few I wanted to consider by price and needs, but used the broker to help with the final decision in the event I was missing something. I like to research, so I didn’t mind doing this.
One thing very important to my husband was the gym membership which 2 of the supplement plans included. As he was a daily gym goer, and needed gym access while traveling for work. He actually belonged to 3 different gyms, two being 24 hour gyms with inexpensive dues, but it adds up. By getting our local, and more expensive gym covered for free, it was a great perk.
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Just for information purposes if you’re looking at the link. The plan B excess charge is a fee some doctors are allowed to charge in excess of what Medicare will pay. I believe it’s capped at 15%. That can get expensive if say you want to use the “best surgeon” or something like that. Plan F is no longer offered to people born after 1955 so the most comprehensive plan is plan G.
It can get expensive if you are traveling too. I had an Uncle with an Advantage Plan (I think an HMO) several years ago that was vacationing in a different state and had to be hospitalized. It cost him well over $20k and took a chunk out of his retirement savings. My parents had a plan F supplemental and never worried about it. My mother had a type of cancer and was treated at the Cleveland Clinic. The only thing it cost them was her premium.
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Yes, we were warned about travel limitations, too. All good advice.
I’d check with your broker about easily changing supplement plans. My understanding is that the only time you can enroll without a medical check is during your initial enrollment. I’m sure you can attempt to change during open enrollment but applying won’t guarantee approval. By starting with a Plan G supplement I think there would be little reason to change unless the premiums just got too onerous. We don’t tend to get healthier as we age and the risk of more expensive care just goes up. That when the Plan G supplement shines.
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Medicare supplement plans can be changed at any times, unlike Part D or Advantage plans which are limited to open enrollment periods. Again, you might need to pass underwriting in order to change.
Edit to add…I wanted a specific plan I knew was available in my area. The broker I originally contacted did not sell that plan. Brokers sell different vendor plans.
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