i'll turn 64 in july of this year & i'm looking forward, sort of, to being eligible for medicare next year.

can someone tell me how medicare works & how it differs from typical health coverage?

i currently use the VA for my medical needs because i can't afford my regular doctor, ($65.00 office visit.).

however, the VA is becoming too expensive for the quality of care they offer.

i pay $8.00 for every 30 day supply of medication, $15.00 co-pay per visit, & $50.00 co-pay for a specialist, that's on top of the 70 mile trip one way to the main hospital.

the service & efficency, or lack thereof, leaves a lot to be desired & it can take 30 days to get an appointment.

any input from you folks is greatly appreciated.

trailblazer

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30 characters is not enough

Medicare pays little on your hospital bill but way more than what most can afford to pay. You have to pay the first $900+ in co-pay per admission.
Medicare pays some on your dr visits but not all. You have to pay some type co-pay. Drs usually do not accept just what medicare pays.

Medicare does NOT, I repeat, does NOT pay for medicines in most cases. They will not pay a dime for prescribed meds but will for hospital administered meds.

I bought a medicare supplement for my wife. It costs $342 a month but it pays 100% on what medicare does not pay and it pays half of all medicine purchases up to $3000 per yr.

If a supplement is bought within six months of becoming medicare eligible, a pre existing condition is included in the coverage.

For us, paying the supplement is about half the cost of what we would pay if we did not have it and in some years just a small fraction of what I would have to pay.

My recommendation is for you to go to medicare.gov. There is a lot of accurate information there, and you can look for your specific insurance situation. People don't like to go to government sites for some reason, but as far as I can tell the above are trying hard to make the information available. They're not perfect of course, but neither are all of the millions of people they serve, so take internet complaints with a grain of salt. I guess we all do that sort of thing automatically when a forum title reads "rare stainless model 53".

I would suggest hanging loose for a while as there are huge changes in the works with Obamacare. What is true today will absolutely not be true a year from now when you qualify.

Bob

Very true.

But hanging loose can be costly. Waiting too long can cause a loss of the ability to get covered.

We learned that the medicare prescription plan is a joke. It is costly and only covers certain meds. My wife is on 19 meds, the most expensive is $480 per month (not covered by medicare plans) and the cheapest is $4 (medicare pays $1).

The ironic part with us is my wife coud be taking Embrel at $1400 a month. Medicare does not cover it at all in any form. Instead she takes Remicade at $7000 per month and medicare pays $3400 of it and our supplement pays the rest. Embrel works better for her but it is not covered by medicare.

My wife and I have had Medicare for the past 5 years. I would highly recommend getting a supplemental policy. Although ours is up to $530 per month now, it is worth it. No vision or dental coverage, but a big discount on meds until you hit the donut hole.

My wife has COPD, but I am in pretty good health. I am on some pretty expensive meds, and so is she. United American is our supplemental provider and we have not paid one extra dollar for office visits, procedures, etc for the last 5 years.

Getting older sucks, but you need to protect yourself again a catastrophic situation.

This also changes as costs for private plans soar under Obamacare. The full impact is in I believe 2014. However, companies must account for it now and this is the multi million dollar charges against earnings you've seen in the last several weeks. Medicare drug coverage will most assuredly be the best you'll be able to get in a few years.

Bob

You say you are a vet and on VA. The important question is are you retired military? If you are, you absolutely must get on medicare and pay part B when you reach 65, otherwise your tricare rights and benefits will disappear.

Medicare is presently my third source for coverage, wife's plan primary, my plan secondary. Yes, the monthly deductions from her pay and my pension are up there but I wouldn't want to just have to rely on Medicare for coverage and who knows what BHO will try to do next.

"But hanging loose can be costly. Waiting too long can cause a loss of the ability to get covered."

Yes, it can. You must sign up at age 65 or when your or your spouse's working insurance coverage (from actual employment with a company that employs 20 or more people) ends. There is no fee for Part A (hospital coverage), but Part B (doctor's visits) does cost. If you don't sign up for Part B when first eligible, you must wait for a window that opens from January to March and the coverage doesn't start until July of that year. Plus, there is a 10% penalty for each year that you skip. IIRC, the current Part B fee is about $114 a month, if you sign up this year, and it can be taken out of your Social Security check.

Check with 1-800-MEDICARE or your local Social Security office. The SSA can sign you up, but other than that, you have to contact Medicare directly for other questions, such as supplemental plans, like Part D (prescriptions).

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John 3:16
WAR EAGLE!

My medicare supplement policy just went up 48% this month. Thanks to the new health care plan..

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Regards,
Windjammer

When eligible, Medicare will become primary to my BC/BS.

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Sure you did

I was the Director of Patient Financial Services at a 325 bed hospital for 35 years, and retired 5 years ago.

So far you have been given some very good information, except that there is now Prescription Drug benefits available, but you have to buy a policy for about $20 - $40 per month.

Medicare is not an insurance, it is a federal law, so they make up their own regulations. There are in excess of 10 thousand pages of regulations for Medicare when I retired.

To be eligible for Medicare you must have worked under Social Security and paid in 40 quarters.

Medicare Part A is provided at no cost and is the part that pays for Hospital care. There is a deductible, currently $1068 for the first 60 days of hospitalization, then a "Co-Pay" of $267 each day for the 61-90 day and then a "co-pay" of $534 per day for each (Life time reserve day, which can only be used one time in your lifetime) from the 91 - 150 day. This is per "Spell of Illness", which will be broken and a new "Spell of Illness" will start once you are out of a hospital for at least 60 days.

There is a lot mere to it, but that's the basic's.

Medicare Part B. This is the part that pays for the physicians bills and all hospital out-patient services, physical therapy, lab work x-ray, etc. You have to purchase this and the premium can be deducted directly from your SS check and is $96.40 per month in 2010. Part B pays 80% of the "Covered Service" (after an annual $135 deductible), but pays the Medicare "Approved Amount", and you will have to pay the 20% of the "approved amount". ("If your physician or provider accepts Medicare assignment", otherwise you will have to pay it all.) Make sure your physician will accept assignment. Most do, but with the "new" government interference many may change their minds.

Medicare Part D. This is the part that pays for prescription drugs. You have to buy a Medicare approved insurance plan, and there are many which all pay different amounts on different drugs. This is where you really have to shop for the plan that fits what drugs you personally need to use. It is not unusual for a husband and wife to each have different policies as they have different drug needs. There will be "Tiers" with different co-pays for drugs in different tiers.

Unless you are wealthy, you need a supplemental insurance policy, and there are a lot of them, and you need to shop as there can be over $1000 per year difference between plans.

My recommendation is to locate an Insurance agent that specializes in Medicare supplements and Long Term Care policies. Ask around you will find friends and associates that will be able to recommend one. Start at least there months before your 65 to get it all lined out. There should be a Senior center in your area, and they can also help direct you.

Good luck, This was just a tip of the iceberg on the whole subject. Medicare produces a booklet, "Medicare and You" each year with all the new changes. There should be one available at your local Social Security office. Get one and read it for more information.

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H Richard
SWCA1967 SWHF244

The monthly premium for Part B can be well over $300 a month. SSA "adjusts" the premium based on your last annual income as reported to them by the IRS. Funny thing is that you could actually blame Bush for this one.

Bob

This is incorrect. Part B changes in amouts each year but Part B is only $96.40 per month and is the same for everyone. Part B is not adjusted on income.

Part D is a new item only implemented in the last few years and it can be pricey, depending on the medicines you take. There should be something said about if you require a new medicine and it is not on your Part D plan, then you pay for that medicine.

Best thing is buy a supplemental and hopefully it will be one that pays some on medicine.

Supplemental plans will vary from state to state.

I don't know about that. Happened to a friend of mine, his premium jumped up to about $140 or so.

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Sure you did

Here it is from the US Government site.

Will my Medicare Part B premium increase in 2010?

The premium is $96.40 no matter what you earn, have or status. It is the same for all unless you are earning over a $170,000 a year.

Notice the Table Part 1 for monthly amount for those over $170,000.

Mine will be 96.40 per month.

It's called IRMAA - Income Related Medicare Adjustment Amount. It's based on your reportable income from two years ago, and some people do pay a significant premium. The amount doesn't affect most taxpayers, just those in the higher brackets. It can sometimes ding somebody who had a one-time large capital gains income, but there are provisions to modify it for that and other reasons.

Other people who pay a higher Part B are the thrifty gamblers who decided they would roll the dice and not take Part B when first eligible to save money per month, hoping their health would hold out. When they do sign up X years later because they have to for some medical event, it costs extra, and is pro-rated by the amount of time you've avoided paying for it. Unless the patient doesn't have any money or resources, then Medicaid (you) pay the Medicare premium and other expenses. You don't see these folks as often as you used to.

You have many choices both for the supplemental and drug (part D) the costs vary with what you select. You want more you must pay more. The sites are good and can help you.
The part D plans are not all the same and do cover different drugs, my sister takes an arthritis drug which is only covered by some plans.
Expect part D plans to go up in price a bunch because the “hole in the donut” is now being covered thanks to Obamacare.

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Ipsis Rebus Dictantitbus

Just one question. When I have all thousands and thousands of dollars of unpaid medical bills, I can set up a $10.00 or $20.00 mounthly payment plan, correct?

That's between you and the medical care provider, not Medicare.

As stated, that is between you and the provider, not medicare.

In 2004, I had surgery that left me with a $28,000 balance. The hospital would not settle for anything less than $500 a month payment. Either I pay or they enter suit.

Adjustments start at $85,000 for singles and can go as high as $353.60/mo. Here's an explaination from HHS.

2010 Part B Premium Amounts for Persons with Higher Income Levels

Bob

My wife and I are on Medicare. However, we are on Humana advantage plan. Medicare pays Humana for the service. We pay absolutely nothing for the plan. It pays for primary doctor's service, cost for specialist is $25.00. All of the labs, all types of x-rays, drugs tiers 1 and 2 zero co-payment. Hospital emergency is $50.00 and $75.00 for hospital admitance etc. for generics, zero cost. It would be a shame if the the health plan discontinues this service. However, in Pasco County, Hernando and Pinellas, the premium is zero because of the senior population. Check with Humana and see what you can save in your area. Hope this helps. I would not think of any other service.

Hobby-Gunsmith

Can you go to doctors and hospitals of your choise..?

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Regards,
Windjammer

With regular Medicare, yes, (but some Dr.'s may not accept Medicare assignment). If you have a Medicare "Advantage" plan (I feel sorry for you), no, that is a managed care contract, and many Hospitals and Dr's don't participate with them.

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H Richard
SWCA1967 SWHF244

Obamacare severely limits the amount of money available for the Advantage Plans, but does not kick in immediately.
If you are interested in Medicare Advantage this year may be your last chance to enroll.
This all may change dependent upon this fall’s elections, and will probably have to be changed anyway, those in a plan may well be “Grandfathered”.

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Ipsis Rebus Dictantitbus

It would be easier to ask who isn't.

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All Rights Reserved

OK, I am not understanding this. If you pay nothing, where does the company make their money. Someone has to pay and I know for sure it is not going to be Medicare. It may come out of some retirement check before you get it but someone pays from some place.

Thanks for the clarification. It IS income based.

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Sure you did