Who buys a supplement policy to cover what medicare doesn't??

Discussion in 'Fibromyalgia Main Forum' started by deb_46, Dec 28, 2009.

  1. deb_46

    deb_46 New Member

    Just curious how many have a supplement along with medicare and how in the heck do you afford it? I'm not eligible for medicare until July 2011 but just wondering how I'll be able to afford a supplement. My husband left me after 32 years and we are in the divorce process right now so I'm on my own financially.

  2. AuntTammie

    AuntTammie New Member

    The supplemental policies can be rather expensive, but not all are, and if your income is below a certain level, the govt may help you pay for Medicare itself and/or part of the supplemental policy you chose....also if your income is low enough, you may be eligible for medicaid, too, and possibly for drug coverage help. If you can get a dr who accepts it, then medicaid is great. If you are in an area like I live in, there are no Drs who accept it. The only reason it helps is if I wind up in the hosp or ER (and I have had to use it a couple of times for the ER - was great for that).

    Also, with the current healthcare bill things may change by the time you are eligible anyway.
  3. quanked

    quanked Member

    what are the co-pays for medicare? A %? I do not understand medicare. Is this something that one has to pay for as somone mentioned above? And supplemental health coverage--then does this pay 100% of what primary insurance (medicare) does not pay on covered services?

    We have insurance through a union trust. The co-pay is about 20% which can leave a significant balance on even minor day surgeries we have discovered. We are moving toward the day when we qualify for social security and medicare. I wonder about these things.

    We live in an area where there are no HMO's. I like choosing my own md however choices are limited here and there are not any experts on these dd's.
  4. butterflydream

    butterflydream New Member

    to cover what medicare doesn't. Yes , this supplement is expensive but, medicare does NOT cover all medical .

    Too much happening in congress with medicare right now, all very much to be concerned with.
    It's all very sad a person pays out so much for medical care.
    As we all know trying to budget on what we have and seems everything has gone up in costs just for everday living.

    Live Life Well
  5. dvdav2000

    dvdav2000 New Member

    It gets worse... if you go to a doc that is not in Medicare or have dropped their " number " having been a former Medicare provider... you cannot submit an " out of network " claim in Medicare supp. programs. So... if your CFIDS doc does not take Med. and you do have out of network cov. you will not be able to get a penny... check your policies now... takes eff. Jan 1.... in the new health deal in congress... if a doc does not take Medicare then they will event. will not be able to see patients...period... it's coming..

    I thought I had great med. w/ group covg. w / out of net. benefits... I make sure I go to docs right out of the plan website for anything other than specialized CFIDS care...

  6. butterflydream

    butterflydream New Member

    Wow, this relates to how one should educate themselves real quick with whats happening.
    Their must be a number of changes to take effect Jan. 1 and that is just Days away.
    Thanks for posting what you know. Every bit helps to learn Now. Thanks

    Be Well
  7. greatgran

    greatgran Member

    You are talking about insurance aren't you? I have found a very good one it pays every dime that medicare doesn't, including the medicare deductiable. Mine is 98 dollars a month. By the time they take out for Medicare and the medicare supplement I haven't much left of my SS check. I also have a Rx plan that is 37 dollars a month.

    If they go up which I am sure they will, not sure if I will be able to keep them but for now I do have both.

    I have CFS and the treatments we sometimes need is not covered by medicare and if medicare doesn't cover it neither does my supplement so not sure if its worth having or not.

    God Bless,
  8. rockgor

    rockgor Well-Known Member

    You can't get blood (or money) out of a turnip, but you can run one
    through the juicer. SOL (Smiling out loud.)

    I just looked at a 40 some page booklet from Blue Cross/Anthem about a new
    plan. It is very confusing. Full of terms which are not explained or defined.

    There is no premium. Sounds like a Ponzi scheme, huh? Anyway, I
    signed up for it. I was previously on a different Blue Cross Plan. Don't know
    if that's a requirement for the new plan or not.

    Anyway, the theory is that Medicare is paying Blue Cross aka Anthem to
    process the medicare claims. Thus no premium. Still doesn't make sense
    to me, but if you want to investigate, do it quickly. The time period in
    which to sign up is pretty short.

    Sorry I can't give you more precise info. When I was a kid the dr. would come
    to your house. His fee was $3. Then the drugstore would fill the Rx for

    Of course the medical care was not as advanced as today, but at least
    it was affordable.

  9. AuntTammie

    AuntTammie New Member

    Medicare is a bit confusing.....There are different parts, too. Part A and part B are the very basic ones and you become eligible after being on SSDI for 2 yrs - I am not sure how long it take to be eligible if you are getting it bc of retirement. For any Medicare plans, you are required to be on part a and b before you can even consider adding a supp. For most people part a and b together cost around $100 and that comes out of your monthly SS check.....if you have a low enough income, all or part of this may be paid by the govt.

    Then, there is part D (not sure why no C, but have never seen anything about a part C).....part D is for meds, and there are a few different ways to get it, but it is usually thru plans that are called Medicare Advantage plans. Some of these have meds included and some don't. These can be HMO's, PPO's, and PFFS's. If they are an HMO, then you have to go with a DR in the network and good luck finding one. If you get a PPO or PFFS, you can choose any Dr who accepts the plans fee structure. Sometimes the PPO's still have a network, though, and if you use it you will save, but you still have the option to go outside of it. There are also special needs plans, which apply to people who are on Medicare and Medicaid and a few other grps. These typically do not cost any additional money per month, but they are all HMO's as far as I have seen.

    There are also plans that are called supplemental plans - technically advantage plans are not supplemental plans, but many refer to them that way, adding to the confusion. Supp plans are actually a little different and are designed to help pay some of the out of pocket costs that regular Medicare does not cover. I think that you can only get one of these is you are on regular MEdicare, not if you choose an advantage plan, but I could be wrong about that. I don't know as much about these, as the info on the site is quite limited.....they are just listed as plan E, plan F, plan G, etc and not much is told about them. I don't even know if any of them include drug costs, or not. I think that they are put out by the govt, like Medicare.

    The Advantage plans are put out by individual companies, like Blue Cross, Humana, Aetna, etc. and even though you have to have medicare a and b to get advantage plans, you do not actually use the medicare card when going to the Dr pharmacy, etc - you just give them the advantage card. For the most part, the best coverage seems to come from the Advantage plans, but it really depends on what your own needs are, and it also depends on where you live....and the monthly fee is usually highest for these. Plan availability is completely dependent on where you live and they will send you something that lists the plans you can choose from if you want an Advantage plan. You can also find out which ones are available by going online to the medicare.gov site. Also, you may get some of the monthly premium paid for by the govt if your income is low enough.

    That site tells a bit more about what each plan covers, but finding out about most plans is a real pain, bc many times, the info will just say something like, "subject to Medicare limits" or "there may be limits" or something along those lines, and it won't tell you what the limits are.....it is an act of frustration trying to get all the info you need.

    Anyway, hope this helps explain it a little better. It literally took me months to try to sort thru it all before I first got medicare. I was pretty happy overall with the plan I had, but this yr they decided to discontinue coverage where I live.....so I just finished choosing a new plan and i feel like it is really flying blind in a lot of ways, bc so much of the info you need is not available until you have already signed up. Then you can go to the members' site and find out more.....until you have a member ID, though, you cannot access much of it. So helpful.....not!

    ETA: and yes there are ALWAYS copays and/or co-insurance (well unless you qualify for medicare and medicaid and can find a Dr who accepts both - but at least here that does not happen - I have found exactly zero docs who accept medicaid - the only reason that medicaid helps here is if you have to go to the hosp - then you don't have to pay anythign and they have to take it).....how much the usual copays are varies depending on the plan and what you are having done, who you are seeing, etc....some of the plans actually charge more for Dr copays than straight medicare would (even though you are paying them an additional monthly fee! I think they get away with this bc they are covering meds, possibly paying more for hosp visits, etc.....and if you need mental health coverage, forget about straight medicare - you will pay 45% every visit!.....the other policies vary, but are less than that)
    [This Message was Edited on 12/29/2009]
  10. JLH

    JLH New Member

    I retired from a large corporation after more than 30 years of service. So, I have my retirement benefits which include a small pension plus insurance benefits which include medical, dental, eye, and prescription drugs.

    When I went on disability and my Medicare kicked in, the Medicare became my primary coverage and my other insurance benefits became my secondary coverage.

    So, with both coverages, I'm in pretty good shape as far as my insurance. I have the same co-pays to meet with my secondary coverage before they start to pay what Medicare doesn't.

    You say you are getting a divorce. Does your husband have medical benefits that you have been on while you were married? If so, do they still apply after the divorce? If not, can your divorce attorney work that out in your settlement--that your husband has to provide you medical coverage as you have been accustomed to during the past 32 years of marriage? Especially if you do not have the means to purchase such a policy.

    Good luck.
  11. GoWest

    GoWest New Member

    If you were covered under your husband's health insurance from his work I would suggest you talk with a lawyer about keeping that coverage in the divorce settlement. This should be doable, but I am not a lawyer.

  12. quanked

    quanked Member

    how incredibly confusing. I cannot help but believe that there must be millions, if not billions, of dollars being scammed out of all this confusion and obfuscation. This Medicare stuff sounds out of control.

    I do not understand why there needs to be all the layers and various choices. Now tell me that this Medicare system cannot be improved! What insanity! The thought of navigating through such a system tires and scares me.

    LISALOO New Member

    I have Part C (supplemental plan) - it's like A & B and D in one thing. It's called private. Like mine is through Humana. I pay my regular monthly premium ($98) or whatever, then the premium that the PFFS, that I picked through Humana costs. It covers doctors, prescriptions, etc.

    I went on Medicare.gov and put in my zip and it gave me all the plans, I entered my drugs. Then it gave me an estimated cost for the year. The Private plan was cheaper by $2000 annually than Medicare's regular program!
    [This Message was Edited on 12/31/2009]
  14. AuntTammie

    AuntTammie New Member

    I absolutely agree with you....and the really lovely thing about it all is that so many people who are on Medicare are ones with cognitive difficulties (myself included - at least brain fog comes and goes, though).....very challenging to figure this stuff out....took me a long time to sort thru
  15. AuntTammie

    AuntTammie New Member

    It sounds like you have a Medicare Advantage plan (that's what the private HMO, PPO, and PFFS plans are).....If so, that is actually not called a supplemental plan, bc you do not use the Medicare card at all, though you have to have it to be eligible - the private company (in your case, Humana) is the one whose card you use, rt?

    In an Advantage plan, the private plan replaces the Medicare plan; technically it does not supplement it. The plans that are considered supplemental are plans where you still use the Medicare card as primary insurance, and then the supplemental plan is secondary (ie; it supplements where Medicare leaves off). I have never seen it referred to as part C, but if you have, I certainly believe you. Also, some of the Advantage plans include medication coverage and some don't.

    If it sounds like I am being picky, I am really not trying to. I just know how confusing this whole thing is and it is really important that people understand the differences when they are trying to pick a plan.

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