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Fri Nov 30, 2012, 05:14 AM

I have questions about Medicare

I am years away from being eligible for Medicare myself--and strongly believe in preserving it. It is a promise we have made to the older generation and we BETTER NOT renege on it.

However--can someone simply explain to me some of the ins and outs of how the Medicare system works? I see stuff about part A Part B etc--what are all these different pieces to it? Are you automatically enrolled in all the parts or do they cost extra?

I know that some people have some sort of supplemental insurance that works along with Medicare--is this necessary or does Medicare on its own cover most needs?

I have heard that it is nearly impossible to get private insurance if you are elderly--so people have no choice other than Medicare. Is this true? Will the new law help with this? (If a senior wants to buy a private policy to supplement their Medicare?) After all--if they can no longer discriminate for pre existing conditions--why allow them to discriminate based on age?

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Response to brokechris (Original post)

Fri Nov 30, 2012, 08:07 AM

1. Those are actually pretty good questions, good for people to have at least an overview.


Look at this link - http://healthinsurance.about.com/od/medicare/a/medicare_overview.htm

I believe what you asked about in your last question is covered under Part C of Medicare.

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Response to jtuck004 (Reply #1)

Fri Nov 30, 2012, 09:32 AM

2. Minor correction.

Part C is actually Medicare Advantage. I know... it makes no sense.


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Response to DURHAM D (Reply #2)

Fri Nov 30, 2012, 01:05 PM

5. Thank you. n/t

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Response to jtuck004 (Reply #1)

Fri Nov 30, 2012, 01:30 PM

6. thanks! I actually was worried

that I would seem ignorant--but it is hard to figure out. I'm trying to learn more about healthcare.

And Medicare is particularly important--because we will all need it eventually.

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Response to brokechris (Reply #6)

Fri Nov 30, 2012, 03:39 PM

10. Funny. People start out trying to learn, and it's fun, what other people think isn't a

barrier to learning.

Then we send them to school for 12 years or more, and suddenly, instead of questions, you get fear and worry.

sigh, progress...

But you picked a good place to ask the question - and as I demonstrated, if you are a bit wrong there is always someone here who knows better - and most times that's really worthwhile



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Response to brokechris (Original post)

Fri Nov 30, 2012, 09:36 AM

3. Medicare basically covers 80% of my Part B (Part A is the hospital) which is dr. visits.

Part D is the prescription coverage.

So I have a supplementary policy through AARP to cover the 20% and another prescription drug plan. Both that cost and a set amount for medical is taken out of my SS check each month. I pay the extra supplemental out of pocket each month.

Other health needs are not covered by Medicare such as certain charges in my vision health needs and none of my dental needs.

The poor must rely also on Medicaid kicking in what Medicare doesn't cover but I am not familiar with how that works exactly since I wouldn't qualify for Medicaid...

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Response to CTyankee (Reply #3)

Fri Nov 30, 2012, 01:32 PM

7. thanks! n/t

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Response to brokechris (Reply #7)

Fri Nov 30, 2012, 03:21 PM

9. I have also called Medicare and got a prompt answer by a knowledgeable person who

answered all my questions thoroughly. There was no waiting, no "I'll have to ask a supervisor." It was great. I was dreading the call but I remembered how easy it was when I signed up for SS. I dreaded that, too, but had a wonderful person on the other end of the line. Everything we very smoothly. I've had more trouble returning Christmas presents!

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Response to brokechris (Original post)

Fri Nov 30, 2012, 09:54 AM

4. Medicare is complicated but there are lots of good websites.

When you turn 65 you call and enroll in Part A and B. A is hospitalization coverage and B is doctor visits and tests, etc. If you have worked 10 years you are automatically eligible for Parts A and B. Part A does not cost anything. Part B in 2013 costs about $100 a month. The $100 is taken from your SS check if you are receiving one and if not you pay quarterly in advance to the government.

Both A & B have deductibles and are 80% coverage. If you want insurance to cover the remaining 20% exposure (and the deductibles) you can buy a Supplemental or Medigap policy from a private insurance company. There are 100s of different medigap policies with different deductible amounts, costs, etc.

Part D is coverage for prescriptions. There is no drug coverage in Medicare so you buy this from private insurance companies. There are dozens of different companies and types of coverage.

I have just described "regular" medicare. So for me the $100 is automatically taken from my SS check and I send a check to one insurance company for the 20% Medicare Medigap coverage (Parts A & B) and send another check to a different insurance company for Part D coverage.

The other option is Part C or Medicare Advantage - often referred to as "not regular Medicare". It is all in one shopping for Parts A, B and D and can also include dental and eye coverage. The plans are sold by private insurance companies.

With regular Medicare you pick your own doctors. With Medicare Advantage you are enrolling in an HMO or PPO.

Starting a year before you turn 65 you will begin to receive stacks and stacks of mail every day with insurance company offers.

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Response to DURHAM D (Reply #4)

Fri Nov 30, 2012, 01:34 PM

8. lots of great detail---very helpful! nt

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Response to brokechris (Original post)

Fri Nov 30, 2012, 03:50 PM

11. Part A is the only part that a 65+ y/o senior gets that there is no premium to pay.

It's the hospitalization part and doesn't cover routine office visits to a doctor. When you enroll in Part B (doctor's visits) or Part D(prescription drugs), premiums are deducted from your social security. You do have co-pays on the latter two so many of us buy supplemental insurance to cover what Medicare doesn't.

Medicare Part C are the Medicare Advantage programs where you sign your Medicare rights off to a private insurance or HMO company. The benefits and co-pays vary with the company like regular insurance. They can't deny you coverage, but they do limit the doctors you can see and other restrictions. There are some chronic diseases they won't cover like end stage renal disease. Mostly I find they are crap because providers don't want to accept them. Even when you get a list of providers, the providers usually tell you that they have stopped accepting new patients, however, when you go back on traditional Medicare, they suddenly are accepting new patients.

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