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Medicare Options

jimwins's picture
jimwins
Posts: 2111
Joined: Aug 2011

I'm reaching out to you guys hoping to get some input on deciding how to handle Medicare which starts for me next month.  I met with a Medicare Counselor yesterday and though he was a very nice and interesting person, I'm still indecisive/confused about which way to go.  I've been on disability for two years and medicare automatically kicks in at this point.  I've been paying a large amount for Cobra continued coverage which has pretty much exhausted my savings but I'm glad I had the coverage.

I qualified for disability (first time) due to Lymphoma and other medical conditions.  I am on medications that are very expensive and like most of us, I have regular CT scans, onccologist visits, etc.  I also have regular specialist visits for the other medical coditions.

I have been considering:

1) Regular Medicare Part A,B,D and medigap policies.  You can't have medigap and an Advantage plan together.  Medigap is expensive but can cover nearly all of the 20% that medicare doesn't cover on Part A & B.  Medigap offers nothing toward Part D (drugs).  This option would offer coverage pretty much anywhere in the US.  The counselor told me Medigap is the best of all options but is expensive (especially if you are under age 65).

2) Medicare Advantage Plans.  These generally combine Parts A,B and D and in many cases there is no additional premium for them.  But like Medicare, they generally cover 80%, may have deductibles and some have out of pocket maximums (Medicare does not).  The drug coverage is good for generic type drugs (reasonable co-pay) but for certain drugs there could be a 33% patient responsibility.  These plans often offer other perks like limited Dental/Vision, gym memberships, etc.  These plans are generally limited to a geographic area and have in-network medical teams.

Anyway, I know some of you are on Medicare and am reaching out for any helpful information you might provide.  I've been paying nearly $750 a month for Cobra and have been looking forward to that going away :).  I would appreciate any infromation/experiences you could share either on this post or via private message.

Thanks and kick cancer butt!

Jim

COBRA666's picture
COBRA666
Posts: 2418
Joined: May 2010

Jim,

  It's one of those things that is 6 of one and 1/2 dozen of the other. You have to look carefully at what you will be needing in the future. Checking to see who is in the network and who don't accept medicare. Some Drs. do not. What medical services you will probably need is the biggest obstacle. I have the regular Medicare, but it seems I still get bills of something that wasn't covered. I find I am on the phone at least every other month asking why this and that was not covered. It seems there is becoming less and less coverage as time goes on. They can and do change the rules in midstream all the time.You will need the prescription coverage as well. You may have to get a private company in on that. Just be careful with that because as you know there are a lot of scam companies out there. They have something now that they call self administered drugs and they will not cover anything. You are responsible for the entire amount of that drug. Aspirin and tylenol are just examples. Over $200 a pill. Of course that is for any hospital stay. If you are not planning on moving you can check who does accept medicare. If you ever move you may find you can't find a Dr. that accepts medicare. This may helps some, I don't know. As you know the insurance companies make it difficult in a decision. I wonder if thats on purpose or not. John 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 1628
Joined: May 2012

Jim,

Sorry you are  having the "insurance squeeze." After a catastrophic accident many years ago, I was on Cobra for about a year. It was too expensive to maintain for long, but I qualified for nothing else, despite 18 fractures, and being unable to walk for nearly two years.

A friend who lives two miles away is dying with prostate cancer, and is on Medicare with a "B" supplement.  As best I can tell, his options are limited and poor. He is denied many pallatative options that others would qualify for.  Despite drawing only social security (he is 71 years old) and a very meager pension, he is denied most grant money due to "too much income ! "   He is trying to shift most care to the VA, which subcontracts (locally, in our area) to the same cancer center that he now gets service from anyway.   We took his primary care doctor's file to them recently -- 80 single-spaced pages.

My mother died in 2005, also on Medicare and a "B" plan. He experiences were much more positive, and I consideed her care and options much more generous. I do not recall her ever being dernied anything for financial reasons, despite an 8 year fight with late-term demential, and numerous strokes during her last two years.  My mother-in-law (now 76) is similiar: Medicare and "B". She more or less lives at the doctor, and seems to get whatever she needs in a timely manner. She had an ovarian cyst (non-cancerous) removed two years ago in rapid fashion, for instance, no questions asked.

It sounds like you have already received a good bit of professional advice, and have the numbers at hand to cruch what will work best for you.  Unfortunately, no one, including insurance corporations, really know what the next few years hold, regardless of how much Obamacare survives Congressional actions. 

Bless your decision.  I am 57, and will be following you down a similar path before too long, if God is Willing I am still around, which seems probable, at this point.

max

vexed
Posts: 10
Joined: Aug 2011

Jim,

     It seems that you understand your Medicare options pretty well.  Medigap policies are great with regular Medicare in having the widest access to doctors and hospitals, but most people can't afford them long-term. Medicare Advantage plans are often much cheaper, but you are usually tied to the plan doctors and plan hospitals.

     If you choose to go the Medicare Advantage route, make sure you get complete information about the rules being used from every Medicare Advantage plan that covers your geographical area. Some Medicare Advantage plans are like HMOs where everything is in-house and some plans have networks of local doctors (such as PPOs or preferred provider organizations).   

     With each Medicare Advantage plan you have to know the in-network doctors and hospitals available in your geographical area to make sure you have adequate services in the specialties you need. Some plans allow you to use out-of-network doctors, but often at higher costs.  

    Since we are lymphoma patients we often need the care of particular specialists.  You have to find out how you get to see the specialists: Can you get a direct appointment with a specialist?  Do you need a referral from a primary care doctor to see a specialist? Do you need a referral EVERY TIME you need to see a specialist or do you need just one referral for a certain number of specialist visits? 

    I am sure that after you examine the contracts of each of the plans you will add your own questions to what I brought up.  I wish you the best of luck in making this difficult decision.

Les

illead's picture
illead
Posts: 648
Joined: Aug 2012

Hi Jim

I am Becky's husband, the guy with the Mantel Cell Lymphoma.Smile I too am going on Medicare as my birthday is Nov. 25 1948. From what I have researched, and you have to remember that I am in CaliforniaFrown I think I am going with the Federal A and B, as is everyone, and am seriously considering AARP for plan F, to pickup all the 20% copay and their plan D for all the drugs.  They have several to choose from.  You might want to check Walmart Humana and Walgreens, they also have plans.  I do not have any drug issues at this time and I can change my plan D next year if that changes. You can make any changes to your plans without penalty as long as you do it within the  "enrollment period" each year which is between like Oct 15- Dec 7.  It sounds like your plan D plans are of the most concern. I would check with AARP and see what would be best for you. As a side note, I do not trust CONSELORS as we all know they do not work for nothing.  My sister-in-law found that out.

Just my thoughts,

Bill

 

PS    My name is Becky, and I approve this message WinkLaughing

allmost60's picture
allmost60
Posts: 3187
Joined: Jul 2010

Hi Becky,

 I love the picture of you and Bill! It's always nice to see who we're talking to. Your P.S. cracked me up...funny lady! Laughing Love...Sue

illead's picture
illead
Posts: 648
Joined: Aug 2012

Boy do I hate photos of myself.  It's definitely out of my comfort zone but figured you guys deserved me to bite the bullet.  Bill has been researching medicare like crazy and l share with him all of the postings etc. so I told him it was his turn (duh, like he's the one with MCL).  Thanks again, Becky 

jimwins's picture
jimwins
Posts: 2111
Joined: Aug 2011

Thank you for your input here and through private messages so far.  It has been very helpful.  I still welcome any additonal input from folks so keep it coming.

Bill and Becky, I think you both look great and love the 4 legged "child" :).  

Thanks again and as always, big hugs from the big hugger,

Jim

NANCYL1
Posts: 289
Joined: Jun 2012

Hi Jim:

Not much input, but here goes:

I have Medicare and United Healthcare as a supplement.  Medicare takes about $100 out of my social security each month.  I pay United Healthcare about $240 each month.  Excellent coverage which I cannot afford.  Does your state have a prescription drug plan?  Mine does.  $5 for 30 days of generics and $7 for others.    Once a few years ago I had a prescription drug which was not covered.   I found that the drug company would cover their drug at a reasonable price.  I changed to something else, but contacting drug companies is a possibility.

This is my second typing of the above.  I have an HP computer with windows 8, which I am not totally happy with.  It does weird things:  Info boxes appear uninvited and typing shrinks to unreadable text.

It is a shame that you must worry about health insurance.  I hope Obamacare improves our situations.

Good luck.

Nancy

Rocquie's picture
Rocquie
Posts: 646
Joined: Mar 2013

Hi Jim, I don't know anything about Medicare but I'm glad you started this thread. It is something I will need in the not too distant future.

I did want to mention, however, that I used to work in medical billing. The very large facility I worked in had specialists in both Medicare and Medicaid. It was their job to bill, collect, and keep up with changes in laws for both. Perhaps you can talk to the billing/collections department at your healthcare provider(s). They do have a strong interest in getting paid, and finding funding for patients without or with limited coverage. As Nancy mentioned, drug companies can also help. The woman who does the collections at my oncologist's office once got the drug company to pay for one of my Rituxan treatments because they had billed it incorrectly and my private insurance disallowed it. 

I wish you luck in making this daunting decision.

(((Hugs)))

Rocquie

 

jimwins's picture
jimwins
Posts: 2111
Joined: Aug 2011

Bear in mind what I share is as of today and will probably change in the future.  I live in NC and things may be very different in other states.  This is pretty general (not detailed).

1. Plan F supplements (Medigap) - you must be 65 (or very near) years old for this plan. the cost (now is around $150 /month).  There are similar policies for those under 65 but they are very expensive ($450 - $800/month).  These cover the 20% that Medicare does not cover on A and B (no drugs).  This may be different in your state.  This just isn't affordable for me at thios time.

2. I decided to go with a Medicare Advantage Plan that costs nothing above the $105 that Medicare deducts from SSD and includes Part D (Drugs).  It is an HMO and all my medical team is in their plan.  If I am not satisfied with it, I can change at the next enrollment period.  I can also purchase a dental plan for about $40/month (pretty basic but better than I expected). 

3. I talked with my social worker and I qualify for assistance on my expensive medications.

4. I plan to look into other sources of assistance to cover all or part of the 20% and A  and B not covered by the plan.  Hopefully I'll qualify for something (fingers crossed).  I plan to investigate other sources of assistance as well.

I found the medicare website to be quite good and it allows you to select up to 3 plans and do a side by side comparison which is very helpful.  It also shows the cost per month of your entered drugs (by pharmacy) - also very useful.  

Thank you everyone for your input and suggestions.  

Jim

 

 

NANCYL1
Posts: 289
Joined: Jun 2012

Medicare Advantage has Co-Pays, as far as I know.

Since I have many medical bills, I decided that Medicare Advantage would not be good.

Nancy

 

 

 

COBRA666's picture
COBRA666
Posts: 2418
Joined: May 2010

Jim,

  The choice is clearly yours, but I have heard some very negative stuff about Medicare Advantage. You may find yourself on the phone with them finding out why this and that was not covered. I know you said you have the option to change at the next enrollment, but in the meantime they might pick you clean. Just my 2 cents for what it's worth.  John

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 1628
Joined: May 2012

John,

As you say, I believe everyone can change things regarding their coverages during the annual "Open Enrollment."

At least if initial choices are not ideal, they can be changed within 12 months or less.

max

UncleBuddy
Posts: 910
Joined: Aug 2013

My brother is in New York and I did extensive research for him. When I went to the site it quoted a higher figure than my phone call. I called the medicare number and after speaking with a representative, here what we did:

Part A (which costs nothing)

Part B (about $100)

Medicare supplemental plan through Aetna (we chose the $300+ plan, it covered more)

Part D ($35 CVS)

He gets about a $1100 disability check per month and his health insurance will cost over $450. Thank God my dad is still around, he lives with dad. 

I have also heard bad things about the advantage plan, that's why I decided to go with the supplemental and part D for him.

Good luck!

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 1628
Joined: May 2012

Be aware that vast numbers of practices are leaving Medicare, like beachgoers who heard that a tsunami is rolling in....

This is from Forbes:  http://www.forbes.com/sites/brucejapsen/2013/01/01/27-pay-cut-or-not-more-docs-to-leave-medicare-in-2013/

Know that the rate of departure has increased since the publication of this report.  Sorry that medical insurance is taking around 40% of your relative's disability check  ! 

.

NANCYL1
Posts: 289
Joined: Jun 2012

Medicare Part A:  Around $100 comes out of Social Security.

Nancy

Mary N.
Posts: 100
Joined: Jun 2013

I was really very unhappy having to go on medicare because I had heard so much about not getting dr's etc.  But I have found that has never been a problem.  I have regular medicare with parts  A,B and got a d plan.  I also have medicare gap coverage from AARP and got the one that has no copays.  It has been wonderful for me.  Together for both my husband and I the gap coverage is about 370 a month and the D is about 50.  It is alot of money but basically I have no deductibles and no co pays so for me it works wonderfully and I can block out everything except the drugs which do have a co-pay.

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