Medicare and Other Health Insurance

Medicare with Other Health Insurance

Question: Hi Connie, this is ALL NEW to me (Medicare Supplement/Advantage Plans) I know you sell insurance for a living, however it appears from your site that you do have an interest in the recipients (and THEIR best interests) - so - let me fire this at 'ya.

I am 67 years old now. I've been enrolled in PART A since 65 (however, never used it) Now that I'm being forced to retire (due to hearing loss) I will NOT have a GROUP health plan available to me after May 31. Medicare has told me that I may sign up for PART B after March 1 (but before May 1) in order to have coverage by June 1.

Since I am a Service Connected Veteran, I do have VA medical benefits available to me should the need arise, however would prefer to use an outside provider for health maintenance and less serious health matters (including medications) The Advantage Plans that I've looked into will provide this for my Medicare Premiums (NO EXTRA COST. )Bearing in mind that you are an insurance salesman; would this not be my best route?

Answer: Even though I AM a salesperson, I'm not going to try and sell you any particular thing! But I will try to help you answer your question.

There are several points you need to consider to make the best choice for YOU! They all revolve around cost and convenience.

The most convenient option is original Medicare (A&B) paired with a Supplement and Drug plan. You can go anywhere you want and with the exception of some copays for drugs, your medical treatment will be covered 100%. This option will run you about $250 /month (in Texas) in premiums, including your Part B premium (assuming you make less than $85,000 single/ $170,000 jointly)

The next level of convenience would be original Medicare (A&B) plus your VA benefits. In most cases VA only pays if you get services directly from them. How far away is the VA facility from you? Medicare A has a deductible of $1132 per hospitalization for 2011. Medicare B (outpatient) has a deductible of $162 for the calendar year 2011. After that, you pay 20% for outpatient services. If you use the VA you will have little if any out of pocket cost based on how you are entered in the system. VA will provide prescriptions by mail order with little or no copay. Should you use Medicare B for doctor visits you may go where you want (as long as they accept Medicare) and it will cost you around $20- $40 for a typical office visit after deductible. Your cost would be your Part B premium of $115.40/month for 2011 and whatever your arrangement with VA is. You would have the risk of the additional A & B costs I mentioned. (This is the option my dad uses)

The least convenient would be a Medicare Advantage plan. You assign your part A & B Medicare to the company you enroll with and you must go to their in-network providers to realize the benefits from the plan. You may not revert to your original Medicare if you are unhappy except at certain times of the year. If you are healthy and are just seeing the doctor a couple times a year for checkups, this can work very well. Of course you don't really have insurance for those situations. You have it for the emergencies and catastrophic events. Advantage plans make money by managing the care they allow members to have. They may be generous with the little expenses but when it gets to the big expenses, they are tightly managed. I haven't talked to anyone who has gone through a catastrophic event in an Advantage plan that was happy with the service provided by the plan. If you're aware of this and the cost outweighs the possible inconvenience, this could be the best option. You do have the risk of out of pocket expenses of up to $5000 in-network with most Advantage plans. If you go out of network your cost risk is unlimited. If an Advantage Plan is the route you choose, ask lots of questions about what is and is not covered as well as what out of pocket expense risk there is, before enrolling. Also check the provider list for providers in your area.

Some other points to consider

Getting VA to pay in an emergency situation outside VA facilities is difficult. This is also the case with an Advantage plan. With the Medicare/VA option you at least have the flexibility of being treated anywhere with your Medicare and Medicare paying a substantial portion of the cost. With the Advantage Plan option, if they don't pay, it's your bill.

You didn't mention if you qualify for any special assistance based on your income or the hearing loss. Have you checked in to that?

Enroll in Part B early rather than late! You will need to call Social Security ( 1-800-772-1213 ) to do that and often they can take care of enrollment over the phone. You may also get information about special help because of the disability or income level from them. The sooner the better!!

I hope this helps you answer your question. Please let me know if I may be of further assistance. I can help you with Supplements, Drug plans and Advantage plans so when you decide on the route you want to take I hope you will consult with me.

Medicare drug coverage

Medicare Drug Coverage

Question: Does Medicare cover the cost of Coumadin when it must be taken for the rest of one's life due to a mechanical heart valve?


Answer: Coumadin and its generic Warfarin Sodium are covered drugs under a Medicare Part D prescription plan. You would either enroll separately in a Medicare Part D plan or in some situations prescriptions are included in Medicare Advantage plans. You will pay a copay for the Coumadin in most cases. Original Medicare (Part A & Part B) does not cover drugs except in certain limited situations. Based on the information you provided, your situation does not meet the criteria. You may go to www.Medicare.gov , download Medicare and You 2011 booklet and on page 40 it gives details about situations where Medicare Part B covers drugs.

Medicare and Medicaid

Medicare with QMB and MQMB

Question: I am a retiree living on $800.00 a month from Social Security. I qualify for QMB which is the same as the "extra help" program. I have Medicare and Medicaid. I need glasses, hearing aids and dentures. The lady at the hearing aid store said I didn’t qualify with them because there is not an "M" in front of my "QMB", in others words, it’s gotta be "MQMB" for me to get any help. My glasses need to be replaced. I can barely hear and the one hearing aid I have came from a friend of mine whose mother died. My mouth is sinking in from no dentures.

Can you please give me some kind of information on how I can get these things I need? 

Answer: You would need to contact your local Medicaid office to get information specific to you. Just in general, the extra help offered to Medicare beneficiaries is based on their income and assets and where that puts you in the level of assistance available. You may call 211 and you will be connected to a Medicaid representative. If you have trouble connecting through 211, you may call 1-877-541-7905. You may also go online to www.211texas.org to search for the phone number to your local Medicaid office using your home zip code. Request Medicaid review your qualifications for extra help.

Medicare and Social Security Disability

 

Medicare and Social Security Disability: When Does Medicare Start?

Question: When on Social Security Disability, does Medicare start automatically?

Answer: Medicare Parts A & B automatically start on the 25th month of your disability. If you have ALS they begin right away. There are some options available in Texas for people under 65 without health insurance who are uninsurable given their disability.

Medicare and Durable Medical Equipment Coverage

Medicare and Durable Medical Equipment Coverage

Question: My friend just got an RX for a walker (Rolator). When I took her to the medical supply store, she was told that Medicare does not cover the nice rolator with the seat now. They only cover the silver metal type one. Is this true?

Answer: Medicare has no such policy about the type of walker they cover. Your friend's prescription determines what Medicare will pay for (& I called Medicare just to make sure nothing has changed!) If she needs one with the seat because she can only walk short distances, they cover that, but her doctor has to write the RX specifically. Not sure why you were told that. I’ve heard all sorts of explanations that aren’t based on fact given to my clients. Be sure you are using an approved supplier. Texas is participating in a "competitive bidding" program Medicare has and you are required to use specific suppliers. You can go to www.medicare.gov/supplier and look for a supplier in your area. Confirm they are participating in the program before you buy as things can change!

Medicare and Glucose Testing Supplies

Medicare and Glucose Testing Supplies


Question: How will Medicare pay for my glucose testing supplies?

Answer: Medicare Part B covers test monitors, test strips, lancet devices and lancets. Some blood sugar control solutions and therapeutic shoes, in some cases, are also covered. With original Medicare alone, you pay the deductible then coinsurance of 20% of the cost. Medicare Supplements or an Advantage plan will pay part or all of the deductible and coinsurance.

Medicare Coverage for Dental and Vision Care

Medicare Coverage for Dental and Vision Care

Question: Is there any way Medicare pays for dental work or eye exams?

Answer: Original Medicare does not cover routine dental or vision care. Some Medicare Advantage plans offer some coverage for vision and dental but make sure you know what is and IS NOT covered before enrolling. Read the fine print! Some Advantage plans only cover vision and dental as covered by original Medicare.

Medicare Part A will pay for certain dental services that you get when you are in the hospital. Medicare Part A can pay for hospital stays if you need to have emergency or complicated dental procedures, even when the dental care itself is not covered.

Medicare provides limited vision coverage in some cases such as after cataract surgery or for some cases of macular degeneration. If you are in a high risk category for glaucoma, Medicare will cover screenings every 12 months. It is a good idea to check with Medicare or your Advantage plan rather than assume a procedure is covered. For more information on Medicare coverage go to www.medicare.gov/coverage .