Navigating the Medicare Maze

Those of you who live in a country that believes ensuring adequate healthcare for all of its citizens is the right thing to do, may find this post puzzling. Feel free to gloat.

Recently, my husband became eligible for Medicare. After 64 years of being either covered by his parents’ healthcare plan or the one provided by his employer, his upcoming 65th birthday presented him with a dizzying array of healthcare plans and options – often with similar descriptions and letter designations – that he needed to choose from. Adding to his stress was the knowledge that he had a limited time window, a wrong decision now could be costly in the future, and, since my healthcare coverage is tied to his through his work until I turn 65, his choice directly affected me.

Even though my husband had officially retired from his company over six years ago, he continued to receive our healthcare coverage through them. With his impending birthday, he had to decide whether to switch to the company’s over 65 retiree medical plan or opt-out and dive into the Medicare pool on his own. There were pluses and minuses with both options, but, once we realized that leaving his company’s plan would force me to find coverage on the costly open market, we decided to stay.

Despite remaining under his company’s program, he still had to decide which plan they offered was best for us. I won’t go into all the details but, again, each option carried with it a set of consequences, and it wasn’t always apparent what those might be. We found ourselves trying to predict the future, including aliments, health challenges, and even if and where we might move at some point. This is one of many instances when navigating the Medicare maze, a crystal ball would have come in handy.

And, we are among the lucky ones.

We have healthcare coverage that we can afford and that is fairly robust. We are currently in good health, and we have the mental acuity – with a lot of research and careful reading – to understand the options offered and the possible ramifications of each choice.

We also know that can change.

The company or the government can – and most likely will over time – tweak the plans, and probably not to our benefit. We will most likely face health challenges as we age and our capacity to read and understand complex subjects and make sound decisions will probably fade over time. All of these likely progressions will impact our experience accessing Medicare.

It has been a month since he officially became a card-carrying member of Medicare. We are confident hopeful that we have made the right decisions for our situation. The financial penalties for non- or delayed-decisions (and there are a few so be careful) have been avoided. And, we have set things up so that we can make desired adjustments once I reach 65.

If you, or a loved one, turns 65 soon, I encourage you to start doing your homework now. There are many decisions to make and missing certain deadlines can be costly. If you haven’t already, soon you will find yourself flooded with mailings from various insurance companies and organizations that offer guidance (some better than others). You might feel overwhelmed and/or confused enough to want to just ignore it all together. Don’t.

Attend a few seminars if you can. Talk to your friends, family members, and colleagues. Ask how they made their decision and if they’ve found any helpful resources. One company you might want to check out is Boomer Benefits. They have a great website that contains a lot of information, answers to common questions, videos, and webinars. Most areas also have local Medicare insurance advisers who might be able to help you sort through the various options (at no cost to you).

Good luck and stay as healthy as you can. The best healthcare plan is the one you don’t have to use.

Author: Janis @ RetirementallyChallenged.com

My blog is about travel, relationships, photography, and whatever else pops into my head (even, sometimes, issues surrounding retirement and aging).

96 thoughts on “Navigating the Medicare Maze”

  1. At 65 going on his company’s retirement plan in order to continue the company’s health plan for you, may put him in a penalty position with Medicare. If he is on the company plan but no longer employed, Medicare will look at it as not complying for the rule (unless he is using the plan to supplement Medicare and then he will miss the no underwriting rule for medicap if he ultimately wants that). Please relook at this carefully as it can have major ramifications

    1. Thank you for your response, it seems like you have a handle on this. My husband is on Medicare. His company’s plan acts as a medi-gap plan with a qualifying drug plan and does comply (we double and triple checked). I’m on a separate portion of the company’s benefit program. Your response is a great example of how complicated it can be and how important it is to do our homework.

      1. I have not read all of what I’m sure are many wisdome filled responses. As a federal government retiree with retiree insurance, the retiree insurance (and almost all retiree insuranceI know of) does act as a medigap policy, and almost ALL of them have better drug coverate than part D. Medicare guided me to keep my health care. Now, the feds allow me to suspend my health care a for zero cost advantage plan, with the understanding that if the governmentgets rid of advantage plans, I can simply come back. But I don’t have dependents to deal with. One of my bog followers is on the opposite side, she’s the insurance carrier who is younger than her husband-what a headache

        1. Hi Barb. I think my husband’s retiree insurance acts as a medigap policy too. When I become eligible for Medicare, we’ll look everything over again and decide what’s best for us. Of course, if we do decide to leave his company’s plan, there is no going back. So many decisions, and it’s not all that clear-cut. I’m glad everything worked out well for you.

  2. I have yet to hear of any health system that is any where near perfect!! Most people have insurance over there working life as did we via Les’s workplace. When you need it the most as in over 65, or ill health, the cost is prohibitive. Many cancer drugs are costly though many are subsidised and many are not available in NZ due to the cost.

    Luckily at this stage, we have a reasonable public health system. Though for non-urgent [depending on pain] cases such as hip replacements the waiting list is very long. The health system will be under significant strain for many countries as us baby boomers creep up to “retirement”.

    What is of concern is how the elderly are treated in the public health system. With comments from a nurse, who made this flippant comment, “do you know how much a pint of blood is worth?”. Horrifying to know that this situation happened to a close family member who is over 70.

    1. It seems that most healthcare systems are broken in one way or the other. Unless you have Oprah’s money (or, are a politician) we are stuck with whatever our particular system provides us. You are right about the upcoming strain the Baby Boomers will put on the programs. In addition to the fact that many of us haven’t taken care of ourselves over the years, just the “normal” ailments of aging are just around the corner. That nurse’s remark was horrible… was she trying to make the person feel guilty of needing blood?

      1. I am not sure what the motive of the nurses comment. I suppose some people may think it is a waste of tax payers money to spent on people over a certain age. Do they include drink drivers? It made me think and very annoyed when I heard what had happened to her. She is a strong woman though at that moment she was vulnerable not feeling well. Or else that nurse would have got a reply!
        Another issue is that many young people are being denied certain medications due to the cost. Might make people anti money spent on the elderly.
        Janis, your post has certainly been thought provoking.

          1. No I haven’t written a post about healthcare when we were housesitting. What we did have was full medical care, which costs a wee bit of money though it was something we wanted to have for peace of mind. We got a worldwide cover so if we changed our minds where we went it was not a problem. All depends on where you travel. Turkey wasn’t a favourite with insurance companies!! We never had to claim in the four years we were travelling to Europe. On previous shorter trips we used the insurance attached to our credit card.

  3. Here in Canada we have a universal health-care system. Some people believe it is ‘free’ health care, but it is paid for by everyone who pays taxes. It is a government run monopoly that suffers from the failures typical of such enterprises. Over time, the government can only keep the cost of the services under control by eliminating services. This forces citizens to buy extra coverage from private insurers. (So, no, I’m not going to gloat!)

    1. I think many of us from the U.S. look at the universal healthcare programs in Canada and other countries with envy. I can’t believe anyone actually perceives it as being “free” but most studies indicate that the overall cost is less than our system. Although I understand why (given that services are being cut or just average wait times) private citizens would want to buy extra coverage, wouldn’t it be nice if everyone could get reasonably-priced, quality care on the same, level playing field (I know, magical thinking).

  4. In Canada, we have a good public health plan, with all hospital care, operations and doctor’s visits (including specialists) covered. We are grateful, but not smug, knowing that nothing is certain forever! There are disadvantages such as long waitlists for some operations, and no coverage for drugs, eye glasses or hearing aids. But I sympathize with those, like you, who have to figure out the maze of Medicare, and hope that someday soon, you too will have universal health care.

    1. In the years since the introduction of the Affordable Care Act in 2010, it appears that more and more people are realizing that having heath coverage access for everyone is actually a good thing. We are grateful that Medicare is still available, I just don’t understand why it has to be so darned complicated.

  5. We muddled through Medicare decisions several years ago. Things have gone well for us so far. I’m glad you wrote as you did for those who haven’t realized they need to weigh things carefully.

    1. I’m happy to know that you are doing well with the Medicare choices you made. Going in, we had no idea that there were so many decisions to be made and, how the wrong decision (or no decision) could cost us. I have talked to several people who thought, as long as they were covered through their work, they didn’t need to sign up.

  6. Hi, Janis – I’m with Diane (STLF) on this — grateful but not smug. The first comment by Lois made me extra grateful that thre is one (extremely) complex system that I will not need to figure out. Fingers crossed!

    So glad to see you posting again. Pressure from friends?

    1. I don’t understand why it has to be so complicated, especially as we get older and are often less able to piece all the options together. I got my first taste of the crazy system when I was caretaking for my dad when he was in his 80s and 90s. There was absolutely no way he could have understood it all.

      (And, yes, a certain friend “encouraged” me to finish up this post and hit Publish 😉 .)

  7. Great advice. Even though I worked for a health insurer for many years, I also find the array of choices confusing. Our refusal as a nation to provide adequate, affoyhealth care for all is shameful. When some politicians decry the cost, they conveniently neglect to acknowledge the huge marketing expense of having all those confusing options.

    1. I think a lot of people think that signing up for Medicare (if they even realize they need to sign up) is just a matter of checking a few boxes. I guess they could easily pick a few options, but, as we discovered, each choice can impact other choices down the line. Of course, those politicians who are trying to scare people away from “socialized medicine” forget to mention that what we have costs so much more.

  8. I too am grateful but not smug about our health care system. It is currently under a major overhaul here in Ontario by a government I do not trust. Although there are no guarantees and life is full of the unexpected, it appears the best course of action is to remain as healthy as possible!

    1. I imagine that people must be pretty concerned that the government is tweaking the system. As I said it my post, that seldom turns out to be a benefit for most. Staying – or getting – healthy seems to be the best option. Even if the healthcare system is good, we’ll feel a lot better.

  9. Great advice, Janis. I signed up for Medicare Part A last year and stuck with my employer plan until I retired. Now I’m on my husband’s employer plan but there are forms that need to be filled out by the employer verifying coverage so I won’t be penalized later when I sign up for Part B. So complicated! I went to an independent insurance broker who did a compressive evaluation of all the available plans taking into account my personal situation and it was so helpful. I will go back and see him when I’m ready to sign up for the entire Medicare plan. And I also advise doing all this research well in advance of the date you need to sign up. You don’t want to be sweating things out at the last minute and make a crucial (and expensive) mistake!

    1. We met with an advisor also and found the service to be very helpful Even though he knew that we weren’t ready to go on straight Medicare yet, he was happy to discuss all the options available. He even came to our house. You are right, people need to start early to research all the options. Putting it off could mean choosing the wrong plan for your particular situation, or you could end up paying a penalty well into the future.

  10. Hi Janis,
    Although we are not there yet -Dan and I continue to carry insurance from our school districts in retirement – your point is well taken. I just wrote recently regarding how difficult the health care system is to manage and how patient “unfriendly ” it really is. This certainly extends to the insurance world, including Medicare.
    If our system is confusing and frustrating for those of us in relatively good health with our mental faculties sharp, how do individuals who are struggling with these things manage adequately or successfully?
    I deliberately avoided insurance in my post because it was a huge, additional story. There must be a way to streamline the system. There is no perfect plan – even folks in countries with universal care acknowledge this. But certainly we should be able to do better.

    1. Hi Nancy. I just read your healthcare post (not sure why I missed it… I also subscribed to your blog again, I hope it sticks this time 🙂 ) and it reminded me so much of when I was caretaking for my mother and father. If my brothers and I hadn’t been actively engaged, I shudder to think what may have happened (even with that, things got messed up). As I mentioned in an earlier reply, I got my first taste of the confusing Medicare system at that time. Absolutely no way would my parents have been able to deal with it if they were on their own.

  11. Now, here’s a topic that hits a hot button with a lot of us. My husband’s company carried retired employees’ insurance for many years but then transitioned to a HSA, giving us a base amount based upon earnings, and then we have to make similar decisions on medical, dental, vision, and prescription plans. It all seems to come back to ‘pay it now or pay it later.’ We wonder each year if this benefit will continue. So far so good.

    1. I understand the one size doesn’t fit all, but I don’t get why it has to be so confusing… and scary. I also can’t blame the companies for changing things around too; healthcare for employees is terribly expensive. I imagine most of them would like to get out of that business too.

  12. We went through this when my wife turned 65 (I was still working). I turn 65 this year, and at least I have a better idea of what to do. They don’t make it easy to understand, and the companies that really are selling essentially the same thing, go out of their way to make you think they have a better mousetrap.

    1. I hope that, when I turn 65, our recent experience will help guide us through. My fear, of course, is that everything will change and we’ll have to re-learn it all. And, you are right, the plans are very regulated so they are pretty much the same, no matter how colorful their marketing pieces are.

  13. Hi, Janis, we were dealing with the same overwhelm and confusion when my husband approached 65. Then we discovered that there are insurance consultants who have a contract with Medicare to help people make their M’care decision. We made an appointment with him. He asked us to bring the names of all physicians Bill sees for anything and all prescriptions he uses. He entered the information into his computer program and brought up the best policies for us–that cover current and expected need. Then we discussed the options and costs and chose the one that was the best fit. We did all this in about an hour and there was no charge. We meet with him every year at renewal time and either change or renew the coverage, depending on whether there’s a new, better plan, or if anything has changed in our health (I’m now on it, too). These Medicare insurance contractors are in every state. They’re paid by Medicare and they have no agendas or “favorites.” We’ve guided several friends to these consultants as they approached the age of M’care decision-making and they all agree that it made a huge, confusing puzzle–one with important consequences–easy and comfortable. I can’t recommend this route highly enough.

    1. I’m glad you described your good experience with a Medicare insurance consultant. We met with one too and he was very helpful. I suggest that anyone who is in the Medicare maze (or, about to enter it) take advantage of their services (try to get a referral from a friend, if possible). The Boom Benefits company I mentioned also provides that service. Gosh knows, we need all the help we can get!

  14. Oddly enough this has been a topic of conversation around our house lately. Neither one of us is of the age to get involved in Medicare, but we know it’s coming and that, like you said, changes will be “probably not to our benefit.” Not looking forward to any of this, but thanks for reminding me to get going with our research.

    1. The experience was eye-opening for us and we were glad that we got started early. Fortunately, my husband had former work colleagues who were also retired and, being about the same age, dealing with the same issues. I’d say that it’s never to early to start looking at your options, but, then again, who knows what will be changed over time.

  15. I believe that ensuring adequate healthcare for all of its citizens (free at point of use but paid for by taxes) is the right thing for a country to do, but I’m certainly not going to gloat. We had that but are moving away from it. I feel angry that your government enforces such a dreadful and uncaring system on you and also that, largely because of Brexit, American healthcare providers are trying to muscle in on our own National Health Service. Until now, Scotland has been protected by having its own NHS but that protection might disappear with Brexit. The utter selfishness of people who don’t want to look after others is beyond belief.

    1. I wasn’t aware that Brexit could impact your healthcare system (I bet no one mentioned that downside to the voters). I’m sorry that we are exporting our morally-bankrupt, healthcare scourge to your shores. Resist! 🙂 My fingers are crossed that it works out for you and you remain under your NHS.

  16. We were fortunate that my husband’s company provided a healthcare counseling company when the time came. It’s complex and multi-layered and the irony is that’s it’s for seniors, some of whom have diminished reasoning skills. I always advise friends to get all elective surgeries done while they are on their employers plan as it’s so much easier.

    1. It’s almost as if an evil committee got together with the specific intention to create an utterly confusing system that is full of expensive gottchas. We could muddle our way through it this time, but I wonder how easy it will be in the future. It’s really shameful.

  17. I live in the most expensive insurance market in the country, Southwest Colorado. Since I am self-(un)employed, I quit buying insurance several years ago and pay as I go. My husband is on Medicare and I will be in eight years. One thing I find interesting as a self-pay patient: the doctors spend more time with me, looking at me, not their computer. I’m happier with the quality of care and I save thousands of dollars by not having insurance. Of course, some horrible health issue could come up, but I think it’s a worthwhile bet in my favor right now.

    1. My fingers and toes are crossed for you to stay healthy. I’ve heard other people say that doctors spend more time, and their fees can be negotiated when they self-pay. That is definitely a plus. I’m glad it’s worked out for you so far… I’m not sure that I’d be that brave.

  18. Hi Janis – The mental transition from 64 to 65 years old was easier for me than that dreadful Medicare kerfuffle. My husband had turned 65 two years before me, and fortunately knew of the necessity for him to keep his employer insurance until I turned 65 also. We don’t live near a Kaiser facility anymore, but I remember how they streamlined the process, and really wished we could have used their familiarity with what-to-do. You are wise to have taken it so studiously 😉 I agree that the best advice is to stay as healthy as possible for as long as possible – but that requires more than a bit of luck!

    1. You sound like you were in a very similar situation as we are. We were with Kaiser and liked them but we kept hearing that they were good for certain things, not so much for others. My husband made the decision to go elsewhere once he joined Medicare, so I had to change too. I guess we’ll see if that was a good decision… I agree about needing a ton of luck to remain healthy. There is a lot we can do ourselves, but genetics/luck/circumstances come into play also.

      1. Janis – we had the same concerns about Kaiser. Looking back, though, I realize how every decision has its complexities. I guess having to keep track of it all is one way to keep up our mental excercise as we age 😉 – personally, though, it’s one aggravation I’d rather give up.

  19. Your post and comments by others is helpful, Janis, and something Hans and I will be looking at closely in a few short years. We both turn 60 at the end of 2019, and are probably truly retiring at age 66. I’m on Hans’ City’s Kaiser insurance HSA plan (means high co-pay but less $ from the paycheck). I go to the doc more than Hans, so we will be looking closely at these decisions before we know it! Kaiser has a senior plan that looked interesting when we looked at plans during open enrollment, but that is years away. Who knows how much things may change during that time?

  20. These are still good problems for you to have had, Janis. So many Americans have such limited choices — or not choices at all. My sister had me assist her last year in deciding to stay on a pretty good Part C (i.e Advtantage) plan or switch back to Part B. For about two weeks I was knee-deep in the minutiae, going back and forth with her on a daily basis about . At one point I told her she was lucky because no matter which one she chose, she was still in wonderful hands compared to so many people. America’s healthcare is a tragic example of a patchwork rubric at best. – Marty

    1. You are right, Marty, we are lucky. And, thank goodness for Medicare. I don’t think it needs to be that confusing, but I am grateful that we have the coverage. It is tragic and it’s definitely a patchwork system. I doubt that this is what they’d design if it could be done over. I bet your sister appreciated your help sorting everything out with her.

  21. Thank you for this valuable information Janis – especially the Boomer Benefits site. I will be turning 63 next month so I have a little time to get up to speed and plan to use a Medicare contractor to help sort it out. I am on Obamacare now and I was on the Obamcare website and an ad popped up for free consultations by “Your Lowest Quote” and I had not tread too deeply into the Obamcare site and gave them a call. I had a great guy who took my info and got me on a plan and it was painless. I switched there when the Humana coverage I had was getting raised to almost $800.00/month and that did not include optical or dental. I still don’t have optical or dental and pay it myself and get a senior/10% discount from each of them. I know this insurance firm does Medicare consultations so I hope they are still in business when I approach 65. It’s terrible that they make things so difficult. My mom used to lament about that all the time. My grandmother had a heart condition for decades before she passed away – she never paid for specialist visits, any meds, nothing – all paid for and had been like that for years (she had OHIP, Canadian health insurance).

    1. When we initially thought that, once my husband transitioned to Medicare, I’d have to go on the open market, I was shocked at the costs. Fortunately, it worked out that I could still be covered under his retirement plan. I’m glad that you were able to find a lower price… hopefully with good coverage. They’ve made so many detrimental changes to the original ACA that it appears, while prices go up, services offered go down. Definitely take advantage of a consultant when you start researching Medicare. They seem to do a good job of breaking down and explaining your options.

      1. Thanks – I am dreading it quite frankly. I stayed on COBRA for nearly 18 months after my boss and I left the firm and went out on our own. He had healthcare from his wife who was a schoolteacher (they are both on Medicare now). At least I had dental and optical then. The out-of-pocket costs for dental/optical is amazing. I got a notice in today’s mail that there was a data breach for the ACA site for Total Healthcare which is what I have. I’m surprised it hasn’t happened earlier. They said our SS#s were not compromised but they draw the premium directly from my checking account so not pleased to hear that.

  22. We crossed this quizzical river a couple of years ago and once the decision was finally made, we’ve been very pleased. I think that although we did a ton of research, we have been fortunate that information was properly and honestly represented. I do agree with you that it could change, and not for the better, at any time. I do agree with you that the goal should definitely be preserving good health and needing the system as little as possible. And I also agree that it’s necessary to begin early. It is a very big decision to make! I hope it is as smooth for your husband as it was for us, Janis. Very helpful post!

    1. Thank you, Debra! The transition has been pretty smooth so far. He had his first, get-to-know-you appointment with his new doctor on Monday. Surprisingly, though, out of that meeting, he needed to make an appointment with a specialist. Turns out there is a six-month wait. Those that talk negatively about long waits in countries that have universal healthcare probably haven’t had much experience with ours.

  23. It is very true that in Europe one is completely covered by health insurance just by being a citizen and paying taxes. It is shocking that some Americans, the majority? consider comprehensive health care to be some outrageous social luxury. The U.S. system as everyone knows is totally broken and most Americans are one serious illness away from bankruptcy. And the drug industry is a whole other story!!

    One of the things that I try to focus on is staying in the best health possible as the food we eat is so closely linked with our health. Having had a cancer scare over ten years ago, I started to do a lot of research and changed my lifestyle and diet completely to be primarily plant based and to include yoga, meditation and reduced stress. At this point, not living in the U.S. but in Sri Lanka, health services are way more reasonably priced the same as in many places in Asia and there are many with great health care services at low cost (for example Bangkok to name one that comes to mind). Our concerns are more around when we travel to the U.S. and if anything were to happen while we were there (hopefully not).

    A sobering and interesting post.
    Thank you
    Peta

    1. Hi Peta! I think more and more people here are realizing how important having some sort of universal healthcare is. Dumping the ACA used to be a rallying cry for right-leaning politicians. Now, they don’t talk much about it because their base likes having healthcare (imagine that). Unfortunately, they have done a lot to weaken the program so it isn’t nearly as robust as it used to be. I don’t blame you for worrying about having the seek out medical treatment while in the U.S. While we are grateful to have healthcare insurance, it does seem that it should be more of a right than a privilege.

  24. Oh Janis… what a nightmare to go through all the plans, make decisions with a deadline, and hope you made the right choice. To be honest, Mark and I face this whole ordeal almost every year, because, as you point out, health care organizations or plans change. Our real nightmare started when Mark was “thrown off” the plan he had been on for years in 2017. (My plan is entirely different, since I’m not a citizen but a resident.) I could write a book about the amount of phone calls, research, poking, Mark informing MassHealth employees, our plan being cancelled because of a mistake made by then (on the verge of needing to see specialists), the fact that we can’t prove our income until it’s too late to submit (we need our tax forms to do so, being self-employed, but they need evidence at the end of the previous year) and so on. The frustration, the time spent, the misunderstandings, the lack of knowledge at the source, the being on hod for hours and then be disconnected to start all over again… I can go on and on. And, we often wonder how other people in our situation do this, as Mark HAS the time, resources, and intelligence to deal with this. Over and over again.

    Anyway, in the end, we did manage to get hold of important people at MassHealth, who actually know their sector and are able to make changes and adjustments. Having their personal information and desire to help is our golden ticket, as, once again, something went wrong and Mark needs to be in touch with them again. Sorry for the moan. All I actually wanted to write is that I understand what you both had to go through…

    1. The system really is crazy. I’m sorry that you had to go through all that, especially since it was because of someone else’s mess-up. Thinking that you might not have healthcare when you need it would be frightening. I really think most of the people who say that the US “has the best healthcare in the world” just haven’t used it much or have been faced with a serious illness. As confusing as all the deadlines, options, and repercussions are, imagine having to navigate all of it if you are starting to have diminished mental capacity due to age. My mother and father would have been very vulnerable if not for their kids helping them out. I hope everything works out well for Mark!

  25. Good advice; you do have to pay attention when it comes time to go on Medicare. But, imho, it’s well worth the trouble. I’ve been on it a couple of years now, and Medicare, along with a decent supplemental plan, has worked out quite well for me. But your last advice might be the best … try to stay as healthy as you can. The best healthcare plan is the one you don’t have to use.it’s been great.

    1. Certainly having Medicare is MUCH better than having to find coverage on the open market, especially as we get older. I am grateful for the program… I just wish it didn’t have to be so complicated. I’m glad that it has worked out so well for you and my fingers are crossed that our experience will be good too. My husband just met his new doctor and likes him very much so, so far, so good.

  26. I appreciate you tackling this topic – which is obviously of enormous interest to your readers. For good reason! I usually bite my tongue around friends about health care. For so many years when my guy worked for a larger company, we didn’t have to really ‘worry’ about health care insurance because it was taken care of through the company. Didn’t seem too much of a financial burden to us, since it was part of his yearly income in a way, and I could be part of that. As an independent worker (I’ve worked for many different companies but all as a part-time employee or consultant), I’d have no insurance if not for my guy. Then. He decided to go into business for himself (with my encouragement). Suddenly, we had to obtain health insurance on our own, and the costs were astronomical. He also has a chronic condition so we either couldn’t get insurance for him, or they upped the price so high we were struggling. Finally, he got old enough for Medicare, which was really an enormous economic help for us. But. I needed to get my own insurance through Obamacare (which I’ve always supported). However, my monthly fee was over $800 and that was with a $4,000 deductible. How is THAT a good system? Health care is definitely broken in the U.S. Costs are just too prohibitive. On the other hand, both my guy and I believe that we also are in charge of our health, so as Peta mentioned above, we eat healthy, exercise, practice yoga and meditation and stay as healthy as possible. Also, agree with you about the complexities of signing up for Medicare. We are really intelligent people, yet had to spend hours and hours trying to understand the system. For those not as well-educated, or without the time to do this – it’s nearly impossible to make good choices.

    1. It seems that a healthcare system that discourages people from being entrepreneurs, following their dreams, and from innovating on their own can’t be good for our country. I had hoped that the original ACA – a not perfect program – would have been improved and strengthened. Instead, its detractors have done what they can to undermine it. Almost no one can afford an $800 monthly insurance bill (with a $4,000 deductible yet!!!). As far as Medicare goes, it appears to be more complicated than it needs to be, especially for our older citizens who may find the intricacies and all the choices overwhelming. We were able to muddle our way through… but how about in 20 years?

  27. Hi Janis, I appreciate you sharing the very complex questions you face making Medicare decisions south of the border. Reading through the above responses, I am sure you have helped readers. Especially when searching for resources, options, and as you said, “to do our homework.” I am grateful for our health care system in Canada especially when serious, life threatening care is immediately required. I truly wish the same for you.

    1. If only we had a crystal ball and knew in advance what our future medical care needs were going to be, it wouldn’t be so daunting. I think the system could have been made so much more user-friendly, but I imagine are were many hands in the pot – all with there own agenda – so it’s a complicated program. It would be nice to have something like Canada has, but I’m not keeping my fingers crossed.

  28. It seems you’ve hit a nerve, Janis, based on the number and depth of the comments. I work for a health insurance company and have a better than average understanding of how it all works and still get confused at times. My husband has chronic health issues, and I am beyond grateful for the healthcare coverage we have. I do worry some about the coverage and costs we will face when I retire. I definitely plan to use an expert to help us wade through the options. I also live a healthy lifestyle in hopes of holding onto my good health, which of course is the ultimate goal!

    1. After helping my father with his coverage, I thought I had a pretty good handle on it too… silly me 🙂 The independent Medicare representatives are a godsend for anyone trying the navigate all the various plans. I wish you the best of luck when you are ready to sign up. And, of course, stay healthy!

  29. Janis, good post. Medicare actually works pretty well, but for those reading there are a couple of musts. Part A (Hospital) coverage is a given, but you must sign up for the other parts. Part B (Doctors) through Medicare and Part D (Prescriptions) through an insurer are critical. You also could do a Medicare Advantage Plan that wraps these benefits together in a limited network, so make sure your Doctors/ Hospital are included. The other option you noted is the Medigap plans which supplement Medicare. The supplemental plans require a little more effort with claims filing, so know that in advance.

    Your comment about doing your homework is critical. Also, if the employer does not have retiree medical benefits, ask about COBRA options to compare to the ACA if you are not 65 and are retiring from the employer (note a covered spouse has rights as well). Many employers do not offer retiree medical benefits.

    Good post. Best wishes, Keith

    1. Hi Keith. Thanks for the great overview. I didn’t want to go into a lot of detail about what we decided to do and why in my post, especially since everyone’s needs are different. My big messages were: start early, do your homework, and know that there are people out there who can help. Although not perfect, my husband and I feel pretty good about what we choose and, most of all, that we can make adjustments down the road if need be.

  30. Janis, I knew we had to sign hubby up when he hit 65 (in less than 2 years), and I knew it wouldn’t be that simple. Now that I know I need to do homework and sort it all out, I’m putting it on my calendar to give myself 6 months to plan it! Thanks for keeping us aware of life pitfalls.

    1. Hopefully working through all the decisions my husband had to make will make it easier when I approach 65. I really suggest asking friends if they can recommend one of those Medicare insurance representatives. They know all the ins and outs and can help you decide what’s best for you. Yes… one of life’s little challenges (but grateful to have insurance!).

      1. Good thought! I will definitely ask around… there are lots of retirees from our company here in town that have had to work through it! (And having dealt with 2 major illnesses this year – one mine, one hubby, YES, I am very grateful for health coverage!!)

  31. Hi Janis! I’m checking in late here on this post because I just get notices once a week. Anyway, I didn’t know you were in the a similar boat as my husband and I. Thom just turned 65 in November so I was doing the big research push all last year. (yeah, he was relying on me to help with the choice.) Unlike you we never had employer insurance and have been shouldering the cost on our own with a high-deductible HSA account. The good news is that even going with a Plan F (one of the best choices of medi-gap IMHO) he/we are saving over $500 a month. I have a year and a half left but I’m REALLY looking forward to how much it will save me too. I agree things can change so it’s good to stay on top of it–but just the fact that we can finally get good health insurance (without a $6,000 deductible) and save so much money is a HUGE bonus for us. ~Kathy

    1. That is a huge savings! Although not as big, once both Paul and I are on Medicare, we’ll see some savings too. I am also grateful for Medicare, I just wish it didn’t have to be so complicated. If we had some sort of universal healthcare, I would imagine that there wouldn’t be any changes to make in our healthcare plans once we reach a certain age. Also, I worry a bit about being able to keep up with things as we get older. I know that my father wouldn’t have been able to do it on his own. Anyway, I hope my post has encouraged people who will be entering Medicare age in the near future not to put off their research because it’s not as easy as checking a box.

  32. I am very grateful for universal health coverage in Canada, and I vote against any party that proposes to reduce coverage or advocates for privatizing it. Although our coverage is universal, the plans differ across provinces. In BC, we have to pay a monthly fee of $37.50 for our coverage. The fee is waived for low income residents. Also many employers cover this cost. BC is the only province in Canada that has a monthly fee. The current government has promised to eliminate the fee in 2020.

    The basic medical services plan covers all visits to doctors, specialists, and hospital stays and treatments, plus some paraprofessional services (massage, physio). However, drugs, dental, ambulance rides, counselling, and vision care are extra (extended health). Many provinces have plans in place to cover most of the cost of drugs for seniors and low income residents. I purchase extended health coverage that provides full or partial coverage for all of these things except dental, and also provides extra medical coverage when traveling outside of Canada. I think it is a good system.

    Jude

    P.s. your blog no longer recognizes me and I have to type in my credentials every time I comment.

    1. Just to clarify – the cost of drugs are largely covered by our universal medical plan. Individually, we just pay a dispensing fee and a small fraction of the cost. The extra extended health coverage, or a free supplementary provincial plan in the case of seniors and low income residents, pays for that small drug cost that we otherwise would pay up front, and this varies by province.

      Jude

      1. Wow, $37.50 monthly fee… I’d be happy paying twice – or more – that amount! Although not perfect, I don’t know many Canadians who would trade their plan for ours.

        I’m sorry that you are having troubles commenting. I’m not sure what I can do to fix that (as far as I know, once someone makes a few comments, they no longer have to jump through any hoops) but I’ll look into it. I know that my commenting experience is very different on my iPad and iPhone (where I often can’t “like” a post or comment, and usually have to type in all my info) than on my desktop. I hope the hassle won’t keep you from commenting – I always enjoy hearing from you!

  33. Hello Janis

    I feel your pain. A good source of information is Alliance on Aging. The booklet you pictured did not help me at all. I have also sat through a seminar for a local agency that basically becomes Medicare Advantage. The nice thing about them is they will be taking care of all the Medicare rig-a-ma-roll that I don’t understand. I have to wait until my husband retires to get this option though. I’m confident you and your husband made the right choice for you.

    Welcome to the wild side
    Laura

    1. Hi Laura. I don’t know why government publications are so often hard to understand… it’s almost like they want to keep us confused. Fortunately, there are a few helpful organizations to smooth the way. I think my husband and I have worked it out to our satisfaction… at least until I turn 65 and we have to make some new decisions.

  34. Thank you for the information. I am going to save this post. Hubby and I have 3 years until we turn 65, but it is never too early to get a plan and get our thoughts together. TYhis is such a confusing subject for many people (including me)!

    1. Hi Laurie. You are right that it’s not too early to at least start to think about it. I was amazed how many people I talked to seemed ill-prepared to make a well-informed decision… right up to their 65th birthday. The most important take-away I learned was to never assume. There are many details and some decisions could cost you money and choices down the line. Good for you to start now.

    1. It’s crazy, isn’t it? I firmly believe that anyone who thinks we have the best system in the world either, A) hasn’t used it or, B) has someone navigate through it for them. That website (and I’m sure there are others) at least helps make sense of it all.

  35. I still have a few years left yet before I have to navigate this part of our crazy system, but The Captain, who has dual citizenship, has had to navigate it, and the journey has not been an easy one. Sadly, being on the road, as joyous as it is, complicates matters and limits coverage. In his case, it has often made better sense to source care outside of the US and he pays for it out of pocket. But as we sail closer to home, he will likely need to consider treatment in the US should the need arise (which hopefully, it won’t for a very long time).

    1. The process was confusing enough with us living here in the US, I can’t imagine trying to work through it (and anticipate future needs) while at sea. Most of the US expats we have met in Mexico pay for their small medical needs out-of-pocket (which, of course in Mexico, is pretty reasonable) and travel back across the border for more complicated procedures. We all hope to never use our medical insurance, but chances are we will at some point. I just hope we made the right decisions!

  36. I hear you. My wife will turn 65 soon and the deluge of supplementary insurance offers is in full swing. We went to a seminar about 6 months back, but now that sign-up time is imminent we’ll be doing a refresher – tomorrow. We have a good idea which way we’ll jump, but still need to work out the transition process for the two of us, especially since I have a little longer to wait. Thanks for the good heads up.

    1. I wish you and your wife luck, Dave! I think attending multiple seminars is the way to go. There is so much information that it’s hard to absorb all at once. So far we are happy with our decisions… I hope you are too!

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