Medicare question
 

Can anyone that is on medicare B, tell me what you pay out of pocket for a visit to your neuro's office? I know it can be different depending on what is done....but I mean an average neuro appointment?

thank you :)

I have a 2ndary (and 3rd) insurance so my circumstance is different.

I know my MD will charge like $57 to get a plain office visit check up without nothing special and medicare will pay him $7. The rest gets pushed to my 2ndary.

My normal nothing fancy neuro is $197 Medicare pays $32 and the rest gets pushed to my 2ndary.

You have to remember the deductible for medicare as well. if you have not met it yet, they will take a portion of the bill and not pay it and use it as part of your deductible. If you have met it then carry on.

Since my MDs are hospital MDs they accept medicare because their hospital accepts federal funds, so they are forced to take the plan. Many private MDs who are in a private office will refuse medicare or medicaid patients. Some have even stopped taking any insurance. you pay cash and then YOU bill your insurance company. It saves them a bundle in office hours, staff pay and so forth. For that $7 my MD gets he probably had to pay his staff $30 to go chase it. He was telling me how much he was losing to accept insurance.

thank you so much....

I am currently covered under my husband's insurance; and recently received disability. I opted out of the part B; however my husband's insurance is going to be changing in October, so I wanted to check and see if it would be more beneficial for me to sign up for the part B. My husband is covered at no cost, but to add me is $300 a month.

But with that I only have a copay for dr visits of $15 and specialists (NEURO) of $30. I would have a deductible of $500 for MRI, outpatient, and hospital visits.

Part B is around $100 a month....then I have to worry if my doctors will even take medicare!

Trying to compare is sooo difficult....my head is spinning!!

medicare is about to take a HUGE price jump so be aware. Its going to be $120 in 2013 but it will double in 2014 to $240! so be aware.

Many MDs are opting out of the program, but if you go to these major clinics that accept federal funds they MUST accept medicare and medicaid. This is why the ER is always so full. Its so hard to find an MD who will take medicaid and if you can the wait list is very long, so off to the ER you go! common colds, rashes, boo boos and the like instead of using the ER for emergencies its clogged with common care. Many ERs have opened an "urgent care" side to the clinic to take care of colds/flu and the like while true emergencies can be handled with the big guns. The cost is less, but the care is still good. good luck finding a dentist who takes medicaid.

I would call your husbands insurance company. Sometimes they demand that if you qualify you MUST take medicare or they will place you on the equivalent program thru them. if it wouldnt be covered under medicare they wont pay for it either. I would ask a patient benefit co ordinator to help you decide. another good advocate is your pharmacist as they are really good at the plans.

Please know that if your spouse is working medicare would be your 2ndary insurance. Once both of you stop working, medicare goes to the head of the line. (that one killed me) and the normal rules apply, but you have the back up of medicare. Normally once you say NO i dont want medicare as part of SSDI they dont normally give you a second chance unless you turn 62. it was highly reccomended that I take it and be triple covered instead of not taking it and missing out. Please call 1 800 medicare and ask if you turn it down, can you reapply in a year or will it cause you to be denied till you are 62.

insurance can be such a mess! good luck. :hug:

For comparison's sake and the craziness of it all

clinic charges 523
medicare approves 121
medicare pays 97
secondary pays 24
my out of pocket- zero to clinic but premiums to insurers

Actually the quote of medicare going up to $240 in 2014 is incorrect. According to FactCheck.org its a inaccurate email that has been floating around for quite a while. The link that supports this is http://www.factcheck.org/2011/04/pre...e-on-medicare/

I'm trying to write this my memory instead of checking my Medicare Advantage card, which is different than just Medicare. My family doctor I pay #25 and a specialist I believe is $40. It's just according to what your helth care needs as to whether Medicare only is better than a Mdicare advantage program. Both my Mom and I got the Medicare advantage plan. It suited me very well. It was terrible for my Mom. Most of my charges arew for medicine. I normally see my family doc once a year and mny neuro once a year. I don't need that many labs or xrays. But my Mom had numerous medical needs, lots of doctor visits, lots of xrays and labs. So she paid a huge out of pocket. Our insurance agent got Mom to drop the Advantage Plan and just go with Medicare. She already had A and B. It helped immensley. So it's acording to what kind of health care you need. Advantage plan is geared towards staying healthy, medicare only is to take care of older sicker people.

This year may be a whole new story for me. I've had a lot of other issues, not MS related and I've to pay a lot of co pays. But I will take them off my taxes.

wow!! now I am more confused when I asked the question!!

Ohh insurance and what to do!?!

Daisy girl you get Medicare and either he A or the B comes automatically. I can't remember which. You can opt out of the other. I took both of them. When my husband retired and I no longer had his company insurance as my primarey I had to depend on Medicare only. So there are all kinds of Medicare supplements sold. At the time I was picking Medicare Advantage was one of the big ones. I think it is manged by the government but lets all sorts of insurance carriers sell it. I got mine through Anthem Blue Cross. At the time I got it I got it for $14/month which also covered, now don't get confused here, Medicare D which was a pharmacy plan with it. Medicare by itself does not have a pharmacy plan except for a very few medicines. And I mean very few. the advantage plan covers wellness issues mainly, things to keep up with to maintain your wellness. If you have, like my Mom, a lot of medical issues you pay out the wazoo! She still paid the $14/month.We did not know that at the time. Our agent dfidn't tell us:mad: I think she was just so glad to get two clients in her office at one time she sold my Mom the same thing as me.

I fear that the wonderful price of $14/month may be in the past though. I sure hope not. I haven't seen what it is. There have been just rumors. One good thing the Advntage plan had was a free Silver Sneakers membership to whatever gym in your area had Silver Sneakers. I chose the YMCA. It's free!!!! My water therapy, gym access, anything you want to do plus the Silver Sneaker programs have little get togethers.

I hope I cleared up some things.

The docs can charge anything they want, but there are standardized medicare payments for each billing code with some minor deviations for local areas. By law, the patient is responsible for that 20% copay which may be assumed by the secondary. The doctor may elect to forgive the copay but must do so on an individual basis for each patient with documentation on inability to pay.

Yes, I understand this....I am just wanting to know if you all will share what you pay...the 20% if you do not have a secondary insurance.

Right now, I have private insurance, and I pay my neuro a $40.00 co-pay each visit.
If I elect the Medicare part B, with no secondary ins; what (on average) would my cost be for each office visit?

And what is the deductible to Medicare B?

That is correct.

Part A is automatic.

If you're paying $40 for neuro followup, sounds like your 20% costs will go down. I pay $25-$30.
A dr's quality/performance/record might dictate the amount medicare approves. A top notch surgeon i've seen gets alot approved.

some of the questions you need to consider:
Medicare:
do I want part A (automatic get this, covers hospitalization needs) with or without part B (which has a base premium, covers non hospital charges such as MD visits, medical equipment, lab fees)

do I want part D (Medicare Drug Plan,covers drugs) or no part D *caution: if you do not sign up for a part D plan when first eligible there is a penalty assessed later, based on how long you waited. Most states have at tleast one part D plan that is free/super cheap compared to eventually having to pay the penalty forever

do I want Medicare (part A, B &D) or Medicare Advantage plan (all cover A&D, check if it includes part D coverage or not)

I often find the easiest and smartest thing to do is to go through my local AAA or SCHIP counselors -> they are paid by the federal government to impartially advise those eligible for Medicare on which plan is best for you, based on your needs and "comfort level" with expensses & coverage. You can also search plans & coverage online at medicare.gov

Note: you are comparing apples to oranges. Remember that every single one of us has different plans (even if called by same name, like Anthem BCBS) based on where we live AND what we need/can afford/can risk

and to answer your original question:

my neuro charges 120.00 for a regular visit. He "Accepts Assignment". This is important to also ask as many doctors take Medicare - the BIG question is if they "Accept Assignment" (which means they agree not to balance bill the patient.)

This year I have choosen a Medicare Advantage plan that includes D (the drug coverage). I pay a $45 copay for each visit to my neuro or any other specialist and that is all I pay him. Primary care visits (to my Int med MD) are $15.00.

I used to have traditional Medicare, parts A, B and D. Some years the D was free/no monthly premium & other years it was a monthly premium. Part B premium comes straight out of my SSDA check.

I went to Med Advantage plans 3 years ago and it has prooved the cheapest option {for me} at the end of the year. My current M.A. plan is Anthem BCBS Medicare Premium- Virginia. I pay $112.00 month, my husband has the standard Anthem BCBS Medicare- Virginia plan for no monthly premium. Based on our estimated expensses and medical needs we both had to choose different plans.

Are you brain fried yet:confused:

eddie and jprinz....
thank you; this is exactly what I was asking.

I am on disability, so I get medicare part A, I have the option to choose B for 99.90 taken out of my disability check each month.

Is there a deductible with part B too?

Or, I can opt out of the part B, and stay on my husbands insurance. It costs me $300 a month to be on his plan. But the coverage is good. I only have copays. $40 for a specialist and $20 for a regular doctor visit.

So, Jprinz; you are saying that even if I choose part B, I have the 99.90 taken out of my disability check, and then I would have to pay an additional monthly fee depending on whether I choose an Medicare plan like Advantage.

One more question, so if the doctor accepts assignment, you do not have to pay the 20%? I am a little confused by this, as you said you pay $45 copay.

thanks so much :)

Does this help. You still need a supplemental plan to pick up the difference if you have Part B. At one point I was going to opt out of Part B but was advised not to. It could have cost me lots of money if I had any medical crises. So I still carry Part B taken out of my SS. Part A is automatic. I do not carry Part D as I do not have any prescription drugs and hopefully never will.

http://www.medicareplanstoday.com/me...dicare-part-b/

so, you can't just have medicare? you have to have a supplemental plan??

You need a supplemental plan to take up what Medicare doesn't pay. That will also depend on how much your supplemental plan will pay. Mine pays it all that Medicare doesn't pay. And I have found that if Medicare does not allow anything for a procedure my supplemental plan won't pay anything either.

Perhaps you could go on the Medicare site and explore. Or ask the insurance company to explain what a supplemental plan will do. There are several supplemental plans depending on which company you go with. Example: Blue Cross Blue Shield. There are many supplemental plans and it certainly can be confusing and it takes some research into it. Not every plan or supplemental plan works for everyone. You have to decide what will work for you.

Of course none of it is cheap in this day and age.

I don't know if this is answering your question or not. I kow every insurance is different than another. My husband had good insurance where he worked. His was promary and my Medicare was secondary. So when I went they would charge the bill first to his insurnce since it was primary. If there was any bill left over it was then sent to Medicare. So I generally had no payment for doctors visits after both insurances took their whack at it. Now procedires were different. How I wish he hadn't retired:( Messed our lives up. And I don't have my days to myself. Does anyone need a spare husband. He doesn't come with any household skills except loosing things.

The best advice I can tell you is to first check with your current docs to find out what plans they accept; otherwise you may have to choose new docs found on your new plan.

Here is the government link with all the jargon explained:
http://ssa-custhelp.ssa.gov/app/answ...-a,-b,-c-and-d

My husband opted for Humana for his "donut" coverage and also for Part D drug coverage. So far, his co-pays have been $5.

I am truly shocked at how difficult this process is!! You would think they could somehow simplify it.

I am in my 40's, and reading all the information on the Medicare C vs. supplimental insurance; had my head spinning. I can't imagine seniors trying to figure all this out!!

What I have discovered:

Part A-hospital coverage, most people get this with no out of pocket expense.
Part B-doctor visits, outpatient, most people pay 99.90 monthly
A and B ="Original Medicare"

Part C-Medicare Advantage, is an option that can be purchased that includes A and B, (however you must still pay the 99.90 for B) and other extras like some dental, vision and hearing, and most include some form of Part D (prescriptions) There are dozens of plans and each a little different, however there is an additional monthly charge.

Part D-Prescription drug coverage, can be purchased separately, another monthly charge.

Medicare Gap Ins-a secondary ins to cover gaps if you only choose "Original A and B" this is also an additional charge.

If you choose Part C you do NOT purchase Gap insurance.

So, we have so many options....this makes my head spin! I really don't know how people decide what to do, or what is the best option.

This should NOT be this difficult!!

Daisy-

I am also in my 40s (which in many states means you can't even buy a supplement). I very strongly suggest you go to the local or state Area Agency on Aging/State Health Insurance Assistance Program {known as AAA or SHIP}

They are trained medicare advisors. Most are located within senior services nonprofits (for example my Area Agency on Aging is called "Sr. Services of SE Va") They serve ANYBODY who is eligible for Medicare - not just those over 65.

These programs have trained counselors who will utilize special software programs to intelligently guide you to the right Medicare plan for you, based on your needs and circumstances. They plug in all your medications, etc and can show you all the details & costs for the plans. The computer program will clearly spell out which plans are your best choice & lowest costs. It is a free and impartial service.

I do not recommend using the medicare.gov website to do this search. For most first timers it is tedious and not always the most accurate (or even simple to understand). Personally, I would rather let the AAA/SHIP advisor guide me as this is his field of specialty - it usually takes less than 30-45 minutes to get a plan picked and signed up for.

And remember - where you live makes a difference on what plans are available & for how much. Just because your friend Jane Doe has a similar sounding plan, she likely has different "details" and costs than a plan in your state with the same name.

Good luck and you will get throught this. I have no idea why it is so complicated - I just call it mental exercise and lessons on patience LOL

If all else fails: a good stiff drink takes good

As far as the 'gap' is concerned, if you are on Medicare D and also on one of the drugs for MS such as Avonex, Rebif, etc, don't worry about the gap. I am in the gap for about 3 weeks. I usually am in the catastrophic period by the end of march. I pay $2.60 for most of my meds. That does not include my Avonex. i think I pay $179/month for it once I was past the gap. The gap is full price. But that is usually just for the one month.