Can we talk about Medicare options?

I was on my own ins. for 2 years before 'Care.  My dh retired and I could no longer get the group rate.  I shelled out over 2 grand a month to get drug coverage in case I had a recurrance. My dh had planned for some of that with a savings account we started years ago, knowing I'd be on my own when he retired.  I have had 'Care for a little over a year and feel lucky to have it, esp. with this back problem and surgery

Hi abba,

I am on disability and have been on medicare since july. I have medicare part A ($96), prescription coverage thru United Health ($27) and a medicare supplement plan thru Mutual of Omaha ( $143). So far everything seems to be going as planned for benefits etc.

I went online to the medicare sight first. There was a link to providers on their sight. I went to those links. The rep from Mutual of Omaha spoke english, was educated in healthcare and took time to answer my questions and to offer choices of coverage based on my treatments and drugs etc. He calculated what my expected yearly costs would be for each plan. He also helped me find United Health for my prescription coverage. Many others contacted me but they either spoke a 100 miles per hour, didnt speak english well or had no interest beyond selling me a policy. I found that some of the local agents in my area could not offer me the same coverage without it costing more. I did have all my plans ready to go several months before I was eligible ..when the time came I ..I received my ins cards and called to finalize my prescription coverage. I hope this helps....Hugs, Mazy

So, let me get this straight.  Mazy is paying over $200 a month just for medicare coverage + a supplemental???!!!  Wow, just wow!

How do people on a fixed social security income afford this?  Not all of us have worked high paying jobs and social security will most likely be the bulk of our retirement income.

abba,

 I would call another company..I had several who spoke with me and took my info..knowing I was planning ahead..Hugs

I am also interested in  this discussion.   My husband died 6 1/2 years ago and I had to go on a self pay plan, as I had quit work before he died.   While living in Pennsylvania, it made sense for me to use BC/BS.   3 yrs ago I sold the house and moved to Virginia, to an area (for unknown reasons) that BC/BS did not cover.  I got another plan, which turned out to be total garbage - they only paid out a maximum of what I had paid into it each year, including the year (2008) that I was diagnosed with BC.  They did not even pay for my mammogram.   Panic set in, as I had one round of dose dense chemo and it was over $ 19 K with not one cent being paid by the insurance company.   I checked what I owed for other tests, scans, biopsy and it was over $ 39 K...!!!!   More panic and could I even get something else with the "pre existing" BC ?

As luck would have it, I was put in contact with an insurance broker who found me a plan, not cheap, but it covered most of my following treatments - $ 100 co pay for chemo since it was in the hospital setting.    The hospital let me set up a payment plan, and recently wrote off $ 17 K since I had been paying regularly.   Then I just got another write off for $ 9 K.   I had joked with my doctors saying they have to keep me alive for a long time so I can pay off these bills.   

I know this is long, but bear with me.  Talking with various friends who are on medicare with supplement insurance, they inform me that the place I go for tx does not participate in some of them... Yikes, now what do I do?  start looking for new doctors?   In jan 2011 I will turn 65, so one year to go to figure out what to do.   All this reform business scares me half to death - pre existing will not be covered, many places do not take medicare, I still owe $$ for my 2008 care, and I have not won the lottery yet.    Any know of a sugar daddy for medical coverage?  I get a pension that is too much to qualify for any reduction or help plans.   Guess that makes me one of the "lucky" ones...     

Thanks Mazy.  I have an appt on Nov 5 with the breast surgeon after my 6 month mammogram and can stop in the financial office and check it out.  

Yes Medicare is complicated at best.  Not to confuse the issue but if you are currently or will soon become a participant in the Medicare program, it would be wise for you to google the words: MEDICARE BUY IN PROGRAM.  This is a federal program using federal funds and handled by each state that offers certain medicare participants for the State to pay for the  monthly medicare premium for part B.  You can also contact Medicare and ask about this plan.  Anyone on medicare weather on social securtiy or disability (SSI)  at any age is eligible under certain income/assets guidelines.  These guidelines are quite liberal  Check it out for yourself.  I have and it works for me.     Cathey

Tina, I think you mean a reverse mortgage, not the homestead act.   When I had my house, the homestead act was lower property taxes if you had lived there as your primary residence for more than 10 years.  

Cathy,   I looked at what you suggested and I have too many assets - mainly an IRA account that I would have to bleed to nothing before I qualified.    

I had major complications after surgery(Seroma, lymphedema, sever radiation burns...then major back issues unrelated to Breast Ca that required several surgeries also) and was unable to return to work as an LPN. I had worked for the same HMO for15 years so was surprised that my COBRA was still $600.00 a month plus co-pays! Used up every dime I had, and then some, just to keep my head above water. Qualified for SSDI and have been thrilled with the Medicare plan I have been using for the last 3 years! Covers way more than my original insurance plan did and even though they say it is an HMO the list of DRs covers most professionals in our local. Mine even covers some dental, glasses and chiropractic! My only current income is Social Security and my total monthly cost is under $200.00 The plan I chose is called TRUE BLUE and I am very happy with it. I live in Idaho and was able to go on-line and compare all the different options offered in my area. I have NO complaints!

I could be wrong but here is how I think of it:

Medicare A and B are pretty self-explanatory.  If you have Medicare part B you will need a supplemental policy to pick up the 20% not covered.  So Medicare part B will cost you about $100 a month, probably deducted from your SS check.  You will have to arrange for a supplemental policy and that will cost an additional $100-150 a month.  If you have those 2 coverages you should be pretty well protected... you still have an annual deductible, drug costs and unknown nursing home expenses should it come to that.  Your medicare and supplemental go with you to any doctor who participates and that is most physicians.  However, not everyone or every place (ie, Mayo Clinic)  "participates" so it is always wise to ask in advance. If you do see an non-participating dr or hospital they can charge more than medicare approves but not a lot more... the amount is capped or limited... it is about 10-15% more, I think.  This approach does give you control of where you go and who you see.

On the other hand, you can choose an HMO type plan.  It typically costs much less but I can't say how much.  You sign up with a plan that is made up of your primary doctor and specialists.  You only go to doctors within your plan and usually go through your primary care doctor in order to be able to see a specialist if necessary.  You cannot look up a doctor in the phone book or go see one your neighbor recommends unless he happens to be a member of your HMO.  This "clinic" type approach works very well for some people and others do not like feeling restricted in their choices.  It does manage costs very well and may be the system of the future.

If you live someplace like Florida there is a very competitive medical market and almost all doctors are participating with medicare so there are broad choices.  In big cities like NY where there are plenty of young working people to fill dr's offices and pay higher prices, it could be more of a challenge to find participating drs and hospitals.  If that is true, an HMO might be better.  Also it's true that HMOs tend to include some services that medicare and a supplement may not cover, like glasses.  They do that to make their "package" of care more attractive.

For me the bottom line is:  am I willing to give up some freedom of choice and self control over my medical care... I said SOME... to save on the cost of my insurance?  

Pam 

Just to clarify there are TWO types of "nursing homes"  Longterm care in a regular nursing home is NOT covered by Medicare, but by medicaid--if you qualify.  You can be "kinda" sick to qualify, and meet financial requirements of no money----and you have to have given away all your money at least 3 years prior to admission.  No cheating--(years ago, as a discharge planner, I knew all the nooks and crannies of this stuff, and we used to get folks to prepay for their funerals to lovver their ready cash---maybe some still do it.)

Skilled Nursing care is covered by Medicare--AFTER 3 days in the hospital (acute care) and if you qualify for it, and it has a limit of days.  To qualify you must need more than personal care, etc.  You will need dressing changes, IV's, and other really SKILLED nursing care, but not "acute care " level of care. 

Ok, that should have confused a few of us even more.

I would recommend contacting Medicare (at 1-800-MEDICARE) to ask them for the location of your closest State Health Insurance Counseling (SHIP) site. The folks at that site are trained and certified through contract with the  Centers for Medicare and Medicaid Services (CMS) to offer assistance with health insurance matters to any Medicare beneficiary and to those who will soon be Medicare eligible. These sites offer advice and inforamtion that is unbiased, as they have no connection with any insurance company or agent. Frequently, your own agent will also suggest that you speak with one of these counselors as the products they offer may not be the best alternative for you. I would highly recommend that you give them a call, they do assist thousands and thousands of beneificiaries each and every year. They also love what they do, or they wouldn't be doing it, as much of it is volunteer efforts. Best to you.