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  #16  
Old 07-17-2018, 08:07 PM
elchivito's Avatar
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Quote:
Originally Posted by cmac2012 View Post
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?
With an Advantage plan you basically surrender your medicare management to a private insurance company. They're cheaper by the month, but they're PPOs, you're locked into providers in a particular area.

Supplement plans are also provided by private companies, but they cover much of what your traditional parts A and B Medicare doesn't cover. There are a number of different plans, named by letter, plan a, b, c, etc. One very popular plan is plan F. All companies offering plans are required by Medicare to cover everything listed in the plan coverage. In other words, they're all the same. The companies can charge their own rates but they only vary by a few dollars. You can enroll at the base rate and keep the base rate forever if you enroll in your first Medicare year regardless of your health. If you wait too long, they can charge you more and consider existing conditions in your rate. Supplements are also accepted by any provider that takes Medicare. Much better for travel or if you want to pic a specialist out of state. Mayo saved my life and I wouldn't have been able to go there with an advantage plan. My supplement costs 123 dollars a month. The best thing I did just prior to signing up for MC was take a one day course offered through the Osher Lifelong Learning Institute at my local community college. The guy offering the course was an insurance pro who laid it all out. Look for OLLI at your local colleges, they're all over.

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  #17  
Old 07-17-2018, 08:49 PM
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Quote:
Originally Posted by elchivito View Post
With an Advantage plan you basically surrender your medicare management to a private insurance company. They're cheaper by the month, but they're PPOs, you're locked into providers in a particular area.

Supplement plans are also provided by private companies, but they cover much of what your traditional parts A and B Medicare doesn't cover. There are a number of different plans, named by letter, plan a, b, c, etc. One very popular plan is plan F. All companies offering plans are required by Medicare to cover everything listed in the plan coverage. In other words, they're all the same. The companies can charge their own rates but they only vary by a few dollars. You can enroll at the base rate and keep the base rate forever if you enroll in your first Medicare year regardless of your health. If you wait too long, they can charge you more and consider existing conditions in your rate. Supplements are also accepted by any provider that takes Medicare. Much better for travel or if you want to pic a specialist out of state. Mayo saved my life and I wouldn't have been able to go there with an advantage plan. My supplement costs 123 dollars a month. The best thing I did just prior to signing up for MC was take a one day course offered through the Osher Lifelong Learning Institute at my local community college. The guy offering the course was an insurance pro who laid it all out. Look for OLLI at your local colleges, they're all over.

Close, but depending on state (all supplemental plans are state regulated), the pricing difference can be significant for the same plan with different carriers In NY, Mutual of O is almost twice the price of AARP). But the tricky part comes only after you buy: each company has it's own claim handling rules. So while a given expense may be covered, a poor company can "automatically" reject every claim and make you work for it. You've probably had this experience with traditional insurance, it's the same problem for supplemental. Again, I don't know of any reference that compares the speed and accuracy of claims processing by company by state. Some states do have websites which compare service quality, so one of your necessary stops is your state's insurance regulator website.
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  #18  
Old 07-17-2018, 09:40 PM
t walgamuth's Avatar
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I bought the best AARP suppliment for general stuff. The worst on drugs since I don't take any. It works great. So far I have had to pay only $236 per knee over what is covered.
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  #19  
Old 07-21-2018, 10:48 PM
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Originally Posted by cmac2012 View Post
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.
Yes I did not realize that you had to pay the $134 what is th $136 a month for the A and B part of the Medicare. If you start it later they penalize you and you pay more per month. When you sign up for it, and get Social Security it is automatically subtracted from your social security benefit.

Since I turned 65 and could not collect Social Security till later I had to pay the A&B fee directly from my pocket till the social security kicked in.

So right now the A&B fee is deducted from the social security check but I let the VA take care of my Medical needs which only has some minimal charge as long as I am low income.
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Last edited by Diesel911; 07-21-2018 at 10:58 PM.
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  #20  
Old 07-23-2018, 09:13 AM
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Live and learn. I as a Canadian thought that any American reaching 65 years of age got automatic totally paid for medical coverage. This thread came as a small surprise.


As a general question what do older Americans do on say minimal pensions? Still rack up costs they cannot really afford in many cases with forms of co pays?


As a general but not fixed rule you require more medical intervention as you age in general. Some of it tends to be expensive. Are prescription drug costs helped as well?


Perhaps it all balances out somehow between our two countries. A one bedroom condo in Toronto is 200k down and 1.8k a month for the twenty five year remaining morgage balance. With interest rates increasing now monthly costs will become of course higher. Plus a regular maintenance cost of course.


You will also pay a fee probably for a dedicated parking spot. This to me approaches the surreal. For the first time there are some noticeable amount of people moving into our area from Canada's hot spots this year.
Since we came ourselves 45 years or so ago.


Most Canadians probably could not fund private insurance plans under the current conditions in Toronto. For all too many even funding private drug plans there might be pushing it.
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  #21  
Old 07-23-2018, 11:21 AM
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[QUOTE=barry12345;3831490]Live and learn. I as a Canadian thought that any American reaching 65 years of age got automatic totally paid for medical coverage. This thread came as a small surprise.

/QUOTE]


At 65, US citizens qualify to buy conventional federal Medicare. It's simple and very cheap, but it only covers 80%, omits a lot of things like dental and vision and only partially covers drugs. If that's all you buy, then you die when 20% of a coronary bypass is more than you can afford. So to make the world safe and profitable, you're allowed to buy an "Advantage plan" (if you don't have much disposable income) or a "Medicare supplement" if you have a little more income. And if you really have money, you self insure.

There are dozens of private companies offering supplementals and Advantage plans from which to choose. The plans are standardized, which actually makes comparison more difficult: the difference among providers is service quality, which is tough to research. Other than the core federal Medicare plan, anything you buy will be state regulated, which multiplies the comparison shopping problem fifty fold. We make it complicated because an uninformed consumer is an insurance company's best customer. And the best part is that whatever choice you make at 65 is almost certainly what you will still be living with at 85.

Winston Churchill said that Americans find every possible way to do things wrong before they do it right. When it comes to health insurance, he was half right.
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  #22  
Old 07-23-2018, 06:03 PM
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I'm glad to hear Medicare Advantage is still around.

Back during the debate over Obamacare the republicans claimed that MA would no longer be available. If you were currently on it you would be out of luck and have to start from scratch on finding insurance.

I knew more than one person who freaked out over this.

I'm sort of lucky with insurance. I have Medicare, of course, but I have some sort of other private plan, too. When I get doctor bills I just turn them over to my business agents and they deal with it.

And for what I'm paying them they should.
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  #23  
Old 07-25-2018, 06:44 PM
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Have to love insurance companies. We have two small property claims underway currently. A break and enter and a car damaged slightly but not in an accident as such. More by intent by an individual.

You meet the nicest people when dealing with claim adjusters. Almost every time in our experience. Have to bear though it as you cannot shoot them.
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  #24  
Old 10-09-2018, 12:59 AM
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The government sent my wife a publication entitled "Medicare & You" about a week ago. It was from the federal department of health and human services, Centers for Medicare & Medicaid Services and is called "the Official U.S. Government Medicare Handbook." I recommend it to anyone who wants to know more about Medicare. The first 110 pages explain the federal Medicare program; it's readable a written for ordinary people. The last 30 or more pages list the resources available to Medicare recipients in Virginia, where we live. It is a state specific handbook.

The Medicare Advantage, the Medicare Supplemental (medi-gap) insurance carriers, the Part D Drug providers, and the PACE programs available in Virginia are all listed. They also list the monthly premiums, the deductibles, and the co-pays under each of the insurance policies or programs. It also provides a number for the Virginia Insurance Counseling and Assistance Program on the back cover. There is a wealth of information that is not readily available elsewhere.

We've received these handbooks every year for the last 12 years. I have ignored them, because my former employer provides medi-gap insurance.

There is probably one of these handbooks for each state. Give you social security office a call and see what you have to do to get one.
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  #25  
Old 10-09-2018, 08:51 AM
vwnate1's Avatar
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To the O.P. :

First and foremost, not knowing a thing means you're ignorant not 'stupid' .

No shame in this .

You're in California and near a Kaiser so look hard at them ~ I've had Kaiser for 32 years and they're not perfect by any means but they don't normally give you the Okey-Doke about anything and they have Doctors for pretty much anything .

I've had way more surgeries than I ever thought possible and multiple emergencies blah blah blah, I'll stick with Kaiser thankyouverymuch .

Yes, they flat out killed the wives of two of my mates and I've directly encountered several incompetent Doctors there but the up side is : if you do your due diligence you can choose to avoid the bad Doctors .

I learned this accidentally after nearly having an obvious, hostile and incompetent quack do neurosurgery on my broken and mangled neck .

On the other hand they once got a Surgeon off the golf course on a Sunday and opened a closed for the weekend building so he could remove steel splinters from one of my eye balls, I could have gone blind instead that's now my better eye as I age .

My point here is : you're doing the right thing, looking into the details sooner than later , keep up the good works and let us know how it works out for you .
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  #26  
Old 10-09-2018, 11:39 AM
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Quote:
Originally Posted by ESchwab View Post
The Medicare Advantage, the Medicare Supplemental (medi-gap) insurance carriers, the Part D Drug providers, and the PACE programs available in Virginia are all listed.

For some reason, the NY version doesn't list Supplemental providers. If something is missing from your particular state edition, you can usually find it on your state's insurance dept website.
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  #27  
Old 10-11-2018, 10:09 AM
elchivito's Avatar
¡Ay Jodido!
 
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Quote:
Originally Posted by Mxfrank View Post
Close, but depending on state (all supplemental plans are state regulated), the pricing difference can be significant for the same plan with different carriers In NY, Mutual of O is almost twice the price of AARP). But the tricky part comes only after you buy: each company has it's own claim handling rules. So while a given expense may be covered, a poor company can "automatically" reject every claim and make you work for it. You've probably had this experience with traditional insurance, it's the same problem for supplemental. Again, I don't know of any reference that compares the speed and accuracy of claims processing by company by state. Some states do have websites which compare service quality, so one of your necessary stops is your state's insurance regulator website.
Good info. In AZ, I compared all the prices for plan G and there wasn't 10 dollars difference between them. Chose M of O due to customer service ratings and so far they've been great. In my case, Mayo is not a medicare "preferred provider"- meaning they don't accept what Medicare pays. I get checks from Medicare and Mutual of Omaha and have to turn around and pay Mayo. The M of O checks come WAY faster than the Medicare payments.
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  #28  
Old 12-07-2018, 12:08 PM
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A little late, as today is the last day for Medicare Open Enrollment - 12/07. First time I noticed this thread.

I retired a little before 65; went on my wifes private plan. She's younger. COBRA health plans were a little stiff - $$$.

Her employer allowed spouses to be added to her private plan. I was in it for about 3 years, but eventually the private rate for employee/spouse escalated substantially. It was time for me to go on Medicare. I first had to obtain proof that I had been in a legit plan that included RX; otherwise, Medicare would have imposed a $$ penalty for Part D/Rx and you pay that penalty every month for the rest of your life. Again, when it comes time to go on Medicare, buy an RX plan or an Advantage Plan that includes RX to avoid paying a penalty later.

I started out with an Advantage Plan. The plan included Rx and Vision. Dental was offered as an add-on. I passed. All I do these days are biannual cleanings and my investigation revealed that Medicare dental plans are not all that lucrative. If you have serious dental issues, a dental add-on might help. You'll need to analyze cost-to-coverage in order to know if it's right for you. I knocked out all major dental issues before retiring. Consider doing the same if possible.

My Advantage Plan had 0 deductibles and was a PPO, hence the cost that was a bit higher than others, but as in all things, you get what you pay for.

Beware of those 0 pay Advantage Plans. Many have very high deductibles and/or an HMO. The HMO route in my opinion is fine when your 25 yrs. old and all you ever get is a cold. PPOs will get you to a better physician when you're older or at least one you prefer. That's why they call them PPOs. For those of you who are unaware, Medicare gives a portion of the Medicare B money deducted from your Social Security check each month to your Advantage Plan provider. This partially explains the "free" Advantage Plan offers that pop up on TV all of the time.

Just recently I switched to a Medicare Supplement Plan. This put me on basic Medcare A & B + what I get from the Supplement. I had to buy an Rx policy - Medicare D. Rx is not included with a Medicare Supplement as they usually are with an Advantage Plan. I found one with a zero co-pay for tier 1 & 2 drugs. I take no drugs and tier 3 and above are about what you would expect under most Medicare Rx Plans. The Advantage Plan I was on paid well, but I only go to the doctor once a yr. for blood work/physical and every May for an anti-biotic prescription to kill whatever it is that crawls up inside my nasal passages. I have the blood pressure of a healty 18 yr. old; not diabetic, healty heart, no COPD or anything else scary.

Something some may not know about Medicare Supplements Plans...

When you turn 65, you have a 6 month window to apply for one. Within that window, you are able to purchase a supplement WITH pre-existing conditions in most situations. If you attempt to purchase a Medicare Supplement past this window, your health will need to be solid; else you'll be rejected. Those things I mentioned above that I do not have, plus others, will keep you out of a Supplement Plan. I spent an hour and a half on the phone with a Supplement Agent when I bought this type of coverage. I don't know how many times I was asked "have you ever had or do you have...". I had to pinch myself to keep from falling asleep during the conversation. You can buy an Advantage Plan online without verbal converation with a company rep. Supplement Plans require a LONG phone conversation as you will be screened for pre-existing conditons if applying outside of the window mentioned above. The call could very well last awhile as well if you're calling when you first turn 65.

A Supplement Plan will cover high $$$ expenses that are limited in an Advantage Plan or straight Medicare A/B. I switched to the supplement not for today, but down the road should my health suddenly deteriorate and hospital bills start piling up.

Supplements cost more than Advantage Plans. In my case, the Supplement I purchased will cost approx. $55 a month more than my Advantage Plan. For me, the additional coverage is worth the cost.

Another benefit to a Supplement Plan is nationwide coverage. Not all, but many Advantage Plans are good only for the immediate area you are in. Should you require medical attention outside your area, your Advantage Plan may disappoint you. Also, you cannot be cancelled from a Supplement Plan unless you fail to make payment or the insurer finds you made untrue statements during the application process.

The following provides information about the appeals process should a claim be denied under the various offerings:

https://medicare.com/resources/know-medicare-rights-youre-denied-coverage/

For those of you new to Medicare, it's important to understand that plans/rates vary across the country. If it's financially feasible, you might want to think long-term and not how things are going for you when you first apply for Medicare.

And NO...I am not a health insurance salesman; just a guy sharing his Medicare experiences thus far.
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  #29  
Old 12-07-2018, 03:53 PM
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For supplementals, you are guaranteed acceptance with preconditions in the six months following application for Medicare B, which can be later than 65 if you have other coverage. Also, if you have proof of creditable coverage (such as an employer plan) up to 63 days before application, you can qualify for supplemental coverage with preconditions and without a waiting period. Note that Cobra is NOT creditable coverage, don't ask me why.
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  #30  
Old 12-07-2018, 07:17 PM
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Diesel Dandy
 
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Location: Sunny So. Cal. !
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Thumbs up Medicare Details

THANK YOU VERY MUCH ! .

The gop works diligently to make this so very difficult to understand .

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1982 240D stripper 393,000 miles
1984 300CD KEEPER ! 481,XXX miles
1984 Euro 300TD Fully optioned SWMBO's
1974 350SLC 4 speed SOLD & missed
Kooky Kommie Ural Motocycles (3)
BMW Moto R60/6 Barn Find, 8,000miles
1959 VW #113 DeLuxe Beetle, 36hp engine, stock
Junk, Rust, Arthritis, Crushed Spine,Broken Neck, Back & arm, lots of screws, pins & plates .
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