Another medicare question... sorry
 

Does anyone have medicare part C? That's the one which is part A,B and D but you have an outside medical insurance to cover the gaps that medicare wont cover! Yada Yada Yada. Just more confusion for me.

HELP!!!!!!! :confused:

Hi KiittyLady,

It can be very confusing and it takes a lot of research to find out what works best for each person's individual circumstances.

Part C is called an Advantage Plan.

Maybe this will help you a little.

If eligible for Medicare, you have basically 3 choices. (NOT exactly but I am just trying to keep it simple.)

Choice One: Traditional Medicare alone (Parts A and B) and you can add Part D (drug coverage)

Choice Two: Traditional Medicare (Parts A & B) and ADD a Supplemental plan that helps pick up some of your out of pocket expenses, like the 20% co-insurance you pay with Part B of Medicare. With THIS choice you have your traditional Medicare AND you purchase another policy through an insurance company. This is having two policies, one is Medicare and the second is from an insurance company.

Choice Three: INSTEAD of having traditional Medicare, you could have an Advantage Plan that replaces Parts A, B, and sometimes D, and it is administered by an insurance company and is referred to as an Advantage Plan or Medicare Part C . They are similar to HMO's and PPO's.


Choice TWO gives you the most coverage but it is also the most expensive.

Does this help any?

For MY situation, after much research, I went with an advantage plan. It gave me the most coverage without having to pay the higher premium for a supplemental plan.

Please feel free to ask if you still have questions. It can be very overwhelming and confusing. NO one can tell you what YOU should do but we are here to help you understand the choices you have available. Everyone's situation is different and what works best for one person may not be the best choice for another person.

Both me and my husband have advantage plans. When I first started mine it was $14/month and I really liked the co-pays and of course it had the free wellness screening such as mammogram, etc. Through the years it has steadily increased where it is now about $60, co-pays are still decent but now the wellness exams are all $50:eek: Hubbies premium is $0. Yep, ou read it right $0/month. He also has decent co-pays but he has more restrictions on what doctor to see. For example, our own family doctor does to much in his office such as trim toenails, remove small lesions. AARP United healthcare doesn't like that and dropped him as a provider. Oh, he also sees his own nursing home and hospital patients and they say all that is a waste of his resources. So he continues to stay with our doctor and pays the non provider fee. It all works out in the end since he likes the monthly premium. I keep on saying i will change and I never do.

Thank you Hopeless for your info, and thank you sleeper for the link, I know I had seen that before as soon as I clicked on it, but it was a great refresher. I am qualified for social security to pay half of my what do you call it co-pay or deductible or both, plus I no longer have to pay for my part B (?) for medicare, I qualified for not having to pay for that. I didn't qualify for state aid, so I was told by medicare I have the kind of medicare that I can change at anytime, and part C might be a good choice for me seeing as Im having such a hard time paying for that 20% that medicare doesn't cover. So they had me talk to a Blue Medicare Access Value Regional PPO guy who referred me to a Anthem BC/BS guy who said he'd send me out the info I'd need to make my decision if I wanted to sign up with them or not. I tell you one thing, my head is spinning with all this medicare stuff worse then that chick on the exorcist!! However, I did learn that I don't have to pay for things if I didn't know that medicare doesn't cover them. That was an interesting little tid-bit! Too bad it was only ONE test I had done that they don't cover :(

Good luck Kitty. My Mom and I both signed up for that Blue Medicare access value. The price was wonderful and that's what Mom loved about it. She soon found out though that it wasn't the right plan for her. My medical needs were mainly medicines and an occasional doctor visit and maybe tests. Her needs were a lot less medicines and many lab and xrays and doctors visits. Her bills were awful for her very limited income. So she changed to I think Medicare F, yes another plan to make your head spin. It was a lot more expensive for the monthly premium but it covered so much more for her and of course we didn't know at the time that she would need nursing home care but it covered extra days there that Medicare wouldn't have. That was such a huge blessing. So you have to have a good agent to help you look at what your individual needs are.

i belonged to AARP. you can call them (plans issued by United Healthcare) and counselors know all about the plans. you can find out over the phone or they can send you the info. i'm sure they must also have the info online.

the plans differ in coverage and also by cost. i found talking to them very helpful.

It's wise to hear about the various plans. Most of us have to find out how these plans work through "experience". There is a sign up at my clinic that Medicare may not pay for breast exams and "talking about" diabetes and another metabolic deficit. In other words, you can't talk about how to manage your diabetes.
The things we DON"T know until they happen are the difficult one, and I realized how difficult when my husband didn't qualify for nursing home for any days at all when he was dying. He would have qualified for hospice, but the social worker at the hospital said I had to pay out of pocket for this. Probably this was because of her ignorance but also because there are not many "Medicare" or "Hospice" beds assigned by our nearby nursing homes. I was getting ready to use up my savings on a Hospice paid for by me when my husband passed on, so I didn't have to pay and he didn't have to endure any more possible indignities.
I got the impression that they didn't operate on rules very closely but just ran by the "skin of their teeth". Medicare also did not pay for more than two days of his hospitalization, as I was told, and it was true. The hospital charged a very high daily fee and thus made up for not being paid for the additional ten days that he was there before he died.
Medicare did not pay for ANY hospitalization when I fell down the stairs and broke my patella. I finally did have a complication while in the "assisted living" where I was recovering, and on that basis was put in a nursing home where I had good rehabilitation.
All of this made me realize how close to financial disaster we live even if we have good "plans' and do our best.

Dear Mariel,

First let me say how sorry I am for the loss of your husband. It was heart warming to hear how you expressed that he did not have to linger and suffer and that you were spared that financial ruin as well.

Yes, sometimes, we only find out what IS and IS NOT covered by experience. There is so much "double talk" in the paperwork we are supplied regarding our coverage. I had the same coverage and insurance for over a decade and knew very well what was covered and what was not but I changed insurance at the begi8nning of this year. I read all the information given to me as to what my coverage included and did not include.

My plan states that it covers eye doctor when you have an existing eye disease but it does NOT cover an eye doctor for routine vision test if you just need glasses or contacts.

My doctor told me that glasses would be of no help and I should schedule surgery. I do not wear glasses or contacts.

OK, I have cataracts (which are covered) and went to the eye doctor. My insurance did not pay because they also "tested" my vision to see how much my cataracts have limited it. They said that since my vision was tested, it was NOT covered.

It was covered under my old plan, sounded like it was covered under my NEW plan, but that was not how the verdict came down.

How does one see an eye doctor without them testing your vision?

Guess the insurance companies use that as a loophole to make you think you have coverage when you don't.

I agree with nurse nancy. Call some of these companies, or a broker that sells numerous. What thy did with mine is to take down a list of my medicines and doctors and find the best match with those in mind. And with AARP, you don't have to be a member. I'm not sure if they have any $0/month premiums elsewhere or not but this one just covers this tristate area, not nationwide. Do you get the Medicare and You book. It has a huge list, state by state, of plans available

I have had an Advantage plan for several years. I have had the plan administered by different comanies according to what plan was best for my needs/ & costs each year. I have been very happy with Advantage plan, esp ince I have high drug costs and multiple specialists (who all seems to insist on appointments bi annually or quarterly)

My advice is to set up an appointment with your local "area agency on aging" or a local agency (perhaps AARP, ins broker or Senior services) that is authorized & paid by the Federal govt to assist Medicare members (either by age or disability) choose the wisest Medicare services based on your needs. They have special computer progrmas that search all the plans and sort them for you (ie. by cost monthly, yearly, gap, etc). They can sign you up and explain everything to where it makes simple sense.

For example: last year it made better sense for me to pay a higher premium than my husband in order to end up with the lowest year-end out of pocket costs. So my husband had the free Advantage plan and I had what we came to call the gold plan. My plan covered drugs during the gap/dout hole. I always hit the gap but my husband never even comes close.

I also have had A&B coupled with a part D years ago & was happy with that. I swiched to Advantage for two reasons:
1. cheapest for me when all is added up at the year end (in my total costs)
2. liked having to deal with a single company, which seemed to make everything smoother for me in coordinating approvals.

Good luck and try not to drive yourself insane.