medicare: does anyone here have medicare now???

maggie_wilson
maggie_wilson Member Posts: 596
edited March 2014 in Uterine/Endometrial Cancer #1
sisters,

i just found out i in fact have medicare, part a, even though i never signed up for it, and have had blue shield from partner's work as my primary insurance. now i learn that blue shield is secondary. if anyone has knowledge about how this works, would you let me know?? blue shield has refused to pay for a pet scan (should i need one), while i'm guessing medicare may approve it. still, blue shield would still need to approve so that the hospital would get enough reimbursement to do a ct/pet scan at all. i'm contacting my gyn and med oncologists to work on getting approval for a ct/pet since they both think they'll probably want me to have this at some point. so far, i've just had the ca 125s and a contrast ct scan.

thanx for any info you can provide.

sisterhood,
maggie

Comments

  • llight
    llight Member Posts: 99
    #2
    Hospital social worker?
    Hi Maggie,

    If you're connected to a hospital, you should be able to get all or some of your questions answered from one of the hospital social workers. Just another possible resource should you need one.

    llight
  • Ro10
    Ro10 Member Posts: 1,561 Member
    #3
    Maggie are you on disability or are you 65?
    It seems like you have mentioned doing counseling, so I don't think you are on disability. But if you have been on disability for two years, you qualify for Medicare. When you turn 65 you also qualify for medicare, the month of your birthday.

    Once you are on Medicare, it becomes your primary insurance and othe insurances become supplemental. I don't have information about what Medicare covers, as I too have BC/BS for insurance.

    The suggestion to talk to the social worker at the hospital or cancer center is good one. They can answer your questions or refer you to someone who can answer them.

    Hope you had a good camping trip and are catching up on all the tennis. In peace and caring.
  • maggie_wilson
    maggie_wilson Member Posts: 596
    #4
    Ro10 said:

    Maggie are you on disability or are you 65?
    It seems like you have mentioned doing counseling, so I don't think you are on disability. But if you have been on disability for two years, you qualify for Medicare. When you turn 65 you also qualify for medicare, the month of your birthday.

    Once you are on Medicare, it becomes your primary insurance and othe insurances become supplemental. I don't have information about what Medicare covers, as I too have BC/BS for insurance.

    The suggestion to talk to the social worker at the hospital or cancer center is good one. They can answer your questions or refer you to someone who can answer them.

    Hope you had a good camping trip and are catching up on all the tennis. In peace and caring.

    ro and llight--thank you

    that's a great idea to talk to the hospital social worker; i'll do that. i'm not on disability, i qualify because of age. in fact, i waited to collect social security until i was old enough not to have any of the social security deducted because of my earnings. so, love that social security.

    thanx and sisterhood,
    maggie
  • upsofloating
    upsofloating Member Posts: 466 Member
    #5
    I have Medicare with another
    I have Medicare with another insurance as supplemental. I recently had a PET scan which Medicare only covers for certain cancers - and uterine is NOT one. Since I'm treated at a university medical center, the PET scan folks got me covered under a research grant evaluating the use of PET scans in treating other cancers. I believe Medicare has been adding which cancers it covers. The person I spoke with thought my supplemental would not cover anything if Medicare denied coverage. --Annie
  • Michaelynn
    Michaelynn Member Posts: 85 Member
    #6
    upsofloating said:

    I have Medicare with another
    I have Medicare with another insurance as supplemental. I recently had a PET scan which Medicare only covers for certain cancers - and uterine is NOT one. Since I'm treated at a university medical center, the PET scan folks got me covered under a research grant evaluating the use of PET scans in treating other cancers. I believe Medicare has been adding which cancers it covers. The person I spoke with thought my supplemental would not cover anything if Medicare denied coverage. --Annie

    Medicare and Medicaid
    I have medicaid right now but will qualify for medicare and social security as of April 1st as I am a widow and will be 60 then. They told me medicare would kick in first and pay 80% of my cost and then medicaid will pick up the other 20%. They also said Medicaid would cover any money they might take out of my social security check for the cost of medicare.
  • maggie_wilson
    maggie_wilson Member Posts: 596
    #7
    upsofloating said:

    I have Medicare with another
    I have Medicare with another insurance as supplemental. I recently had a PET scan which Medicare only covers for certain cancers - and uterine is NOT one. Since I'm treated at a university medical center, the PET scan folks got me covered under a research grant evaluating the use of PET scans in treating other cancers. I believe Medicare has been adding which cancers it covers. The person I spoke with thought my supplemental would not cover anything if Medicare denied coverage. --Annie

    thanx annie and michaelyn

    geeze, sounds like unless both my oncologists fight for a pet scan, i won't get one. well, i don't have to cross that bridge quite yet, but am alerting both doctors that blue shield denied pet scan, and medicare well might as well, so they need to go to bat for it if they think it's important that i have one. seems like most women here have had ct/pets, so i don't see what the big deal is, except money of course.
    sisterhood,
    maggie
  • kathybd
    kathybd Member Posts: 126
    #8
    maggie_wilson said:

    thanx annie and michaelyn

    geeze, sounds like unless both my oncologists fight for a pet scan, i won't get one. well, i don't have to cross that bridge quite yet, but am alerting both doctors that blue shield denied pet scan, and medicare well might as well, so they need to go to bat for it if they think it's important that i have one. seems like most women here have had ct/pets, so i don't see what the big deal is, except money of course.
    sisterhood,
    maggie

    Hi Maggie
    This Medicare stuff and cobra really confuse me. I hooked up with the social worker at Stanford yesterday and got so much info, my head is spinning. She was a bundle of information, but i am sure I will need to go back for clarification once I sort through all of it. Did your problem resolve itself?

    Best,
    Kathy
  • maggie_wilson
    maggie_wilson Member Posts: 596
    #9
    kathybd said:

    Hi Maggie
    This Medicare stuff and cobra really confuse me. I hooked up with the social worker at Stanford yesterday and got so much info, my head is spinning. She was a bundle of information, but i am sure I will need to go back for clarification once I sort through all of it. Did your problem resolve itself?

    Best,
    Kathy

    hi kathy
    pet scan problem not resolved. my medical oncologist who has really fought for the pet scan has simply not heard back from blue shield once they said they would review it. she tells me she's left several terse messages in the meantime. i don't know how it's going to resolve. i don't think medicare will pick any of it up because all i have is part a for hospitalization. still mean to call the social worker at my hospital and see if she can help in any way.
    thanx for asking,
    sisterhood,
    maggie
  • Ro10
    Ro10 Member Posts: 1,561 Member
    #10
    maggie_wilson said:

    hi kathy
    pet scan problem not resolved. my medical oncologist who has really fought for the pet scan has simply not heard back from blue shield once they said they would review it. she tells me she's left several terse messages in the meantime. i don't know how it's going to resolve. i don't think medicare will pick any of it up because all i have is part a for hospitalization. still mean to call the social worker at my hospital and see if she can help in any way.
    thanx for asking,
    sisterhood,
    maggie

    My husband just went on Medicare
    He got a book today "Medicare and You". I was reviewing the book to see what was covered. I will qualify for medicare in April 2011 as it will be 2 years since I qualified for disability due to my Stage III-C diagnosis. It said it covered PAP tests once a year. I have them every 6 months now. I wonder if they will be covered. I almost wish I could keep my BC/BS which has paid so well since my diagnosis. I have a big deductible, but then it covers 100%. My deductible is cut in half since my husband went on medicare. It sounds like medicare covers 80%. I guess a supplement will cover the other 20%. I sure hope so. I guess I will find out in April. In peace and caring.
  • kkstef
    kkstef Member Posts: 688 Member
    #11
    Ro10 said:

    My husband just went on Medicare
    He got a book today "Medicare and You". I was reviewing the book to see what was covered. I will qualify for medicare in April 2011 as it will be 2 years since I qualified for disability due to my Stage III-C diagnosis. It said it covered PAP tests once a year. I have them every 6 months now. I wonder if they will be covered. I almost wish I could keep my BC/BS which has paid so well since my diagnosis. I have a big deductible, but then it covers 100%. My deductible is cut in half since my husband went on medicare. It sounds like medicare covers 80%. I guess a supplement will cover the other 20%. I sure hope so. I guess I will find out in April. In peace and caring.

    My Medicare Experience
    I started on Traditional Medicare 1 month before I was diagnosed with Uterine Cancer. WHEW! Almost everyone is covered for Medicare Part A (hospital coverage). I then took out Medicare Part B (which you pay for), and Medicare Part D which is drug coverage (for any meds you would have filled at a pharmacy) (which you also pay for). Medicare pays 80% of “allowable charges” (they greatly discount the hospital and physician but do better with the outpatient charges).

    In addition I have a “tie-in” plan to cover the 20% that Medicare does not pay. There are lots of different tie-in plans with varying prices, but mine covers the deductibles and the 20% co-pay. I am finding the tie-in plan has increased significantly in cost in the last 2 years. They can not raise your rate unless all individuals in your age group and in your service area are increased as well. But it does get pricey.

    I had my total hysterectomy via Da Vinci method, radiation, and chemo including 3 Neulasta injections, plus a CT scan of the chest, abd and pelvis between the radiation and chemo and again 3 months after last chemo (March 2009). All that was covered by Medicare and my tie in. Medicare also covers my 3 month visits with the Oncologist (now moved to 4 months). My gyn onc does NOT order scans after the 3 month post chemo, unless there are physical findings and/or symptoms that need checking out. He does a Pap test every time. I have no lab work related to my cancer as my CA125 was not a marker. SO, I do not know if Medicare would continue to pay for CT scans if they were routinely ordered. Also, I read the Medicare only covers PET scans for specific types of cancer, and uterine is not one of the “approved” ones.

    Medicare currently does not pay anything for an annual routine physical exam but I believe that changes next year. So I pay out of pocket for my physical. My family physician does that and orders the routine lab work. Medicare has been covering an annual mammogram and has covered my colonoscopies as I have some “pre-cancerous” polyps in the past.

    IF Medicare does not cover a test/procedure, then the tie-in will not pay anything either. Also, if a physician or hospital accept Medicare assignment, then they can’t bill you for the portion that Medicare has “discounted”. I know some people are having a hard time finding physician’s who are taking Medicare, so that can be a problem. I am so thankful my physician’s accept Medicare AND incredibly pleased with the coverage I have had. I don’t know what I would have done without it!

    The worst part was trying to sort out WHICH Plan B and WHICH Plan D to sign up for….there are way too many choices and that gets very confusing!

    Good luck!

    Karen
  • maggie_wilson
    maggie_wilson Member Posts: 596
    #12
    kkstef said:

    My Medicare Experience
    I started on Traditional Medicare 1 month before I was diagnosed with Uterine Cancer. WHEW! Almost everyone is covered for Medicare Part A (hospital coverage). I then took out Medicare Part B (which you pay for), and Medicare Part D which is drug coverage (for any meds you would have filled at a pharmacy) (which you also pay for). Medicare pays 80% of “allowable charges” (they greatly discount the hospital and physician but do better with the outpatient charges).

    In addition I have a “tie-in” plan to cover the 20% that Medicare does not pay. There are lots of different tie-in plans with varying prices, but mine covers the deductibles and the 20% co-pay. I am finding the tie-in plan has increased significantly in cost in the last 2 years. They can not raise your rate unless all individuals in your age group and in your service area are increased as well. But it does get pricey.

    I had my total hysterectomy via Da Vinci method, radiation, and chemo including 3 Neulasta injections, plus a CT scan of the chest, abd and pelvis between the radiation and chemo and again 3 months after last chemo (March 2009). All that was covered by Medicare and my tie in. Medicare also covers my 3 month visits with the Oncologist (now moved to 4 months). My gyn onc does NOT order scans after the 3 month post chemo, unless there are physical findings and/or symptoms that need checking out. He does a Pap test every time. I have no lab work related to my cancer as my CA125 was not a marker. SO, I do not know if Medicare would continue to pay for CT scans if they were routinely ordered. Also, I read the Medicare only covers PET scans for specific types of cancer, and uterine is not one of the “approved” ones.

    Medicare currently does not pay anything for an annual routine physical exam but I believe that changes next year. So I pay out of pocket for my physical. My family physician does that and orders the routine lab work. Medicare has been covering an annual mammogram and has covered my colonoscopies as I have some “pre-cancerous” polyps in the past.

    IF Medicare does not cover a test/procedure, then the tie-in will not pay anything either. Also, if a physician or hospital accept Medicare assignment, then they can’t bill you for the portion that Medicare has “discounted”. I know some people are having a hard time finding physician’s who are taking Medicare, so that can be a problem. I am so thankful my physician’s accept Medicare AND incredibly pleased with the coverage I have had. I don’t know what I would have done without it!

    The worst part was trying to sort out WHICH Plan B and WHICH Plan D to sign up for….there are way too many choices and that gets very confusing!

    Good luck!

    Karen

    karen, wow, thanx for your complete response!

    right now all i have is medicare part a, as i've said. i have blue shield through my partner's work, so between them, they cover all hospitalizations. then blue shield picks up everything else, plus i have a small copay for drugs and doctor visits. my medical oncologist is in a battle right now with blue shield to get me covered for a pet scan; she seems kinda confident, but i don't know. in any case, i don't have to choose any other medicare parts, at least at the moment, since blue shield up to now has been great and has paid for everything without blinking an eye, so to speak.

    i'm assuming, if worst case scenario, my partner lost her job, we'd have cobra for 1 1/2 years, plus i'd still have my medicare. it's hard to believe that my doctors would decide not to see me should i only have medicare, but who the heck really knows? in any case, i'm covered for now.

    thanx again for such a full response. i love to hear all the details, even about medicare!

    sisterhood,
    maggie

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