medicare insurance

goldie123

I'm soon going on medicare  instead of my private insurance. I haven't had any trouble throughout all my treatments for the last 5 years,but i hear that some of the medicare supplement companies are worse than others. What should i look for in choosing a company

                                                                     goldie

SpecialK

goldie - can't advise on choosing a medicare supplement company, but be aware that some docs limit how many medicare patients they accept because of the reimbursement rate.  Many docs allow only a certain percentage of their patients to be medicare patients to minimize financial impact on their business.  Check with your regular docs and make sure they will continue to see you as a medicare patient.

Alpal

Some docs here refuse to accept patients who have the Medicare Advantage plans but have no problem accepting those with the Medicare Supplement plans. You might check on that. DH has the AARP one (United Health Care). Not exactly cheap and you do have to get a separate drug plan. No problems, so far. I'll probably get the same thing in August when I celebrate my 65th.

Chickadee

Can your current private insurance become secondary?

lauri

Be prepared for transition mishaps -- when I switched from my employer's insurance (I worked until 66, so that insurance was primary and Medicare was secondary after 65) it took a FULL YEAR before the billing got straightened out.  Medicare kept rejecting bills, saying they were secondary, and the old prinmary insurer kept rejecting because my insurance had expired.  And one provider kept sending bills to the wrong place even after numerous letters.

Some supplemental plans have preferred providers, others will let you go to any provider who accepts Medicare.  Every company offering a specific coverage (F, K, etc) has to provide the same benefits, but the prices vary by a lot.  (I took Anthem Blue Cross plan F)

goldie123

thanks all if I thought the world of bc was complicated,boy the world of insurance is just as bad

beergirl

I have had traditional Medicare with Aetna as a secondary insurance. It has worked well. I am in the Houston area and my doctors prefer traditional Medicare instead of the Medicare HMO.

ibcmets

Goldie,

Ask if your company will go secondary.  I'm starting medicare in Jan and they just sent me the 2012 Medicare & You book that details coverage & medicare advantage plans. Call & ask for one.

Terri

cycle-path

I have a question about Medicare Advantage Plans. Above, Alpal notes that some docs accept supplemental plans but not advantage plans. I'm assuming, then, that MPAs just reimburse at a lower rate? 

Medigal

It's true what was posted about doctors only accepting so many Medicare patients.  When I was trying to desperately find a gyn, I was told they all had their quotas of Medicare patients and that was even tho I have an Advantage Plan with it.  I had to end up with this really "creep" of a gyn who was the only one who would take my Plan.  Thank goodness I only have to see him once a year so far!  It makes sense he was the only one still available from the way he acts.   So if you are on or going on Medicare, make sure you start looking "now" for docs you need in the plan you have and start calling!

NJMarilyn

Goldie, check with your County Office on Aging. They will help you make the right decision.

SyrMom

Does anyone know which medicare supplement covers cancer related treatment the best?  Is there always a 20% copay?  I would think it should be the same throughout the U.S.

Dilly

I went on Medicare last summer, and things went ok (with the exception of one provider kept billing my old insurance), but I just got a stack of explanation of benefits from the  CMS - center for Medicare Services, and they have denied the claim submitted by my onc for blood tests which we do each six months to check tumor markers, liver function, etc.  So, now I have to appeal that decision.  Has anyone done an appeal, or had their blood work denied?

edited to add, I have a Medicare Supplement plan F, and it has picked up all my copays & the Medicare Part B deductible -

chele

Lost creek, have you rec'd a bill from the provider? It could be as simple as the provider failed to bill with the appropriate diagnosis code. Contact your provider, see if they have already or will re-bill it for you. With Medicare the patient can not be billed for non-covered care unless the patient was notified it would not be covered and signed a consent for the non-covered care.

Dilly

I've undoubtedly signed something without realizing the implications - Murphy's Law.

Take a simple task and complicate it. - Lost Creek Law.

Thanks, Chele -  I'll check with the provider.  And California has an advocacy program I can tap into if necessary.  I may have unwittingly complicated the situation because my onc and my PCP belong to two different medical "groups" - the coordination of care issue can get murky.  The onc ordered the blood work, to be done at her group, but I had the blood drawn at my PCP's, and sent to onc.  (Part of that is that PCP is 6 miles away, onc is 45) .... It appears I'm about to go on a Medicare Appeal learning curve. I'm hoping it's an easy fix, because I believe these tests are a reasonable and necessary part of bc care.

EllieD

If you go on www.Medicare.gov you can view the plans and compare. I agree that your Area Agency on Aging is a good place to get expert, unbiased assistance.

scuttlers

Ask your current medical providers which plans they accept BEFORE signing up with the plan. I was very surprised when MD Anderson would not even give a consultation appointment for my dear BIL because he had the AARP United Healthcare. (we pleaded and begged, even offered to pay cash for all charges, no go). He died 5 months later before he could get changed to a plan that would have let him get a consultation.



Go through ALL the plans available in your area. Check the cost of medications and IF they are covered, how much they are covered. Even infusion medications! All this is available on the Medicare web site.



Narrow it down to several plans that you can LIVE with (key would being LIVE with). Meet with the financial department at all of your providers and lay the sheet with the plans in front of them. Simply ask if it was their decision for their family - which would they probably choose. (they can not tell YOU which to choose, wording is important).



It sucks, it takes precious time away to do this, but it would REALLY be a shame to be told "no appointment for you" (this one happened to my BIL) or "you can only get 30 pills filled a month, even though you are taking 4 a day" (this one happened to my SIL).



Be careful, be VERY careful. DO NOT believe the insurance person trying to SELL you the policy. My DAD signed with the one mentioned that is advertised as being so wonderful and endorsed by AARP. He was verbally told by the agent that mom could go ANYWHERE and would be covered. Technically, probably true, realistically - she would not be able to get an appointment if, say for instance, she wanted to get a consult at MD Anderson ...

Chickadee

Which brings up a good point, if there is a major cancer center you plan to consult eventually once you have found some possibilities, contact them directly with your list and find out if they accept any of the plans you are considering.

riverhorse

Just a note re: Medicare.  I called MD Anderson regarding a consult and was told that it would not accept Medicare.  When I said that the consult could be paid for directly in cash I was told that by law (I assume the law governing Medicare) MD Anderson was not allowed to bill a person on Medicare for any amount beyond (I think) 15% more than the Medicare re-embursement. Since that is the case, MD Anderson just does not deal with Medicare, regardless of supplements, advantage etc.  The same seems to hold true for Johns Hopkins and perhaps other major cancer centers.  

scuttlers

I went to the financial office last time I was at MD Anderson.  They DO accept Medicare WITH the right supplimental.  (I am leaning towards Humana Gold, and will be going in April for 6 month followup, I will check again in the financial office to MAKE ABSOLUTELY SURE that I can continue my followups with the insurance that we go with.)  What we were told when we were there was that the plan MUST be a PPFS (private fee for service) plan.  

 Once again, be very careful when choosing a plan, and MAKE SURE that your desired facility will accept the plan. 

riverhorse

I hope you are right.  I just changed my plan to a PPFS from an HMO (I have Federal Employees Health Benefits -- which is the same for retirees and for those still working) and checked first to be sure that Anderson accepted it.  My new coverage is not a Medicare supplemental or advantage plan, which if I recall correctly the guy from MD Anderson said would not do the trick.  However, I was not calling about breast cancer.

riverhorse

I hope you are right.  I just changed my plan to a PPFS from an HMO (I have Federal Employees Health Benefits -- which is the same for retirees and for those still working) and checked first to be sure that Anderson accepted it.  My new coverage is not a Medicare supplemental or advantage plan, which if I recall correctly the guy from MD Anderson said would not do the trick.  However, I was not calling about breast cancer.

lauri

Hmmm ... how can centers taking bucketloads of Federal research dollars refuse Medicare ??  I go to UCSF and there has been no problem with original Medicare plus Anthem supplement F.  I can understand not taking Medicare Advantage since that's a HMO that replaces Medicare (the HMO gets paid from Medicare for covered items, but can make its own rules.) 

And yes, providers can only charge the Medicare-approved amount plus 15%  (and Medicare only pays 80% of the approved amount) -- so UCSF bills $5,000 for an MRI and gets around $1,000 from both insurers ... and my responsibility is ZERO.

Chickadee

They don't refuse Medicare, that's far too blanket a statement.  They may not accept some of the Supplemental and Advantage programs but those are not your basic Medicare.  As for the bucketloads of federal dollars, I can't think of a place where it's better used.

PipersMom

I received my Medicare card - effective June 1, 2012 - after two years on disability.  Do I HAVE TO accept Medicare or can I stay with my private insurance?  My private insurance has paid for everything 100% (after family $4,000 deductible) since 2009 without any problems whatsoever.  I figure if I have to go on Medicare, getting the supplemental programs is a must.  I get my care at MD Anderson.  Based on what I have read here, I plan on talking to MD Anderson to see what they recommend and then also my primary care.  I know the Medicare HMO's can be a problem, but I am hoping with the better supplemental progrmas I won't have a problem.  Am I delusional?  Any advice?

ibcmets

Pipers Mom,

You should call Medicare & ask for their supplemental booklet.  It has lists of healthcare providers and their co-pay & yearly deductibles.  I've read it and it sounds like your private insurance will provide more coverage for less.  You should call to see if you can keep your private ins. as secondary and maybe your monthly premiums will go down but you would have to accept part A & B of medicare and pay around $115 a month for part B.

I just went on Medicare, but my prior company is still providing my healthcare as 2ndry coverage but had me accept Medicare part A & B. 

Terri

Katarina

ibcmets -- how are you getting your prior company to still provide healthcare??  Are you paying Cobra since you say "prior" company, or did you get a nice severence package?

I'm curious because I'm still under my company policy but will get medicare soon. I don't want to give up my current provider.

Hugs 

Chickadee

I'm not sure if ibcmets will notice your post after so much time but I'll take a stab at it. I retired from a large corporation an retained full healyh insurance coverage in retirement. Not common these days. My husband worked for the same company. He reached Medicare first. Medicare is now his primary and our retirement insurance secondary. I'm still on our retirement insurance and on SSDI so eventually I will also have Medicare and retain my retirement coverage as secondary.



As long as my corp doesn't pull the rug out from under us. However they are still very big and very profitable so that I dont worry about for now.

Katarina

Thanks Chickadee,

I work for a big Corporation but high tech, they don't have any pension or retirement plans, just 401K.  You retire by taking a package, when they offer it, and that's been 2 years of Cobra payments. That's it.

Hugs 

itsjustme10

My parents' supplemental insurance was through my dad's retirement benefits, administered by his employer - does your company have something like that?  The HR department should have some  information for you.