Medicare

[poisonangel168]

I am on Medicare due to disability. Disability is my only source of income, and I became disabled only a few years after I began working, so my payments are low. I qualify for a program called QMB where Medicaid pays my premiums, coinsurance and deductible. Because I qualify for this program,  I also receive extra help from Medicare with part D drug costs. This eliminates the donut hole and keeps all of my drug copays under $5. I pay nothing for doctor visits or any other medical services, as long as the provider accepts Medicare with Medicaid as the secondary insurance. I would spend my entire check on medical costs if not for these programs, so I wanted to share this information in case there are others in a similar situation who may be unaware that this type of assistance is available. You can apply through your local social services office.

[irish]

mistyrain, I just got back to this thread and I did tello it wrong about the Medicare. The part A is the "free" part and it is the part B that we pay out of our social security. I have 204$ taken out of my social security prior to the SS being deposited in my checking account. This happens every month. If you check the SS info that comes out every year stating your total monthly amount that you receive from medicare and then check your bank statement you will note the difference in these amounts. The difference is what we pay for the Part B.

I also misspoke when I said that the bills are sent to BCBS. Actually, the medical bills are sent to Medicare first and medicare determines what they will pay. The bill are then passed to BCBS (or supplement) and then they determine how much they will pay. In some places the Medicare and BCBS almost have offices next to each other or else down the street.

Also, a person has to receive disablity for 2 years before they are eligible for Medicare. When I quit work at 60 due to health in June 2003 and then applied for disability in November of 2003(have to be off work for 5 months before you can even apply for disability) I was approved and started getting the disability in May of 2004. It was 2 years from this date that had to go by before I could get Medicare. I was very happy to get the disability, but sure disgusted with how much they docked me forgetting the social security(in form of disability) early. I was 61 when I started the disability.

It behooves a person to get a supplement if they can and to really shop around and see what best fits your needs as dictated by the part of the country that you are in. Health costs are different in all parts of the country. If a person can't afford it then going to social services in your county will ehlp- sent you in the right direction. Good luck Irish
 

[mistyrain]

Cheers Irish and to everyone providing good stuff on this forum - there is always something new to learn and especially MediCare can get quite involved.  It takes a bit of concentration to figure MediCare's possibilities - good that you can keep on track so well Irish after all you have been dealing with.

I just happened to call my doctor's office new billing provider last week to try to get them to spell out some of the intricacies of MediCare's offerings and billings.  They took over the billing a few months ago but I had not had a bill this year - by the time I received a bill covering more than one visit, there were dates and items that were a bit complicated - help help I said - this is ridiculous that you send a bill to Medicare that is way above and beyond what they will actually pay.    Well, I did happen to speak to a truly good expert and one of the things she told me about (I have had MediCare for quite a few years) that each year you can be eligible for what is called "a Wellness doctor visit".  This is covered completely by MediCare.  No doubt some of you know about it.

It did not occur to me until after I spoke with this expert that such a visit might be quite a good idea.  For one thing, they will go over your history and provide an opportunity to combine all of your past doctor and specialist visits into one coherent meaningful summary.  They will also provide the opportunity to discuss what YOU might be doing to help your health get in a better condition, particularly if you have found alternative supplements and health items that were helping you that might not necessarily be in your records. 

I figured I will request that my next appointment will be the Wellness appointment - seems like I have a few finer points to have listed on my records - like for instance WHY I have so many bad medicine reactions and how sjogren's syndrome ties in with the other health issues - after all it is one body even if the cardiologist says the heart is doing better, I still think the sjogren's discussion has to come into it overall with your primary doctor who can then send a report to all the different specialists.

Well, that is the latest in my neck of the woods.  I think it would be helpful to have such an appointment rather than always trying to fit in exactly why you are visiting the doctor today without getting sidetracked by being told I need to see this specialist or that consultant in order to make any progress.

Thanks Irish for sorting out that MediCare stuff - it can be very confusing to many people.

Best
Edith

[mistyrain]

Here is the website about the MediCare Wellness visit.  IMO they don't make it that clear that you can have this visit once a year.  But it does show what you can discuss and could be quite helpful to many people:


yearly ?Wellness? visit


http://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html

[irish]

For those of you who have a BCBS supplement you should receive a booklet every year that explains the new Medicare coverage that will take place. This is where you pick up on things like the once a year wellness visit that you are allowed. I have had these and they are not as in depth as you might think. They do cover the needed blood work panels---this is good when you have diabetes, etc.

It is a general physical and probably will help some people cover some of the needed info with their doctors. It really doesn't cause bells and whistles or improve the odds of getting a diagnosis---at least from my perspective. Of course, I am old and I still think that years ago the physicals were done at a slower pace and the doctor "touched" the patient more. Nowadays we get the quick once over usually and if there is a complaint they usually end up ordering a CT scan. I don't think the young docs can function without those scanners. Yes, they are useful, I will admit, but they become a crutch come times. My opinion.

I also would think that if you want more info on Medicare you could do some on-line searches for info. Maybe medicare whats new 2014--etc. You will get to a link and then it just keeps on expanding and sometimes you learn a whole lot. Also, try the health insurance websites as they have a lot of info on their or access to it. Thanks Irish. Anything I know is from working in the medical environment and also fighting through bills, etc for both me and my hubby. I just got a notice from the company who provided the machine for his INR testing saying that I owe them money. I called hospice and have to figure that out.

I just "won" an ongoing billing ordeal that lasted from August 2013 to April 2014 when hubby passed away. I had called the company, regional, national office and you name it many times. I had to call so many medical offices and work my way through all the junk that the oxygen company wasn't doing. It almost wore me to a frazzle, but I documented and argued my way through---plus I hollered a few times also. I just got the news that Medicare has covered this bill. Do not be intimidated by these companies. Call, keep documentation, names of people you talked to, dates, place and number you called and what was discussed and you will be amazed at what you can accomplish. Also, let them know that you will report them to the Attorney General of your state. Enough of my rambling. Good luck all. Irish

[Helene]

I have Medicare with the AARP United Health Care supplemental that cover nearly all copays. The only copay I've had to pay is a surcharge for laser cataract surgery. I also have Prescription coverage. It's been wonderful. It just about pays for everything. I used to pay a lot for private insurance before I turned 65. Medicare seemed so cheap that I bought the best coverage I could find and am grateful everyday.

[slccom]

Be aware that if something is "found" during your wellness visit, Medicare may end up billing you for the visit. Also, if you have issues, there is no such thing as a wellness visit. EVERYTHING is a "follow-up" visit.

Sharon

[gurs]

This billing stuff is just crazy...I have to fight all the time for my doctors offices to use the correct diagnoses/procedure codes.
Our labs should not be "Routine", and if they are, medicare doesn't seem to want to cover them, therefore, BCBS wont pick it up either.
Its really on how the doctors office does the billing..call the office manager, whatever, until they find a code that is allowed and will be covered. So tired of this. My mom has had high homocysteine levels and needed them checked, and they billed this as routine, not covered? crazy.......don't get a doctors/hospital/lab bill and just Pay it...fight it.

Gursie

[Calli66]

Does Medicare cover any medications, for example, anti-cancer drugs, etc.? I don't understand what's covered and what isn't. Is the Part D only for meds you have to take on a regular basis, or do you need it to cover in-hospital meds that are given as result of accident, surgery, disease, etc.?

Thanks,
Calli

[litliwlowa]

Does Medicare cover any medications, for example, anti-cancer drugs, etc.? I don't understand what's covered and what isn't. Is the Part D only for meds you have to take on a regular basis, or do you need it to cover in-hospital meds that are given as result of accident, surgery, disease, etc.?

Thanks,
Calli

If you have Medicare Part D, that would be prescription coverage and it would be best to call Medicare directly on what is covered and what isn't.

I get my RX coverage through my supplement package and I know they have formularies on what is covered vs what is not covered. If I require a med that is not on the formulary, then my physician basically has to justify it as medically necessary with a proper code for an exception.

[irish]

You are right about the wellness visit. I think I only had one and that was the first or second year that I was on Medicare. After we end up being so sick everything is a follow up and we work like heck to not have to go back for 3-6 months to keep the cost down. Medical coverage,  doctoring and keeping up with it all is enough to drive  a person crazy. Irish

[Jasper]

They do not do much for the wellness visit as far as I am concerned. It is mostly vital signs, weight, BMI, depression screening, alcohol screening, maybe a couple of other minor things. They don't get paid as much if they don't do those screenings. The screenings are just a very few questions on a piece of paper, rather useless if you ask me. They do order some labs and tests, whatever is due according to Medicare policy.

I get a free physical with my second insurance so they do a cursory physical at the same time as my wellness visit. They miss a lot. Not very thorough at all. However, I use the visit to get my regular prescriptions refilled for the coming year and to get my Dexa scan and mammogram ordered.

I don't go to my PCP for anything related to Sjogren's. I don't think she knows what Sjogren's is. I see my specialists for everything except for the yearly physical or if I get something like pneumonia, which I just had in June. My Rheumatologist orders the Plaquenil and next year she will also be following my bone density, ordering the Dexa Scan and ordering the HRT.

The one wellness visit that is really worthwhile is the first one because they can order a bunch of tests, labs, vaccines, aortic ultrasound, and a few other things.

[litliwlowa]

I do go ahead and get my "wellness" visit annually. But I sure wouldn't call it a physical. CBC w/diff and Lipids. If I happen to have a medical issue at the time, then it's a very limited exam. Most of the time a quick peek in ears and a lot of talking, as I usually do have something flaring at the time.

However, it may be as my PCP knows I am being followed by several specialists so doesn't feel teh need for an extensive "physical" exam.

Not at all what it used to be pre-Medicare. Or maybe it has nothing to do with Medicare but is more the trend in medicine these days.

[gurs]

I just got a bill today from Gyno office for my yearly exam? confused. I have medicare and I know they didn't cover some of it.
It was for a pap,breast-pelvic,urinalysis only..I know I had to pay 52.00 to my docs at time of the visit because medicare never covered it, but now, the docs sent me bill for 105.00? im confused..did medicare change something again, or did my docs use the wrong billing codes?
they prob had to bill it as routine? oh my gosh..so tired of this. Left a message for the docs. I had a total hyster 8 years ago and don't even need this...never again. My rheumy can check for lumps etc. I always have yeast infections going on so that is why I went in the first place...ughhhhhhh.

Gursie