\n\tDan Weissmann<\/span><\/p>\n

Medicare may sound like an escape from the expensive world of U.S. health insurance, but it\u2019s more complicated, and expensive, than many realize. And decisions seniors make when they sign up for the federal health insurance program can have huge consequences down the road.\u00a0<\/p>\n

Host Dan Weissmann speaks with Sarah Jane Tribble<\/a>, KFF Health News\u2019 chief rural health correspondent, about one of the biggest choices seniors must make: whether to enroll in traditional Medicare or the privatized version, Medicare Advantage.\u00a0<\/p>\n

Then, Weissmann shares practical tips about how soon-to-be seniors can avoid penalties and pick the plan that\u2019s right for them.<\/p>\n

\tDan Weissmann<\/p>\n

\t\t\t
\n\t\t\t\t@danweissmann\t\t\t<\/a><\/p>\n

\t\t\tHost and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago’s WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.\t\t<\/p>\n

\n\t\tCredits\t<\/h3>\n
\tEmily Pisacreta
\n\tProducer<\/p>\n
\tAdam Raymonda
\n\tAudio wizard<\/p>\n
\tEllen Weiss
\n\tEditor<\/p>\n
\t\t\t\t\tClick to open the Transcript\t\t\t\t<\/p>\n
\t\t\t\t\t\tTranscript<\/strong>: The Medicare Episode<\/strong>\t\t\t\t<\/p>\n
Note: \u201cAn Arm and a Leg\u201d uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.<\/em><\/p>\n
Dan:<\/strong> Hey there\u2013<\/p>\n
So, one thing we have never talked about on this show? Medicare. You know, that free-health-care thing you may expect to get when you turn 65.<\/p>\n
It\u2019s been on a list of things where I\u2019ve been like, \u201cthat is TOO big, and TOO complicated. I can\u2019t get my arms around that just now.\u201d\u00a0<\/p>\n
Especially because: There\u2019s this thing called Medicare Advantage \u2014 a kind of privatized version, run by insurance companies? Seems controversial, and REALLY complicated.\u00a0<\/p>\n
I\u2019ve been like, Maybe someday.<\/p>\n
And that someday? That\u2019s today. Or at least, we start today. Mainly because a colleague of mine just did a BUNCH of work that we get to piggyback off of.<\/p>\n
Sarah Jane Tribble:<\/strong> my name is Sarah Jane Tribble and I\u2019m Chief Rural Health Correspondent with KFF Health News.<\/p>\n
Dan:<\/strong> And as Sarah Jane reported on Medicare, she was surprised by how much she didn\u2019t know. And how much other folks didn\u2019t know either.\u00a0<\/p>\n
Sarah Jane Tribble:<\/strong> At Thanksgiving, when I was working on some of these stories, I have friends who are nearing retirement. They\u2019re not really close , but they\u2019re close enough to care and they\u2019re avid NPR listeners. And they were like, wait, so what\u2019s the difference between Medicare Advantage and Medicare? And I was like, they should know.\u00a0<\/p>\n
Dan:<\/strong> Who\u2019s going to tell them?\u00a0<\/p>\n
Sarah Jane Tribble:<\/strong> Right?<\/p>\n
Dan:<\/strong> That\u2019s us, I guess.\u00a0<\/p>\n
Sarah Jane Tribble:<\/strong> This show will help tell them.<\/p>\n
Dan-in-tape:<\/strong> I hope so. I hope so.\u00a0<\/p>\n
Dan:<\/strong> Because this traditional-Medicare vs Medicare Advantage \u2014 it is a high stakes decision, it happens when you first sign up.<\/p>\n
And here\u2019s the big thing that Sarah Jane learned: if you sign up for Medicare Advantage, at that point, when you first get on Medicare, you\u2019re pretty much stuck with it. And some people end up with buyer\u2019s remorse. Big time.<\/p>\n
And actually, beyond that choice \u2014 between Medicare Advantage and what\u2019s called \u201ctraditional Medicare\u201d \u2013, there\u2019s literally a whole alphabet soup of other choices you\u2019re gonna need to make. Each with a price tag, and maybe some big trade-offs.\u00a0<\/p>\n
And there\u2019s been a lot of questionable information that comes at people. TV shows that older folks watch have been full of ads with People Who Were Real Famous in the 1970s.<\/p>\n
J.J. Walker: <\/strong>Hi, I\u2019m Jimmy JJ Walker.\u00a0<\/p>\n
Joe Namath: <\/strong>Hi, I\u2019m Joe Namath.\u00a0<\/p>\n
William Shatner:<\/strong> William Shatner here with an important message. I\u2019ve been on Medicare for longer than I\u2019ll admit, and it sure has changed.\u00a0<\/p>\n
Dan:<\/strong> Some of these ads make claims that sound too good to be true<\/p>\n
J.J. Walker: <\/strong>And get this, I\u2019m entitled to an extra 100 a month. That\u2019s 1, 200 a year added to my social security check. And I was like, dyn-o-mite!<\/p>\n
Dan:<\/strong> Last year, the feds finalized new rules to try and rein in sketchy claims from some ads like these.\u00a0<\/p>\n
So understanding what\u2019s going on, it\u2019s a big deal. We\u2019ll run down what I\u2019ve learned so far, including some extremely expert guidance.\u00a0<\/p>\n
Our expert, by the way, set me straight on a bunch of things, including, sadly, this: Medicare isn\u2019t actually the free-health-care thingy some of us hope for.<\/p>\n
Sarah Murdoch: <\/strong>Unfortunately, I think a lot of people think, Oh, Medicare is going to be free , it unfortunately is not.<\/p>\n
Dan:<\/strong> The question is how much it\u2019s going to cost you\u2013 in dollars, and maybe in your choices managing your own health care. And surprise! It\u2019s super complicated.<\/p>\n
So by the time we\u2019re done, you\u2019re gonna understand the difference between Medicare Advantage and traditional Medicare \u2014 and<\/em> how to start sorting through the alphabet soup.We\u2019ll also leave you with some solid resources to figure out what your best choice might be when the time comes, either for you or somebody you care about.<\/p>\n
Let\u2019s do it.<\/p>\n
This is \u201cAn Arm and a Leg,\u201d a show about why health care costs so freaking much, and what we can maybe do about it. I\u2019m Dan Weissmann. I\u2019m a reporter. I like a challenge \u2014 so the job we\u2019ve chosen here is to take one of the most enraging, terrifying, depressing parts of American life, and bring you something entertaining, empowering, and useful.<\/p>\n
OK, when it comes to Medicare, the biggest choice folks have to make is between traditional Medicare \u2014 run directly by the government \u2014 and Medicare Advantage plans, which are run by private insurance companies. And again, that\u2019s plans, because a bunch of different insurance companies offer different Medicare Advantage plans.\u00a0<\/p>\n
And last year, Sarah Jane Tribble started hearing from CEOs of rural hospitals.<\/p>\n
They were telling her: Medicare Advantage plans are killing us. We\u2019re spending a ton of time and money fighting with these insurance companies to get paid. And sometimes we don\u2019t get paid.<\/p>\n
Sarah Jane Tribble:<\/strong> And then I was also hearing about patients showing up at the hospital and these local hospitals saying, \u201coh, no, we actually don\u2019t take your plan.\u201d And so you\u2019ve got these small town, you know, folks who have only one hospital and a long, you know, large radius. And they would show up and the hospital would be like, \u201cAh, you\u2019re going to have to pay out of pocket because we don\u2019t take this Medicare Advantage plan.\u201d And the patient, of course, would be like, \u201cbut I\u2019m on Medicare, you\u2019re supposed to take care of me.\u201d<\/p>\n
Dan:<\/strong> Yeah. Isn\u2019t that deal with Medicare? Everybody accepts it. You get on Medicare, you\u2019re taken care of?<\/p>\n
Sarah Jane Tribble:<\/strong> I began wondering, how much does signing up for a Medicare Advantage plan actually affect the care you get?<\/p>\n
Dan:<\/strong> And the answer seems like: Maybe a lot.\u00a0<\/p>\n
A little Google searching turns up a lot of headlines about claims getting denied, and about hospitals dropping Medicare Advantage plans.\u00a0<\/p>\n
And it also turns up a report from the Inspector General\u2019s office at the federal Department of Health and Human Services.\u00a0<\/p>\n
And if you\u2019ve got regular insurance, you may be familiar with what\u2019s called \u201cprior authorization.\u201d That\u2019s when your provider needs to get the insurance company\u2019s OK, their authorization, before going ahead with whatever they think you need \u2026 a test, a procedure, a prescription.\u00a0<\/p>\n
And sometimes the insurer issues a denial. They say no.<\/p>\n
The Inspector General\u2019s report looked at a random sample of denials by Medicare Advantage plans. They found one out of every eight denials was for care traditional Medicare totally covers.\u00a0<\/p>\n
Which, you know, as you get older, if you got sick, you could have eight of these requests in a month.\u00a0<\/p>\n
Sarah Jane started talking with patients.<\/p>\n
Sarah Jane Tribble:<\/strong> I called one gentleman in Washington state, and he wanted out of his Medicare Advantage plan and he couldn\u2019t get out.<\/p>\n
Dan:<\/strong> That gentleman is Rick Timmins.\u00a0<\/p>\n
Rick Timmins:<\/strong> I\u2019m a retired veterinarian. I\u2019m living on Whidbey Island in Washington, which is just north and west of Seattle.<\/p>\n
Dan:<\/strong> Ooo, wow! So, is your life just a succession of paddling trips \u2026<\/p>\n
Rick Timmins:<\/strong> Ha ha ha ha ha ha.\u00a0<\/p>\n
Dan:<\/strong> and swims in the sound?<\/p>\n
Rick Timmins:<\/strong> Yes, sort of. Although the water is a little bit too cold for me to swim in. So, it\u2019s kayaks when we get out into the water.<\/p>\n
Dan:<\/strong> Rick signed up for Medicare Advantage in 2016 after attending an informational seminar run by an insurance agent.\u00a0<\/p>\n
Rick Timmins:<\/strong> \u2026 nice guy, and he said, you know, the best thing to do is to get a Medicare Advantage plan because they cover everything, and it\u2019s, it\u2019s far less expensive than traditional Medicare,<\/p>\n
Dan:<\/strong> OK, why would that guy say Medicare Advantage is far less expensive than traditional Medicare? I mean, for one, a lot of us think Medicare\u2019s gonna be free.\u00a0<\/p>\n
And even if it\u2019s not<\/em>, why should \u2026 I mean, how could \u2026 one kind of Medicare be more expensive than another?\u00a0<\/p>\n
We\u2019re gonna have a lot<\/em> of details on this later, but here let\u2019s just get into the difference between Medicare Advantage and traditional Medicare. Traditional Medicare is run by the government. Government pays all the bills.\u00a0<\/p>\n
BUT traditional medicare only pays 80 percent of everything and you\u2019re on the hook for the other 20 percent. There\u2019s no out-of-pocket limit. Let\u2019s bring back Sarah Jane Tribble to briefly say what that means:\u00a0<\/p>\n
Sarah Jane Tribble:<\/strong> You could pay out the wazoo. It could bankrupt you.\u00a0<\/p>\n
Dan:<\/strong> Out the wazoo. Because you know: Medical bills, hospital bills \u2026 they can get into the tens of thousands, hundreds of thousands of dollars. Twenty percent of that is paying out the wazoo.\u00a0<\/p>\n
To avoid that risk, if you\u2019re on traditional Medicare you basically need another insurance policy \u2014 a supplement, often called Medigap \u2014 like it covers the gaps that traditional Medicare leaves.\u00a0<\/p>\n
Some people get Medigap from their old employers. But most people have to pay for it. It can get expensive.\u00a0<\/p>\n
Medicare Advantage plans, plans run by private insurance companies, DO have an out of pocket limit. You don\u2019t have to buy a supplement. That\u2019s an advantage.\u00a0<\/p>\n
Also, there are things traditional Medicare doesn\u2019t pay for \u2014 like dental care, and glasses, and hearing aids. Medicare Advantage plans generally DO cover those things.\u00a0<\/p>\n
And as Rick recalls, the insurance agent pushed Medicare Advantage kinda hard.<\/p>\n
Rick Timmins:<\/strong> Basically what he said was, yeah, if you want to sign up for traditional Medicare, I can help you for that, but if you want Medicare Advantage, which is a much better program\u2026<\/p>\n
Dan:<\/strong> Then sign right here. So Rick did. Fast forward five years. Rick\u2019s wife notices a little bump on his ear.\u00a0<\/p>\n
Rick Timmins:<\/strong> She said, you should get that looked at. I have a family history of melanoma. My two sisters have had melanoma.<\/p>\n
Dan:<\/strong> Rick says he saw his primary care doc, then started trying to get his insurance company\u2019s promise that seeing a specialist would be covered. He says he called and called, over more than six months.<\/p>\n
Rick Timmins:<\/strong> It was not a fun time. I mean, I didn\u2019t know what it was, but I knew that it was growing and it was sore and you know, I was frightened. It\u2019s like you can\u2019t think about anything else when you\u2019re wondering about what\u2019s happening with this little lump.<\/p>\n
Dan:<\/strong> Rick says when he did get seen, the thing was the size of a dime. They found it was malignant, cut his earlobe off, and scanned his lymph nodes. They were clean, but he spent a year on immunotherapy. Now he says he\u2019s getting scans every six months.<\/p>\n
Sarah Jane Tribble asked Rick\u2019s insurance company about all this. They said they wouldn\u2019t comment on his case.<\/p>\n
Meanwhile, Rick says he\u2019s had enough of Medicare Advantage. On traditional Medicare, you don\u2019t need anybody\u2019s OK to go see a specialist. You just go.\u00a0<\/p>\n
But of course to switch to traditional Medicare, Rick would need a supplement, a Medigap policy.<\/p>\n
Rick Timmins:<\/strong> Otherwise, uh, you\u2019re just forking out thousands of dollars if you have any issues.<\/p>\n
Dan:<\/strong> Because you\u2019re on the hook for 20 percent of everything. No out of pocket limit. Paying out the wazoo.<\/p>\n
But Rick doesn\u2019t think he can get a medigap policy. Because in most states \u2014 including Washington, where Rick lives \u2014 insurance companies don\u2019t have to issue you a Medigap policy if you have pre-existing conditions.\u00a0<\/p>\n
Not unless you sign up for it when you FIRST enroll in Medicare.\u00a0<\/p>\n
Rick Timmins:<\/strong> The insurance companies can tell me, no, we don\u2019t want to insure you. You\u2019ve had too many issues. Look, you had a knee replaced. You had cancer.\u00a0<\/p>\n
Dan:<\/strong> This is what made Rick\u2019s story, and the whole Medicare situation, so striking to Sarah Jane Tribble.<\/p>\n
Sarah Jane Tribble:<\/strong> It\u2019s sort of shocking, actually, right? The Affordable Care Act passes and makes it so that everybody with pre-existing conditions can get insurance no matter what, but it leaves out the people who might need that the most, who are 65 and older.\u00a0<\/p>\n
Dan:<\/strong> Four states have laws that do require Medigap insurers to take everybody. But only four.\u00a0<\/p>\n
Sarah Jane Tribble:<\/strong> If you\u2019re Rick in Washington state, you could get rejected.<\/p>\n
Dan:<\/strong> I talked to someone else who would like do-overs on signing up for Medicare Advantage. In the 1970s, in his 20s, Robert Wolpa was a professional musician, a guitar player.\u00a0<\/p>\n
Robert Wolpa: <\/strong>Played in bands up and down the west coast. Went to Canada with an Elvis act. It was really a lot of fun.\u00a0<\/p>\n
Dan:<\/strong> And he worked in call centers for decades. When he turned 65, he says he got inundated with ads and calls and flyers.<\/p>\n
Robert Wolpa:<\/strong> I got one of the mailers says have a free dinner on us. And we\u2019ll teach you all about Medicare, the ins and outs of Medicare.<\/p>\n
Dan:<\/strong> He went, and got what he thinks of in retrospect as a hard-sell pitch for Medicare Advantage, which he bought. And, over time, he\u2019s gotten disillusioned.\u00a0<\/p>\n
He says, you know, it\u2019s one thing to have to call to get a pre-authorization or a referral. \u201cIs this doctor covered? No. Oh okay. Which doctor is covered?\u201d It\u2019s a lot of calls. And then there\u2019s the difficulty of getting through the calls.<\/p>\n
Robert Wolpa<\/strong>: It got harder and harder and more frustrating, talking to some of these people who didn\u2019t know what they were doing. I mean and I\u2019ve been a call center guy too for most of my life but these poor people. I mean they are so undertrained and underpaid.<\/p>\n
Dan:<\/strong> At least, that\u2019s the impression Robert gets, as a guy who spent years working in call centers.<\/p>\n
Robert has priced out a Medigap plan. Because he\u2019s got pre-existing conditions \u2014 HIV, a pacemaker \u2014 it would be expensive: four hundred seventy nine dollars. Which is almost a third of what he gets from social security.\u00a0<\/p>\n
Robert Wolpa:<\/strong> And I said, okay. Next option.\u00a0<\/p>\n
Dan:<\/strong> I suggest maybe his work background gives him an advantage in jumping through hoops, like making all those calls: both knowing how to navigate, and having empathy that could help him keep his blood pressure from spiking too hard. He says, yeah, up to a point \u2026 For now.\u00a0<\/p>\n
Robert Wolpa:<\/strong> And I think to myself, you know, I\u2019m 71. I just turned 71 in November and I\u2019m, I\u2019m a little, I\u2019ve got, I\u2019ve got a little of the HIV cognizant crap. Like my, my short term memory is gone.<\/p>\n
Dan:<\/strong> After talking with Robert, this part really gave me pause. I mean, dealing with insurance companies and all the attendant hassles is hard work, right?<\/p>\n
It\u2019s not the kind of job I\u2019d wish on somebody as they get older and start slowing down.\u00a0<\/p>\n
And it could be a job that increasing numbers of people are signing up for: Last year the number of people in Medicare Advantage plans became the majority of people on Medicare.<\/p>\n
Alright, I may have scared the bejesus out of you. I\u2019m a little scared myself.\u00a0<\/p>\n
But I\u2019ve got some super-practical information coming your way. I talked with one of THE best people in the country to find out: What should I know BEFORE it\u2019s time to sign up for Medicare?<\/p>\n
Turns out the answer is \u2026 A LOT. That\u2019s next.<\/p>\n
This episode of \u201cAn Arm and a Leg\u201d is produced in partnership with KFF Health News. That\u2019s a nonprofit newsroom covering health care in America. Their reporters, like Sarah Jane Tribble, are amazing. I\u2019m honored to work with them.<\/p>\n
OK, so, if you want traditional Medicare, you pretty much need to choose it when you first sign up for Medicare.\u00a0<\/p>\n
And signing up for Medicare turns out to involve a LOT of choices, and a lot of different price tags.<\/p>\n
And some big potential pitfalls. It is wild, the things I\u2019ve learned.\u00a0<\/p>\n
I found maybe the best person in the country to learn from.<\/p>\n
Sarah Murdoch: <\/strong>My name is Sarah Murdoch. I\u2019m the Director of Client Services at the Medicare Rights Center, and we\u2019re a national non profit that assists with Really any Medicare issue that you could conceive of and we serve like a massive quantity of people on our helpline, about 20, 000 people in a year.\u00a0<\/p>\n
Dan:<\/strong> What would you want people to know when they\u2019re like, say, I don\u2019t know, 64, uh, about the choices there? Because I think a lot of us think, like, \u201cOh, I\u2019m going to turn 65. I\u2019m going to call the federal government or maybe they\u2019ll call me and I never have to think about health insurance again, or healthcare, or you know, paying these ridiculous prices.\u201d And I think that\u2019s not exactly true. Right?<\/p>\n
Sarah Murdoch: <\/strong>To start off, they\u2019re not going to call you.\u00a0<\/p>\n
Dan:<\/strong> And not only do I have to call THEM, I have to do it on time. Apparently, I get a seven month window \u2014 like three and a half months on either side of my 65th birthday. And I better not miss it.\u00a0<\/p>\n
Because if I do, well, number one: I have to wait until the following January to sign up. And till then, I better have some OTHER health insurance. Because no Medicare for me.\u00a0<\/p>\n
And not only that: When I do sign up, I\u2019m gonna have to pay a penalty. When Sarah told me this, I was like, \u201care you kidding me?\u201d<\/p>\n
Sarah Murdoch: <\/strong>No, I wish I was kidding, but unfortunately, unfortunately not. So yeah, there are very stringent, kind of, enrollment windows that people need to stick to.<\/p>\n
Dan:<\/strong> I kind of couldn\u2019t take it all in at once. I was like, \u201cSo either I have to wait, or else I have to pay?\u201d Is that it? Sarah\u2019s like, \u201cno, dummy.\u201d<\/p>\n
Sarah Murdoch: <\/strong>You would have to wait AND you would have to pay. So, \u2026<\/p>\n
Dan:<\/strong> You\u2019re going to charge me for not having Medicare? That sounds awful.\u00a0<\/p>\n
Sarah Murdoch: <\/strong>I love talking to people like you said when they\u2019re 64 because you can kind of head off the pitfalls before they happen.<\/p>\n
Dan:<\/strong> Oh, get this: The penalty is not a one-time late fee. It bumps up what you pay for the rest of your life.\u00a0<\/p>\n
Holy crap! I had done some homework before talking with Sarah, but I had not seen that one coming at all. So yeah. Don\u2019t miss that deadline! And about the rest, the part I thought I\u2019d done my homework on, boy did Sarah fill in a lot of blanks.<\/p>\n
So, just to get started, here\u2019s the big picture: Medicare is alphabet soup. There\u2019s part A, that covers hospital bills. There\u2019s part B, that covers doctor visits. And there\u2019s part D, for drugs.<\/p>\n
What\u2019s part C, you\u2019re asking? Oh, that\u2019s Medicare Advantage. If you\u2019ve got that, it basically takes over for A, B and\u2013 a lot of the time, D.\u00a0<\/p>\n
And let\u2019s say you don\u2019t want to go with Medicare Advantage when you first sign up for Medicare, because for most people, this is like your one shot at getting traditional Medicare, accepted just about everywhere, no questions asked.<\/p>\n
Then, you\u2019ll need to buy a Medigap supplement, so you don\u2019t end up paying out the wazoo if you run into health problems\u2013 because traditional Medicare only pays 80 percent.<\/p>\n
But no matter what you pick\u2013 Medicare Advantage or traditional Medicare \u2026 it\u2019s gonna cost you. As we heard from Sarah right at the top of this episode\u2026<\/p>\n
Sarah Murdoch: <\/strong>I think a lot of people think, Oh, Medicare is going to be free, it unfortunately is not.<\/p>\n
Dan:<\/strong> Yeah, so each part has its own price tag \u2026 Or tags. Sarah walked me through it.<\/p>\n
And actually, the very first step involves some GOOD news.<\/p>\n
Sarah Murdoch: <\/strong>Part A, which is hospital and inpatient coverage is free for most people.\u00a0<\/p>\n
Dan: <\/strong>So, if you\u2019ve paid into social security and medicare for ten years, that\u2019s you. So, great.<\/p>\n
And unfortunately, that\u2019s where the easy, simple part\u2026 ends.\u00a0<\/p>\n
Next, we move on to Part B \u2014 doctor bills. Outpatient stuff.<\/p>\n
Sarah Murdoch: <\/strong>Part B has a monthly premium, uh, of $174\u2026 let me just get the exact, it\u2019s $174 and change,<\/p>\n
Dan:<\/strong> A hundred seventy-four dollars and seventy cents.\u00a0<\/p>\n
And important to note: Picking a Medicare Advantage plan does NOT mean you skip paying this part B premium, this 174 dollars and seventy cents. It applies to pretty much everybody.<\/p>\n
And folks with higher incomes \u2014 starting at 103,000 dollars \u2014 can pay more.\u00a0<\/p>\n
OK, that\u2019s part B. Doctor visits. On to part D for drugs.\u00a0<\/p>\n
Fun fact: This is 100 percent run by private insurance companies, actually.\u00a0<\/p>\n
Which, among other things, means it involves shopping for a plan. Every year.<\/p>\n
Sarah Murdoch: <\/strong>Those plans and their premiums change year to year. In New York, like, we would see them ranging from anywhere from like $3 monthly premium to $120. So all over the place.<\/p>\n
Dan:<\/strong> $3 sounds good, but I\u2019m guessing there\u2019s a catch.<\/p>\n
Sarah Murdoch: <\/strong>Yes, so not every plan is identical.\u00a0<\/p>\n
Dan:<\/strong> Some Part D plans cover more drugs than others. Some leave you paying more for the drugs they do cover. Which one is a good deal will depend on what meds you need.<\/p>\n
Ugh, sounds fun, right? Well, Sarah tells me there\u2019s actually a bit of good news here, because we\u2019re not on our own with this.<\/p>\n
Sarah Murdoch: <\/strong>Medicare does, on medicare.gov, have a really great tool called \u201cplan finder\u201d where people can enter their medications. It sort of matches up your medications with the plans that cover them in the most affordable way.\u00a0<\/p>\n
Dan:<\/strong> This is a huge relief, because shopping on my own? Yeesh. It looks like there are 21 different Part D plans in my area, so comparing all of them would be a big job.\u00a0<\/p>\n
OK! Now I\u2019ve got Parts A, B, and D. I\u2019m on the hook for, well start with $174.70, plus however much for drugs.\u00a0<\/p>\n
And if I still want traditional Medicare \u2014 just about everyone takes it, hardly any pre-authorizations to worry about \u2014 I still need a Medigap plan. Also called a supplement. And, again, now I\u2019m shopping for insurance from private companies.\u00a0<\/p>\n
And guess what? We\u2019ve got a whole new bowl of alphabet soup!\u00a0<\/p>\n
Sarah Murdoch: <\/strong>Yeah. So there\u2019s 10 Medigaps. They all have a letter.\u00a0<\/p>\n
Dan:<\/strong> Yeah and each letter has its own set of benefits and exclusions \u2014some have higher deductibles, others cover some extras, but they\u2019re all supposed to protect you from paying out the wazoo.<\/p>\n
So for example, Plan G is the most comprehensive, and the most expensive. And of course, once I\u2019ve picked a letter, I\u2019m sifting through however-many companies offer any given plan in my area.\u00a0<\/p>\n
Where I live, in Illinois, it looks like there are 57 Plan G\u2019s on offer. Prices: A hundred thirty bucks to four sixty four.\u00a0<\/p>\n
But here\u2019s another little bit of good news for us. Because Sarah has a super important tip.<\/p>\n
Sarah Murdoch: <\/strong>I think it is very important for people to keep in mind there that all the G\u2019s are identical, right? A G offered by company 1 that\u2019s $500, versus the G offered by company 2 that\u2019s $300, have identical benefits, so there\u2019s no reason to pick the, um, more expensive.\u00a0<\/p>\n
Dan:<\/strong> I ask Sarah: Wait. How are any of these companies getting away with charging more for the exact same thing? Like, why would anybody ever choose the more expensive one? She\u2019s like, maybe they just don\u2019t know any better.<\/p>\n
Sarah Murdoch: <\/strong>Maybe they had that company, you know, when they were working and they have, you know, preconceived notions about it.<\/p>\n
Dan:<\/strong> So when people call the helpline, Sarah and her colleagues tell them \u2026<\/p>\n
Sarah Murdoch:<\/strong> Pick one that\u2019s the most affordable. Don\u2019t make some other selection for whatever reason you might imagine in your head.<\/p>\n
Dan:<\/strong> So of course it turns out in the case of Plan G, which just happens to be the example Sarah\u2019s using, there IS a caveat: In some states, there are Plan G\u2019s sold with a high deductible and lower premiums. Okay, more to watch out for. But in general, this is some really good advice right here.<\/p>\n
All of this leaves me with a big take-away:\u00a0<\/p>\n
Medicare is not free. There\u2019s that 174 seventy for the Part B premium \u2026 and then you may be looking at a bunch of money on top of that, for a Medigap plan.\u00a0<\/p>\n
Or, if you go with Medicare Advantage and avoid paying for a Medigap plan, you are looking at dealing with private health insurance companies that we all love so much.<\/p>\n
All the shopping for a plan:\u00a0 \u201cDo I get an HMO? A PPO? What\u2019s the difference again?\u201d\u00a0<\/p>\n
And then all the questions, all the run-arounds, all year round: \u201cIs my doctor covered? Is my doctor still covered this<\/em> year? Is the company gonna approve the care my doctor says I need? If they don\u2019t, what the hell am I gonna do?\u201d<\/p>\n
All of it left my colleague Sarah Jane Tribble pretty ticked off.<\/p>\n
Sarah Jane Tribble:<\/strong> The thing that blew my mind is how expensive it is to have any form of Medicare, right? It\u2019s not a free ticket for your health care. This is to me, the most outrageous thing that you\u2019re going into retirement, you\u2019ve lived your life, and America is supposed to give you this promise of Medicare, and then the promise is actually hundreds of dollars a month.<\/p>\n
Dan:<\/strong> Or you can save some money by signing up for Medicare Advantage, and hope it works out for you.\u00a0<\/p>\n
And hey: It does work for some people. My mom\u2019s on a Medicare Advantage plan \u2014 she\u2019s 93 and definitely sees a few doctors \u2014 and she\u2019s got no complaints.\u00a0<\/p>\n
Here\u2019s Sarah Murdoch from the Medicare Rights Center:<\/p>\n
Sarah Murdoch: <\/strong>When people ask, I think often, like, which one is better? It\u2019s like, that\u2019s, that\u2019s not \u2026 I can\u2019t answer that because people\u2019s needs are different. People\u2019s doctors are different. Where they live and their access to different services might be different. If you\u2019re in a plan that all your doctors take, then that\u2019s great. You can save some money that way too on those premiums.<\/p>\n
Dan:<\/strong> And hope the insurance company doesn\u2019t change the deal next year. And that your doctors don\u2019t decide to leave the plan.\u00a0<\/p>\n
OK, I\u2019m not trying to freak you out \u2014 or myself. And I actually have some good news, thanks to Sarah Murdoch.\u00a0<\/p>\n
Because: We\u2019ve covered a lot of ground on what you should know about Medicare. But holy crap, there is SO much more to know. Medigap plans are regulated by states\u2013 that\u2019s 50 different setups right there. Not to mention the ten different flavors of Medigap. And all the kajillion and one different Medicare Advantage plans out there.\u00a0<\/p>\n
And there\u2019s deals we haven\u2019t talked about too. Some people with low incomes qualify for Medicaid, which kind of serves as a Medigap. Some people can get government subsidies to cover that Medicare Part B premium. And, again, all of this is state-by-state: 50 different deals.<\/p>\n
So if you\u2019re looking at actually signing up for Medicare, you\u2019re gonna have a lot more questions than I can start to answer here.\u00a0<\/p>\n
And the good news is: You don\u2019t have to go to an insurance broker, like Rick and Rob did, and hope they steer you right instead of, you know, chasing a higher commission.<\/p>\n
Sarah Murdoch says every state has an agency you can call. They\u2019re called SHIPS \u2014 for State Health Insurance Assistance Programs \u2014 the A is silent, I guess. And their job is to give unbiased advice.\u00a0<\/p>\n
If you\u2019re in New York, you might even end up talking with Sarah or one of her colleagues.<\/p>\n
Sarah Murdoch: <\/strong>The SHIPS don\u2019t get anything. They don\u2019t have any financial incentive. We participate in the New York ship, like I don\u2019t care what plan you pick. I just want to help you pick something that is going to work for you. And that may be original Medicare with a Medigap and Part D. It might be a Medicare Advantage plan. It might be, you know, Medicare and Medicaid.\u00a0<\/p>\n
Dan:<\/strong> So if this episode is pitched at someone who\u2019s at or approaching age 64, the bottom line is like, go get on a ship. Go sail on a ship. Is that right?\u00a0<\/p>\n
Sarah Murdoch: <\/strong>Yeah. There\u2019s a central website, shiphelp. org, where you can just click on your state and it will kind of direct you to the phone number to call. So, they\u2019re there as a resource.<\/p>\n
This was a LOT. Let\u2019s just review:<\/p>\n
First: Medicare isn\u2019t free. Got it.<\/p>\n
Second: Don\u2019t forget to sign up on time! You could end up paying a late fee every month for the rest of your life.<\/p>\n
\u201cAn Arm and a Leg\u201d is a co-production of KFF Health News and Public Road Productions.<\/p>\n
To keep in touch with \u201cAn Arm and a Leg,\u201d\u00a0subscribe to the newsletter<\/a>. You can also\u00a0follow the show on\u00a0 Facebook<\/a>\u00a0and\u00a0 X, formerly known as Twitter<\/a>. And if you\u2019ve got stories to tell about the health care system, the producers\u00a0 would love to hear from you<\/a>.<\/p>\n
***To hear all KFF Health News podcasts,* click here<\/a>.<\/em><\/p>\n
And subscribe to \u201cAn Arm and a Leg\u201d on *Spotify<\/a>, Apple Podcasts<\/a>, Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n<\/div>\n***