Wellness

[Carmie]

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@Snowpuppy wrote:

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@Carmie wrote:

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@Kachina624 wrote:

Before signing up for any plan, I'd call medical providers I might be using and ask if they take XXXX insurance. 

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This is not necessary with Traditional Medicare and a Supplemental Plan.  All providers in the US  Must accept this type of insurance by law.

If one has a Medicare Advantage Plan, this would be a good idea.

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While I'm not old enough for Medicare I can tell you that my PCP quit taking all insurance several years ago.

You pay in advance and you wait for your provider to reimburse you. 

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Well,the,law.does not apply to insurance that is not Medicare.  Your experience is not unusual.

[Carmie]

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@goldensrbest wrote:

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@Zhills wrote:

I have a Humana PPO and I have never had a problem with Doctors taking it or with Humana paying.

Humana SELLS different plans like Ford makes different cars!  You can't just compare Humana alone.

My PCP visits are $5 and Specialists are $20.  That's good coverage if you ask me.  

When a provider takes your Medicare Advantage Plan they negotiate a price that  the PLAN will pay in return to taking more of their patients.  If a Doctor takes it, Humana pays it.  All of it!  You don't have the yearly deductable and you have drug mail order svc.

I had an episode in 2016 that ran over $350,000 and I paid $800.  I was in the hospital and rehab a total of 35 days and had major surgery.   I won't complain.

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What is your monthly premium?

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Medicare Advantage Plans are not the same as Traditional Medicare and supplemental plans,

Advantage Plans are not all the same.  Advantage plans differ from state to state and from different insurance companies.

Some Advantage Plans like Zhills has do not charge a monthly fee.  The Medicare Part B payment taken from the SS check each month is sent to her insurance company and she is not billed any additional money. Unless you live in the same area, her insurance plan will not be available to you...even from the same company,

Some Advantage Plans do have a monthly fee in addition to the Medicare Part B payment.  

If you choose an Advantage Plan, please be aware that you will probably not be able to afford to switch back to Traditional Medicare if you change your mind.  The reason is, you will not be able to purchase a RX plan and the insurance companies will charge you a high premium rate for the supplement. Most Advantage Plans include an RX plan for no additional cost.  There is no RX coverage with a supplemental plan, you have to purchase it separately and get it when you sign up for Medicare.  You will be pentalized for waiting.

It is much less expensive to switch to an Advantage Plan if you have Traditional Medicare and a supplement policy if you change your mind.

I worked for over 20 years in health insurance.  If you have any questions about coverage, I will be able to help you.  Just ask.

[goldensrbest]

@Carmie,I have been trying to find a Independent medicare insurance broker ,in my area i have typed in many terms for this ,just having no luck,i just do not understand all of this about medicare, i really need a person in my local area ,my zip is 03903.

[bakergirl]

I have an Rx plan with Humana - they are higher in cost per month, but there is no deductible and it is the best plan for me, at this time because of one brand rx I must take. The good thing with the RX plans is you can switch each year pretty easily.

Re the supplemental Medicare insurance, our advisor told us to go with the one  we could most readily afford(the best one with best coverage to start) and as years go by, change to a lesser plan if we had to. I think we have "F" and yes, all the plans with the same letter, should cover the same things no matter who the insurance co. is, ours happens to be BCBS of PA.

So the "f" plans is a really good one, more expensive but considered about the best no matter which insurance company you get it from Hope this helps!

[terrier3]

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@goldensrbest wrote:

@Carmie,I have been trying to find a Independent medicare insurance broker ,in my area i have typed in many terms for this ,just having no luck,i just do not understand all of this about medicare, i really need a person in my local area ,my zip is 03903.

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You should check out your local senior center. They often have seminars on Medicare.

I can only describe NY State, where I have sold health insurance, but there are often health fairs at senior centers. Here our county senior services departments also have licensed navigators who can help you.

Or you can call a Medicare provider and get assistance, no broker needed. This is a good time to call, BEFORE open enrollment starts. Many companies hire temps after Nov. 7th - the full time staff is available now.

There isn't a lot of money to be made selling individual plans to people - whether Medicare, ACA or Medicaid. Brokers concentrate on groups and signing up businesses - where they can enroll dozens or hundreds of people at a time. Brokers make commissions from insurance companies (paid by the insurance company, not you!)

[NickNack]

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@Carmie wrote:

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@Kachina624 wrote:

Before signing up for any plan, I'd call medical providers I might be using and ask if they take XXXX insurance. 

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This is not necessary with Traditional Medicare and a Supplemental Plan.  All providers in the US  Must accept this type of insurance by law.

If one has a Medicare Advantage Plan, this would be a good idea.

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@Carmie  This may be true of your PCP, although I don't know, but it's not true of Specialists.  I called my dermatologist to see if they accepted my Blue Cross Medicare plan, and they did not.  I go to another specialist that doesn't take Medicare, too.

[Snowpuppy]

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@Nicknack wrote:

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@Carmie wrote:

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@Kachina624 wrote:

Before signing up for any plan, I'd call medical providers I might be using and ask if they take XXXX insurance. 

---

This is not necessary with Traditional Medicare and a Supplemental Plan.  All providers in the US  Must accept this type of insurance by law.

If one has a Medicare Advantage Plan, this would be a good idea.

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@Carmie  This may be true of your PCP, although I don't know, but it's not true of Specialists.  I called my dermatologist to see if they accepted my Blue Cross Medicare plan, and they did not.  I go to another specialist that doesn't take Medicare, too.

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I did some reading and yes, physicians can "opt out" of accepting Medicare.

Also, even if a physician currently accepts Medicare patients, they can refuse new Medicare patients. Important for new enrolees to ask if you want to keep your current doctors.

[Carmie]

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@goldensrbest wrote:

@Carmie,I have been trying to find a Independent medicare insurance broker ,in my area i have typed in many terms for this ,just having no luck,i just do not understand all of this about medicare, i really need a person in my local area ,my zip is 03903.

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I can understand your frustration.  My DH will be eligible for Medicare in a few months and my phone has been ringing off of the hook and my mail box is full of Medicare information everyday.  Some of those brokers are very assertive.

I will try to break down what your choices are in a broad sense.

1st choice is Traditional Medicare.  Under this program, your work history provides you with Medicare Part A at no cost to you.

 Part A pays only hospital bills for impatient services at 100%, but you must pay $1,316 each benefit period first.  This is called Medicare Part A deductible.

Part B of Medicare must be purchased at $134 a month for most people.  It can be more costly if you are in a higher income bracket.  Part B pays 80% of most hospital and doctors and medical suppliers for out-patient services.  Part B also has a deductible of $183 each year that you must pay in addition to the 20% not paid by Medicare.

If you always choose providers who are participating with Medicare, you will be responsible for only the Part B deductible and the 20% coinsurance for out-patient services.

if your provider is not participating they can charge you an excess fee.  The excess fee is the amount over and above what Medicare allows. 

Example:  surgery bill is $750.  Medicare approves $500 for that service.  Medicare pays 80% of $500.  You must pay for 20% of $500 after your Part B deductible is met.  If the provider accepts, he will be paid a total of $500.  If the provider does not except, he can also bill you the $250 excess fee that Medicare did not allow.

Most people choose a Medicare Supplemental Plan to cover the deductibles and coinsurances that they would have to pay out of their pocket.  Plan N that you mentioned in a post is one such plan.  In addition, you must purchase Medicare Part D, which is RX insurance.  This must be purchased when you are first eligible.

Medicare also has a 2nd Choice for you to consider. It is called Medicare Advantage.  Advantage Plans come in PPO and HMO choices.  They can include RX coverage, dental, vision, hearing aid and gym memberships.

These Plans are usually less expensive and can differ depending on where you live.  They are very attractive to healthy people on a limited income.  It's these plans you are restricted somewhat.  They don't work the best for people who travel a lot or snow birds.  If you live in an area where they are popular and your available provider are in network with your Advqntage Plan, they could work well for you. IMO PPO's are better and easier to understand and follow the rules.  HMO's can get complicated with referrals and such.

if you decide to switch from an Advantage Plan to a Traditional Plan in the future, you probably will not be able to afford to, plus you will not have any RX coverage. There are penalties to pay monthly.

Something to consider when you make your decision.  FInd a plan that covers more than 20 days at 100% in a Skilled Nursing Facility (SNF).  Traditional Medicare covers days 1-21 at 100%.  You would owe $164 coinsurances a day for days 21-100 which adds up fast. Some Advantage Plans cover more than 21 days in full.  Try to find one that does if you go in that direction.

WIth today's changing medicine, many people spend more than 20 days in a SNF.  I have heard many people crying on phone over the years because they could not afford the $164 a day and were not ready to go home.

I would suggest that you not look for a broker to help you, but to instead call SHIP in Maine (Office on the Aging) 1-877-353-3771 or 1-800-262-2233.  They probably have an office you can visit free of charge to explain and guide you through the process.

A broker will want to sell you insurance that they can sell and get a commission on.  They may not steer you in the right direction for your circumstances.

Best of Luck.  I hope this helped.

[Carmie]

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@Nicknack wrote:

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@Carmie wrote:

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@Kachina624 wrote:

Before signing up for any plan, I'd call medical providers I might be using and ask if they take XXXX insurance. 

---

This is not necessary with Traditional Medicare and a Supplemental Plan.  All providers in the US  Must accept this type of insurance by law.

If one has a Medicare Advantage Plan, this would be a good idea.

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@Carmie  This may be true of your PCP, although I don't know, but it's not true of Specialists.  I called my dermatologist to see if they accepted my Blue Cross Medicare plan, and they did not.  I go to another specialist that doesn't take Medicare, too.

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A Blue Cross Medicare Plan would be an Advantage Plan.  Providers do not have to accept Advantage Plans.

They must accept Traditional Medicare, though they can charge you an excess fee in some states if they are not participating with Medicare.  They must submit the claims to Medicare for you and if you have a supplemental plan, it will pay the 20% coinsurance and often the excess fee if it is included in your supplemental plan... Plan F, for instance.

People with Traditional Medicare and Supplememental Plan F get their bill paid 100% no matter what type of provider they go to if the services are medically necessary and not excluded by Medicare like cosmetic surgery, for example, which is not covered.

[Carmie]

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@Snowpuppy wrote:

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@Nicknack wrote:

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@Carmie wrote:

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@Kachina624 wrote:

Before signing up for any plan, I'd call medical providers I might be using and ask if they take XXXX insurance. 

---

This is not necessary with Traditional Medicare and a Supplemental Plan.  All providers in the US  Must accept this type of insurance by law.

If one has a Medicare Advantage Plan, this would be a good idea.

---

@Carmie  This may be true of your PCP, although I don't know, but it's not true of Specialists.  I called my dermatologist to see if they accepted my Blue Cross Medicare plan, and they did not.  I go to another specialist that doesn't take Medicare, too.

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I did some reading and yes, physicians can "opt out" of accepting Medicare.

Also, even if a physician currently accepts Medicare patients, they can refuse new Medicare patients. Important for new enrolees to ask if you want to keep your current doctors.

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Opting out of Medicare just means they can charge the excess fee.  Some supplemental plans cover this excess fee, so your claims would be paid 100%.  If your Supplemental insurance does not cover the excess fee, you can still go to an Opt Out doctor and get 100% of the Medicare allowed fee covered and pay the excess fee yourself.

If doctors do not accept new Medicare patients and you are 65 and over or disabled with Medicare, you can't be their patient and must go to someone who will see new patients. You have no choice, but to move on.