Question about Medicare coverage

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NanaBee
Veteran Member


Date Joined Jun 2005
Total Posts : 541
   Posted 11/25/2014 2:07 PM (GMT -6)   
I have qualified for Medicare but I am totally lost as to what is the best way to go. Does anyone have any advice. My doctors will only accept the Original Medicare.

Thank in advance.

Mary Ann

Bsime
Veteran Member


Date Joined Apr 2006
Total Posts : 1341
   Posted 11/25/2014 5:10 PM (GMT -6)   
Are you 65 or younger on medicare and SSD? I have not found any doctors or clinics that will not accept medicare. Of course, basic medicare only pays for 80% and does not pay for meds. To have complete coverage you also need a private medigap policy that covers the other 20% and a private Part D policy that covers your meds. There is only one open enrollment for medigap so choose wisely. Although you can change later you will not have an open enrollment and insurance companies can rate you or turn you down. My wife and I chose Blue Cross/Blue Shield for medigap and after 17 years combined experienced find it great....maybe not the cheapest but everything gets paid. Part D is entirely different. Policies, premiums, formularies change every year and you need to review it in relation to your specific meds every year. We just changed ours but what was good for me was not for my wife. You can do this on www.medicare.gov and there is a find a plan application there. Only way to do it efficiently and make sure you have the cheapest and best plan for you.

There is something called medicare advantage which is private and takes the place of basic medicare and I do not recommend it.

For medigap there are different levels but most folks get level F which is what we have.

If you are new to this a local social security office can help you get started but you need to understand the big picture and that full coverage means 3 policies...basic medicare, medigap, and part d. Medicare advantage would take the place of all of them.

If you are under 65, there are different medigap policies. Not sure about part d.

In all the time we have been on medicare (except for some copays for meds), we have paid $0. And we have had LOTS of problems and claims.

Bill
MCTD (SLE Lupus, polymyositis, scleroderma). Diagnosed 2005. Kidney, liver, GI tract, dysphagia, raynauds, barretts esophagus, quadriplegic in 2005. Recovered and now active in downhill skiing, golf, hiking. Meds: amlodipine, benezapril, omeprazole, potassium, folic acid, vitamins, maxide.

Remain Optimistic and you can overcome.

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 11/25/2014 5:34 PM (GMT -6)   
I'm going to use an agent my parents use. She told me there was only two policies available for my county if I want an advantage program.
Joy
Lupus, RA, Fibromyalgia, Glaucoma, Asthma, Hypothyriodism, Sleep Apnea, Depression, Allergies, and benign familia tremors

When life throws you lemons....
Pick them up and throw them right back at them! :))

Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7699
   Posted 11/25/2014 7:50 PM (GMT -6)   
I am under 65 with Medicare (due to Lupus disability) and use a Medicare Advantage Plan that includes prescription coverage. There are several to choose from, for me the best fit when I initially choose a plan was Humana PPO Gold Plan - so I could keep my existing Drs. I have never been turned down by anyone for anything.

The SS website has great tools for comparing plans; I highly recommend you look there.
Lynnwood, Lupus & Sjogren's Moderator, Dx: 2002
DIAGNOSING LUPUS & LUPUS RESOURCES
"Life is far too important to be taken seriously." - Oscar Wilde

NanaBee
Veteran Member


Date Joined Jun 2005
Total Posts : 541
   Posted 11/25/2014 10:04 PM (GMT -6)   
Thank you all for your replies. I spoke to someone who does insurance and she told me that because I am under 65 I don't qualify for a Medigap policy. So to keep my doctors I guess I am just going to go with the Medicare B and get a Prescription Drug plan. My doctors won't accept the Medicare Advantage Plans.

thanks again,
Mary Ann

PattyLatty
Veteran Member


Date Joined Mar 2006
Total Posts : 2606
   Posted 11/30/2014 9:01 AM (GMT -6)   
Just before I turned 65, I called Medicare directly and was pleasantly surprised at how easy it was to get through and how helpful the folks were. They walked me through every step. I had dreaded going through the process but found it to be easy with the help of the Medicare folks. I hope you have the same experience.

Bsime
Veteran Member


Date Joined Apr 2006
Total Posts : 1341
   Posted 12/1/2014 10:16 PM (GMT -6)   
Medicare does not require insurance companies to those on medicare due to disability and under 65 BUT 27 states do. Not sure what state you live in but here is an article that lists them.

http://www.aarp.org/health/medicare-insurance/info-10-2008/ask_ms_medicare_getting_medigap_insurance_under_age_65.html
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