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Change to 2018 Medicare Part D

artringwald

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If you have an overnight hospital visit, and take medications daily, be aware of a change to Medicare Part D.

I had a total knee replacement surgery last October. While I was there, the hospital gave me my daily medications. I have Blue Cross Platinum for Part C, and I never saw a bill from the hospital. Between Part A, Part C, and Part D, I had to paid $0 of the $48,674.68 it would have cost without insurance.

DW had 2 disks replaced in her neck this past April. She got a $114.32 bill from the hospital for the 2 days they gave her the "self administered" daily medications. I found out that starting in 2018, hospitals will no longer submit claims for "self administered" medications. You have to request that the hospital send you a printout that includes the "national drug code" for the medications. You also have to request that the Part D insurance company send you a claim form so you can get reimbursed.

I'm glad I'm retired and have the time to make the calls and find out what's going on. Otherwise, with a long list of charges and no detail on the hospital statement, I would have just paid the $114.32 thinking it was a good deal since the hospital said without insurance the total bill would have been $88,649.66.

Here's another tip. If you're near Medicare age, and are facing a major surgery that you can delay, wait until you're on Medicare and choose the most inclusive Part C you can get.
 

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Here's another tip. If you're near Medicare age, and are facing a major surgery that you can delay, wait until you're on Medicare and choose the most inclusive Part C you can get.

Another thought from my perspective. Don't be sucked in by the low cost of Medicare Advantage vs traditional Medicare. Sure with Advantage you will save a lot of money in the years you don't have to pay for a Medicare Supplimental Policy. But if/when you have something serious to address, being able to go anywhere to get treatment can be life saving vs being stuck in a Medicare Advantage network...

George
 

pedro47

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If you have an overnight hospital visit, and take medications daily, be aware of a change to Medicare Part D.

I had a total knee replacement surgery last October. While I was there, the hospital gave me my daily medications. I have Blue Cross Platinum for Part C, and I never saw a bill from the hospital. Between Part A, Part C, and Part D, I had to paid $0 of the $48,674.68 it would have cost without insurance.

DW had 2 disks replaced in her neck this past April. She got a $114.32 bill from the hospital for the 2 days they gave her the "self administered" daily medications. I found out that starting in 2018, hospitals will no longer submit claims for "self administered" medications. You have to request that the hospital send you a printout that includes the "national drug code" for the medications. You also have to request that the Part D insurance company send you a claim form so you can get reimbursed.

I'm glad I'm retired and have the time to make the calls and find out what's going on. Otherwise, with a long list of charges and no detail on the hospital statement, I would have just paid the $114.32 thinking it was a good deal since the hospital said without insurance the total bill would have been $88,649.66.

Here's another tip. If you're near Medicare age, and are facing a major surgery that you can delay, wait until you're on Medicare and choose the most inclusive Part C you can get.

Thanks for sharing this very important piece of advice.
 

VacationForever

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If you have an overnight hospital visit, and take medications daily, be aware of a change to Medicare Part D.

I had a total knee replacement surgery last October. While I was there, the hospital gave me my daily medications. I have Blue Cross Platinum for Part C, and I never saw a bill from the hospital. Between Part A, Part C, and Part D, I had to paid $0 of the $48,674.68 it would have cost without insurance.

DW had 2 disks replaced in her neck this past April. She got a $114.32 bill from the hospital for the 2 days they gave her the "self administered" daily medications. I found out that starting in 2018, hospitals will no longer submit claims for "self administered" medications. You have to request that the hospital send you a printout that includes the "national drug code" for the medications. You also have to request that the Part D insurance company send you a claim form so you can get reimbursed.

I'm glad I'm retired and have the time to make the calls and find out what's going on. Otherwise, with a long list of charges and no detail on the hospital statement, I would have just paid the $114.32 thinking it was a good deal since the hospital said without insurance the total bill would have been $88,649.66.

Here's another tip. If you're near Medicare age, and are facing a major surgery that you can delay, wait until you're on Medicare and choose the most inclusive Part C you can get.
I am a little confused by this post. What does your wife have? Medicare Advantage? Most Medicare Advantage that I know of covers A, C and D. In this example, your wife received a bill from the hospital. Are you saying to send the bill back to the Medicare Advantage insurer to get reimbursed? If one has Supplemental Plan + an additional Part D Drug plan, does this affect them?
 

artringwald

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I am a little confused by this post. What does your wife have? Medicare Advantage? Most Medicare Advantage that I know of covers A, C and D. In this example, your wife received a bill from the hospital. Are you saying to send the bill back to the Medicare Advantage insurer to get reimbursed? If one has Supplemental Plan + an additional Part D Drug plan, does this affect them?
We both have a Supplemental Plan (Blue Cross Platinum) + an additional Part D Drug plan (AARP). I don't know if the change applies to Medicare Advantage plans.
 

rapmarks

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I was in the hospital overnight in 2018 and I was not sent a bill for medication, I am not exactly sure what you are saying.
 

artringwald

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I was in the hospital overnight in 2018 and I was not sent a bill for medication, I am not exactly sure what you are saying.
If it's medications that are part of your hospital treatment, they will be covered by Medicare part A. If you take daily prescriptions, the hospital will order them from their pharmacy, and add them to your bill. They will not submit a claim for them to your part D insurer.
 
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VacationForever

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If it's medications that are part of your hospital treatment, they will be covered by Medicare part A. If you take daily prescriptions, the hospital will order them from their pharmacy, and add them to your bill. They will not submit a claim for them to your part B insurer.
Part D or B? Drugs are Part D.
 

artringwald

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rapmarks

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I was given my thyroid replacement and something else and not billed for it when I was in the hospital overnight in January for knee replacement. They did not give me most of my daily drugs though
 

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So if the person has Medicare Advantage instead of Supplemental, it should not create an issue as Part A, B and D are all managed by the same Medicare Advantage plan, right?

Yes you are right. The Advantage plans and supplemental insurance are two different animals. I took a continuing ed class when I approached 65 and got pretty confused...but now it's clearer but...I still might ditch my medicare advantage plan next open enrollment. I've little need for drugs (right now) and take no meds. But I believe in chiropractic and to get adjusted via my medicare advantage plan costs twenty bucks...and if I had straight Medicare and just used that red/white/blue card at my provider's office, that same chiro adjustment would be 8 bucks. Feels like I'm always having to do price comparison...wish I had a national single payer system like France or Canada, instead of medicare!
 

Luanne

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Yes you are right. The Advantage plans and supplemental insurance are two different animals. I took a continuing ed class when I approached 65 and got pretty confused...but now it's clearer but...I still might ditch my medicare advantage plan next open enrollment. I've little need for drugs (right now) and take no meds. But I believe in chiropractic and to get adjusted via my medicare advantage plan costs twenty bucks...and if I had straight Medicare and just used that red/white/blue card at my provider's office, that same chiro adjustment would be 8 bucks. Feels like I'm always having to do price comparison...wish I had a national single payer system like France or Canada, instead of medicare!
I don't know if you are considering ditching the prescription drug plan completely, but it you are think again. A friend of mine, who now has all kinds of medical complications advised everyone to have a drug prescription plan because you never know what will happen. If you wait until you need it, you may not be able to get one, or to afford it. Both dh and I take blood pressure medication, which isn't expensive, but it's the "what if" that keeps up enrolled in a drug prescription plan. We do have medicare supplements and a separate prescription plan.
 

WinniWoman

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My husband turns 65 next April (and hopefully will still be working) and i have a lot of anxiety over this whole Medicare enrollment thing.

Why does it have to be so darn complicated? Why can't it just be one plan for everyone. I just don't get it.
 

artringwald

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My husband turns 65 next April (and hopefully will still be working) and i have a lot of anxiety over this whole Medicare enrollment thing.

Why does it have to be so darn complicated? Why can't it just be one plan for everyone. I just don't get it.
Many of the insurance providers offer free seminars to explain the options. We attended one offered by Blue Cross and it really helped us choose what was best for us. Insurance brokers also offer web sites where you can enter your information and they'll show you the cost of a variety of providers. It is complicated, but it's easy to get help for making your choices. If you make a bad choice you only have to wait a year to change it.
 

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Why does it have to be so darn complicated?

Actually I don't think it is all that complicated...

(a) If you are near 100% healthy, want to save money, are willing to be locked into a Network and don't mind needing to get referrals from your Primary Care Physician to see a Specialist, go with a Medicare Advantage Plan....

(b) If you are near 100% healthy but want the flexibility of using any doctor or hospital anywhere in the US accepting Medicare, go Traditional Medicare with a Plan F High Deductible Supplement and a Prescription Drug Plan...

(c) If you have health issues and want the flexibility of using any doctor or hospital anywhere accepting Medicare, go Traditional Medicare with one of the other Supplements and a Prescription Drug Plan...

(a) is least expensive; (b) is more expensive; and (c) is most expensive...

Personally I went with (b) because I am near 100% healthy and want the option to go to a Center of Excellence specializing in whatever serious issue may befall me...

George
 

WinniWoman

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Actually I don't think it is all that complicated...

(a) If you are near 100% healthy, want to save money, are willing to be locked into a Network and don't mind needing to get referrals from your Primary Care Physician to see a Specialist, go with a Medicare Advantage Plan....

(b) If you are near 100% healthy but want the flexibility of using any doctor or hospital anywhere in the US accepting Medicare, go Traditional Medicare with a Plan F High Deductible Supplement and a Prescription Drug Plan...

(c) If you have health issues and want the flexibility of using any doctor or hospital anywhere accepting Medicare, go Traditional Medicare with one of the other Supplements and a Prescription Drug Plan...

(a) is least expensive; (b) is more expensive; and (c) is most expensive...

Personally I went with (b) because I am near 100% healthy and want the option to go to a Center of Excellence specializing in whatever serious issue may befall me...

George


What is the difference between B and C?
 

WinniWoman

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Also- my husband will still have health insurance through his employer if he is still working.
 

VacationForever

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B (Plan F) actually more expensive than C (other Supplemental Plans). Plan F is the most expensive in our last comparison and with best coverage, in and out of the US.
 

Patri

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It IS complicated. I recommend sitting down with an insurance broker. They explain all of the options, various supplemental plans (some companies are better than others for your specific situation), etc. I met with two, just to make sure what the independent person was saying was accurate. The agency said the exact same things. A person can answer your questions as you sit there, and they are easy to contact with follow-up. In our case, there was a glitch so it was helpful to have the broker intervene. You should start several months in advance of enrolling. Medicare is a language all its own. Yes, it should be simplified.
 
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As a Florida Licensed Health Insurance Agent, specializing in Medicare, I can say this: ***DO NOT*** refuse or drop Part-D (drugs)! The Medicare Part-D law states that you will be charged (by Medicare) a fee/tax for every year you do not subscribe to one. If you never took one, the tax could go as high as $33/month. Definitely talk to an insurance agent. If you do not take drugs right now, there are Part-D plans that are very cheap monthly (if not free).

In terms of medications, there is a difference to how they're administered and billed. If it is injected at a doctor's office or other medical facility, that is covered by Part-B. If you're in a hospital, most likely they will be billed under Part-A. But, if you buy them from a pharmacy and take them home to administer yourself (like pills), that is Part-D.

As a side note, I took a couple years off, so I can not sell plans, do not ask. But, I will be able this coming Open Enrollment, as I will be doing it "on the side".

TS
 

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B (Plan F) actually more expensive than C (other Supplemental Plans). Plan F is the most expensive in our last comparison and with best coverage, in and out of the US.

Note that I said "High Deductible" Plan F. It is a whole lot cheaper than the other Supplement Plans. Something like $70 per month vs $300 per month. It only works if you anticipate not using your Insurance much. I think the deductible is something just South of $2,000. I have had a High Deductible Plan F for the last 4 or 5 years and each year the deductibles I had to cover were between $200 and $300...

George
 
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VacationForever

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Note that I said "High Deductible" Plan F. It is a whole lot cheaper than the other Supplement Plans. Something like $70 per month vs $300 per month. It only works if you anticipate not using your Insurance much. I think the deductible is something just South of $2,000. I have had a High Deductible Plan F for the last 4 or 5 years and each year the deductibles I had to cover were between $200 and $300...

George
Ah I did not read High Deductoble. If so, yes.
 

Luanne

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Many of the insurance providers offer free seminars to explain the options. We attended one offered by Blue Cross and it really helped us choose what was best for us. Insurance brokers also offer web sites where you can enter your information and they'll show you the cost of a variety of providers. It is complicated, but it's easy to get help for making your choices. If you make a bad choice you only have to wait a year to change it.
Our insurance provider, State Farm, sent me a letter prior to my 65th birthday. Our agent offered to meet one on one with us to explain the options. It was very helpful. We didn't get our supplement policies through them (I didn't even know State Farm) offered one, but again, the information was very helpful.
 
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