Medical charges

[simpsontruckdriver]

FYI, CMS and the Biden Administration are cracking down on insurers declining Medicare-approved procedures.

TS

 

[davidvel]

[...]
A supplement plan (AKA Medigap) is exactly what it is says. With a medigap policy you are covered by Medicare Part A and Part B. Typically Medicare covers 80%. You are responsible for the remaining 20%. Thats where the Medigap(supplement) comes into play. They all cover the 20%. Depending on what plan you have there may be co-pays and/or deductibles to cover.

Medicare Advantage is run by private insurance, and you won't be on original Medicare.

Please talk to an independent agent or read up on it at Medicare.gov.

Thanks for pointing this out. People often think they are the same thing.

For those still confused, here is a simplified comparison: An advantage plan is like an HMO that REPLACES your medicare coverage, for better or worse. You may pay 0 premium or something more, and have various other copays and deductibles to pay depending on the plan you choose.

A supplemental plan does exactly that, it supplements your existing medicare coverage. You pay a premium for the policy and it generally covers your out of pocket costs under medicare.

 

[kanerf]

So I found out today that the idiots at the lab I use for routine tests prior to seeing my GP provided the wrong address for him on the paperwork and the insurance would not process it. When I went in today, I had to pay the entire bill before they would do further tests. According to my insurance company it will be resubmitted and I will be re-imbursed, but you know how long this sort of stuff takes.

 

[dago]

Thanks for pointing this out. People often think they are the same thing.

For those still confused, here is a simplified comparison: An advantage plan is like an HMO that REPLACES your medicare coverage, for better or worse. You may pay 0 premium or something more, and have various other copays and deductibles to pay depending on the plan you choose.

A supplemental plan does exactly that, it supplements your existing medicare coverage. You pay a premium for the policy and it generally covers your out of pocket costs under medicare.

Thanks for the simpler explanation. I had a difficult time making that point. LOL.

 

[dago]

FYI, CMS and the Biden Administration are cracking down on insurers declining Medicare-approved procedures.

TS

That's a start. Until if/that happens i have no interest in Medicare Advantage.

 

[Glynda]

That is a Supplement not available to anyone who enrolls in Medicare after 2015. It paid for everything, no matter the cost, all the person paid for was the (somewhat high) premiums. Anyway, Medicare Advantage with Prescription Drugs is regulated by CMS (Center for Medicaid & Medicare Services), it's $0 premium, you can choose an HMO (in-network only) or PPO (out-of-network higher price). PPOs are good for frequent travelers. HMOs are good for those who stay in their state, BUT if you travel, you can call and get in-network care out-of-state.

On the other hand, a Medicare Supplement is regulated by the state, several plans ("Part") are available depending on how much you want them to cover. Right now, the one that covers the most is Plan-G, which covers 100% after you pay your deductible (around $200). Premiums and whether or not they go up every year is up to your state.

TS

I'm confused. I thought that we have an Advantage Plan. However, reading these posts, I just got out my card and it reads "AARP Medicare Supplement Plans insured by United Health Care Insurance Company, etc. etc. and then bottom line AARP MEDICARE SUPPLEMENT PLAN F."

So we don't have an Advantage Plan after all?????

 

[dago]

I'm confused. I thought that we have an Advantage Plan. However, reading these posts, I just got out my card and it reads "AARP Medicare Supplement Plans insured by United Health Care Insurance Company, etc. etc. and then bottom line AARP MEDICARE SUPPLEMENT PLAN F."

So we don't have an Advantage Plan after all?????

That's correct. You have the Supplement Plan. I have the same plan from UHC. I should have commented on your prior post when you mention not paying anything extra but your Rx was a problem. I don't know of any advantage plans that do not have copays and also most, but not all, advantage plans cover Rx.

 

[Talent312]

... and then bottom line AARP MEDICARE SUPPLEMENT PLAN F."
So we don't have an Advantage Plan after all?????

No... Plan F is considered the best (most comprehensive) Supplement.
It's also expensive in part becuz there's no deductible and no co-pays.
It's followed Plan G which is identical, but subject to Part B deductible.

It's nice walking out of a medical office without whipping out a CC.
Also nice, my DW's knee replacement and rehab was covered 100%.
.

 

[Luanne]

I'm confused. I thought that we have an Advantage Plan. However, reading these posts, I just got out my card and it reads "AARP Medicare Supplement Plans insured by United Health Care Insurance Company, etc. etc. and then bottom line AARP MEDICARE SUPPLEMENT PLAN F."

So we don't have an Advantage Plan after all?????

As mentioned, you have a Supplemental plan, not an Advantage Plan. I hope you also have a separate prescription plan.

 

[Glynda]

As mentioned, you have a Supplemental plan, not an Advantage Plan. I hope you also have a separate prescription plan.

I do. It's not great most likely because three or four of my prescriptions are now category 4. Two not covered at all anymore.

 

[Glynda]

So now I'm wondering if I need travel insurance when leaving the country. I recall Jim often saying that if you have an Advantage Plan you need it.

 

[dago]

I do. It's not great most likely because three or four of my prescriptions are now category 4. Two not covered at all anymore.

The prescriptions is separate from the supplement plan. The prescriptions are covered by Part D insurance. So, you have a separate Part D plan for your prescriptions. I am guessing that it's also with UHC.
Open enrollment starts next week (OCT 7). I suggest you shop around for a better Part D plan to see if your prescriptions are in a different tier.

Added: Who is your provider for Part D?

 

[Glynda]

The prescriptions is separate from the supplement plan. The prescriptions are covered by Part D insurance. So, you have a separate Part D plan for your prescriptions. I am guessing that it's also with UHC.
Open enrollment starts next week (OCT 7). I suggest you shop around for a better Part D plan to see if your prescriptions are in a different tier.

Added: Who is your provider for Part D?

I do have a separate Part D insurance. It's with Cigna.

 

[dago]

I do have a separate Part D insurance. It's with Cigna.

To reiterate. Check to see if there is a better plan for your needs.
I will be checking myself as I do every year which is a nuisance.

 

[Glynda]

To reiterate. Check to see if there is a better plan for your needs.
I will be checking myself as I do every year which is a nuisance.

Thanks. I will.

 

[Talent312]

Medicare open enrollment is October 15th - December 7th.
But the website has already loaded searchable 2024 plans.
-- https://www.medicare.gov/plan-compare/#/?year=2024&lang=en
Input your pharmacies and Rx's, and it will provide the total cost.
-- It's well worth the effort to find a plan that's cheaper overall.

-------------------------
I currently have a pricey -0- deductible plan thru WellCare.
They have a lower -0- premium plan (Value Script) that's lower
cost, but the deductible ($545) would be all taken in January.

 

[Luanne]

I have prescription coverage (Part D) through Wellcare. My monthly premium was $11.10/month. Next year the premium will drop to $.50/month. Most of my medications will not be impacted. I will continue to pay nothing for them. The one that may be is Eliquis, which is a Tier 3. Since the price I pay bounces around all the time anyway I figure it will be what it will be and I'll deal with it.

 

[Glynda]

Medicare open enrollment is October 15th - December 7th.
But the website has already loaded searchable 2024 plans.
-- https://www.medicare.gov/plan-compare/#/?year=2024&lang=en
Input your pharmacies and Rx's, and it will provide the total cost.
-- It's well worth the effort to find a plan that's cheaper overall.

-------------------------
I currently have a pricey -0- deductible plan thru WellCare.
They have a lower -0- premium plan (Value Script) that's lower
cost, but the deductible ($545) would be all taken in January.

Thanks! I'll check that out!

 

[Sugarcubesea]

Even so, he (and you) should sign up for Part A at 65 as it has no premium,
and likely, your health-plan becomes secondary to it for hospitalizations.

Also: When you do elect Part B, you'll need to hand in a certification form
to get a Special Enrollment Period... which was a chore when I enrolled DW.
.

@Talent312 , Since I'm in enrolled in a High Deductible Plan that comes with an HSA Bank Account, if he signs up, I would have to move to a different medical plan that is not cost effective for our family. Plus I would have to stop contributing to an my HSA Bank Account if Hubby signs up for just Part A.

 

[dago]

@Talent312 , Since I'm in enrolled in a High Deductible Plan that comes with an HSA Bank Account, if he signs up, I would have to move to a different medical plan that is not cost effective for our family. Plus I would have to stop contributing to an my HSA Bank Account if Hubby signs up for just Part A.

I confused. OR maybe I don't understand how HSA's work. If the HSA is yours's and you are not eligible for Medicare, then you can still contribute to it. At least that's how I understand it. Is your HSA a family plan. I haven't read all of the posts.

 

[Sugarcubesea]

I confused. OR maybe I don't understand how HSA's work. If the HSA is yours's and you are not eligible for Medicare, then you can still contribute to it. At least that's how I understand it. Is your HSA a family plan. I haven't read all of the posts.

@dago , I've meet with the Medicare expert hired by my company, hubby also called - 1-800-MEDICARE (1-800-633-4227 - on speakerphone ), and we spoke with Boomer Benefits. All 3 sources stated to us that since hubby is on my work policy and since I have creditable coverage, and I'm contributing to a HSA Bank Account, I would have to stop contributing to the HSA Bank Account 6 months prior to hubby going on Part A.

My accountant has also stated the exact same thing, he stated that the information that we received that was confirmed by the three sources above, to have hubby stay on my insurance because I'm in a high deductible plan that comes with a HSA Bank account. f you enroll in Medicare Part A and/or B, you can no longer contribute pre-tax dollars to your HSA. We are using my HSA Bank account as a retirement savings vehicle. We could have hubby sign up for Part A but then I could not contribute to my HSA Bank account

If I was not in a High Deductible Plan everyone has told us that it would make sense for hubby to then sign up for part A.

This is all so confusing but I will stick with what we have found out thru 4 credible sources we contacted and wait till I turn 65 and hubby comes off my medical insurance, so that we can both move to medicare at the same time.

 

[Talent312]

I defer to "your 4 credible sources."
Have you compared the $$ you are contributing now
to what it would cost to take him off your plan and
sign him up for Medicare?

I'm not saying its a good idea, but you might save $$.

.

 

[Sugarcubesea]

I defer to "your 4 credible sources."
Have you compared the $$ you are contributing now
to what it would cost to take him off your plan and
sign him up for Medicare?

I'm not saying its a good idea, but you might save $$.

.

@Talent312 , I've done the math on this, my company pays 97% for 2024 for the medical plan that I'm on. I really do not want to leave this company, medicare will cost me more than what I'm paying monthly today. My company gives an employer contribution of $4K annually if you choose this medical plan and once we hit the deductible the rest of the year is free for us. My daughter is on this plan till she turns 26 next year and she is a type 1 diabetic, by hubby is a type 2 diabetic, so between all the doctor visits and meds these two take, I hit our max out of pocket deductible by April of each year and then the rest of the year is free.

My company does not have the highest wages in town but it has the very best benefits in town.

Next year I will pay $87.72 per month for my medical insurance for 3 people on it .

My accountant keeps telling me, he has never seen such a rich medical benefit from a company in over 20 years, he wants to come and work for this company...LOL

 

[dago]

Don't know if this will help, but it may be helpful for people new to Medicare

 

[rapmarks]

I just found out that my medical plan covers transportation to medical visits. I am scheduled early morning, rush hour, for a pet scan and another date for a Catscan. I called and will have a ride for what is a high traffic destination. Might as well relax before the procedures