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NEED INFORMATION (ALIAS MEDICARE 101)

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Posted 8/8/2010 8:34 PM (GMT 0)
Here is part of an email I sent a friend.. But some background first.

I will be 65 years old in June. So, I need to figure out this Medicare stuff.

I currently work (College Prof) with excellent health insurance. This insurance I believe turns into a supplement policy.

I am also eligible to pick up insurance from the retiree system (State of Michigan). It is a BC/BS plan and it too would be a supplemental plan.

Here is what I wrote. Any enlightenment would be appreciated:

>>>>>>>>>>>>>>>>

I read your email with interest, especially the MediCare part. I fear I have a lot of research to do. First of all, I need to learn about the services. You mentioned Parts A, B, and D. I assume one is for doctors and one is for medications and maybe one for hospitalization and then medical lab tests go somewhere. I need to learn about that. Hopefully, my HR person knows a good deal or can connect me with someone who does.

But then there's the issue of supplemental insurance. I have fabulous insurance at work, which will become a supplement. But I can drop that and do the Michigan BC/BS retirees insurance, which would become a supplement. I do know my work insurance is far superior to the BC/BS policy, but that is as a primary insurer.

Then I have my own special circumstances. By the end of January I will have 2 more PSA readings. So, I might have an idea that I am heading towards using that second bullet (radiation). That might figure into my insurance choices. In fact, I suspect I will have to delineate "essential" doctors/hospitals and see if they are in network.

>>>>>>>>>>>>>>

OK, any comments??

Mel

Posted 8/8/2010 8:51 PM (GMT 0)
I'm not to Medicare yet, but I have noticed in my various searches for "in-network" doctors that a number of the more highly-recommended ones made the point that they did not accept Medicare, thus wanted to verify my plans for medium term care. My current GP is the same - his group does not accept Medicare.

I saw an article in on of the AARP newsletters titled "Find a younger doctor now" - they expect that most people going into retirement forget that their doctors will as well, and be caught in a transition they might not be prepared fo later on.

You are correct to pay very careful attention to the services covered by the supplemental and drug plans (part D). I had a friend in a distant nursing home who could not make her own decision and had no nearby family to help - under the state guidelines they just went down the hall assigning alternately an equal number of people to each of the part D plans that operated in the area. There were some very expensive consequences, as the match of patient and needed/covered drugs was, at best, abysmal.
Posted 8/8/2010 8:53 PM (GMT 0)
Hi Mel,

Hubby & I went through this exercise a couple of years ago when he went on Medicare.  We are State of Florida retirees and carried the BC/BS state employees plan as our only insurance prior to that time.  When he went on Medicare, his State of FL BC/BS became his supplement.  This BC/BS plan has a prescription drug benefit, so he did not need to purchase Medicare Part D.  Medicare Part A is hospitalization insurance & Part B is for almost everything else besides prescription drugs.

In your situation I think it would be wise to compare your current insurer's benefits as a Medicare supplement against the State of Michigan's plan and decide which is best for you.  If one or both have prescription drug benefits included like ours does, you would not need to purchase a Medicare Part D plan.

We have a small co-pay for medications, but he has never had to pay a dime for any of his other PC - related costs, including surgery, hospitalization, MD visits, and now radiation therapy treatments.

Margie

Posted 8/8/2010 9:05 PM (GMT 0)
The resource for Medicare is

http://www.medicare.gov/

Part A: Hospital
Part B: Outpatient

Part C: Medicare Advantage--private plans, better benefits, but you have to stay in network like an HMO or PPO. The government has extra costs for these plans, and these subsidies will go away in the future.

Part D: Drug coverage--have to sign up with a private plan, coverage varies widely

Doctors who don't take Medicare are typically private entrepreneurs and have enough patients with commercial insurance so that they can decide not to take it so they can get higher reimbursements. Most large clinics, and all academic centers take Medicare.

Medicare supplemental: coverage--mostly covers copayments.

After you hit 65, most commercial and retirement plans require that you get Medicare, and they act as supplementals.
Posted 8/9/2010 1:14 AM (GMT 0)
Except for OB/GYN's & pediatricians, doctors here in Florida almost HAVE to take Medicare in order to stay afloat!
Posted 8/9/2010 1:48 AM (GMT 0)
Mel,
I'm an IBM retiree, a little over 2 years ago I was using my IBM medical insurance. As soon as I turned 65, my IBM insurance became supplemental insurance to medicare. Part A is for hospital, part B is for out patient (Doctor's visits and such) and part D is for medication. the medicare supplement that I carry is called part F which has covered every office visit, hospital stay and surgery 100% with no deductible ( I pay a monthly fee to IBM). For medication I do have a copay that varies depending on the medicine (generic vs non-generic). So far I have paid zero dollars during my PC journey. All my doctors accept Medicare, I doubt any Urologist will refuse Medicare patients since most of their customers are likely to be over 65. The one advice I have is to avoid "Medicare Advantage" which restricts you to a group of doctors that may not include the ones you want or need.
Posted 8/9/2010 2:11 AM (GMT 0)
I hit that wall 3 years ago..I decided on Medicare Advantage - United Health Care-Secure Horizons, an HMO type network my GP belonged to. It works great in the Denver Metro area but no coverage when we travel..I chose Plan 3, which required no extra premium payment. For an extra $200-$300 a month, you can get a "Cadillac" plan with broad coast to coast coverage and few limitations..

I could find no local GP's who were willing to accept any new standard Medicare patients...

Had I been diagnosed at age 62 (or whatever) the treatment costs would have bankrupted my family...
Posted 8/9/2010 3:20 AM (GMT 0)
I've read all the responses and it is still confusing!!!

I'll be checking with my HR person!

Mel

Posted 8/9/2010 4:05 AM (GMT 0)
"But then there's the issue of supplemental insurance. I have fabulous insurance at work, which will become a supplement. But I can drop that and do the Michigan BC/BS retirees insurance, which would become a supplement. I do know my work insurance is far superior to the BC/BS policy, but that is as a primary insurer."

See if the company you have now offers a Medicare Advantage plan..Then your coverage will be almost seamless, you keep the same doctors you have now, your network will not change..

Radiation treatments can be very expensive. Medicare will only cover 80% of that..Be sure to get "pre-approval" before you begin any treatments to avoid any nasty surprises..

Post Edited (Fairwind) : 8/8/2010 10:11:05 PM (GMT-6)

Posted 8/9/2010 4:22 AM (GMT 0)
Mel,
When dealing with insurance, you need to get a very detailed list of coverages under each plan, and that would have to come from your HR people. Also, be sure that there is a proper notification method of changes, as insurance plans change to some degree every year.

BTW - I was refused as a new patient at several practices, being over 55, as they do not take Medicare, and don't want new patients that are "too close" in age. I guess it may be a given in Florida that they would accept it, but not where I live.
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