Community Chat

[gertrudecloset]

@NickNackyou should speak to the brokers and such for the specific plans in your area.  Like I said in my post within.

You didn't give State specific information.  The fact that you have to pay $100.00 everytime you get this injection tells me the drug is on a tier 4 or 5 on the formulary on your plan's drug list.  There is a likelihood this cost will always be borne by you because you can't get everything for free. 

Every plan that allows for drug coverage will cover some of the cost of certain drugs and then some plans won't cover certain drugs at all.  It's the Insurance comany's discretion.

Always start at Medicare.gov. 

[gertrudecloset]

@CelticCrafter  why?  No one else said where they were for their Part N plans or whatever they have.  Not a soul.  Why should I disclose my state?

If you want to know the amounts for your state go to Medicare.gov.

[gertrudecloset]

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@Carmie wrote:

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@gertrudecloset wrote:

All of the lettered plans people are talking about are TYPES OF SUPPLEMENTAL PLANS.  F, K, A, B and so on.

I was not referring to Medicare SUPPLEMENT PLANS.  I'm referring to Medicare.  Medicare C is what is called an Advantage Plan.

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare.  If you join a Medicare Advantage Plan, you still have Medicare.  These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).  SOME MA OR PART C PLANS DON'T COVER DRUGS.

If they don't you can get a stand a lone Part D Prescription Drug Plan.  NOT A PART D SUPPLEMENT PLAN.

THE SUPPLEMENT PLANS ARE LETTERED LIKE THE ADVANTAGE PLANS AND ORIGINAL MEDICARE. 

Original Mediare Part A

Original Medicare Part B

Advantage Plan Part C

Medicare Drug Coverage Part D.

Not all Medigap policies will be sold in every state.  Medigap is also known as a Supplement plan.  They too are lettered like Plan F, K, and they each have differing monthly costs and structures for your needs. 

Example for my area of a Supplement Plan A

Medigap Plan A

Plan DetailsView Policies

Monthly CostPremiums range from $169-$331 for a 65 year old Female that doesn't use tobacco

Doesn't include:
$148.50 Standard Part B premium

Medigap Plan B

Plan DetailsView Policies

Monthly CostPremiums range from $226-$510 for a 65 year old Female that doesn't use tobacco

Doesn't include:
$148.50 Standard Part B premium

Medigap Plan D

Plan DetailsView Policies

Monthly CostPremiums range from $391-$502 for a 65 year old Female that doesn't use tobacco

Doesn't include:
$148.50 Standard Part B premium

You can not have a Medicare Advantage Plan and a Medigap (supplement plan at the same time).  It's illegal.  You can only purchase a Medigap plan when using your stand alone TRADITIONAL Medicare.  Those monthly premiums you pay will help offset some of the 20% out of pocket costs that Medicare doesn't pay.  That's what the premium is for.  No one's gonna pay for your 20% share for nothing.  Either you pay a premium for it monthly or your income is so low that you get Special Needs plans that cover more for you.  It is not free.  You might not have to pay a dime, but SOMEONE IS PAYING IT FOR YOU.  If you live below the poverty line with a State that offers Medicaid then your state can supplement your Medicare with Medicaid.  This is all based on income.  Some people meet the qualifications, but their state Medicaid will tell them to spend a certain amount first, then they will pick up the rest.  It's called a "draw down."

The best thing to do when you're ready to get Medicare is to peruse the Medicare.gov website.  You can create an account, look at plans and speak to insurance agents of the particular plans your'e interested in. 

I do it every single year.  This way there is not cost to you.  I am not eligible for a Medigap/SUPPLEMENT policy (OF ANY KIND) as one must be a certain age (65) to purchase.  That's the law and it does not depend on your State.  It's a Medicare rule.

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Not everyone pays $148.50 for Medicare Part B.  many pay a lot more than that.  There are members in this board who would be happy to just pay $148.50. Medicare Part B is billed differently  based in your income.

There is no standard Medicare Part B fee.  The fee is based in your income.

You  keep referring to the 20% Medicare part B coinsurance  and say everyone must pay for it and it is not free.  No one is debating that.

But, I keep telling you that if you have Medicare advantage  ( Part C) there is NO 20% that needs to be paid.  Some of those Advantage Plans pay 100%.  And there is no monthly fee to purchase them after you have paid the Medicare B amount.  

So many people have the Medicare Part B preminum taken from their SS check monthly and pay nothing else for insurance and most of their medical bills are paid at 100%, except for RX drugs.

if you don't understand this there is nothing I can do to convince you.  The info is on the  Medicare website in case you need to see it in writing.

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@CarmieNo one said everyone pays $148.00  every month.  Higher income people have up to $185,00 per month coming of their SS checks.

The amounts provided were based on the lowest part B deducted.  If you see the information under what I posted you have to click in to get more details on the site.  It would give the name of the insurance company, ask income and other such things.

What I posted provides A RANGE FOR WHAT THE PLANS WILL COST.  Who said everyone pays $145.00 for B?  Not me.

It's all on Medicare.gov.  Go look for yourself for your own State and see the ranges of premiums, co-pays and deductibles.

[Carmie]

@NickNack   Try this first.

here are two organizations that will help with paying Prolia injections.

A poster gave me this information..I didn't write down her nic name.  But thank you who ever you are.

HEALTHWELL Foundation.org

1-800-675-8416

M-F 9 to 5

PAN Foundattion.org

1-866-316-7263

I understand they Lepto with paying for Prolia injections.  You must apply every year.

Let me know if this helps.

[Silverfox1]

@gertrudecloset 

I forgot to mention that every 3 months out of pocket expenses of 20% in the amount of $374.00  I have to pay to my Neurologist for boxtox injections for severe migraines I have had since I'm eight years old. They help so I can't complain.

It use to be doctors would forgive the amount owed after the insurance companies paid them....not any more.

20% is eating us up alive but we don't really complain.  Most of the time, LOL!!  With all my health problems it must sound like I'm in pretty bad shape...but I happen to be doing just fine! At least acccording to ALL my doctors and tests, LOL!!!

[Carmie]

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@gertrudecloset wrote:

@Silverfox1  That's the point I was trying to make.  The Federal Government will get it's 20% for Medicare whether you pay it or a subsidy pays it.  That's a fact.  No one is getting their other 20% for free.

Your post is spot on.

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No one pays the Federal Govt 20%.  The 20% coinsurance is paid to the provider of the service and if you have a supplement, it will be paid by your insurance.  If you have no insurance except for Traditional Medicare, the patient will be billed for it.

[NickNack]

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@Carmie wrote:

@NickNack   Try this first.

here are two organizations that will help with paying Prolia injections.

A poster gave me this information..I didn't write down her nic name.  But thank you who ever you are.

HEALTHWELL Foundation.org

1-800-675-8416

M-F 9 to 5

PAN Foundattion.org

1-866-316-7263

I understand they Lepto with paying for Prolia injections.  You must apply every year.

Let me know if this helps.

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@Carmie   Thank you so much!  I will look into it immediately.

[Carmie]

@Silverfox1   It sounds like you have a Medicare Advantage Plan that is not very comprehensive.

I would suggest that you keep a list of your RX drugs you and your DH are taking, and during open enrollment starting in October have them checked by different plans to see if you could save some money.

AARP does not offer the best plans out there and they make money on the plans you buy that they represent.

I think you could do better if you make the effort. 

[Silverfox1]

@Carmie 

I know our plan is awful however we have done exactly what you suggest for so many years and have gotten nowhere.  Like I said when Medicare opens up we call to check all plans but we are always told we have the best plan for us...case closed for that year.  Last time my DH called he was on the phone for more than 2 hours.  Could this be a Wisconsin problem?  I can't begin to tell how many people on Medicare in our State also have United Healthcare insurance with AARP.  Like us, we have Medicare and United Healthcare Ins.thru AARP.  I'm sorry I should have  made myself clear about all our insurance.

[FrostyBabe1]

Yikes...after reading thru this thread, I'm not the least bit happy about having to make Medicare choices a few years down the road. 

I private pay my medical insurance...no ACA supplement. It's not inexpensive, but at least I only had to choose one plan and I know exactly what I'm (not) getting for my monthly premium.