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Sat Feb 23, 2013, 11:05 AM

What I learned about Medicare and "supplement" Medicare

When you are choosing a Medicare supplement please consider very carefully! I chose AARP-United Health Care, because it was free. Plus it gives coverage for some vision and dental work which Medicare does not.

I assumed, that bec. "supplement" means in English ADD TO, that the supplement would provide things where Medicare coverage stops.

big whoops! My supplemental plan does NOT supplement Medicare it replaces it.
What this means in my case is that the therapist I was going to, who thot she was going to be remimbursed by medicare (as did I) is not - bec. the AARP plan does not cover her, therefore I am shit out of luck.

Altho if I didn't have the AARP, Medicare would cover it.

Of course when I signed up, the person in the Senior Center who was helping me, {they call them SHP Counselors - some are very good, some, like mine, are shit.} did NOT tell me this.

She also did not tell me that once I signed up, I would have a brief time (which ended Feb 14) to change plans. So no matter how dissatisfied I am with the plan, --and it alround SUCKS - besides this particular issue -- I am stuck with it.

America land of the free, right!
I hate this country and the rich fucks who run it.

~~~
Hope my experience helps someone --check out the plan you are considering very very carefully!!

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Response to ellenrr (Original post)

Sat Feb 23, 2013, 11:25 AM

1. thanks!

I turn 65 in January so those decisions are coming up for me.

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Response to ellenrr (Original post)

Sat Feb 23, 2013, 11:27 AM

2. I found this

http://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html

What's Medicare supplement (Medigap) insurance?
A Medicare supplement (Medigap) insurance, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

8 things to know about Medigap policies

You must have Medicare Part A and Part B.
If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.
Medigap policies don't cover everything

Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Insurance plans that aren't Medigap

Some types of insurance aren't Medigap plans, they include:

Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
Medicare Prescription Drug Plans
Medicaid
Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
TRICARE
Veterans' benefits
Long-term care insurance policies
Indian Health Service, Tribal, and Urban Indian Health plans
Dropping your entire Medigap policy (not just the drug coverage)

If you decide to drop the entire Medigap policy, you need to be careful about the timing. For example, you may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage), or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.

If you drop your entire Medigap policy and the drug coverage wasn't creditable or you go more than 63 days before your new Medicare coverage begins, you have to pay a late enrollment penalty for your Medicare Prescription Drug Plan, if you choose to join one.

For more information

Find a Medigap policy.
Call your State Health Insurance Assistance Program (SHIP).
Call your State Insurance Department.

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Response to ellenrr (Original post)

Sat Feb 23, 2013, 11:48 AM

3. AARP-United Health Care paid nearly 100%

of my mother's $100,000 ankle replacement surgery. She paid $350 in deductables to the hospital and $750.00 to a rehab center.

Worked well for our family.

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Response to ellenrr (Original post)

Sat Feb 23, 2013, 01:05 PM

4. Sounds like you got Medicare Advantage.

That is just a scheme to privatize Medicare. A Medigap policy is what you need. As her guardian, I handled both for my mother. The Medicare advantage was better for her when she was confined to a nursing home. I still don't understand why, maybe it was the prescriptions.

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Response to ellenrr (Original post)

Sat Feb 23, 2013, 07:10 PM

5. bookmarking because , at 63, I am confused as hell abut this stuff..

Also, because my husband is a fed retiree, I'm not sure If the coverage that came with his pension phases me off when I turn 65.. or what..

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Response to ellenrr (Original post)

Sat Feb 23, 2013, 11:01 PM

6. I think you have Medicare Advantage and used a provider outside the network.

Truthfully, I think I will sign up for a Medicare Advantage plan when I'm eligible in a few years. I like the idea of more coordinated care. The feds have enough control over these plans that I'm not too worried about it being a private insurer.

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Response to ellenrr (Original post)

Sun Feb 24, 2013, 08:35 AM

7. bad advice from SHIP volunteer on Medicare Supplement vs. Medicare Advantage

 

ellenrr

Do not give up yet.

If you made a switch from a private Medigap plan to a public Medicare Advantage plan FOR THE FIRST TIME sometime in the last 12 months you may be able to switch back. Also. if you received bad advice from a SHIP volunteer at the senior center, you may be able to switch back. See special situations at this government web site: http://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances/join-plan-special-circumstances.html#collapse-3221 And of course you can switch back next year.

Also you may be able to negotiate a deal with your therapist to pay him or her cash with the money you are saving by having no supplemental premium this year. And you can go to a therapist that is covered by AARP.

However, when you switch, get good information this time. There is some bad information in this thread and elsewhere on the Internet. Trust medicare.gov (in the rare case that it's wrong, you have proof that a federal employee gave you bad advice and can almost always then reverse the choice). Both the public Medicare Advantage approach and the private Medigap approach to supplementing Original Medicare Parts A and B have pluses and minuses.

The public Part C Medicare Advantage approach is typically but not always a classic HMO, what is being called an accountable care organization by Obamacare. HMOs and ACOs are the wave of the future supposedly because you get coordinated care from a primary care physician. Some Medicare Part C health plans are PPOs, not quite as coordinated but still coordinated. It is not a case that your new AARP insurance replaced your Medicare (in fact you have to be on Original Medicare Parts A and B -- and keep paying your B premium -- in order to sign up for Part C) but just a case that your therapist is not in the HMO or PPO. You are right that your SHIP volunteer should have explained this and if she or he did not, this alone might be grounds to allow you to switch back right away. Medicare Part C plans are also geographically restricted to your local region for normal treatment

But public Part C Medicare Advantage has some important advantages too. The most important is that all Part C plans offer catastrophic coverage. Original LBJ Medicare does not. Most private Medigap plans do not. Also as you found out, most Part C plans cost less than the combination of Original Medicare and a private Medigap plan and offer more services, such as dental and vision coverage but also usually drug coverage, annual physicals and even coverage outside of the U.S. (I'm not suggesting that you're considering the grand tour but -- depending on where you live -- you might want to head over the border to Nassau, Niagara Falls, Vancouver or Mexico for a few days vacation. Original Medicare and most private Medigap plans will not cover you if you take such a mini-vacation and get sick--even in an emergency.)

Private Medigap plans offer the reverse. They typically cost more but let you go to any doctor that accepts Medicare, like -- apparently -- your therapist, anywhere INSIDE the United States ANYTIME without a referral from a PCP. Great if you spend the winter in the south and the summer in the north. Also can be a good deal if you don't have a lot of medical issues and no drug needs (take the cheapest Medigap plan and no Part D).

Like everything else in life, it just depends.

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Response to dennisbyron (Reply #7)

Mon Feb 25, 2013, 02:04 PM

8. thanks for posting. glad you decided to join in!

Do you have to make all of these decisions within the first few months when you sign up?

Can you add more coverage as you get older, or are you locked in at 65?

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Response to ellenrr (Original post)

Wed Mar 13, 2013, 04:07 PM

9. I am on the verge of getting "medigap" coverage (turn 65 in May)...

http://medicare-supplement.us/

This is a private agent, Garrett Ball. He specializes in comparing medigap coverage in your state/area according to your age and zip code. He sums up the coverage (not in complete detail) and identifies the companies in your state which offer various plans and their costs. For example, plan F is the fullest coverage, but costs $20>> more a month than plan G, which does the same thing, but does not pay the deductible of Part B (approx. $150/yr); hence plan G can be a better choice. He also speaks to "upgrades" of policies whereby you can drop a plan and sign up for another in most cases without going through being subject to a time "window." So, my plan will probably be Medicare ($105 deduct. from SS for Part B), and medigap plan G ($99 deduct. from my acct. by AFLAC) for a total of under $210/mo. Check the web site, it is easy to use and you can e-mail questions and get a quick response (well less than a day).

Good luck to you and me!

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Response to ellenrr (Original post)

Thu Mar 21, 2013, 07:24 AM

10. This is why we should have universal health care!!

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Response to ellenrr (Original post)

Wed May 29, 2013, 10:18 PM

11. This is all so complicated it is obscene. Whose interests are served by having

the choices be so byzantine? We know the answer to that question.

Sorting through the processes, and the medical insurance companies interested in your supplement dollar, is a huge mess.

Single payer! Now!

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Response to ellenrr (Original post)

Thu May 30, 2013, 02:57 PM

12. I am turning 65 in August, and even though I consider myself a fairly

intelligent person, I'm as confused as hell about all these choices.

I FINALLY figured out, after reading stuff on the social security website, that I only need to sign up for Part A, because I'm working for a large enough company (I think it's 50 employees or more) that provides health care coverage, and I intend to continue working for several more years.

I work at a hospital, and our coverage seems pretty good. Not that I often use it, given that I'm exceptionally healthy, basically never sick. I did break an arm four years ago, and last year I had cataract surgery, but that's it.

One of my friends at the hospital who works in our billing department, said to me that her advice is to sign up for Part A, someday get Part B, but do not get one of the Advantage Plans, (Part C) because in her opinion they all too often wind up covering less than A and B will.

Part D is the prescription coverage, which I don't need to worry about until I leave this job. And since I don't take any prescription meds, I guess my best bet is to sign up for the cheapest possible coverage, and then refigure everything if I'm put on any prescriptions.

It's all entirely too confusing, it really is.

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Response to SheilaT (Reply #12)

Thu May 30, 2013, 03:36 PM

13. Isn't there a penalty if you don't sign up for B

during the initial enrollment period? By penalty, I mean it will cost more.

I will turn 65 in Jan. I don't know what to do. I'm retired already, and don't have any coverage.
I haven't been to the doctor in over 20 years except for mammograms. I'm very lucky.

I could afford around $250.00 per month. My husband will be getting his on the Obamacare program. He is only 60.

Edit to add... I just read this:

There are NO annual enrollment periods for Medicare Supplements, contrary to popular belief. You have a 6-month initial enrollment period when you first turn 65 or enroll in Part B. During this time, there is no medical underwriting or health questions. After that time, you can sign up for a supplement or change your supplement at any time; however, you do have to answer health questions.

--- this would make a difference for me I bet. I'm healthy, but would be considered overweight by the insurance industry.

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Response to OKNancy (Reply #13)

Thu May 30, 2013, 10:33 PM

14. There is no penalty if you have other coverage, which I do.

And will have until I leave this job, which I expect to stay in for a few more years. I only work part time so it's very sweet.

I work for a hospital, and I've been very happy with the health care coverage, for the two times I've used it. One of my co-workers has a number of health issues, and she's also as happy as a person can be given it's still not the kind of universal coverage it ought to be.

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