# Medicare basics



## simpsontruckdriver (May 9, 2014)

Since I've been answering questions about Medicare here and there, I thought I would put it all out there in one mega-post. I am licensed and appointed in Florida, so most of what I am going to post is Federal. I can only do basics on Medicare Supplements, Part-D (Rx), and Medicare Advantage plans. An agent in your area (I *HIGHLY* suggest a local agent, not a call center) can give you specifics.

Part-A is paid for when you work 40 quarters (10 years), so at 65, you pay $0 premium. It is also available for someone who has been on Social Security Disability Income (not SSI) for 24 months, those with Lou Gherig's Disease, or End-Stage Renal (kidney failure) Disease. If you go into the hospital, you are charged:

Days 01-60 = $1216 (average stay 1 week)
Days 61-90 = $304 per day
Days 91-150 = $608 per day
Days 151 on = 100% of costs
If you are sent to a Nursing Home:

Days 01-20 = $0
Days 21-100 = $152 per day
Day 101 on = 100% (most people go on Medicaid at this point)

Part-B has the same qualifications as Part-A, but is "optional". What I mean is, if you choose NOT to take it at 65, your premium will go up 10% per year (Late Enrollment Penalty - LEP) for life. If you have a PPACA-compliant group or Exchange plan, and you choose to keep it, you will not be charged the LEP. It is either withdrawn from your Social Security Check ($104.90/month as of 2014), or you can have it billed every quarter ($104.90 x 3). This is what you will also pay:

Deductible = $147
Doctor visits, outpatient medical/surgical, diagnostics, etc = 20%
Durable Medical Equipment = 20%
Blood = first 3 pints $0 + 20% for additional pints
Annual physical exams = $0
Clinical laboratory services = $0
Extra charges over Medicare-approved amount = 100%

Part-D (Prescription Drug Plan - PDP) is very tricky. It is not run by Medicare, but it is regulated by them, and run by private insurers. Whatever you pay in premium, they lower many of the copayments. If you do not sign up at 65, you are charged 1% per month Late Enrollment Penalty (LEP) up to 100% of average premiums (approx $35).

Deductible = $310
When Deductible met, Initial Coverage Phase = Generics usually under $3, Brand-Name usually under $35, Non-Preferred Brand-Name usually under $95, Specialty usually under 33%
When Out-Of-Pocket reaches $2850, Coverage Gap = 72% Generic cost/47.5% Brand-Name cost
When True Out-Of-Pocket (Out-Of-Pocket + discounts) reaches $4550, $2.55 Generic/$6.35 Brand-Name or 5% coinsurance

Most Retirees want to cut those costs! The first way is a Medicare Supplement (aka MedSupp or Medigap). This plan has a premium based on the plan the person chooses, what they want covered and what they want to pay for themselves. But, there are NO networks, since the only "network" is any doctor, specialist, and hospital that accepts Medicare. They do not include a PDP. They are standardized by Medicare, but they are regulated by your state. Premiums vary by state and sometimes regions within the state. They are guaranteed renewable, meaning you will not be dropped for any reason, except non-payment. They are customizable to what YOU want.

Another option is the Medicare Advantage Plan with Part-D (MAPD). These plans are regulated by Medicare, they have low copayments, usually no deductibles even for drugs, add vision and dental, may add Silver Sneakers, and they are either an HMO or PPO (networks). They are paid for by Medicare, so if budgets change, your insurer may cancel your plan, requiring you to sign up for another one with higher deductibles/copays - or switching to a Medicare Supplement. The only pre-existing condition is ESRD (above), so a person can not join an MAPD plan if they have kidney failure, but the plan will allow them to join _ONLY IF_ they had a successful transplant. Basically, MAPD plans are "one size fits all".

Now, what if the retiree needs MORE assistance with the bills? Social Security and Medicare offer help depending on income. If your assets (not including primary home and automobile) are less than $26860 married/$13440 single, and your monthly working income is less than $1790/month, Medicare and/or Social Security will erase many of those costs. Many don't want it, but Medicare and Social Security has millions available to help low-income retirees.

Since people paid for Medicare with their hard work, they should take it and make it work for them, as soon as they turn 65. Using an agent to wade through this whole maze is a must, not some $12/hour rep at a call center, but a person who you meet and forge a business relationship with. I know agents in 49 states (not Wisconsin), if you want a referral. It is what fits YOUR budget.

Now, when can you FIRST sign up?
Part-A = 65th birthday or 24 months after beginning SSDI
Part-B = 65th birthday or 24 months after beginning SSDI. If you fail to sign up at 65, you can sign up in February for a July 1st effective date
Part-D = 65th birthday or January-Valentines Day
Medicare Supplements = 6 months before your 65th birthday or 24 months after beginning SSDI
MAPD = 3 months before your 65th birthday or 24 months after beginning SSDI

I welcome any and all questions. You can ask here, or privately. My qualifications: I am licensed with the Florida 2-40 Health Insurance License, and AHIP 2014 (aka Medicare Advantage and Part-D certification). I'm NOT advertising, only offering help.


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## rapmarks (May 10, 2014)

how about the "letter that keeps popping up on Facebook and through emails that if you are admitted to the hospital under observation rather than as an inpatient Medicare will not pay the bill.

I have been able to ascertain that the claim that Medicare will not treat you for cancer if you are over 76 is false.


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## falmouth3 (May 10, 2014)

Thanks for the information.  I'm not 65 yet, but this area is indeed very confusing.

Sue


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## susieq (May 10, 2014)

Thanks for all the info. ~ it's very confusing ~ but your explanations help. I'll have to print this out and study it and try to understand.


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## LisaH (May 10, 2014)

So the earliest one can go on Medicare is 65?


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## rapmarks (May 10, 2014)

LisaH said:


> So the earliest one can go on Medicare is 65?


It sounds like it unless you are on social security disability or have one of the illnesses he mentioned.


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## simpsontruckdriver (May 10, 2014)

Yes, it is confusing. That is why insurance agents have to learn all this, so we can explain it to YOU. Like I said, I can refer you to agents in 48 states if you don't have one, whether you have (or are coming close to) Medicare. I don't know anyone in Wisconsin. For MA, I would refer you to my in-laws' insurance agent in Boston. I am licensed in Florida, and I am considering being licensed in Georgia (I would do everything by phone and/or online).

I was able to find out about the Observation issue. It is slightly true. Under the "Observation", the hospital codes the patient as "Observation Status". Under Medicare, that is covered under Part-B, not Part-A. That is a hospital issue, not a Medicare issue. So, if they rack up $20,000 in hospital bills, the hospital codes it as "Observation", the patient is billed $4000 instead of the Part-A $1216 copay. The ONLY time this would be good for a patient is if his total hospital bill (before insurance) is less than $6080. It is currently running through the court system in Connecticut.

TS


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## bogey21 (May 10, 2014)

I've been on Medicare for about 14 years now.  My take is that it is fine for users as long as we have Doctors and Hospitals who will accept it.  So far, so good but it is getting tougher.  I had to knock on a few doors before finding a replacement willing to accept a new Medicare patient when my PCP retired.  I can't say the same for the taxpayer.  I've seen too many Doctors trying to overcome the low reimbursement rates by billing for multiple items during one visit and performing unnecessary tests (within their practices).

George


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## momeason (May 10, 2014)

Question: Do stay at home spouses qualify for Medicare under the working spouse's record as they do with Social Security? 
In my case, half of my husband's social security benefits are more than 100% of mine.
Does each person need to qualify for their own Medicare benefits or is it possible to qualify under your spouse's work record?


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## PStreet1 (May 11, 2014)

http://www.socialsecurity.gov/pubs/EN-05-10043.pdf

Check the section under "Who Qualifies for Medicare"


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## rapmarks (May 11, 2014)

momeason said:


> Question: Do stay at home spouses qualify for Medicare under the working spouse's record as they do with Social Security?
> In my case, half of my husband's social security benefits are more than 100% of mine.
> Does each person need to qualify for their own Medicare benefits or is it possible to qualify under your spouse's work record?


 

 my husband qualifies for Medicare on my work record.  His Medicare number is my social, with the letter B after it.


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## simpsontruckdriver (May 11, 2014)

In that PDF - typical government paperwork - under the section *Special enrollment period for people leaving Part C*, it says you can disenroll (leave) your MAPD plan and go to Medicare under that disenrollment period. It fails to mention you are then eligible for a Medicare Supplement plan, in addition to a Prescription Drug Plan (PDP). If your plan drops you, you can go to another MAPD, or a MedSupp plan.

For example, a friend of mine who was on Medicare signed up for Humana during the Open Enrollment. In January, she received a notice that she was dropped from the plan, most likely because she has ESRD (above). At that point, she could not join another MAPD plan, but she could sign up for a MedSupp. Unfortunateiy, the MedSupp plan I sold charged just under $800/month, so she chose to stick with basic Medicare for her Dialysis. 

TS


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## simpsontruckdriver (May 18, 2014)

More on Medicare Help. We suggest Medicare Recipients who make less than $3500/month and have less than a certain amount of assets (stocks/bonds, annuities, etc) to go to the Social Security Extra Help site. Basically, if you are approved, they eliminate the Coverage Gap ("Donut Hole") and - depending on your cost - eliminate the premium and any Late Enrollment Penalties. If/when you're approved, you will also have a Special Election Period, meaning you can change your plan.

It does not hurt to apply. It's not exactly "welfare", since the funds come from Social Security taxes. For example, my dad pays $140/month Medicare Part-B (includes Late Enrollment Penalties) and around $100/month Medicare Supplement, no Part-D. I had him apply for it, since he has zero assets and income within the guidelines. With my Florida-only plan (PUP), if he was accepted, I would save him at least $200/month! If not, and he wanted to sign up for a Part-D plan, he would be charged $35/month Late Enrollment Penalty (he never had a Part-D plan) in addition to the other premium/fees.

TS


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## Conan (May 18, 2014)

Very useful info.  A couple of further notes:

If you (or your spouse) are working beyond your age 65 and there's employer-provided insurance that covers you, there is no penalty if you decide to defer applying for (and paying for) Part B coverage until you no longer have the employer-provided plan.

The $104.90 monthly premium for Part B is for people whose modified adjusted gross income (taxable AGI plus tax-exempt income) from two, sometimes three, years before is less than $85,000 (single filer) or $170,000 (joint filer). If you're in a higher income bracket, your premium can be as much as $335.70 per month.
The income brackets are here (scroll down on the page and click to expand):
http://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#collapse-4809

If you have high income and then in a later year your earned income falls below the threshold, there's a procedure to ask Medicare for a new determination of your proper premium.
http://socialsecurity.gov/pubs/EN-05-10536.pdf


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## bogey21 (May 18, 2014)

If you delay taking Part B or Part D because you have insurance from your Employer or Past Employer, make sure you get a letter explaining that you have insurance equal to or better than Part B or Part D.  That way you will not be subject to "late enrollment" penalties down the road.

George


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## momeason (May 29, 2014)

simpsontruckdriver said:


> Since I've been answering questions about Medicare here and there, I thought I would put it all out there in one mega-post. I am licensed and appointed in Florida, so most of what I am going to post is Federal. I can only do basics on Medicare Supplements, Part-D (Rx), and Medicare Advantage plans. An agent in your area (I *HIGHLY* suggest a local agent, not a call center) can give you specifics.
> 
> Part-A is paid for when you work 40 quarters (10 years), so at 65, you pay $0 premium. It is also available for someone who has been on Social Security Disability Income (not SSI) for 24 months, those with Lou Gherig's Disease, or End-Stage Renal (kidney failure) Disease. If you go into the hospital, you are charged:
> 
> ...



Thanks so much for the helpful information.


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## rapmarks (May 29, 2014)

I have a really unusual situation regarding paying for medicare.  I earned my 40 credits doing part time work.  Because I have a pension from  a state that reduces your social security to offset your pension, I only receive about 60 a month social security, not enough to pay for Medicare.  They will NOT let me pay the rest with automatic deductions from checking.  They send me a bill anytime from January to April for the entire year.  One year they didn't send me a bill, and I almost got dropped. In fact I received a letter saying I had been dropped.  My husband gets no social security, he is covered on my work record, and he is allowed to pay with monthly automatic payments.  This makes no sense. We got hit with an extra amount each month of between 33 and 39$, this  comes in the monthly bill, I received one bill  for three months and didn't get it again, so I am going to owe a big amount of money eventually.  this is something to do with the the IRMAA related to Part D and it is over and above the income related increases.
another strange thing is one year we paid totally different amounts from each other, and we always pay something slightly different than the listed costs.


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## pedro47 (May 29, 2014)

To the OP thank you for your explanation of the system.


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## simpsontruckdriver (May 29, 2014)

rapmarks - because you have varying billed amounts, I suggest going to your local Social Security office (if you haven't already) and find out what you can do to fix it. You can also apply for SSA Extra Help while there, if your assets (not primary home, car, burial plots) are less than $26k. I am not sure what else can be done.

TS


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## rapmarks (May 29, 2014)

I believe the only way they would "fix it" is to raise the lower one.  and we have assets over $26000.


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## Don (May 30, 2014)

rapmarks said:


> It sounds like it unless you are on social security disability or have one of the illnesses he mentioned.


It's true.  I have ESRD and went on A & B at age 49.


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## simpsontruckdriver (Jun 5, 2014)

Just some other enrollment dates. In the original post, I talked about the Initial Enrollment Period, which begins 3 months prior to turning 65. There are Special Enrollment Periods for MAPD plans:
- Changing address (2 months prior to the move up to 1 month after)
- Gaining or losing government assistance (2 months after receiving the letter - if you get assistance you can change your plan any time but ends 2 months after you lose assistance)
- Moving into our out of a nursing home
- Going into or out of jail
- Insurer cancels your plan (begins 2 months before and up to cancellation date)
- Insurer drops in rating (2 months after Medicare informs you)

If you have a Medicare Supplement (MedSupp), most of those apply, *but* you can also change your MedSupp any time. If you change your MedSupp plan and it's not under the rules above, you will be subject to underwriting, which may mean higher rates and/or not covering Pre-Existing Conditions for a time.

Personally, my suggestion for the Initial Enrollment Period (IEP) is this: talk to an agent (I can do it in Florida) 4 months before your 65th Birthday. As soon as you hit 64 yrs 9 months, and you sign up for Medicare, your mailbox will be FULL of mailers from every single Medicare-based insurer wanting you to sign up with them. Then, if your situation changes (qualifying for a SEP), you can contact your agent to get everything straightened out.

TS


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## vnfilm (Jun 5, 2014)

DH will be there in 4 more year. Thanks for information


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## simpsontruckdriver (Jun 8, 2014)

Talking about ESRD (End-Stage Renal Disease), which is also known as kidney failure, Medicare is almost required. The average cost is about $6000 per month if the person is without insurance! If the person is diagnosed, they MUST get Medicare ASAP. Medicare and their private insurance will coordinate to lessen the out-of-pocket expenses. But, what if the person loses their private insurance? Like I said in Post #1, Medicare Part-B has the $147 deductible, then 20%. So, in the case of Medicare (no Medicare Advantage or Medicare Supplement plan):

MONTH 1
$6000 (estimated) Total Cost
$-147 Deductible
$x0.2 Your coinsurance
-------------------
$1318 FIRST MONTH

Add the $104.90, you're looking at $1423 for the first month for JUST Dialysis. Then, $1200 per month afterwards. Add $104.90/month Part-B, your total for the year is approximately $17081, not including other Part-A or Part-B expenses.

If an ESRD patient is already on one, an MAPD plan would charge less (like no deductible), but they also have a Max Out Of Pocket (MOOP). The MAPD plan I sell in parts of Florida has a $6500 MOOP, which in this case, would be hit in a few months. So, if the person has a $6500 MOOP, their grand total would be $7758 over the year (MOOP+Part-B Premiums). That is a savings of $9,322 over basic Medicare! If the ESRD patient loses his/her MAPD plan, they must either take basic Medicare (above), or sign up for a MedSupp plan within 60 days of being notified. If they don't, they lose all ability to sign up for a MedSupp, and won't be able to get onto an MAPD *unless* they have a successful transplant. There are a few exceptions where a certain insurer may let a patient with ESRD join, but personally, I know of none.

The Medicare Supplement plan I sell in Florida has a Plan-F (zero out-of-pocket) for $976 per month for ESRD patients - or a grand total of $11,712 premiums. The "plus" to that is, in addition to being able to go to Dialysis and not worry about coinsurance, the person could go to their Primary Care Physician (PCP), any specialist, the hospital, etc and STILL pay nothing. That is a savings of $5,369 over basic Medicare!

Simply put, ESRD is expensive. Some may say dying is cheaper, but that's a different conversation altogether. With the expensive MedSupp Plan-F, if a person is enrolled, then is diagnosed with ESRD, they will not be charged the high rates *unless* they choose to change plans. An ESRD patient can not join a MAPD plan (although there are exceptions), but if they're on it when diagnosed, they won't be dropped (except if the insurer cancels the plan for everyone).

TS


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## Don (Jun 9, 2014)

Luckily, I also have Federal Employee Plan BCBS.  Between the two I have only Rx's to pay for.  The FEP has a mail order Rx part that you only pay a set amount.  Before my Rx for Cellcept went generic I paid $80 for 3 months (90 days).  Non-insurance price was almost $1000/ month.  Now the generic is $10 for 3 months.


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## johnrsrq (Jun 9, 2014)

*very very good*



simpsontruckdriver said:


> Talking about ESRD (End-Stage Renal Disease), which is also known as kidney failure, Medicare is almost required. The average cost is about $6000 per month if the person is without insurance! If the person is diagnosed, they MUST get Medicare ASAP. Medicare and their private insurance will coordinate to lessen the out-of-pocket expenses. But, what if the person loses their private insurance? Like I said in Post #1, Medicare Part-B has the $147 deductible, then 20%. So, in the case of Medicare (no Medicare Advantage or Medicare Supplement plan):
> 
> MONTH 1
> $6000 (estimated) Total Cost
> ...



I have been selling insurance in Florida since 1986. (ceased health other than Stand-alone LTC, LTC/hybrid since 1993). I think your service to this user's group is very helpful. Very reliable info in a swarm of endless data. Real life info.
Thanks.


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## simpsontruckdriver (Jun 9, 2014)

My reasoning is simple... I don't want to hear about a retiree decide between food and medical care. If a retiree has financial issues, Social Security and Medicaid (state health) are there to help. Not to mention, Medicare is a lot of Government gobbly-gook, sometimes tough to understand. Do we make commission on sales? Yeah, because we are working. For me, commission is a "perk" for helping people understand it.

After all, a person who has worked 10 years (40 quarters) has paid for Medicare Part-A, and much of Part-B. Look at insurers and figure out how much a plan with a very small Deductible + 20% coinsurance REALLY costs. For a working person, the cost is astronomical! But, for a retiree, only $104.90/month + approx $35/month prescription drugs (or less). Retirees are not ENTITLED to it, they PAID for it.

TS


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## rapmarks (Jun 10, 2014)

I appreciate your sharing of information.


I have another question.  was switched to a Medicare Advantage plan and we must pay the 20 percent co pay.   
There is a discrepancy between the doctor's bills and our EOB's, the doctors office said it is the sequester amount.  What is this?

also we have a charge for IRMAA Part D on our Medicare Premium bill, what is this.


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## simpsontruckdriver (Jun 10, 2014)

First, the IRMAA is the Income-Related Monthly Adjustment Amount. What that means is, if you make over a certain amount, Social Security will tack on extra for it. Since it is Social Security who charges it, you can appeal the amount. Here is the PDF of the appeals form.

The "sequester amount" is Medicare recipients being required to pay a little more, due to the infamous Sequestration in Washington DC. As a result of the Sequester, Medicare pays less than they used to for doctor visits. But, doctors must be paid, and a cut from Medicare has to come from somewhere (patients). Some doctors could absorb it, but I am assuming yours is not able to. You could call your Plan and ask them about the Sequester Amount. <POLITICS>Everything budget-wise, including Medicare, is bipartisan to blame, not one single party is at fault</POLITICS>.

One good thing: the Medicare Supplement plan I sell in many states will pay those extra amounts. For instance, if the Medicare-approved doctor charges $75 (before insurance), and the patient already paid the 2014 Part-B Deductible ($147), the patient pays 20% ($15). The plan + Medicare pays 80%.

TS


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## rapmarks (Jun 10, 2014)

I am now a florida resident but on an Illinois retirement plan.  a bill passed the senate, but was not allowed on the floor of the house, to allow retired teachers to go off the plan and come back on.   all other state retirees are allowed to do so.    I would buy a plan other than the state plan if I knew i could get back on it.  between us the change in plans has cost us an additional 5000$ out of pocket since July not counting the extra cost to our medicare charges.


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## simpsontruckdriver (Jun 18, 2014)

This past week has shown us that a MAPD is not all it is cracked up to be. Last year, an MAPD was raided by the FBI, and members had 2 months to move to another one. This past week, PUP (Florida MAPD) went belly-up. Based on what was published, and talking to a friend (who is a PCP), it is a HUGE mess! All of the members were retroactively dropped to "basic" Medicare effective June 1st (see first post), which means they were billed Medicare's 20% minus what they already paid for medical care. Those whose surgeries would have been $125/day (max 5 days) now see their surgery skyrocketing to $1216 minus what they already paid. Same issue with specialists billing patients for the difference. The earliest they can start a new plan is July 1st, which means they will probably delay their medical care until that date.

I will gladly sell a person an MAPD if they want to pay zero premium and low copays, but my preferred sale is a Medicare Supplement. With a MedSupp, there's zero chance of your plan dropping you or forcing you onto another plan, except for non-payment, and you can go to any doctor who accepts Medicare anywhere in the USA. Some doctors may drop Medicare patients, but their primary reason for doing so is Washington forcing Medicare to reduce payments to doctors. Extra Charges are covered 100% by my MedSupp, meaning doctors can charge more to make up the cost.

My point is, if you have an MAPD, tomorrow is not guaranteed. An MAPD can cancel your plan and force you to get another one, or they can go belly-up, all within 2 months. They can kick doctors out, or doctors can leave, and you can't do anything about it other than finding another doctor. They can also switch from PPO (you choose your doctor) to HMO (no doctor choice), again giving you 2 months to switch. It's a gamble on what will happen tomorrow, or in January, but the federal budget determines your MAPDs health.

TS


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## Talent312 (Jun 19, 2014)

rapmarks said:


> How about the "letter that keeps popping up on Facebook and through emails that if you are admitted to the hospital under observation rather than as an inpatient Medicare will not pay the bill.



I had a hospital business manager tell me that if my DW stayed 3N (or less), she would be considered an "outpatient under observation," with no Part A coverage for that.

However, I had an employer-group plan that covered all but $100 of the hospital's $25K bill. No wonder they could build a $100 mil addition... and the food was still terrible. I think they recycled the green beans.  A nurse advised us  to bring in food from "the outside."


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## simpsontruckdriver (Jun 26, 2014)

In the end, every Medicare recipient must look at VALUE, not SAVINGS. Economists are saying that, due to budget cuts, MAPDs will lose value. If you're on one, you MAY see a rise in your premiums, your benefits MAY drop (like added deductibles), your Max Out-Of-Pocket (OOP) MAY rise, all because the Federal Government pays MAPDs. Outside Florida, I highly suggest talking to your agent about getting off MAPDs in October (Annual Enrollment Period). Or, find a new MAPD plan then where the costs are less. Will you have to change doctors? You might have to.

Like I said, value is more important than savings, in this age of Congress' budget cuts.

TS


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## judyjht (Jun 26, 2014)

Do you know an Agent in Maine?


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## simpsontruckdriver (Jun 29, 2014)

As a side note, a friend has a friend who is retiring. I offered my assistance, where the friend said his friend should be able to "go at it alone" (saying I should not be offering my services). Scroll up, and read everything I have posted. Would you be able to "go at it alone" with all that information? Having an insurance agent is the best thing you can do. It is a HUGE maze, and agents can help you through it.

TS


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## bogey21 (Jun 29, 2014)

In general I'm a do it myself guy.  No lawyers, no accountants, no advisers of any kind.  I only turn to the above when my research tells me I am in over my head (which is not very often).

George


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## simpsontruckdriver (Jun 29, 2014)

True... if a person wants to go at it alone, MEDICARE shows you everything you need/want to know about the program, and so will the person's Medicare Advantage/Supplement plan. Can everyone do it alone? If they're willing to do a lot of reading and research.

TS


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## simpsontruckdriver (Sep 16, 2014)

On the somewhat political side, the NY Times quotes the Congressional Budget Office (CBO), saying that Medicare is NOT damaging the budget, nor is it going broke any time soon. One other factor is, much of the "Baby Boomers" have enrolled in Medicare already, so the numbers of enrollments won't stress the system. In addition, retirees are living healthier, meaning visits to the hospital are down.

Just like timeshare salesmen, politicians who say Medicare is going broke are lying because their lips are moving.

TS


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## bogey21 (Sep 16, 2014)

simpsontruckdriver said:


> On the somewhat political side, the NY Times quotes the Congressional Budget Office (CBO), saying that Medicare is NOT damaging the budget, nor is it going broke any time soon.



Great news.  For one I would be willing to pay more for my Medicare if it can be used to help reduce the overall Deficit.

George


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## rapmarks (Sep 16, 2014)

because my SS payout is only 60 a month, and my medicare is 231 a month, I have to pay my year's worth of medicare payments in January.  they will not let me do auto payments (they let my husband do it, but he gets no SS).  Now i am getting a monthy bill for $31.10 for Pt D.  When the second bill came I enclosed a check for the entire year, and a note explaining it was payment for the next six months.  they cashed the check but are still charging me $31.10 a month.  Because I am away from Florida,this bill reaches me at the last minute, and I try to have everything I can prepaid or on auto pay.  so basically I have paid double for IRMAA Part D, as they will not recognize the six month payment they received and cashed.  My only hope is next January, they recognize the overpayment, and credit me and also include the Pt D payment in my yearly bill.  Don't say call them, i spent two days doing that one year, and never did find anyone who could fix it or even knew anything about it. 

they pay claims very efficiently, I have no complaints about that part.

They have refused two claims and stated I do not need to pay those bills.  However, the provider still thinks I should pay those bills, and has told me to call Medicare and tell them to pay the bills.   so I am at a standstill with them.


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## isisdave (Sep 16, 2014)

I hope I am not hijacking this thread, but it seems to have turned into a series of anecdotes. Here's mine.

I turned 65 in July. In April, I expected and received an automatic enrollment notice. I am still employed and have insurance through my job. The form says "if you have other insurance and don't want Part B, sign below and return this form." I did that the same day I received the notice.

In June, I got a bill for the first quarter part B premium (since I am not receiving benefits). I called SSA. The guy hemmed and hawed, asked three times when I sent the form back ("the day I received it"), said he'd "send a message to the center" and told me to wait 30 days.

In July, I got a second notice. Called again. Different guy, same story. Said I could use a form to terminate insurance, and he'd send one. Not on the website as "it's too complicated" and needs help filling out. Never came. Downloaded from another site. Besides identification section, it has one question: Why do you want to terminate Part B, and when?  Pointed out I declined Part B and had called twice, and wanted my account credited and Part B not just terminated, but cancelled from the beginning. Sent it in.

September: got a notice my Part B was being terminated by my request, effective end of September. "Please send in the $327 you owe for July to September." Sent in the Appeals form the notice said I could use.  

That's the current situation. My last interaction with SSA took 7 months and 5 calls before I got someone who could fix the problem. Is it time to call my Congress-person, or does anyone have a suggestion for next month?


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## Fern Modena (Sep 16, 2014)

Don't call your congressman, write them a letter. With all the pertinent information. I think I'd still do a snail mail letter, cause tangible is always better to me, but you could do email, too, I'd think.

Every government agency I've ever dealt with has a special section of people whose only/main job is to investigate and reply to members of congress and the media. They are very good at what they do.

Fern



isisdave said:


> That's the current situation. My last interaction with SSA took 7 months and 5 calls before I got someone who could fix the problem. Is it time to call my Congress-person, or does anyone have a suggestion for next month?


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## simpsontruckdriver (Sep 16, 2014)

If you have an issue, you can go to your nearest Social Security office. When you go, take all pertinent information. But, if submitting appeals and making phone calls gets you nowhere, send your information to your Congressman by mail. Calling them may get your information lost or not enough to make a decision. That applies to ALL the complaints posted today.

FYI, do NOT worry about "hijacking the thread", if it has to do with Medicare, post it and I - or others who may have gone through it - should be able to help!

TS


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## isisdave (Sep 16, 2014)

Thank you. At the time when I was working second shift, visiting the office was practical. Now it's in the opposite direction from work.

But hey, I'll bet I could visit any office, can't I? Why would they care where I live?

And thanks for advice.  I had in mind a physical letter.  I must have a stamp or two here somewhere!


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## simpsontruckdriver (Sep 16, 2014)

Correct, ANY Social Security office should help. It's not like county government assistance offices where you have to be in that county. Social Security is a federal office, so anyone can go to any office anywhere in the USA to get assistance.

TS


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## simpsontruckdriver (Sep 17, 2014)

More concern about Medicare Advantage with Prescription Drug plans. One thing I told people who asked about our (now bankrupt) plan: if you're going into the hospital for surgery, find out beforehand if the hospital is "in network", same with doctors/specialists. The only reason you can go to any hospital is if it is due to a visit to the Emergency Room. If you go to a doctor, specialist, hospital, etc that is not in-network, you're responsible for 100%. Under CMS (Centers for Medicare and Medicaid Services), a MAPD can drop doctors/hospitals at will, and you have no recourse other than to find a new doctor.

Or, if you don't want the hassle of networks and don't mind paying a premium, move over to a Medicare Supplement, which is BETTER than a PPO. In the original posts, I talked about the difference. MedSupps are regulated by your state, MAPDs are regulated by Medicare. You can change MedSupp plans at any time, MAPDs can be changed once a year.

TS


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## Kal (Sep 17, 2014)

Make sure you look carefully at the Co-pays for any Advantage Plan.  Don't be distracted by the "extras" such as vision, hearing and fitness centers.  Remember, there is no free lunch in those plans.

 The overall Federal strategy is to significantly cut the Advantage Plans and herd them into HMO systems.  What plans you see today might very well not be available tomorrow.


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## simpsontruckdriver (Sep 17, 2014)

Whatever plan you're on now is what you will be on for the foreseeable future. Your plan may kill the plan, but they must give you 2 months advance notice. Let's say they want to cancel the plan on 12/31/2014, they must notify you in October 2014. If you do not respond, you will be placed into basic Medicare and you're only eligible for Medicare Supplements until the next AEP (unless you qualify for another Special Election Period).

It is very true, Medicare wants to cut costs, the first place to do so is to encourage all MAPDs to be HMOs (ending PPOs). Vision and Dental usually don't cover complete care, most only cover yearly cleanings and eye exams.

TS


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## rapmarks (Sep 18, 2014)

these last statements are very scary to me.  the state forced the retirees to go on the medicare advantage plan, and now you are all saying it is going to go to an HMO.  we are really going to be up the creek if that happens, the nine months we were on an hmo were the worst we have ever had.


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## Clemson Fan (Sep 18, 2014)

Just a little side note on vision plans.  Vision plans are only meant to help defray the cost for glasses or contacts and a yearly refraction.  That's it!  Anything medical with the eyes (cataracts, glaucoma, etc.) is covered under your primary Medicare or insurance plan and has almost nothing to do with any vision plan you may have.

As an ophthalmologist my billers have to answer questions about that every single day because the patient is responsible for a 20% co pay with stand alone Medicare or whatever co pay they may have with their private insurer.  Many ask why we're not billing their vision plan and why we're billing their regular insurance or Medicare.  We have to explain to them that I'm treating their cataracts or glaucoma or whatever which is considered medical and thus doesn't fall under the vision plan.  In fact, cataract surgery and the costs surrounding that are typically the #1 Medicare budget expense each year.


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## Ironwood (Sep 18, 2014)

Glad to be living in Canada....I don't have to worry about whether I'm covered or not!   All I have to worry about is how long will it take to see a specialist...if I were to need one.


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## rapmarks (Sep 18, 2014)

Clemson Fan said:


> Just a little side note on vision plans.  Vision plans are only meant to help defray the cost for glasses or contacts and a yearly refraction.  That's it!  Anything medical with the eyes (cataracts, glaucoma, etc.) is covered under your primary Medicare or insurance plan and has almost nothing to do with any vision plan you may have.
> 
> As an ophthalmologist my billers have to answer questions about that every single day because the patient is responsible for a 20% co pay with stand alone Medicare or whatever co pay they may have with their private insurer.  Many ask why we're not billing their vision plan and why we're billing their regular insurance or Medicare.  We have to explain to them that I'm treating their cataracts or glaucoma or whatever which is considered medical and thus doesn't fall under the vision plan.  In fact, cataract surgery and the costs surrounding that are typically the #1 Medicare budget expense each year.



an ophthalmologist is a new neighbor.  another neighbor claims he does 35 cataract surgeries a day.   Is this possible?


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## simpsontruckdriver (Sep 18, 2014)

I think 35/day is a stretch. On this site, cataract surgery can take between 10-45 minutes. If every single cataract is the 10 minute deal, it could happen, but not all cataracts are the same.

TS


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## rapmarks (Sep 18, 2014)

the same neighbor just had back surgery, and she claims they removed two discs from her back.   she isn't any shorter though.


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## rapmarks (Sep 18, 2014)

I just received a big bill for three visits from January when i was on Medicare that Medicare refused, and which my statements ssid i was not responsible for.   I did not carry these statements with me when i left for the summer, and I can no longer access Medicare on line because I went on the Medicare advantage plan in Feb.  How can I get copies of all Eob's from Medicare,? 
 obviously the provider incorrectly billed, because all the other visits which were identical were covered, and i paid them my copay a long time ago (which they are not crediting me)


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## simpsontruckdriver (Sep 18, 2014)

A couple questions:

(1) Were you on "basic" Medicare when you went to those visits? Scrolling back to the original post, Medicare has a $1216 copay for hospital (in-patient) visits, while Part-B (outpatient) is $147 + 20%. The original post is everything Medicare pays for. It is not the "official" EOB, but my information is straight from Medicare. Their EOB is the 150-ish page book everyone gets called "Medicare And You", but my first post is easier to understand (I hope)!
(2) Did you go to a facility that accepts Medicare? "Basic" Medicare will only pay for procedures that a Medicare doctor has prescribed at a facility that accepts Medicare.

My suggestion, if they bill you the full amount (not a 20% out-patient or $1216 in-patient), take the bills to your local Social Security office. They can either help you out, or point you in the right direction. Your MAPD is a different matter, anything after February 1st (but not before) is their responsibility.

TS


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## rapmarks (Sep 18, 2014)

I was on basic medicare with cigna as secondary. I went to a facility that accepts medicare.  i had lots of dr bills, my deductible was met, i went to therapy ten times, three visits were rejected, so cigna can't pay their part because they pay only what medicare doesn't pay. I did not go over my physical therapy limit.   i asked physical therapy to resubmit claims with correct codes, they are obviously doing something wrong.  they want me to pay the entire bill for these three visits, at their full rate, not the amount medicare would have paid, I was paying for two insurance plans at the time, i paid them my portion, and they want the rest.
I think if I go to social security, they will tell me i have to contact Medicare, it is not their business.

it is obviously human error, either on the billing from PT or from Medicare, but no one will take care of it.


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## Clemson Fan (Sep 19, 2014)

rapmarks said:


> an ophthalmologist is a new neighbor.  another neighbor claims he does 35 cataract surgeries a day.   Is this possible?



Yes it's possible, but you need a lot of help!  You need to run multiple OR rooms at the same time with multiple anesthesiologists and very capable staff that basically have the patient draped and all ready to go the second you enter the room.  You can then just scrub and gown and immediately sit down, do the surgery and then the second you're finished you leave and go to the next OR room where the next patient is ready to go.  The support staff will then undrape the patient and give them all their instructions, etc.

During my fellowship with my fellowship director and I (when I did my fellowship I was already a board certified and fully licensed ophthalmologist), we routinely did 15 cataracts and 5 cornea transplants in one day and would be done by 2 in the afternoon.  He would basically start a case and I would finish it and he would move onto the next case.

In my private practice the most I've done is 15 in a day and that was just with one OR and one anesthesiologist.  My typical day, though, is 10 cases because frankly I don't want to work that hard and at such a frenetic pace.  I like to spend some time talking and interacting with my patients as well as taking a break for lunch, etc.  I then typically finish up around 2pm which gives me time to do my dictations and then go and pick my son up from school at 3pm.


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## Brett (Sep 20, 2014)

Ironwood said:


> Glad to be living in Canada....I don't have to worry about whether I'm covered or not!



yes, health care does seem less complicated and cheaper in Canada


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## bogey21 (Sep 20, 2014)

I have regular Medicare and Cigna as Secondary.  It works fine for me other than Cigna who puts off paying their share.  I finally figured out that if I send Cigna a copy of a Statement from my Doctor; a copy of the Medicare EOB; and Cigna's most recent denial, they pay at once.  Sounds like a lot of trouble but actually it isn't and other than annual deductibles I pay nothing.

George


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## rapmarks (Sep 20, 2014)

I believe I straightened out my unpaid bills.  Cigna told me they take up to 52 weeks to pay.  they cannot pay if Medicare denies and says i am not liable.  If Medicare says I am liable for the bill, then they will pay their portion as primary.   only took two half days on phone to get straightened out.


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## simpsontruckdriver (Sep 24, 2014)

FYI, the Annual Enrollment Period begins in exactly 21 days. I suggest contacting your agent the week of the 15th to see if any new plans will save money. If you want to do it on your own, you can go to medicare.gov to compare plans. Back when I worked for now-bankrupt PUP, I met people who had old plans that were more expensive. Remember, if you have not received notice that your plan is cancelled,  you can keep it as long as possible.

I am licensed only in Florida, so i can't give you any MAPD/MedSupp information in your area. If you are a resident (receive mail/Social Security in) Florida, I can assist.

TS


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## Pat H (Sep 24, 2014)

And the deluge of mail has begun. Part D with my present provider is going from $17/mo and no dedectible to $30.70 and $320 dedeuctible. I will have my broker shop around for a better plan. My problem is that I take a brand name prescription with no generic equivalent and most plans don't cover it.


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## simpsontruckdriver (Oct 17, 2014)

From now until December 7 is OPEN ENROLLMENT! The Annual Enrollment Period has begun. I suggest taking to an agent, figuring out if another plan may be cheaper in 2015.

TS
Medicare agent in Florida since 2012.


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## simpsontruckdriver (Oct 27, 2014)

This is my Craigslist ad for those that live in Florida, and the pinpoint is close to where I live.

TS


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## WinniWoman (Oct 28, 2014)

Ironwood said:


> Glad to be living in Canada....I don't have to worry about whether I'm covered or not!   All I have to worry about is how long will it take to see a specialist...if I were to need one.



I am always curious to how Canadians feel about their health plan since we are constantly hearing in the US how it is bad because of long wait times for surgery or seeing a specialist as you mentioned. If you are healthy, I guess you might think it is great since you don;t need to use it, but if you have a chronic condition and need a lot of ongoing care- how would you say it works? I am always looking for the truth in these things...


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## Passepartout (Oct 28, 2014)

I got notification from my Medicare supplement carrier that my plan would not continue to be available next year. So last night, I went to www.medicare.gov entered my zip code, input my meds & pharmacy, answered just a couple of health questions (do you have end stage renal disease, are you in a care center?). It returned a very usable side-by-side comparison of plans, with expenses laid out for the year. I selected one, filled out the application, and was all set for next year. Saved about $20 a month. 

The whole thing took under an hour. Piece of cake.

Jim


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## simpsontruckdriver (Oct 31, 2014)

For those who are internet savvy, http://www.medicare.gov is a great way to get set up on a new Medicare Advantage Prescription Drug plan. Since Medicare is paying the insurer (so you don't have to), there's no cost difference between doing it online or having an agent do it.

On mpumilia's question about Canadian health care, I can relate a story. I have a friend in the Toronto area. Last year, she got sick, and the doctor (no wait to see her doc) said she had malignant cancer. She was in the hospital for a few months, and is now living at a nursing home, as more and more of her body falls to cancer - she is in her 40s by the way. She never had a wait to see her doctor, she nor her family paid one cent to the doctors/specialists/hospital/nursing home, and she is getting the best care possible. It is all politics in talking about the differences between Canadian and United States medical care.

TS


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## short (Nov 10, 2014)

*Q on Part D coverage.*

My DH just turned 70 and is researching going off my employer coverage and going onto Medicare part B and D.

He is use to ordering his drugs mail order using a 90 day prescription.  He can reorder about a month ahead so as to make sure he is never in a panic.  Most of the drug plans seem to have a 30 day limit and use local pharmacy.  Once you join is there any mail order pharmacies that can be used or plans that allow 90 day scrips?

He has one tier 3 brand name drug plus some lower price generics.  I am thinking that if he picks a plan with a deductible and/or copay that he would be better off just buying the generics outside the plan and not claiming to insurance.

Any insight on how these Plans would change how is does things?  FYI he is interested in the least restrictive plan.  He will be paying the IRMAA so I am not sure any of the plans lower his cost overall.  He would be doing this to protect himself in case he needed to add some new high price drug.

Short


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## Passepartout (Nov 10, 2014)

It would be incredibly hard- and lucky- to get an accurate answer or suggestion for your DH. We don't know where you are and supplemental plans are keyed in to your location. 

I'd suggest you get with an independent insurance agent and compare plans. Or. You CAN do it at www.medicare.gov That's what I did and it isn't difficult. Just have your (his) prescription formulary handy to type in. Getting 3 months' supply of 'scrips is allowed- even encouraged through my supplement carrier, so I suspect you (he) can find a plan that probably even has his regular mail-order pharmacy as an approved supplier.

Jim


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## simpsontruckdriver (Nov 10, 2014)

To answer the question, most Part-D plans have a 90-day mail-order. I know for a fact that United HealthCare's Medicare Advantage and Part-D plans have a mail-order program (Optum). Being that I am a health insurance agent (licensed in Florida), I know the value in having an agent who will look for the best plans for you.

TS


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## IngridN (Nov 10, 2014)

Simpson,

I have been following this thread as DH will be retiring next year and moving to Medicare. He's on Part A now, but other coverage is through his employer. 

You mention getting a good agent. What type of agent should we look for? Any independent insurance agent or is this a specialty? We do a lot of international travel, so this coverage is a must. Also, I am not eligible for Medicare and will hook back into my former employer's retiree group coverage paying full costs. I'll also be looking into Obamacare plans as my former employer's coverage is pricey.

Thank you.

Ingrid


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## simpsontruckdriver (Nov 10, 2014)

I would definitely suggest an independent agent, because they would compare the best plan for your DH. Since you said you're looking at an "ObamaCare" plan, an agent would help.

Here's what I can do. Send me a message privately (e-mail or private message), and I will get you in touch with an agent in your area who can take care of both of you. 

TS


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## simpsontruckdriver (Dec 2, 2014)

Two important Medicare dates are coming up!

December 7 = deadline to change your plans for 2015.

Jan 1 - Feb 14 = Medicare Advantage Disenrollment Period, where you can drop your MAPD and get basic Medicare + Medicare Supplement. Just like you can not change your MAPD after December 7, you can not re-enroll in an MAPD until October 15, except for special enrollment periods.

TS


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## simpsontruckdriver (Dec 19, 2014)

For those in Florida and are in the coverage area, "CarePlus" became the ***ONLY*** Medicare Advantage plan in the state to be ranked 5 stars by Medicare! What that means is, you can switch from ANY MAPD to CarePlus by December 31. It is another of Medicare's Special Enrollment Periods, and an agent can assist you in figuring out which ones you qualify for.

Currently, I am not appointed with CarePlus, but I can refer you to an agent here in Florida who can get you set up.

TS


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## bogey21 (Dec 19, 2014)

simpsontruckdriver said:


> I would definitely suggest an independent agent, because they would compare the best plan for your DH. Since you said you're looking at an "ObamaCare" plan, an agent would help.



I'm normally a "do it myself" kind of guy but after kicking some tires vis-à-vis Medicare Advantage, Medicare Supplemental Coverage, and Medicare Drug Plans I willingly concede that an Independent Agent would probably be in my best interest.

George


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## simpsontruckdriver (Dec 25, 2014)

*Important changes for 2015 Medicare*

Premium and Deductible for Part-B unchanged
Part-A Hospital Copay (days 1-59) rises to $1260
Part-A Hospital Copay (days 61-90) rises to $315/day
Part-D Deductible Phase vary by provider
Part-D Initial Coverage Tiers vary by provider
Part-D Coverage Gap begins at $2960 Out-Of-Pocket
Part-D Coverage Gap Brand-Name coinsurance drops to 45%
Part-D Coverage Gap Generic coinsurance drops to 65%
Part-D Catastrophic Coverage begins at $4700 True Out-Of-Pocket
TS


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## bogey21 (Dec 25, 2014)

Medicare never ceases to amaze me.  I visited my Nephrologist last week and had a couple of lab tests run.  

Doctor billed $175; Medicare approved $106.56 and paid $83.54.  My Secondary picked up $21.31.

LabCorp billed $141.00; Medicare Approved $141.00 and paid $27.83 (apparently the contract rate) and noted that neither me or my Secondary is responsible for the difference.

My question is are the rack rates knocked down as much for private insurers?

George


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## rapmarks (Dec 25, 2014)

George, I had medicare until Jan 31, 2014. I went to physical therapy during Jan and Medicare approved $108 for February under my Medicare Advantage plan, and they approved $50 per visit, and I had a twenty percent copay.   Three of the 12 January visits under Medicare were originally disallowed, the provider filed 4 times, finally approved and all put 4 percent paid by my secondary. I paid this amount to my provider for January and since I have been getting weekly bills from provider for amounts from $660 to as low as twelve dollars.  He received more than double than he got in February, and more than Medicare said he was due for the January bills, but still wants money from me.   So go figure.?????


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## simpsontruckdriver (Jan 4, 2015)

With respect to charges, they MAY differ between Medicare/MAPDs and private insurers. Those without insurance are usually charged a much higher rate, basically making up for lost revenue. Bargaining with doctors' offices to get lower copays/settlements actually helps!

TS


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## simpsontruckdriver (Jan 15, 2015)

FYI, 10 years ago, Medicare Part-D went into effect, giving seniors Prescription Drug plans! Back then (before ObamaCare), seniors paid 100% of drug costs in the Coverage Gap. In addition, it has a Late Enrollment Penalty if a person does not sign up, and charged forever (unless they get Social Security Extra Help).

What's funny is when people blame the current President for the LEP and calling it a tax, but it was signed by the previous administration.

TS


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## simpsontruckdriver (Oct 18, 2015)

FYI, due to finances, I basically gave up my Florida Health Insurance licence. I was great at advising others about MEDICARE, but only SALES make money (commissions). I went back to being a truck driver. So, I can't advise or talk about health insurance, Medicare, etc any lomger. You can refer to this, and if you want to speak to a local agent, I can put you in contact with one.

TS


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## bogey21 (Oct 18, 2015)

I just switched from traditional Medicare with supplemental coverage for Plan B and for drugs to a Medicare Advantage Program (HMO).  I used an Agent who seemed to know what he was talking about.  Without him, I'm not sure I would have done it. 

Monthly premium is $0; maximum annual out of pocket is capped at $4,900; and I will have more co-pays and deductibles than presently.  I'm a little apprehensive about making the change but what the heck, nothing ventured, nothing gained.

George


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## Fern Modena (Oct 19, 2015)

I presently have traditional Medicare with  Suppliment PPO and "credible coverage" for Medicare Drug coverage.

This go round I was offered what I currently had or a Medicare Advantage plan which was also a PPO (didn't even know there were Advantage PPOs, bought all we we HMOS). Drug coverage would remain the same. No premium for me to either plan. BUT, there were different deductibles, different coinsurance and copays, and different maximums. 

Some, but not all my doctors we we in both plans. Visits to your PCP was zero cost, but visits to specialists we we $20. Coinsurance and a percentage. Labs were free, but hospitalization had a bigger copay.  

It's not easy to figure out what is the best fit. You really have to run typical health year, and what else you think might occur and then see how it plays out. In my case, since both we we zero premium, it was fairly easy for me to figure it out.  Unless you were super healthy, changing to the Medicare Advantage just didn't pay.

Oh, and if you can't figure it out, ask your local/state's SHIP program to help you.

Fern



bogey21 said:


> I just switched from traditional Medicare with supplemental coverage for Plan B and for drugs to a Medicare Advantage Program (HMO).  I used an Agent who seemed to know what he was talking about.  Without him, I'm not sure I would have done it.
> 
> Monthly premium is $0; maximum annual out of pocket is capped at $4,900; and I will have more co-pays and deductibles than presently.  I'm a little apprehensive about making the change but what the heck, nothing ventured, nothing gained.
> 
> George


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## simpsontruckdriver (Oct 21, 2015)

Actually, the best way to find the best fit is to talk to an independent agent. An agent who sells several MAPDs has no incentive on one single plan, he gets paid in January on whatever plan you choose. A simple HMO plan from company X pays the same as a full-featured plan from company Y.

TS


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## Fern Modena (Oct 21, 2015)

My insurance is employer sponsored/subsidized (no premiums!), so it is just a matter of figuring out which of their plans works the best for me. Since I live "out of area," none of the HMO plans are available, so I used to not even have to worry about choices. This year UHC offered two plans, and that's why I had to figure out which was better.

Fern



simpsontruckdriver said:


> Actually, the best way to find the best fit is to talk to an independent agent. An agent who sells several MAPDs has no incentive on one single plan, he gets paid in January on whatever plan you choose. A simple HMO plan from company X pays the same as a full-featured plan from company Y.
> 
> TS


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