Medicare - H E L P ! !

[mitch5252]

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For first-timers, here's a potentially helpful site:

https://www.medicare.gov/people-like-me ... icare.html

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[mitch5252]

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Sarah posted this over on this Facebook discussion.
It's an excellent article explaining the Donut Hole.
I used to eat them. Now I have to worry about them...

http://www.gomedigap.com/blog/medicare-part-d-donut-hole/

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[JudyJB]

There are 2 main ways to get your Medicare coverage— Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Some people get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap). Use these steps to help you decide what coverage you want:

Medicare Advantage Plans handle all parts of Medicare. They contract with the government to cover, in one package, A, B, C, and D. You pay one fee directly to them and they handle everything. Usually, this also means that in return for a slightly lower cost, you have to use their systems of doctors and hospital. If you out of their service area, except for true emergencies, you have to pay more of a co-pay and might have to get advance permission to use other services.

With the "original" Medicare, you pay through a SS deduction for Part A and B, and then you buy a supplemental policy, Part C, from a provider such as United Health Care through AARP. (That is what they are calling a Medigap policy.) You can also buy prescription coverage through an outside provider. I pay for that through automatic checking account payment each month. The advantage to me is that I can use any provider anywhere, at no extra cost. No need also to get pre-approvals, also, gives me a lot of flexibility.

So these ARE choices: Advantage Plan OR original Medicare and a supplement (Medigap) plan.

Also, I take a ton of prescription drugs, some of them pretty expensive, and have never hit the donut hole. I think it would apply only if you were taking some really, really unusual stuff like cancer treatments. And the donut hole is getting smaller each year, so some day it will disappear.

[mitch5252]

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I might be reading things wrong on the medicare.gov site, but I don't think so:

Part A is, under most circumstances, provided at no cost.

Part B, in most cases, is around $120/month, or higher, depending upon your income.

Part C combines Parts A & B, and sometimes other benefits, and is offered by a private insurance company approved by Medicare.

Medigap Insurance has no "part"...IF you choose to be covered by Part C (a Medicare Advantage plan) you CANNOT have a Medigap policy.

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[Bethers]

Part C is the Advantage Plan, I believe, which the above ladies all decided against and went with the medigap insurance instead.

[mitch5252]

Part C is the Advantage Plan, I believe, which the above ladies all decided against and went with the medigap insurance instead.

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Yes, that's right!

So, as you said, most have chosen Original Medicare Parts A & B, in conjunction with a Medicare approved private insurance company offering medigap insurance, and maybe Part D (prescription drugs).

The Weakley County TN Medicare Advantage offerings were all HMOs and 1, I believe, PPO. Slim pickins...so we all must check for our individual locations.

Beth, what is offered to you, as a full-timer?

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[Bethers]

Since I can't do anything till next fall, I haven't looked that close yet. But I want the coverage that goes everywhere like has been mentioned above. I need to check in advance though, because I'll change states if necessary to get that.

[snowball]

Larry was on medicare the normal one with prescription and with ARRP with Prescription as well
we never had problems with drs and "live" in the same state as you Beth
even with both prescription coverage he would fall into the donut hole occasionally about once a year
and he wasn't on any unusual meds.. I think Lipitor was the one he usually went into the "hole"
it's confusing so I opted for the normal one don't take any meds so don't feel like I need prescription
coverage...but I have often wished I had supplemental...it just seems like so much but given what it could
cost guess not ...need to look into it
sheila

[Pooker]

I am so ignorant about what my coverage might be because my (and my hubby's) retirement packages from the university cover everything. I think I have the Advantage plan (my HMO's plan is called Seniority Plus), but here in California we have oodles of HMOs that perhaps the rest of the states don't have so I don't have a problem with it. I have 6 or 7 choices offered by the university (i.e., Blue Cross, Kaiser Permanente, etc.) and I simply go to my large one-stop HMO for everything. I may choose from a large list of doctors and specialists; and I have dental, vision, prescription, etc. coverage. I choose which dentist or pharmacy I want. Co-pays vary depending on income, I think, but I pay $20 per doctor visit, $0 for any tests including MRIs, scans, etc., and $25 for emergency room visits anywhere. I went by ambulance to the local hospital shortly after I moved here and I have no idea what the cost was because it was totally covered. My prescriptions run from $5 for generic up to $15 for my most expensive. I discovered how great that was last week when I screwed up ordering a refill and it went through without my insurance and the bill was $169! After straightening out the mistake, my medicine was $5.00!!! So, am I happy having Medicare Advantage with an HMO? You betcha!

All I know is that I get a 12 inch stack of booklets each year! Of course I read every one from cover to cover (tongue firmly in my cheek).

Evie

[Yakn1]

Thanks for all of the input. I too will need to start figuring this out in the near future.

[Birdie]

Ladies, please note that your Zip Code will impact your costs. At least it did impact mine when I signed up ages ago. If the Zip Code has lots of old or sick folks living in it, the cost is higher. If it has young worker bees the costs are lower. Choose your resident mailing address with that in mind.

I also recommend the original Medicare with a medigap coverage and yes if you go that way and fail to get a prescription plan, you will be penalized or possibly unable to add prescription plan later. Just had a friend in Advantage plan unable to get medical help with infected eye when out of state...he is Advantage Plan. They did not consider it an emergency. Good luck and Congratulations on making it this far.

[mitch5252]

Ladies, please note that your Zip Code will impact your costs. At least it did impact mine when I signed up ages ago. If the Zip Code has lots of old or sick folks living in it, the cost is higher. If it has young worker bees the costs are lower. Choose your resident mailing address with that in mind.

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What costs are based on your zip? I would think maybe the Medicare Advantage (Part C) or Prescription Drug Plans (Part D)? Oh, I'll bet for sure on the Medigap coverage??

From medicare.gov, Part A is normally free and Part B is, for the most part, a standard fee country-wide (see Part B cost chart below).



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[Birdie]

Nice numbers in the chart but not the same as I pay each month.

[mitch5252]

Nice numbers in the chart but not the same as I pay each month.

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The amount changes most years.
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[bluepinecones]

If you want to see what coverage is available by state, get a copy (or go on line for it) of the annual publication "Medicare & You 2017". It includes both advantage plans and supplements as well as cost. Within the state, some are broken down by area.
Until Obama Care, these didn't change much at least for my state. Since then, the changes generally were for more options. Blue Cross has had a near monopoly for medical insurance in AL for many years.
I have Blue Cross Advantage plan which is a PPO. However, if I am out of my coverage area I do not pay a higher copay for emergency or urgent care. The only strict requirement is the facility/physician must be Medicare eligible (most hospitals and urgent care facilities are). If I just went to a doctor for a minor problem or check up however, the copay would be more than I would pay for an in network physician.