randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
I go on it in april and im scared. how does it pay?
am thinking of keeping my bc and bs. I pay about 200 for single option low cost.
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
| IP: Logged |
Judie
Frequent Contributor (1K+ posts)
Member # 38323
posted
Medicare Part D plan has been great for paying for meds.
I dropped Part D to take my husband's insurance and regret it this year. So many things are not covered, while Part D covered everything.
The issue is finding doctors who still take medicare. A lot are opting out, while other will ONLY take medicare as insurance.
All my Igenex tests were paid in full by medicare. There are a lot of labs that only take medicare.
Where I did get screwed was a colonoscopy. I was having gut pain. Medicare will only pay it for it 100% if it's routine. Since it was diagnostic, they only paid 80%.
Posts: 2839 | From California | Registered: Jul 2012
| IP: Logged |
posted
Keep your other insurance. Part D may pay but the cost is always something you can pay.
I had a prescription go in for Tindamax, Bactrim and Mepron and they wanted $2500 out of pocket for three generic drugs.
-------------------- Faithful
Just sharing my experience, I am not a doctor. Posts: 2682 | From Colorado | Registered: Oct 2009
| IP: Logged |
kam
Honored Contributor (10K+ posts)
Member # 3410
posted
It is confusing. I just went on it this year.
I had one plan for drug coverage that wanted a certain amt up front so I stopped paying on that plan.
And got another plan. It is $20 more a month ($41 total a month) but I didn't have to come up with a large deductible.
The $200 I would have had to pay for the biaxin was $10 on the other plan.
I don't know what it would have been on down the line.
Drugs are averaging $10 each a month.
I was to get an MRI recently. My cost was going to be $300. Part of that was deductible.
Cost I owed for doctor's visit is $150 after what medicare paid.
Primary care doc.
I have A and B. It is confusing for me...but i confuse easily.
I think the plans are different.
There also are people who will help you know which plan might be best for you without charging you.
They get paid by the insurance company r drug company.
You can also add a second insurance but the ones I looked into were about $300 a month here so I haven't been able to do that.
Posts: 15927 | From Became too sick to work or do household chores in 2001. | Registered: Dec 2002
| IP: Logged |
TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
You can go on Medicare Parts A and B and keep your BC/BS. If you do that, BC/BS will pick up the 20% or so that Medicare doesn't pay.
BUT, if you take Part B (doctor's insurance), then some lyme doctors may not take you as a patient. In my area, there are a good number that won't take you because if they did, they would have to accept the Medicare payment as their full payment.
A very few of the top notch lyme docs have opted out of Medicare which means they will take you but they don't participate in Medicare, so you pay them just as if you didn't have Medicare. You pay the entire bill and submit to BC/BS for some reimbursement. I don't know if you will get any reimbursement. You cannot submit the bill to Medicare because the doctor has opted out of it.
If you take Medicare Part B, then Medicare is your primary insurance. It pays first. Then, BC/BS is secondary (pays second).
If you take Medicare Part B, then all of the Medicare rules appy to you--like how often you can get a cholesterol test, mammogram, etc. Whether or not you can get a Vit. D test, bone density test, colonoscopy, etc.
With BC/BS, as you know, you can get any test any time as often as you want. A few staff in a few doctors' offices told me that "Blue Cross is the best." I had my husband decline Medicare Part B. That is how the staff reacted to hearing about my decision.
Medicare Part A is hospital insurance. Take that because it is free.
If you are going to keep your BC/BS, your only decision is whether or not to take Part B which costs you monthly. You won't need any of the other parts of Medicare because your BC/BS will take care of it--prescriptions, etc.
Blue Cross has a pamphlet in chart form that shows you what they will pay if you take Part B. Maybe call them and request it.
Posts: 9931 | From Maryland | Registered: Dec 2007
| IP: Logged |
poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
It is my understanding that if Medicare does not pay for something, then your secondary insurance will not either. Correct me if this is wrong.
Our health insurance "system" is a nightmare. It couldn't be more complicated. How do they expect sick people to figure this out?
Posts: 2888 | From USA | Registered: Mar 2004
| IP: Logged |
randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
y'all this exactly why im having it done, my surgery, now before I go on medicare. my cardiologist, gastro and my colorectal surgeon, all of them, dont take medicare.
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
| IP: Logged |
MADDOG
Frequent Contributor (1K+ posts)
Member # 18
posted
I got anthem senior atvantage all in one plan.Being below a certain income levil I get extra help paying for drugs.
I am still stuck with 20% I think on surgery.I gave up on getting my shoulder,hip,or any thing else fixed.
MADDOG
Posts: 3996 | From Ohio | Registered: Oct 2000
| IP: Logged |
TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
randi, if your current set of doctors don't take Medicare, then why are you considering going on it?
Posts: 9931 | From Maryland | Registered: Dec 2007
| IP: Logged |
quote:Originally posted by randibear: y'all this exactly why im having it done, my surgery, now before I go on medicare. my cardiologist, gastro and my colorectal surgeon, all of them, dont take medicare.
- Not a good reason to have the surgery. My SIL had a hip replacement because she was afraid of ACA making it so she couldn't get it done at all.
Now she is in more pain all the time. She had an unnecessary hip replacement. (2 yrs ago)
She has knee problems because of it and now lower back problems. It's one thing after another.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
| IP: Logged |
randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
oh ive got enough reasons to have it done.
im keeping my govt bc and bs. I will supplement the medicare which I understand is mandatory.
several of them have said they will consider it if I have additional insurance. but my obgyn said no way so ill be looking for a new one there.
ill be 65 so I wont have a choice.
my docs have been telling me to have this surgery for at least two years.
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
| IP: Logged |
TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
I have govt BC/BS and I am not required to take Medicare.
My husband is on my policy. So, that is why I had him decline Medicare Part B. This way, no change for him. He still has the BC/BS he always had.
None of the Medicare rules apply to him. We see who we want as much as we want and get the tests we want any time we want.
Posts: 9931 | From Maryland | Registered: Dec 2007
| IP: Logged |
randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
whoaaa,, maybe I dont have to go on it. I thought it was mandatory.
hmmm better look this up.
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
| IP: Logged |
lpkayak
Honored Contributor (10K+ posts)
Member # 5230
posted
Poppy-mine isnt like that. Usually medicare ays first then aetna pays the rest except copay
They are combined somehow
I havent run into anything not covered...yet...but things are changing for the worse
Hard to get a human to talk to you if you have questions
-------------------- Lyme? Its complicated. Educate yourself. Posts: 13712 | From new england | Registered: Feb 2004
| IP: Logged |
Judie
Frequent Contributor (1K+ posts)
Member # 38323
posted
"It is my understanding that if Medicare does not pay for something, then your secondary insurance will not either. Correct me if this is wrong."
Yep. That's been my experience.
From my understanding if the regular insurance is with a company that has over 50 employees, it's considered primary (it just means they pay first and then the bill is passed on to the other insurance to pick up the difference).
It there are under 50 employees, medicare will be primary.
" Part D may pay but the cost is always something you can pay."
For me, Part D paid MUCH better than my husband's insurance. Bicillin would have been $100-$200 per month compared to $800-$1000 per month.
You can go to the medicare website, enter your meds and it will show you the MANY part D plans (and supplemental plans) and what they will cover in cost.
posted
You are right Judie. If you are not covered under medicare guidelines for something then your secondary insurance won't pay either.
If it is an out of network doctor visit, usually your secondary insurance will pay 20% of the visit if you prove the doctor opts out of medicare with the opt out form they have you sign.
-------------------- Faithful
Just sharing my experience, I am not a doctor. Posts: 2682 | From Colorado | Registered: Oct 2009
| IP: Logged |
randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
strange. I talked to my bil yesterday. he had emergency quaddrouble heart surgery. they have govt insurance and he said they paid what their medicare didnt.
also talked to anns husband and her bills were over 250k, yep that right, and they paid on them also.
do I absolutely have to go on medicare or can I decline? I am not eligible for social security cause I never got 40 quarters.
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
| IP: Logged |
posted
I think I am in the same boat. I won't get SS unless my husband dies and I have a state insurance and paid very little to Medicare over the years.
I always figured I wouldn't even QUALIFY for Medicare. I don't get any of that stuff.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
| IP: Logged |
kam
Honored Contributor (10K+ posts)
Member # 3410
posted
randibear...i wondered about whether or not I had a choice too to go on medicare or not.
But, health wasn't doing well enought o loo into it.
They automatically signed me up last year.
I thought I needed to pick which plan to go on this year but wasn't doing well enough to do so.
I was told by one person I cconttactd that since I had the white, blue and red medicare card that I would automatically be enrolled in the same plan again if I did nothing.
I assume they were right.
I want to see a LLMD out of state that takes medicare but was told that they do not take HMO medicare.
I am still trying to figure out if I have an HMO medicare...I assume so.
I od know the web site for medicare is medicare.gov
not to be confused with medicare.com although I am sure they will help also for a fee.
Since my reading skills are poor I have yet to be able to read much on that web page.
And I continue to forget what my log in password, etc is..not able to write things down like I use to be able too before lyme and company.
At the apatments I live in, there were 3 different people who left flyers to contact them if you have questions.
I contacted all 3 at one time.
Via email for me.
One got back to me.
But, it was in regards to getting a drug plan with medicare.
The local pharmacy gave me his card. He also helps with medicare plans.
Maybe there is somoene in your area that does this for a business that can help.
Posts: 15927 | From Became too sick to work or do household chores in 2001. | Registered: Dec 2002
| IP: Logged |
phyl6648
Frequent Contributor (1K+ posts)
Member # 28522
posted
I have Medicare and a supplement, if Medicare pays the supplement pays but if Medicare doesn't pay the supplement doesn't either. Medicare is my primary since I am 71. I had no other insurance so didn't have a choice about taking medicare. I am not sure but once you turn 65 I too thought you had to take it.By the way the supplement isn't cheap..Then there is the rx plan another expense.
There are getting more and more doctors that don't accept medicare. The doctors I need to see for lyme is all out of pocket..
Posts: 1058 | From VA | Registered: Oct 2010
| IP: Logged |
poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
randi- we are not talking about the same thing. Your brother did have medicare pay their part, and then insurance followed with the rest.
But if whatever the medical procedure was had been declined any medicare payment, then insurance would not have picked up any of it either.
Another twist is that if you are eligible for medicare part b and do not take it, keep other insurance instead, then the reimbursement will be at the medicare level anyway. That apparently is the law. If a doc takes your kind of insurance but not medicare and they are paid at the medicare rate, that might make some unhappy.
Posts: 2888 | From USA | Registered: Mar 2004
| IP: Logged |
posted
If you have secondary insurance that isn't from medicare supplemental insurance and you only have Part A, your secondary insurance pays at their insurance rate.
If you buy Medicare supplemental insurance then the Medicare rate does apply to a doctor who accepts Medicare.
I do know that if you have Medicare supplemental insurance and you have a procedure that isn't approved by Medicare, the supplemental insurance won't pay.
They make it so hard to understand how this all works.
-------------------- Faithful
Just sharing my experience, I am not a doctor. Posts: 2682 | From Colorado | Registered: Oct 2009
| IP: Logged |
TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
I used to sign people up for Social Security benefits and Medicare. So, when I tell you that you are not required to sign up for Medicare, I know what I am talking about.
Nobody can force you to take Medicare which you have to pay for.
I don't have enough quarters for Social Security either. I worked for the Federal government.
I don't have to take Medicare, and my husband who is on my Blue Cross/Shield policy did NOT take Part B of Medicare when he turned 65.
But, he took Part A because it is free. (So, he was not forced to take it.)
This way, he can see any lyme doctor he wants if he ever gets lyme. And, more and more of the best doctors are not taking Medicare patients. But, they take him. (I agree that if they have not opted out of Medicare, they will still be reimubursed at the Medicare rate, but they don't have to worry about all the Medicare rules with a patient who has declined Part B).
Each year, there is a Medicare "open season" that allows you to change your mind and decide you now want to take Medicare Part B.
If you don't take it when you turn 65, there is a 10% (or thereabouts) penalty for every year you don't take it. So, if it costs $110 per month, if you want it a year from now, it will cost you $121 per month (ann $11 penalty). That penalty applies for the rest of your life.
So, your decision is not irrevocable by any means. However, I expect that in the next few years you are going to see Medicare patients having a harder and harder time finding doctors who will take them, and especially the good doctors that they would like to see.
Why don't you just call Blue Cross or Social Security and get this confirmed?
I pray that you are doing well in the hospital after your surgery, randi. And, I trust you will have much better health after this operation.
Posts: 9931 | From Maryland | Registered: Dec 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!
Printer-friendly view of this topic