Medicare insurance & supplemental plans

[Tom]

Maybe I and II is the same as A and B?

Oops, yes, that should have been parts A & B.

... might wanna make sure it works when you are out of state...

Already did, and it covers me.

... even out of the country if that's a factor...

Having spent a career traveling the world, the only place we go nowadays is to the home country, where I'm covered by their social medicine, thanks to my prior payments.

 

[Marsha/CA]

Tom an d taoshum,

We have Anthem Blue Shield and one of the reason we chose it is because it will work in all the states and out of the country.  You just need to make sure the doctor you pick accepts Blue Shield.  Before I chose it, I called my personal doctors to make sure they all accept Blue Shield.

Marsha~

 

[Tom]

We have Anthem Blue Shield...

Marsha, are you sure that's not Anthem Blue Cross? That's who Chris is currently insured with, and she has a few years to go before Medicare.

You just need to make sure the doctor you pick accepts Blue Shield.

Since Medicare will be my primary coverage and Blue Shield will be a supplemental, that's not an issue. The provider has to accept the primary coverage (Medicare in my case), and Blue Shield will cover what's left over. Our (primary) family doctor accepts Medicare and, in fact, recently "congratulated me on making it to Medicare".

 

[Marsha/CA]

Tom, you are right, It's Anthem Blue Cross.  I had to pull out the card to check.

Marsha~

 

[Tom]

Thanks Marsha. I thought there might have been a third insurer called Anthem Blue Shield that I hadn't heard of.

 

[Ernie n Tara]

FYI If you read closely, the 10%/year penalty applies if you are not covered by other insurance and decline part B when you become eligible (at 65). The penalty is normally waived if you are employed and have insurance past 65 so long as you have a "letter of equivalent coverage" for meds.
I'm about to pick up Part B since I'll be retired this month at 69.

Ernie

 

[garyb1st]

I have had Kaiser since I retired.  Fortunately I have been in good health and other than physicals and an occasional hammer to my thumb, haven't needed them much.  Maria on the other hand has been in twice for surgery.  Our experience has been very good and while I was reluctant to use them initially, a personal friend, employed by Kaiser in an administrative position, told me, "Kaiser is great with one caveat  You have to know the system."  Based on our experience I have to agree.  Once a primary care physician is selected, I simply communicate my concerns and needs on line.  As far as I know, I can change physicians when I want.  Maria broke her shoulder in March.  Had surgery in April.  This followed by numerous follow ups with the doc and therapist.  $10.00 each visit co-pay and meds are our only out of pocket costs. 

I'm so sold on Kaiser that I'm reluctant to move out of one of their coverage areas.  Before Kaiser I had Blue Cross.  The problem with them, at least a few years ago was their negotiated fee schedules were so low, many physicians, including both my Internest and Opthomologist refused to accept patients that had their insurance.  So, when I had an appointment, my out of pocket was their standard fare.   

 

[Terry A. Brewer]

Tom

AARP Medicare Supplement Insurance Plan F for medi-gap

Amana/Walmart Part D for drug plan.

 

[Bob Buchanan]

Once a primary care physician is selected, I simply communicate my concerns and needs on line.  As far as I know, I can change physicians when I want.  Maria broke her shoulder in March.  Had surgery in April.  This followed by numerous follow ups with the doc and therapist. 

Yes, I have Kaiser (my thoughts are elsewhere on this topic) - and have changed primary care doctors several times. There are zero questions asked plus not sure if you've looked at the array of doctors to choose from, their complete resume, education, board certifications, and person backgrounds as to why they became a doctor and specifically why the chose Kaiser.

Travel is a drawback but only if I would like to go check some non-emergency thing out in person. Have had 4 ER visits out of CA and each worked out very well, w/Kaiser paying all expenses w/o my being involved at all. Otherwise, I can chat by email with my primary care doctor or any other doctor that I have seen - and include up to 4 jpg's with each email. My PC Dr always answers my questions, prescribes meds, or whatever within 24 hours and most often within a few hours. For non emergency or urgent care stuff, it's like having a non urgent office visit whenever I want it. Their mail system of getting my meds is flawless - plus on the occasions I've run out they call whatever pharmacy number I give them right away.

I've had 4 operations in 5 years (will be cancer free next month for 5 years). Also, had both hips replaced plus a fun time w/my gall bladder. W/the hips, they provided a PT that came to my MH twice a week (I'm a full timer), plus an Occupational Therapist as often - plus a nurse several times at no charge. They would have also placed me in a nursing facility for up to 60 days at no charge if I had wanted or needed it. The PT was very thorough and, eg., moved the fire extinguisher to within hands reach beside my couch. The OT provided tools for dressing, made certain I could get in and out of the shower, measured the height my toilet, etc. They even supervised the construction of steps so I could use a walker to go for walks outside the RV. Again, all recovery costs other than meds were free.

We all get attached to our primary care giver doctor - but I've found w/Kaiser, each one I have been assigned selected is as good or better than the one prior. Have come to realize that if employed by Kaiser, they are damn good.

Edit 6/27/12: Edited to make the point that when changing primary care doctors, I selected the new one from reports of others and my review of the info available on each on their website. It is possible that one may be fully booked, and a second choice would be necessary - tho that has not happened as yet.

 

[Rancher Will]

For those, like my wife and me, especially if self employed (as I am) you might look into a Medical Savings Plan.
I have had a Medical Savings Plan for over 35 years. The plan is owned by me, covers my wife and myself, and I have no expensive insurance premiums. The Assets in our plan after these years exceeds any benefits we could get from most insurance plans, especially at our ages now.

 

[Tom]

[quote author=Terry A. Brewe] AARP Medicare Supplement Insurance Plan F for medi-gap
Amana/Walmart Part D for drug plan.[/quote]

Thanks Terry, I'll check them out.

I'd still be interested in hearing from anyone who has used Blue Shield; They're a California not-for-profit, but coverage is not limited to within CA. Had a regular (non-medicare) health insurance with them at one time, but have no medicare-related experience with them.

 

[garyb1st]

Tom, before you select an insurer, check with your docs to make sure they accept their insurance.  Some times an insurers fee schedule is quite low and the docs may expect you to pay the difference. 

 

[Tom]

... before you select an insurer, check with your docs to make sure they accept their insurance.

Thanks. My primary coverage will be Medicare, and I already checked that my primary doctor accepts their payment. I'm looking at Blue Shield for a supplemental policy, and the plan I'm considering will pay whatever Medicare doesn't pay. Their web site says this:

"Our Medicare Supplement plans allow you to choose any doctor, hospital or other provider who accepts Medicare - without being limited to a network."

I'll be making another call to my doctor this afternoon, just to be sure.

 

[garyb1st]

Isn't it fun reading insurance policies.  Always remember, The big print giveth and the small print takes away. 

If you can't get your docs/insurers to memorialize any conversation about what is covered, send them an email confirming your understanding.  That will serve you well if it ever gets messy. 

 

[Tom and Margi]

Tom was eligible for Medicare for six years before I was.  He was covered by Blue Shield Plan F.  Never had a problem while we were traveling.  When we moved to Oregon, we changed carriers but still stuck with Plan F.  If I'm not mistaken, Plan F coverage is the same no matter who the provider is.  The premium varies widely, though, and might have something to do with the region from which the policy originates.

Just this last winter, we switched to a Medical Advantage Plan.  The Plan F premium was becoming too expensive for our budget, and we are no longer traveling.

Some of the doctors in Roseburg, OR have refused to accept something called Blue Cross Regency.  Don't have a clue why or what type of coverage it is. 

Margi

 

[Tom]

Thanks Margi. Their Plan F is what I'm looking at. You're right, their premiums vary by 'region', with a region including several counties. I assumed it had something to do with prevailing medical costs in the respective counties.

 

[Tom]

Amana/Walmart Part D for drug plan.

OK Terry, I spent ages wading through appliances on their web site, but couldn't find their prescription plans  That's when I realized you meant Humana  ;D

After doing some reading, I spent some time on the phone with them, talking about their Part D (prescription) plans and their Medicare supplemental plans. It appears that I'd only be limited to Walmart pharmacy if I chose the lowest premium plan, which doesn't cover all my meds anyway; The other two plans do cover all my meds, and would allow me to go to any pharmacy.

Any reason for not having Part D and supplemental with the same company?

 

[Terry A. Brewer]

Tom

I must have refrigerators on my mind.<G>

I chose them because they were the cheapest that covered my meds & offered mail delivery at even a cheaper rate, and if I do have to pick them up at a pharmacy for some reason Walmarts are everywhere.

I can get my meds as cheap/cheaper in Mexico but if you don't sign for a drug plan when you are first  eligible they penalize you with higher monthly rates if you decide to join in the future. I think this happened to Shelia K.

 

[ArdraF]

Tom and Terry,

You two probably can't have the same coverage because you're "based" in different states.  And ours is probably different from both of yours.

I spent about three days last fall figuring out which drug plan would be best for us and it's all determined by your zip code.  It's enough to cause a headache!  What I got seems to be okay so far with less premiums and less copay.  Best of all, it's good all over the U.S.and we can go to any pharmacy.  We didn't want tied to a specific pharmacy because they're all not in all the states.  Happy to say our prescriptions are so minimal that we don't need to worry about receiving them on a schedule so mail delivery isn't a consideration.

ArdraF

 

[Wendy]

I can get my meds as cheap/cheaper in Mexico but if you don't sign for a drug plan when you are first  eligible they penalize you with higher monthly rates if you decide to join in the future. I think this happened to Shelia K.

If you sign up with VA, even if you don't use them, they count as a drug plan and if you later add a drug plan, there's no penalty.

Wendy