A question about Medicare and secondary coverage. I have Medicare. Not Advantage.

[Lint Head]

I'm needing a knee replacement. I've heard so many different takes on how Medicare works for major surgery. Has anyone here had experience positive or negative getting Medicare to pay or the secondary insurance to pay? I do know of some folks who had coverage for major surgeries but were left with big co pays and other charges. I'm for single payer because I know there are still many kinks in the system that leave people out even though we now have ACA in effect.

[Downwinder]

1. I have Medigap and have never paid a copay.

[KC]

2. What do you

have to do to get that?

[Downwinder]

3. Pay $202 a month to an insurance co.

Medigap (also Medicare supplement insurance or Medicare supplemental insurance) refers to various private supplemental health insurance plans sold to Medicare beneficiaries in the United States that provide coverage for medical expenses not or only partially covered by Medicare.

[KC]

4. Thank you

I'm new to this and just confused I guess.
A certain amount is going to be automatically deducted from SS like 100 something that I guess is for Medicare. Is the 202 in addition to the 100+ ?
Also how do you find those private supplemental insurance co? lol sorry I feel really stupid regarding this stuff. The one I hear about on tv is always aarp. I think my mom has that.

[Downwinder]

5. The $100 is for basic Medicare Part B.

Supplemental Insurance covers costs over and above what Medicare covers. The plans are regulated by Medicare and are offered by most of the major health insurance companies.

To Find a Medigap Policy in Your Area:
https://www.medicare.gov/find-a-plan/questions/medigap-home.aspx

You also need prescription coverage. It can be a separate Part "D" policy or included in the supplemental plan. Some of the supplemental plans also include vision and hearing. There can be a penalty assessed if you do not enroll in a plan when first eligible.

[KC]

6. Thank you for

explaining it! I'll have to start looking pretty quick so I won't have any kind of penalty!
Thanks again!

[Downwinder]

7. There are also several income based programs for extra help

with the premiums listed at that Medicare link.

[ellenrr]

8. I strongly advise against the free medicare supplement by AARP/UHC

I am about to drop it.
It has cost me a lot of money.
If you can afford the one that is ~$200/month, my father has it, and he has excellent coverage, and usually pays nothing.
I can't afford that. But I am better of with medicare along than with medicare PLUS supplement.

[ellenrr]

9. and good luck with your knee replacement. A friend had both knees

replaced, and she is so happy, bec. before she had so much pain.
Her entire personality has changed, bec, now no pain.
I hope you have equally good result.

[Lint Head]

10. Thank you so much. I have a lot of anxiety about surgery.

[ellenrr]

11. yes, I can imagine. Surgery is always scary. My doctor

this morning rec. an MRI for me (ugh) and said if it shows as he thinks a tear in my meniscus (knee) surgery MIGHT be needed.
-depending on the damage, and we'd first try exercise.
but still hearing that (and I don't know yet if it will be needed) freaks me out.

but later I ran into someone who is in his '80's, - I'm 66- and he had knee surgery some years ago, and felt a lot better after.

so that was somewhat reassuring.

Are you into meditation?
Bec. meditation can reduce anxiety -unless the person really doesn't like to do it, and then it probably raises anxiety.

Apparently it can improve surgery outcome bec. you are relaxed.
But that depends on the individual.
Just wondering if you have considered it.

I meditate on and off, and right now... since I've had this health issue for the past 7 weeks- being a medical mystery as no one can figure out what the problem is - is very anxiety-producing, and my friend sent me a meditation which I have been doing and find relaxing, and also feel like my head is not so f"ed up.

In any event, I do wish you the best.

[Lint Head]

12. Thanks. I do meditate occasionally. I've had issues with my knee for several years but the last

month it has gotent much worse. To the point that I have to use a cane. And I have always been an active person. It's depressing and I do need to take action so I can get back to the things I love to do. I'm 65. One of my surgeons is recommending an epidural and a twilight sleep but a different one is saying a femoral nerve block and total anesthesia is better. I'm torn. I don't like to be put totally under because the recovery is longer but I also want to become mobile as soon as possible.

[ellenrr]

13. I'm using a cane too.

some times I have excrutiating pain, can barely even walk to the bathroom. but then, like the last 3-4 days, I have little pain. I'm uncomfortable, I'm using the cane, and I'm being very careful, but what a difference to have the pain level so much lower.

I've been taking some natural pain healers, I don't know if that is helping, or if meditation is, or if is just something that comes and goes.

As grateful as I am to be able to move now, even a little, I know that something is wrong, and needs to be dealt with.

I really hear ya when you say it's depressing, and that you are used to being an active person. Amen to both of those! Sometimes my spirits fall very deeply. It is very hard. And most people who have not been thru this do not understand.
It really changes your life. That's what I find. I'm having a hard time remembering that I used be a person who thot nothing of walking an hour if I felt like it.

If you don't mind- bec. I am having to be a medical detective since I still have no absolute diagnosis, what was your diagnosis?
I know you have to have the knee replaced, but do you know exactly what the problem is?

thanks.

[Lint Head]

15. I don't mined at all. I have osteoarthritis. 88% of the population will get it. It

impacts the cartilage between joints. That's what happened to my knee. The cartilage is gone on one side. I also have this genetic thing that causes my immune system to attack the cartilage between my joints if I have an infection. First it attacks the infection then goes on to attack the substance between my joints as if it is part of the infection. My Dad had rheumatoid arthritis and passed away from it's impact. That was before they had better treatment for it. I do not have rheumatoid. Thank goodness. He suffered like no one I have ever seen in my life. It was terrible to witness. I found out I had this genetic thing with my immune system while being tested for rheumatoid.

My Dad used to watch commercials when they would ask, "Are you suffering from the minor pains of arthritis? Then take...." He would say back to the television, "There is NO MINOR pain of arthritis." Ha!

[ellenrr]

16. yes it seems that a lot of people have arthritis.

Gary Null a nutritionist and expert in alternative living, says arthritis is caused by inflammation. Which is why I'm taking curcumin and omega 3 to hopefully reduce inflammation.
yesterday the 4th doctor I've been to is sending me for an MRI, he thinks I may have a meniscus tear. and also sending me for a lyme test.

if it is a meniscus tear, he says they would try exercise first, and might have to have surgery.

let us know how you are doing after surgery.

[SheilaT]

14. What additional coverage is best for you

depends on your situation.

Medicare Part A covers hospitalizations. Part B covers doctors. If you want any additional coverage, including prescription coverage, eye or dental, you need a Medigap or an Advantage Plan.

It takes some time, but research on the internet and you should be able to figure out what you need. I just recently quit work and got my Medicare Part B coverage and went straight to an Advantage Plan with Humana. I have the good fortune to be very healthy, and I only take a diuretic for high blood pressure. And with my Advantage Plan, my co-pay went from $10 per refill to $4. Nice. And if I'm willing to get three months at a time through some mail order thing, I'll have no co-pay at all.

My Humana plan costs me nothing beyond the fee Medicare collects for Part B.

A friend of mine has a different Humana plan which allows her to see more doctors and she takes more prescriptions. A year and a half ago when she had a pulmonary embolism, she spent about two weeks in hospital and only paid a few hundred dollars out of pocket. She's told me the amount and I can't quite remember, but it was astonishingly low considering she was in Intensive Care for the first week. Human also sent a nurse to her home at least once to make sure everything was as it should be.


Different companies have different plans in different parts of the country, but the Medicare website is very useful. It is important to remember that if you relocate to some other city, state, or part of the country, you may need to switch plans.

[ellenrr]

17. thanks for this. I will look into Humana.

I didn't know there were other free Medicare Advantage plans. when I signed up for the one I have aarp/uhc, it was under advice of a "medicare consultant". People are trained and sup'd to help you find the best paln for you. But the one I had only suggested I sign up for this one, and since it is free, I thot - why not. It wasn't until I came to use that I found out, that it doesn't supplement Medicare, it replaces Medicare. It becomes my primary. So doctors who would take Medicare, but who are not in the aarp/uhc network are not reimbursed. It has saved me a bundle of prescriptions - prescriptions cost me usually $2.50. I rarely take prescriptions drugs, but who's to say - that could change. And I do have eye and dental.
I also have brain fog and don't think I can wend my way thru these sites. Have to look for a competent medicare consultant.

[SheilaT]

19. When I was getting ready to sign up I actually phoned

Humana to make sure I absolutely understood what I was getting into. I could have actually found out everything on line, but the phone call made me a lot happier.

Advantage plans do take the place of Medicare A & B. If drug coverage is included, they also replace Part C -- I think that's the drug coverage. My primary care doctor is in my Humana Plan, but not all doctors would be. My friend who pays more for an upgraded Humana plan is that way covered for doctors that would otherwise be out of the network. I just called her, and she pays $15 for a regular office visit, $40 for a specialist, and $65 for an ER visit. Interestingly enough, I have zero copay for a regular office visit, $30 specialist, and the same $65 for ER.

You also want to put in whatever prescription drugs you are currently taking, because I'm guessing that's the big complicating factor.

The other thing to keep in mind is that if something drastically different happens, you can then change plans outside of the normal open enrollment time, but I don't know if say, getting a kidney transplant and now needing to take all the immuno-suppresents would trigger being able to make that change. I know moving would.

It seems complicated, so the best thing to do is take it slowly as you can, find out as much as you can, and compare plans with your personal circumstances.

[ellenrr]

20. thinking about this last nite, I think that aarp/uhc is also my drug plan

something to check.
cause prescriptions drugs - which I really take - are very cheap. Once got something for my eye which cost $100. for a tiny tube, and cost me $5.00.
I now pay $20 for regular, $50 for specialist and $65 for ER.

[RebelOne]

18. I only have the basic Medicare plans A and B.

I had to have cataract surgery in March. Medicare paid 80% of the cost and the balance was up to me, which was about $600 out of pocket. But without Medicare I could never have afforded the surgery. But you can bet when open enrollment comes around in October that I will be switching to the Advantage plan. I cannot afford to get supplemental insurance because it is not cheap and I am living on Social Security.

[ellenrr]

21. check if your state has this--

In NJ, there is some program which pays my Medicare premium bec I am low-income.
I think it is administered thru Medicare, or the state..

[RebelOne]

22. Thanks. I'll check it out. n/t

[ellenrr]

24. I checked to see who I got it thru

It was my state (NJ) medicaid agency. They pay Medicare Part B premium.
(I don't have medicaid).
and you do have to be very poor, can only have a designated amount of savings.
and
they are (at least in my case) total shits about giving you what you're entitled to. They kept stone-walling me - lost my paperwork, etc.
clearly an attempt to get me to give up.
the process took about 6 months, and I only finally got it, after having my state congressperson take up my case.

[SheilaT]

23. You've brought up another important point.

Every time I was checking on line about the Advantage plans, the website kept on more or less asking me if I were low income and therefor qualify for assistance.

Lucky me, I'm not that low income, but it's always worth checking out.