Among Friends

[hyacinth003]

Oh my heavens, this is confusing!  I thought I had at least average intelligence, but I am having trouble sifting through this Medicare stuff.

My husband will be going on it.  I am younger, so it will affect only him for now.

I understand they will take a premium out of his Social Security benefits.  He is already signed up due to collecting SS.  So, if I understand anything, he now needs to choose a supplement (which I think his former employer will give him something toward). 

The supplement will be used to get prescription drug coverage.  Do I have that right?  Otherwise, I guess there is Medicare D.

The supplement will help pay for what Medicare doesn't.  Do I have that right?

Is there anything else I need to know?  I am pretty good with dealing with financial/medical issues, yet this has me confused for some reason!

Hyacinth

[catwhisperer]

@hyacinth003....Don't feel bad. It is all very confusing and frustrating. Best to talk to a Medicare consultant/insurance person. Good luck.

[Ladyrain]

"Supplement" usually means secondary insurance (to cover the 20% Medicare doesn't).  I don't think it means prescription drugs.  My husband basically has what you've described and his former employer reimburses him for the secondary insurance premiums, but not the Rx drug ins. premiums.  But that's okay, as those are quite small; secondary insurance can get pricey.

[nomless]

I second the advice that you discuss your situation with a certified Medicare advisor. Don't pay much attention to other advice given on a message board such as this.  The advice posted on such forums is often incorrect.

[hoosieroriginal]

It is confusing!  I went to a local insurance company and she sat about an hour with me going over plans, prices, etc.  Find a good insurance broker that will explain it all to you.  It's worth it - there is too much to try to figure out yourself.  I don't sign up till February, but wanted to get it all figured out ahead of time.  We have my plan all picked out.  I will go see her when I get my Medicare card and she will sign me up for my plan. 

[KathyPet]

You need a supplemental policy because Medicare only pays 80% of the Medicare APPROVED amount.  You have a medical test run.  The sticker price on that test is $100.00.  The claim is submitted to Medicare for $100.00.  Medicare determines that the approved amount for that test is $50.00.  They will pay 80% of that $50.00 or $40.00.  You are responsible for the remaining $10.00.  Your Medicare supplement plan will pay that $10.00,.  

My husband died of brain cancer in Feb.  He spent from mid-September to early Feb in the hospital.  The only time he was not in the hospital was 7 days each two different times between his chemo treatments and even then he was in a skilled nursing facility.  The "sticker" price for all his care was over a million dollars.  The Medicare approved amount totaled in the area of $300,000.  They paid 80% of the approved amount.  My husband's plan F (the best you can get) paid the remaining amount of the Medicare approved amount.  My total out of pocket expense for all his care totaled about $300.00'for some specialized post chemo,drug that I had to bring to the nursing home when he was there between his chemo treatments.  That's it.  Medicare and the supplemental plan paid all the rest and I never saw a bill.

[catwhisperer]

@KathyPet....I am very sorry for the loss of your DH, but not all of us can afford to pay for supplemental insurance.

[Moonchilde]

@hyacinth003, the truth is that in any "need help with Medicare" thread (and there have been many), you will get accurate, factual answers and you will get partially correct, and completely incorrect answers. You won't know which is which, but you will have posters accusing each other of being wrong, wrong, wrong while they insist they are right, right, right.

Having gone through all of this less than a year ago, my best suggestion is that you seek out an insurance broker who specializes in Medicare supplements and let them explain your choices to you in detail. That's their job and they do it all day, every day. They will simplify it for you as much as possible.

[hyacinth003]

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@KathyPet wrote:

You need a supplemental policy because Medicare only pays 80% of the Medicare APPROVED amount.  You have a medical test run.  The sticker price on that test is $100.00.  The claim is submitted to Medicare for $100.00.  Medicare determines that the approved amount for that test is $50.00.  They will pay 80% of that $50.00 or $40.00.  You are responsible for the remaining $10.00.  Your Medicare supplement plan will pay that $10.00,.  

My husband died of brain cancer in Feb.  He spent from mid-September to early Feb in the hospital.  The only time he was not in the hospital was 7 days each two different times between his chemo treatments and even then he was in a skilled nursing facility.  The "sticker" price for all his care was over a million dollars.  The Medicare approved amount totaled in the area of $300,000.  They paid 80% of the approved amount.  My husband's plan F (the best you can get) paid the remaining amount of the Medicare approved amount.  My total out of pocket expense for all his care totaled about $300.00'for some specialized post chemo,drug that I had to bring to the nursing home when he was there between his chemo treatments.  That's it.  Medicare and the supplemental plan paid all the rest and I never saw a bill.

So sorry about the loss of your husband.

You have been through so much.

Hyacinth

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[hyacinth003]

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@nomless wrote:

I second the advice that you discuss your situation with a certified Medicare advisor. Don't pay much attention to other advice given on a message board such as this.  The advice posted on such forums is often incorrect.

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I know I am responsible to fact check everything.

But, often, people will mention something I may not have thought of.  So, I like to hear input.

It makes me wonder how people less savvy than some of us do it.

Hyacinth