A health insurance question for eldergays

Pretty sure it depends on your employer. I have a friend who is 67 and still on her employer’s health plan. She’ll sign up for Medicare when she retires next year.

Medicare rules are complicated. The answer to your question depends on several variables. The Medicare Rights Center website (www.medicarerights.org) is an authoritative source for learning about Medicare rules. Medicare.gov is also good. If it's more data than you want to process, each state has an approved program of trained advisors to answer questions about Medicare (see link).

Medicare is quite convoluted, especially at a time when people are getting on in their years and want to simplify their lives, here comes Medicare complicating healthcare even more., with their part A, B, C, D bullshit. The only people who don't have to deal with that garbage are those who have a combo of Medicare and Medicaid.

Why must people, especially those who like their health insurance, especially those who pay out of pocket for it and have never had any issues, be forced to take Medicare and then pay for it on top of everything else?

A friend went on Medicare last year, he also kept his longterm insurance. He then found out the non-synthetic thyroid med he was taking for years. Armour, was no longer covered by Medicare because, get ready for this: "The pharmaceutical company which produced this medication doesn't have a contract with Medicare." WTF?? After many calls from his endocrinologist stating my friend is extremely allergic to all the synthetic thyroid meds, he was allowed to get his prescription. Armour isn't even an expensive medication.

The US is sure one fucked up country. If anything should be protested at the Capitol, it's our totally fucked healthcare system.

The usual rule is that you can keep your employer's medical insurance at 65 then switch to Medicare when you retire. But Medicare and Social Security rules have all sorts of gotchas, so you have to examine them closely with your particular situation in mind.

Talk to your benefits department for their recommendation.

[quote]The usual rule is that you can keep your employer's medical insurance at 65 then switch to Medicare when you retire. But Medicare and Social Security rules have all sorts of gotchas, so you have to examine them closely with your particular situation in mind.

This isn't true, Medicare sure doesn't cover everything, that's why the elderly need to have two health care insurance plans after they turn 65, Medicaid and a secondary insurance plan.

The 'gold star' is Medicaid, nice work if you can scam getting that! Medicaid covers everything, don't let the ReThugs claim otherwise. Some of my mom's friends have Medicaid, with a secondary insurance also covered by Medicaid, and they even get their monthly OTC expenses covered, up to $125.

You are required to take Medicare at 65, even if you want to continue working. If you don't accept Medicare at 65, the the monthly premium will be higher if you wait years to accept it. Also, if you are not accepting your Social Security at 65, you must still pay that monthly Medicare premium. The US laws are absurd, no wonder so many elderly become destitute.

I've been going through all this nonsense for years with my elderly mother. She's lucky my late father opted for her to keep his health insurance after he died. She doesn't pay a dime for her private insurance. However, it sure doesn't cover nursing home stays. Everything but co-pays on her medications is 100% covered.

Unfortunately, the choice was to receive my dad's pension or the health insurance. Since health insurance is so costly in the US and my dad's pension wasn't much, less than $15,000 a year, he made the better choice choosing the health insurance for my mom.

Aging in the US really sucks. Especially if you are not wealthy or smart enough to get on Medicaid.

Sorry Medicaid sucks big time. A lot of doctors won't accept it as it pays very low rates that are set in stone. Now it's easy to get medicare (in those states with extended medicare) but finding a GOOD doctor that takes it, is not easy.

For medicare, it's usually advisable to sign up right away unless you're employer has a GREAT health plan. The reason is, each year you delay signing up for medicare the more it costs YOU. That is right, your medicare rates go UP if you don't sign up right away.

So the decision on when to sign up, needs to balance your current (and potential future plan) versus the higher rate. Remember your nice employer plan NOW may be gone or reduced next year.

I retired two years ago and applied for Medicare several weeks before retirement. Also purchased a supplemental plan and drug insurance plan.

Reading the linked article @R6 would give anyone a migraine. Medicare is quite confusing.

WHY the hell is this all so convoluted as we age? Who wants to deal with such bullshit in their old age? Not everyone has adult children who can help.

I'm not near retirement, but I am self-employed and I've had a great HMO plan since 1988. I still have most of my doctors (they were young she they started) and my newer doctors are great. My plan is trouble-free: I pay a fairly low monthly premium, everything is 100% covered and a have small co-pay for any meds I need. I don't have co-pays on anything but my medication. There are no-copays on bloodwork, diagnostic tests etc. I've been hospitalized once since 1988 and that was 100%. covered.

However, when Medicare kicks in, and even if you aren't extremely ill in old age, it seems your medical expenses suddenly get higher (remember you are also then paying an additional monthly cost for Medicare) or Medicare refuses certain medications because of their bizarre rules. This all seems to be in place to frustrate people.

I'd like to know why the government makes everything so difficult when it comes to Medicare? Do they simply want people to not even apply?

Reading the linked article @R6 would give anyone a migraine. Medicare is quite confusing.

WHY the hell is this all so convoluted as we age? Who wants to deal with such bullshit in their old age? Not everyone has adult children who can help.

I'm not near retirement, but I am self-employed and I've had a great HMO plan since 1988. I still have most of my doctors (they were young she they started) and my newer doctors are great. My plan is trouble-free: I pay a fairly low monthly premium, everything is 100% covered and a have small co-pay for any meds I need. I don't have co-pays on anything but my medication. There are no-copays on bloodwork, diagnostic tests etc. I've been hospitalized once since 1988 and that was 100%. covered.

However, when Medicare kicks in, and even if you aren't extremely ill in old age, it seems your medical expenses suddenly get higher (remember you are also then paying an additional monthly cost for Medicare) or Medicare refuses certain medications because of their bizarre rules. This all seems to be in place to frustrate people.

I'd like to know why the government makes everything so difficult when it comes to Medicare? Do they simply want people to not even apply?

You can keep your employer's health insurance until you actually retire. Give your employer form CMS-L564, which is proof of coverage, when you're getting ready to retire so you can enroll in Medicare at that point.

Do not have a gap in coverage between the dates your employer's coverage ends and you enrollment in Medicare or the premiums will be higher and will remain higher the rest of your life.

Something to keep in mind. Most Health Care Insurers, Blue Cross, Humana, etc offer Medicare plans. They are are offered as bronze, gold, platinum. I have Humana Gold. I have a $35 co-pay for medical visits. And if I need medications purchase them online through Humana pharmacy. I only take one medication and it costs me nothing. My monthly premium is $145. Why don’t you just look around for a Medicare insurer that you like and have your employer pay the extra cost to get the highest grade of insurance offered. One that has no co-pay or deductibles. It might cost your employer $400/mth but you’d be 100% covered with no out of pocket expenses. Just something to consider.

If you don't sign up for Medicare when you are first eligible you will pay higher premiums for life. Why wouldn't you sign up anyway? It makes no sense not to sign up.

Your private employer's insurance acts as a catch all for what Medicare doesn't cover. I think medical bills go first to Medicare and residual billing goes to your insurer. I think that's required IIRC. And, of course, insurance companies love that payment scheme. It saves them a fortune.

People who are employed with medical insurance and have MC never have a clue how it works because the MC premiums are automatically deducted and they almost never know how the billing gets taken care of.

[quote]Something to keep in mind. Most Health Care Insurers, Blue Cross, Humana, etc offer Medicare plans. They are are offered as bronze, gold, platinum. I have Humana Gold. I have a $35 co-pay for medical visits. And if I need medications purchase them online through Humana pharmacy. I only take one medication and it costs me nothing. My monthly premium is $145. Why don’t you just look around for a Medicare insurer that you like and have your employer pay the extra cost to get the highest grade of insurance offered. One that has no co-pay or deductibles. It might cost your employer $400/mth but you’d be 100% covered with no out of pocket expenses. Just something to consider.

Not everyone works directly for a specific employer. Lots of people are self-employed. I've been a contract worker for many years. I'm an art director, graphic designer and photographer. My field doesn't have a union, so I cannot even get cheaper healthcare through a union.

For many US citizens, getting health insurance isn't as cut and dried as you surmise. Plus, for many of today's young people, it's a gig economy, which means there is no healthcare provided by any employer.

Add a monthly premium from your private health plan to the monthly cost of Medicare, well, some Americans cannot even afford that, then add on co-pays and/or deductibles.

The US sure does need universal healthcare. The US should be thoroughly ashamed of how they treat taxpayers.

In the US, healthcare is an industry which makes absolutely absurd yearly billion dollar PROFITS, while denying paying patients important diagnostic tests.

Healthcare should not be this profitable and this convoluted. Americans are way too complacent, especially when it comes to fighting for cheaper health plan costs.

[quote] Medicare is quite convoluted, especially at a time when people are getting on in their years and want to simplify their lives, here comes Medicare complicating healthcare even more., with their part A, B, C, D bullshit.

Welcome to government-run healthcare.

R16 I don't think it's completely fair to write it off as bad just because it's run by the government. The involvement of private insurance contributes to making it more complicated because you have to work around the rules of both. It was also created a long time ago, needing an urgent update.

If they expanded Medicare for all, they would have a large pool of insured to help pay for it. It would work better if it was more like Medicaid, where most things are covered, maybe 90%, meds included, without all the bs plan options. Those that want to could still get private supplimental insurance to cover the 10%, along with extra like therapy, dental, etc.

As annoying as it is, it's at least reliable for paying 80% of general medical bills. I don't think the decades of fraud helped any either, leading them to be more stingy with covering certain related costs.

From my understanding as an employer, the employee signs up for Medicare part A and keeps his company insurance as supplemental. There are penalties if you wait until later to sign up for Medicare, so it's best to do it as soon as you are eligible.

Medicare A is free - you pay no premiums. But it doesn't cover 100% of hospital costs or even every type of cost while in-hospital.

Medicare B is not free. It costs about $144 per month and if you are self-employed you pay quarterly premium of about $400+ If you are receiving your Social Security checks then it gets deducted from that monthly.

Part B pays for doctor visits, office check-ups, office procedures, annual exams, shots, etc. There are sometimes co-pays. With Part B you become eligible for supplementary insurance which in some parts of the country is very good and very cheap. For instance in the DC area Kaiser charges $30 a month premium and their co-pays are low. I think I have only paid a co-pay one time but then I haven't been sick. The doctor did burn off some growth I had on my back that was annoying me - a mole or something - and I thought I would get charged but I never got any bill for it. You can also get a "higher quality" supplementary policy which costs about $130 a month. When I compared the 2 it didn't seem worth it to get the higher one for me. With the Kaiser policies you also get Part D for prescription coverage.

The insurance companies like Kaiser just want you in their network so they can bill Medicare and they make money that way - they could probably not charge anything for premiums but rather just get you into their network. I have heard about some no pay premiums but I haven't looked into it. Now this kind of cheap private supplemental insurance isn't available all over the country for all insurance companies.

All through this pandemic I thought why don't they suspend these Medicare premiums for seniors. That would put a chunk of change in their pockets - maybe even enough for food for the month for some or keep their phones/internet connected - and during a pandemic don't you want to make sure that everyone's health coverage continues? But noooooo. Not one fucking Democrat even seems to have suggested that.

A tip for anyone approaching Medicare. About a year before retirement, every time I had a different doctor's appointment (primary care physician, dermatologist, ophthalmologist, etc) I asked the person responsible for billings in that office which of the medicare supplement carriers they believed offered the best coverage. In my situation, they all named the same two carriers - Mutual of Omaha and BCBS. (All my doctors are associated with the same big city hospital group, so this may have impacted their recommendations.)

Second tip: There are insurance brokers who specialize in medicare supplement plans. It costs you nothing - the carriers pay them a commission. (The rates are published so it's not like they will talk you into paying more than the published rates.) These brokers can research coverage in your area and can focus on specific hospital groups if that is important to you. (It was important to me since I didn't want to change doctors.) These brokers can do the same for prescription coverage based on the medications you take. Before you engage with a broker, be sure he/she represents the carriers your doctors' offices recommended. Researching online, I found a lot of brokers but not all of them represented Mutual or BCBS.

Add me to the Medicare is too damn confusing crowd. I'm not yet eligible but I looked into it when my mom retired. I ended up reading Medicare for Dummies--it was a quick easy read to understand the basics. I didn't attend but my local library also had Medicare presentations. As it turned out, my mom's social security income is so low, she qualified for Medicaid. In CA, qualifying for Medicare and Medicaid (aka Medi-Cal) equals free healthcare and my mom doesn't have to worry about the Medicare alphabets.

My mom still receives Medicare advertisements though and she's constantly asking me to confirm whether or not they are official government communications. I'm running interference on this stuff for her, god knows who's going to do it for me when I'm in my dotage. I can only hope they simplify Medicare somewhat in the next couple of decades.

There are people here like R8 who are ignorant as can be of the detailed Medicare rules and dangerously so. They don't even know the difference between Medicaid and Medicare!

But a forum like this with a lot of contentious no-nothings just isn't the place for a discussion of something like the Medicare rules. Because all you'll get is back-and-forth argument that'll confuse you.

So talk to your employer's HR people instead. This is the most common of questions and they'll have the right answers that apply in your situation.

"know-nothings" of course.

[quote]Welcome to government-run healthcare.

STFU, Boris.

[quote]A tip for anyone approaching Medicare. About a year before retirement, every time I had a different doctor's appointment (primary care physician, dermatologist, ophthalmologist, etc) I asked the person responsible for billings in that office which of the medicare supplement carriers they believed offered the best coverage. In my situation, they all named the same two carriers - Mutual of Omaha and BCBS. (All my doctors are associated with the same big city hospital group, so this may have impacted their recommendations.)

Isn't it true that certain aspects with any healthcare plan do change yearly? Such as formulary plans, eyeglass coverage and even dental plans.

I have dental included with my HMO, they even pay for root canals and caps. Caps are only covered for teeth which show, so, front and side teeth. Same with root canals, they are covered on teeth with can be seen when we smile. So crazy, especially as we need all our teeth to chew and digest properly. Once again, there are always bizarre convoluted rules for needed medical procedures.

For years, my dentist has been accepting my dental plan associated with my HMO, but the HMO sent me info that they will be changing to a new dental plan as of January 2022. I have to call my dentist to see if they still accept the dental plan. I like my dentist, hope I don't lose him.

[quote] The general rule for workers at companies with at least 20 employees is that you can delay signing up for Medicare until you lose your group insurance (i.e., you retire). Many people with large group health insurance delay Part B

If you meet the exception requirements, you can delay enrolling in Medicare and it will not cause you to have a lifelong premium penalty for Part B. You can stay with your good employer sponsored insurance, if your employer lets you, until you retire and not have to downgrade to Medicare at 65.

I don't understand the person complaining about Medicaid, everyone I know who has Medicaid, included with secondary insurance, seems to have zero complaints. They don't seem to know anything about Medicaid.

Medicaid is universally accept, especially if coupled with another insurance.

Medicaid is actually the best insurance, since the hospitals and doctors know the government will always cover most procedures, most doctors and hospitals do happily accept Medicaid.

How is Medicare downgrading?

Several of you are giving misinformation. Don't spout off about things you don't know about. I'm addressing you R7 and R14 amongst others.

The people telling you to talk to your HR department at work are correct. There is no reason to sign up for Part B (professional) or Part D (drugs) if you are still on your employer's plan and the employer's coverage is primary. That is usually true if there are 20 or more people in your employer group, but, again, check with your HR and with your insurer. There is no point in paying for Part B or Part D yet if you don't have to.

As others have stated, each employer group can have different rules about whether you can stay in the group or not once you qualify for Medicare. Some rare groups even allow retirees to stay in the employer group coverage. It is all definitely complicated.

R29, you're right about exceptions to the penalty for late signing. Here's a good synopsis.

Sorry for my incomplete info.

None of you will make it to 65 anyway.

Very simply, NO. An employer can not force you off the company group plan and onto Medicare when you turn 65.

Get original Medicare with a supplement to cover copays/drug costs. Do not get a managed Medicare plan! Don’t listen to the ads promising you the world; keep it simple with original Medicare.

Please elucidate, R33. You’re saying don’t go with a Medicare Advantage plan? I’m going to be faced with that decision soon, and would appreciate hearing more.

R33 I'd like to hear more as well since I'm on Medicare already. I got a supplemental because it seemed easier, but it keeps going up in cost every year. I rather just use Medicare and drop the extra few hundred dollar cost.

R34 & R35 Sometimes Medicare Advantage plans have low or no monthly premiums, but high annual deductibles (i.e., thousands of dollars) and/or limited doctors and hospitals that you can use. Access to even in-plan specialists and certain procedures may be controlled by the PCP and other in-plan doctors. Cancer in your family? Be sure a Medicare Advantage plan gives you access to the best cancer treatment facility in your state.

Note that even if you go with a Medicare Advantage plan, you still have to pay the monthly Medicare Part B premium of $148.50 in addition to the monthly premium of the Medicare Advantage plan, even if it’s zero.

There are other issues that depend on the individual and the state in which they live. The best advice I can give is to contact your state’s “SHIP” program, which I linked in my R2 message in this thread.

[quote] Get original Medicare with a supplement to cover copays/drug costs. Do not get a managed Medicare plan

This is not helpful info. Some parts of the country have crap coverage while others have good coverage. I guess it's easier to provide it when there are sufficient numbers of potential patients to make it profitable.

In the Washington DC area you can get good supplemental coverage. It's called MidAtlantic Region. I think what Kaiser has, e.g., is essentially an HMO or is that also called managed care. It works fine.

[quote]Several of you are giving misinformation. Don't spout off about things you don't know about. I'm addressing you [R7] and [R14] amongst others. The people telling you to talk to your HR department at work are correct. There is no reason to sign up for Part B (professional) or Part D (drugs) if you are still on your employer's plan and the employer's coverage is primary. That is usually true if there are 20 or more people in your employer group, but, again, check with your HR and with your insurer. There is no point in paying for Part B or Part D yet if you don't have to. As others have stated, each employer group can have different rules about whether you can stay in the group or not once you qualify for Medicare. Some rare groups even allow retirees to stay in the employer group coverage. It is all definitely complicated.

Again, little of your 'info' applies to people who have been self-employed or contract workers most of their adult life. I work in a creative field, I haven't worked on staff since the early 1990s. There is no HR department self-employed people and contractors can contact. Your info is mostly irrelevant to the self-employed.

I was told by a person who works for Social Security, that you must sign up for Medicare at 65, even if you are not yet accepting your SS, it's imperative that you sign up so you don't face higher monthly rates later on. This info came directly from a SS worker. How is my info not correct?

No, I haven't given misinformation,. I've been going through a lot of nonsense trying to navigate my elderly mom's health plans, her private plan and her Medicare.

As they age, every person has their own personal experience with healthcare plans. Again, not everyone can go to their HR office to discuss their health care plans when they are close to retirement, mostly because so many Americans are now self-employed or they are contractors, while others live gig to gig.

If someone has one low-paying freelance account, or works part-time on staff (usually as a cashier), they are usually poor enough to be able to receive Medicaid.

You'd be surprised how many elderly Americans are now on Medicaid. The elderly who aren't poor are definitely savvy enough to move their assets and property to a family member, which makes these people eligible for Medicaid, especially for Medicaid to pay for their nursing home stays.

Medicaid is great for me, I pay NOTHING no co-pays nothing. All doctors accept it here if guess because people are so poor here. I even have a supplement which I don't pay for either and since I'm under 65 this supplement is unbelievable at nearly 1000 per month! I even have good dental coverage at NO cost. So Medicaid is great but you still don't want it because it means you're sick.

Traditional Medicare is essentially what health insurance used to be. Doctors and hospitals go ahead and do what they think is appropriate and submit their bills. Unless something is really out of line they get paid about a month later at Medicare's take-it-or-leave-it rates.

Medicare Advantage is managed care. The insurance company is there at every step second-guessing your doctor. What you get is what the insurance company thinks you should get.

A good example is rehab. If you qualify for rehab after hospitalization under Traditional Medicare, you pick the rehab place. They all take Traditional Medicare, which pays fairly well.

But if you are on Medicare Advantage, you go where the insurance company sends you. And the insurance companies negotiate rates with the rehab places to get the cheapest deal.

Now, do you really think that under that arrangement you're going to end up in the best rehab place in town if you're on Medicare Advantage? Dream on!

And anyone who's had a first-hand look at this knows rehab places vary greatly in quality.

So be sure what you're in for before falling for those Medicare Advantage ads.

So what are the pros of Medicare Advantage plans? If they are terrible, why are people choosing them over Traditional?

R39, my mom gets Medicaid because she's old and poor. You're right, if you qualify for it, it's because you're in dire straits. The bright side is that it is so simple--everything is covered at almost $0. I always remind my mom to never do anything to jeopardize her coverage, short of winning the lottery.

R38, that’s not an absolute. If you already have coverage through an employer you do not have to sign up for Medicare and you will not be penalized later.

[quote] If you already have coverage through an employer you do not have to sign up for Medicare and you will not be penalized later.

Except once you leave that employer (or lose that insurance) you have to sign up with Medicare within 7 months or you will have to pay the higher premiums.

[quote] Except once you leave that employer (or lose that insurance) you have to sign up with Medicare within 7 months or you will have to pay the higher premiums.

Which can be after age 65, with no penalty.

R41 Medicare Advantage plans are seemingly cheap(er) upfront and simpler than the alphabet soup of original Medicare. If you’re lucky enough to lead a long and healthy life, you’ve likely won bigly, financially-speaking with Medicare Advantage. If you have medical conditions and want more control over your medical care, then original Medicare will probably make you happier.

Folks can switch from Medicare Advantage to original Medicare during certain times of each year (see link), but in some states you may not be able to get a Medigap plan, or it may be prohibitively expensive. This issue can sometimes lock people into Medicare Advantage for the rest of their lives.

Think this is all outrageously complicated? Complain to the people who created and perpetuate this mess: our federal and state congresspeople, but remember, their re-election campaigns are often heavily funded by insurance companies that profit from Medicare Advantage plans.

The MA companies keep sending adverts to my mom. Since she's not English fluent, she freaks out that they may be important government communications about her Medicare/Medicaid coverage. It would be great if we could inform these companies that my mom has Medicaid, so please kindly fuck off.

My mother had a BCBS MA plan and what I liked about it was that it had a nationwide provider list and could be used out of area. The provider list included every doctor a person could want. It was a little confusing though with the local BCBS affiliate handling claims in its area, when out of area, and not the BCBS company the insurance was with.

[quote] Except once you leave that employer (or lose that insurance) you have to sign up with Medicare within 7 months or you will have to pay the higher premiums. Which can be after age 65, with no penalty.

Okay I thought I was clear but I guess not.

Everything we are talking about here is about Medicare. Medioucare for Seniors who we are assuming are 65 or older. As a senior y become eligible for Medicare at 65.

For those seniors who do not have employer provided health insurance you need tp sign up at 65 to avoid future increased premiums.

For those seniors who DO have employer provided health insurance you can delay signing up for Medicare past 65 without future increased premiums BUT once you leave the employer then you have 7 months to sign up for Medicare or you face increased premiums.

Is that clear?

[quote] Okay I thought I was clear but I guess not.

It’s clear that you were wrong in your original reply, but it’s not clear if you are owning up to it or not.

Do they cover pReP and Viagara?

R41 Why do people nonetheless sign up for Medicare Advantage?

First, there's constantly a big advertising sell for it. And it's a one-sided advertising campaign. You never see any ads on TV stressing the advantages of Traditional Medicare.

Second, a lot of people have learned to live with the restrictions of managed care. They've forgotten what it's like to be able to choose their own doctor and care.

Third, people are cheap and MA can appear cheaper overall than TM. Everybody loves a bargain. But both MA and TM can be really complicated and that bargain may not actually be there. It all depends. Again, it goes back to that one-sided advertising, which stresses the pluses but not the minuses of MA.

[quote][R39], my mom gets Medicaid because she's old and poor. You're right, if you qualify for it, it's because you're in dire straits. The bright side is that it is so simple--everything is covered at almost $0. I always remind my mom to never do anything to jeopardize her coverage, short of winning the lottery.

Medicaid is is how ALL healthcare should work, healthcare should be easier to navigate as we age, not more difficult, with all that A, B, C, D Medicare bullshit. The problem is, US politicians get kickbacks from the massive high-profit health insurance companies. Politicians don't care about taxpayers, they'd rather worship their corporate overlords, especially the ReThugs, they have always been about the rich over the average working class and middle class US citizen.

The US government cares more about corporations than its taxpaying citizens, Americans need to face this very sad reality. We are so backwards in so many areas: healthcare, education, day care for kids, healthcare for the elderly etc. Compare Europe with the US and weep. The US is supposedly the richest country in the world, yet cares so little for its taxpayers.

As far as needing to be in dire straits to qualify for Medicaid, this isn't true. Do you realize how many of the upper middle class and wealthy elderly move their assets years before they get ill and need to be in nursing homes? Some of these elderly rich people are just greedy, they no longer want to pay for their health insurance.

These upper middle class and wealthy people move their bank accounts, their investment portfolios and any real estate they own to their children or close relatives. They put everything in a trust, there are financial planners whose sole job is to do this.

The stories I heard from these rich people while my mom was briefly in a nursing home really blew my mind! All these people bragged about owning apartment buildings (though they no longer technically owned them, yet they still had access to all the building's income!), all these people with a lot of money were on Medicaid.

Lots of people today who are on Medicaid, many of them are not exactly poor, this is a fact. Tons of people who are not old and poor receive Medicaid, most work under the table or report they work part-time or freelance. My sister's hairstylist is on Medicaid! He's a foreigner living in NYC, he has a green card. He even accepts the food stamp card. Some Medicaid recipients are simply happy to get free medical, others accept everything.

The hairstylist's US citizen relative, an uncle, owns the hair salon. The uncle reports that his hairstylist nephew only works part-time a few days a week, which makes him eligible for Medicaid. The nephew actually works five days a week. The salon owner uncle, pays his hairstylist nephew the bulk of his income off-the-books. The nephew makes close to $80,000 a year, yet gets Medicaid because only a very small portion of his salary in on the books!

This 'system' is how so many working foreigners who live in the US, and working Americans, who make salaries way over the Medicaid threshold, scam the Medicaid system. Not sure how this works in other states, but this is sure going on in NY, this has been going on for many years.

R53 Perhaps you’d consider reporting this at the link below.

[quote][R53] Perhaps you’d consider reporting this at the link below.

Oh, you know so little about our corrupt government. Anyone who is a whistleblower, whether to the IRS, Medicaid etc, the government immediately gets the whistleblower's background looked into.

I don't even know this hairstylist, why would I report him? He's one of thousands screwing the US government, I'd rather see Trump and all his corrupt bootlicking cronies in jail.

Fuck this government.

R55 Perhaps because that hairstylist was foolish enough to to tell your sister about his scheme, he told it to other people, and someone who has no fear of possibly being investigated themselves will step up to the plate.

[quote][R55] Perhaps because that hairstylist was foolish enough to to tell your sister about his scheme, he told it to other people, and someone who has no fear of possibly being investigated themselves will step up to the plate.

Lots of people on Medicaid openly brag how they are 'working the system', the hairstylist is not the first person I know running this scam.

A few years ago, in NY, a wealthy Jewish community on Long Island was charged with Medicaid fraud. People living in million dollar homes were on Medicaid. This story was all over the newspapers and local TV news. Many of these people who live in these so-called 'religious enclaves' make most of their income off the books or they find others ways to hide their actual assets. Some legal, some not at all legal. The irony is that so many religious people are cheats and so many of these people are from foreign countries, in this instance, they were mostly Russian Jews.

I see the rich elderly who put their assets in trusts as yet another a form of scamming the Medicaid system. Even though what these wealthy elderly are doing is perfectly legal, to me, that's just another way the upper classes in the US get away with so much. The wealthy should never be eligible for Medicaid.

So many wealthy elderly people haven't even paid their fair share of taxes over the course of their working lives, yet they manage to get on Medicaid years before they are ill. Some of these rich people manage to get on Medicaid way before 65. They make sure the Medicaid is already in place to cover their nursing home and assisted living expenses. There is a look back period which is used to check when the assets are moved, the wealthy know all about this.

Upper middle class and wealthy elderly Americans being eligible for Medicaid is completely absurd. US laws are ridiculous. We can easily see how so many US laws are always swayed towards people who don't actually need financial assistance.

These rich people can easily protect their assets being used for their health bills, meanwhile, the rest of us are screwed almost daily.

R38, my post was obviously geared towards people with existing GROUP insurance, not Individual. I stand by the statement to talk to your HR person and your current insurer customer service in that situation.

If you are self-employed and don't have an HR department, then you need to talk to your existing insurer, but, if you have Individual coverage or even in a small group under 20, you will lose your coverage when you qualify for Medicare at age 65 and, of COURSE you should sign up for Medicare in that situation. That is self-evident. You're trying to put my answer on a completely different set of circumstances. Even people with an ACA plan lose coverage when they turn 65.

Also, for those of you shopping for Med Supp coverage (I also agree that going with regular Medicare parts A, B, and D and getting Med Supp is preferable to Med Advantage; remember, you'll also have to get separate Dental coverage because current Medicare doesn't cover dental, but some MA plans do), know that shopping for regular Med Supp is like shopping for aspirin: it is the exact same coverage and provider network EVERYWHERE. It has to be by law. Plan G is Plan G is Plan G whether you are in Maine or Hawaii. As long as you go to a provider that accepts Medicare (which you obviously will be in the first place, although I have to be VERY clear for R38), then the Med Supp coverage is in play and is the same for every insurer. That is why you should go to your state's insurance commission/department page and look for comparative prices because there is no reason not to go with a cheaper insurer.

Med Supp is priced to go up with age, usually, which makes sense since the older you are, the more likely you are to have higher bills. Plan G is the best, if you can afford it, because it covers everything that Medicare covers but doesn't pay except for the annual Part B (professional) deductible, which is only a couple hundred bucks. The other letters (A, C, K, N, etc.) have lower premiums because you have more out-of-pocket costs. Be careful about Med Supp SEL:ECT plans as those are cheaper, but they do have restrictions around which hospitals you can go to and have it covered under your Med Supp policy. It can still be a very good way to save premium money if your normal hospital is included. Your potential insurer will explain it all.

This is why Biden’s proposal to require banks to report to the IRS the total amount deposited to bank accounts is important. Scumbags who report low income on their tax returns yet are banking thousands more per year will either be caught, or will think twice about underreporting their income.

I never thought I’d see a day when people in the U.S. would be proud not to be successful and to be on the dole with Medicaid.

R57 I agree with you that what you describe is widespread, and greater legal enforcement and major political change are needed to stop it.

Despite how widespread this is, I note that you specifically mentioned foreigners and Jews in your messages. Perhaps you could think about also explicitly acknowledging in your future messages that white Christian Americans do these things, too, and based on population make-up, would be doing far more of it in absolute numbers than any minority population. Either that, or refrain from singling out any group in the future.

R58 Thank you for your informative message. One FYI is that Massachusetts got approval from the Fed to not use the lettering system for Medigap plans, so MA has only “Supplement 1” and “Supplement 1A” plans. Also, MA is one of only 4 states that require insurers to provide Medigap coverage to everyone age 65 and older, irrespective of health status or when they first became began Medicare coverage.

Interesting, R62. Not using the Medigap plan letters is actually detrimental to customers, in my opinion. "Supplement 1," etc., doesn't help explain anything. At least people are used to the lettering system if you have been involved with it for others. Choose whatever is equivalent to G!

R63 Agreed, and I don’t know what the justification to the Feds was that got it approved. But imagine my surprise when I learned about all the lettered plans only to find out it was irrelevant for me! The two plans are essentially the maximum coverage lettered plan either with or without payment of the Part B deductible.

Perhaps it had something to do with the 365 days a year guaranteed issue requirement for Medigap plans in MA. There are relatively few Medigap providers in MA. Maybe there was no point in subdividing the plans when there are only a few providers, and it kept their costs down in exchange for guaranteed issue. Also, much of the powerful medical community in the state was against the formation of Medicare Advantage plans, so perhaps the guaranteed issue requirement is to encourage people to get off Medicare Advantage plans and still be guaranteed a Medigap plan.

How Medigap (aka "MedSupp") works does vary a bit by state, including how premiums are set.

Note there's no Government subsidy in Medigap. Over time most people pay in roughly what they take out plus profit for the insurance company. But paying copays yourself can be a surprising hassle especially after a hospital stay, so having Medigap tto deal with it may be worth it.

When the glorious day comes that we're all on Medicare, regardless of age, everyone will better understand Medigap and no one will even be talking about group coverage. Doctors and hospitals will hate that even more than insurance companies.

Well, duh, anyone can easily figure, the lower your premiums, the higher your out-of-pocket costs.

This only proves that pretty much almost everyone in the US cannot survive solely on Social Security. Healthcare in the US is costly, probably one of an American's largest bills they are expected to pay, add navigating this in old age, especially for people with diminishing cognitive abilities, it's a double whammy!

As most people age, few can afford to pay 100% out of pocket for their health insurance. Imagine paying a high monthly premium, then add the Medicare monthly fee deducted from your SS check, then there's medicine co-pays and whatever deductibles you have on your plan, no wonder so many people try top get on Medicaid. Healthcare bills don't seem to leave you much for the rest of your monthly bills.

People need a decent pension as well as a lot of money saved for retirement, so many Americans simply don't have that sort of money.

I have a relative who is 70 and still working. He's off his employer's healthcare because his medicare plan was better in terms of coverage.

[quote][R57] I agree with you that what you describe is widespread, and greater legal enforcement and major political change are needed to stop it. Despite how widespread this is, I note that you specifically mentioned foreigners and Jews in your messages. Perhaps you could think about also explicitly acknowledging in your future messages that white Christian Americans do these things, too, and based on population make-up, would be doing far more of it in absolute numbers than any minority population. Either that, or refrain from singling out any group in the future.

I know exactly where you're going with this, smarty-pants. You are as transparent as glass.

I was simply mentioning my own experiences hearing these stories from people who know Medicaid cheats. These situations are also based on the area of the US where I live.

Lots of religious Russian Jews in various NYC communities are well known Medicaid scammers. Most New Yorkers know this. Don't try to swing this into me being a xenophobe or a racist. One afternoon at my medical office, this attractive Russian woman tried to chat me up (her gaydar was really off!), I have no idea how we got to talking about our medical insurance, we were initially discussing what was on the waiting room's TV. This woman actually told me she was on Medicaid, I didn't ask, she offered this private information. She told me, since she worked "mostly off the books", making $75,000 a year, she was able to get on Medicaid, because her "on the books salary was so low."

Believe it or not, lots of people are extremely proud to scam the system and so many of these Medicaid scamming braggers are foreigners.

Pretty sure, in many other parts of the country, US-born white working class Christians are scamming the Medicaid system too. I would assume lots of Drumpf fans are on Medicaid. These people are way too ignorant to comprehend Drumpf wanted to take those entitlements away from them too, not just destroy entitlement programs which help Black and brown working class people.

Social Security was never intended to cover all living expenses. It's supposed to represent about 30% of planned living expenses and you are still responsible for the rest.

Off-topic, but good news!

I have R69's back 1000% on this. I live in Brooklyn. EVERYONE knows who the biggest fraudsters are here.

One fucking Russian doctor. ONE billed Medicare and medicaid for around $100M. The worst fucking thing to ever happen was that wall coming down in Germany. They are an atrocious addition to NYC. They've taken advantage of this country. But you'll never here a fuckhead like Trump go after them.

And I live near Boro Park, and that's an even bigger nightmare when you throw in the fraud involving Section 8 housing.

hear*

[quote]Social Security was never intended to cover all living expenses. It's supposed to represent about 30% of planned living expenses and you are still responsible for the rest.

Thank you, Mr. 1950. That was when people had pensions and employers didn't make everyone contractors etc. and medical care and housing were affordable.

That model no longer works.

[quote] Thank you, Mr. 1950. That was when people had pensions

People with pensions wouldn’t have needed Social Security. Social Security was designed to protect people in need by covering part of their living expenses. It’s more important than ever that people have substantial retirement savings.

[quote] Medicare is quite confusing. WHY the hell is this all so convoluted as we age? Who wants to deal with such bullshit in their old age? Not everyone has adult children who can help.

Welcome to the bull that is American healthcare. The elderly in most other developed countries get more guaranteed healthcare than we do, even with Medicare. All the rules of Medicare are made to save money by making you pay for things instead of Medicare.

[quote] Social Security was never intended to cover all living expenses. It's supposed to represent about 30% of planned living expenses and you are still responsible for the rest.

When the majority of Americans can't come up with a spare $400, this won't end well.

It isn't at all realistic to think that Social Security could ever be expanded to pay for "everything." Even if it somehow was expanded, the qualifying age would have to be raised to probably 90 and everyone would just have to keep working longer.

Everyone knows that they are going to get old so they have to start saving early on. Even when I wasn't making much money, I always still made it a priority to save money because I didn't want to have to work forever. I'd much rather get "something" at 62 versus nothing at all until 70 or more.

[quote] People with pensions wouldn’t have needed Social Security.

Of course they would have. We're not talking about the very generous pensions of today or even recently. Or about the spectacular government pensions of more recent decades. Anyone dare to dream that a kindergarten teacher in NJ would have a $97k a year pension after 30 years with top of the line health insurance and they'd call you crazy.

What kind of pensions do you think people got back then? This is exactly why Social Security was enacted.

Social Security is a safety net, not a ticket to the good life.

[quote]WHY the hell is this all so convoluted as we age? Who wants to deal with such bullshit in their old age? Not everyone has adult children who can help.

Get a broker to do all the work for you. My broker is currently looking for a Plan B and D that suit my needs - she has a list of all my doctors and meds.

Years ago I used to hear people complain that their MDs didn't take Medicare. These days it's hard to find one that doesn't take it because the population has aged. I live in lower Westchester.

My aunt was on Medicaid until she died 3 years ago. She put all her assets into her father's name to qualify.

Of course, she was a Trumper. So is my grandpa.

While Medicare Advantage combines the hospital, doctor, and drug benefits into one package, you're stuck with a defined group of doctors and hospitals, like private insurance. If you travel around the country at all, your Medicare Advantage won't help you much if you're not at home.

The best is regular Medicare because almost every doctor and hospital across the country takes it. The problem is it doesn't cap the amount you may have to pay if you have a catastrophic illness. Plus, there is now a trend of some doctors only taking Medicare Advantage and not regular Medicare (although still not significantly). You will also have to get the Medicare drug insurance.

So many people buy extra private insurance (Medigap) to add to the regular Medicare. This limits co-pays and places a max on the amount you may have to pay overall per year.

Yes, figuring all this out is a pain in the ass. I had to because my parents went through this choosing process.

[quote] Social Security is a safety net, not a ticket to the good life.

Sadly, it's the sole income for a large swath of elderly. Thankfully, it's there at all because otherwise the elderly poverty rate would skyrocket.

[quote] Sadly, it's the sole income for a large swath of elderly.

It’s important to plan early for retirement.

R85, truthfully everyone needs to start in their 20's. If they miss that decade of saving and investing, they will lose nearly $1 million extra they could have had when they retire.

When my husband turned 65, he didn’t take Medicare Part B, but kept his employer’s insurance. When he did retire a few years later and went on Part B, we learned a little known lesson. If you take Part B at 65, the annual increases cannot be greater than the increase in Social Security. So if your Social Security went up $25, your Part B premiums could not increase more than $25. They could raise your Part B premium by $30. But if you wait until later, that rule doesn’t apply. Annual premium increases are greater for those who hold off taking Part B than it is for those who take it at 65.

Because of learning that I took part B at 65 and used my employer’s insurance as a supplement.

As for Medicare Advantage programs, it depends on where you live. I have been my mom's caretaker for thirty years and had to go through all of this when she finally retired at 88. In our island of a city, all the hospitals ALL belong to ALL the insurer plans. There is no out of plan hospital. We have been going to the same clinic, first as PPO and then HMO, and always had the same doctors. So I went with a UHC/Optum (how is it that private insurers can own entire clinics and practices but the US government cannot outside of Tri-Care?) Medicare Advantage program. Plus, I have a not bad State Government pension, and I am putting off applying for Social Security and paying my own Med B Premium. So easy to set up.

Would be nice if Biden could do away with the fake Reagan windfall crap. The extra couple of hundred (WINDFALL!!!!!) a month would be nice.

[quote]It’s important to plan early for retirement.

Sure, lots of working class people who don't have any sort of degree and don't earn a decent income can do this!

The naiveté or just plain reluctance of DL-ers to comprehend many Americans work, yet are extremely poor. These people can barely pay their monthly bills, how can they save for retirement?

Funny how 401Ks were supposed to be little side accounts for the rich, and then they turned them into defined benefit pension alternatives and foisted them onto regular people.

Here ya go ya fucking poor people, save up for your own retirement as we pay you substandard wages.

Same with HMOs and Healthcare for profit, both done under Nixon.

R89, they get free insurance through Medicaid. In NYS a Medicaid Managed Care policy is exactly like regular insurance except for no premiums or co-pays.

Except that regular insurance does not come after your family for Medicaid reimbursement once you die.

[quote] It’s important to plan early for retirement.

The gobsmacking ignorance of some people. Have you paid ANY attention to the state of the work force and the economy on the working and middle classes these past several decades?

Social Security recipients need to start to be needs-tested. We can't afford to give benefits to those who have over a certain income and have over a certain amount of assets.

Lol, R93, so you're okay with people over a certain income paying into Social Security for your benefit, while you spend your income on whatever you want, but those people shouldn't get any benefit for having contributed? Stop wasting money on crap you don't need and start saving it.

R94, it never fails, when you dare mention saving for a rainy day, someone will lecture you about how it's impossible to save in this age and day. My immigrant single mother of 3 kids worked low wage service jobs but still managed to sock away cash into the upper 5 figures. She likely would have had more but was afraid to "gamble" in the stock market.

Yes, wages have stagnated. Yes, there is huge wealth disparity. But even so, there are many Americans working full time jobs where they can and should sock away some savings. Yeah, it takes some sacrifice but them's the breaks for us wage slaves.

[quote] so you're okay with people over a certain income paying into Social Security for your benefit, while you spend your income on whatever you want,

Yes.

The reality is almost no one knows what their financial situation will be when you get to be 65 or 70. Unless you have inherited wealth which is not the norm.

I paid into health insurance for decades and almost never used it because I chose not to use drugs or smoke or get fat or play risky sex games etc. Those who were less careful with their lives benefited from my contributions.

We are really quibbling about whether to take care of our most vulnerable population - the elderly - by providing them with sufficient resources to live with some dignity.

Most of these people obviously worked or they wouldn't qualify for SS in the first place. The fact that many didn't make enough to save or invest or buy investment properties or work for employers who provided pensions and other benefits (like down payments for houses or tuition, etc.) does not make their work contributions to the society any less valuable.

Scrap the cap on Social Security contributions and let rich Americans subsidize poor Americans.

If institutional racism is predicated on shifting success outcomes to white people, then MAKE them share the wealth.

It's a shame that the blowhards here make it impossible to seriously discuss the structure of Social Security (and a lot of other things).

For example, the life expectancy of black men is seriously below that of white women, in the neighborhood of 10 years' difference if I recall correctly. That's a lot of Social Security payments.

I've never come across a proposal to redress this. Probably because it would also mean paying women of all races less than men of all races generally, since they do tend to live longer.

r98, what you propose is some sort of means testing.

Lower the age to 60 and, not by percent, add a specific amount to SS payments. Like $400 across the board per month.

Percent increases bloat the top end.

Social Security has become the third rail in politics because it is not means-tested. If we abandon this approach, it becomes yet another welfare program for the right to incrementally dismantle.

R99 The problem in R98 has nothing to do with means testing.

Several years ago an old friend of mine had to have emergency surgery on a strangulated hernia. I helped him navigate all the paperwork after he got home from his 20 days of in-patient rehab paid for 100% by Medicare. I was shocked when he told me he had no Medigap policy. But was even more shocked when I started going over the bills from all the medical providers involved. His total bills from doctors and the hospital totaled a bit more than $125,000.00. After Medicare paid what they paid his out of pocket amount was only a tiny bit more than $2000.00. He had the money so he just wrote checks for his out of pocket amounts and went on with life. Medicare certainly did right by him.

I do admit I found some of the bills completely outlandish. On the day he was admitted to the hospital he was seen by 3 doctors before he was taken into surgery that day. All they did was come in, talk to him, & look at the Xrays and decide he needed surgery right away. Another doctor performed the surgery. The 3 initial doctors billed him $4350.00 each for their 15 minute examinations (why it took 3 I don't know). Medicare paid each of them $428.00. That plus his 20% of the Medicare approved amount was all they could get. There were far more billing amounts that were outlandish. I know the doctors all knew what they were going to be paid by Medicare. I'm just not confident of why they bill such outlandish amounts they know they're not going to get. I have thought at times maybe they take the unreimbursed amounts as tax losses, but who knows.

[quote]I know the doctors all knew what they were going to be paid by Medicare. I'm just not confident of why they bill such outlandish amounts they know they're not going to get.

Because if they billed less, Medicare would pay them less.

Because if they billed less, Medicare would pay them less.

That's not true. Medicare pays what it pays, no matter what the provider bills (which is always more than they get from Medicare). If those doctors had billed just $800.00 each they would have still received a reimbursement from Medicare for $428.00.

R103 Does anyone know if that's really true? Having looked at a fair number of Medicare statements I have the impression that the amount billed by the provider is practically irrelevant.

"Medicare does not rely on a competitive market to generate physician prices through the choices of millions of consumers and producers operating independently. Since the program began, physician prices have been set through a series of administrative calculations. Since 1992, Medicare has set prices using the Resource-Based Relative Value Scale (RBRVS), which calculates the estimated amount of work and practice expense involved in delivering specific services. The original purpose of the RBRVS was to bring physician prices more into line with the costs of providing services.

The challenge with such an administrative-pricing approach is finding data to compute the RBRVS values. The task requires annual updates for more than 10,000 prices built on various sources of information. The Centers for Medicare & Medicaid Services (CMS) relies on a special committee of the American Medical Association (AMA) to propose data on which to base the prices."

What really pisses me off is when I hear multi-millionaire doctors bitching and moaning about the amounts they get paid by Medicare and other insurance providers. One of my old school friends is very guilty of this. He and his wife (also a physician) live in a $3 million house and have a $1.6 million beach home and both drive a Lexus. They live like kings and he gets fighting mad when anyone starts talking about Medicare reimbursements.

[quote] it is not means-tested. If we abandon this approach, it becomes yet another welfare program for the right to incrementally dismantle.

That just is not strictly true, actually not true at all. People on SS have paid into it. People on welfare have not paid into it

Remember that as your income goes up so do a) the proportion of your SS payments subject to Federal income tax and b) your Medicare Parts B and D premiums, and pretty drastically, too.

That is, there already exists something of a means test, though it's indirect.

From what I've seen Medicare premiums rarely go up drastically, if at all. There's still the "hold harmless" provision that insures the Medicare premiums don't rise at all if there is no SS COLA (or a very small) increase. The new part B premium for most people will only go up $10.00 for 2022. Part D is a different matter. Those are plans provided by other concerns than Medicare.

But just imagine the fallout, R108, if it ever became means-tested, with only the less affluent being eligible. The popular support for the program would vanish.

[quote] I'm just not confident of why they bill such outlandish amounts they know they're not going to get.

Here’s your answer: they bill the same amount for all patients they see regardless of age or insurance status, and yes Medicare pays the lowest reimbursement, but private insurance will pay a much higher percentage of that fee (whatever price that insurer has negotiated for that service). The uninsured are the ones who really get shafted - they get billed for the FULL amount.

[quote][R89], they get free insurance through Medicaid. In NYS a Medicaid Managed Care policy is exactly like regular insurance except for no premiums or co-pays.

Sure, for now. However, the ReThugs have been trying to abolish Medicaid for decades! If The Orange Menace ever gets back into the WH, beware, it will be the end of democracy as we know it.

The ReThugs are already installing politicians to screw up any kind of fair elections in the future. Democrats, both the politicians and voters, need to stop being so damn complacent.

PAY ATTENTION.

It does seem, every time retirees get a Social Security raise, Medicare rates are also raised.

No, Medicaid pays the lowest rate, though the difference varies by state.

By the way, don't shed tears for hospitals over "low" Medicare payments. Medicare goes by its rules and any hospital head administrator worth his $3million salary knows how to game them.

As to the uninsured, yes they get shafted but most if not all hospitals will negotiate one-third to half off, which of course is still a lot more than Medicare pays.

[quote]As to the uninsured, yes they get shafted but most if not all hospitals will negotiate one-third to half off, which of course is still a lot more than Medicare pays.

Not all Medicaid recipients "get shafted". Since the hospitals are guaranteed that Medicaid will pay, most of these hospitals easily cover Medicaid patients, especially if the patient has a secondary insurance (which is also covered by Medicaid!)

A friend on Medicaid had their cancer surgery at one of NYC's best hospitals, New York Presbyterian.

Where are some of you people posting from, the red states?

It wasn't until we had Medicare that doctors started making really big money. The huge influx of patients guaranteed incomes from a reliable payer with whom you ddidn't have to fight with like insurance companies.

The AMA was bitterly opposed to Medicare in the 1964 election. I remember it - I was in elementary school and our civics teacher was a male - rare in a Catholic school - and he made some snarky remark because one of my friends said she was for Goldwater and the teacher made some remark like Of course you are your dad's a doctor. Doctors were very very comfortable but it was different after the government started paying for health care. My friend was one of 11 children and had a gorgeous house.

This is the same reason some insurance companies now will give you insurance without premiums or some minimal fee like $30 because they just want you as a patient so they can bill the government for your care. They don't need your crappy premium. They need your sick aging body.

Hospitals all over the country were hammering for states to sign on to the Medicaid expansion. Why? Because they knew they'd actually get paid for anything they did for those patients. The number of uninsured patients who never pay a dime or pay very little for their hospital stays all over the country is staggering. It has actually closed some hospitals. There's not much the hospitals can do legally. If the patients don't have the money or live in poverty it's not like winning a lawsuit against them is going to magically make the money appear. So suing is useless. The best they can hope for is to sell the debts to collection agencies for pennies on the dollar. At least they get a little money.

R117. Exactly. This notion that hospitals and doctors get screwed on Medicare is nonsense. Follow the rules and you'll know how much you'll get paid and you'll get paid within about a month, no hassling so long as you do the forms right.

Note that we are talking Traditional Medicare here not Medicare Advantage. With MA it's back to hassles and games with the insurance company.

Does the the government really pay for our health care via Medicare? The Medicare premium is taken out of most people's paltry SS check, which is essentially our money.

Most of us have paid taxes our entire working lives, yet some have never participated in any social service programs.

Many Americans don't drive which translates to never using the highways, others never had children who go to public schools. The list is very long for many Americans who have never received anything from the government. For us, the taxes we pay have never helped us, please don't go on about "clean water" etc. Our infrastructure is literally falling apart.

Others have taken advantage of social service programs their entire lives and they continue to expect their continuing free ride. That money should go towards training these people (not everyone is college material, but there will always be a need for electricians, plumbers, construction workers, these are all good paying union jobs), the problem is, too many of these people are way too used to being on the government dole and no, I'm not a ReThug. I'm not talking about people who have worked and suddenly fell on hard times, I'm talking about permanent social service program recipients.

At 65, the government, demands we pay into Medicare, whether or not we are accepting our Social Security, we must pay that premium. People who are not accepting their SS yet, and are not working at a staff position, are expected to pay their Medicare monthly premium.

All of my still working friends over 64, people who are contract workers and freelancers, must pay a monthly Medicare premium.

[quote] At 65, the government, demands we pay into Medicare, whether or not we are accepting our Social Security, we must pay that premium. People who are not accepting their SS yet, and are not working at a staff position, are expected to pay their Medicare monthly premium.

You're only required to have Medicare if you aren't covered by any other health insurance plan at the age of 65. Nothing wrong with that. Everyone needs to be insured. If you're also eligible for Medicaid you pay nothing for your Medicare as (in most if not all states) Medicaid pays your Medicare premium.

No one is forcing you to take Medicare. You only should if you don't have other insurance coverage or the coverage you have is more expensive (which it will almost certainly be). If you think that a couple hundred bucks a month for Medicare is out of line, you're nuts. If you were having to pay for the level of coverage that Medicare provides in the commercial insurance world, it would be probably a thousand dollars a month.

I am taking Medicare and opting to take SS later. I come from a line of long livers and will increase my SS pay by a third if I wait till I'm 70.

[quote]No one is forcing you to take Medicare. You only should if you don't have other insurance coverage or the coverage you have is more expensive (which it will almost certainly be). If you think that a couple hundred bucks a month for Medicare is out of line, you're nuts. If you were having to pay for the level of coverage that Medicare provides in the commercial insurance world, it would be probably a thousand dollars a month.

Once again, if you are a contract worker or freelancer, who has decided to hold off on SS, you are forced to take Medicare. If you wait, years down the line, the monthly Medicare cost will be higher.

The person in this thread who keeps shilling for Medicare must work for Medicare!

Once again, if you have Individual (not group) insurance YOU HAVE TO TAKE MEDICARE WHEN YOU QUALIFY FOR IT anyway. All insurance companies kick people out of Individual coverage at 65. Your health insurance has nothing to do with how you get money, be that as a contract worker, freelancer, or anything else. You can also take SS at age 62 when you don't even qualify for Medicare yet. What is so difficult to understand about the concept that SS and Medicare are completely separate issues?

Oh, and I do not now, nor have I ever, worked for Medicare. I just know a lot about health insurance.

[quote]What is so difficult to understand about the concept that SS and Medicare are completely separate issues?

How on Earth can they be "completely separate issues", when your Medicare premium is taken out of your Social Security check?

If you decide to hold off on accepting your SS, you will still get billed in the mail for Medicare, a bill which covers three months of Medicare premiums, which is about $450, add that to your monthly private insurance premium. Some people simply cannot afford this. Especially those who don't have the luxury of continuing their low costs health insurance plan which they had at their former staff jobs.

My father is extremely lucky he was able to carry on his health insurance from his longterm job. IIRC, his monthly premium is about $75 a month. His Medicare premium is taken out of his SS check.

How many people are able to pay such a low amount for a private insurance premium? My father doesn't have any co-pays for doctor visits, blood tests, diagnostic tests or basically anything, just a yearly deductible of about $300. His medication co-pay is around $3 to $5.

These types of low cost health plan situations no longer exist. Only if you are on Medicaid, would your costs be this low or not at all

They are completely separate issues because you can have either one without the other. That's how. Yes, for everyone's convenience, IF you have both, they withhold the premiums from your SS payment, but, if you go on Medicare at 65 but don't take SS yet, they obviously can't do that.

Sigh, @R128, yet a person still has to pay a Medicare premium at 65. How many times must I repeat this in the thread?

If someone doesn't accept their SS, they are still required to apply for Medicare at 65 or risk paying penalty or a larger monthly premium down the line. All my friends who freelance were told this directly by SS workers! These people called to inquire about not wanting to accept their SS at 65, this was the information they got directly from the SS office.

I have no reason to lie. I'm not yet in my 60s, not on Medicare or collecting SS.

You are the poster going on and on about the health insurance a retired Medicare recipient might be able to carry on from a former job. Contract workers and freelancers don't get health insurance from an individual employer, these workers must pay for their health insurance 100% out of pocket. Add on the extra expense of paying for Medicare, yet not yet wanting to receive their SS at 65.

From all my friends who are self employed, I've heard so many horror stories re Medicare.

Medicare suddenly stopped covering a certain maintenance medication they were taking daily for years, these people also suddenly got co-pay bills on their blood tests or other tests, these are bills they never had before. Medicare seemed to be the main reason for this, especially as most of these freelancers have continued to pay into the health insurance plans they've had for many years. How the hell does Medicare affect peoples private insurance to this bizarre extent?

Since you seem to be such a health insurance and Medicare expert, can you tell me why this has been the case with so many of my friends?

If you are on either original Medicare or Medicare Advantage and had high enough income two years ago, you will be notified by the Social Security Administration how much additional Part B premium (known as IRMAA) you will have to pay. I am on original Medicare, but I'm not taking social security yet, so I get my annual IRMAA notice from SSA, and I pay my Part B base premium plus the additional IRMAA premium to the Centers for Medicare and Medicaid (CMS).

But wait, there's more. I have a Part D plan. SSA notifies me each year how much the Part D IRMAA will be, I pay the base premium to the private insurance company that provides the Part D plan, and I pay the Part D IRMAA to CMS.

This is what our politicians, red and blue, came up with. Beyond the annoyance of dealing with the complexity, there's the danger a Reagan, Bush, or Trump will use the complexity as a pretext for why government needs to be cut back. They never want to cut back the complex tax laws and regulations that allow millionaires/billionaires to pay lower tax rates than lower- and middle-class Americans, but they're all for reducing and privatizing complex social service and public support systems. And now, look at how "well" the US Postal Service is doing since the time it was largely privatized during the Nixon administration.

I am starting to think you are too dense to have this conversation with, R129.

When I write "Individual," I don't mean from an individual employer; I mean Individual coverage as in non-group as in purchasing health insurance outside of getting whatever an employer has deemed they are going to offer to their employees. Everyone who has coverage through the ACA healthcare.gov site has Individual coverage. People who aren't employed and don't qualify for Medicare or who are self-employed like the people you keep referencing also can purchase Individual coverage directly from insurance companies (not all of them offer it) without having to go through healthcare.gov.

When you don't have health insurance through an employer group, you either have Individual coverage or you have no health insurance at all (or you get it from one of those scam "Christian" cooperatives, but that's a completely different discussion). When you turn 65 you have two options: take Medicare and pay for it, regardless if you are getting SS or not, or don't take it yet, have no health insurance at all, and, yes, pay more for it later on when you do finally sign up for Medicare because you didn't sign up for it at your first opportunity. Again, whether or not you sign up for Medicare has zero to do with whether you sign up to draw Social Security yet or not. You do still have to sign up THROUGH Social Security to get to Medicare coverage, but you don't have to sign up to DRAW on your Social Security until you want to up to age 70.

Ask your friends if the insurance they had been paying for for years was still willing to cover them once they were turning 65. I'm betting the answer is "no."

I also didn't say a Medicare recipient would be carrying on their coverage from a former job, I said that some people can keep their group employer coverage from a former job and not need to sign up for Medicare meaning they aren't a "Medicare recipient" but they are 65 or older.

The rules of which drugs are covered can change over time. That happens with all prescription drug coverage whether it is commercial coverage or Medicare coverage. Things change with drugs over time. Drugs lose their patents and generics become available, etc. Pharmacy companies are worse than illicit drug dealers. One of the changes in the proposed Build Back Better act is to allow Medicare to negotiate with drug manufacturers over costs which will mean potentially more changes with allowed drugs. That said, people get all freaked out for no reason because they believe that what they have been taking is the only thing that will work for them. Too many people buy into the plethora of ads put out by drug manufacturers.

As far as going from no co-pays to having them, are you talking about when they switched from their own Individual insurance to having Medicare coverage? Rules will obviously change when you change health insurance plans. If you are talking about all within Medicare, they never change the rules during the plan year but rules can change annually as they deem appropriate.

Medicare.com makes it simple to make the premium payment and if you set it up early enough they only take out the monthly premium. I am one of those waiting till 70.

It's not a good idea, but technically you can take only "free" Part A (hospital bills) and not take Part B (doctors' bills) and Part D (drugs) which both have monthly premiums.

R130 Politicians love to tax people by finding ways to call a tax something other than a "tax." IRMAA is a perfect example of this. As is the way more of your SS payment becomes taxable as your income increases.

Dollars to donuts those bills working their way through Congress have plenty of the same. You really think Bernie's dental coverage won't come with premium increases?

R134 IRMAA is a peculiar tax because each IRMAA bracket is a dollar amount rather than a percentage of income. Hence, each IRMAA bracket is regressive, rather than progressive, e.g., the tax is higher as a percentage of income when your income is lower than when it’s higher, within a given bracket. IRMAA ultimately becomes infinitely regressive once income exceeds the top IRMAA bracket, because there’s no additional IRMAA tax. So, Congress gave yet another gift to the uber wealthy by having them pay a lower percentage of their income on the IRMAA tax than folks with middle-class incomes.

r135, I'll get back to you when I make over $91K.

The rich shouldn't accept their SS checks, this money should be put into a pool to allow working class and middle people to get larger SS checks. Or at the very least, the SS money the rich wouldn't be getting should be put towards making Medicare premiums lower.

It's laughable that extremely rich people such as Mike Bloomberg and every other elderly multi-millionaire and billionaire is drawing a monthly SS check.

Scrap the cap and let the rich keep their little rebates while they fund the poor.

R137, I'm willing to bet there are a lot of people who are poorer than you who could, and would, say the exact same thing about YOU getting SS benefits. Let me guess: the line indicating who is wealthy enough to not qualify for the SS payments they contributed to is above your level of wealth and not below, right? You realize that there are plenty of wealthy people who die before ever receiving a dollar of SS benefits just like poorer people, don't you? Why aren't you more concerned about cutting off people who draw far more out than they ever put in?

[quote]Medicare suddenly stopped covering a certain maintenance medication they were taking daily for years

Medicare Part D is run by private insurance companies. Every year these plans change what they cover, then you change to another plan that covers it. They just don't "suddenly" stop covering a Rx mid-year. It's a pain in the ass, but I'm doing it right now.

RE: IRMAA

I don't mind paying my fair share, and my broker has been selling off my inherited portfolio based on my age (68). This drastically increased my capital gains in 2020, which will increase my IRMAA in 2022. Fine. What ticks me off is that Medicare goes after NON-TAXABLE income as well as taxable, which bumped me into a higher IRMAA in 2021. I've been middle-lower middle class all of my life until very recently, you never lose that mentality.

IRMMA income brackets:

But just wait until you are required to take distributions from you 401(k) plan when you are 72. The highest premium you could pay, depending on income, is 3.4 times the standard amount ($148) which would be $503 per month. And that's before the additional premiums for medigap, drug coverage, or Medicare advantage premiums.

Another example for someone not in the highest income bracket: a single person making $142,000 would pay 2 times the standard Medicare premium, or $296 per month.

It's still a very good deal, especially when you compare Medicare with Obamacare premiums for people in their 60s, the group with the most expensive premiums. Coming off of Obamacare and going onto Medicare was a relief. The options for coverage, premiums, and networks under Medicare were so much better than Obamacare. I was grateful that Obamacare even existed for what felt like high premium catastrophic coverage (I didn't qualify for subsidies), but glad to be off of it, too.

[quote][R137], I'm willing to bet there are a lot of people who are poorer than you who could, and would, say the exact same thing about YOU getting SS benefits. Let me guess: the line indicating who is wealthy enough to not qualify for the SS payments they contributed to is above your level of wealth and not below, right? You realize that there are plenty of wealthy people who die before ever receiving a dollar of SS benefits just like poorer people, don't you? Why aren't you more concerned about cutting off people who draw far more out than they ever put in?

Did I hit nerve, DEAR? I'm not old enough to be on Social Security yet, so, please STFU. I have many years of working and PAYING TAXES ahead of me.

You have no idea what you are talking about. Rich people should never be accepting their paltry SS checks.

Who is collecting SS before they've contributed? The children of a parent who died fairly young? Are you talking about people on welfare? Welfare isn't SS, get some facts before flapping your lips. Or are you referring to actual legitimately disabled people who are receiving SS disability benefits? Most people who have become disabled have already contributed to years of SS payments. Please stop with the tedious predictable Faux New talking points.

I did mention millionaires and billionaires should nt be collecting SS. Here are the highest amounts individuals can receive on SS: $3,895 for someone who files at age 70.

$3,148 for someone who files at full retirement age (currently 66 and 2 months).

$2,324 for someone who files at 62.

Do millionaires and billionaires need these checks? Especially the people who earn more than that in a day!

A relative is a financial advisor, some of his biggest clients are the rich trying to hide their assets. These rich cheats are putting their money, homes and other assets in trusts so they can qualify for Medicaid to cover their health needs and nursing home stays.

Get a clue.

R141 Agreed, the use of modified adjusted gross income (AGI) instead of AGI to determine IRMAA taxation is vexing. Congress also did that for determining eligibility to make direct Roth IRA contributions. Now that Congress is about to eliminate “back door” Roth contributions that are done via traditional IRAs, modified AGI will become a deal-breaker for some folks trying to contribute to a Roth IRA.

R142, it depends on what ACA plan you got through your state. My single/no deductible plan through NY State costed a blood fortune, but they paid for everything. The network of MDs was good too. The only problem was the premium amount.

Even though I'm in the highest IRMAA bracket, the entire amount of Part B with a Medigap plan and Part D is HALF of what I paid before.

A reminder that certain methods of exempting assets for Medicaid eligibility and estate recovery are legal. I feel it’s a moral issue whether people chose to use these methods. I think the cheaters are the federal and state congresspeople who made and keep these methods legal. They cheat the majority of their constituents for a minority of wealthy campaign contributors.