Why sign up for Medicare next year at age 65?

Actually lots of reasons, to me the biggest is the lack of portability of Medicaid for a younger & active 65++ person. Medicare is a federal program so is available anywhere in the US or its territories. So you live in Maine but while on vacation you break your hand lunging for Mardi Gras beads in New Orleans.......you will be billed for your ER visit as your Maine Medicaid is not valid in Louisiana. However if you had Medicare it would be. Medicaid is limited to paying within the state yiu live in as Medicaid enrollment is done uniquely by each state. There are exceptions like for level 1 trauma hospitals that are right across the state line situation but otherwise, your Medicaid is only good in your state.

Also if you do not sign up for Medicare in the very first initial period, you will have to pay a significantky higher monthly rate when you do sign up. And I think the higher rate is till forever IF you didn't enroll within the initial period

Medicaid since its state run can change the eligibility rules.....it could require a co-sharing of costs for those who can get another insurance Payor. So if you could be on Medicare to totally cover your hospitalization under the Part A, and don't, Medicaid could decline to pay. Also Medicaid could change the income & asset rates, and you could disqualify from Medicaid.

Most hospitals take Medicare - as Part A covers hospitalization and reimburse pretty quickly - but many do not take Medicaid at all.

Also you have been paying into Medicare via FICA during your work life.

From what I have read on the forums here, Medicare would become your primary health insurance and Medicaid would be your secondary insurance picking up the cost that Medicare won't pay. Best to contact both Medi-Cal and Medicare to ask what to do.

Payment for Medicare comes automatically out of your social security check.

At $1815 per mo. we don't travel far. And I don't enjoy traveling far anyhow.
And being low income, we wouldn't pay extra for medicare when we sign up. Also to whoever says it covers then medicaid picks up the rest isn't entirely accurate. We'd pay $1250 deductible for any hospital stays, amongst other costs regarding drugs. It appears there really is no valid reason to switch from Medicaid to Medicare as it can only cost us. And the possibility of Medicaid switching their rules would require new laws so that is doubtful. So for us, for our health and safety, it seems remaining with Medicaid. My husband will get a SS check so he will be forced into co-pays and deductibles but if I never sign up for my SS, then we can keep medicaid from what I understand. In the form of myself never signing up for medicare. This is what I understand from reading the forums.

Anytime someone accepts a Social Security Check, that person is automatically enrolled in Part A when it's time. (which is what bankrupts many as it has loopholes where full medicaid has none). I could accept a SS check but the value of the Medicaid is much more than the amount of the check, or it could be depending upon my health as I age.
I am surprised I am the only one who has figured this out...I guess when people are told constantly medicare part A is free (if you've worked enough) they believe it is free. When it has loopholes which require large out of pocket expenses where medicaid just covers everything. I know I said that many times in my initial post but it still seems no one gets that part. The risk involved with Medicare. I am aware now due to doing hospice 3 times the last 4 years. Thanks everyone :)

Medicaid does not have to have changes done by enacting new laws necessarily. It would be too too cumbersome to require this. Medicaid is set up to allow for the states to have waiver programs. Waivers are diversion of funding from skilled nursing services to broader community based programs via different waiver programs.

One issue with waivers is that policy can change from year to year, so often some providers will not participate or not renew in Medicaid waiver funded programs as its hard to do long term planning due to this. One trend right now is for states to establish PACE programs and phase out other older & established Medicaid paid for programs. Laws didn't have to be passed to do this as it's within the purview of Medicaid to allow for flexibility with funding by the states.

Medicare is pretty well set to have funding (even if reinbursement rates decrease) guaranteed.

As far as "loopholes" with Medicare, to me, that's really about finding the right secondary or medigap policy to take care of that. My mom had Medicare and federal employee BCBS as her secondary policy for years before she entered a NH, and she had zero copay. Between the two, everything was covered and it didn't matter whether she was in TX or visiting family in LA or on vacation in FL. My aunt had a really crappy secondary policy which limited payments 100% only to providers within a somewhat small health system and of course most of her old docs were NOT in the system, so she had out of pocket costs. You have to do the research to find what works best for your needs but you can get total coverage to happen within Medicare.

freqflyer has brought up an important point.....you need to find out if your state will require Medicare to become your primary and Meducaid your secondary once you are eligible to get Medicare.

Also on medicaid waiver funding, often if there is a PACE type of program available in your area that will provide the level of services Medicaid has determined that you need, then it will need to be the health care system that you will need to participate in if you want Medicaid to pay. You don't get a choice. It's how Medicaid can attempt to do cost-containment. Personally I think this (required participation in a PACE type of program) will be the new normal for those over 55 on Medicaid.

Medicare is "self-directed" so you can pick which doctors (that accept Medicare) to see.

I've studied medigap policies and there are loopholes but they are also expensive. We only make $1815 per month. The providers here who take Medicare are getting fewer and fewer. We are set regarding Doctors, always will be since I am Native American. It just seems that everyone seems to have objections to this except never can present any reason why in our circumstance, signing up for Medicare is necessary. I will note being Native American doesn't mean I get a free health policy, just that I am in with a Native American Clinic which will never refuse me due to my ethnicity. But that is a sidenote really...I am trying to plan for the future. Right now I have a medical plan which will begin soon, pay just $10 a month. It's actually pretty good and I'll keep it until it is time to retire. And beyond if there is a way to get this healthcare under control (keeping SS at a level that we qualify for medicaid). If I can get out of the 35 highest earning years, then I might be able to work well into my 70's keeping this health plan for myself. That is what I'd really prefer to do, never stop working until I am too old to work. I love my job also but would want to work anyhow. My husband has health issues so I don't want to take any chances, it is him I am concerned about. He's only 54 but due to his occupation, has severe breathing issues. Thanks again everyone for the advice :).

Pace I've read up on. There is also a new program in California called MediConnect which is gaining momentum. Appears to be running smoothly so it will probably eventually advance into our County. But the issues remain the same, only the care between Medicaid and Medicare is streamlined better regarding the red tape they deal with. The rules and eligibility remains the same, same paperwork submitted and such. Thank you Igloo for informing me laws do not need to be changed in order for the individual programs to change.

Our Medigap premium is $122.86 a month. I would consider that pretty reasonable. It's through BCBSM. Given the cutbacks in Medicare due to sequestration, I think the loopholes there are more problematic, especially on the issues of DME supplies.

Sounds like you've evaluated all the options and made your choices; go with them, and I hope everything works out well for you.

If you had $1812 to spend for a couple, then deducted $122.86 x 2 people, that leaves only $1567 a month. We are still tinkering with his breathing machine, he purchased some filters online (technically they are paint store filters) but they seem to do an almost better job than the medical ones sent to us for his machine. They are very cheap too. I read something about Medigap policies which made me uneasy they don't cover everything and may not even be around by the time we retire. They expect the price to skyrocket by then. Thanks, best of luck to you too :)

Outdoorsy - so your Native American, right? Well that can change everything as IHS is its own entity as to how services are done & provided within your community as NA are special status. IHS does work in tandem with other programs, like I think IHS is working with PACE (I'd bet it's a catholic nonprofit group) in OK but policy is different for Native Americans. IHS may have it's own coding & bill payment system like what RailRoad Retirement Medical does.

It's special status situation & policy derived from that status.

Like what the special status is for Cubans in that they immediately qualify for food stamps, medicaid & SSI up to $ 733 a mo (SSI if over 65) and good for 7 years whether or not they apply for US citizenship and then forever once you become naturalized. Plus subsidized housing as well in some areas too.

But for most on this site, none of this will matter as their not Native American, Cuban or a RRR family.

If you don't sign up for Medicare part B when you are eligible (3 months before, the month of your birthday or by 3 months after your 65th birthday), you would be facing penalties. (Unless you are actively working). If you are receiving Social Security already, you will be signed up automatically with the option to decline part B. DO NOT DECLINE part B unless you are ACTIVELY working.

While I could could offer you lots of information here, I am going to suggest instead to seek a State Health Insurance Assistance Program (SHIP) within your county. The easiest way to find a counselor, free by the way, is through your local Area Agency on Aging. Just call and say you need a Medicare counselor and you will be directed or referred to one. You can sit one on one with someone by appointment, ask dozens of questions, and get recommendations for help with Medicare.

As an extra side note, you likely will continue on Medicaid and receive almost the same type of benefits; it's just that you will have a Meicare/Medicaid plan vs. solely a Medicaid plan. Also, it is likely that you will qualify for a program that will pay your Medicare Part B premium, and also the Federal Extra Help program that will keep your prescription prices low. that Medicare counselor can do those applications for you or help you with them. I'd suggest starting this process as soon as you receive your Medicare card in the mail and not waiting until later. This will avoid you seeing that deduction for Part B and then having to wait months to be reimbursed.

If your state is California, you can look up your SHIP here also:
https://www.aging.ca.gov/hicap/?AspxAutoDetectCookieSupport=1
Jen

Thank you :) I spoke with the Medicare Advocate, he husband had the same health issues and they can be very very pricey later in life. I told her of my desire to work as long as possible, likely into my 70's doing what I do now and it comes with a pretty good health plan. She stated that when I turn 65 I will be ineligible for Medicaid. Meaning I can sign up all I want but they will not provide it for me. I also spoke with our Indian Health Clinic. She suggested I work until well into my 70's (Since i am a cyclist, it is likely I will be able to do so) keep that health plan and sign up for Medicare when I develop really bad health issues or after my husband passes away. I would also not sign up for Social Security because while my husband is still alive, it would put us over the QMB (A medicare savings program) limit. This is the only program that makes your healthcare completely free guaranteed. Medigap policies are horrible, they hardly pay and refuse to grant necessary services. So whenever, if I sign up for Medicare after my husbands death (when we won't go over the QMB limits) she suggested Traditional Medicare Anyhow. That when the insurance companies are involved the Clinic has a hell of a time getting paid. So we can keep under $1325 QMB limit, I will continue receving the basic services the Health Clinic offers for free (inlcudes dental) and not be over the QMB limit, be allowed to work as much as I want (yipee!!) yet our health needs covered. What people don't generally know is you can wait until you are in dire straights and it will be covered. Medicaid which is what pays the QMB deductible, premium, copays, basically all what Medicare doesn't pay is retro-active to 3 months. Since I've done IHSS for a neighbor, a Medicaid benefit, I know it goes back 3 months to pay my salary. As does Medicaid in General. So all this hype about if you don't sign up on time blah blah blah is nothing to someone who is low income. It is covered, and there is no fee to sign up late anyhow. As long as you qualify for a Medicare Savings Program. My husband is 8 years older than me, by default he will die before me and with these health issues, I see at least 10 years before. And it's usually the last 5 years of life that accumulates most of the bills (actually the last year). When he passes, my earned SS will be about $1000 a month which will qualify me for QMB when I am ready to sign up for SS. Because once he is gone, so is our $1000 he had. We cannot allow him to take more than $1000 from SS or when he passes, I will be over the QMB limit. What is sad is those people who never worked at all, never married, so have no earned work credits of their own or a spouse/ex spouse, they fall within the cracks unable to qualify for medicare. And unable to use Medicaid apparently (which I think is untrue as the conversation didn't continue for me to hear the end, it's about 4% of the population falls under this category. OH and ANOTHER wonderful benefit of QMB program is they cannot come and take the house you own. We bought property and built illegally a very modest home on it. So the property can remain passed down to our son along with his inheritance of about 100 Thousand. We hardly spend much, most everything we do is outdoors so all we need is food and one car to use. Of course life could change but overall, when you are healthy when you are young exercise and eat right, it usually pays off in the end. Unless some accident occured. Thanks for everyone's help and to Jen for giving me the advocate link

Just to clarify, the Indian Clinic has a heck of a time getting paid when an insurance company linked to Medicare is involved. Stick with Traditional Medicare if you can. I can because the Indian Health clinic comes with dental care (not major, but the necessities). These insurance companies are denying payment and saying medical services are not needed. They have no problems with Traditional Medicare. Also check to ensure if you are close to the Medicare Savings Limit, try to keep yourself at the lowest one possible, QMB. We were foster parents for years (very low pay if any at all, at times) so I didn't pay into the system much and he was self employed much of the time. Now I work 44 hrs a week at a job I love for the last year or so. Some of the other employees who do the same work are well into their 70's. There is also a law that the microchip will be installed inside of people, something i expect as a Christian. (Revelation 13:16 might be coming to pass in this manner.) Either way, they will figure a way to mark you with some electronic device to keep tabs and like Hitler and the Holocaust, they begin with gaining control of your healthcare first. But that is another subject, not one I worry too much over really. Thanks again everyone for your help and time. You were very generous with my ramblings :)

What law exactly are you referring to which provides that "the microchip will be installed inside of people..."? And who are the "they" who hyou claim will 'figure a way to mark you with some electronic device...?"

Honestly, I've never heard of such nonsense.

BTW, can you get psychiatric services through the Indian Clinic?

Outdoorsy, I'm glad the medicare counselor helped. Always the best way to go, I think, since everyone's situation is unique.

I'll caution others to be sure to follow the deadlines because if, per chance, you didn't fall within low enough income guidelines for those federal and state programs, (and this includes asset $ guidelines as well), you could face those penalties, caught unawares. The cost gets tacked on to your monthly medicare cost for the rest of your life. Better safe than sorry!

Jen

Oh, I also wanted to add that Medigap policies are actually some of the best Medicare plans out there and there are rarely issues with them not paying. There issues with Medicare Advantage plans as you have to be concerned with networks. In terms of the Indian Clinic, there are May be other coordination of care and reimbursement issues as you mentioned.

Microchipping people huh? Well that is a great consoling feature for me. over here we only microchip animals who can be euthanised when they become terminally ill. if being microchipped means I can opt for voluntary euthanasia I am al for it....sadly I know that is not the case