Author Topic: Medicare  (Read 13140 times)

mistyrain

  • Guest
Re: Medicare
« Reply #15 on: June 25, 2014, 09:47:34 AM »
quietdynamics:

If you haven't already done so, take a look at MediCare's section on disability called I HAVE A DISABILITY:

Sections on:

Find out how Medicare works for people who have a disability.

compare Medigap policies

etc

http://www.medicare.gov/people-like-me/disability/disability.html

I have also found them very helpful either by chat online or by phone when trying to sort out a maze of bills I had with so many different dates and doctors and confused titles - I set up a file on their site so I can keep up to date and catch anything that might be questionable.   Some medical offices don't always "get it" and other times there can be a very big time lag.

All the best



slccom

  • Guest
Re: Medicare
« Reply #16 on: June 25, 2014, 12:48:56 PM »
AARP plans are often the most expensive out there. So, find a good insurance agent who represents lots and lots of health insurance companies to find the best plan for you.

Sharon

Tivia

  • Guest
Re: Medicare
« Reply #17 on: June 25, 2014, 01:33:37 PM »
I dont understand medicare, I have been on partial disability since 18. It was only recently with the new dx's that I had to go on full disability and ssi now too. Im not old enough to get the retirement stuff medicaid is my coverage. It sucks for the last two years I am so poor I dont know how people live like this. If I didnt have a home already paid off I would be homeless. Is medicare what they switch you to when you get older? I thought I had it but everything I get says medicaid

mistyrain

  • Guest
Re: Medicare
« Reply #18 on: June 25, 2014, 02:03:33 PM »
Tivia:  I did a quick search and found a little bit of information on the Social Security website.  Why not give them a call and see what they have to say about it:

http://www.ssa.gov/dibplan/dapproval4.htm

excerpt from their website:

"We automatically enroll you in Medicare after you get disability benefits for two years. The two parts of Medicare we enroll you in are hospital insurance and medical insurance."

All the best  :)

Carolina

  • Hero Member
  • *****
  • Posts: 5823
  • —if it ain't one thing, it's another." Roseanne R.
Re: Medicare
« Reply #19 on: June 25, 2014, 02:10:00 PM »
Well, I'm not a specialist, and certainly don't know about Medicare disability.

But Medicare when you're over 65, and don't have anything from your former employer runs something like this:

Straight Medicare.  You get this and you have deductibles.  It's pretty straightforward.  It applies to all US facilities that take Medicare.  You have choices as long as the doctors and hospitals participate in Medicare.

Everyone gets Medicare A, hospitalization with no extra charge.  You have to CHOOSE and pay for Medicare B, doctors and outpatient, and you pay extra for it.  OF COURSE you want to choose Medicare B.

Straight Medicare does NOT cover Prescriptions.  You must buy a Drug Plan, Medicare D, and you have to choose a plan offered by an Insurance company.  Of course you want a drug plan.

Medicare Supplement:  This is a plan that pays for a great deal of what Medicare does NOT cover (deductibles).  The plans are regulated by LAW.  They are listed by alphabetical letter, and they are all the same from company to company.  You choose the plan that meets your needs, the more coverage, the higher the cost.  The highest cost plans also cover you (in a limited way) out of the country! (I buy travel medical insurance for trips out of the country, instead.  Both my husband and I were covered for 3 weeks in Paris for about $250) 

Medicare Supplements requires you to buy Medicare B, but does NOT cover prescriptions.  You must buy Medicare D, prescriptions, from an insurance company, if you want prescription coverage, which of course you do.

Medicare Advantage Plans  Medicare Advantage Plans are offered by Insurance companies.  They require you to buy Part B, medical/outpatient.  The vary by state and by area of the state.

Some Medicare Advantage plans have drug coverage and you also buy Medicare Part D, prescriptions.  The Medicare Advantage Plans fall into three main categories:

Straight coverage, any doctor/facility that takes Medicare.
PPO coverage: lower rate in network, higher rate out of network.
HMO: only covers doctors and hospitals in network.

The costs vary according to how much freedom you have.

Medicare Advantage Insurance plans negotiate rates with hospitals and doctors and prescriptions providers and actually get a better deal than Medicare does....so the plans make their money on the difference.

The fees for all of the plans are deducted from your Social Security Check, Part B, Part D, and whatever type plan you have chosen, if you choose a Supplement or an Advantage plan.

I see your eyes glazing over.

Sorry about that.  It's hard enough to be 1) old  2) have a chronic conditions 3) negotiate the mine field of medical insurance and medical coverage.

If you've read this far, you are a better woman than I (or man as the case may be).

Hugs,  Elaine




« Last Edit: June 25, 2014, 02:13:33 PM by Carolina »
Female-Elaine,78-CVID-pSJS-IC-PN-CAD-Osteoarth-SFN-Knee/Shoulder Degeneration-SIBO-Act.Purpura-Tinitus-Meniere's-Hiatal Hernia-Achalasia-Hand Surgeries, UTI's-Braces/Walker-IVIG Gamunex-Medrol-Gabapentin-Atenolol-Pilocarpine-LDN-Nasonex-Lipitor-Estrogel-D-Mannose-NAC-Omega 3-Naltrexone-Esomeprazol

Tivia

  • Guest
Re: Medicare
« Reply #20 on: June 25, 2014, 02:34:38 PM »
Tivia:  I did a quick search and found a little bit of information on the Social Security website.  Why not give them a call and see what they have to say about it:

http://www.ssa.gov/dibplan/dapproval4.htm

excerpt from their website:

"We automatically enroll you in Medicare after you get disability benefits for two years. The two parts of Medicare we enroll you in are hospital insurance and medical insurance."

All the best  :)

Oh thanks for that, I think I need to look at my disability action dates and see when this may kick in.

@Elaine, LOL yes I think I may have glazed over a little reading that, but its good information thank you.


litliwlowa

  • Hero Member
  • *****
  • Posts: 1780
Re: Medicare
« Reply #21 on: June 25, 2014, 02:59:50 PM »
I dont understand medicare, I have been on partial disability since 18. It was only recently with the new dx's that I had to go on full disability and ssi now too. Im not old enough to get the retirement stuff medicaid is my coverage. It sucks for the last two years I am so poor I dont know how people live like this. If I didnt have a home already paid off I would be homeless. Is medicare what they switch you to when you get older? I thought I had it but everything I get says medicaid
Tivia,

Medicare should kick in two years plus six months automatically from date of onset of full disability. Medicaid, is the state program.

I find it much easier actually to call SSA than to navigate their website.

Even when Medicare kicks in, you may still be eligible for Medicaid assistance with part B premiums depending on your income. Another reason to call SSA specific to your situation, given that you were on PARTIAL disability before full disability.

They're very easy to talk to on the phone, in my experience, and take their time to answer your questions

Medicare is not limited to retirement. Includes fully disabled as well. I don't know if age of onset of full disability is a factor though.
SJS-Primary; Hashi's, Post surgical hypothyroidism, Hypoparathyroidism, Spondylolithesis, L&C Facet Arthropathy, Fibro, gluten intolerance, TBI, Radiculopathies, Neuralgias, Osteopenia, GERD, Asthma, Allergies. Sphincter Dyssynergia. OSA, Fasciitis, Cervical Spondylosis, Cancer, etc etc etc

Breia Lee

  • Guest
Re: Medicare
« Reply #22 on: July 03, 2014, 12:33:12 PM »
It is confusing, and I think the doctors' offices are confused as well.

I had signed up for a Medicare Advantage plan which didn't cover the 20% insurance gap but which did provide prescription drug coverage, all for $0/mth cost.  When I spoke with my doctor's office about taking it, the business office told me I didn't have Medicare anymore--she told me 'I don't what that company told you, but it's not Medicare'. 

Of course it is, but there was no convincing them or fighting it, so I dropped it.

It was just as well, because I have a prescription that would have resulted in a huge monthly drug cost 5 months in due to the prescription 'coverage gap' currently built into Medicare when your drug costs hit $2800 (or thereabouts).  I was able to sign up for a drug plan tailor made to levelize this cost for me, but it took alot of research on the Medicare.gov site in order to find it.

Sooki

  • Hero Member
  • *****
  • Posts: 881
Re: Medicare
« Reply #23 on: July 03, 2014, 01:05:57 PM »
I have also heard people saying their doctors don't take Medicare.  I haven't had any problems.  The difference may be that my doctors are all associated with a big hospital system.  They all take Medicare.  I don't think the big hospitals could survive without taking it. And they have billing depts to submit all the paperwork.  Individual doctors however may find that all the paperwork involved with submitting claims to Medicare isn't worth the time it takes.  You might check doctors associated with hospitals and see if they take Medicare.

I have Medicare parts A and B, the AARP supplemental plan at the lowest level, and the AARP part D drug plan.  I'm newly 65 so I can't speak to everything, but so far I haven't paid anything except for the deductible on drugs and drugs that medicare doesn't handle.  I don't have any dental plan, but may pick that up in the future (from United through AARP).  I'm sure to spend enough on cleanings and fillings to get my money's worth.  I would get three cleanings a year which would about pay the premium and might make an improvement to my teeth over my current two per year.
« Last Edit: July 03, 2014, 01:10:32 PM by Sooki »
68 yo, Sjogren's, Lupus, Hashimoto's, fatigue, MGUS, peripheral neuropathy, ocular rosacea
Plaquenil, CellCept, Synthroid, Atorvastatin, Xiidra, doxycycline, D3, biotin, B12, ALA, DHEA, Ubiquinol, CPAP, D-mannose, Paleo AIP, fish oil, Cliradex wipes

litliwlowa

  • Hero Member
  • *****
  • Posts: 1780
Re: Medicare
« Reply #24 on: July 03, 2014, 01:15:28 PM »
I've had no problems with any of my doc offices taking Medicare. Now I don't have Medicare Advantage, but I do have Medicare Supplement which includes rx coverage.

When I became Medicare eligibile, I looked into the Advantage programs and decided no way.

My limited understanding of the difference is the why I went with supplement is that it kept me in traditional Medicare, whereas the Advantage programs are underwritten differently.

I have seen posted in some of my doc offices that certain Medicare ADVANTAGE programs were not being accepted.
SJS-Primary; Hashi's, Post surgical hypothyroidism, Hypoparathyroidism, Spondylolithesis, L&C Facet Arthropathy, Fibro, gluten intolerance, TBI, Radiculopathies, Neuralgias, Osteopenia, GERD, Asthma, Allergies. Sphincter Dyssynergia. OSA, Fasciitis, Cervical Spondylosis, Cancer, etc etc etc

Jasper

  • Hero Member
  • *****
  • Posts: 1009
  • P SJS; SFN; Sensory Polyneuropathy/Ganglionopathy
Re: Medicare
« Reply #25 on: July 03, 2014, 01:37:45 PM »
My understanding is that Original Medicare works like a a regular insurance plan and pays "fee for service," although Medicare sets it own amount that it will approve to be paid for each service. Also, Medicare  also limits some services and frequency of some services. Medicare Part A covers hospital and Medicare Part B covers doctors, lab, outpatient, etc. So the doctor (or facility) may bill $300 but Medicare may approve only $100 for that service. Medicare pays 80% so Medicare pays $80 for the service. If the doctor (or facility) accepts Medicare then they have to go with what Medicare approves. You need the supplemental insurance to pick up the 20% that Medicare does not cover. And you need Part D to cover prescriptions.

My understanding of Medicare Advantage is that the government pays the Medicare Advantage plan a set amount for all of your health care, and that Medicare Advantage plans work like an HMO. The company has a certain amount of money that they are paid to care for you for the year. If your health care costs are under the amount the government has paid them, then the company makes money. If your health care costs go over the amount the government has paid them, then the company loses money (on you). So it is advantageous to a Medicare Advantage company (same as with an HMO) to NOT spend money on you. Every penny they spend on you is less money in their pockets.

That is the reason I would never get a Medicare Advantage plan. They will nitpick and argue about services you need and they will deny those services too. Every single person I know who has gotten a Medicare Advantage plan and who has had health problems, has had problems getting good medical care and has had needed tests and services denied.

« Last Edit: July 03, 2014, 03:32:58 PM by Jasper »
ANA 1:160; SS-A+; MSG +; Plaquenil, Rituxan infusions, Restasis, HRT, Curcumin, Calcium, CoQ10, NAC, Resveratrol, Whole Omega, Omega 3, R Lipoic Acid, Acetyl L Carnitine, Krill Oil, Mag. Threonate, Bio-Collagen UC II, NAD+, & Vit A, B, C, D, E, K 1 & 2.

litliwlowa

  • Hero Member
  • *****
  • Posts: 1780
Re: Medicare
« Reply #26 on: July 03, 2014, 02:53:44 PM »
Thanks, Jasper!!

Yes I remember now that is the way Medicare explained the difference to me in 2008. No way would I do well in an HMO type plan.
SJS-Primary; Hashi's, Post surgical hypothyroidism, Hypoparathyroidism, Spondylolithesis, L&C Facet Arthropathy, Fibro, gluten intolerance, TBI, Radiculopathies, Neuralgias, Osteopenia, GERD, Asthma, Allergies. Sphincter Dyssynergia. OSA, Fasciitis, Cervical Spondylosis, Cancer, etc etc etc

Iris

  • Sr. Member
  • ****
  • Posts: 305
Re: Medicare
« Reply #27 on: July 03, 2014, 06:11:22 PM »
I thought you only got Medicare if you were disabled and qualified for SSDI.. Some people that have never worked or didn't work long enough to have the credits to draw SSDI get SSI and Medicaid.. As far as I know they don't get changed over to Medicare until retirement age..

I was declared disabled in Oct 2011 and didn't have enough credits so I get SSI and Medicaid.. It's never been changed over to Medicare. Maybe it's different in other states..
Sjogren's Syndrome, fibromyalgia, essential tremor, RLS, degenerative disc disease, gastritis, Ischemic colitis, heart disease.
Lisinopril, Pantoprazole, Ranitidine, Plavix, Diltiazem, Simvastatin, Magnesium, Aspirin, pain meds, serum tears, fish oil

ellieas

  • Full Member
  • ***
  • Posts: 154
Re: Medicare
« Reply #28 on: July 03, 2014, 07:12:19 PM »
I  also have  AARP United Healthcare as my supplemental and i have one of the better plans. All of my doctors are with the University of Rochester Medial Center group and all have taken my plan. Will definitely call this doctor back. Maybe  I didn't hear it right. Thanks for your help

Lesley
sjogrens dx'd 2010, non hodgkins Lymphoma(1999), fibromyalgia, age 65, keep trying Plaquenil, Zoloft, Forteo, ibuprofen, love being near my kids

litliwlowa

  • Hero Member
  • *****
  • Posts: 1780
Re: Medicare
« Reply #29 on: July 04, 2014, 02:21:40 AM »
I thought you only got Medicare if you were disabled and qualified for SSDI.. Some people that have never worked or didn't work long enough to have the credits to draw SSDI get SSI and Medicaid.. As far as I know they don't get changed over to Medicare until retirement age..

I was declared disabled in Oct 2011 and didn't have enough credits so I get SSI and Medicaid.. It's never been changed over to Medicare. Maybe it's different in other states..
Iris,

That may well be so. I am on SSDI so don't know how that works if on SSI. I know that if SSDI is low enough, some are eligible for a portion of SSI also plus Medicaid in that situation can assist with Medicare Part B Premiums. I don't think it's a difference between states as Medicare is Federal and Medicaid is state. hmmmm
SJS-Primary; Hashi's, Post surgical hypothyroidism, Hypoparathyroidism, Spondylolithesis, L&C Facet Arthropathy, Fibro, gluten intolerance, TBI, Radiculopathies, Neuralgias, Osteopenia, GERD, Asthma, Allergies. Sphincter Dyssynergia. OSA, Fasciitis, Cervical Spondylosis, Cancer, etc etc etc