Good grief, I am confused. Medicare coverage, too complicated!

[Paper Roses]

Last edited Tue Oct 28, 2014, 05:52 AM - Edit history (1)

I am going to be 72 in a few days. Thank the powers that be, I have been healthy. My family suggests, and I agree, that I should pick up prescription drug coverage in addition to the supplement I now have to Medicare.

I just called my provider and was told that the supplement plan I now have (HMO) no longer offers drug coverage and the rep told me that they now offered an Advantage plan that includes drug coverage or I could call a certain # and ask about 'stand alone' drug plans.

They will be sending me info about my options but did not offer me any affordable suggestions. In fact, other than offering me a new plan, they offered me no other options. I will call the # given to me to see what the cost of a 'stand alone' (her words) policy would cost. My current plan is HMO, not Medicare Advantage. A quick Google and I note that the new Advantage plan will cost me almost double what I am now paying.

Holy Mackerel, will it ever end? Living on Social Security is fun, Isn't it?

[alfie]

1. Go to www.medicare.gov

Click on Drug coverage Part D (top of page). Scroll down and on the left side column is a place to click (I forgot what it says) but something about costs of different plans. Then you put in your zip code so they will know what pharmacies are in your area. Then they will ask for each of the drugs you take. Finally they will have a list of all the Part D plans, what the deductibles and co-pays are, and how much each one costs.

[left-of-center2012]

2. I have Blue Cross Medicare Advantage

It pays my medical and prescriptions and I have no monthly premium.
There is no copay for my primary care doctor; I pay $20 each time I need to see a specialist (like my foot doctor for diabetic care and my eye doctor for Glaucoma) but I only see the specialists a couple times a year. My medications have a copay of about $2.50 each.
I had ten sessions of physical therapy and I paid $5 each visit.

Finding the Right Blue Cross Blue Shield Plan
http://www.individualhealthquotes.com/zip/blue-cross-blue-shield.jsp?link_id=1000&src=G-IHQ&cmpn=New_Mexico_BCBS&adg=Blue+Cross+Blue+Shield+-+LT&ad=26617569417&kw=blue%20cross%20and%20blue%20shield&pos=1t1&mt=e&ds=S&pl=&nw=g&exp=&sl=&tg=&p1=&p2=&p3=11617130894244952100&p4=&p5=&lp=1&gclid=CJmZpMqaq8ECFYI7aQodQ3UAbw&lst=bw

[SheilaT]

3. Since you have access to a computer,

do research on line.

It all depends on where you live, what is available to you.

I went on Medicare about six months ago, and I likewise found it confusing and complicated. I'd always had coverage through a job where I had very few choices, and so this is an entire new world for me.

Here's what I suggest: Make notes about what you need. What prescription meds you take. Do you need a yearly eye exam?

I happen to have an Advantage plan, because that is the best for me. I pay nothing above and beyond what I pay for my Medicare, about $150/month. I have a high enough income that I pay more than some people. It's a PPO, but my primary care doc and my eye doc are in the plan. I am wondrously healthy, which is nice. I have zero co-pay for office visits.

That's me. Just look at the various options, and see what is best for you. If you have a good friend around your age, ask them what they are doing for their additional coverage. That's what I did when I was getting ready to go on Medicare. A very good friend has a slightly different plan with the same company (we happen to use Humana) and had a pulmonary embolism that put her in a coma nearly two years ago. She came out if it with absolutely no ill effects, and paid almost nothing out of pocket.

So again, look at what's available to you where you are. I know, it shouldn't be this complicated, but for now this is what we have.

Oh, and a couple of years ago I got into a brief conversation with a woman about four or five years older than I am, and she praised Medicare highly, saying it had made her whole health care much simpler. And I know that her husband worked for a major university, and so I hope they had good health coverage through his job. She said life was much easier now on Medicare.

I know, these are only anecdotes, but that's mainly all any of us have to work with when trying to navigate this system.

[blackcrow]

4. easier

Yes, Medicare + my Medigap plan + Plan D has simplified my life considerably. I got Medigap Plan F (there are a bunch of different Plans with different coverage in Medigap), so I have no copays and no deductible, i.e. nothing to track and no worries about do I have $20 in my pocket when I go to the doctor.

I looked around at info and asked around when I first went on Medicare. I wound up with the plans my neighbors had and liked, Medicare Plan A and Plan B, AARP Medigap Plan F, and AARP Medicare Rx which is Plan D. With this setup, I can see any doctor I want and don't even need a referral from my internist. AARP has been great - a couple of times I have needed approval for a med, and they approved it overnight. When I needed med approval when I was covered by an employer's plan, it could take weeks or months or never happened.

[SheilaT]

5. Good to hear you've got the plan you need.

I'm actually in awe at how good Medicare is, at least so far.