Medicare insurance & supplemental plans

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haven't had medical insurance in 20 years. I am turning 65 in two years. Do I really need medicare?

Tom S - Life being what it is, if you do not take it, you'll need it for sure and wish you had it.  If you have something catastrophic happen - which often does as we get older even though we pray it won't - you'll be glad you to have it.  You've been really lucky all these years; some of the rest of us, not so much.  Medical costs are unbelievable.  When I broke my elbow in 2003 the three surgeries, physical therapy, etc. were over $10,000 and I suspect it would be a whole lot more now.  When Jerry's mom got sick she was in ICU for 30 days and the bill was $100,000 in 1993.  Not many of us can take a hit like that!

All - I noted the other day that we changed drug plans this year.  Just picked up my first prescription under my new plan and it cost $3 less than it did under United (same drug and same amount).  So far, so good!

ArdraF
 
Thanks for sharing that Bob, it's a good reference for Kaiser.

FWIW a local friend has had Kaiser for 25 years and has tried on several occasions, including yesterday, to convince me I should go that way. My prescription drugs are not in their formulary, so I would pay full price.

A few months ago this friend contracted pneumonia while on vacation in Mexico and spent 10 days in a hospital down there. He was finally able to get home and visited Kaiser the next day. Fortunately, the MX hospital doctor did a good job of documenting his condition and what they'd done, which Kaiser was grateful for. He's now waiting to hear if Kaiser will re-imburse him for the MX hospital stay he paid for with a credit card.
 
Tom said:
My prescription drugs are not in their formulary, so I would pay full price.
Interesting. Seems Kaiser doctors would evaluate the condition and prescribe a med. Can't imagine they would prescribe something they wouldn't partially pay for. Have you had the opportunity to chat with a Kaiser representative?

He's now waiting to hear if Kaiser will reimburse him for the MX hospital stay he paid for with a credit card.
Kaiser "is" essentially medicare when it comes to reimbursement - so whatever response he would have gotten from Medicare he will most likely get from Kaiser. I always call Kaiser and ask them what to do to make sure that call is on record. If the nurse is not sure, he/she will contact an appropriate doctor for a decision. Did your friend call Kaiser prior to entering the hospital?
 
Have you had the opportunity to chat with a Kaiser representative?

Not yet, and don't know if I will. When we retired early, Kaiser decided they didn't want to insure me, giving some phony reason. So, they already have one strike against them, and I'm suspicious. Meanwhile, we took a long time to find a family doctor we're comfortable with in this area, although he's two towns away; Switching to Kaiser would force us to go to unknown (to us) doctors at a facility that's four towns away. Meanwhile, during yesterday's discussion (that I've heard numerous times), our friend told me he'd had to "fire" his Kaiser doctor and insist on an alternative.

Did your friend call Kaiser prior to entering the hospital?

I have no idea, but he's been with them long enough to know the rules, and has been out of the country on numerous occasions. Hopefully, he'll be re-imbursed. Otherwise, having a big uncovered hospital bill while in your 80's wouldn't be fun.
 
Tom said:
Switching to Kaiser would force us to go to unknown (to us) doctors at a facility that's four towns away. Meanwhile, during yesterday's discussion (that I've heard numerous times), our friend told me he'd had to "fire" his Kaiser doctor and insist on an alternative.
2 towns away vs. 4 -- imagine how bad that would be if living in West Texas.  :)

I "do" understand though. Ones family, or in my case, personal, doctor is most important to ones peace of mind. Actually, that's a big plus for Kaiser to me. Moving from one doctor to another is simply a case of going to their web site, reviewing all the bios of all the doctors in whatever area of expertise one desires - then selecting one. No "firing" or "insisting" on another in my experience. I have done that on three occasions now. I didn't have to give a reason or discuss it with anyone in any way - just a mouse click on their website. The bios include pictures, complete educational history, board certifications, experience, specialties and personal stuff such as their family and personal approach to medicine.

Otherwise, having a big uncovered hospital bill while in your 80's wouldn't be fun.
For sure, it would not be good. I hope medicare reimburses their portion. It is my understanding that Kaiser does not reimburse other than the supplemental they provide. The main money comes from medicare and payment is authorized by medicare. Kaiser just administers the program according the plan one is under. BTW, my plan is called the Senior Advantage. And I don't fill out any paperwork at all.

According to what I have just read again, Kaiser covers me for emergency services anywhere is the world. Also, I am reading they cover me for urgent care when not in the Kaiser services area. That would probably have to be approved in advance - as Kaiser most likely decides what is urgent and what is not. I will be chatting with them next week about what I might do for some therapy for my wrists while out of their service area.

Hope you find a plan that suits you, Tom . . .
 
Tom, just an FYI; and Bob no offense to what you have decided to use as your medicare coverage; but in Bakersfield and also in So. California, Kaiser has a very bad reputation for several things.  First, not being able to get an appointment in a timely manner was one issue.  And getting a second opinion is a long procedure.  I have friends who used the Escondido facility, as well as, the Bakersfield facility.

You must go to a Kaiser facility, I wanted to be able to choose my own doctor and not have to just use the Kaiser doctors or drive several hours to reach a Kaiser facility while traveling.

What got me confused when I was trying to figure it all out last year was that there are two roads to follow after you get your medicare card.  Everyone gets Medicare A and B.  The next step is you have to decide if you want to follow the one path, which is original medicare supplement often called "Medigap" and have to purchase Part D which is drugs; or the second road which is to buy a Medicare Advantage program which includes the supplemental coverage and drug coverage.  Once I figured that part out it made it easier for me to choose.  Plus the fact that if you do not take the original Medicare (medigap), you are penalized.

The things important to me were:
  • choosing my own doctor
  • coverage out of the country
  • quick appointments and second opinions
The Drug formulary is often different with different companies and it often changes each year.

I chose the Original Medigap with Humana as my Part D drug provider.  My decision on the supplement was between AARP or Anthem.  I went with Anthem because we were already covered with them.

For those who aren't interested in Medicare, my husband a, healthy never been sick husband had to have a pace maker put in a couple of years ago.  The cost for 3 days of hospital stay was over $75,000.  We had catastrophic insurance with a $5,000 deductable.  I would have hated to pay the whole $75,000. 

Marsha~
 
Marsha/CA said:
. California, Kaiser has a very bad reputation for several things.  First, not being able to get an appointment in a timely manner was one issue.

Marsha,
We have had Kaiser for 7 years now and  it has been wonderful for us.  If I call about three weeks to  a  month in advance, I am able to get an appointment on the specific day I want.  In one 3 day period I had  9 appointments coordinated between me and Terry. Dermatologist, orthopedic specialist,  2 regular GP visits, Mammogram, Ob gyn, cardiologist .  The flexibility I had was due to the fact that my service area is in Orange County and they have so many facilities that I could choose from to allow the scheduling.   

We have really appreciated the online information.  I have results of lab work online within 4 hours of a blood test and it charts it to compare with past visits. I too had heard negatives of a big HMO like Kaiser but  were very  very pleased.  They are proactive and did  lots of prevention checks. Seeing Doctors is a very personal decision.  Reminds me that recommendations to  " good Mexican Restaurants"  varies widely among our tastes as well.
Betty
 
ArdraF said:
Tom S - Life being what it is, if you do not take it, you'll need it for sure and wish you had it. 
Ardra - Yes I know I am going to have to have Medicare. I just happen to hate insurance and I really hate doctors and hospitals.
 
My parents had Kaiser while they were full-timing. They had to return annually to southern California for appointments, but they wanted to anyway because the grandkids were there. Once they started spending more time in central Oregon, they got tired of driving over the mountains to Portland for appointments and switched to a different plan. It was nothing against Kaiser, they just wanted to use their local doctors.
 
Marsha/CA said:
. . . and Bob no offense to what you have decided to use as your medicare coverage;

None taken, Marsha . . .  :)

None of what you mention has ever happened to me or been a concern, or, my Mom and Dad while alive, my brother and SIL, their 4 children, their four children's' 10 children, the 5 spouses of the the 5 that are married - well, it just goes on and on as to the positive feedback by friends and family.

Anyway -- Kaiser works for me for the reasons I've posted.
 
Thanks Marsha. I've pretty much decided on original Medicare plus third party Medigap and Part D. I too currently have Anthem, so will look at their Part D in addition to AARP.
 
I really hate doctors and hospitals.

HA!  Don't we all!

Kaiser covers me for emergency services anywhere is the world. Also, I am reading they cover me for urgent care when not in the Kaiser services area. That would probably have to be approved in advance - as Kaiser most likely decides what is urgent and what is not.

Many years ago when we were changing jobs we were given the Kaiser option for our employer health care.  We were very hesitant but eventually decided to go with Kaiser.  We originally were convinced to go the Kaiser route because our friend's wife had died of cancer and he said she couldn't have received any better care anywhere else.  Like everywhere else, there are good doctors and bad doctors, good hospitals and bad hospitals.  We were at the Kaiser in Redwood City and loved it.  When I went through my breast cancers and surgeries they gave me really good care - and all I paid for out-of-pocket was the TV in my room and the co-pay for some of my drugs!  Being able to have doctors coordinate care, having all the records in one place, being able to have tests done in one place, etc. is really a positive.  Now we have to go all over town to get x-rays, MRIs, see different specialists, etc.  It's a royal PITA!!  We were spoiled by Kaiser.  All that said, I wouldn't go with any other HMO because at Kaiser the doctors decide on your care but with other HMOs the bean counters decide what you can have or not have.

Our experience out of plan was interesting.  In South Africa we thought I had malaria.  Kaiser had no trouble paying for the doctor to come to my hotel and the lab tests (no malaria, just another bug).  All I did was give them the receipts when I got home and they reimbursed me.  One time in Australia Jerry had an eye problem caused by the bright light of his overhead projector.  He went to an eye specialist and again Kaiser reimbursed us.  If there's an emergency where spur-of-the-moment care is needed, it's not a problem.  What "is" a problem is if you decide you want to get "regular" care out of your area.  That's a no-no.  Although when I was having allergy shots back in the 1970s we went on a summer trip.  They gave me the solution for the shots which we kept refrigerated and when it came time for my weekly injection I went to the nearest hospital.  Canada was not a problem.  In New York the SUNY hospital was the only one that gave me a hard time.  And somewhere down in Alabama or Mississippi, I went to a clinic where the nurse advised me to go to a hospital in the next city because she was worried I might have a reaction and a doctor wouldn't be close enough.  But Kaiser paid the fees where there were any.

How we miss Kaiser now that we're out of their coverage area!  I have to say, I had absolutely superb care with them.  My doctor there was the best one I've ever had and I really miss her!  One day on an elevator I heard someone comment negatively on this doctor's bedside manner and I felt like saying "yes, but how good is she as a physician?"  In my opinion, a good bedside manner doesn't count for anything if you don't get good medical care and advice.

ArdraF
 
Tom said:
Thanks Marsha. I've pretty much decided on original Medicare plus third party Medigap and Part D. I too currently have Anthem, so will look at their Part D in addition to AARP.

The "F" medigap option is pretty comprehensive.
 
[quote author=taoshum]The "F" medigap option is pretty comprehensive.[/quote]

Thanks.
 
Something that hasn't been mentioned here ....

Further reading on Kaiser reveals that having original Medicare Part A & Part B is a prerequisite to enrollment in their Senior Advantage plan. IOW in addition to the Kaiser $84/month premium, a Kaiser member pays the original Medicare Part B premium. This Part B premium is based on income (AGI) two years prior, and, for 2012 enrollees, ranges from $99.99 to $319.70/month (based on 2010 AGI).

Not a deal breaker, but Kaiser appears to be the only plan having this prerequisite. With the other insurers, one opts out of Medicare Part B.
 
Tom, If I'm reading your message correctly:

Further reading on Kaiser reveals that having original Medicare Part A & Part B is a prerequisite to enrollment in their Senior Advantage plan.

Everyone pays Part B.  $99.00 (or something close to that) is taken out of my social security every month.  I then pay the extra for the supplemental from Anthem-Part F.

Marsha~
 
Tom said:
Something that hasn't been mentioned here ....

Further reading on Kaiser reveals that having original Medicare Part A & Part B is a prerequisite to enrollment in their Senior Advantage plan. IOW in addition to the Kaiser $84/month premium, a Kaiser member pays the original Medicare Part B premium. This Part B premium is based on income (AGI) two years prior, and, for 2012 enrollees, ranges from $99.99 to $319.70/month (based on 2010 AGI).

Not a deal breaker, but Kaiser appears to be the only plan having this prerequisite. With the other insurers, one opts out of Medicare Part B.


Every Medicare Advantage Plan I've seen operates that way.  They get payments from Medicare plus your premium as "income"  to pay claims.
 
Tom said:
This Part B premium is based on income (AGI) two years prior, and, for 2012 enrollees, ranges from $99.99 to $319.70/month (based on 2010 AGI).

My understanding is that is way all such plans work. A supplemental plan is just that, supplemental to medicare. I believe I am paying about $100 out of my SS check and $100 for the supplemental.

Your friend with the MX situation, for example. Medicare should be will be paying their share and Kaiser will be paying the supplement amount. Kaiser would be administering both.
 
Tom said:
Something that hasn't been mentioned here ....

Further reading on Kaiser reveals that having original Medicare Part A & Part B is a prerequisite to enrollment in their Senior Advantage plan. IOW in addition to the Kaiser $84/month premium, a Kaiser member pays the original Medicare Part B premium. This Part B premium is based on income (AGI) two years prior, and, for 2012 enrollees, ranges from $99.99 to $319.70/month (based on 2010 AGI).

Not a deal breaker, but Kaiser appears to be the only plan having this prerequisite. With the other insurers, one out of Medicare Part B.



It's interesting that Medicare is already "means tested" but few know about this and even fewer in congress will admit it publicly.  Oh well.
 
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