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Medicare and ?????

MetalneckMetalneck Island of Misfit toysPosts: 1,364
edited 06/11/2012 - 9:02 AM in Health Insurance Issues
Medicare ????

When getting your Medicare .... are most of you having to purchase a supplement (medigap coverage) or is the disabled status leading to medicaid as a secondary??

Oh please do tell!!

Thanks in advance,


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  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    I know that some of us SSD people have Medicare by now. What are you doing for a secondary??

    Gee I didn't think this was a tough question.

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  • A name brand that touts covering so much, needless to say they forget to mention that every proceedure has a $100 co-pay, doctors office visits vary from $25-$45. The most common types of pain medicines have a larger co-pay.

    After looking around alot more, it seems that they all are very similar in price and coverage.

    And after all these co-pays, I'm about to hit the donut hole where the insurance doesn't cover anything on Rx's except for a small discount on drugs, oh joy. So the next $2000 is out of pocket, after that I don't have to pay anything for co-pays, but this will be after about $5000 out of pocket for the year.

    What did the wise man say "buyer beware"?
  • Dave,
    I have a policy that pays the portion Medicare doesn't. Costs me $370 per month, but without it I'd be sunk. It is Blue Cross plan F. At this point, I haven't had to pay for anything, except for meds. I purchased a rx plan for about $45 per month with United Healthcare. I have a co-pay with that.

    The premium is a killer, but it would be stupid for me not to have it. There are a lot of different companies out there, but this was the one I chose because I don't have any co-pays. It even pays the medicare deductible at the beginning of the year.
    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    All I can say is YIKES !!!!!

    The fun just never ends, one step foward 3 steps back!!

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  • both of our plans cost about the same, mine would be a little lower if I didn't have so many Rx's where I hit that wonderful $2000 donut hole where they don't cover.

    My wife takes almost no Rx's, so she doesn't carry a Rx policy. It's a lot cheaper, but if anything happens where she needs an expensive prescription, it's gonna be expensive. It's the chance you take I guess.

    My prescriptions cost over $1000 per month retail. I only pay $3 each until the donut hole. It works out that I have to pay cash for my drugs 2 months out of the year.

    And to think I used to love donut holes(the sugar coated ones)lol.
  • I have Medicare Supp Insurance thru Anthem BC BS of Missouri (state I used to live in) got it 8 yrs ago;
    5 yrs ago; switch coverage plan to F - High Deductible my monthly premium has been as low as $45 with yearly deductible of $1,000 and is currently $52 with a $2,000 deductible.

    I was told by Missouri insurance experts to not change my policy once in another state, i.e. Florida rates quite different, not as good on coverage and much higher rates.

    Sorry, Dave, this may not make you feel any better, but thought you might want input anyway :)

  • Hi Dave,
    First off, many people get Medicare and Medicaid confused. When one is on SSD for 2 years, one is eligible for Medicare. Otherwise, Medicare starts when one turns 65.
    Medicaid is a federally funded program run by each state so the income and assets eligibility vary from state to state. Usually one has to have very low income and assets to qualify. For those that are on Medicare and don't qualify for Medicaid, a medigap plan or a Medicare Advantage plan can be a big help in covering the portion of medical expenses that Medicare doesn't cover or at least some of the expenses that Medicare doesn't cover. If you are under 65, you may have less selection in plans that are available in your state. One place to get advice on what is available in your state is your area office on aging. Ask for a SHIP counselor. (State Health Insurance Program) These individuals are trained to guide people through the Medicare maze and they could give you some ideas about what programs are available in your state.
    Regarding drug coverage for those on Medicare, finding the most cost effective prgram can be found by using the plan finder at medicare.gov. You enter all your meds and the computer program will list all the programs available in your area by total cost. A SHIP counselor can also help you in finding a drug program. A SHIP counselor can help evaluate your eligibility for other programs such as the Extra Help from Social Security in paying drug costs or assistance from drug manufacturers.
    A SHIP counselor does not sell insurance. They help people understand what is available and how programs work. They are trained and tested to maintain their certification as Medicare/Medicaid counselors. They are a great resource for people on Medicare or going on Medicare and their services are free.
    I know. I'm a SHIP counselor.
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    edited 06/26/2012 - 3:51 AM
    I chose a Blue Shield of Illinois plan F that covers both the inpatient and outpatient deductibles .... and will also cover any excess charges that non-participating Medicare (accepting assignment) docs might bill. No deductibles with the supplement and then picked up a Medicare part D plan through Blue Shield also.

    The supplement coverage is about $240 per month and the part D plan is $38.

    My SSD payment is greater than 133% of the federal poverty level so there is no Medicare part B premium help or public aid help with the co-pays on drugs or the donut hole. At least I have great coverage for everything else. Most of my meds are generic and are fairly low cost .... all 10+ of them so it might cost me a bunch of $3,00 co-pays but thats still better then 10 X $20 - $50.

    It also opens up a entire new bunch of meds that I can try, now that I am viewed as a real person with real insurance instead of just another patient on "public aid". (They had a very limited formulary).

    Medicare with a Blue Shield secondary!! I'm in insurance heaven!!

    Thanks for all the input and suggestions. My insurance broker and I are going out for a nice steak dinner this Thursday night!! First time I've been out to eat in over a year ++. I think he may even buy!!

    Nothing like a nice aged char-crusted filet mignon!!

    Oh and P.S. I'm moving out of my ex's spare bed room in her apartment into a great ground floor one bedroom that is two blocks from everything!! Grocery store, Big Park, Walgreens, Donut Shop, Pizza place, Attorneys office, train stop. etc. Its location location location - Moving on July 14th - back to independent living!! Yippie !!

    Regards to all,

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  • Dave,
    You made a good choice getting Plan F. It is interesting to note that Plan F costs vary a lot depending on where you live. The Plan F that I have been looking at costs about $117 a month. ( I live in a small town, rural area.) Same coverage though.
    Re: your BCBS drug plan, or any drug plan as far as that: If your pharmacy offers generics at a lower price than your drug plan, you don't have to use your drug plan. A good pharmacist will work with you in getting the lowest cost on your meds. It is generally good to get in a drug plan so you don't get a penalty for non-coverage later on.
    Good job! Great coverage!
  • Hi Dave,
    Sounds like things are looking up for you :) Independence is a wonderful thing, enjoy it!

    I am reading and trying to understand all I will need to know in the future. I am very new to SSDI and won't be eligible for Medicare till next summer.
    I have been very spoiled with regards to health insurance. My hubby has great insurance. I have had very little out of pocket expenses. I am so very scared of what is to come...
    I hope I will be as fortunate as you when my time comes :)

    take care,
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    edited 07/10/2012 - 10:04 AM
    Seemed to work well for my rx today .... Co-pay price $9.00 ..... my insurance saved me $314.98 ...... for a $38.00 premium Im already ahead on the deal!! TIme will tell the total tale .... I think I'm gonna do an Excel spead sheet and see how it really comes out at the end of the year.

    Do-nut holes I thought were something we ate ..... not caused our insurance coverage to lapse in the middle of the year then kick back in!! Kinda like a mid term deductible ..... maybe we can not pay our politicians for their mid year term??

    Talk about a "carve out"! Carve outs should be reserved for Turkeys not RX coverage!!!

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  • Hi Dave and the others that posted in this thread
    I have about 7 months before I get the Medicare coverage but in CA it looks tuff to find a good medigap without joining a HMO or ppo that limits who you can see as far as doctors.
    I am so looking forward to the Medicare because my out of pocket counting my insurance premiums has been $18000.00 to what will be almost $22000.00 this year five years of this has wiped me out.
    My biggest question now is can you see what doctors you want and is everything covered under your new plans.
    I found all states have to offer medigap policys for 65 and over but not those of us that are under 65. I did come across one for about 350 a month which will still be better for me then what I have but still another cost to deal with...
    Oh and by the way I understand part of Obama care will phase out that dang donut hole over time so that will be a help at a later date depending on the election of coarse which may or may not change anything anyway.
    I have at least one doctor appointment every two weeks for pain management then add in the other 7 docs I see and copays alone are killing me plus 12 scripts a month too so I hope it gets better for me
    The SHIP program someone wrote about sounds like a good place to start also soory I am on a small tablet and can't scroll up to give the poster credit but thanks for that information.

    Take Care
  • I'm 65 and opted not to take the part of Medicare that pays for a dr. visit. Why? It would have cost me,$100/mo - 10% of my monthly income, still demand co-pays, and then still wouldn't cover everything. That would mean buying still more insurance. Considering that my rent and electric cost nearly 50% of my income, I simply couldn't afford it. Alternately, I could try for some kind of government program that would "help" me, but, I prefer not to sell my soul to the government. I think I'll just continue to live until I die. The only thing that concerns me now is having an injury that I know I can't pay for. But, even with insurance, I couldn't pay for it anyhow. My extras in life are the Internet and a 1998 Honda Civic and I don't want to give them up.
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    Saultup is the member that said he/she is a SHIP Advisor. You could P.M. your question and I'm sure he/she would help or at least steer you in the correct direction.


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  • saultupssaultup Posts: 71
    edited 09/29/2012 - 4:02 PM
    Just saw the last post. As a SHIP counselor, I would suggest that "island fever" check with Social Security to see about eligiblity for Extra Help/Low Income Subsidy and with the state agency that oversees Medicaid. In Michigan the Department of Human Services handles Medicaid applications and in addition to Medicaid, they screen individuals for a program called the Medicare Savings Program. It is a program that pays the monthly Part B fee. Another way of putting this is Medicaid is for low, low income and assets. If one is not eligible for Medicaid, the next level up is possible eligibility for the Medicare Savings Program. Usually if one is eligible for the Medicare Savings Program, one is eligible for the other program administered by Social Security. The Social Security program really helps pay for medications and the costs of a prescription drug plan.
    While not having Part B sounds like not a big deal, remember that outpaitent services are covered under Part B. A lot of surgeries these days are being done on an outpatient basis so it is possible to get a substanial bill for outpatient treatment. Yes, Medigap polices mean buying other insurance to cover the annual deductibles, co-pays etc. that Medicare doesn't cover. For Part B, Medicare pays approximately 80% so the paitent is left with the 20%. Some Medigap policies will cover all of these other expenses.
    I realize a very limited income makes choices even more difficult. The Medicare Savings Program and the Extra Help/Low Income Subsidy are great programs and I would encourage you to check them out. I would encourage you to find a SHIP counselor in your area (go to medicare.gov)and at least discuss what options are available to you in your state. Our services are free. We are not selling anything but just giving out information and helping with advocacy. I'm really interested in people getting the help they are entitled to.
  • Rick,
    You are right in that it might be tougher finding a medigap policy for someone under 65. One bit of encouragement: when you do turn 65, the cost of a medigap policy should be significantly reduced...I mean really reduced. Again, this varies a bit from state to state but generally speaking, these under 65 policies are more expensive (except in MI where we do have access to a policy for under 65 at a reasonable rate of $122.) Good luck in finding one you can afford. They really help. And don't forget to get in a Part D program.
  • Thanks for the input. I just started looking and so far found one for about 349 per month which would be better then what I have to pay now anyway. For the last six years my medical expense counting insurance copays and out of pocket has been from $18000.00 to what will be about $21000.00 this year. I am about out of money, my retirement is almost gone.
    In about 8 months I get Medicare and I hope that helps plus I hope my medical issues slow down too.

    In some of the post above island fever is talking about waving off part B isn't he going to pay a penalty each year he doesn't buy B. I was told each year you don't buy it you pay a 10% penalty if you add it later so 10 years without B you would pay 200% of the cost. Is this right?

  • You're right, Rick.
    If you don't sign up for Part B and you don't have other insurance, there is a penalty which is 10% for every year (that is a full 12 months) that you went before signing up. The good news is if you are on Medicare and are under 65 and you didn't sign up for Part B, the penalty disappears when you turn 65 and are in a new enrollment period. Otherwise, it just keeps on building up.
    There is also a penalty for Part D. That penalty is 1% for every month that you could of signed up but didn't and you did not have "creditable" drug coverage through another source.
  • Yep, I didn't sign up for a pharmacy plan within the first 6 months, mostly because my meds are paid by workers compensation because my injury was work related. I didn't see the need because I don't take any other meds. About a year into Medicare, I decided to get the part D. Makes me mad that I now pay a penalty on my prescription drug plan. By the time I pay the $100 for Medicare, $40 for prescription coverage, and now $378 for my plan F coverage (which is great), that is a big chunk of my income. But there is no way I can get rid of the coverage.

    I was speaking with my doctor just today about Medicare. He predicts that in the very near future, most doctors will quit accepting medicare patients. He said they already limit the number they will take, because the amount Medicare pays is so ridiculously low. It used to be that it was only Medicaid that had the poverty stigma, but now Medicare is getting a very similar stigma and doctors don't want to participate. That scares me.
    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • What is a good time frame to get the medigap and part d insurance. My Medicare comes up in June so is now the time?

  • Congratulations! I would recomend that your sign up for a Part D (drug) program the beginning of May so that it is in effect the beginning of June. If you wait to later in May to sign up, it just takes time for all the computers to talk to one another and things just go smoother if you allow several weeks to get things in place. If you don't get a piece of plastic to take to the drug store, no big deal for the pharmacist can look up your name in the drug plan and see if you are officially enrolled. Another suggestion, allow lots of time to sign up by phone, if you do it that way, for the program has to inform you of all your rights, etc. Of course, you can sign up at medicare.gov, too.
    Now is also the best time to sign up for a Medigap policy. I don't know what is available in your area for people under 65. You might want to find a SHIP counselor in CA (at medicare.gov web site) that can tell you what policies are available. By all means, begin the research now for the sign up takes a couple of weeks and is usually effective the beginning of the following month.
    Medicare is complex and it usuallly takes hearing or reading the stuff 2-3 times from different sources before it begins to make sense. Just remind yourself of that point when you think, holy cow, how does this work. Find a SHIP counselor in your area....we are usually helpful and there is no cost for our service.
    Many people I see are happy to get on Medicare for it does provide good medical coverage. If you income is low, you might qualify for the Extra Help program through Social Secureity that helps pay for the cost of medications. That is a great program and is really worth checking it out. There is another program called the Medicare Savings Program that pays the Medicare Part B monthly premium. That program is administered through your state human services agency and has qualifications simialr to the Extra Help program. Again, a local SHIP counselor can help you learn about these programs.
    Good luck in researching all this. I hope this helps you get started.
  • RickilalasRRickilalas Posts: 559
    edited 05/04/2013 - 7:39 PM
    Thanks for the info. I have calls into the Calif ship people sounds like they are short on people. I dig get some person from aarp who uses a insurance company and a F plan is 266.86 and a part D for about 50. Not has bad as I thought. I like the F it looks like I will have nothing out of pocket.
    I really want to hear what the ship has to say first. Is next week good enough to get things done for June first or should I keep my regular medical one more month. I will save over 1000 a month and have better coverage , its till going to cost but it will be much better.

    Again thanks and are you guys paid or do you volunteer. Calif is asking for volunteers right now .
    This should be a paid job.

  • saultupssaultup Posts: 71
    edited 05/04/2013 - 2:46 AM
    Good job, Rick.
    For your Part D, if you sign up next week that should be plently of time for the computers to get you on board. You can always sign up via phone and ask them, or rather tell them, you whant the plan to be effective 6-1 so you can get the verbal commitment.
    For your Medigap F, that's a longer application. Make sure they know you are under 65. (In some states this is a major issue to find a policy for <65.) If you call, they will take preliminary info and then send you a paper application. I would ask them can you app. be processed in a timely fashion so that it will be in effect 6-1. See what they say.
    I'm glad to hear your expenses will go down. The Plan F is top of the line and copays should be non-existent.
    And yep, this SHIP is volunteer. It is a good program. The training is excellent. But, like many programs, it is overwhelming initially to learn rules, exceptions, etc. but if one stays with the program it gets better. There are always updates, etc. and every day I learn something new. The people I see are so appreciative that it makes it all worthwhile.
  • RickilalasRRickilalas Posts: 559
    edited 05/04/2013 - 7:52 PM
    Yes the price they gave me was for under 65. I tried to do it online and then it. Said I had to call in because of the age issue. She verified everything and then took my Med information and gave me a total copay for it of 98 a month which for my list is pretty good but my pharmacy isn't on it so I may shop around some I have many combinations CVS will not fill for me. My small pharmacy does great and I hope they take some plan.

    Thanks again
    I worked insurance repair with adjusters for fire insurance repair work and learned a lot.
    I may volunteer for this later. I have met some many people so confused on this and it is not as bad as I thought.

    That's for helping people when there lost.

  • If you don't qualify for Medicaid, you may check to see if they have plans like they have here in Florida. My Medicare comes into effect on Nov 1 (YAY) and I don't qualify for Medicaid because my husband has a measly 10,000 401k insurance plan. They have a plan called OPTIMUM which not only pays me back most of the $104 Medicare takes out of my check (I get $80 put back in my check every month), but I have no co-pays at my doctors my copays on my meds are only gonna be $25 a month. It's certainly worth looking into!
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