Medicare Question

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Retired Mom
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Date Joined Feb 2010
Total Posts : 1753
   Posted 12/5/2010 9:14 AM (GMT -6)   
Hi all,
 
I understand from the SSD people that Medicare is awarded 2 years after SSD (not sure if the start date is two years from date of disability or two years from date of first payment or what).  Anyway, I have absolutely NO knowledge of Medicare and currently have a State Health Benefit Plan through United Healthcare Choice (HMO).  I will not be giving that one up because it is a family policy, but I have no idea about Medicare and what it pays for, or even does.   I would appreciate information from anyone who has used Medicare on what type benefits it offers and if it covers Dr visits, hospital stays, medications, PT, or what.
 
I know I can look this up online, but personal information seems to be much better than that put out by an agency. 
 
Please no horror stories though, I'm only looking for general information and I don't want to start a debate at all.....especially a political one. :-)
 
Thanks!
Retired Mom

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 12/5/2010 12:18 PM (GMT -6)   
My mother is on medicare. Her DR visits are free, she has low co-pays on medication, they pay all other bills up to 80% of it.
I'd definitely keep the UHC HMO. It will help with the extra cost.
Joy

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 5028
   Posted 12/5/2010 4:35 PM (GMT -6)   
The problem with straight Medicare is that if you have a heart attaack or something else that's expensive you are going to pay 20% out of pocket, and that's after your deductible. that could amount to several thousands of dollars.

There are tons of Medicare "advantage" plans - supplements - that will pay much better, and are accepted by docs who don't accept straight Medicare. Quite a few have no premium, just a deductible. So if you don't get sick you pay nothing.

Do understand that everyone, straight M or supplement, has to pay "part B."

Medicare doctor visits are not free, even if you also have Medicaide, although that pays most stuff. There is a deductible up front. Advantage supplement plans have various "co-pays" for doctor visits, which do not count towards any deductible.

The best way to figure out what plan is best for you is to visit the medicare.gov website and plug in your numbers. It will calculate which plan is best for your particular circumstance.

Since not all plans are available in every state and every county within the states, you have to go to seminars, look on the websites and figure out what works for you.

For my husband, who never has doctor visits, takes no meds, the "high deductible" with no premium is best. If he would suddenly have a stroke or something he would only have to pay the deductible, not the 20% of the total cost.

For me, and I take a number of meds, last year was treated for breast cancer and had a some surgical procedures and lots of MRIs, CTs and other tests, have lots of doc visits for pain from fibro, arthritis, pinched nerves, the same plan is best. I paid the deductible off mid-year and will get my colonoscopy for free this week.

Straight Medicare does not cover medicines. You have to have some sort of additional policy for that. Advantage plans do cover meds, although there are co-pays.

Since most docs I know are dropping out of straight Medicare, if you want to keep your docs you'd better ask them what plans they do accept before just jumping into any of them.
Alcie
 
 

straydog
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Date Joined Feb 2003
Total Posts : 16787
   Posted 12/5/2010 4:40 PM (GMT -6)   
I am on regular Medicare because it is less controlled, meaning I can go to any dr that accepts Medicare not all drs do and it is getting tougher finding good drs because they have cut the fees so bad many drs will not mess with it and I don't blame them one bit. Medicare offers HMO's and PPO's but you are controlled in those programs on what drs and hospital you can have treatment with. Meaning you have to see drs and hospitals on the list. There is no set amount I can give you on what regular Medicare pays because its so different. They have their schedule of what they pay at 80%. Right now next years fees if you are hospitalized is we pay the first $1,100 up front and they pay 80%. If you get re-admitted for the same problem within three months of the original problem you do not have to pay the $1,100. But, if its after 3 months another admission another $1,100. Each year Medicare changes up what they will pay for and what they won't pay for and you are mailed a new booklet each year setting out. Its really controlled in so many ways either way you go, regular Medicare or the HMO or PPO. I want to say the 24 months start at the date of disability SSD uses. Medicare only pays for certain things like a Bone Density test every two years at 80%, Colonoscopy every 2 years, they do restrict you believe me. RM by the time you are eligible for whatever you decide to choose, it will have changed up so much I would worry about it until it is getting closer to your time to start having to use this coverage. Some of the HMO & PPO's I believe are only offered in certain states, its just a whole different ballgame is all I can tell you. I have been lucky, all of my specialists accept Medicare, except I did have to find a new PCP. The drug plan offered is a joke in my book, none of my meds are on it and like my husband if we buy a drug plan for him, it will cost more to have it than what we pay for his scripts. I get his meds generics $10.99 for 3 months, Medicare can't match that. We got hit with the donut hole early this year because his insulin is so expense so the last 3 months of the year he had no drug coverage thanks to the donut hole. You really have to do your homework with this stuff believe me. You know I still have his insurance since I am under 65, but it is considered my secondary insurance and I still have my script card, thats the only reason we keep it is because of the script card. We pay $530 a month for my insurance thru his employer. They do not pay hardly anything to my drs or hospitals and I always end up paying much more than them. If it weren't for the script card I would change. The reason we keep it on me is the Forteo is $1,000 a month, my Humira for the crohns is $1,000 a month, plus 16 other scripts I take. My drugs a month are astronomical and I need the script card for that reason. Its kind of a switch off I guess.

All I can say is enjoy your husbands insurance as long as you can. I know once I went to Medicare I felt like I was on an indigent plan and a dr tried to discriminate me because of Medicare. Drs have a different tone with you as a patient when you are on Medicare. At least this has been my experience.
Moderator Chronic Pain Forum

bwald1
New Member


Date Joined Dec 2010
Total Posts : 5
   Posted 12/5/2010 6:40 PM (GMT -6)   
Regarding the 24 month waiting period for SSD. If you are approved for SSD and medical documents support the date of filing as the date your disabilty began then the file date is when the 24 month period begins.

Check with United and they can tell you if they would be primary or secondary to Medicare coverage.

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/5/2010 7:39 PM (GMT -6)   
RetiredMom,
I haven't yet posted to your other thread (just stopping by tonight and trying to stay warm!) but congratulations on your SSD approval!

Since I'm making my way through the early stages just slightly ahead of you I can answer your question about when it starts - it's 24 months after the date you start receiving benefits (including your back pay). For me, that differed from the date of disability determination, since they went back to my surgery date in 2007 and used that as the date of my disability. However, they only pay back benefits for 12 months prior to the date you applied, and so that is the date used to start your 2 yr. wait for Medicare. That's why I still have to wait until next July.

I think what straydog's saying is probably true - it's so complicated and constantly changing that you may want to wait until you are a few months from receiving benefits to start pouring over the choices. I don't think there's any way around us having to learn about the details, unless we just want to go blindly and that could lead to some lousy choices.

I'm waiting until next spring to start that portion of things. I've still got enough paperwork to keep me busy for now! Plus an upcoming knee surgery in January!

Congrats!

PaLady

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 5028
   Posted 12/5/2010 8:14 PM (GMT -6)   
On my high deductible ($0 premium) BC/BS PPO the deductible is $1250, but there is no additional fee or co-pay for tests and hospitalizations after this is paid.  You can have as many tests or hospitalizations as needed.  There's no 20% to pay, nothing but the part B premium that everyone, even straight Medicare pays.  There is no premium for drugs either, just the co-pays.  The drug plan is included in the PPO.
 
The cost of Forteo and Humira would be 1/3 the cost of the drugs - specialty drugs.  But they are at least available.  The problem with those nice reduced price cards is they are no good once you are on Medicare or any of the associated plans.
 
This year specialists cost $15 co-pay.  Next year it's $25.
 
It's a good idea to get the cheap generics, free antibiotics at some pharmacies here, and not have them charged to your plan because they go against your drug "costs" that end you up in the doughnut hole.
 
The best thing is to find out what plans are locally accepted by the most docs.  It's different in different states and parts of the states!  Then look up the plans on the medicare website and have it calculate what is the best plan for you.  I can't recommend straight medicare because if the govt doesn't get moving and stop the 23% doc pay cut there will be a bunch more drop out of accepting it.  We can't wait for the govt to act either.  We have only til the end of this month to change plans.
 
 

harplady
New Member


Date Joined Dec 2010
Total Posts : 3
   Posted 12/6/2010 9:58 PM (GMT -6)   
Actually you will have to wait 2yrs. and 5 months from the date your disability started. There is a 5 month waiting period from the time you were determined disabled and when you received you first disability check. I was awared disability in May of 2008 and could not get medicare until Nov. 1st of 2010.

If you have many doctor visits and take several medications, it would be best to get a medicare advatage plan. There are many different kinds, but only certain ones are available depending on what area you live in. You can look it up on the internet. I tried to get the best policy I could, It costs me $121 a month on top of what I pay for part B. Depending on your household income, they can raise what you pay for part B.

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1753
   Posted 12/7/2010 4:53 AM (GMT -6)   
I really appreciate all the information. It's quite overwhelming, isn't it? I think I'll just do some reading on the SS website in a few weeks or months. I have quite a while yet and this is too muct to take in at one time.

All of you are great! Thanks for the help!
Retired Mom

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16787
   Posted 12/7/2010 2:05 PM (GMT -6)   
RM I knew this would happen, lol. You get so much input on a subject it just gets overwhelming to say the least. That is why I said not to worry about Medicare at this point since you have plenty of time before before needing to be on it. It does change yearly with little changes here & there. I got a letter recently about durable medical supplies which is what my oxygen falls understand in some states they have come up with what is called Competitive Biddding something or another and said to make sure my current company is in this group. If not Medicare will not pay, so I called them and thankfully they are and I have been grandfathered in. But its just little things like this we deal with every year. Oops I need to check on my husbands diabetes supplies to make sure his supplier in this group too. We are sent a new booklet for the following year well in advance to look at any new changes or additions and of course it is all available online.

So, for now don't stress over something you don't need too, you don't need the extra stress. I did not attend any seminar either, actually I don't remember any being offered and I live in a very large city. I was able to decide by reading what info I had available online and what was mailed to me. No way could I have sat thru a seminar. Also you are mailed info with everything you may need when making your decision. It is all a personal preference when deciding which direction to go in whether original Medicare or using a managed care program. For me it was an easy decision, none of my drs participated in any of those programs and I have been with them far too long to change drs in mid stream. Not only that, but the drs that were on these plans I would not have taken my dog to them, so it was an easy decision for me to make. But, it will all change again next year so don't give any of it a thought until you have to, lol.
Moderator Chronic Pain Forum

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/7/2010 4:00 PM (GMT -6)   
RM,
Reading directly from the SS website is the best, most accurate way of getting info, and that's how I clarified a few things - even things I was told on the phone or got in the mail. I'm a little confused as to why you are waiting so long for anything because didn't you apply awhile ago? I would have thought you passed the 5 month wait period.

One way to get some info. about your first check could be to just call your caseworker and ask her to check on their computer, and if you've not received a notice to ask one be sent to you.

I just found out last night (while exploring the SSD website once I was logged in - and you have to get a notice from them about that so you can register your own password) is that I can request a notice be sent to me about being approved for SSD, and even decide some of what I want in that notice - to use for other purposes (like if it's going to be sent as proof of disability to people you don't want to know certain details). I didn't go through the section yet in detail because I'm not sure what I want/need yet, but it's interesting to know that's there. It takes awhile for them to send you the notice as you request it, though, so it's not something you can get last minute (I don't think!).

I definitely agree with straydog about waiting about Medicare stuff. No telling how it's going to change every year, and like she said some of it may get decided rather easily for you by looking at your doctors and what they accept, etc.

One other thing I think I forgot to tell you (maybe I did, mind's not sure so I'll repeat it! LOL) that when I requested a copy of my IME's from my LOCAL SS office, the woman put in a request for a CD to be sent to me with that info. Well, that CD contains ALL the medical information I submitted to them, all they collected, the caseworker's notes, and the IME reports all nice and neat in one place! And free! So you may want to request that (I was there in person, so it made it easy to sign releases, etc.) if you're interested.

And the date you receive your check is tied to your birthdate month and year, like regular Social Security - at least for most people. I believe it comes on the Wed. after the date of that month that's the same as your birthday day. Except mine changed to earlier in the month because I initially got SSI, so I guess they get you your money earlier if they know your resources are nil. I think. I don't know - that one came as a surprise, just like the first check and back pay did!

PaLady :-)

p.s. Just realized I should have put this on your other thread! Oh, a mind is a terrible thing to waste! shakehead eyes

Post Edited (PAlady) : 12/7/2010 2:05:35 PM (GMT-7)


couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 12/7/2010 8:19 PM (GMT -6)   
I talked with my mom. Her medicare is some speciality type that is specific for elderly who live in a "poor" county in Georgia. It's called "Southeast Community Care". You can only get it if you're low income and live in a "poor" county. You might want to see if your county is on the list since you live in Georgia.
Joy
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