Wellness

[151949]

It is really a shame that so many people do not understand medicare and supplements or advantage plans at all. Many don't even know what they have. There was once a lady here arguing with me that she had a supplement AND an advantage plan (despite that this would be impossible because SS would be either paying for your advantage plan or for medicare but never both).However, she thoroughly believed she had both.

[151949]

On 1/5/2015 rina33 said:

On 1/5/2015 woodstockillinois said:

I am on a medicare advantage program which I love!!!!!!!!!!!!!! I always shoe both insurance cards. I always recommend a medicare advantage program, if they have to go out of the program to get you the right help, they do. No questions asked. Good luck.

Is that supplemental insurance? Sorry, I'm just learning this stuff. I'm not 65 yet.

Thanks.

NO. When you become eligible for medicare you can choose to either have medicare- which pays 80% and a supplement (gap policy) OR you can select to have a medicare advantage plan - which essentially is the same as having private insurance instead of medicare(except medicare pays for it or part of it). It is still overseen by medicare but is essentially like opting out of medicare and going private. generally, advantage plans cost less than medicare and a gap policy - but they are also HMO /PPO plans and usually have copays.What is the best choice is usually dependent upon individual needs.

[Lavenderjunkie]

On 1/5/2015 happy housewife said:

On 1/5/2015 rina33 said:

On 1/5/2015 woodstockillinois said:

I am on a medicare advantage program which I love!!!!!!!!!!!!!! I always shoe both insurance cards. I always recommend a medicare advantage program, if they have to go out of the program to get you the right help, they do. No questions asked. Good luck.

Is that supplemental insurance? Sorry, I'm just learning this stuff. I'm not 65 yet.

Thanks.

NO. When you become eligible for medicare you can choose to either have medicare- which pays 80% and a supplement (gap policy) OR you can select to have a medicare advantage plan - which essentially is the same as having private insurance instead of medicare(except medicare pays for it or part of it). It is still overseen by medicare but is essentially like opting out of medicare and going private. generally, advantage plans cost less than medicare and a gap policy - but they are also HMO /PPO plans and usually have copays.What is the best choice is usually dependent upon individual needs.

RINI: Just to add a little more info for you.... the supplement or medigap policies are available to pay for some of the 20% that medicare doesn't. The medigap policies are offered by a number of different insurance companies. The medigap policies have letter designations A, B,C,....F, etc. Every company that offers a plan with the same letter is offering the same coverage for that plan, but
the rates may be different.

Medigap policies only cover expenses that medicare approves. People think medicare covers every legitimate medical expense, but that's not true. Medicare benefits have restrictions and limits.

Whether you are choosing a medigap policy or an advantage plan (which takes the place of medicare) there are lots of things to evaluate. Not only do you have to see if your doctors are in the plan (if it's an advantage plan there are networks), but you also have to decide how much coverage you want to pay for and what risks you want to be insured for. Most people only focus on doctor visits, but for some it's important to consider how much hospital coverage is included. There is no one right answer that works for everyone.

And remember, with medicare and a medigap policy you still need to sign up for a separate drug plan. With an advantage plan drug coverage is often included. But that doesn't mean an advantage plan is the right answer for everyone. And over time, the cost of the advantage plans will be increasing because the level of government subsidy will be going down.

[goodstuff]

If you're on a Medicare Advantage plan, you present just the Medicare Advantage card, since all of your Medicare benefits are incorporated into and managed within that plan. Usually your doctors, all tests and diagnostic procedures, hospitals and other facilities, and prescription medications are incorporated under the one plan.

If you have a Medicare supplement ("Medigap") plan, you will present both your Medicare card and the Medicare supplement card. The medical provider will file under both to receive payment from Medicare for the portion it pays (usually about 80% of covered expenses), as well as payment from the supplement plan to cover the remaining (about 20%) portion of covered expenses. You will also apply for a Part D prescription medication plan to help cover the cost of prescription drugs.

When you sign up for Medicare, you will choose either a Medicare Advantage or Medicare Supplement plan. Medicare Advantage plans are simpler because they are alll-in-one plans, but they function like HMO plans, with a narrow network of providers and often require referrals from your PCP for specialists, etc. The Medicare Supplement ("Medigap" plans are usually more expensive, but more flexible, as they are generally accepted by any provider or facility that accepts Medicare, and cover the portion of Medicare-approved treatments not covered by Medicare itself.

As you approach Medicare enrollment you will receive bushels of marketing materials from various plans. DH and I just went through this process and found it extremely helpful to work with a knowledgeable Medicare insurance agent who could look at our situation and evaluate various options to choose the best, most cost-effective plans for us.

[Lavenderjunkie]

There are charts available comparing the various medicare supplement plans to one another, by letter identifier. I've seen the info on the medicare site and also on the AARP/UHC and the Humana site. It helps to see the side by side comparison to decide which ones you want to understand in more detail and then compare the benefits and prices.

[kcladyz]

It would not hurt to have both cards presented. They should know how to bill both.

[Kathlen]

I have Medicare and secondary retirement benefit insurance ... I give doctors both cards. My secondary picks up after Medicare.

[Nonametoday]

On 1/5/2015 namaste000 said:

When you go to a doctor you need to show your medicare card and the supplemental card. Usually, once they copy them and put both in their records, you will not have to show anything at future visits with that doctor. They will just ask if you have any changes in your healthcare. Any new doctor will ask for both cards.

That said, it is safer to have the 2 cards with you at office visits, just in case they want to see them.

The bill from your doctor visit goes thru Medcare first and then they route it to your supplement plan.

Although I am on Medicare as a result of turning 65 and have MS and a supplementary insurance, I have to show them each January or each "first visit" of each calendar year.

[terrier3]

Since I started enrolling people in individual and marketplace plans - I have come to realize that seniors are VERY well versed in the Medicare program. There are seminars, brochures, one on one meetings - LOTS of ways for seniors to make their best HI decisions.

I wish they had similar plans for everyone!

[Roni]

She has to present both cards IF she wants balances after medicare payments billed to her secondary insurance..... Otherwise the doctor has no idea..