Medicare and Medigap question

Discussion in 'Fibromyalgia Main Forum' started by DVoit, Oct 6, 2006.

  1. DVoit

    DVoit New Member

    I search and found entries on this subject but still have questions. I am able to get Medicare because I am disabled and 61. Here is the rub:

    I have good insurance but I pay over $400 a month. I only get $601 a month now. (I live with my daughter and husband). Does anyone know how good medicare is and how much it pays on doctors, etc? Does anyone have Medigap to help with the copays and such? Medicare says I can get a policy much less than I pay for my federal insurance and they will pay what Medicare doesn't. Any help would be greatly appreciated. When you call Medicare, you don't get much help or the correct answers. Thanks for your help.
  2. JLH

    JLH New Member

    Do you pay over $400/month for a single insurance policy now? Or, is it a family policy which also covers your husband?

    I pay close to $300/month for my employer's retiree medical/dental/eye/drug policy now. I also am on Medicare due to being on disability. Medicare is my primary; the other is my secondary.

    I do not know anything about those Medigap policies.

    Medicare has fairly decent coverage on doctors and hospital.

    You have to make sure you sign up for Medicare Parts A & B (Part D is the Drug Plan).

    Medicare Part A = Inpatient hospital care, inpatient care in a skilled nursing facility following a hospital stay, home health care, and hospice care.
    Medicare Part B = Doctors' services, diagnostic tests, ambulance services, durable medical equipment, and other healthcare services.

    Parts A & B both have a deductible. After it is met, Medicare pays 80% of all covered expenses. If doctors/hospitals accept Medicare, they accept what Medicare pays.

    For example, on my last out-patient knee surgery (scope),
    * hospital charges were $5,742.09
    * Medicare only approved $1,610.53
    * Medicare paid hospital $1,283.29
    * Balance of $327.24 was paid by my secondary insurance policy--or if you did not have any additional insurance, you would have been responsible for this amount. (In my case, my secondary insurance policy covered the entire balance of $327.24).

    So, the $4,131.56 (which was the difference between what the hospital charged and what amount that Medicare would approve) had to be written off by the hospital.

    I don't know if a Medigap policy would pay the entire balance of what Medicare doesn't pay or not. I also don't know if they cover dental and eye either.

    I do know that Medicare's Part D prescription drug policy doesn't begin to equal my employer's drug benefits. In fact, I think Medicare's drug plan is just barely better than nothing!! Someone else would have to tell you more about it.

    I kept my employer's coverage as my secondary due to the execellent dental, eye, and drug coverage in addition to great benefits on medical--I pay only a $10 copay on all doctor visits. (Doctor visits are billed to Medicare and they pay 80% of what they approve, then my secondary pays the entire balance--all except for $10, which is my copay.)

    Is this the type of info that you wanted?

  3. 69mach1

    69mach1 New Member

    the state to help pay for you medicare and supplemental...and also get medi-cal or medicaid in your state...possibly some food stamps...

    you need to get on a section 8 voucher waiting list.....

    call you local housing authority for info...

    and if you need a overnight attendant they will give a two bedroom 30% the rate of your 601.00 a sure as heck don't have much left over for food or anything...

    well good lukc


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