Medicare and Social Security advice and options

[Thunder Good-Oil]

I’m not there yet, but trying to figure it all out.

Right now Social Security can begin at age 62 and should never be delayed beyond age 70. The latter leaves benefits on the table.

With SS I guess electing to take it early works best if you’re no longer working or only working part time and under the earnings threshold.

Medicare is much more complicated and depends a great deal on how much income one has. How healthy the participants are is another huge consideration.

Medicare: need too chose between (1) the basic government plan and probably adding “Advantage” -or- (2) going with Medigap/Supplemental coverage.

There’s no extra cost when using a broker, although they will collect far more lucrative commissions by steering the sheep into one of the “Advantage” plans.

It can be difficult to switch from Advantage to “Gap” policies.

Also, there is a 7 month window to sign up for Medicare (birth month plus and minus 3 months) and missing that window creates financial penalties for the rest of your life.

 

[Thunder Good-Oil]

Social Security benefit adjustments:

6% less per year than the amount received at the full benefits age (adjusted monthly - 0.5%)

8% more per year than the amount received at the full benefits ago (also adjusted monthly - 0.667%)

62: 70%
63: 76%
64: 82%
65: 88%
66: 94%
67: 100%
68: 108%
69: 116%
70: 124%
71-forever: also 124%

 

[Thunder Good-Oil]

Also, despite paying 1.45% of your wages/salary for your entire life (plus the 1.45% employer match) Medicare isn’t free. Everybody is still required to pay almost $200/month for the basic government coverage (Plan B).

Plus IRMAA can triple the monthly premium.

 

[Go aeiou]

I’m not there yet, but trying to figure it all out.

Right now Social Security can begin at age 62 and should never be delayed beyond age 70. The latter leaves benefits on the table.

With SS I guess electing to take it early works best if you’re no longer working or only working part time and under the earnings threshold.

Medicare is much more complicated and depends a great deal on how much income one has. How healthy the participants are is another huge consideration.

Medicare: need too chose between (1) the basic government plan and probably adding “Advantage” -or- (2) going with Medigap/Supplemental coverage.

There’s no extra cost when using a broker, although they will collect far more lucrative commissions by steering the sheep into one of the “Advantage” plans.

It can be difficult to switch from Advantage to “Gap” policies.

Also, there is a 7 month window to sign up for Medicare (birth month plus and minus 3 months) and missing that window creates financial penalties for the rest of your life.

Advantage plans are cheaper as long as you are healthy. Have a health problem and you will be better off with regular Medicare and a supplemental plan.
At 72 I can tell you that most people that age have health problems.
Do your own calculations.
Your coverage options:

Your coverage options

Once you’ve signed up for Part A and Part B, you can choose between Original Medicare and Medicare Advantage.

www.medicare.gov

 

[Thunder Good-Oil]

Advantage plans are cheaper as long as you are healthy. Have a health problem and you will be better off with regular Medicare and a supplemental plan.
At 72 I can tell you that most people that age have health problems.
Do your own calculations.
Your coverage options:

Your coverage options

Once you’ve signed up for Part A and Part B, you can choose between Original Medicare and Medicare Advantage.

www.medicare.gov

The government, the insurance companies, and the insurance sales reps push the Advantage plans.

A couple of big problems with Advantage instead of supplemental are (1) you often need insurance companies to approve procedures that a participant’s doctor wants to do, (2) you can’t use any doctor or you might be out of network and have to pay a huge part of a bill, and (3) if you have a health problem switching from an advantage plan to a supplemental plan is going to get denied.

Supplemental is more expensive, but there won’t be any way for the insurance company to deny coverage for things.

Another decision is which plan to go with if somebody does elect to go with gap/supplemental. Plan G or Plan N are the most popular. F was popular but is now closed to new enrollees.

There are also high deductible versions of G and N.

N is a little less expensive than G… BUT rates are going to go up faster with G. People with G pay zero once they’ve met their deductible whereas those with N have to always pay a co-pay when visiting a doctor or the ER. The math works out to about one visit per month being the same out of pocket cost. More visits and the higher G premiums are off set by the zero co-pays. People on G will be in a group that doesn’t care how often they visit the doctor since there is no additional costs. People in group N will be more selective since they still have to pay $20-$50 for the visit.

The other cost of N is that in rare situations certain specialists don’t participate in Medicare and there would be big charges for the participant to cover. But I think it’s only about 1% of the doctors doing that and it’s a scare tactic used by the insurance companies to push participants to G or Advantage.

I can’t believe how incredibly difficult it is understanding the whole process. It might be on purpose to get more people on Advantage. Advantage gets the government out of the process.

I haven’t even touched on part D (drug) plans yet. They seem to be stand alone options. Dental, hearing, and vision are similar. Selling points for Advantage but not necessarily providing a lot of value.

 

[VOLLeeann]

Excellent thread, this will help!

 

[Thunder Good-Oil]

Excellent thread, this will help!

This affects almost everybody. Even if somebody isn’t making these decisions in their 60s yet, they probably have family members that are faced with all of the complicated options.

It is incredibly complicated. And insurance companies and the government’s interests are counter to citizens making decisions that are best for them.

One other little tidbit, once a person is receiving Social Security benefits the basic Medicare premiums are deducted from the monthly SS benefit. Those that elect to begin SS benefits AFTER age 65 will have to pay the government that $140/month directly or they could end up with the life long penalties.

 

[Go aeiou]

The government, the insurance companies, and the insurance sales reps push the Advantage plans.

A couple of big problems with Advantage instead of supplemental are (1) you often need insurance companies to approve procedures that a participants doctor wants to do, (2) you can’t use any doctor or you might be out of network and have to pay a huge part of a bill, and (3) if you have a health problem switching from an advantage plan to a supplemental plan is going to get denied.

Supplemental is more expensive, but there won’t be any way for the insurance company to deny coverage for things.

Another decision is which plan to go with if somebody does elect to go with gap/supplemental. Plan G or Plan N are the most popular. F was popular but is now closed to new enrollees.

There are also high deductible versions of G and N.

N is a little less expensive than G… BUT rates are going to go up faster with G. People with G pay zero once they’ve met their deductible whereas those with N have to always pay a co-pay when visiting a doctor or the ER. The math works out to about one visit per month being the same out of pocket cost. More visits and the higher G premiums are off set by the zero co-oats. People on G will be in a group that doesn’t care how often they visit the doctor since there is no additional costs. People in group N will be more selective since they still have to pay $20-$50 for the visit.

The other cost of N is that on rare situations certain specialists don’t participate in Medicare and there would be big charges for the participant to cover. But I think it’s only about 1% of the doctors doing that and it’s a scare tactic used by the insurance companies to push participants to G or Advantage.

I can’t believe how incredibly difficult understanding the whole process. It might be on purpose to get more people on Advantage. Advantage gets the government out of the process.

I haven’t even touched on part D (drug) plans yet. They seem to be stand alone options. Dental, hearing, and vision are similar. Selling points for Advantage but not necessarily providing a lot of value.

If you take any drugs go to medicare.gov and put you drugs in to get quotes for plan D. You will need to get new quotes every year during the renewal period which is now till early Decmber for 2025. Look at "Annual drug cost + plan premium". One thing to keep in mind is that annual Rx drug cost is now capped at $2000. Once the website has your list of drugs it will be kept, and you will only need to add new drugs or delete drugs you no longer take when you get quotes.
Regular Medicare supplement(Medigap) insurance is different because you will be experience rated. Once you've had significant health issues moving to a different Ins Co. will likely be very expensive. We've been with Mutual of Omaha since the beginning. I think we pay $230/mo. for both of us.
The folks you call are shills for the Advantage plans. At least that was the case when I became 65, 7-8 years ago. My niece graduated from UT a couple of years ago, and took a job trying to get people on the Advantage plans when they called. She quickly moved on.
Finding Drs, hospitals, etc. is no problem. At least in Nashville all the Drs and hospitals take Medicare.

If you have dental problems you might take a look at plans. Much of it is just prepaying for dental cost.

 

[Go aeiou]

If you take no drugs now you still need a plan in case things change. There is a Wellcare plan with a monthly premium of $0.00. At least it is available in my Zip code.
It was also the cheapest for "drugs + premiums" when I put in my drugs.

 

[TennesseeTarheel]

For medicare, go to Medigapseminars.org and set up an appointment. Boomer benefits is another one. These are brokers who will discuss your health situation and help you select a provider. They get a small compensation that isn't effected by the company you go with. The government is pushing the so-called "Advantage" plans. These plans require approval by a review panel before ...well, you get the idea. Good luck.

 

[TennesseeTarheel]

If you take no drugs now you still need a plan in case things change. There is a Wellcare plan with a monthly premium of $0.00. At least it is available in my Zip code.
It was also the cheapest for "drugs + premiums" when I put in my drugs.

My wife just signed up for Medicare and got the Wellcare rx plan. 0 dollars. Lucky her!

 

[Tin Man]

I’m not there yet, but trying to figure it all out.

Right now Social Security can begin at age 62 and should never be delayed beyond age 70. The latter leaves benefits on the table.

With SS I guess electing to take it early works best if you’re no longer working or only working part time and under the earnings threshold.

Medicare is much more complicated and depends a great deal on how much income one has. How healthy the participants are is another huge consideration.

Medicare: need too chose between (1) the basic government plan and probably adding “Advantage” -or- (2) going with Medigap/Supplemental coverage.

There’s no extra cost when using a broker, although they will collect far more lucrative commissions by steering the sheep into one of the “Advantage” plans.

It can be difficult to switch from Advantage to “Gap” policies.

Also, there is a 7 month window to sign up for Medicare (birth month plus and minus 3 months) and missing that window creates financial penalties for the rest of your life.

Go to the official social security site and create an account. You’ll have options for creating a log in. Login.gov works with many Federal sites, including Medicare.

Once you have an account, use the site’s tool to check your approximate benefit going forward to 70. Adjust the earnings estimate and observe the impact. Note, it defaults to SocSec known earnings. If these are increasing or decreasing, it will impact your projections.

Initial enrollment period for Medicare begins 3 months before your birth month and closes three months after. If you are presently covered by an employer health plan (yours or your spouse’s), you may delay applying for Medicare without penalty. You will be eligible for a special enrollment period. You can start the process before your end date for employer coverage to avoid gaps. If you have a change in employers, obtain a letter from your prior employer attesting to your participation in their health plan with effective dates.

 

[SuzyVol]

If you take no drugs now you still need a plan in case things change. There is a Wellcare plan with a monthly premium of $0.00. At least it is available in my Zip code.
It was also the cheapest for "drugs + premiums" when I put in my drugs.

It's been a while since I looked at it, but I believe those who don't purchase a Part D Plan when eligible, will have to pay a lifetime penalty when they ultimately purchase one.

 

[Thunder Good-Oil]

Go to the official social security site and create an account. You’ll have options for creating a log in. Login.gov works with many Federal sites, including Medicare.

Once you have an account, use the site’s tool to check your approximate benefit going forward to 70. Adjust the earnings estimate and observe the impact. Note, it defaults to SocSec known earnings. If these are increasing or decreasing, it will impact your projections.

Initial enrollment period for Medicare begins 3 months before your birth month and closes three months after. If you are presently covered by an employer health plan (yours or your spouse’s), you may delay applying for Medicare without penalty. You will be eligible for a special enrollment period. You can start the process before your end date for employer coverage to avoid gaps. If you have a change in employers, obtain a letter from your prior employer attesting to your participation in their health plan with effective dates.

The Social Security break even, on average, seems to be around 75 +/- years old. Live longer than that and deferring to age 70 to begin works out better. But starting early at least increases the odds of getting something back.

Wait until the “full benefits” age of 67 and die one month before turning 67 and you and your heirs receive absolutely nothing back after paying into the program over your entire life.

Married couples/surving spouses complicates the math. Continuing to work if electing to begin taking benefits before 67 complicates the math.

One thing that is pretty easy, anybody that is sick and won’t live well into their 70s will be best off starting as soon as possible (age 62),

Changes in legislation isn’t really something that can be assumed. I really don’t expect benefits to be cut to address the annual SS deficits, but who knows?

 

[Tin Man]

To assess your Medicare coverage, have on hand the totals of costs paid for medical services in the past 12 months. Use the data to estimate your potential copays for medigap and advantage options. Your retirement budget will be your bottom line, so you’ll take this into account. A good agent can help you with this. Not all are shysters trying to steer you to the highest commission product, but many are. Get recommendations. Find a good one. Know that you can do it yourself online, but that requires time and effort. You know you. The decision is yours.

I perform an analysis every year on a total cost basis - premiums + projected out of pocket. It’s never perfect. Various plans have different negotiated rates with preferred providers and copays with others. Who you’re receiving care from is a factor.

This year, my medigap plan has a policy to allow me to switch to an advantage plan for a year and come back to it the following year. This policy could change.

I don’t have dental or vision coverage. It’s a factor in my coverage decisions every year during open enrollment. My dentist isn’t the least expensive, but negotiates pricing with me. I shop for eye exams and glasses ~every two years.

Luckily, I don’t need many drugs. I get by with the cheapest drug plan coupled with discounters like GoodRX. Two years ago, I was going to three different pharmacies, last year, two, this year, one.

Good luck.

 

[Thunder Good-Oil]

Cataracts are common for people in their 60s. That procedure is covered by regular Medicare rather than vision insurance though.

 

[Ernest T. Vol]

The Social Security break even, on average, seems to be around 75 +/- years old. Live longer than that and deferring to age 70 to begin works out better. But starting early at least increases the odds of getting something back.

Wait until the “full benefits” age of 67 and die one month before turning 67 and you and your heirs receive absolutely nothing back after paying into the program over your entire life.

Married couples/surving spouses complicates the math. Continuing to work if electing to begin taking benefits before 67 complicates the math.

One thing that is pretty easy, anybody that is sick and won’t live well into their 70s will be best off starting as soon as possible (age 62),

Changes in legislation isn’t really something that can be assumed. I really don’t expect benefits to be cut to address the annual SS deficits, but who knows?

Here is a great little website used by a lot of financial planners to make a better informed "guess". It's a free and safe tool. Just key in your FRA SS estimates and make your personal assumptions about life expectancy, etc. :

Open Social Security: Free, Open-Source Social Security Calculator

opensocialsecurity.com

 

[Tin Man]

The Social Security break even, on average, seems to be around 75 +/- years old. Live longer than that and deferring to age 70 to begin works out better. But starting early at least increases the odds of getting something back.

Wait until the “full benefits” age of 67 and die one month before turning 67 and you and your heirs receive absolutely nothing back after paying into the program over your entire life.

Married couples/surving spouses complicates the math. Continuing to work if electing to begin taking benefits before 67 complicates the math.

One thing that is pretty easy, anybody that is sick and won’t live well into their 70s will be best off starting as soon as possible (age 62),

Changes in legislation isn’t really something that can be assumed. I really don’t expect benefits to be cut to address the annual SS deficits, but who knows?

Mitch McConnell objected to increasing the pay threshold for SocSec and FICA. When pressed, he stated the two programs will have to adjust downward the benefits payed out when the trust funds run out of money. That’s one politician’s take on elder Americans’ future. We don’t know if the promises made to us as we paid into the systems for 50+ years will be kept during our lifetimes. Tail end baby boomers gonna get screwed, or politicians have to make the systems whole to meet the promises made to us. It sucks, but that’s the reality for which we must try to plan.

 

[AdoptedVOL]

Wish we could opt out of both Medicare and SS. Terrible return. Don’t call them an investment.

Medicare has been more expensive than I thought. I’d have benefitted from an experience-based insurance plan. I’m active and good genes.

SS = Employee rate of 6.2% with equal Employer match (total 12.4%)

Medicare = 1.45% Enployee + 1.45% Employer (total std 1.9%)

In all for some type of minimal social safety net and happy to pay for those truly in need due to circumstances beyond control.

 

[Go aeiou]

Cataracts are common for people in their 60s. That procedure is covered by regular Medicare rather than vision insurance though.

Yep, you don't need glasses to drive after that. State of TN Drivers License center wants my glasses on when I get my picture taken for my new license.
And the procedure is painless. Over in a few minutes.

 

[Thunder Good-Oil]

Yep, you don't need glasses to drive after that. State of TN Drivers License center wants my glasses on when I get my picture taken for my new license.
And the procedure is painless. Over in a few minutes.

Both of my parents had it done and it was amazing how much better their vision was compared to mine.

 

[K-town Vol Fan]

It is incredibly complicated. And insurance companies and the government’s interests are counter to citizens making decisions that are best for them.

Murica....

 

[Thunder Good-Oil]

Wish we could opt out of both Medicare and SS. Terrible return. Don’t call them an investment.

Medicare has been more expensive than I thought. I’d have benefitted from an experience-based insurance plan. I’m active and good genes.

SS = Employee rate of 6.2% with equal Employer match (total 12.4%)

Medicare = 1.45% Enployee + 1.45% Employer (total std 1.9%)

In all for some type of minimal social safety net and happy to pay for those truly in need due to circumstances beyond control.

I only brought up the political angle because it is something to consider when choosing among the various options. If SS is going to have a fiscal meltdown then that is another reason to begin taking SS benefits ASAP (age 62).

 

[Thunder Good-Oil]

Murica....

I bet for individuals unable to make their own decisions and that don’t have family to chose for them, that the government will automatically put them on an Advantage plan. But maybe if they little income those are the best plans for them anyway.

 

[AdoptedVOL]

Advantage plans are cheaper as long as you are healthy. Have a health problem and you will be better off with regular Medicare and a supplemental plan.
At 72 I can tell you that most people that age have health problems.
Do your own calculations.
Your coverage options:

Your coverage options

Once you’ve signed up for Part A and Part B, you can choose between Original Medicare and Medicare Advantage.

www.medicare.gov

Just find a broker to advise you in plan selection. My Cigna Advantage Plus plan has been good.