Medicare vs private insurance confusion

[flatbutt]

I hope someone here knows something about this.

I went on medicare last summer Part A and Part B (B costs $240 per month) I also bought a private policy for drug costs. The private provider told me that in order to qualify for the drug benefit I had to buy their PPO medicare policy in addition to Part B.

Today I go to a specialist and give them both of my ID cards. They say "which one do you ant to use". HUH?

They say "you can't have two medicare policies". OK sez I,use my private insurance.

My question is why should I spend almost $3k a year for part B if my private insurance covers it anyway?

[Halm]

Ok, been on Medicare for 3 years now. Here is my understanding.

Part "A" is required. Not terribly expensive. I think I pay about $400/quarter.

Next is Part "B" also known as MediGap. I have top tier package and pay about $150/month

I also have Part "D" which is prescription drug plan.

There is also a Part "C" which is a privately run version of Medicare called Medicare Advantage. Not 100% sure but I think it is Part A, B, and C rolled up. While it low cost, it is also basically a HMO approach to healthcare.

Talk to an expert before you drop out of Part and B. There are very strict rules about moving in and out of various coverages. You don't want to lose this coverage.

[John Rogers]

It appears to me that the only people who know are those doing the commercials! I have had Medicare since I turned 65 in 2010. I am lucky because unknown to me earlier in life once I retired from the US Navy and started Medicare I get Tricare for life which cover the prescriptions and any costs Medicare doesn't. It does not cover dental or vision so I had to buy a small add on policy. It sounds to me like the seller of your add on was getting paid for what they sold and if there is still time ( I think there is ) I would cancel that one and shop around. What you have is as the person told you ARE TWO COMPLETE policies! Good luck.
John

[ossiblue]

Okay, bear with me.

Medicare part A is basically hospital care. Most people qualify for it at age 65, and usually it's free if you've paid into the SS system long enough, or your spouse has.

Medicare part B is a bare bones medical insurance policy that you must sign up for if you want it, and requires a monthly premium. Part B "can include outpatient care, preventive services, ambulance services, and durable medical equipment. It also covers part-time or intermittent home health and rehabilitative services, such as physical therapy, if they are ordered by a doctor to treat your condition." https://www.ehealthmedicare.com/about-medicare/medicare-part-b/

Part B does not include a drug plan but you can either buy drug coverage through a private company, a Medicare Advantage Plan, or forego it altogether, but if you don't get one as soon as you first sign up, you pay a penalty thereafter. You can buy supplemental part B plans, called Medigap through private companies, to improve the care and coverage of your Medicare part B insurance. These plans use your part B payments as part of their cost to cover you, and may charge a monthly premium in addition. That's why you continue to pay your part B payments--your private company won't cover you unless you are signed up for Medicare part B, and that's why they are referred to as Medicare supplemental plans. These plans are regulated by the federal and state governments and there are currently 10 different options for them, "the benefits for all the basic benefits options are generally the same regardless of insurer. The differences will be in the price, who administers the plan, and which of the 10 options the insurer chooses to offer."

A Medicare Advantage Plan (part C) is a medical insurance plan, offered by a private company, that must offer at least what original Medicare parts A&B offer, plus a drug plan. These advantage plans take your Medicare part B payments as part of the cost of your coverage, like the other plans, but include the drug plan as well. These plans coordinate the coverage for parts A and B, as well as providing other benefits like dental and vision. They can be in the form of HMOs, PPOs or other organized medical provisions offered by private companies.

The OP sounds like he purchased an Advantage plan. A Medigap plan covers the "gaps" in costs for services that Medicare doesn't cover, so the doctor shouldn't reject that card or ask which to use. If the OP had an Advantage plan, however, that is the plan that covers all benefits and is the one that would be accepted over the Medicare card.

Use the link in my post to clarify anything that still seems confusing.

[Tobra]

Originally Posted by ossiblue

The OP sounds like he purchased an Advantage plan. A Medigap plan covers the "gaps" in costs for services that Medicare doesn't cover, so the doctor shouldn't reject that card or ask which to use. If the OP had an Advantage plan, however, that is the plan that covers all benefits and is the one that would be accepted over the Medicare card.

Medicare advantage plan is supposed to do this. In my experience, not always the case.

If you have Medicare, it is ALWAYS your primary insurance. Your doctor's office really ought to be hip to this.

I would not characterize it as a bare bones plan.

[RKDinOKC]

Took care of my Mom. She had medicare and a gap insurance. Changed her insurance to Generations. Generations is managed health care that covers 100% in their network and receives her medicare as payment. She no longer had or filed "Medicare" only Generations. Saved her the cost of the gap insurance and still got full coverage. There was another insurance that did the same thing. Think it was called Silver Care. But it would not take her because of one of her current prescriptions.

They use what is called a gateway doctor. Her GP had to prescribe and make any appointments to see anyone else or it was not covered at all. The only exception being the ER.

[greglepore]

It may vary from state to state, but here in Pa I can purchase a Medicare advantage PPO with decent drug coverage (at least until the doughnut hole) and 5 copay primary/40 specialist with a 250/day inpatient copay, good network, for NOTHING over my Part B premium. Minimal dental and vision coverage.

To answer fb's question, its open enrollment, so shop around. There are specialists that can help if needed. I agree he probably has an advantage plan now. The 3k/year your spending isn't all just for the drug coverage, you'd likely need a gap plan anyway, as Medicare only covers a substantial part of most bills. But there may well be cheaper Advantage plans.

[flatbutt]

Thanks guys

[Sunroof]

It does vary from State to State! But in a nutshell, I opted for the Medicare Advantage Program with Humana (Humana Gold Plus HMO). My health is excellent so I figured I would select a Primary Care Physician, which is required and can be changed anytime, and all within a huge network of doctors, hospitals, walk in clinics, etc (Piedmont Health Care of Georgia). With this type of set up my records stay within the Piedmont system and follow me anytime I need a specialist, lab work, testing (physical, colonoscopy, physical therapy, etc, etc). So now I have this large network of doctors to choose from without benefit of referral.

Add to this free vision care, silver sneakers (free membership to just about any health club like Planet Fitness for example), 24-hour nurse hotline, FREE Tier One drugs (Humana Lab Services where 90-day supplies are mailed to my home) and a bunch of other free services all for the cost of.......................ZERO DOLLARS!!!!!!!!!!!!!

The cost of Medicare A and B come out of my Social Security check each month for $105.00 per month. For me Medicare is the greatest bargain in the world!!

If however, I had health issues and opted for the PPO program which allows for using doctors outside the Piedmont network, the cost could be as much as $75 per month. So really its all dependent on your location, health, drug needs and who in your state offers Medicare Advantage programs. I live in a large metropolitan area so I am fortunate I have huge support within the Piedmont system.

What I discovered is a multiple number of programs that each insurance provider offers which would include HMO's and PPO's and Part D drug programs. Much of this depends on your present day health needs. Costs would vary state to state, so do your RESEARCH if your close to getting on Medicare.

[wdfifteen]

The amount you pay for part B is dependent on your income. You pay $135 plus an Income Related Monthly Adjusted Amount (IRMAA) based on the following:

[Baz]

Originally Posted by Sunroof

It does vary from State to State! But in a nutshell, I opted for the Medicare Advantage Program with Humana (Humana Gold Plus HMO). ---snip---

Thanks for your post & input, Sunroof!

I've heard nothing but good things about Humana.

I turned 63 in June so Medicare is just around the corner for me and I'm excited to get on board once I qualify.

I'm in good health as well (knock on wood) - in fact - I don't even go to doctors, except my dentist a couple times a year and my optometrist once a year.

Some of the folks I have talked to who had Humana, had the exact same experience as you so they must have also had that plan.

I'll have plenty of social security income to cover this so don't anticipate paying any monthly premiums...just whatever is deemed out of pocket on the occasional doctor visit.

I already have the contact info for the local Humana Marketpoint Sales rep. I think I will send her an email and verify what to expect going forward. Will post in the thread what her reply consists of.

Thanks again!

[JackDidley]

Something to look at. I joined AARP only because I found the best advantage plan through them. Several choices at prices better than I found anywhere else. Just google ARRP advantage plan. The only negative is the huge amount of junk mail they send you. Not a problem for me. I have a big trash can.