Medicare Question

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 12/21/2010 7:54 PM (GMT -6)   
OK, a general question. I will be 65 in June.
 
I will only need basic Medicare (Part A) as I am currently employed at a large University and they said their group insurance is primary. My questions:
 
1) Will Medicare send me an application/card automatically, or do I have to apply?
 
2) If I left employment, say in June 2012 or something like that, can I add some other part of Medicare at that time?
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2680
   Posted 12/21/2010 8:18 PM (GMT -6)   
I turned 65 in August and signed up for Part A about a month ago, and then decided to also sign up for Part B. They require that you do so within 3 months of your birthday, or you'll pay a bit extra. I retired 5 years ago. They do not send you an application card. You can go to the website or visit your nearest social security office. Since you're still working full time and are insured through your employment, you should be able to find up for other parts of Medicare when you retire, but there are clear answers to those questions on the Medicare website.
Age 65
Dx in June 2010.
PSA gradually rising for 3 years to 6.2
Biopsy confirmed cancer in 6 of 12 cores, all on left side
Gleason 7 (3 + 4)
Bone scan, CT scan, rib x-rays all negative.
DaVinci surgery late August at Advocate Condell, Libertyville IL
Negative margins; negative seminal vesicles
5 brothers, ages 52-67 ; I'm the only one with PCa
Continence OK after 7 weeks. ED continues.

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 12/21/2010 8:48 PM (GMT -6)   
Mel,  Here is a link to the info clocknut was referring to: http://www.socialsecurity.gov/medicareonly/.
 
Carlos
Dx 2/2008, age 71, PSA 9.1, G8,T1c. daVinci surgery 5/2008, G8(5+3), pT2c. LFPF, good QOL. PSA <0.1 for 2 yrs. PSA rose to .2 at 30 months, started SRT 12/15/2010.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 12/21/2010 11:45 PM (GMT -6)   
As I recall, about 90 days before your 65th birthday you will receive an information book and application to fill out..I was uninsured at the time..

You get to choose between Standard Medicare and Medicare Advantage. The majority of new members are taking one of the Medicare Advantage Plans. You will be barraged by the offers from the different private companies..

Once you choose, you are locked in for a year or until Nov 15 when, for 30 days, you can change you plan to one that suits you better.

It's all VERY confusing...I went with Medicare Advantage because few doctors are willing to accept new Standard Medicare patients..Mine is a basic Secure Horizons / United Health Care plan that is sort of like an HMO..My primary care physician was a member of "The Group" and so far I have no complaints..But except for emergencies, I must be treated in the Denver area..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 12/22/2010 2:19 AM (GMT -6)   
tHanks Fairwind et. al.
 
As I said, my primary health insurance will remain my group plan at work and Medicare will be secondary, so I believe I just do the Med. Plan A
 
Mel

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 12/22/2010 4:34 AM (GMT -6)   
Mel,

A lot depends on how much of outpatient services your work group plan covers plus your anticipated medical expenses for 2011.

Also factor in the actual cost for Plan B coverage that would be based on your income level

In you go to Drs often ( 2x a month or more) and your work Ins covers in the 80% range then Part B may save you a great deal of $$

Plan A is usually free so need it or not you may as well take it, its a good safeguard in case you are hospitalized

you may want to check into the complete plans to see if they are offered if you have ins already

knotreel
Veteran Member


Date Joined Jan 2006
Total Posts : 654
   Posted 12/22/2010 8:22 AM (GMT -6)   
Mel, I am certainly no expert but you should ask your work insurance administrators about this. Perhaps the work insurance will give you coverage that will act as a suplimental to medicare and use your medicare as the primary. This would save them some money and I think you will then have really excellent coverage. I am now 66 and had the medicare part a with a blue cross medicare supplimental policy in place 6 months before my RRP. I went where i wanted did what I wanted like going to one than doctor and had 3 month of PT, cost to me 0.0. Since then I traveled to houston to see an incontintence and mens sexual specialists and now elected to have the AUS and IPP. I have not had the implants yet ( scheduled 1/11) but they are covered as well. So far having medicare with suplimental is the best insurance I have ever had by far. I don't even have to check my supliemntal to see if they cover what I am about to do, the provide coverage if medicare covers the primary. Now a word of advice, be very careful about getting one of the "free" and "better" policies ( managed care) that offer expanded coverages for medicare. THey operate by having you sign over your medicare to them and they then manage your care so they, working with their provider, can operate in the margin of those costs. ( they also recieved a fee from the gov. for them handling the admin. but the obama care may have altered that) So, the rule of thumb for this is if you can afford to purchase a suplimental policy and keep your own medicare you are golden insurance wise. If you can't or don't want to afford a suplimantal then the "managed care" policy that is free might be appropiate. My friend who had one of these managed care policies ended up having his bladder removed ( bladder cancer) was unable to go to the specialist in houston, in his case md anderson. They were not a provider for the managed care provider he had. When he got into the issue he then found out the he choices were very limited. I was sick for him. My suplimental policy from blue cross costs a little over 100 per month and if this arrangement is available to you through your work then I guess it would be zero.
Like I said I am no expert but only point out that i like medicare a lot! and that you may have some options that could be really good.
Ron
PS, i am betting your psa scare will evaporate after your upcomming test.

Post Edited (knotreel) : 12/22/2010 7:29:58 AM (GMT-7)


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 12/22/2010 9:07 AM (GMT -6)   
Ron: I think you and I will talk about this when we visit. I still have lots of time sence I just trun 60 in April. I am still in the thinking process as I am retired. I think what my friends have done is have the work insurance as secondary and Medicare as the primary.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 12/22/2010 9:16 AM (GMT -6)   
Mel,

I believe you have 90 days from last date of employment to add Plan B and I think you will pay a little more for it. You will get most of these questions answered on the Medicare website...the FAQs are very helpful.

Totally agree with knotreel above. I had Medicare A and B and a supplemental plan through AARP (United Healthcare). So far, I haven't written the first check for my PC treatment. And like him, I go where I want and see who I want for care.

Joe
Age 67 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. Normal activity within 3 days. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA as of 12/9/10 - 0.1

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 12/22/2010 9:17 AM (GMT -6)   
Mel,

I believe you have 90 days from last date of employment to add Plan B and I think you will pay a little more for it. You will get most of these questions answered on the Medicare website...the FAQs are very helpful.

Totally agree with knotreel above. I had Medicare A and B and a supplemental plan through AARP (United Healthcare). So far, I haven't written the first check for my PC treatment. And like him, I go where I want and see who I want for care.

Joe
Age 67 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. Normal activity within 3 days. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA as of 12/9/10 - 0.1

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 12/22/2010 10:30 AM (GMT -6)   
Mel,

Check with your Ins co from work as to who is Primary and secondary. In most cases if you are working its your work ins primary, medicare secondary

If you decide to not pay for part B then you may as well get one of the Advantage plans they cost $0 and it would be a risk free alternative. You area determines if its a PPO or HMO , you dr's today may already be participants

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 12/22/2010 12:35 PM (GMT -6)   
Boy, this sure seems confusing.
 
I can say with certainty that my group insurance at work is primary and Medicare would be supplemental.
 
My HR specialist at work suggested that I just take Part A (the free part).
 
My insurance has been very good. At the end of each year, we get a rebate from my University depending on how much insurance has been used. Some years we got 95% backMy insurance cost for med/dental for my wife and myself is $200 per month before the rebate. A typical rebate is 70% or so. Hence our premiums are minimal after the rebate.
 
Office visits are $12. Many doctors, hospitals are in my network, including Umich and Ford. So my consultations at Umich were $12. The surgery was $64000 but my cost was about $200. I can get 3-month drug supply for $10 (mail order, generic). Lab tests are 10% (after a negotiated discount). We have out-of-pocket maximum of $1000. I went over that in 2010 and then my costs were zero.
 
In short, I think I have very good insurance. If I have to travel to Mayo or MD Anderson or MSK I would have to check my insurance carefully. I believe Mayo might be covered (ie: in-network). I think my cost out of network is 30%, which can get up there.
 
So, I still have a question. Let's say I average 2 doctor visits per month, at $12 each. That's a tad under $300. I assume Medicare Part A has nothing to do with that. Does it make any sense at all to tack on some other Medicare Plan? I am thinking it isn't worth the effort (also, the 2 per month is probably an over-estimate). If I do have radiation, I suspect I would be seeing the radiation oncologist quite a bit (once a week). I'm not sure if that is a seperate billing each time. I assume that is just part of the general cost for the radiation.
 
Also, we do have a $200/$400 deductible
 
Mel
 
 

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2680
   Posted 12/22/2010 12:52 PM (GMT -6)   
You have outstanding insurance presently.  I'm a retired federal employee, and our Blue Cross PPO insurance costs us just over $400 per month to cover my wife and myself.  Our copays are $20.
 
A key question for  you is:  can you carry your exiisting insurance into retirement.
 
I had been unable to do that, I wouldn't have retired at age 60. 
 
Since I was retired when I reached 65, I had 3 months after the birthdate to elect coverage under Part B without paying a penalty in higher premiums to sign up later.  I chose to sign up.
 
If you're still working when you reach 65, you don't have to worry about signing up at that time.  You need to  make a decision, though, when you retire.  If you can keep that level of coverage by continuing your existing policy into retirement, you might not want to spend another $110 dollars or so per month for Part B coverage.
 
You can schedule an appointment at your nearest social security office to discuss your options.
 
One other factor in my case:  my wife is four years younger than I, so there's no way I could drop my existing insurance, since she would then have no coverage.  We found our best choice was to continue our existing insurance and also sign up for Part B.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 12/22/2010 2:28 PM (GMT -6)   
Clock:
 
My wife is 5 years younger than I am.
 
When I retire, the scenario changes. I could keep my work insurance under COBRA, but that is very expensive.
 
But I am also in the State Retirement System. In fact, I am drawing a pension since 2003 from them right now (35 years in on that). Their insurance is Blue Cross/Blue Shield. I could have elected to go with that rather than my current group policy with my present job. When I analyzed it, my group plan was a winner in every way.
 
Some of the irritants for me were:
 
1) Most of my doctors were NOT in-network for that BC/BS Plan.
 
2) They made a big deal about lab tests being free if you used their contracted lab (QUEST). But at that time, the nearest such lab was 30 miles away. I could just see me being sick and having to decide whether or not to go there or pay a hefty amount at my local hospital lab (they have a satellite lab that's literally a 5-minute walk from my house).
 
Subsequent to my decision, a QUEST Lab opened that's a 4-minute walk from my house, and I think more doctors are now in-network for that BC/BS plan.
 
When I actually do retire, MediCare would be primary and this BC/BS would be supplementary. I guess at that point, I'll revisit the subject.
 
I really have no desire to retire. Quite the contrary. I am blessed in that I totally love my work. I get up and look forward to going to work. Unfortunately, these health issues could skuttle my plans to work, but I hope not. My best friend was a fellow teacher (he taught chemistry and I taught calculus, so we had a lot in common -- of course we know that math is more important -- but I digress!! <g>).
 
He got MS and had to retire. He is now confined to a wheelchair. That was truly tragic as he also loved his job and hated the fact that he had to quit. He often urges me not to retire if at all possible (and he gets no argument from me). As far as I'm concerned, it's not work when you enjoy it!!
 
Mel
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