One of our major life changes is making the transition to Medicare. There is both good and bad news that comes with it. The bad news is we’ve hit the traditional elderly status age of 65. The good news is that healthcare costs could be vastly reduced, at least it was in our case. But there are some challenges, I mean “fun stuff” that needs to be dealt with whenever reaching this milestone. Fun stuff of which I hadn’t considered until it became a reality. Everyone’s situation is different and I’m no Medicare expert, but I can share a few things I experienced while making this retirement healthcare jump.
Retirement’s Magical Transition To Medicare
Reaching Medicare eligibility was something I was looking forward to after over 13 years of early retirement paying for my health insurance. In our case, my old corporate world career’s retirement benefit health insurance premiums consistently grew over the years. The last of which was $1,640 a month for the both of us. It came with a $2,400 deductible before it would enter into the 80% / 20% payout phase and a $4,800 out of pocket maximum. It was changed to a use-it-or-lose-it benefit so we didn’t dare leave it over the past 13 years.
Since we would come close to or hit the yearly out of pocket yearly max, I was budgeting $24K a year just for healthcare.
No need to express how much I was looking forward to ending that high amount of retirement healthcare costs. Here are a few fun things we dealt with during our transition to Medicare.
Becoming Disowned
My past 31 year career company started sending warning letters 6 months before my 65th birthday. My birthday is in June and I was receiving warnings that on May 31 my retirement healthcare benefit will end. I replied (verbally to the universe), don’t worry, I’m more than happy to ditch you and sign up for my transition to Medicare.
Timing Is Everything, So Is Social Security/Medicare Personnel Funding and Staffing
If you’re not already collecting Social Security, in which case you would be auto applied to Medicare part A and B, you can apply for Medicare 3 months before turning 65 to 3 months after. If you applied before your birthday, your Medicare coverage starts on day one of your birthday month regardless of when in the month your birthday is.
With my having a June Birthday, February was the earliest I could apply. I went online and applied on Feb 2. It responded that my application would be reviewed and I should get my Medicare cards in 2 to 4 weeks. 6 weeks turned into 8 weeks and it was still not finalized. Running out of insurance coverage time, I had to call and wait out a queue lasting over an hour.
The Social Security-Medicare agent was nice but couldn’t assist because a local agent had my case.
I let them know I was within weeks of losing health insurance so they gave me another telephone number to call the office where the local agent worked. That did ring through and answered quickly but my assigned agent wasn’t at their desk. The person who answered my call said hold on and they would look at it for the hold up reason to spare me phone tag with the other agent. They returned within a minute and said, done. Should get your cards in a week or 2 at most. They did come before my regular insurance ended and I was able to get my Medicare number in enough time to pick and establish my additional medicare insurance coverage.
Applying for my wife’s Medicare 6 months earlier went far smoother. She applied online and her cards came within 3 weeks without drama or delay. But her transition to Medicare began in fall of 2022. Apparently Social Security/Medicare staffing and funding fell behind and they have been trying to catch up ever since.
My advice, apply at the earliest date and set some followup reminders on your calendar. Phone calls and patience may be necessary.
OMG! The Mail And Phone Solicitation Calls
Medicare is big business and a lot of people are ready to earn their bucks guiding you through the process. How do they all know we are about to turn 65 and who shared all of our contact information? It was a relentless attack of sales calls and junk mail. We went through all the material provided by the Medicare folks and from their online portal or other sites. We also talked to people in our community who were already on Medicare to get a feel for their experiences.
I did end up talking to such a Medicare consulting group tied to my old corporate retirement benefit plan. Frankly they didn’t offer any magical information above what we had figured out on our own. More about that below.
My advice, pay attention to the mail from the Social Security/Medicare Administration. Talk to others in your area about their Medicare choices and experience. Their experiences carry weight because as all of the annoying Medicare TV commercials say, it’s all about your Zip Code as to what is available to you. What people warned us about, sometimes available doesn’t necessarily equate to great.
Making The Drug and Medigap vs Advantage Decision
Some of the fun in all of this is having the choice to pick your healthcare insurance based on your unique situation. It’s super important to understand what Medicare does and doesn’t cover and there are some important decisions to make.
As mentioned, I did go through everything that Medicare sent and what is on their online portal. I also looked through most of the advisor-consultant mail sent to us to see what additional information that they had to offer. But I really appreciated and took to heart what others in my area said about their Medicare experiences.
Basically, Medicare Part A and Part B doesn’t cover everything, mostly hospital stays and doctor’s visits. To get coverage for drugs, lab work, things Parts A/B don’t cover you can expand with a Part C Medicare Advantage plan that takes the place of Medicare A/B and beyond.
If a Part C route isn’t your thing, then you can decide to stay with Medicare A/B and add a Part D (Drugs) and a Medicare Gap plan (Part G).
These C, D, G plans are offered by private insurance companies. The Part C Advantage plans are geared around being In-Network to save money on your premiums and offer extras that the regular Medicare doesn’t offer, like Dental. Once again, think In-Network with these which depending on where you live or travel to, can be limiting.
The Medicare consultants seemed to really push the Part C Advantage plans in their mailings and conversations.
It smelled to me of higher commissions causing bias. Perhaps they work great in some Zip Codes where their Part C Advantage networks are more robust but most people we talked to locally warned us to stay clear for many reasons. That advice and our being sick of In-Network insurance hassles had us go the standard A, B, D, G plan route. So far so good. I am saving $1K a month in premiums and thousands in deductibles over our pre-Medicare retirement days.
Good Luck With Any Specialized Medical Equipment
I happen to have what is considered specialized equipment to treat Central Apnea. Basically a BiPAP and the wife uses a CPAP. I was in the middle of a replacement period where my insurance set up a goofy 9 month lease-to-own arrangement.
That insurance company is now gone and out of the picture where they were covering 80% since my meeting my deductible. There’s still 4 months of payments left and Medicare doesn’t cover these. That’s all up in the air for me now. Checking the my portal account on the medical provider’s billing shows I owe zero but I think they are still trying to rework things. I did see a Medicare denied coverage billing statement to them. Like I said, FUN stuff with this transition to Medicare.
Starting All Over- I’m Talking Deductibles
Depending on what month your birthday is in you may be meeting 2 full-year deductibles within a single year for 2 different insurance plans. In my case I have a June birthday so I had just met my insurance deductible in the first 4 months of the year. Just as I was getting some insurance coverage in the 80% 20% split I have to start all over again with the Medicare deductibles. Fortunately they are small in comparison.
My advice is proactively try to plan any non critical Medical procedures using a deductible management strategy. Also take the time to update all your prescription providers and doctors of your insurance change.
With only a couple of months into this it’s all still shaking out. I do love not seeing the big $1,640 Health Insurance debit hit my bank account anymore.
The smaller Medicare debits are much easier on the eyes and budget. I anticipate that it will take 6 months to understand exactly where I’m at, budgeting wise.
The one time we had to go in for an outpatient surgical procedure for my wife was much smoother on Medicare too. Before they would insist on an up-front payment because of questions on deductible coverage. Now they just later bill what isn’t covered by Medicare.
In essence what I think is important to take away, making the transition to Medicare isn’t a lights on/off situation even for something that happens thousands of times a day in this country. It’s still not all that fluid or seamless. Go figure. You have a lot of decisions to make and live with until the next open enrollment period. It’s important to stay involved with everything with followups until it’s all established and settled.
All in all I will say Medicare seems to be a lot better to deal with once you do get it setup.
