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We went to our first Medicare info session last night, and my overall conclusions so far:

The part D drug plan seems to get more attention than the rest and almost every question was answered by slipping in info about it. I'm still confused about this open enrollment period other than the initial one and when I tried to pin the lady down about the topic of changing plans she kept referring back to the open enrollment of 11-15 to 12-31 for the drug plans. Overall, I know just about as much now as I did before attending, so I plan on calling their main office in Little Rock first chance I get.

....the coffee and cookies were good however! And my Dh is still pushing an Advantage Plan for me....
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...I'm still confused...

Me too.

I received a consultation from a non-profit advocacy group. Still I'm confused as to which route I should take. We covered Medicare A, B, D and Medigap Standardized Plans. We also touched upon HMO's. My next consultation is going to be with a SCAN representative. SCAN is a HMO. I'm looking into SCAN because 2 of my friends and my doctor recommended SCAN. My doctor also recommended AARP’s HMO plan.

Corrections are welcomed.

The same insurance company may offer several plans. They may offer HMO and Supplement D without HMO benefits.

As far as I can make it out, open enrollment is indeed Nov 15 to Dec 31 but you have until May 15 to finalize it. Since I am enrolled in an employer health insurance I may enroll anytime within 90 days from termination. In fact, I plan to enroll in Medicare starting June 1.

You may compare Medicare Prescription Drug Plan online at plancompare.medicare.gov. But if there is a data bank for Supplement Insurance, (in California), I know not where. Rather the consultant gave me a list of about 40 companies. It becomes my responsibility to call each one and determine which one is best for my situation. I read awhile back that there is a fee-only Medicare consultant, in Southern California. If I find his address, in my stack of notes, I shall see what he has to say.

I conclude that I shall probably take the easy way out, and signup with an HMO Advantage plan. I.e. SCAN, AARP, etc. etc. The HMO requires that you are enrolled in Medicare A and Medicare B. The HMO then takes care of A, B, D, and what other options I choose.

I shall keep this board posted as I learn more.


Good luck,

TB
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You may compare Medicare Prescription Drug Plan online at plancompare.medicare.gov. But if there is a data bank for Supplement Insurance, (in California), I know not where. Rather the consultant gave me a list of about 40 companies.



i found a Supplement plan comparison chart SOMEwhere last winter on medicare.gov ... dunno where exactly.
(& i'm in Calif.)

i also asked my Doctors and they didn't rec HMOs (pretty sure they don't belong)

... if you like HMOs, my Mom was very happy with Kaiser


Good Luck!


=
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I am very opinionated, but I will try and keep those out of my comments.

Here is the deal on Medicare -

You can either get "traditional" medicare or what is called a medicare Advantage Plan.

If you do not get drug coverage(and there are two options here), you are a fool or very wealthy in my opinion. In short, you will loose money if you do not get drug coverage one way or another upon becoming elgible. There are choices of what coverage.

No for some complexities.

First I will describe the tranditional medicare, because that came before the Medicare Advantage.

With traditional your premiums plus funds from the government pay 80% of the cost of your medical care. You can pay the remaining 20% out of pocket or get various supplement insurance coverages which will pay varying amounts of the 20% depending on the coverage you select.

(Now a word here -- my figure of 20% is for all the retired people. That 20% is in the form of copayments and deductibles. If you never exceed your deductible obviously you will pay for more than 20% of your personal medicare care.)

If you give the traditional Medicare, you will want to get a traditional type Part D. There are many types of plans, the best place I have found to look at them is on the Medicare.gov website.

If you do not get drug coverage, and you have that choice, you will have a penalty until your death should you decide at a later date to get Part D coverage. That penalty is 1% per month. So lets say you are healthy today and say no to Part D. 25 months from now you are sick and decide to get coverage. You can. But if the plan you choose has a normal price of $50/month, you will pay a 25% penalty i.e. your monthly fee will be $62.50/month. Does not matter which drug plan you pick. Does not matter what the premium for the plan is -- you will pay a penalty.

You can change your plan every year in the period from mid November through December 31st. One approach some people take is get a lower priced plan until they need more drugs, then change.

Some plans offer no copay on generic drugs, if you mail order your drugs. So with those plans, there is no cost except the premium.

The basic government plan has the "donut" hole. It pays for a while, then nothing and finally after thousands of dollars worth of drugs, it pays again except for a small co-pay. I expect, but can not say with certainty, there are some plans that cover this "donut" hole. Those plans will have much larger premiums assuming they exist.

You are guaranteed the chance to get a supplement insurance policy when you start medicare. Does not matter if you are sick or not. I am talking about the supplemental insurance that covers the "20%" not paid by your premiums to the government and taxes workers are paying. Pick carefully here. Do not assume you can change in the future. With limited exceptions, the insurance companies can either limit your coverage or charge you higher premiums.

Now about the Advantage plans -- these are essentially HMO type plans. The insurance company provides all your medicare care and drugs. In some cases you have no monthly premiums -- that appeals to people. The government pays money to the insurance company. You may or may not pay a monthly premium. The money the government pays is essentially the same money the government would pay to doctors, hospitals, etc. if you had chosen traditional Medicare.

The downside here is simple - it is the insurance company who will decide what hospital, doctor and even pharmacy you can use. Today there are lots of choices. But if the government reduces the payments to the Advantage Plans (and in my opinion they will), the insurance companies will be forced to pay less to hospitals for example. Some hospital will say no to the insurance company. At that point you have one less hospital that will accept your insurance.

Gordon
Atlanta
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I'm a little less confused tonight as I called the BCBS office in Little Rock thia AM and spoke with one of their medicae reps. The questions I asked:

# 1 Can I change supplement plans back & forth every year from an Advantage to original Medicare & supplement & back to Advantage etc. The answer is definite maybe. There is a 12 month period after you sign up for Medicare that allows you to change your mind on what you chose and you can enroll in original Medicare with a supplement THAT WOULD REQUIRE NO medical underwriting. After that year is up, you're set in what supplement you have. You can change Advantage companies too. I hope I made this clear, but it's a little confusing.

# 2. Can I still see my out of state oncologist? Medicare & Plan J...YES Advantage plan would not be likely.

#3. If Dr. & hospital accept Medicare and BCSB Ark.Plan J does that mean they will accept BCBS Advantage plan too? Answer NO They might, but not guaranteed.

4. What happens if I'm traveling, get sick but not life threatening emergency will Advantage plan cover costs....Answer: Probably not.


The cost for Plan J is reasonable, especially since I'm paying $475/mo for healh insurance right now. I'm thinking the best for me would be original Medicare and Plan J. I had cancer 15 years ago and have a slight heart problem that has given me a couple of rides with the paramedics, and frankly, the idea of an Advantage plan like Humana or any others just scare me.
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The cost for Plan J is reasonable

Did you look at Plan F? I don't know what the difference in cost would be. I think Plan F is the usual recommended one cost-wise and it covers almost the same things. DH has had and is having horrendous medical problems and many bills. Medicare has covered every thing and Plan F has also covered the balance deductible and 20%. We have had no out of pocket expense.

Carol
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<<4. What happens if I'm traveling, get sick but not life threatening emergency will Advantage plan cover costs....Answer: Probably not.
>>


With regular Medicare, I think you have to be pretty concerned about whether doctors will be willing to accept you as a patient.

Not much help if Medicare is willing to pay but no docs are willing to provide your with services.

I suspect that one good reason for doing a Medicare Advantage plan is access to a list of docs under contract to a good insurance plan.



Seattle Pioneer
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If you do not get drug coverage, and you have that choice, you will have a penalty until your death should you decide at a later date to get Part D coverage.

You gave a very good critique, Gordon. The only thing I would mention is that if you already have an approved drug coverage, eg. with a retirement plan, you are not penalized if you don't take the Plan D.

Carol
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I suspect that one good reason for doing a Medicare Advantage plan is access to a list of docs under contract to a good insurance plan.

And the docs can drop out out the contract too and leave you with having to find a new doctor. I think the list of docs is constantly changing.

Carol
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In this area of Illinois most docs accept Medicare. Relatively few are in the Advantage network. Same is true with hospitals. Regular Medicare is accepted everywhere. Advantage is often limited to a single hospital in a wide radius. Advantage is much more limited even than the health insurers regular PPO health plans.

Might be better in the large cities but I wouldn't touch Advantage in more rural areas.
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The cost for Plan J is reasonable

Did you look at Plan F? I don't know what the difference in cost would be. I think Plan F is the usual recommended one cost-wise and it covers almost the same things.



i forget the differences, but J looked better to me (a bit more expensive a bit more coverage ..and i have Lots of medical issues)

but J wasn't available in my county.


-b
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.4. What happens if I'm traveling, get sick but not life threatening emergency will Advantage plan cover costs....Answer: Probably not.


The cost for Plan J is reasonable, especially since I'm paying $475/mo for healh insurance right now. I'm thinking the best for me would be original Medicare and Plan J. I had cancer 15 years ago and have a slight heart problem that has given me a couple of rides with the paramedics, and frankly, the idea of an Advantage plan like Humana or any others just scare me.


that number 4 would scare the snot out of me.


actually surprises me they won't cover travel ...even HMOs cover travel (iirc)


=
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In this area of Illinois most docs accept Medicare. Relatively few are in the Advantage network. Same is true with hospitals. Regular Medicare is accepted everywhere. Advantage is often limited to a single hospital in a wide radius. Advantage is much more limited even than the health insurers regular PPO health plans.

Might be better in the large cities but I wouldn't touch Advantage in more rural areas.



i live suburbs (SF Bay area) ..the one Advantage plan i checked out -- none of my Docs on the list; the three nearest hospitals not on the list.

iirc --nearest hospital listed was 16 miles away --might as well be rural.

best i can figure, Advantage Plans are for people who don't want to spend much and are confident they'll never have a chronic problem



=
.... maybe the plan charges the Doctor for a listing?
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Carol wrote The only thing I would mention is that if you already have an approved drug coverage, eg. with a retirement plan, you are not penalized if you don't take the Plan D.

Carol that is correct with two cavets.

#1 The drug plan must be equal to or better than Medicare Part D (and you need that in writing annually from your plan - should Medicare ask for proof and your plan has ceased to exist you will be up the creek.)

#2 When that drug plan ends, the penalty time clock starts. Myself, I was covered under my wife's medical coverage for 2 years - then she retired and I went on traditional medicare.

Gordon
Atlanta
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Let me add to and clarify: Plan J would be $117.20/mo compared to Plan F @ $161.30/mo. Their basic drug plan is $ 21.60/mo. With the exception of 1 brand name drug I take, which I plan on asking my Dr. for a different generic drug, the ones I take are available from Walmart using their $10/90 days. The lady from BCBS Arkansas recommended using one of the $4/30day places and not applying the cost to your drug benefit (good for her for telling the truth).

As for question # 4, perhaps I didn't phrase it right....I was speaking about a non-emergency sickness, such as sinus infection, sore throat etc. when a walk in clinic not available and I ended up at an emergency room....and this was using one of the Advantage plans while out of state. Emergencies while traveling will always be covered while out of state.

As for other random thoughts of availability of Drs. and hospitals, we have 2 medium sized hospitals here and a good supply of Drs, but I have heard of some of them not accepting new Medicare patients, the only way of getting in to be a patient before the onset of Medicare. And I plan on being exactly that in July/August.
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As for other random thoughts of availability of Drs. and hospitals, we have 2 medium sized hospitals here and a good supply of Drs, but I have heard of some of them not accepting new Medicare patients, the only way of getting in to be a patient before the onset of Medicare

++++++++++++++

That sentence didn't work well...lol. Resaying: Some here have said you need to be an established patient before you start Medicare or you may have trouble finding a Dr. to accept you as a new patient AND on Medicare. I plan on becoming an established patient in July here in NW Arkansas so that will not be an issue.
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My own sense is that you should use an "advantage" plan. They seem to work well from what I've seen.
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actually surprises me they won't cover travel ...even HMOs cover travel (iirc)

And I'm not sure this is true. I'm a CA resident and needed walk-in clinic treatment in FL. Showed em my card and was seen immediately. They didn't even take the co-pay which I told them I would owe.
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TwoCybers: Now about the Advantage plans -- these are essentially HMO type plans. The insurance company provides all your medicare care and drugs. In some cases you have no monthly premiums -- that appeals to people. The government pays money to the insurance company. You may or may not pay a monthly premium. The money the government pays is essentially the same money the government would pay to doctors, hospitals, etc. if you had chosen traditional Medicare.

I opted for the HMO. Should I also get Schedule D coverage? I didn't, but wonder if I should. Would ocver the co=pay, or whatever?

Horace
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...I opted for the HMO. Should I also get Schedule D coverage?...

I too wonder if I should also get Schedule D if I were to go the HMO route. Would not takeing the Schedule D option cause me to have to pay that 1% per month surcharge if later on I were to leave my HMO?

TB
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Since you have an HMO, I suggest to call your HMO customer service. I do not have a clue - the Advantage plans do combine drug and medical. It depends on your specific plan.

Gordon
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actually surprises me they won't cover travel ...even HMOs cover travel (iirc)

Kaiser does.

We went to England. Our daughter was hospitalized.
Our travel agent had purchased us some "medical travel insurance assistance" that was a big nuisance because he wanted to fax me forms to have me have the doctors fill out. England's medical system doesn't work like that. I wasn't able to get to forms filled out correctly.

We just submitted the bills to Kaiser and they reimbursed us. No problem. No forms needed.

Vickifool
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