Medicare choices???

miamimama

Medicare choices???

miamimama

I will soon be going on Medicare (groan) and have been reading as much as I can about it.  Can anyone give me advice on which plan to choose - a medicare supplement or one of the medicare advantage plans?  Since those of us with bc have numerous doctors, perhaps you can give me some guidance.

Thanks, Claire

abbadoodles

Cripe, I wish I knew.  I'm ***only*** 60 and dh is going to be 62 this summer and I'm starting to worry about Medicare and the like.  Esp. after bc. 

My aesthetician told me a few years ago that her husband (older) had had Medicare but then bought one of those "other" policies thinking it would cover him in all cases.  Unfortunately, because he had something else he was not covered for some stuff Medicare does normally cover and he had to pay out of pocket!  It's very tricky.

Medicare and related insurances are moving target; things keep changing. 

I'm all ears if anyone out there knows anything.

Tina

saluki

Tina and Clare-

There is allot of info on this thread about Medicare.

http://community.breastcancer.org/topic/8/conversation/700362?page=2#idx_36

It won't link.  The thread is titled Medicare and it is in the recurrance section started by Florik.

saluki

Here is some of what I posted there.

(I myself have elected a Medigap plan as I am a medically complicated patient and wanted to keep my options open. With a medigap plan

Original Medicare remains your primary and Medigap is secondary)

With Medigap--If you ever give it up for a Medicare managed plan--you can never return to Medigap---so you have to be very careful about your decision.

If you elect a private plan such as a Medicare advantage plan--a medicare hmo, medicare PPO, or Medicare point of service---that becomes your primary-

It is a Medicare plan, but a private one

That is what leads to the confusion

Here is a little more info from medicarerights.org

Medicare Options

It is important for you to think about your particular health care needs. Do you have a doctor you prefer to see? Do you have a condition that requires frequent doctor visits? How many times have you been hospitalized in the past couple of years? How much have you spent on health care in the past few years?

Once you have an understanding of your health needs, you need to understand your Medicare options so you can decide which one best suits your needs.

Everyone starts with Original Medicare—your red, white and blue card. Then you can decide if you want to get supplemental insurance or join a Medicare private health plan (also called Medicare Advantage) and get all of your benefits that way.

Note: If you want Medicare drug coverage (Part D), it must work with your health coverage.

Your Medicare plan choices are:

   1. Original Medicare.
   2. Original Medicare with supplemental coverage (Medigap).
   3. Original Medicare, with supplemental coverage (Medigap) and/or Medicare private drug plan.
   4. A private Medicare plan. The most common types:
         1. Health Maintenance Organization (HMO);
         2. Preferred Provider Organization (PPO) plan; or
         3. Private Fee-For-Service (PFFS) plan;

If you do nothing, you will automatically get Original Medicare.

Three Things You
Should Know

1. No matter what Medicare choice you make, as long as you have Parts A and B, you have the right to the same basic benefits.

2. Before you sign up for a private Medicare plan, make sure you know what you are signing up for. Don't sign anything right away. Give yourself time to think about it and look into it further.

3. If you do not get the care you think you need under Medicare, don't take no for an answer. Appeal the decision. Appealing is easy and free.
1. Original Medicare

Original Medicare (also known as traditional or regular Medicare) is the fee-for-service program offered by the federal government. The government pays for part of each service you get.

You are automatically enrolled in Original Medicare when you sign up for Medicare. If you want to stay with Original Medicare, you do not have to do anything.

In Original Medicare, you can use almost any doctor or hospital in the country and can get care when you think you need it.

But, unless you have supplemental coverage, you will have to pay a large hospital deductible, an annual deductible for doctors' visits, and 20% of the cost of most outpatient medical care. (Get more information about Medicare costs.)

Original Medicare does not cover routine dental care, hearing aids, vision care, routine foot care, or long-term care. To get Medicare drug coverage (Part D) and keep Original Medicare, you must join a Medicare private drug plan that offers only drug coverage (see below).
2. Original Medicare with Supplemental Coverage

If you do not have insurance from a former employer that fills gaps in Medicare, there are several insurance companies that sell supplemental coverage to fill these gaps. They sell policies called Medigaps that help cover Medicare deductibles, coinsurance and some additional benefits.

There are 12 different standardized Medigap plans, labeled A-L (except in Massachusetts, Minnesota and Wisconsin). Not all plans are available in all areas.

Each Medigap plan pays for a particular set of benefits. Plan A offers the fewest benefits and is usually the least expensive. Plans that offer more benefits, like plan J, are generally more expensive.

The most popular Medigap plans are C and F, because they cover major benefits and are less expensive than other plans.

To learn more about the benefits offered by each Medigap plan, see MRC's Medigap Plan Benefit Comparison Chart

All Medigap plans (A-L) must include the following basic benefits:

    * Hospital coinsurance coverage
    * 365 additional days of full hospital coverage
    * Full or partial coverage for the 20 percent coinsurance for doctor charges and other Part B services
    * Full or partial coverage for the first 3 pints of blood you need each year

Depending on which Medigap plan you choose, you can get coverage for additional expenses Medicare doesn't cover, including:

    * Hospital deductible (plans B to L)*
    * Skilled nursing facility coinsurance (plans C to L)*
    * Part B deductible (plans C, F and J)
    * Excess doctor charges (plans F, G, I and J)
    * Emergency care outside the U.S. (plans C to J)
    * At-home recovery (plans D, G, I and J)
    * Preventive care that Medicare does not cover(plans E and J)

*Note: Medigap plans K and L will only pay for a portion of the cost that Medicare does not cover until you reach a yearly out-of-pocket limit.

Medigaps with drug coverage stopped being sold as of 2006. If you have a Medigap H, I, or J policy with drug coverage that you bought before 2006, you cannot have drug coverage both through your Medigap and through the Medicare drug benefit.

Your State Department of Insurance can give you a list of companies that sell Medigaps in your state. You can also call your State Health Insurance Assistance Program or the National Medicare Hotline (1-800-MEDICARE) for free Medicare help. In addition, the Medicare.gov web site let's you compare Medigap plans in your area.

Health coverage from a former job, often called “retiree” coverage, generally gives you better coverage than a Medigap plan. You should think carefully before giving it up because you may not be able to get it back.

If your income and assets are low, you may be able to get free supplemental coverage from Medicaid or other government programs.
3. Original Medicare, with supplemental coverage (Medigap) and/or Medicare private drug plan.

If you want to get Medicare prescription drug coverage (Part D), you must choose a private plan offering the drug benefit in your area and enroll in it. You can choose to have the premium, which may vary by plan, taken out of your monthly Social Security check or pay it directly to the company.

To continue to get all your other medical services (such as doctor visits, hospital stays) through Original Medicare, you must choose a stand-alone Part D Plan (PDP). A "stand-alone" plan provides only prescription drug coverage. You can also have a Medigap policy to cover your other out-of-pocket costs (see above).

Note: If you qualify for Extra Help paying for the Medicare drug benefit because your income is low, your monthly premium will be free or reduced. If you have Medicaid or you are enrolled in a Medicare Savings Program (MSP), you will be able to change your Medicare drug plan once a month.

To learn more about Part D and Extra Help, read MRC's educational materials about the new Medicare drug benefit.
Medicare HMOs

Five Things You Should Know About Medicare HMOs

1. You are limited in when you can switch HMOs or go back to Original Medicare. You are only allowed to make one Medicare health plan change–either to a private Medicare health plan or to Original Medicare–from January 1 through March 31 each year during the Open Enrollment Period. You cannot add or drop drug coverage during the Open Enrollment Period. You can change your choice of Medicare health and/or drug coverage between November 15 and December 31 of every year, during the Annual Coordinated Election Period. Your new coverage will start January 1.

2. Don't assume that because a benefit is listed in a Medicare HMO brochure that you will get it when you want it. Medicare HMOs decide how much care you need and when you need it.

3. If you want to keep seeing your current doctors, call them to make sure they are in the HMO network and are taking new HMO patients.

4. Before joining a Medicare HMO, ask if it will cover the medications you currently take. Many Medicare HMOs will cover only specific drugs on their lists.

5. Stay on top of changes in your coverage every year. Medicare HMO doctors and hospitals can leave the HMO at any time, and HMOs can raise premiums cut their benefits, or end their Medicare contracts each year. Changes are usually announced in September and take effect the following January.

Medicare HMOs are run by private companies that are paid by the federal government to provide Medicare-covered health care. You must have both Medicare Part A and Part B to enroll in a Medicare HMO.

Unlike Original Medicare, a Medicare HMO will only let you see certain doctors or hospitals within your area unless you have an emergency. These doctors and hospitals are part of what is called the HMO’s network. You must choose a primary care physician (PCP) from the network. That doctor decides when you can see a specialist.

A Medicare HMO could save you money because some do not charge premiums, deductibles or coinsurance. You may only have to pay a small copayment each time you see a doctor, as long as you use the HMO’s doctors and follow HMO rules. Before joining a plan you should compare exactly what each HMO in your area is charging and offering.

You can get all your Medicare benefits, through a Medicare HMO. If you want the Medicare drug benefit (Part D), you must get this drug coverage as part of your HMO's benefits package. Medicare HMOs must cover the same kinds of care that Original Medicare covers, but they decide when you need it. They may also offer additional benefits like:

    * Dental care
    * Eyeglasses and vision care
    * Hearing aids
    * Physical exams

To learn more about Part D and Extra Help, read MRC's educational materials about the new Medicare drug benefit.
4b. Medicare PPOs

Medicare PPOs are private insurance products, much like Medicare HMOs. You must have both Medicare Part A and Part B to enroll in a Medicare PPO. You will be responsible for paying fixed copays if you use in-network providers, but you will also get some coverage if you go out of network. They provide Medicare benefits and may offer some additional benefits. You can get Medicare drug coverage (Part D) as part of your PPO's benefits package.

PPOs differ from HMOs in only two key ways:

   1. Medicare PPOs will likely charge higher monthly premiums than Medicare HMOs.
   2. But, Medicare PPOs will cover some of the costs of your care if you use doctors and hospitals outside the network.

To learn more about Part D and Extra Help, read MRC's educational materials about the new Medicare drug benefit.
4c. Medicare PFFS

Private insurance companies can offer PFFS plans. These companies pay contracting providers on a fee-for-service basis. You must have both Medicare Part A and Part B to enroll in a Medicare PFFS plan.

The companies offering these plans can charge you as much as they want for the premium for the coverage, but they are limited in the amount of copayments and coinsurance they can ask you to pay.

In a PFFS plan, you can go to any doctor or hospital you want, as long as they agree to accept the plan's pre-set fees, terms and conditions. Be aware that if your doctors don't accept the plan, they often won't see you.

Doctors, hospitals and nursing homes may bill you for up to 15 percent above the plan’s approved amount (which may be higher than Medicare’s payment rate) if the PFFS plan permits them to do so. For example, if the plan's payment structure allows $100 for a particular service, the doctor can charge you up to $15: $100 plus 15% is $115. The plan pays $100 and you pay the other $15. That would be in addition to any copayment or coinsurance the plan may have.

If you join a Medicare PFFS plan that does not offer Medicare drug coverage, you can join a stand-alone Medicare private drug plan (PDP) that offers drug coverage.
Key Points About Your Choices

    * If you're happy with your current Medicare coverage, you can keep it without doing anything.
    * You are limited in when you can switch HMOs or go back to Original Medicare. You are only allowed to make one Medicare health plan change–either to a private Medicare health plan or to Original Medicare–from January 1 through March 31 each year during the Open Enrollment Period. You cannot add or drop drug coverage during the Open Enrollment Period. You can change your choice of Medicare health and/or drug coverage between November 15 and December 31 of every year, during the Annual Coordinated Election Period. Your new coverage will start January 1.

    * You will be signed up automatically for Original Medicare when you first get Medicare, unless you sign up for a private Medicare plan.
    * You can get free, reliable information from your State Health Insurance Assistance Program (SHIP).
    * Original Medicare is available everywhere. Private Medicare plans, like Medicare HMOs, Medicare PPOs and Medicare PFFS plans, may not be available in your area.

Here is that website:

http://www.medicarerights.org/maincontentmedicareoptions.html#hmo 

miamimama

Saluki, Thanks so much for your wonderful explanation.  It will help me, and possibly others,  as I try to make the right decision.