Medicare Question

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.

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.

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

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.

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.

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.