Help with Medicare for Mom

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wassabi
Posts: 532
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Help with Medicare for Mom

Post by wassabi »

Hi Bogleheads. I need some help making sense of Medicare for my mother. I've searched around but have come across so many confusing answers that I'm hoping someone with experience can help us.

My mother is 67 (July birthday). She's been retired for ten years and has had insurance coverage through her retirement plan (Cigna). Her rates have increased each year and the coverage gotten worse to the point that she cancelled it last month (perhaps prematurely). She has medicare part A and we're trying to figure out how she can get parts B and C.

I'm trying to figure out:
1) can she enroll now for parts B and C?
2) will she pay a penalty for enrolling late even though she had group coverage since she turned 65?
3) anything else I need to do or be aware of to get her enrolled asap.

She's been stretched thin providing full-time care for my ill father so when she does have time to research it and make calls, she's so overcome with exhaustion and grief that she can't make sense of what anyone is telling her.

I greatly appreciate any help you all can offer to get on the right track.
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prudent
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Re: Help with Medicare for Mom

Post by prudent »

I would suggest calling boomerbenefits.com and having one of their reps do the legwork.
tallguy3891
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Re: Help with Medicare for Mom

Post by tallguy3891 »

wassabi wrote: Wed Dec 01, 2021 7:54 pm Hi Bogleheads. I need some help making sense of Medicare for my mother. I've searched around but have come across so many confusing answers that I'm hoping someone with experience can help us.

My mother is 67 (July birthday). She's been retired for ten years and has had insurance coverage through her retirement plan (Cigna). Her rates have increased each year and the coverage gotten worse to the point that she cancelled it last month (perhaps prematurely). She has medicare part A and we're trying to figure out how she can get parts B and C.

I'm trying to figure out:
1) can she enroll now for parts B and C?
2) will she pay a penalty for enrolling late even though she had group coverage since she turned 65?
3) anything else I need to do or be aware of to get her enrolled asap.

She's been stretched thin providing full-time care for my ill father so when she does have time to research it and make calls, she's so overcome with exhaustion and grief that she can't make sense of what anyone is telling her.

I greatly appreciate any help you all can offer to get on the right track.
The answers to your questions might require more information. Is your mother a federal, state, or local gov't retiree? Or, is her husband? Was she on a Medigap plan, or Medicare Advantage plan, or did she have Part B at all in the past or now? Was she on this recent insurance as an individual or as a spouse, or does she have the option to enroll on her husband's insurance? Or, was this insurance she recently cancelled through a private company retirement and does she still have time to get reinstated or re-enroll? If you want to provide more information it might help lead this discussion in a helpful direction for you. Not trying to be intrusive, but insurance and Medicare can go down many paths depending on one's personal situation.
twh
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Joined: Sat Feb 08, 2020 2:15 pm

Re: Help with Medicare for Mom

Post by twh »

wassabi wrote: Wed Dec 01, 2021 7:54 pm Hi Bogleheads. I need some help making sense of Medicare for my mother. I've searched around but have come across so many confusing answers that I'm hoping someone with experience can help us.

My mother is 67 (July birthday). She's been retired for ten years and has had insurance coverage through her retirement plan (Cigna). Her rates have increased each year and the coverage gotten worse to the point that she cancelled it last month (perhaps prematurely). She has medicare part A and we're trying to figure out how she can get parts B and C.

I'm trying to figure out:
1) can she enroll now for parts B and C?
2) will she pay a penalty for enrolling late even though she had group coverage since she turned 65?
3) anything else I need to do or be aware of to get her enrolled asap.

She's been stretched thin providing full-time care for my ill father so when she does have time to research it and make calls, she's so overcome with exhaustion and grief that she can't make sense of what anyone is telling her.

I greatly appreciate any help you all can offer to get on the right track.
She needs to get on this ASAP. Once you terminate a plan, you only have a certain amount of time to sign up for Medicare before you become subject to possible lifetime monthly penalties, in the case of Part B, or age/health based underwriting in the case of Part C, D or Medigap.

I don't know what kind of retirement plan she had, but she may already be in trouble. I'm thinking not, but the rules are complex.

It is confusing...here is a short primer...for those who know more, yes there are some missing details, but they aren't so important at this point...

Almost everyone gets Part A for no additional cost - that's hospitalization, but only 80% and the place needs to accept Medicare.

Part B cover doctors and non-hospitalization - but, only 80% and your doctor needs to accept Medicare.

Option 1:
For people that have Part A and Part B, they would also get a Part D drug plan and a Medigap policy to cover the 20% that Medicare doesn't pay.

Option 2:
There is an alternative and that's Part C. Part C is functionally mutually exclusive to A/B/D/Medigap. What happens is the Part B premium that is deducted from her SS check is sent to the Part C provider and the Part C provider is on the hook for all the care. Part C is also known as Medicare Advantage. Most, but not all, Medicare Advantage plans include drug coverage, but you can find some without.

Beware:
The kicker is that your mother could be denied or pay more due to health issues if she fails to act timely. If she acts timey, she is in the guaranteed issue period. Also, if you fail to get Part B or Part D when you should have and then get it later, there will be a lifetime monthly penalty. Some states are more or less generous on the timing.
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wassabi
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Re: Help with Medicare for Mom

Post by wassabi »

Thank you all for the replies. Your replies helped me to direct my research more into the important points and then I called medicare to talk about options with them. They told me we need to fill out the Part B application within three months of terminating the other coverage and also submit a proof of coverage form all to SSA.gov. SSA will review and determine if the previous coverage was 'credible'. If so, then my mother can enroll with no penalty or wait. If not, then she can enroll between 1 Jan - 31 Mar for coverage to start 1 Jul but there would be a premium penalty.

I think we have a plan of action now, but please let me know if there's something we're not considering or if the medicare rep did not give us complete/accurate information.

Thank you again for your time and help!
billfromct
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Re: Help with Medicare for Mom

Post by billfromct »

Since your mother is signing up for Medicare after age 65, I believe that she will need to get a “credible coverage form” (CMS-L564) in order not to pay the Medicare penalty for applying for Medicare after age 65.

She can get this form on-line & she will fill out the first section, then her company HR will fill out the 2nd section. This completed form will be required for her to apply for Medicare since she is over 8 months past her 65th birthday. It would be best to apply for Medicare in person but I don’t know if local SS/Medicare offices are open for in-person visits.

When I left my job a few years ago (I was a few years over age 65), there was no local company HR, so I had to fill out the form & send it to HR in another state by U.S. mail so they could complete the 2nd section. This all took time to complete & I had a limited time before I was taken off the company health insurance plan. Luckily I didn’t have any medical issues in the interim.

SS would not accept my current company health insurance card as proof of “credible coverage”.

bill
HomeStretch
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Re: Help with Medicare for Mom

Post by HomeStretch »

Given how busy your mom is, she can automate payment of her Part B premiums via deduction from her SS benefit or auto billed to a credit card/bank account.

In addition to enrolling in Medicare Part B, your mom should consider MediGap (Medicare supplement) and Part D (drug coverage) offered by various insurers.
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JoeRetire
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Re: Help with Medicare for Mom

Post by JoeRetire »

wassabi wrote: Wed Dec 01, 2021 7:54 pm My mother is 67 (July birthday). She's been retired for ten years and has had insurance coverage through her retirement plan (Cigna). Her rates have increased each year and the coverage gotten worse to the point that she cancelled it last month (perhaps prematurely).
She canceled her insurance? Now she has none? :shock:

Does your ill father still have insurance?
She's been stretched thin providing full-time care for my ill father so when she does have time to research it and make calls, she's so overcome with exhaustion and grief that she can't make sense of what anyone is telling her.
You, or someone else, needs to sit down with her immediately and figure this out.

There is professional help available: https://www.shiphelp.org/

Do it now.
This isn't just my wallet. It's an organizer, a memory and an old friend.
ModifiedDuration
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Re: Help with Medicare for Mom

Post by ModifiedDuration »

HomeStretch wrote: Thu Dec 02, 2021 5:24 am In addition to enrolling in Medicare Part B, your mom should consider MediGap (Medicare supplement) and Part D (drug coverage) offered by various insurers.
+1

She should also consider a Medicare Supplement (also called Medigap) Plan G, Plan G- high deductible, or Plan N.

Without a Medigap plan, she would have unlimited exposure to the 20% that Medicare Part B does not cover for doctors’ visits, but more importantly for 20% of all outpatient services (outpatient surgeries, ER visits, chemotherapy, MRIs, CAT scans, biopsies, lab tests, while being held for observation at a hospital, etc.). In particular, the chemotherapy can be extraordinarily expensive.

Also, at least an inexpensive Part D prescription plan, to at least provide catastrophic coverage.

A reputable broker, like Medicare Nationwide or Boomer Benefits, could help. No cost to your Mom, as the commission is paid for by the insurance company.
Last edited by ModifiedDuration on Thu Dec 02, 2021 8:19 am, edited 1 time in total.
egrets
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Re: Help with Medicare for Mom

Post by egrets »

I have Medicare and Medigap (AARP Medicare Supplemental.) I would never change to replacing them with a Medicare Advantage plan, because the latter puts one right back in the insurance company can deny stuff you may need situation. Medicare itself is much more honorable, and once Medicare pays its 80%, the Medigap plan is obligated to pay the 20%. I also have Plan D for prescriptions.
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thursdaysd
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Re: Help with Medicare for Mom

Post by thursdaysd »

Her employer should provide proof of credible coverage.

In addition to meeting with a SHIIP counselor (or whatever s/he is called in your state), I highly recommend reading the latest (4th) edition of "Medicare for Dummies".
Thursday's child has far to go
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