It can be worth it to have insurance just for the pre-negotiated pricing. We found that prices with cash discounts off the list price were still higher than the pre-negotiated prices. It might vary depending on the location. Plus, $700 a year forces one to actually go see the dentist for those cleanings to get the money’s worth.
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But … as soon as that $200-something part B deductible is met, everything is covered. I thought Medicare + Supplement was a little pricey when H started on it last year, but it’s proving to be less expensive overall. H had an eye exam earlier this year, and the majority of the exam (from our longtime eye doctor) was covered by Medicare. Then he had something weird happen with his eye a few weeks later. The whole visit was covered by Medicare, so that got him to the Part B deductible, with the balance covered by the supplement. He had to return to the eye doctor a few weeks later to make sure everything was good … covered 100%. Everything from here on out will be covered for the rest of the year.
That is, if we can get the healthcare system for his medical doctor to bill Medicare instead of his pre-Medicare insurance. They billed his well visit/bloodwork & his abdominal aortic aneurysm ultrasound to the wrong insurance, and it was of course denied. They did that for a visit with another doctor in the healthcare system last fall, and he called them to straighten it out. Now they did it again. Ugh.
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Unless you have very expensive medications your estimate for Part D is high. Our Part D plan in MA is less than $1/month each. It’s worth going to Medicare.gov and plugging in the meds you take and see what it comes up with as the cheapest plan.
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H pays $0 for Part D. If he wanted to have one particular medication he takes covered, he would have to pay at least $35/month. But it costs him less than $35 for three months to have it filled at Costco without insurance. His other medication is free with the $0 part D insurance.
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It was surprising to me too when husband (older) got to age 65. Medicare is cheaper than most health insurance policies and has excellent coverage, but it’s not free.
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I think you are correct - we haven’t picked our drug plan yet but my estimate my be high
Does anyone know what Medicare WON’T cover? It might not be up to date, but my (deceased) husband’s former internist’s office had a list of vaccines that Medicare would not cover.
I’ve got one year to go to get anything that Medicare won’t allow, so I am looking for tips. (When I asked my internist, he was clueless, unfortunately).
I’m a breast cancer survivor, and I’m planning to see my plastic surgeon next month to see if there’s anything “we” should do before Medicare.
All input welcome!
Medicare (Part A/Part B) doesn’t typically cover vaccinations … that’s Part D, which is handled by insurers outside of Medicare itself. None of the plans I reviewed charged for vaccines. H’s plan states that most vaccines are covered at $0 cost - the formulary details the coverage. I suspect that maybe some non-typical vaccines like those you might need to go to certain countries might not be covered, but I’m not certain.
You might need to go to a participating pharmacy for the shots your doctor says aren’t covered. It’s possible that your doctor doesn’t bill Part D, although I don’t know that for sure.
Here, I found this: Tdap Vaccine Coverage.
You might want to work with a Medicare broker that sells lots of different plans or your state SHIP office. They can help you figure out what would be good for your situation.
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Correct, most vaccines are covered by your drug plan, not Medicare. Medical offices usually don’t file to Part D, so those are usually given at the pharmacies. I have had several vaccines at my local pharmacy and all have been covered.
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I know there aren’t that many on CC who are federal workers or retirees, but interested to know what people in this category are planning or have done related to Medicare. We are lucky in that we can keep our insurance at a pretty good price forever. It’s not a great price but we are not giving it up. So if we do Medicare it’s in addition to our insurance, and it gets quite expensive.
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I’m keeping my husband on my private insurance util no longer feasible. It only costs us $150 a month, drug coverage included. If he were to get Medicare, my insurance would be primary so no reason to pay additional $$ yet.
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Thanks - I know what she has done already.
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Some vaccines are covered by Part B and some by Part D
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I put off going on Enbrel injections because it gets me to that area where after 1 month i end up paying full price for the rest of the year due to cost. However, if I drive to the rheumatologist office and get and Enbrel infusion every 6-8 wreeks its 100% covered! I cant figure that one out but am likely going to make the hour drive in the next month or so to see if it will help with my recent flairs.
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Oh yes, Medicare would not cover my 2nd shot of Hepatitis B. Not sure why since supposedly it is a 2 or 3 shot series. I didn’t even know I needed it, Publix Pharmacy said it didn’t show I had the shot in the Georgia registry and it was covered by Medicare so i got the first shot and went for the 2nd shot after 30 days and they said Medicare would not cover it. Could because my age it is unlikely needed?
That sounds about what we pay each month (in AL). But you will have good health coverage, and not get nickeled and dimed during the year - you have the one Medicare deductible for the year and that is it.
Sounds like you have your budgeting in place for both of your transitions to retirement.
So, I do know that if you keep federal insurance and take Medicare that Medicare becomes your primary insurance. I have also heard that those that end up taking both federal and Medicare end up having basically no out of pocket costs as apparently everything is covered. I can’t confirm that though.
So, the question becomes, is the cost of carrying the additional coverage of Medicare less than what one might have to pay in copays and deductibles, etc. in the lower income tiers it’s probably a good move. Not sure though.
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Infusions are covered by Part B, while the injections are under Part D. I have a good friend on Enbrel, and he coordinates his travel so that he can be in town for infusions.
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Yes, it is a bit ridiculous that Medicare doesn’t pay for DPT immunization unless you have some kind of injury? But Medicare is such a huge thing, and to change the ‘system’ for a relatively inexpensive shot…
Yes, do whatever with your plastic surgeon as breast cancer survivor before Medicare - and make sure your insurance will cover. At appt time with surgeon’s office, can inquire about insurance coverage too.