Re: Can you reach a limit with Medicare in a calen... - Page 2

millieshops · ‎03-09-2010

@Nightowlz Not all Advantage plans operate the same as yours - and some people are not eligible for all of the various plans.

I often see "if you are eligible for both Medicare and Medicaid..." as part of many of the annual ads for available plans.

As for the idea of a top limit, I've never had n experience to test that, Hope I never do!

Q-Checker · ‎05-09-2010

@monicakm You did not specify whether you were talking about original govt. MC or a MC Advantage plan, a different kettle of fish.

wagirl · ‎03-09-2010

When I broke my ankle in Oct of 2022----am on medicare and a supplement plan----I never got a physical bill. Just saw the bill online as it came thru and seemed like it took almost a year before I even paid my $50 for the ER visit . That little adventure cost well over $35,000. I might have paid a few dollars here and there, but never did I actually see the whole bill.

Carmie · ‎10-25-2010

Before my father passed many years ago, he was in the hospital for about two weeks.

His inpatient hospital bill was almost $400,000, but Medicare allowed about $85,000 of that and paid the hosp all but his inpatient deductible.

His outpatient bills also had a deductible and 20% coinsurance. His supplement paid both the deductible and coinsurance.

The professional providers billed for the deductible which was already paid by insurance. My sister was paying bills when I walked in.

I was shocked that he was being double billed. I called the billing office and read them the riot act. She would have paid it.

Be careful out there. Sometimes the billing dept. makes an error and bills patients for things that are already paid.

Check Your EOMB ( Explanation of Medicre Benefit statement ) or call your insurance company to make sure you should pay it.

When I was working, I had access to the Traditional Medicare files and I could see what Medicare covered and how much they paid.

There were a lot of people being billed when they shouldn't have been.

Carmie · ‎10-25-2010

@Q-Checker She has Traditional Medicare and a supplement.

Barkanyc · ‎06-04-2015

The problem with Advantage programs is that they are attractive when you are well but using the plan when you are ill is problematic. I have traditional Medical plus a Plan F (now Plan G) and during my 6 week hospital was not charged a penny. Plus I was able to choose my phyisian out of network. Medicare has no limit but advantage plans come with large deductibles and perhaps compromised treatment. Who really cares about a free gym membership when your life is at stake. Yes, supplemental plans are expensive but I chose to sacrifice in other areas to enroll in the plan. It has paid dividends many times over.

CalminHeart · ‎03-09-2010

Medicare & supplemental policy here. I had surgery 11/30/2023. I received my (minimal) copay bill in June 2024.

Nightowlz · ‎03-11-2010

@millieshops wrote:
@Nightowlz Not all Advantage plans operate the same as yours - and some people are not eligible for all of the various plans.

I often see "if you are eligible for both Medicare and Medicaid..." as part of many of the annual ads for available plans.

As for the idea of a top limit, I've never had n experience to test that, Hope I never do!

@millieshops

Well I'm paying for Part B, Part D plus a supplement plan which costs more then an Advantage Plan.

We are supposed to buy a supplement to pay the 20% Medicare doesn't pay?

My MIL has Medicare but not a supplement. She didn't have to pay her 20% when she had full hip replacement.

I don't get why some have to pay 20% while others don't? I bet if I had hip replacement they would want their 20%.

If we don't have to pay the 20% if we don't have a supplement why pay for the supplement? I could just save the money? That's the big question?

I will have to ask my SIL if she has to pay 20% or if she just pays the copays, coinsurance & deductibles. She had $300,000 heart surgery & was only out of pocket $3000?

Sounds like if you are on regular Medicare not an Advantage Plan that we are helping pay the bills of those on Advantage Plans IMO.

Nightowlz · ‎03-11-2010

@Barkanyc wrote:
The problem with Advantage programs is that they are attractive when you are well but using the plan when you are ill is problematic. I have traditional Medical plus a Plan F (now Plan G) and during my 6 week hospital was not charged a penny. Plus I was able to choose my phyisian out of network. Medicare has no limit but advantage plans come with large deductibles and perhaps compromised treatment. Who really cares about a free gym membership when your life is at stake. Yes, supplemental plans are expensive but I chose to sacrifice in other areas to enroll in the plan. It has paid dividends many times over.

@Barkanyc

I have Medicare with a supplement.

Looks like an Advantage plan where I live makes perfect since.

When it comes to a real emergency doubt you will get much help around here. The doctors here are not worth .02¢. That's what happens when you live in a smaller are.

One of my brothers passed away last year due to the hospital not having anyone on staff to do the job that was needed where he lived.

My SIL is lucky she survived her stroke. The 911 operator that answered the call was a retired nurse.

My SIL would have never made it to the hospital in time if it had not been from her. She had to go by ambulance an hour & half away from here. They said they could not mediflight her due to the ceiling was in the sky.

I'm pretty sure they couldn't mediflight her due to her weight. She weighs too much to fit in the tight space they have on their planes with their equipment.