Medicare.....What Would You Do?
 

Okay, I got my Medicare info in the mail and have to either accept Part B or decline it. If I decline and later decide I need it it I can always sign up for it at a later date.

Medicare will deduct about $112 from my SSDI check each month for my Part B Medicare coverage. The way I understand it I am covered for hospitalization at no charge to me.

Here's my question. Should I just get the Part A Medicare and put the $112 in my savings account to use if I need it or should I get the Part B which automatically deducts $112 each month whether or not I need it or not?

I rarely go to the doctor. Just once every 6 months to the Neuro in order to keep my records current for LTD and SSDI. Those visits are $85 each.

Sheesh, Kell, I've been paying for part B for 5 years and don't think i've used it that much....what a dummy I am. I guess I didn't realize you had a choice. :eek:

You do have a annual deductble of 250.00.

I think if I had it to do over, I'd pay for my own dr. bills???

Ask your Docs if they will reduce your fees, since you won't be subjecting them to the Medicare allowances.

I say you can never have too much insurance. This latest hospital stay of mine ran into the thousands, or tens of thousands. MRIs, CTscans, blood work, hospital stay, ER visit, it would have quickly bankrupted me had I not been very insured.

I vote for too much insurance, vs not enough.

I tend to think like you do, Sally. I think I could start my own "Medical Fund" and spend less than if I had money automatically deducted from my SSDI check.

Dej, I will get Medicare hospital coverage. I'm talking about the health care coverage for doctor visits, etc.

I did a cost analysis and could save some money by paying cash for doctor visits and tests. Like Sally, I don't go to the doctor that often and even if I went five times a year that would be less than half of what I'd be paying yearly for Part B Coverage.

I think I'm going to try it with just Part A for the first year. I can always sign up for Part B later if I feel I need it.

I don't know, Kelly. For me, it would be taking a huge risk considering I have a chronic illness. One bad flare could put such a financially burden on you or even ruin you financially. Part A doesn't cover any outpatient treatments such as PT, vision, home health, etc. that you could potentially need.

Also, I only pay $96.40 for my premium. Unless it went up and I didn't realize it. Anyhow, for it was worth it because my bills for this past year far exceeded $1,200 for the year that I paid in my premium.

Kelly, I agree with Tricia. Sounds rather risky to me.

Kel,
Why don't you call your doc's office and ask them how much they charge for doctor's appointments? It will give you more information before making your decision...
I am always afraid of not being covered...I see how much docs charge those who don't have coverage vs. those who do, and those who don't, IMHO, are raped by the docs.

I would (and do) err on the side of caution, you need to think about durable medical equipment, MRIs and other items that only get coverage with B.

My most recent MRI was $7500, 20% of that came to $1500. My mammo last week cost me $7.51 vs. $300 & change. Pap smears & annual physical, routine blood work, IVSM (the cost of the help, not the juice) walkers, scooters, manual wheel chairs and all that stuff get 80% coverage. One hit like that could destroy a year's budget.

Never forget that unless you're admitted, visits to the ER don't count as hospitalization. Ask around among your adults and find out how many people have had freak/stupid injuries, without MS.

Take serious care against assuming that the only thing that could go wrong would be MS related or within your normal routine. No one plans to trip in a doorway, over a pet, or step in a sinkhole in their lawn.

It's a huge gamble with not-so-good odds.

On the other hand, that +/- $100 a month could buy a lot of candy and magazines. ;)

I have used, and used and used my Medicare. Part A and B. Any medical center that I want to see, takes me in. Medicare pays, and then my 2ndary pays the rest. I meet/exceed my deductible by Feb each year. When I need an extra MRI due to a flair, I slide in the machine, and dont fear what it costs me. When i need blood tests to check liver functions, I hold out my arm, not my wallet.

There are places at every hospital to help those paying cash, or those who are under or not insured, but its alot of paperwork, and not a gaurntee of services. Call the financial aid office of your local hospital and ask them "what would happen if I showed up with cash, not insurance?" would you get a discount for paying in cash? Most discount for cash.

Be prepared to scrutinize every bill that ever comes your way. With or without insurance. I saw a paidin full for a full body radiation treatment on my bill once. :eek: I called the hospital and argued the charge, which even tho paid, was removed from MY history. If you are paying cash, you will want to be twice as careful.

With insurance, they have a main office that sorts out every charge, and argues it for you.

You are bravier than I am. I simply would be terrified to be uninsured. My brother does this, and it scares me. I keep telling him,he is one stumble away from financial disaster.

***edit*** please go to the website and check to see what part of medicare covers what services. it should be pretty easy to look up. This way you can make an informed choice. GL no matter which way you choose.

Medicare Part A is hospitalization and Part B is everything else. If you decline it now, you will pay a penalty when you want it in the future . . . so check this out at the Medicare Website. Medicare without any supplements has deductibles and co-pays, and no prescription coverage. You must take Part D to get drug coverage. There are a host of medicare supplements (medi-gap) plans available, and there are online sites that can help steer you to which ones are available in our state and which would be the best choice for your situation.

I do not recommend declining Medicare Part B coverage. It will cost you in the future, and it offers decent basic coverage for office visits, clinics, and diagnostic tests.

My mom took the safest route. She has both have A & B and raises you a supplement. With her health problems we could not take a chance. She pays nothing, absolutely nothing out of pocket except for her scripts which she also has a plan for. :wink: The total taken out of her SS is about $130 for the supplement and script coverage and whatever Medicare is charging now, hers went up too. So, maybe total about $240?

If you can afford the 20% without a supplement, that's great, but my mom couldn't afford to take the chance she'd get put in the hospital for a lengthy stay. And guess what? She did and needed 30 days of rehab. Her cost? $0. Her total hospital stay plus rehab? Well over $50G's. Her cost if she didn't have the supplement? 20%= $10G's. Jim has A & B but no supplement because he has the Va for his long stay care.

So, to answer your question, I say take the B, and look into a supplement as well. Don't take a chance and end up bankrupt if you have to be placed in the hospital for anything. Just as soon as you think you are healthy something could pop up you never expected and it doesn't have to be MS, you know? And don't forget your script coverage! Go with one that has gap coverage.

And call SS because they have income help for those who cannot afford their premiums. Some state programs do too. Good luck. I learned more than I ever wanted to know about all this thanks to mom and Jim. :p It wont help me though since SS informed me I am not Medicare eligible anymore now that I don't get a paycheck. I'll be pimping the streets for medical coverage.:rolleyes:

I have Parts A & B, but you can't get a supplement until you are age 65 years old. So I pay for COBRA to get all medical, dental, vision, and Rx's. I have had it for years. You never know. I have had 9 to 11 mostly major surgeries, lost count. I collect them like auto-immune diseases.:rolleyes:

The cost of my MRI's and specilists tests alone, pay for the monthly payment to my ins co. Biopsies, etc., and the blood work (Lab bills) in the thousands, for odd tests.

When a specialist bills my ins he gets very little, as we all know, nowadays. So after he bills my ins, he bills Medicare for the difference. I only pay a co-payment for drugs. The ER would be $100.00 co-pay unless I am admitted. But, Medicare would pay for the co-payment back to me either way.

but you can't get a supplement until you are age 65 years old -- not true. However, if you are or can be covered under your spouses policy, the rules are a little different. I have had a supplement since I was about 53 or 54. Again, check with the Medicare website: http://www.medicare.gov/ Click on the eligibility tool.

One is eligible for COBRA when your employer coverage is terminated, but it has limited coverage life. COBRA allows you to keep the exact coverage you had as an employee, but you pay the full premium. Medicare + supplements can cost less than this, but may lack the dental and eye coverage.

Jim was able to get a supplement too, I forgot to add that he is Tricare for Life eligible thanks to his military career. He is 43. BUT, he had to take part B to get the supplement.

It's all a confusing cycle isn't it?

LH, very confusing. I think I read the whole Medicare site and still feel confused.

I am under my own work history, my own Social Security Disability, not my husbands. I have worked all my life (it seems, lol) so his Social Security does not effect mine. I believe.:confused:

Is it made confusing so we'll give up, do you think?
Sounds like math problems that make my head spin:Crazy 2:

I am on a Medicare Advantage plan. For me, it was the best option with the least amount of out of pocket expenses.

In addition, because my income is so low, I am on an LIS plan for my prescriptions through some Medicare program. It is for low income, limited income sources. I pay $1.10 for prescriptions and $3.10 for C. Actually, I met the deductible a while ago and don't pay anything for the prescriptions now.

Also, I am on a state program that helps pay my premiums - while it lasts. The program may be cut.


Again, Kelly, as others have stated as well, it is better to have something than nothing at all. Things come up that we are completely unprepared for MS related or not. I would hate for something like that to happen where you don't have the proper coverage and no way to take care of yourself.

As you know, I spent a few months fighting with state programs for DD18. Ultimately, I got stuck with the bill from an ER visit. That bill was over $4,000 plus another $3,000 from another ER visit. Because she didn't have insurance, the hospital cut the bill down to 1/2 and I am still making small ($10 monthly) payments on it.

Ya know, Kell, what these smart people say makes sense. In retrospect, you may be able to see, saving money, by not opting fot part B, but you cannot predict what may happen, down the pike. :eek:

Maybe you should consider getting Part B....and deffinately, look into the premium saving possibilities, Trish points out.:cool:

Lady, I know it is confusing, but it doesn't have to be as confusing if you use one of the many "calculators" that some of the Medicare sites offer. I think the confusion here, however, is that you can only carry COBRA if you were working at the time of your disablity. Here is some information about COBRA: http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTML And some information on how COBRA and Medicare work together: http://onque.com/tips/cobraandmedicare.html

Yep......all my smart friends here have convinced me that it's not worth the risk. I'll sign up for Part B and look into a supplement plan. The only prescriptions I have right now are generic and I spend about $575 a year on those. But, things can happen (just like MS did) and I don't want to be caught unprepared. Thanks for all the advice! :)

I'm so glad to hear that, Kelly. I think you are making a wise decision.:hug:

I also think you are making a good decision. I was a tad bit worried:)

Trish, isn't Medicare Advantage going away when the Health care plan passed goes into effect?

well, i decided on original medicare because i wanted to pick my own drs.
HMO's are cheaper but i wanted choice. i also decided to get part B and supplemental (AARP) because i've had other problems.

in '08 i was dx'd with breast CA and had surgery and radiation. in '09 i needed a lot of PT. 20% of those expenses would have killed me. as it was i put a lot out of pocket from what was left over.

you just can't predict what may happen. i guess that's why it's called insurance.