Medicare: What covers? What not?

I have a Medicare Advantage plan, not a supplement. I don't pay for it. I have no to low copays for Dr and tests. No copay on tier 1 meds. Just got pump for my LE arm. 0 out of pocket.

I need to say the Advantage plans are NOT income related. They are for anyone eligible for Medicare. Mine is from Humana.

I'm on traditional Medicare A and B, plus a Blue Cross/Blue Shield medigap plan (65 Special) with Rx included in it. Paid nothing except the annual required $150 Medicare deductible while under treatment (only surgery and rads, no chemo or hormonal therapy; post surgical mammos and an MRI; vit D tests). Medicare only refused a claim once, for the Oncotype DX test, but when the claim was resubmitted, Medicare paid for it with no complaints or glitches.

Friends who started out in "Advantage" programs with both Aetna and Humana dropped them after learning the hard way that some hospitals refuse to take Advantage patients. This limitation can restrict one's treatment options, especially in an area (like Boston, NYC, Philadelphia, Baltimore) where there several topnotch medical choices are available only to regular Medicare folks.

Fifth - agree entirely about problems getting docs you want on the Advantage plans. That's why I stayed w/traditional medicare. I don't think you have to join AARP to select their supplement, but I can't remember. The plus side of joining is discounts at restaurants, theaters, hotels, etc. and the fee is nominal. It's often a better discount than AAA.

Choosing a drug plan will depend on whether you take lots of meds or not. If so, you need to find the names of your drugs on their 'formulary lists' and see which has the better deal. Each state is different and those lists change every single year. Sooooo... annoying. I don't take any drugs regularly so I stayed with the absolute cheapest program available in Houston - which turned out to be Humana/WalMart. I'm sure that will change next year since Humana is just going to be bought or sold - can't remember which.

fifth - I grew up in Palo Alto years ago - when Silicon Valley was green hills w/cows. You do have some great medical care in the area. Good luck w/your sign-ups. And now, reaching this grand age, you can have fun. You earned it, you paid your dues, you deserve it!!!!

Oh I'm not eligible yet. Only turning 63 this year. Just commiserating with the decision process. He's the one turning 65 but staying in work force to keep me insured until I turn 65. Just reading to get ideas here. Keep them coming. Friends are all younger except for one and she had to shop around for the very best pharmacy plan. She actually used an agent to find one. And no not for CA drugs of any sort.

mysunshine - it depends on the individual circumstances and the way the doctor presents the need for PET/CT and the codes the billing office uses when submitting the bill, etc. Personally I have had several in the last two years. When my MO retired last December he said I would probably have to fight to get more or find a different doc who believed they were critical to ongoing care. Someone else told me there was a life time limit, but I don't know if that's true.

Hello. The most important thing is to ask up front it the clinic. doctor etc. ACCEPTS medicare, if they do there should be no cost to you. ALL my tests, scans, biopsies, surgery, radiation and follow up appointments with surgeon, and now MO, were and still are at NO Cost to me. I am on original medicare and have a supplemental ins., plan F.

Hope this information helps someone.

dsgirl

Yes, Part D, the drug plan. I just started on this Medicare roller coaster and the drug plan just went into effect. Now, like I said, just got a letter about open season for Part D plans and I want to change. Cost is $67.00 a month and now $350.00 deductible. I only have one RX and it is not expensive. I get Arimidex through the manufacturer.

Thank you! All this Medicare stuff is new to me. My Part D just started and now it looks like I will be looking to change already! I do not want a $350.00 deductible and I the monthly cost of this one is around $67.00 a month. I choose this one as there were only 2 I could find that covered Arimidex. But, having just started Arimidex, I am getting it directly from Astro Zenika, so Part D won't play a part in that. I hsve United through AARP, I think, for a supplemental and will see if they might offer Part D too. Why does all this have to be so complicated? Why not one for everything? That would be too easy!