Gioing on Medicare

[Earth Mother 2 Angels]

((((((HUGS TO ALL)))))) ~

I apologize for any confusion about our Medicare experience. I hope that I can clarify our situation.

Jim (my husband) and I are beyond retirement age, but we are still working and earning an income as our son's (Jon) care providers. We aren't taking our Social Security benefits now. We will take them when we stop working, which will be when Jon dies, or we become incapable of caring for him.

We are not disabled, and we don't receive SSDI or any other government assistance for ourselves. Of course, Jon receives SSI and many other social services.

I don't know whether any of that makes a difference in how Medicare works.

In our case, we signed up for Medicare, which is through the government, and every three months, we each receive a bill from Medicare for about $300. Because Medicare doesn't cover everything, it is recommended that we (everyone) supplement with a private insurer for Part B, and for Part D (drugs). So we did. We pay a monthly premium for both of those supplemental insurance plans.

Jim had a physical with our PCP, and we paid nothing. The doctor billed Medicare and/or our Part B supplemental supplier (United Health Care). My husband had a mammogram, and we paid nothing for that. The blood test bill ~ I might have been able to contest that, with United Care Part B, but I have my hands full at the moment and didn't have the energy to enter a new battle. According to the lab, which analyzed his blood, United Health Care denied the claim. And basic Medicare (from the government) doesn't cover certain blood tests, to our amazement.

When we first began investigating Medicare for Jim, we consulted some of our older friends about the process, and they had all gone through the same process as we did. Sign up with the government for Medicare. Then find a Part B and Part D supplemental insurer. Then pay and pay and pay.

One of our friends retired at 65, while she was still working, caring for her son, and received her Social Security benefits. She later learned that the longer one waits to claim the Social Security benefits, the more one will receive in the monthly stipend. So, Jim and I chose not to "retire," until we are no longer working/receiving an income. I don't know whether that has any effect on our Medicare.

I'm so sorry if I've muddied the waters regarding Medicare. I hope that this helps to explain our experience. Please feel free to ask me any questions.

Love & Light,

Rose

[Howie]

If it's any help, I am on Medicaid. My only income is SS Disability, I'm 61. Medicaid makes my meds, like $2.50 each. Depending on your income, you may qualify. I take no MS drugs, and they may be a diferent story, but worth checking it out. Good luck with it.

[Cat Dancer]

So I'm confused. I'm on Medicare I have all the various parts of Medicare, I don't send odd a check to Medicare for anything. I have private health insurance which, when I became eligible for Medicare, became my secondary plan. Meaning bills go to Medicare first, then to the plan.

I pay $15/month for my MS drug tecfidera). I pay around $5 a month for each of my other meds, for a total of about $45. Everything else --2 hospitalizations, 6 weeks in a nursing home, 1 month in a rehab center, visiting nurses, therapists, home aides, home hospital bed, special mattress, follow up liver and blood scans, all of it paid for either by Medicare or my insurance, most often a combination of both. I get monthly statements from Medicare telling me how much they paid, and what has been sent on to my private plan. And a monthly statement from navitus, the drug provider, telling me how much they are paying for the drugs. I don't send them anything, either. Only things I'm buying out of pocket are things like depends. Everything else, including the dressings for my wounds, is covered. Same so far with TC, even his rare copper transfusions have been covered. A mystery. Guess my private plan is pretty good. Should be, for the $850/month we pay for it...

[newone]

Cat Dancer - do you mind telling me who your private plan is with? I pay $1000 per month now (non-medicare) and not everything is covered. I finally got approval for provigil after trying for a few years - I doubt that's covered on Medicare!

[agate]

I'm on Medicaid too. If you're in a certain Medicare category called "QMB"--for Qualified Medicare Beneficiary--you don't pay Medicare premiums.

It's hard to say what anyone else should do when it comes to Medicare because every situation is different.
Some people in this thread are talking about apples and others are talking about oranges.

Newone's best bet may be to use Medicare.gov links for finding information.

Newone, at least this thread will have helped you to realize how complicated this whole medical insurance picture is, in case you didn't already know.

[Virginia]

Cat, I think your private insurance is a very good plan and remember that $850.00 is for 2 people so it really is not all that bad in premiums.

If you kept your SS statement that comes the first of each year telling you how much you will get for the coming year (including any cost of living raises) check to see if after the gross amount they tell you the deduction for Medicare. If that does not appear on your yearly statement then your private insurance is indeed very good and the premiums are good also, because the Medicare amount would come out of yours and TC's Social Security both.

Have I confused you further? I know what I am saying, but maybe no one else does.

By the way, Agate is right that Newone should get her information straight from Medicare because her circumstance and mine or yours might be completely different.

[Frog42]

I hate to tell you what our ins. charges per month. It's thru Lenny's co. so we don't send them any money but the co-pay is high.

[Jeanie Z]

:) I first applied for disability in 1988. I never got it. When my husband and I divorced in 1991 I went on Cobra for 3 years and paid $400. a month. When the 3 years was up they wanted me to pay yearly and upped the amount to $1700.00. So I had no insurance from 1994 until I started collecting Social Security. I paid for all my visits, tests and Rx's then.

When I went on SS in 2006 I went on my exes because I had no working quarters for all of the previous 10 years. A volunteer ombudsman called me to help me figure out which supplemental insurance to get. I gave him my Rx names and he said he would look and see which company would cover those. He signed me up with Care Plus HMO and I do not pay a premium. I pay $7.15 for one Rx a month and of course I pay for LDN as it is off label.

I don't understand why but Care Plus is my primary and Medicare is my secondary. I only have a primary care doctor and I only see him twice a year to get 6 month refills of my rx'. Medicare does deduct just over $100.00 before I get it and so I only get $641.00 monthly. My ex gives me $400.00 a month and has to by court order. He also has to carry an insurance policy of $100,000.00 for me in case he dies. My house and my van are paid for or I would not make it.

I was under the impression that you could not have Medicare be your primary. Right now I am doing ok health wise and I can always make another appointment if I should have a new medical problem. I do all I can to boost my immune system and that has worked well for me. Jeanie :)

[Lazarus]

I can't really add any more detail to the discussion. My situation is like Cat Dancer's in that we continued my husband's insurance when he retired and we both have Medicare and a secondary insurance.

When I was going on Medicare, I made an appointment by phone. It was great! They actually give you an appointment to get a phone call from Medicare on a certain date and time. And they called when they were supposed to!

The woman who was helping me register was like a universal mother. She walked me through things, figured out what I needed and told me when I was making a wrong decision. It was a pleasant experience.

Just thought I would share that experience.

[agate]

My situation is probably like Howie's. For years there was Medicare Parts A and B, and I had Medicaid as well, which usually picked up the 20% of a bill that wasn't covered by Medicare. Medicaid usually paid the premiums too.

When Medicare Part D came along a few years ago, everyone had to choose a supplemental insurance, and there were certain plans that worked with Medicaid. I chose one of them, and there was a nice person on the phone who guided me through the process. I'm sorry I can't recall if this nice person was connected with Medicaid--I think so.

Now all of my Medicare claims get subsumed under United Health Care, which was the supplemental insurance I chose. It's a PPO, available through AARP somehow or other, but I understand United Health Care also has an HMO that some people are on.

It's all about as confusing as anything could be, but every time I show my United Health Care card, I'm hardly ever asked for a Medicare card or a Medicaid card, and somehow or other the coverage works and I end up paying 0 copays for most doctors (specialists sometimes have a copay) and copays on rx's of about $2.50 per rx.

[Howie]

Medicaid is there to be used, not abused, for people who can't afford insurance. Remember not long ago, I had a detached retina, and needed eye surgery. Medicaid paid every penny. Without Medicaid, I would be blind in one eye because I couldn't afford that surgery out of pocket. That's why it's there, and I am forever grateful!

It wasn't a gift, but I paid for it with deductions from my paychecks since I was 16. It's a good plan, and I'm glad not only for myself, but for others who through no fault of their own, are forced to use it.

[Cherie]

I have $104/month and 40.98/month deducted from my SSDI check for parts B and D. Part A is free. Part C is your supplemental policy (not B as mother noted above) and mine costs me $232/month.
I signed up last August to become effective October 1. You can set your start date. The Medicare Plan year goes from January 1-December 31 so by my starting in October when my regular insurance was due to be renewed, I quickly paid my maximum out of pocket ($4500) before December 31 then had to start all over again January 1. Rebif copay on Medicare was costing me $2000/month. Could not get help with that till just a couple of months ago when EMD Serono got me into the Patient Access Plan which gave me $5000 assistance for the year to cover copays from my out of pocket expense.

[newone]

I thought that if you're on Medicare you can NOT get any financial assistance for your medications? Good news if that's not accurate!

[stillstANNding]

My understanding, new one, is that is only Medicare part D. I have original Medicare and commercial insurance. I switched from Copaxone daily to 3x a week. I got co pays paid for by Teva though I didn't ask for that or need it.

ANN

[agate]

Medicare Part D covers prescription drugs. It was added to Medicare only recently--about 5 or 6 years ago?