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03-18-2010, 06:24 AM | #1 |
Donating YT 5000 Club Member Join Date: Oct 2006 Location: Ohio
Posts: 5,304
| Help from those on Medicare !! Patti's post on their issues with Medicare made me address this with my parents. What I'm trying to find out is who has: Original Medicare+ Medigap policies VS Medicare advantage plans We are trying to do a cost comparison on which makes more sense, especially for my Mom. I would appreciate advice on experiences with cost, etc... Thanks!
__________________ Crosley Wrigley Camden |
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03-18-2010, 06:44 AM | #2 |
No Longer A Member Join Date: Aug 2005 Location: NEW YORK
Posts: 16,218
| I am still working but am looking into retiring at some point. Medicare use to just about cover everything and doctor's would write off the 20% that they are allowed to over bill for. It is wise to ask the doctor if he accepts Medicare Allowance, this meaning accepting whatever medicaid allows. Some do , some don't so the additional 20% would be out of pocket if you did not have supplemental ins. However, if your healthy and don't have existing illnesses that can add up it may not pay to purchased additional ins at say $200.00 (estimate) a month if it's not going to be used. That would be $2,400.00 per year out the window. I am thinking of just putting that in the bank, if I need it fine, if not yipeeee for me. Of course prescriptions drugs are another thing. You have to have a drug program. Epic is one that goes buy your income and thus far is affordable for me. I'm still learning and looking into everything. I know Blue Cross/Blue Shield has a plan that you pay for when it's needed instead of paying monthy. A friend is on it and swears by it but I don't know the details. It's all so confusing and scary not to be covered. It's important to have insurance but it seems crazy to pay monthly when it's not being used too. |
03-18-2010, 08:40 AM | #3 | |
Donating YT 5000 Club Member Join Date: Oct 2006 Location: Ohio
Posts: 5,304
| Quote:
She has a $20 co-pay for Dr. visits One thing we are confused on if the Dr. charges $200 for a visit & Medicare pays $100 if she would be responsible for the difference along with the $20 co-pay. My understanding of an HMO and having co-pays would be that in-network Dr.s agree to the Medicare charges already. On the Medicare original plan I know it says you pay 20% for visits unless you have a Medigap policy to cover the gap.
__________________ Crosley Wrigley Camden | |
03-18-2010, 12:53 PM | #4 |
No Longer A Member Join Date: Aug 2005 Location: NEW YORK
Posts: 16,218
| One thing we are confused on if the Dr. charges $200 for a visit & Medicare pays $100 if she would be responsible for the difference along with the $20 co-pay. It is my understanding that a doctor can not bill more than 20% of Medicare allowance. It's a law. So if a Doctor charges $200.00 and Medicare allows $100.00 you would be responsible for $20.00. Because the doctor, by law, cannot bill more than 20%. A co-pay is a co-pay paid at time of service. In NY anyhow. Hence the additional insurance Medicare recipients take out to cover the additional 20%. |
03-18-2010, 12:59 PM | #5 | |
Donating YT 5000 Club Member Join Date: Oct 2006 Location: Ohio
Posts: 5,304
| Quote:
Her co-pay for a primary care Dr. is $20 and that is ALL they can charge her. It's an HMO and she only has to pay the co-pay! She pays $15 for lab/20% for certain radiology, etc.. Now if she had the original Medicare she would pay 20% of whatever they charge unless she had a Medicare supplement to cover the gap! So confusing!! We are trying to weigh now her total prescription + co-pay costs + diagnostic costs to see if it's less expensive to switch off the Advantage plan!
__________________ Crosley Wrigley Camden Last edited by Reese1; 03-18-2010 at 12:59 PM. Reason: . | |
03-18-2010, 02:06 PM | #6 |
My little Shadow Donating YT Member | I am so glad you started this thread. My Mom & I were having this exact conversation earlier today. She keeps getting multiple letters about whether to change her Medicare & she's afraid to do any change to what she currently has. She's had so many health issues. It is so confusing.
__________________ Bella Ganma-ma to ColeRIPNoahRIP |
03-18-2010, 02:19 PM | #7 |
Donating YT 30K Club Member | My Dad has Medicare and a secondary policy. He pays 300.00 a month for that policy and it covers the deductibles from Medicare part A and B. My only advice is try and find a plan that covers skilled nursing. My father just went into the hospital and was transferred to a skilled nursing facility to hopefully get him strong enough to go home. I thought he had a good supplemental plan until I found out that after 20 days of Skilled nursing care you have to pay 137.00 a day under Medicare and I thought no problem he has supplemental insurance. Wrong they won't pay anything. Sadly, my Dad is not doing well and will be going into Hospice. Medicare will pay for hospice care but not room and board so we will have to pay the nursing home ourselves. That can run anywhere from 155.00 a day to 255.00 a day if you want a private room. Scary!
__________________ Cali Pixie Roxie : RIP Nikki; RIP Maya;RIP my sweet Dixie girl 1/17/08 http://callipuppyscastle.bravehost.com/index.html |
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