Medicare, what plan do you have?

[Bummer Knees]

I receive SSD, today in the mail I recive a book about the different medicare plans.

I also have BCBS with a very high decuctible and co-pay, so the medicare is needed.

I need to make a decision on a plan and would like to know what plan works for you?

[jayne]

Bill called his insurance company and asked them which was best....his now has no deductable and no co pays.....medicare can also help......I cant get it till I have collected SSDI for 2 years so I have a co pay for another 13 months.... medicare is now secondary and picks up what champus doesnt

[red1030]

Hi bummer... for me I have the VA and when I end up in a hospital due to an accident or something else, then the VA still covers it. I also have medicare A..and I didn't pick up a B plan. The Medicare "A" plan only covers the first 20 days through the year at 100% and then 80% for the last 80 days. Also within this first 20 days Medicare expects you to pay a flat rate of $952.00 for first day of each hospital admission. I use to have Champus also in combination with the VA but it was dropped as soon as I was put on Medicare A.

I didn't accept a medicare B plan because of its focus of care. Medicare "B" is about outpatient care, DME's, prescriptions, and so forth. However it does not cover, eye, dental, or audiology which is very unfortunate because this was a program first created in the country as a retirement program and who needs these last two services the most, our retired population. If I were going to pick up a second insurance to compliment my A & B, I would most likely true to BCBS or a keystone plan. I would also really investigate all of what is out there to assure that your can get the best program for the money.

I hope this helps you a little bit...love you Red

[Bad Boy Bad Boy]

I had learned this from our elders;

They told me to take Medicare Parts (A) & (B) as soon as you can. So, yes once I got Medicare i took them.

Then came Medicare Part (D) for pharmacy Drugs. I took that through AARP. Yes, I do save alot of money there also.

My cost for everything over the last 2 years has been way less if I did not have them.

What the elders said, is taking the Part A & B now is, because trying to get it later sometimes is a problem, or it might cost you more or something I don't fully remember. But I did remember they said it would save me money and headaches down the road. My past knee surgeries has not cost me a dime. guess that should explain alot.

[Bummer Knees]

I am on the BCBS family policy.

It does not cover dental, eve glasses, or audiology, and I have a large co-pay for pharmacy.

I paid $9,000.00 for new hearing aids last year, they will need replaced every few years as I have a progressive condition.

Maybe the B plan is what I need.

Is there somewhere I can go to help with decision making.

[sweet tooth]

call them and ask all kinds of questions , its all i have so i cant hepl sorry

[red1030]

When part "D" first was passed I believe it was in 2003 and started in 2004... the pharmacy companies did a lot of training and assisting with teaching people about what program would work best for them. Also when you come in to time to your copay coverage, then you will recieved a lot of information about each of the many coverages. My mom and dad have blue cross and blue shield as a co pay, but again it does not cover the three areas of care which I explained. However, there are programs where you can obtain this coverage usually with a lot of extra money. also, for dental, most dentant franchises will have their won programs available and you can use from their programs depending what your needs are and your budget.

Medicare Part "D" has some loop holes and so when you find a co pay you need to understand the what exactly D will pay for. For instance, Part "D" from my recall will only pay for generic names of medications. These are the older medications on the market. For instance, when I first was prescribed Avonex IM QW (weekly injection) it had just been approved by the FDA in April of 1996. I was started in Febuary 2007. So for the first 10 years of taking it, it cost $1500.00 a week so therefore $6,000 a month. Now past the 10 year mark it cost $600.00 a week. So as you can see the medications come down in price. This is for two reasons, 1) the orignal research is usually paid for, and 2) the federal regulations on the pharmacy industry states that after 10 years on the market the other pharmacy companies can copy the chemical make up with another name or two..which creates our generic drugs and a much lower cost, becasue now they all are competing with each other. So in the case of Part "D" it is important for someone with MS, who must use a certain medication which in the 10 year mark, to assure that the Insurance compliment will pay for new drugs and how much of a copay there is in this situation. Never believe that just becasue you have an insurance which says it has a prescription plan that it pays for all drugs. In a lot of cases, you only need to ask the doctor to provide you will a presciption for a generic drug versus and named drug. I hope this helps.

Step one: Know what you individualized current and future healthcare needs are or are projected to be such as a new hearing aid. Make a list of them.

Step two: Know what your medications in terms of generic names and non generic names. How many are not gerneric drugs. Make a list of them.

Step three: Know exactly what part A, B, and D pay for and do not pay for. Make of list of these benefits with expected out of pocket cost. Make a list.

Step four: Develop a cost analysis sheet of a annual expected out of cost pay for your needs with just the three medicare programs. In this budget allow for the additional cost of part B and part D.

Step five: Call Social Security office and ask for their assistance. Typically a government organization can not give you any information on any Civilian Company. It is unethical and heavily regulated to prevent bias within the SSDI department. They will, however, give you a list of names of programs which work with them a lot etc.

Step six: Call each of the names you recieve or hear about through friends, family, and neighbors. Ask them for information on their programs which will supplement Medicare programs.

Step seven: Identify the program you receive information on and then compare to your needs. Use a line by line cross of if nessary and then list them by 1 - ? 1 being the greatest priority of needs.

Step eight: Once you have found the Insurance which meets all your needs, then compare this insurance company programs cost to your analysis that you did earlier and see where your bottom line falls. Is it less out of pocket with this insurance program that best fits your needs or more. If it is more then go back to the drawing board and deduct a need based on your needs or just start over again with step 1 until you find the insurace supplimental policy which best fits your healthcare needs and your budget.

As an adminstrator in Long Term Care, this was a simple process that the homes CFO or myself would help a family member to go through when their family member was being admitted to our facility. Most people do notthinks of the cost of PT, OT, and SPeech when doing their cost analysis annual healthcare cost. Only Medicare B will cover these cost as an out patient. It is covered as a in patient. usually however, that will be very short term, so then most of a therapy is as an out patient.

Another point to remember is that it use to be, and may still be, that medicare was charged by the hospital or long term care by a room rate only. THere fore, the hospital will only want to give you what you need to get home as fast as you can. As an example, one of the reasons I came home from the hospital so quickly is becasue my avonex and a few other medications are very costly. My medications cost a little over $20,000.00 per month, so if Medicare is paying approprimately $3,100.00 per day.. which would equal $3,100.00 X 5 days = $15,500 ... this means that if my medications cost would be for 51/2 days would be about $3,620.00 for the 5 days. So the hospital only has $11,980.00 left to pay for all lab work, tests, and nursing care. In long term care, a facility could not afford to admit this patient becasue there is no profit margin as a matter a fact, I could show you how they would loose money. This is justinformation so that you can be aware when you are looking at insurance that it is not always apparent what you need to ask and why. Also the reason I said 5 1/2 half days for cost on medications is because of Admission day is day one of billing, but discharge day healthcare can not bill for reqardless of the time you leave the facility butyou are still getting your care and your medications.

I hope this gives you some information on how to possibly begin to wade through the whole mess of healthcare insurances and how it equates with hospital billing practices. Love Red

[Bummer Knees]

Thank you Red.

I have copied the information you posted and placed it with the medicare information that came in the mail.

You are very resourceful.

[Bad Boy Bad Boy]

Maybe this will help.

http://www.medicare.gov/

But as I said, and been told, Medicare Parts (A) & (B) should be taken as soon as offered. As I was told, pay now, or pay later. No need for surprises then down the road. It comes right out of the check, and once you get use to it, you don't miss the small added cost of protection.

My Perscription medications are Tier (2) Teir (1), so the Co-pay isn't all that much. That;\'s for Medicare part (D).

It's not our choice to prodict the future, so beware early.

My father has BCBS, and Medicare Parts (A), (B), & (D), he doesn't pay for hearing aides he gets.

[Lilly]

Hi ,
I have A and B...but since my working husband carries me on his insurance....HIS IC is considered my primary...and medicare has paid ziltch. I must go fequently for blood draws (INR), and so far , I'm always stuck paying the small left over cost his IC doesn't cover. His insurance picks up my monthly meds, but i must pay the co-pay. I have an echo coming up in a couple of months, and we'll see how much of that i get stuck with.
so far....it seems I'd be better off uninsured, with only medicare to cover. I have always been insurance dumb...and don't understand what they should & should not pay for....therefore, I'm sure we pay a lot of bills that aren't necessarily mine to pay.
Lilly