Medicare Anyone?

[Jo6]

I will be on Medicare before the year is up. I am not looking forward to it either. My private insurance should be enough, but the way things are going it looks down right crazy!!

People look at you like you have some dread disease. Why I would like to know? My health is worse, not better. Is it expected to get better just because I go on medicare?:eek:

I read all the problems of other patients and wonder how I have lived this long? I have learned the names of many procedure's that I had not idea what to call it. I didn't THINK I was THAT stupid, never knowing the names of what was going on with me. Oh, I have an idea, where it hurts like hell, pain never letting up. Does it help to know what to call it?

I guess I am just needing a good crying jag here. This whole chronic pain crap is killing me and now I will suffer more just because I will be 65.! What a blessing
Julia

[BrokenBladder]

Cry, cry away!! I agree that this CP stinks and it never seems to get better. I havve health insurance through my husband's policy and I have medicare. I get all of my doctor and hospital bills paid for, but I do have to pay alot for prescriptions.
Ahhh let's have a good cry together!

[Maggie]

If you have a choice of having your husband's insurance be your primary you will do better, but, in most cases, unless you are the employee, Medicare will be your primary. I am finding the prescription coverage is the part that I don't like. With no bargaining agent as companies have, the Ins. company is pretty much setting the rules as to what is covered, etc.

I have also been turned away by a couple of doctors because they don't take medicare patients.
Just keep pushing for your rights and stay on the phone as much as you can to get things done right.
Maggie

[Mark N]

This is a good place to come and cry. It is amazing that CP doesn't cause us to feel despair more often. Julia, I hope you have a better day tomorrow.

[photonut]

Hi Julia:

Cry, cry away!! I agree that this CP stinks and it never seems to get better. I have health insurance through my husband's policy and I have medicare. I get all of my doctor and hospital bills paid for, but I do have to pay alot for prescriptions.
Ahhh let's have a good cry together!

I agree whole heartily with BB except......I still have to pay some Dr's and some hospital bills (co pays). I am permanently totally disabled from WC and have SSD w/medicare. I guess it depends on which insurance is primary and what kind it is...Allie:(

[Jo6]

could someone point me to the Medicare place? Hate to sound so dumb, but guess that is exactly what I am. Thank you to those that responded to my thread. thanks, Jo

[Jo6]

Medicare is going to be my primary. We are already paying out around $1000 just for me monthly.

One of our granddaughters, around 3 always warns me if she is going to cry for her mommy. She says, granny, I think I am going to cry for my mommie. tHAT'S MY CLUE TO PUT THAT LITTLE ANGEL IN THE CAR AND TAKE HER HOME, asap!!

Well, my mommie has gone on to her reward, but I think I am going to cry for my mommie!!:( Jo

[Boxerlover]

I want to join in on the crying! I am on my husband's insurance, but I also have medicare. For me one of the things that causes absolute confusion is my husbands insurance is my primary unless I am hospitalized, then medicare becomes my primary. Because of this, now every time I have a claim (which is like every day:D ) I get a letter saying that they are aware that I have medicare and they will not pay the claim until further explanation so I end up calling every other day and telling them the exact same information over and over!:mad:

And today took the cake. We are going on vacation and normally I am allowed to get my prescriptions early for a vacation once a year. So i took my scripts in today but because of the narcotics, they wouldn't fill them early.

Anyway, with what I pay them for my meds, you'd think they'd give a little!

Melissa

[Jo6]

I'll get the Puffs and crying time shall start!:p You know, I feel for all of you, and me to but especially you all. Most are way younger than I, even Mark.

I hate to see all of you in such pain and not able to do as you once did, it is a shame! :eek: I don't want to give the pain any more of me! It has enough already.

I wonder how on earth the "elderly" makes any sense of the Medicare/medicaid issues. I spect many get very little help. I simply do not understand it all myself:o

Time to slather the Bio-Freeze on the old back and hip, shoot, everywhere I can stand it. Maybe I can at least sleep aan hr. or so.

Take care all and thank you all for your input. Yes, I really hate to see the young having a life like this!:mad: Julia

[Pharmacist.steve]

I wonder how on earth the "elderly" makes any sense of the Medicare/medicaid issues.

Medicare is not all that complicated...

Part A - covers hospital and home nursing .. there is ~ $1000 deductible per hospital stay..

Part B pays for doc office visits, labs, home medical equip .. $124/yr ded.. they pay 80% of medically necessary services

Part D - each provider has their own formulary.. the basic program is $265/yr ded... then they pay 75% of the next $2000... then the patient pays 100% of the next ~ 2800 then they pay 95% of all drugs for the balance of the year.

All Medicare supplements have been defined by Congress - 10 in all ( A thru J).. Every insurance comp that offers a particular plan - MUST provide the same coverage as everyone else offering the same letter plan.

Supplement premiums are generally figured two ways... one type is age rate - initially cheaper - but goes up every couple of years depending on increase in medical cost and your age

Other type .. premiums are based on the age which you sign up ... increase premium is based only on increase in medical costs.. this type of supplement usually has a higher premium up front..

Virtually all supplements are automatically crossed over from Medicare claims.. so there is no paperwork for the patient to deal with...

There is a Medicare Advantage ( Part C) which is basically a Medicare HMO... where Medicare pays a private insurance company to provide services.. They tried this back in the 80's & 90's and their track record has been grossly underwhelming.

[Female Hank 1]

I have been on Medicare since 1987. I was 39yrs. old. My doctor had said I was totally disabled.

My husband worked until his retirement last year. I was always on his insurance and it was primary for both doctors and hospitals. I didn't even pay co-pays at most places.

When my husband retired, I was covered by Medicare alone. Now I pay co-pays everywhere and when I had to have back surgery in March, the hospital ask for partial payment of what was estamated to be my final charge up front. My husband paid the total amout of my part. I developed pheumonia and had to stay a week instead of the overnight that they thought. They told me the bill would be quite a lot more. My daughter works in administration at another hospital here, and she told me the hospital could not charge me anymore than what I had already paid and they would eat the rest. She was totally right. When my husband went to the main office to check me out, he told the lady that of course when I went in, we were not expecting to pay so much more. The lady said since we had pre-paid and even if we hadn't, our part of the hospital bill was paid in full.

We did have to pay our part of the extra doctors they called in. Here, the radiology department is not a part of the hospital. They bill on their own, so we did have to pay all off our part of that.

We even got a check from the hospital for $92 for overpayment.

Now I dodn't know if it is the same everywhere, but it should be. What was really a puzzle to me was the Medicare prescription plan. Last year I used AARP and we had to worry about the Gap where I had to pay for All of my Rx.
Since I was on Topamax, it alone was over five hundred dollars a month.
My husband retired at 62, so he doesn't have any insurance. He also has a lot of prescription bills each month.

I joined another Rx (Medicare) plan this year and pay extra not to have the Gap. I had to be taken off Topamax in June, now I am paying about four times as much for my Rx plan than my meds. cost. To bad I didn't have a magic ball to see the future.

Linda

[Jo6]

that is the pits is it not? They talk about the golden years!, Has anybody seen them? I'm sorry Linda but also glad your daughter told you about the hospital billing. the hospital does not want to tell that to anybody. To me, there is the shame!!

My husband retired this year at 60. He had good insurance and he opped to keep me on his policy because of my already health problems. It had to be my secondary coverage though. It doesn't seem to matter, they all make up the rules as they go along it seems.

[GJZH]

Jo,

There is a big difference with the Part D...I learned today that I automatically signed up with Blue Shield for drugs for September and they will not cover some of my drugs...and actually would be better off with AARP...so I will be switching to that plan before I get started...I sort of thought that BS was not for me, since they have been denying and giving me a problem with most of my scripts lately...They are a real pain...so I am going to switch out of their program for drugs...before I get started and ask for a refund...

You might want to check out the Government Site...

https://myportal.medicare.gov/eservice_enu/start.swe?SWECmd=Login&SWEPL=1&SWETS=

I am happy for the Medicare and so far all of my docs do particiapate. We are paying more for our policies...but my husband and kids can go onto a better policy now that I am not on with them...They are all well and do not go that often to the doctor...so I am certain they will qualify for a better policy.

[GJZH]

Linda,

I was thinking of switching to the AARP plan because it looks like they cover all of my drugs...but are you saying that it cost you more with their plan? I plug in all of my drugs and they covered the drugs, but I have to check at what level and how much it is going to cost me in the end...

This is all so very complicated that I cannot imagine how a senior citizen with no computer skills determines this....

Gloria

[Jo6]

Yes, it is very confusing. I suppose I should start calling myself a "senior citizen" because that is what I am:p I only have very basic knowledge when it comes to computers too:)

I'm just thankful hubby has worked with computers all these years, but he will push me until I understand things. I try to beg off, but he doesn't give in:eek: When I sat down here to look all of this over I was stunned!!

I am trying very hard to work thru this on my own and I am so very glad of all the info you all have given me. I hadn't thought of looking into AARP. My Mom was with them and her meds. were all paid. I need to go back and look at some of her stuff.

I'm glad you all are sharing, I would be more lost than ever! I had no idea they had so many rules and if you choose this, or that you are stuck with it?? Yes, this makes my head hurt!!:confused:

thank you Gloria and Linda and all you other dear people. You sure are nice to senior citizen's. Someone told me recently that I "didn't sound" like I was 64 yr. old :D I'm still trying to figure out how one goes about telling your age by reading your typed words:confused: I could not help but laugh. :D

thanks to you all, Jo

[GJZH]

Jo,

I did not know your age...but was at the Post Office the other day when the woman behind the desk started to discuss with another customer retiring...I looked at both of them and thought geez...they do not look old enough to retire...so 64 must be looking awfully young these days....or me getting closer and closer to this age myself just makes me think ...heck that really is not that old...I certainly do not feel my age and no one thinks I look my age or they didn't until I had a few spinal surgeries...The spinal surgeries make you age...The last one made me age ten years I think...I still have no grey hair though...:D LOL...!

I am glad you started this thread! I am so lost when it comes to this Medicare stuff...I would rather just put a piece of paper on the wall and throw a dart at it...It is just too mind boggling!:eek:

[Kathi49]

Gloria,

I think what you probably saw at the post office (being federal and all) is that a lot of fed employees are under the older retirement system; they can retire at age 55. :) Or, like me, 25 years in at ANY age. An/or even a "Buyout" like I took or rather an "Early Out". The newer retirement system is age 62. OPM is trying, in a sense, to get the older retirement system gone and off the books! And that's one reason among many that "Buyouts" are offered. I am just glad I was under the older system since it is more lucrative than the other one. When they wanted us to switch to FERS, I declined. And I declined because I was over halfway in my career. I wasn't about to go to the newer system KNOWING I would have to wait until age 62 before I was fully vested. My husband will have to work until age 62 being under the newer system. But he has said that if a "Buyout" rolls around at about that time...he will take it.

I just got tickled because I am looked at sometimes like...you are too young to be retired! Which I am I guess. But, hey, when the time came, had my 25 years in, was in pain and an incentive was offered, I took it! It just all happened to coincide at the same time. But trust me, I ran the numbers and ran the numbers...over and over again. I even had Personnel go over all of it with a fine tooth comb! And it worked out just fine.

Anyway, back to insurance. I have to admit I know nothing much at all about Medicare. I took BC/BS with me into retirement and also have Tricare. I do know that when I hit that age, Medicare will become primary and BC/BS secondary. All I know for sure is that my mother was a federal employee as well and she has told me that what Medicare does not pick up, BC/BS does. And she will not go to part D. I have yet to discuss that fully with her. All she said is that her meds are covered. And she did say she was flabbergasted to have her friends tell her they are writing checks for $300, as an example, for their meds. And ended by it saying she just doesn't have a problem with coverage. I THINK she had a problem getting a Mammogram one time...but then got that ironed out...whatever the problem was. I believe she was allowed only one a year and it was special circumstance where she needed another one that year. Anyway, she got that taken care of. I will have to ask her about the Part D but there are reasons she wouldn't opt for it. If I had to guess, probably because BC/BS picks up on the cost of her meds. Ugh, I hate even mentioning all of this because I just don't know what her reasons were. I will have to ask.

[Indenial]

I will be on Medicare next month (a few days) and am only in my 40's. (Disability) I have not picked out a part D plan as of yet. I am still on my husbands insurance and he will continue to carry me because of the cost of everything I have read. :eek:
It is just too confusing every time I look at the plans on-line. I have already put in all of my meds and the pharmasist was wonderful enough to tell me that since I am on Topamax and oxycontin, to choose a plan without a gap. Shoot! I don't even know what a gap is! :confused: I think I have figured out it's your out of pocket expenses for meds not covered, from reading some of these threads. I had signed up for medicare part 'B', but if I am going to continue coverage under my husbands insurance I think I need to cancel that. We really can't afford the extra $100 a month taken out of my check and still paying the premium of almost $500 a month for me out of his check.

We had been waiting for months for me to begin medicare and part D, so that things would be a little easier with money. Little did I know that it was not going to happen. :( At least with my husbands insurance I have co-pays at the Dr.'s office and co-pays for my meds. From looking at the charts for some of the part D suppliers, my medication would cost me about $500 a month. :mad: It makes me sick! You are damned if you have insurance and damned if you don't! We make a few hundred dollars above the cut off line for assistance. :rolleyes: So, I always say we are not poverty, we are just bitchy! :o

I guess some how I will figure this system out. I'm sure if my brain was not drug induced and my body was not burning in pain, it would be just like my ABC's.:p

Hugs to you all~

[GJZH]

We are self-employed so for us the Medicare is a better option...We have BS, but it is a lousy policy because I am sick. With me off the policy I am hoping my husband can get onto a better policy with the kids. At this point I am thinking of switching him and the kids to an Aetna policy. Aetna will insure him and the kids on one policy, but BS will not. The problem for me is that many of my meds are not generic, so I will probably pay a lot of money out of pocket for my meds or have to go off of them...I am considering the later...We cannot afford the meds. I will pay for the pain meds, but may just stop the ones I take for gastro problems...When I can no longer afford to pay for them I will just stop taking them...or will go to taking them every other day. I cannot bankrupt the family because of my health. I have a daughter in college and one more child to go...

[GJZH]

I found this information at AARP website ....It explains the drug, Part D, of Medicare a little better....I wish I had seen this before I signed on with BS...

https://www.aarpmedicarerx.com/ovation/pdf/pdp/en/S5820S5805_PDP227.pdf

[Pharmacist.steve]

Open enrollment for Part D is Nov 15th - Dec 31 for the next year... you can move from Part D program to Part D program without pre-existing exclusions or premium penalties

[Jo6]

thank you for your input about how Medicare works. I have a "Medicare & You, 2007" book, but it is hard for me to understand so much at once. I have been reading between the book and the ".gov." URL on the computer all day and I am about saturated on it.

I hope you don't mind me asking you questions. You have already been a great help. Thanks a bunch, Julia

[Pharmacist.steve]

thank you for your input about how Medicare works. I have a "Medicare & You, 2007" book, but it is hard for me to understand so much at once. I have been reading between the book and the ".gov." URL on the computer all day and I am about saturated on it.

I hope you don't mind me asking you questions. You have already been a great help. Thanks a bunch, Julia

I am more than happy to help .. fortunately/unfortunately I have a good knowledge about all this Medicare BS.

[Female Hank 1]

I can't remember what the amount is right now, but after Medicare has paid a certain amount, then you have to pay for all of your meds until you pay so much (somewhere around $3,000 I think) That is what the Gap is. If you pay extra ever month, you can get a plan without the Gap. My problem was
with AARP they didn't have a plan without the Gap that covered Topamax. Now that I am off the expensive meds, I could use the cheaper plan, but now I am locked in until next year.