Author Topic: Medicare  (Read 13141 times)

susanep

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Re: Medicare
« Reply #30 on: July 04, 2014, 08:14:37 AM »
This thread has helped me a lot. I have the regular basic Medicare. I have the part A, B, and D. The only thing I don't have is a supplemental. I wanted one, but was too confused with all the advertisements on t.v.

We at the time thought supplemental was the same thing as the Medicare Advantage. We went with our feelings we were having when we called a place that was going to tell us more on the Medicare Advantage. A guy called us to set up an appointment to speak with him. We then decided to cancel until we found out more on our own. Well, he kept calling us, and finally my husband told him to not call again or he would have something done about it.

I guess he knew that if he could win us over he had a lot to gain.

Now I just have to figure out where do I look to find a supplement to go with the regular Medicare? Some of you may have already answered that, so sorry if that is the case. With my brain fog these days, I would not be surprised.

I also feel I need to have a supplement in mind that would work for me when enrollment begins again, due to my concern if I need to go into the hospital or have a lot more tests.

susanep

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litliwlowa

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Re: Medicare
« Reply #31 on: July 04, 2014, 09:16:27 AM »
susanep

Supplement works differently and of course it depends on the plan. I have Medicare Part A and Part B. I have my supplement plus RX coverage as a retiree benefit. Medicare processes the claims initially then forwards to supplement. Once deductible is met, my supplement picks up 80% of teh 20% Medicare doesn't cover of the Medicare Approved amount.

I pay a hefty premium every month for my supplement (nearly $300 a month, but that includes also dental and RX coverage and vision coverage - separate coverages but billed as one premium monthly).

There were less costly plans via my former employer, even a Medicare Advantage plan, but when I weighed the premium costs vs actual coverage and also what has been a typical year for me as far as specialists, my entire medical situation, etc...the better plan was really the only choice for me.
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Breia Lee

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Re: Medicare
« Reply #32 on: July 04, 2014, 07:28:35 PM »
Medicare open enrollment isn't until later this year.  Did you just get Medicare, or did you lose creditable coverage recently (last 60 days)?  If not, I think I read that if you apply, you may not be approved, and if you are, it may be higher than it would normally be during open enrollment (this according to the Medicare.gov website.)

I wasn't aware that you could apply outside of open enrollment, so I was going to tough it out and wait.  Glad I checked.  I lost creditable coverage when my husband changed jobs--I had been using his as a gap/drug plan.  Turns out that if you go more than 60 days Medicare can (and will) charge you a late fee!  I was shocked to see that, as I had never heard or been warned of such a thing.  Makes me wonder what else I don't know.

I didn't have any trouble getting covered-both plans I applied to took me and quickly too.  I'm very happy to have a prescription drug plan again.  I'm working hard to restore my health, and it's hard to do so without one.

anita

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Re: Medicare
« Reply #33 on: July 04, 2014, 08:50:06 PM »
I guess I'm very lucky.  I have never had any problem finding doctors that take regular Medicare (never even had to 'look'--mine all took it).  I will say that one determining factor in my NOT taking a Medicare Advantage plan was the Johns Hopkins didn't take ANY OF Those Medicare plans (had signs up all over the hospital)...they only took regular Medicare, so that's what I kept.

It worked out ok as my husband is retired military so I get Tricare for Life (which is 100% coverage when disabled (which I have been since 1996).  So now I have Medicare as primary and Tricare for life as secondary and it picks up EVERYTHING...I have NO deductibles, NO copays, NO out of pocket at all and cheap Rx.  Great now, but it wasn't always this way.  Before the Tricare I had another secondary and paid thousands upon thousands each year in out of pocket expenses.  So it's nice to breathe a little easier financially now.

Best suggestion I have is to check with your main providers and see what they accept, then shop for supplements accordingly. 
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katie1111

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Re: Medicare
« Reply #34 on: July 05, 2014, 06:53:22 AM »
As I posted in another thread, I was recently hospitalized for 2 weeks, had my gall bladder out, 3 ERCPs and lot of other tests, blood work, etc.  The bill so far is over $175,000.  As of now Medicare has covered all but about $400.  I also have United Health Care supplemental through my husband previous employment with GE and think it must have kicked in.  I have had no trouble getting doctors, but I think that may be due to the United Health Care Supplement.

I did have trouble getting one medication.  I reacted badly to the anesthesia and the anesthesiologist told me they could not give me the medication they wanted to because it was in short supply and unavailable.  A bit scary.

Katie

cccourt1942

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Re: Medicare
« Reply #35 on: July 05, 2014, 07:47:02 AM »
I guess I don't understand what Medicare is.  I do remember when I had an accident on the job...and I was told I could apply for Medicare at 62 due to the partial disability.  I had good insurance and did not take it.  How do people get Medicare before 65?  Thru disability?  I thought that was covered under Medicaid.
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litliwlowa

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Re: Medicare
« Reply #36 on: July 05, 2014, 08:02:17 AM »
I guess I don't understand what Medicare is.  I do remember when I had an accident on the job...and I was told I could apply for Medicare at 62 due to the partial disability.  I had good insurance and did not take it.  How do people get Medicare before 65?  Thru disability?  I thought that was covered under Medicaid.

All I know is when I was 52 in 2008, disabled as of 2006 (age 50), approved for SSDI in 2008 and Medicare kicked in automatically Nov 2008. Maybe it has something to do with work credits. I sure had plenty of those. As my SSDI exceeds income criteria for Medicaid, I am not eligible for Medicaid, nor SSI.

As to your situation with partial disability, sounds like the age 62 factor may be more related to early retirement age. My roomie (not rheumy, but roommate) put in for early retirement at age 62. No mention of Medicare for him, but perhaps as he is a veteran with full health benefits thru the VA maybe Medicare doesn't apply for him.

I find it very helpful when I have questions re: medicare or social security to call them directly. While I haven't had to call often, the times I have called they are very helpful in answering questions. When in doubt, check it out with the source. ;)
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Sooki

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Re: Medicare
« Reply #37 on: July 05, 2014, 08:22:11 AM »
Last month, I signed up for Medicare. (It's soooooo much better and cheaper than my brutal self-employed policy with high premiums and high deductibles!)  In case my wanderings can help someone, this is what I learned.  (This was just my experience so I can't swear to any of it.)  And all you readers who live in more reasonable countries - you can just shake your heads in wonderment!

The medicare.gov site answers a lot of questions about medicare (including disability).  Most people get Part A (hospitalization) automatically at 65 (this might be connected with social security).  Part B is available for about $100 a month (usually paid automatically from social security).  I pay that myself until I start drawing social security.  You are eligible for Medicare starting the first day of your birthday month (just before you turn 65).

These two plans pay a good chunk of medical bills.  There are still deductibles (low, compared with individual private insurance), and bills when treatment exceeds maximum allowed.  And it doesn't cover prescriptions.

You can elect to get a Medicare Supplemental plan (also called Medigap policy - same thing).  These plans are standardized by the government but sold by private insurance companies.  These pay towards deductibles and leftover expenses from Parts A and B.  These don't cover prescriptions.  There are various standardized plans, labeled A through N, which cover more or less and charge accordingly.  This link describes the basics of each one:
http://medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html
The private companies are also rated by Medicare.

You can also sign up for Part D for prescription drugs.  These are also sold by private companies under regulation by Medicare.  There is some standardization, but they appear to be different for specific drugs.  Good idea to put in your drug list and see which plans save you the most money.  I break even on it now, but figure if I have to increase my list, I'll be in a good position to save.  I probably won't decrease my meds :(

INSTEAD of getting an Supplemental or Medigap policy on top of the Part B you pay for, you can choose to get a Medicare Advantage plan from a private company that includes all the things in the government Part B plan as well as some things in supplemental plans.  Some of these also cover prescription drugs. If you have family coverage already, you might be in one of these.   Personally, my latest doc was happy to see a Part B + supplemental plan rather than an advantage plan.   I elected to do standard Part B and the minimal Supplemental plan (plan K).

If you go through the medicare.gov website and enter your zip code and basic info (when I was just cruising through, I made up a birthdate that was close to mine), it will list links for companies providing policies in your area.  You have to link to an individual company's website to get the price and benefits table for that plan.  Plan K is the cheapest and probably a good place to start looking.  Plan A is the most expensive, I think.

Regardless of the plan I finally selected, I found that the aarphealthcare dot com site had the best organization of information. I would recommend reading some basic info from this site and then start comparing details with other sites.  I think the benefits are pretty standard across companies for the different plans (I could be wrong here). 

I'm thrilled to be on medicare.  I previously had a $6000 deductible plan which cost the two of us over $1000 a month in premiums.  This is my first month and I've been saving up doctor visits for it - I've been to four new doctors this month, had a sleep study, two blood draws, and a bone survey.  I couldn't have afforded that before.  Part D isn't great, but I hope to get the details about pharmacies etc. tweaked before too long.
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irish

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Re: Medicare
« Reply #38 on: July 06, 2014, 12:21:10 AM »
I am just going to tell you my limited experience. First of all, you have to have 40 work credits to be eligible for medicare and that involves 40 credits in a certain number of years prior to getting medicare. Generally, you get medicare when you retire. You can retire at 62 but most people don't cause who can afford to retire these days.

I quit my job at age 60 because of my health. Never considered applying for disability until one doc told me to apply. Well, I got disability on the first try. While I waited the two years for the medicare (medicare sent out a letter telling me I would be eligible for medicare in 2 years) I had to obtain insurance through the "pool" in MN. This is insurance that MN has made mandatory to provide for those of us that are uninsurable. The health insurance companies bid the contract and lowest bid wins. Thgis insurance is paid by each person and is very spend.

When the 2 years were almost up I got info from medicare explaining that I had the choice of plain medicare or the medicare advantage. I read over the info that was sent and chose to go with the old medicare. MA had just come out and it didn't sound all that great nor did it have a track record for me to check out. I then went to my BCBS agent in town and got the Senior Gold plan. This runs me a little over 200$ a month but for all these years I have paid almost nothing in medical costs. Medicare must pay a portion of the medical bill in order for the supplement to pay. Medicare doesn't pay then the supplement doesn't pay. One has to watch their docs and lab work, etc to make sure that things are covered.

The part A is always received when you go on medicare. It is a given and the latest charge per month has changed from 109$ to 204$ a month and they take that out prior to depositing your social security in your checking account. I also take part D from BCBS. I pay a lot in insurance, but it is considered part of my budget and gets paid along with the utilities, so to speak. After health insurance is paid then I can go out to eat. Insurance is that important.

With my health issues I am on IVIG and the doc bills BCBS for over 13,000$ (docs have to bill high in order to get what they do get paid. sort of an artificial system if you ask me) a month and medicare pays him a certain amount and my supplement picks up the rest. It comes to over $6,000 a month that I don't have to pay a cent on. I have been on this for about 8 years. Plus, all the doctors visits, surgeries, lab work, etc. I will never, ever complain about paying health insurance and am so thankful that I can pay it. If you can check out your states BCBS as I know our state has BCBS policies that are much cheaper with pretty good coverage.

I didn't worry much about dental as most of my teeth were pulled by then. I don't have vision insurance and I don't worry about that either. Many of those policies don't pay enough to make them worth while. Please make sure that you research health supplements really well and keep track of enrollment times, etc. I know people on medicare advantage and all they do is complain about how much they have to pay on their doctor and hospital bills.

One thing is for sure, one can't sit around and just let things happen, you have to be involved and keep abreast of things in order to make sure you have appropriate insurance.. Good luck Irish

gurs

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Re: Medicare
« Reply #39 on: July 06, 2014, 04:53:15 AM »
Im not sure how anyone with illness doesn't have a supplemental insurance with Medicare. At least for me anyways..I know it sounds confusing, but it really isn't. I went on the medicare.gov and did my research a bit. I have had a BCBS legacy plan for about 5 years now, and it has been a godsend so far. I only pay 125.00 a month, and it picks up everything medicare doesn't. This does not include my dental or scripts though. I don't have to have pre-approvals, and can see any doc that accepts medicare/BCBS. I don't have any office co-pays either. You have to be careful. A lot of these brokers will contact you and you will end up with a plan that is not best suited for you. My mom got scammed and was paying 250.00 a month, and it didn't cover hardly anything..I got her on the BCBS legacy plan (Michigan) and she loves it. Im also noticing more issues with doctors offices and the way the bill the insurance now. Some of my offices are billing as "Routine" labs, where medicare wont cover???? are you kidding me???? Called back and told them they need to use different billing codes. My mom just got a bill from lab for the same thing. She needed her homocystein levels checked because she had problem with elevation, and they billed it as routine..not covered? are you kidding? be careful and fight it with your doctors office.  Sorry to ramble guys..this stuff gets me heated!! haha

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warmwaters

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Re: Medicare
« Reply #40 on: July 06, 2014, 09:40:23 AM »
Iris - you got it exactly right. Some people have not enough not paid into SS, and are not eligible for Social Security Disability.(SSDI) For example - young people who haven't work, people who were in the Armed Forces, people who worked in city or state government jobs, like teachers and firefighters.
Details here http://www.socialsecurity.gov/pubs/EN-05-10029.pdf

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..
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mistyrain

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Re: Medicare
« Reply #41 on: July 06, 2014, 09:55:51 AM »
gurs said: "Some of my offices are billing as "Routine" labs, where medicare wont cover? are you kidding me? Called back and told them they need to use different billing codes"

And in particular, with sjogren's syndrome and our multivarious symptoms and different problems, it is easy for doctors to assign more than one code number (and therefore different code charges) for items that should all come under sjogren's syndrome code if that is what you are discussing - you really have to watch that one or alert your doctors about this.  Last time I was attending my regular doctor, I said "I have a question but I hope this question will not produce another medical code number" - half jokingly but at least to make it clear I don't intend to let them become medical code charge junkies on my behalf - laugh!

Irish: I am a bit confused with your statement that:

"The part A is always received when you go on medicare. It is a given and the latest charge per month has changed from 109$ to 204$ a month and they take that out prior to depositing your social security in your checking account" 

since I believe that it is the same in every State.

I don't pay anything for Part A (Hospital Insurance) which is paid for by the taxes you paid in while working.  Part B (Medical Insurance) has a deduction before Social Security payment is made each month of $104.90 and there is a yearly deductible of $147.

No doubt some of this stuff will be going up next year but at this time of my life I live as much as possible for the moment.  It can get so complicated I sometimes think half the insurance companies don't have their facts quite right.

litliwlowa

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Re: Medicare
« Reply #42 on: July 06, 2014, 10:22:19 AM »
Quote
I don't pay anything for Part A (Hospital Insurance) which is paid for by the taxes you paid in while working.  Part B (Medical Insurance) has a deduction before Social Security payment is made each month of $104.90 and there is a yearly deductible of $147.

That's consistent with my direct experience. It's Part B that has the premium, not Part A, and the $104.90 comes off the top out of my SSDI directly. My deductible is also $147 on Medicare Part B.

Then my supplement premium is almost $300 and deductible on supplement for me is $300 before supplement pays anything.
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mistyrain

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Re: Medicare
« Reply #43 on: July 06, 2014, 11:07:43 AM »
Some States will help with those MediCare premiums.  When applying for help on different programs, most of those agencies require the same information over and over so just keeping a few bits of paper handy in a folder is a great idea - maybe 6 key pieces of paper is all then you don't have to get in a paper frenzy each time  :)

http://www.medicare.gov/your-medicare-costs/help-paying-costs/medicare-savings-program/medicare-savings-programs.html

Jasper

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Re: Medicare
« Reply #44 on: July 07, 2014, 01:58:52 PM »
Most people cannot get Medicare until they are 65 years old even if they retired at 62. I retired at 62 and had to wait until age 65 to get medicare.

It may be different for those who are disabled or got disability retirement.
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