General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsEnrolling in Medicare
A friend reached out to my husband letting us both know that as we are both within 6 months of our 65th days, we need to start applying for Medicare now or face penalties (i did not know you could face penalties for not applying!) He also sent us a link for this:
https://medicareschool.com/
Anyone ever heard of them or have dealings with them?
Edited to add: If this not the right forum for this, let me know and I will move it.
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W_HAMILTON
(10,333 posts)Look up reputable and highly rated Medicare brokers in your area and schedule a meeting with them to have them help guide you through the process.
If one tries to steer you into Medicare Advantage, run away as fast as you can.
Response to W_HAMILTON (Reply #1)
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W_HAMILTON
(10,333 posts)I will admit that I don't know the ins and outs of how Medicare interplays with Medicaid, but even that doesn't sound quite right because if you qualify for Medicaid, usually Medicare is the primary payer with Medicaid being the second payer (rather than a Medigap plan, if you do not qualify for Medicaid) -- Medicare Advantage doesn't even have to come into the picture.
And, yes, all the benefits you list are straight out of a Medicare Advantage commercial, but what they don't tell you is you are at the whim of a for-profit insurance company that will very much act like one. Medicare Advantage is great -- until you get really sick, which you almost assuredly will at some point when you are aged 65+. Then a loved one will have to spend what could be their final weeks/months with you fighting with a private insurance company whose AI says it's time you get discharged home even though you just had a stroke less than three weeks ago and can no longer care for yourself. Then your loved one is thrust into the role of a unprepared and inexperienced 24/7 caregiver.
Moral of the story: as I said previously, seek out a local, reputable, and highly recommended Medicare broker to help you navigate through these things.
Response to W_HAMILTON (Reply #28)
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Shrek
(4,428 posts)I would recommend going directly to the source: https://www.medicare.gov/
We found a wealth of information there that clearly explains everything.
NewHendoLib
(61,857 posts)Plenty of free help out there.
LetMyPeopleVote
(179,822 posts)As a partner in my law firm, I had to pay the full cost of my insurance coverage. I switched to Medicare and I am now paying one-third what I was paying through the firm's insurance coverage.
Bottomline, do NOT trust Medicare advantage plans. The fact that they spend some much money advertising and calling people told me that these plans are profit centers. I have Medicare A & B and a G supplement with a prescription drug plan.
I am not a fan of the Medicare Advantage plans. These plans may work for some but the insurance consultant I talked to confirmed my belief about these plans
mwmisses4289
(4,179 posts)SheltieLover
(80,448 posts)They are free & they know this stuff inside out & backwards.
bluestarone
(22,174 posts)They help a bunch, and no charge!! 
cilla4progress
(26,525 posts)I got all my advice free from them 5 years ago when I turned 65.
I have the same setup as LetMyPeopleVote. My gap policy is from State Farm. Bundled with home and car.
No complaints!
mwmisses4289
(4,179 posts)Due to family reasons, we had to move back to a red state. Ugh.
cilla4progress
(26,525 posts)I'm sorry.... hugs
Emile
(42,283 posts)
Sogo
(7,191 posts)Advantage plans can save you from bankruptcy if you get a catastrophic medical condition such as cancer, because they have a an out-of-pocket maximum, whereas regular Medicare has no cap.
Emile
(42,283 posts)Advantage plan denied a life savings surgery for his leukemia. He needed a total thyroidectomy, removal of the entire thyroid. Something about the thyroid gland was messing up his medication for his leukemia. They kept denying his surgery even when after his doctors pleaded his case.
area51
(12,690 posts)
Ms. Toad
(38,635 posts)Mine is between $200 and $300 (whatever the annual deductible part B deductible is). I can go to virtually any doctor, anywhere in the country - and all but 20% of out of country costs are paid. I am not dependent on insurance approval for medical care.
The out of pocket cap for Medicare advantage plans is permitted to be as high as $9250 for 2026, and is an annual cap. Once you have cancer (or other chronic Illness) you will likely hit that cap for years in a row. Once you opt out of the traditional Medicare system (Medicare + Supplement), in most states you can never I'll back in - so your expenses will always be at the mercy of insurers.
Sogo
(7,191 posts)my annual out of pocket will be $4400 starting in 2026.
Ms. Toad
(38,635 posts)At 93, my father pays about $2400 a year. His only additional expenses for A/B covered matters are the annual deductible ($200-$300/year), and a handful of office visits at $10-$20 per visit.
Mine, at 69, costs about $1200/year, and the only extra expense is the annual deductible. (I have more medical conditions, so one step up in the plan was more cost effective). Mine will climb over time to around what his is.
(Part B premium is on top of that - but Medicare Advantage participants also pay that)
Sogo
(7,191 posts)My advantage premium starting in 2026 is $0, with $0 for doctor visits, and $0 for deductible. If I had to be taken by ambulance or flown to a regional large hospital (which is not uncommon in rural areas), my cost would only be $300. (For reference, a one-hour life-flight in our area costs upwards of $9000.
Advantage plans vary in availability from state to state.
Medicare + supplement in my state is always available if one wants to switch back.
SickOfTheOnePct
(8,710 posts)You can always go from Medicare Advantage to Medicare, but costs may be higher and you may not be able to get a supplement.
Ms. Toad
(38,635 posts)They can't diminish what is offered in a supplement plan, but they can put restrictions on insurance companies and providers, as long as they don't contradict federal law. Federal law allows rejection or price increases based on health at the time if late enrollment - It doesn't require them. It also allows, but doesn't require, non-participating providers to charge 15% above Medicare rates.
Illinois, for example, offers at least one MA plan which can be converted at a later date to a supplemental plan (guaranteed, no price increase). That is mandated by state law.
Some states permit rejection based on health - others prohibit it, and others govern whether (and how much) the insurer can increase prices for late enrollment.
The surcharge in some states changes the value of some of the plans, based on restrictions on non-participating providers. Medicare allows non-participating providers to charge 15% more than the Medicare rate. The best supplement plan covers that - but the second best doesn't (so if you go to a non-participating provider you may have to pay 15% on top of the 20% not covered by Medicare. Ohio prohibits this supplemental charge - so my father, who is unlikely to get treatment outside of Ohio doesn't need the best plan. Texas - allows it. I may week need treatment in Texas - one of the reasons I opted to pay a bit more for the top plan, rather than the one my father had.
SickOfTheOnePct
(8,710 posts)…not the supplement plans. States can’t make a determination about who can or can’t get regular Medicare, but they can have oversight of the supplements.
Ms. Toad
(38,635 posts)Not to mention that if you only talking about Medicare and you are already on Medicare Advantage, your costs for Medicare do not go up when you switch from Medicare Advantage to Medicare, since being on Medicare Advantage means you are already enrolled in Medicare. The premium for Medicare is identical whether you are on Medicare, alone, Medicare +supplement, or Medicare Advantage.
Your costs for a Supplement may be higher, and supplemental insurers may reject you - but that is
the reason I mentioned states - because some states have imposed additional requirements on insurers and providers that impact cost, availability, and relative value of the plans.
SickOfTheOnePct
(8,710 posts)It’s simply not true that in most states you can never get back into traditional Medicare.
Ms. Toad
(38,635 posts)Maybe, just maybe, I was defining what I meant by when I said "the traditional Medicare system" - so someone didn't get confused and assume I was talking only about Medicare parts A and B. It's a pretty standard/common way of clarifying what one is discussing, especially when using a term which has multiple meanings.
W_HAMILTON
(10,333 posts)I guess you could say Medicare Advantage saved her from bankruptcy because it denied coverage over and over and over.
Although I'm not sure saving her from bankruptcy was worth costing her her life and having my last memories of her be the four agonizing months I tried to be a 24/7 caregiver to her when I was wholly unequipped to do so.
Once again, DO NOT GET A MEDICARE ADVANTAGE PLAN. For all the talk about singlepayer, Medicare For All, etc., why would someone willingly choose to return to private for-profit health insurance? DON'T DO IT.
LetMyPeopleVote
(179,822 posts)I get up to a dozen calls a day trying to sell me an advantage plan from different providers. That tells me that these plans are profitable to the insurance companies and they can spend a ton of money on advertising
dalton99a
(94,109 posts)
Nigrum Cattus
(1,316 posts)The penalties increase the longer you wait after you turn 65.
Original Medicare with supplemental and part D (drugs) will serve
you very well. I have had one surgery and a number of treatments
with almost no co-pays ( it's like $250 per year). The "advantage"
plans are all just insurance and you will have to pay a co-pay
every time you use it and they can turn you down for any surgery
or treatment anytime.
enough
(13,759 posts)When we enroll enrolled in Medicare at 65 they were tremendously helpful and patient. It might be slow now after all the Doge layoffs, but the staff really has our interests at heart.
murielm99
(32,988 posts)It worked out well. If you are flummoxed, go to your senior center. Mine has people who help with Medicare D, the prescription part. They help find the best plan for you. I think they may offer other guidance as well. See if they can steer you in the right direction if you are apprehensive.
haele
(15,394 posts)Here's the issue. You are required to enroll in Medicare, but you can put off paying for it if you're working and it's going to be too expensive to have both your workplace insurance and Medicare. However, once you retire and stop getting your work insurance, you will need to pay back the time you weren't paying after you turned 65.
Which, if you plan to stay employed to get max SSI or Pension/TSP, ect...might end up close to $10k or more, depending on how much they determined your income would bear.
My situation is such that I need to pay $157 a month for my Medicare to keep my Tricare for Life, which so far has paid everything for me (severe arthritis, old age problems in general) that my Aetna Health and United Concordia Dental/Vision doesn't. My younger spouse and grandkids still get the Tricare, it's just an additional cost for me.
djtexas
(38 posts)The medicareschool.com website is excellent and free.
They have past and current videos on all topics Medicare related, both traditional Medicare, Medicare Advantage, Part D prescription coverage, medigap policies, how to compare, potential problems and how to resolve them, etc.
You are not forced to apply at that age, or pay penalties in higher rates, unless you do NOT have credible, employer based health insurance.
You can apply for Part A & B when you qualify and use it in conjunction with credible employer insurance. Or you can wait until you no longer have employer insurance.
Stay away from Medicare Advantage. The only way they make money is to reduce the benefits they pay out.
Use your online resources to enroll in Medicare Parts A and B, then find the best Part D plan in your area and prescriptions, and consider adding a Medigap policy.
You do not need a broker. Educate yourself and make the best choices for you.
I recently retired and signed up for both Social Security and Medicare online at the same time (May of this year). The process was simple, painless, and quick.
I was laid off on April 29 at 68 years old.
I applied online for both SS and Medicare online May 26.
I received my first SS direct deposit around June 12th (for May since they pay the month following).
Once I had my Medicare number, I researched and selected my Part D plan online ($0 monthly premium in my case) and then a Medigap G policy which was best for my situation.
The cost of Medicare Parts A and B comes out of your SS payment. A Medigap policy is charged direct.
I worked past my original qualification date but always had qualified health insurance so there were no higher premium penalties.
Google "how to sign up for Social Security and Medicare online" for video help. Some of the questions are poorly written, so it helps to have a video guide on how to properly answer the questions.
Emile
(42,283 posts)the rest of your life and pay a higher cost.
https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties
Shrek
(4,428 posts)We enrolled my wife in a zero-premium Part D plan just to get her covered before the deadline.
She can switch plans later if she finds something better (without penalty) but it's important to get covered right away.
Ms. Toad
(38,635 posts)Just Google your states name + SHIP. If it brings up boats, as insurance to the search. They provide neutral information, and can provide you with historical information on stability and historical COLA increases in the plans.
hunter
(40,689 posts)Follow the link that says " Find out when you should sign up to avoid penalties."
The site will ask you a few questions and tell you what you need to do.
All the salesman who make people anxious trying to scare them into buying commercial products can go fuck themselves. That sort of thing really ought to be against the law.
Skittles
(171,704 posts)had zero problems.....that was, of course, before the Trump.2 shitshow
stay away from "Advantage" if you can afford to
kimbutgar
(27,248 posts)It was a nightmare applying for Medicare and took more than 3 months. Luckily we were able to not go without healthcare. Start now even if you’re not 65!
Nictuku
(4,656 posts)I saw an ad on a youtuber channel that I trust (I think it was Adam Mockler), and I wrote the name and number down. Chapter 706-312-8635.
My mom was notified that one of the insurance companies she has was no longer going to serve our area. She had a local person she called, but they were not able to help. So she called this Chapter and was blown away by how helpful they were. She is now all set, and will have to pay even less than she was before. She highly recommends them. (I'm going to need to get my situation figured out by next July, so I'll be calling them too. I also gave the number to my cousin, but I don't have anything to report about his experience.
I hope this helps. This chapter gives Free medicare advice, and I'm pretty sure it is a non profit. They didn't ask my mom for anything, and they really did help her figure out this medicare mess.
Wifes husband
(720 posts)Before I got on Medicare they sent me a thick pamphlet that explained everything. If you get one, read it cover to cover, carefully. I had no issues getting on Medicare, and they have been very good to me. I also have blue cross.
You will hear many comments about Medicare advantage, my brother thinks it is great, but I have been in and out of the hospital a lot in the last few years, and I mean a lot, and as I said before, they have been great.
I have never had any medical professional have any thing good to say about Medicare advantage.
Again, I can only speak from my experience.
Rebl2
(17,738 posts)about right now due to the shutdown, but six months out from my 65th birthday I got information from Medicare telling me about enrolling in Medicare.
BlueSpot
(1,302 posts)I called and was assigned to an agent who walked me though everything. I don't know a lot of insurance terminology so having help was a great boost to my confidence when filling out the forms and answering the questions correctly. Got a notice recently that my Part D was going to increase its premium by $50/month (!!!). I called the guy again, gave him a list of my scripts and he suggested a plan that would serve my needs just fine at a substantially lower cost.
And, yes, you need to get your part D right up front or there is a penalty and I think more loops to go through. Doing it right away eliminates both.
Edited to add: I began the enrollment process 3 months before my coverage was to take effect. I don't know if this might vary by state. The six month notice *might* be so you can start getting your ducks in a row.
JustABozoOnThisBus
(24,681 posts)... if you are covered by an employer's plan, either through your employment or spouse's employment. If this applies, then you will need a form from your employer when you eventually retire, to avoid penalties.
And, it's not exactly a penalty. If you never sign up for Medicare, you'll never pay a penalty. But if you sign up late (without the employer letter), you will forever pay more than the normal amount. That's the penalty.
I got parts B and D at age 68, because I was on my spouse's insurance. Part A was "automatic", I didn't apply, it just happened 
.
I avoided Medicare Advantage (part C), but some of my friends are on it and they like it. It has "advantages". And some disadvantages.
Best of luck, muddling through all the "information".
MurrayDelph
(5,750 posts)who went through all of my options. Because I travel a lot, I didn't want to be stuck with an Advantage plan which, like a PPO, only covers you if you go to one of THEIR doctors, and even then only if they want to.
The main other takeaway was that since I was already on Social Security, getting Medicare starting on my 65th birthday month would be easy. If I'd needed to sign up for both, it might have taken longer.
So, my advice, which I admit is just as valid as all of the others her (and worth what you paid for it), is to start looking into it now, so it'll be set up by the birthday.