Parts Catalog Accessories Catalog How To Articles Tech Forums
Call Pelican Parts at 888-280-7799
Shopping Cart Cart | Project List | Order Status | Help



Go Back   PeachParts Mercedes-Benz Forum > General Discussions > Off-Topic Discussion

Reply
 
LinkBack Thread Tools Display Modes
  #1  
Old 06-25-2018, 02:37 PM
cmac2012's Avatar
Renaissance Dude
 
Join Date: Dec 2004
Location: Berkeley, CA
Posts: 19,395
Medicare

Well, it's happened y'all. I've turned 65, well, 66 a few weeks ago. I haven't hardly dipped into Medicare yet beyond making the payments. I've had one brief visit so far. But now I may need knee surgery. Not sure but I think I should get an MRI and have it looked at.

I spent way too much time on my knees recently knocking a job out that had a deadline. I felt the pain, the weariness, but hey, I'm a tough guy, right?

The next morning had swelling and pain in the right knee. Best I could find on the web, it was bursitis. My one doctor visit that I mentioned was to my previous clinic, she agreed that's what it was, said to keep icing and elevating it. This was 3 weeks and a few days ago. But I'm feeling something loose in there and occasional sharp pain. I definitely do not walk as well as I did. I know from my shoulder operation (rotator cuff) in Aug '16 that if you wait too long the chances of success go down - scar tissue.

My question, I'm considering going with the Kaiser Permanente plan. They have a large center about 2 miles from my place. I think it will be $105 a month, and I'll have to pay the medicare fee also, right?

But damn, there is so much I don't know. Trying to find out which is the best route for sports medicine action.

__________________
cmac

1986 300SDL, 351K
1984 300D, 133K
Reply With Quote
  #2  
Old 06-26-2018, 12:28 PM
elchivito's Avatar
ĦAy Jodido!
 
Join Date: Aug 2009
Location: Rancho Disparates
Posts: 4,075
We don't have K-P out here, but hopefully their plan is a Medicare supplement and not a Medicare Advantage plan.
Lots of top tier places don't take Advantage plans. I got sent to Mayo clinic in Phoenix last fall for a pretty serious issue. I asked the intake person how I was accepted at Mayo with Medicare. She said "we don't take Advantage plans, you have a supplement, you're all covered. If you showed up here with an Advantage plan and a dumptruck full of money, we wouldn't accept you".
__________________
You're a daisy if you do.
__________________________________
84 Euro 240D 4spd. 220.5k sold
04 Honda Element AWD
1985 F150 XLT 4x4, 351W with 270k miles, hay hauler
1997 Suzuki Sidekick 4x4
1993 Toyota 4wd Pickup 226K and counting
Reply With Quote
  #3  
Old 06-26-2018, 04:12 PM
Registered User
 
Join Date: Dec 2006
Posts: 3,640
At a gross level, there are two different paths for medicare:


1) Traditional medicare. This covers major medical and hospitalization. There are a lot of holes in the plan, so you need to think about whether and how to supplement it:


a) take Part D, which gives you drug coverage but leaves gaps Optional
b) Enroll in a Medicare Supplement plan, which covers the deductible and co-pays. This is sometimes called Medigap coverage. (1) and (1a) are purchased through Social Security and are gov't benefits. (1b) is purchased through an insurance company, an is private coverage.



2) Medicare advantage. If you choose this, you cannot take regular medicare, or purchase a Medicare supplement. A Medicare advantage plan is private insurance coverage which may cover more than traditional medicare, but comes with more restrictions. Again, offered through insurance companies or HMO's.


Once you choose (1) or (2), then there are dozens of insurance offerings to compare and consider. While the general structure of Medicare is standard nationwide, insurance companies are state chartered and medicare advantage (2) or supplemental (1b) plans are state specific. So advice you get from someone living outside your state is worthless. There's no obvious right choice, nor will it be the same for everyone. Your state probably has a website which provides comparison shopping information for locally chartered providers. You will have to do your own research.



This stuff is way more complicated than it has to be, and some of the decisions you make day 1 can affect you for the rest of your life, so think carefully. My suggestion is to get the book, "Get What's Yours for Medicare" by Phillip Moeller. You may hate the subject, but read it until you're crosseyed. Then research insurance providers in your state. Then make an informed choice.
Reply With Quote
  #4  
Old 06-28-2018, 03:55 PM
cmac2012's Avatar
Renaissance Dude
 
Join Date: Dec 2004
Location: Berkeley, CA
Posts: 19,395
Sorry, didn't get back right away, I didn't think anyone was going to respond. Good advice here, much appreciated. I'll look for that book. I hate being stupid. Ask me how I know being stupid is not good.

In the short run, went to a sports med place today, just using regular plan B. Doc says no surgery is needed, though maybe in a few years I'll want artificial knees. Just creeping arthritis now. Who woulda thought? Way too much basketball on concrete courts when I was younger.

He gave me a steroid injection in both knees, both have been hurting off and on but the recent event was the worst I've had with a knee. Feel better already. Maybe I can make it to that soft retirement teaching math and then get new knees one summer.
__________________
cmac

1986 300SDL, 351K
1984 300D, 133K
Reply With Quote
  #5  
Old 06-28-2018, 10:46 PM
t walgamuth's Avatar
dieselarchitect
 
Join Date: Apr 2005
Location: Lafayette Indiana
Posts: 35,552
Good deal!
__________________
[SIGPIC] Diesel loving autocrossing grandpa Architect. 08 Dodge 3/4 ton with Cummins & six speed; I have had about 35 benzes. I have a 39 Studebaker Coupe Express pickup in which I have had installed a 617 turbo and a five speed manual.[SIGPIC]

..I also have a 427 Cobra replica with an aluminum chassis.
Reply With Quote
  #6  
Old 06-29-2018, 03:52 PM
cmac2012's Avatar
Renaissance Dude
 
Join Date: Dec 2004
Location: Berkeley, CA
Posts: 19,395
Quote:
Originally Posted by t walgamuth View Post
Good deal!
I need to research the cortisone and other shots therapy. It has limits of course. But if I'm going to go the artificial knee route someday, I'd prefer to do it some years hence after the tech is further developed. Was it you who was talking about at artificial knee?
__________________
cmac

1986 300SDL, 351K
1984 300D, 133K
Reply With Quote
  #7  
Old 06-29-2018, 03:52 PM
cmac2012's Avatar
Renaissance Dude
 
Join Date: Dec 2004
Location: Berkeley, CA
Posts: 19,395
Quote:
Originally Posted by elchivito View Post
We don't have K-P out here, but hopefully their plan is a Medicare supplement and not a Medicare Advantage plan.
Lots of top tier places don't take Advantage plans. I got sent to Mayo clinic in Phoenix last fall for a pretty serious issue. I asked the intake person how I was accepted at Mayo with Medicare. She said "we don't take Advantage plans, you have a supplement, you're all covered. If you showed up here with an Advantage plan and a dumptruck full of money, we wouldn't accept you".
BTW, I've heard of both types of Medicare add-ons (didn't want to say supplement) but I've not heard of this difference in terms of actual usefulness.

So is Advantage (cap. A) a specific brand item as opposed to another category of extra coverage, hence the small s, and use of 'a' supplement?
__________________
cmac

1986 300SDL, 351K
1984 300D, 133K
Reply With Quote
  #8  
Old 06-29-2018, 07:58 PM
Registered User
 
Join Date: Dec 2006
Posts: 3,640
It’s complicated. Medicare advantage isn’t a supplement. It replaces Medicare entirely with private health insurance. So the coverage will depend on what your particular plan provides. These tend to function like HMO’s, with a limited network of providers and referrals required for everything.

Really, I don’t want to treat this lightly. You should get the book, because it takes a book to explain.
Reply With Quote
  #9  
Old 06-30-2018, 12:58 PM
cmac2012's Avatar
Renaissance Dude
 
Join Date: Dec 2004
Location: Berkeley, CA
Posts: 19,395
Good call. For now seems best to just keep paying the govt. premium and co-pays, the supplement can come later.
__________________
cmac

1986 300SDL, 351K
1984 300D, 133K
Reply With Quote
  #10  
Old 06-30-2018, 01:53 PM
Registered User
 
Join Date: Apr 2016
Posts: 897
If you will get a Kaiser plan, talk to them about how it integrates with Medicare and what options you should choose with Medicare. Ask them to give you and across-the-desk, sit down visit with you to explain it all.

You are eligible for Medicare, Part A, which covers hospitalization and certain doctor care. It generally pays 80% of the hospital bill. You are responsible for the other 20%. You are also eligible to choose Medicare Part B (doctor bills) and Part D (prescription medications), for which you pay additional premiums. The premium for part B is about $100 a month; I don't know what the Part D premium is. If you don't enroll in Parts B and D when you first become eligible for Part A, the monthly premiums are higher on the later dates that you choose to enroll.

The Medicare supplement insurance is private insurance that pays the amounts that Medicare does not pay. It looks like that is what Kaiser wants to sell you.

The Medicare Advantage Plans are a different form of Medicare, which pays everything on what they cover -- no 20% or co-pays. The problem is that they don't cover everything, and it is somewhat of a mystery as to what they do not cover.
Reply With Quote
  #11  
Old 06-30-2018, 02:28 PM
ArcaicAeronaut's Avatar
Registered User
 
Join Date: Sep 2015
Posts: 22
Wow, how time appropriate. Just turning 64 in a few days and have been trying to find out some info on supplementals. Thanks for the tip on the book!
Reply With Quote
  #12  
Old 06-30-2018, 10:47 PM
Registered User
 
Join Date: Dec 2006
Posts: 3,640
Quote:
Originally Posted by cmac2012 View Post
Good call. For now seems best to just keep paying the govt. premium and co-pays, the supplement can come later.

As I said, there's no answer that fits everyone. But really, you need to get informed and think it through. The bullSh_t about Obama care may make you think that signing up immediately for the supplemental is some sort of socialism, that you can always wait and can never be refused for preexistings. But Medicare is an old insurance system that wasn't affected by the rules of O-care. It will become much more expensive and difficult to add a supplement as you get older and sicker, and unless you die, you will do both. The best time to sign up for a plan is when you initially sign up for Medicare, at which point your preexistings won't be prejudicial and your rates will be as low as they will ever be. After that you have to mind the rules and open enrollment periods to minimize penalties, but delaying will always be more costly.



If you check with your state insurance department, they may be able to direct you to counselors who can help you with this decision. You can also contact the Medicare Rights Center, a non-profit that helps seniors work through this problem. Please find the time to do the research, because a mistake made today will be with you for the rest of your life.
Reply With Quote
  #13  
Old 07-10-2018, 01:47 PM
dynalow's Avatar
Registered User
 
Join Date: Feb 2002
Posts: 1,599
A little late in coming in here.. When I signed up I had an insurance guy walk me through the supplemental ins. basics. Plan F seemed the best for me at the time. I still have it through United of Omaha. I think it started at 180.00 +/- per month and is now up to 228.00 a month. The plan is pricey, but in the Medicare network I haven't paid any out of pocket costs. I believe the AARP favored policy, last time I checked a couple of years ago was about 20.00 per month more. Each lettered plan has different options with different cost, naturally. To each his own. Each separate plan must offer uniform coverage & options. Only the premium cost differs.

My Part D co insurer is Well care. 37.00 a month. My RX out of pocket run from 2.50 to 8.00 to 10.00 ( all generic cardio mostly) per refill. When choosing this coverage, make sure the coverage you select offers your medicines in their formulary (covered brand name drugs)

I'm going in for a hip replacement in 4 weeks with an overnight stay and I don't expect to incur much if any out of pocket or co-pays. I hope.
Reply With Quote
  #14  
Old 07-10-2018, 02:21 PM
greazzer's Avatar
dieselfuelinjector.guru
 
Join Date: Sep 2010
Location: 2021 - The Great Florida Count-down
Posts: 5,618
Before they cut on you, I would try to re-hab yourself. All my old jump buddies are in the same boat and so far every single one of them who got cut on is now in this horrible domino effect where it's not fixing anything. NO VA healthcare hacks. They all went to the best of the best. I don't think folks heal like they did when we were 20 something.

I would try some supplements. It has kept me walking and put off a 3-level fusion in my neck and 2 level fusion in my lumbar ...
Reply With Quote
  #15  
Old 07-10-2018, 08:08 PM
t walgamuth's Avatar
dieselarchitect
 
Join Date: Apr 2005
Location: Lafayette Indiana
Posts: 35,552
I have had great luck with partial knee replacement. I was very bow legged and wore out the menescus on the inside of my knees, so the doc replaced that and I still have my outside menescus. It was an out patient procedure.

I previously had a "cleanup" done which found my menescus so torn by the time they finished I had none left and it hurt worse than before the surgery.

With a partial replacement the bone loss is minimal and healing pretty quick...and in 20 years I could have a full replacment if needed.

I've had both hips done now too. The first was done at age 57 and it now feels like original equipment and has been so since about the one year anniversary of the surgery. The second one is now about a year and a half and is still not completely healed. of course I was 68 when it was done.

I still need my right shoulder done probably. I had the left done about five years ago. Long recovery time, but it is very strong now.

__________________
[SIGPIC] Diesel loving autocrossing grandpa Architect. 08 Dodge 3/4 ton with Cummins & six speed; I have had about 35 benzes. I have a 39 Studebaker Coupe Express pickup in which I have had installed a 617 turbo and a five speed manual.[SIGPIC]

..I also have a 427 Cobra replica with an aluminum chassis.
Reply With Quote
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is On
Trackbacks are On
Pingbacks are On
Refbacks are On




All times are GMT -4. The time now is 02:31 PM.


Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2020, vBulletin Solutions, Inc.
Search Engine Optimization by vBSEO 3.6.0
Copyright 2018 Pelican Parts, LLC - Posts may be archived for display on the Peach Parts or Pelican Parts Website -    DMCA Registered Agent Contact Page