What I Have Learned About Medicare Supplement Programs

How many people took Operations Research in college? Who remembers how to set up a system of simultaneous equations and solve for min/max? I remember doing it, but not exactly how. Deciding on a medigap vs. medicare advantage vs. a straight up drug plan vs. the former employer's really expensive gold plated supplement is starting to feel like solving a system of equations.
If you, gentle reader, are approaching 65, I can not recommend strongly enough that you start examining your options ahead of time. Perhaps I am the only procrastinator on the planet, but Jim and I left it a little late.
First, know that Medicare does not pay for everything. Often, a supplemental policy of some sort is financially prudent.

Here is what we think we know so far.

• You have a 6 month window after turning 65 during which you can buy a medigap policy with no underwriting (this means looking at your medical history to determine if you're well enough to insure).
• You have a 3 month window after turning 65 to do something about Part D, which is drug coverage. Failure to do this will result in fines, and I think a life long increased cost to have Part D.
• Medicare advantage programs are basically Medicare Part C. They have low monthly premiums (Humana offers 2, one is $24, the other is $36). They pay a little more on top of what Medicare pays, but they limit your yearly out of pocket costs to $3 or $4k. They include drug coverage, with copays. They also have some vision and dental which Medicare doesn't. If you do not see the doctor often, this may be a good option. There will be co-pays for some services. Both PPO and HMO plans are available. Due to our moving about, we have to have PPO.
  
• Medigap policies are named A - F (or L or something). Plan F is a Plan F is a Plan F. So go for the lowest cost, highest rated carrier. At present this would be Mutual of Omaha. They charge $103 a month, and pay all ( I think ) the deductibles, and there are no copays.
• Drug benefits are extra if you have a medigap policy. The coverage plan you select depends on what meds you are taking. Each plan has its own formulary and rate schedule.
• Neither Medicare advantage plans nor purchased drug coverage protect you from the donut hole. When the amount of money you paid (including your deductible if you have one) and your insurer paid for your drugs hits $2840, you're in the hole. You stay there until your TROOP (true out of pocket) hits $4550. Then money flows your way once again. I am still fuzzy on the math that gets you to the $2840. I think it's important to know the retail cost for a non-generic that the plan you are considering has negotiated with the pharmacies, I think that's the largest factor in the events driving you to the edge of the donut.
• All plans are local. You have to get something that is offered in your zip code. If you move, rates will probably change. Some states have more plans than other states. We're SD residents, and we appear not to have so many options.
  
• There are many brokers on the web. Some only broker medigap, some broker medigap and medicare advantage plans. Be aware of what they're selling, because that will determine what they tell you about.
• AARP offers plans underwritten by United Health care. They are different in that they don't start significant questions about your health until you've been on medicare for 3 years.
• Everything changes every year. Every dang year you will have to revisit your plan to make sure your non-generics are still covered and that they didn't move into a more expensive tier. There is no fire and forget.
• Changes must be made during the open enrollment periods which are generally Octoberish to early Decemberish.
  

I'm writing this to synopsize what I think I know, and to point out that this is something that will not be accomplished over a couple of days. As I said, I may be the only person on the planet who did not realize how time consuming this is, but I didn't. Now you do.
Having only ever worked for one employer, who provided gold plated coverage, I never had to know any of this stuff. They provided it, I used it. This has been a very enlightening experience for us.
Nothing in this post can be taken as being accurate. This is what I think I know, which might be totally wrong, so do your own research.

Medicare Lesson #1

If you apply for Medicare and Social Security to commence simultaneously, the Medicare premium is deducted from the SS check. If you apply for Medicare without SS, you must find a way to pay for it.
In order to have the premium payment deducted from checking, or applied to your credit card, you must fill out a form. The form is not available on the website, it must be mailed to you. This will take 2 to 3 weeks. We asked for the form on the phone, I do not know if there is something on the website that allows you to request the form.
So, that's our first Medicare lesson.

Riding and Medicare

Today it warmed up so we went out to Fantasy Island. This flag marks the southernmost confluence of trails. One comes in here from the south or from Rez, and either goes north or back to the southern parking lot.

I saw this in a tree at the Shark circle. We're not sure why it's there. Mountain bikers - what can you say?

So, I have closure on an item (note the use of the singular preposition). I finally got my bike shorts from Terry. First I ordered mediums and they were tight, I exchanged for larges and they were huge, so I re-exchanged for mediums, and these seem to be a better size. Terry has issues with consistency in their sizes and more annoyingly in their receiving department. It takes them 12 to 14 days to open a returned package. I realize they're a small company, but 2 weeks?
We continue to rassle with Medco. Drugs by mail is a beautiful thing, but getting it set up every year is such a pain. It seems like the wheel must be reinvented on an annual basis. We're not done yet.
Jim is starting the enrollment process for Social Security/Medicare/Supplemental Medicare programs. We thought we had more time, but apparently one must do it 90 days in advance of being 65. So this will be added to the mix of things that must be done by the end of the month before leaving for the continent. I think my head may explode. All of the enrollments are online, maybe it'll go smoothly, but I doubt it, it's the gubmint. One does wonder when one became so damn old.
I think maybe if it doesn't go smoothly, I'll document the bumps in the process so that those who follow behind us in years can be prepared.