what to do about Medicare?

[SwedishPrince]

Hi all... well, I'm about to turn 65 and just like magic, stuff has begun showing up in the mail with all kinds of info and choices to be made. So, I'm curious as to what works best for MS and DMDs.

If I understand this so far, seems like the basic first decision is 1) straight Medicare (A & B) with a supplemental plan (to augment part B) and a Medicare part D Rx plan;

or 2) an all-inclusive "Advantage" plan

Would sure like to hear what others have chosen, and why. Thanks.

[kmallory1]

Two of my doctors have posted signs at the front desk that they do not accept Medicare Advantage plans. Both accept regular Medicare, so I don't know what the problem is. I contacted the billing office, who confirmed the fact but could not say why.

So check with your doctors to see if they have any issues with Medicare Advantage plans as part of your research.

[anneth121]

MEDICARE

BEEN ON MEDICARE FOR YEARS CAUSE OF DISABILITY BUT LAST YEAR MADE A MISTAKE AND GOT A HMO. BOY, WHAT A YEAR! HAD TO GET PRE-AUTH TO BREATH. EVEN MISSED TWO APPTS CAUSE PRE-AUTH HADN'T COME THROUGH. AND MEDS TOOK FOREVER TOO. MY PRIMARY DOC HAD TO OK EVERYTHI NG. I'M 66 AND HAVE PPMS DX 1997.

[Redwings]

Two of my doctors have posted signs at the front desk that they do not accept Medicare Advantage plans. Both accept regular Medicare, so I don't know what the problem is.

The problem is that Advantage plans are basically HMOs that require doctors to be on their panels, then reward them by paying badly, both in amount and timeliness. That's how they deliver cost savings to their members.

[Camsue]

HMO + Medicare

I have been on Medicare for 9 years and have an HMO plan from work retirement. I have not had problems and am very grateful my Betaseron is covered. I pay a co pay (currently $50).

The preauthorizations are completed by the primary physician's office. I believe anneth121 should have a conversation with her primary/referring physician re: the delays. Once is bad enough!

[David]

Medicare

I have Medicare Part A and B. I have the supplimental Plan F (Aetna) and I have presciption coverage through AARP. I pay about 450 a month for all. I love it and have had no real headaches with it.
When buying a supplimental plan, you have lower cost choices to lower monthly costs and to tailor it to what you need.

[techie]

Don't forget Part D!
techie

[Tapdancer]

David, you mentioned the AARP plan. In my state, I have a choice of the AARP Preferred or Enhanced. The Enhanced has gap coverage and is more expensive. Is that the one you use? Has it been worth the greater expense?

[there]

I have something similar to David Medicare A+B and a supplemental that pays the last 20% that medicare does not cover and for Medicare D I have united healthcare and have had no problems. I know enough about my health problems to know if I need a specialist and no thanks don't need the preauth thingy or worse have to go my gp to get it or discuss my problems for no other purpose than get to the specialist/procedure or whever else I need.

[celeste]

I chose A & B and have had no problems. I've heard bad things about Advantage plans. It makes me wary that they advertise so heavily during open enrollment. I don't think they care as much about seniors as about making tons of money. Also, consider how an Advantage plan would work for you if you ever travel for vacation or move to a new community.

I'm not sure but I think if you choose Advantage you can never go back to Traditional but you can go from Traditional to Advantage. That might be a hint that it's not as good. Also, almost all insurance plans (even through employers) seem to get worse & worse as time goes by so think about sticking with the oldest type offered.

After all this, you may still find Advantage better for you if you find prescription and supplemental policies too expensive. There really are a lot of things to consider.

[SwedishPrince]

Thanks to all for your feed-back. I'm meeting with an insurance agent next week and see what he wants to "sell" but I'm leaning toward regular Medicare A & B, with a supplemental/medigap policy and a Part D (Rx) policy as well.

Both the supplemental and Rx policies seem to be tightly regulated by the government, so it seems the choice of companies (within reason, of course) is not terribly critical. With Advantage plans, it seems the choice of company would be more important.

Thanks again to all.

[lydialou]

Hey Swedish Prince. I haven't reached the medicare age yet but I have taken care of my mother for probably 10 years and have dealt with a few of the medicare drug plans. The only one that has really burned my mother was the AARP drug plan. They had noted her checking account number in her records and just continued to draft from her account without permission to do so and after I had moved her to drug coverage with another company. I saw the draft right away because I am her guardian and manage everything.

I had to move her money to her savings account so that they could not have access to her money. It took maybe 7 months to get this corrected and to get the money they took returned to her. It was also common to not allow the antibiotics she needed to be filled. So she would have to take something else and generally need it several times before the infections were under control. AARP would not be my first choice for even my dog.

[Ga dancer]

I started with a Medicare Advantage plan, but found out when I had some complex medical problems that places like Mayo Clinic and Johns Hopkins will not accept you as a patient because they refuse that insurance.

I switched to Medicare this year and had big problem with finding a supplemental plan that would accept me with a diagnosis of MS. You have to list all treatments in the last 6 mos. and they all refused me except BCBS of Ga - mainly because their online application did not ask the right questions. Under the neuro section they only had stroke and migraines, not MS.

So in the part where I had to list my treatments, I put MS and not Multiple Sclerosis, because I hoped they hired clerks with little medical knowledge. Apparently, I was right about that and I have a supplemental Plan G, plus prescription meds with Cigna. I get Betaseron from the Veterans Administration though.

If you get refused for supplemental coverage, keep trying. Good luck.

[DianeD]

No Advantage to the Advantage plans

Hi all... well, I'm about to turn 65 and just like magic, stuff has begun showing up in the mail with all kinds of info and choices to be made. So, I'm curious as to what works best for MS and DMDs.

If I understand this so far, seems like the basic first decision is 1) straight Medicare (A & B) with a supplemental plan (to augment part B) and a Medicare part D Rx plan;

or 2) an all-inclusive "Advantage" plan

Would sure like to hear what others have chosen, and why. Thanks.

Well, I find myself in that rather exclusive 'Senior Club' here. I'm 69 (how did that happen :-) and on Medicare. Hubby is 71 and we are on SS. I hate it, but there really is not much else a person can do.

Our State doesn't offer Advantage plans but also our docs don't take them. Every year there is a new list of 'don't accept' posted in the doc's office. Just now there is only one insurer who will even cover my MS. We have the Part A, Part B and D, plus the supplemental insurance. I laugh when I see articles and news shows that talk about us living off freebies because we are on Medicare.

Not only do we all pay into the program through our payroll deductions (mandatory) but when we are Medicare eligible we have to pay for the Medicare and it generally goes up every year.

Just a few days ago, to top things off, I was informed that the drug I take (Copaxone) is not in the Medicare 'formulary' and will not be covered unless my doctor requests an exemption. They are providing 28 days and if I don't get the exemption that's the end of coverage.

Now I do find it amusing (perverse humor I guess) that Medicare pays a tiny portion of the drug coverage for Copaxone and my secondary insurance pays the bulk of it.

So on Monday I'll start jumping through the hoops to get this straightened out. Guess Obama didn't include those of us on Medicare in the pre diagnosed group who wouldn't be turned down.

I'm going to post here to find out if anyone else has received the letter from Medicare Part D.

By the way, I find most of my drugs are no longer covered under the formulary. My docs put me on the drugs that either worked best for the condition or the ones I tolerate best.

Sure is an interesting time of life!

Diane

[its2much]

Ineligible for Medicare

Does anyone know why someone age 65, a US citizen who paid into Social Security for 20 years, would be ineligible for Medicare?