is medicare good to have?

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Illy
Regular Member


Date Joined May 2008
Total Posts : 117
   Posted 6/27/2008 12:50 AM (GMT -7)   
I get SS for disability.  I get almost $100 taken out of my check every month.  I haven't registered it yet and I've heard it's possible to refuse it and keep the $.  my experience with family member is they don't pay much, they have lots of exclulsions, but someone said they cover Calprotectin test, for instance, which my private insurer would not, I'm sure.
 
can you folks please weigh in on how well Medicare covers tests and procedures?  if they would cover my capsule endoscopy and a calprotectin test, that would already equal my monthly payments for 2008.
 
thanks a lot!

Dave D
Regular Member


Date Joined Aug 2005
Total Posts : 404
   Posted 6/27/2008 4:45 AM (GMT -7)   
My experience is this: I went on medicare 8 years ago. Previously I had a group BCBS plan from my former employer. It runs in my mind that it ran about $300 a mionth and had very good payoffs. Now I have Medicare plus a BCBS secondary plan and my total premium expenditure is still about the same, even though I'm older. So, it's about a push, but in my case the private insurance plan discontinued so I had no choice.
Dave D
Retired male in late 60's. Perforated Colon in 92. Diagnosed as Ulcerative Colitis in 93. Uncontrolled flareup in 97 dictated J-pouch surgery. 04 Capsule endoscopy diagnosed as Crohns not UC. Emergency surgery in 05 to remove lodged camera capsule. Biopsies positively diagnosed Crohns at that time. 12/06 Unsucessfully tried Naltrexone(LDN). 2/07 developed scleritis of the eye, tearing and detaching the retina. Treated with high doses of Prednisone. 6/07 Thought eye was healing and started taking Entocort counting on the residual (non-systemic portion) as treating the eye. Wrong. In October eye was not stabilized. 11/07 Started Remicade to try and reduce the ocular inflamation of the Scleritis since I had been requiring more and more Prednisone to keep the eye quiet. 12/07, retina tares and detaches again. Started Remicade every 4 weeks plus 20mg of Prednisone per day. Six months and seven infusions later, good eye is back to 20/14. Bad eye is 20/70. Had cataract surgery on June 05 on bad eye. Eye returned to a correctable visionary level of 20/40. Life looks good (literally) today.
Married with 4 grandkids.


CrohnieToo
Veteran Member


Date Joined May 2003
Total Posts : 9448
   Posted 6/27/2008 6:22 AM (GMT -7)   
My experience is similar to DaveD's. Close to the same time length too. Our group BC/BS plan was excellent. We paid our own office calls, other than that it covered everything we had had done. But that was an option we willingly chose all our life, pay our own doctor office calls in return for being able to go to any doctor, anywhere in the US, have all procedures, etc. covered. So our coverage remained the same but our office call cost was reduced to 20% of the amount that Medicare allows for that office call.

I do understand that in some areas there are doctors who aren't taking new Medicare patients or who restrict the number of Medicare patients as part of their practice but I've never heard of one turning away an established patient when that patient had to revert to Medicare coverage. The last two years our secondary insurance covereage has been reduced somewhat but that has nothing to do w/Medicare and everything to do w/the company, now union, that provides it as part of our retirement benefits.
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.


nruth
Regular Member


Date Joined Mar 2006
Total Posts : 195
   Posted 6/27/2008 8:35 AM (GMT -7)   
I've been happy with Medicare. I also have a good supplemental plan that is reasonably priced, and they pick up everything that Medicare doesn't pay...which is generally 20%. I have no complaints.

CrohnieToo
Veteran Member


Date Joined May 2003
Total Posts : 9448
   Posted 6/27/2008 2:27 PM (GMT -7)   
I'll tell you what I HAVE run into w/Medicare tho. This is in relation to durable medical equipment. Sheister DME suppliers who like to provide bottom of the line equipment and tell you Medicare won't pay for a slightly better quality product. I've found that you can NOT believe WAY TOO MANY local DME suppliers. If they don't outright lie, they are less than truthful - and if you dig out the coverage info yourself, including providing them w/the proper HCPCS code - goshes, they didn't know that! And/or they conveniently weren't aware of the allowed interval for replacement items or even that they were replaceable by Medicare.

Just as one "for instance": CPAPs (continuous positive airway pressure devices for sleep apnea). All straight CPAPs, from bare bone devices, thru compliance data only devices thru fully data capable devices are billed and reimbursed by ONE HCPCS code, Medicare has NO idea what brand and model, just that the device is an HCPCS code E0601. Of course, the fully data capable devices are somewhat more expensive than the bare bone devices so IF the DME supplier provides you w/a bare bone device their profit margin is greater. So they try to convince you, if you know enough to insist on a fully data capable device, that Medicare won't pay for it or that YOU must pay extra out of pocket for it. Both stories are just plain HORSEPUCKIES! The price they are allowed and are paid for this HCPCS code WAY MORE THAN COVERS the price of purchasing it online via a reputable internet DME supplier (who is also making a profit on the same device).

Which wouldn't be so bad IF they actually provided the education, support and service they claim as the reason for their higher prices. But way too many of them DON'T. Three of the leading interface manufacturers will replace FREE to the local DME supplier most ALL of their interfaces that a patient has tried and been unsuccessful w/IF the supplier fills out a form and returns them w/in 30 days. Yet way too few local DME suppliers have a reasonable much less lenient interface exchange policy. Once your proper pressure need has been established the interface is THE KEY to successful CPAP compliance and therapy.

All too often the blame is placed on Medicare or the insurances when it is strictly a matter of protecting and padding the local DME suppliers' profit margins.

Of course, if one hasn't yet been successful w/their CPAP therapy and is still severely sleep deprived it can be a real pleasure to vent your spleen by thwarting the DME suppliers' lies and half truths w/the facts and printed proof. *wicked grin*
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.


Illy
Regular Member


Date Joined May 2008
Total Posts : 117
   Posted 6/28/2008 3:04 AM (GMT -7)   
Sorry you had that experience, CrohnieToo.  Good to know the ins and outs of the medical supplies industry.  it occurs to me that the same thing might/could happen with regular insurance, too.  Maybe if you have a few more bad experiences you can write a book. eyes

CrohnieToo
Veteran Member


Date Joined May 2003
Total Posts : 9448
   Posted 6/28/2008 4:33 AM (GMT -7)   
Oh yes, Illy. It applies to insurances as well. Insurances contract w/local DME suppliers with certain prices for certain HCPCS codes, not the brand and model of an item, just by the code for that item. Insurances generally contract at a somewhat higher reimbursement than Medicare. But Medicare makes up the largest part of a local DME suppliers income. Very few online DME suppliers accept insurance, if any; one of the reason's for their lower prices, drastically less paperwork.
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.

New Topic Post Reply Printable Version
Forum Information
Currently it is Wednesday, December 07, 2016 5:12 PM (GMT -7)
There are a total of 2,734,354 posts in 301,204 threads.
View Active Threads


Who's Online
This forum has 151324 registered members. Please welcome our newest member, worldviews.
363 Guest(s), 11 Registered Member(s) are currently online.  Details
Psilociraptor, Tnmproject, desert bound, Jasperilla, mikeb2308, northerner, dismissed, Scaredy Cat, U B Tough, Suffering34, Hilander64


Follow HealingWell.com on Facebook  Follow HealingWell.com on Twitter  Follow HealingWell.com on Pinterest
Advertisement
Advertisement

©1996-2016 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer