Topic: do you have Medicar Supplement or Medicare Advantage?
cottonbrain
Frequent Contributor (1K+ posts)
Member # 13769
posted
It's driving me crazy trying to figure this stuff out. Thank goodness I have JUST started to have a small improvement in my cognitive functioning, otherwise I would just throw up my arms!
Do you like your plan? Any caveats? Any advice?
thank you, all.
Posts: 1173 | From USA | Registered: Nov 2007
| IP: Logged |
cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
I have regular medicare and a medicare supplement.
I pay no copays when I go to dr. I had a medicare specialist help me pick my plan...its with shenadoah life.
Ive been on it since March, and so far havent had any problems, but not all of my claims have been processed.
From what my specialist told me, the advantage plans are more like an HMO, in that they usually have a select set of dr you can see, and there are usually copays. the pluses are that the Rx plan is built in to the plan.
it is confusing and I spent a lot of time researching. The most difficult is finding the Rx plan that covers everything.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
| IP: Logged |
cottonbrain
Frequent Contributor (1K+ posts)
Member # 13769
posted
hey cantgive, did you get your prescription drug plan through shenandoah life as well?
hae you had to enter the donut hole yet?
also, when you said you got help through a medicare specialist, what is that?
The Advantage Plan is really appealing, as it only costs $102 per month in my area. The plan says that I can get a doc outside the network and be reimbursed at network rates
but I am not really sure what that means. Network rates are usually contracted lower than regular rates, yes?
anybody know: If a doctor accepts Medicare Assignment do they have to accept Medicare Advantage patients if they are not in the network?
I just can't get over how complex they make this!
Posts: 1173 | From USA | Registered: Nov 2007
| IP: Logged |
daise
Unregistered
posted
Hi you guys,
I spent months in frustration trying to understand Medicare.
My conclusion is that NO ONE understands it--not even the Medicare people themselves. And also that people with Lyme especially will get mighty stressed trying to figure out something that is a mess.
I've been told it's improved from years past!
But I understand some things. I have a Medicare Advantage Plan. It is through a very good non-profit health insurance company. The clerks in the company almost never know what the rules are and that is frustrating and brings Lyme stress.
But eventually--with a lot of my anguished time--it usually works out.
No, a doc who takes Medicare doesn't necessarily take a Medicare Advantage Plan. I bought it and was then shocked. But, well ... my LLMD is going with it!
I've been on the phone with insurance clerks and supervisors saying: Don't you give my doctor a hard time. He's a very good doctor! Pay him!
I found that after I signed-up for my plan, that it was after that, that my information from Social Security / Medicare could be downloaded by my new Medicare Advantage Plan salespeople and guess what? The "extra help" (for low income) of Social Security (and the state) kicked in and lowered my drug costs, my monthly premium and so on!
But your salesperson can't know what that savings is until after you have signed up with that company.
If you are eligible for "extra help" then if you choose a Medicare Advantage Plan and don't like it, you can cancel and go with another plan the next day.
I did that. I got out of the contract with United Healthcare: they are under the umbrella of companies with IDSA policies against Lymies!
Google these companies and see who owns who. I called nurse case managers at companies and asked questions! Then, as a Lymie, try to choose wisely!
Mine has free gym! It's called Silver Sneakers, for seniors and also the disabled. My gym also has a warm pool. This fits very well with Lyme machine weightlifting and warm pool stretching, which has very much been a part of my recovery.
That exercise program is found at www.ilads.org; "Treatment Guidelines," Dr. Burrascano's 33 pages of tips for 2005, near the end of it.
There is a Silver Sneakers website--just google it for plans that offer this.
An Advantage Plan may offer (or not) surprising extra things, like accupuncture or massage.
Some of these companies are crooked. What they say is not what they do and there is no one to complain to. Like, United Healthcare--bad news for Lymies.
Anything else ... I don't know. 'Tis a mystery. One thing, you have to have the Medicare & You book. They didn't send me one and I had to argue at the local Social Security office--and I mean ARGUE just to get a copy.
Another thing--a number of states take a year or more to reimburse you (if you are eligible) for Part B Premium. Politics! Make copies of all paperwork for this SHOWING THE DATE you entered the paperwork!
cottonbrain
Frequent Contributor (1K+ posts)
Member # 13769
posted
thanks, daise, for your input. i checked out the Silver Sneakers program -- that sounds good, especially if one of the gyms has a sauna for detoxing.
I currently have UHC through my husband's employer, and they have caused me countless hours of untold grief.
On the other hand, it looks like Secure Horizons DOES work well for some.
if you go with Fee for Service, can you use any Medicare doc or only ones who agree to this program?
Posts: 1173 | From USA | Registered: Nov 2007
| IP: Logged |
daise
Unregistered
posted
Hi Cottonbrain,
quote: You wrote;
if you go with Fee for Service, can you use any Medicare doc or only ones who agree to this program?
My understanding is that many of the fee-for-service companies are notorious for not paying. Not all, but many. Medicare was thinking of doing away with those, but...
They are often sold by NEW companies or NEW company names who do not have any reputation, if you catch my drift: there is no loss to the company if they are scamming people--if your company name is not known.
And when they don't pay, you have no recourse through Medicare. They say they have actions to take--but it is just on paper, really. No muscle. That is outrageous.
A doctor who accepts Medicare will not at all necessarily accept a fee-for-service plan in the Medicare book or a Medicare Advantage Plan.
Sorry. Need an aspirin?
Idea: What healthcare companies are people in your area getting LLMD's and / or Lyme meds paid from? Ask your local support group people.
(Go to the top of this page, on the left, to the leafy menu and click "Support Groups.")
Then, look in your Medicare & You book again, for those companies!
cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
cotton- I have bluerx for my Rx plan, i went with them because they are cheaper then found out they have NO online acess, which I hate because I cant track and print how much I have spent :-(
I stocked up on a few drugs before I lost my good insurance...so havent used bluerx much since March.
My urologist said absolutely do NOT go with united health care. My medicare specialist said the same thing, they are bad news.
By medicare specialist- I called the insurance agent that I bought my car insurance/homeowners through, and he referred me to an agent that specializes in medicare.
This agent came to my home with recommended plans that he thought would be good for me.
If you are in SE Pa i maybe able to help you find someone.
Also, Medicare takes forever to process claims, so you never know if services are being covered or you are going to be stuck with a huge bill, and they wont guarantee or preaprove anything!!!
They treated me like garbage when I called them and hung up on me. So, we are left to figure it all out on our own, nothing new in lymeland.
I would call your dr and see if they take medicare advantage or medicare and get their opinions.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
| IP: Logged |
cottonbrain
Frequent Contributor (1K+ posts)
Member # 13769
posted
my PCP does not take medicare; my gyno takes supplemental but not advantage; my radiologist takes supplemental and advantage; my LLMD opted out of Medicare. Labcorp takes BCBS Advantage and supplemental (i think -- it's all running together in y head now)
where are those aspirin?
SO, no matter what I do, i have to find a new PCP and pay out of pocket for LLMD.
I can get an Advantage plan for 101 a month,including rx. The cheapest supplemental is about 200 plus another 90 for rx if i want to get donut hole coverage.
So the Advantage is a lot cheaper but I'm scared that it might be inadequate.
That's a good idea about asking in my support group, but there's no support group in my area -- charlotte, NC -- because we don't have Lyme here, of course.
I can't believe the stories i am hearing about the rude medicare people!!! that is disgraceful.
let's all get together for a group scream.
thanks, all.
Posts: 1173 | From USA | Registered: Nov 2007
| IP: Logged |
posted
I have a Medicare Advantage Plan through Humana, and it is called Humana Choice. I live in Kentucky.
Medicare Advantage plans replace Medicare and Medicare reimburses the Medicare Advantage Plans for their services. You can choose either a PPF plan or PPO plan. I chose the PPO with no monthly premium and $25 copay for Specialists in their network and $5 copay for my PCP. My Presciption Plan Part D is included with this Medicare Advantage Plan.
If I choose out of network MDS, there is a $250 deductible to meet and after the visits will be 25% of the approved Medicare amount charged.
Medicare Supplements are expensive. Right now in my situation, the Medicare Advantage plan is the best one for me.
I do not know if my Lyme would be covered or not as I cannot find a Lyme Doctor who accepts Medicare Advantage plans or even Medicare.
I am eligible for extra help and you can only change your Medicare Advantage the first 90 days of the year..Jan to end of March... After that you are locked into the plan until open enrollment begins on Nov 15th with effective date of Jan 1st.
I hope I have been of some help.
Hugs,
Perplexed Posts: 324 | From Lexington, KY, USA | Registered: Dec 2001
| IP: Logged |
posted
Woops! I forgot to mention that on March 26th I had a heart cath done and ultrasound of the heart. Claims were filed and paid within 3 days of date of service. Thid was with the Medicare Advantage plan I have...Humana Choice. I was impressed!
Heart cath was fine, but wonderful cardiologist wants me to be watched, and I will see him again in 2 weeks to discuss plans for me to see a cardio physiologist for the electrical part of the heart. He told me that Lyme disease can affect the electrical systme and may be why I am experiencing symptoms of tacycardia, irregular heartbeats and other symptoms. These symptoms have been bothering me on and off sine I got bit in 1972. Now they seem to be getting worse.
Thank God for this Cardiologist and his residency in a Massachusetts hospital and his obtaining his Fellowship there and treating patients there for quite awhile before coming to Lexington Ky in 1999. I pray he will be able to help me.
Hugs,
Perplexed Posts: 324 | From Lexington, KY, USA | Registered: Dec 2001
| IP: Logged |
cottonbrain
Frequent Contributor (1K+ posts)
Member # 13769
posted
Perplexed, thank goodness your cardiologist understands Lyme. I hope everything works out for you -- i am very sorry you are having to go through all that.
thanks for the information. I will look at Humana -- that sounds like a good plan --I know we have some humana plans in my area.
thanks again, all.
Posts: 1173 | From USA | Registered: Nov 2007
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
![[bonk]](graemlins/bonk.gif)
![[Smile]](smile.gif)
![[confused]](graemlins/confused.gif)
Printer-friendly view of this topic