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  • #61
    Re: Medicare

    I received my Kaiser Senior Advantage benefits book for 2010 in the mail yesterday. Many preventive procedures like mamagrams, pap smears, prostate screening, colonoscopys, etc, had a co-pay of $20 to $100. They are now all free in 2010. I guess free preventitive medicine is cheaper than on-going cancer treatment.

    My annual maximum out-of-pocket expense is going to be increased from $3350 to $3400. I can live with that.

    Also, Tutu, I was looking at their drug formulary. A note said that if your drug is not on the formulary, contact them with an explanation why you need that particular drug. They said they look at each request on a case by case basis.
    Peace, Love, and Local Grindz

    People who form FIRM opinions with so little knowledge only pretend to be open-minded. They select their facts like food from a buffet. David R. Dow

    Comment


    • #62
      Re: Medicare

      Originally posted by matapule View Post
      Many preventive procedures like mamagrams, pap smears, prostate screening, colonoscopys, etc, had a co-pay of $20 to $100. They are now all free in 2010.
      I just learned my HMSA plan does not cover colonoscopy. The out of pocket cost would be about $3,000. I've undergone it twice in the past, so that means this is something new.

      But Medicare covers it, I was told. Unfortunately, I'm about four years away from that. My doctor still scheduled me for the procedure, pending approval from HMSA. If it's not approved, I won't get it. Isn't that ridiculous?

      By the way, I've been skimming this thread. I really should study this more closely, but every time I look at it, I get dizzy. Why does health care have to be so complicated? I have the same gripe about taxes.

      Comment


      • #63
        Re: Medicare

        Originally posted by Honoruru View Post
        I just learned my HMSA plan does not cover colonoscopy. The out of pocket cost would be about $3,000. I've undergone it twice in the past, so that means this is something new.

        But Medicare covers it, I was told. Unfortunately, I'm about four years away from that.
        Holy Shit! Pardon dee expresion. I betta go check my HMSA Policy. It's about dat time foa me to get onnada colonscopy done. They found three polyps. I'm glad I got it done. I recently received a letter from Medicare informing me I will no longer be having coverage anymore. It's fine with me. When I retire or am disabled again, I can reapply.

        Auntie Lynn
        Be AKAMAI ~ KOKUA Hawai`i!
        Philippians 4:13 --- I can do all things through Christ who strengthens me.

        Comment


        • #64
          Re: Medicare

          Originally posted by Honoruru View Post
          If it's not approved, I won't get it. Isn't that ridiculous?
          Be careful Honoruru! You really rolling the dice on this one.

          Kaiser Senior Advantage pays for the colonoscopy once ever 2 years if at high risk (I am since my Dad had colo-rectal cancer) otherwise it is once every 4 years.

          I really should study this more closely, but every time I look at it, I get dizzy. .
          Let me simplify it. Medicare part C (Senior Advantage) is the least expensive and most comprehensive coverage for 95% of seniors. Several companies offer Senior Advantage in your area. In general the top three companies (most dependable) are Kaiser, Secure Horizons (AARP), and Aetna. Compare the price and coverage of these three.
          Peace, Love, and Local Grindz

          People who form FIRM opinions with so little knowledge only pretend to be open-minded. They select their facts like food from a buffet. David R. Dow

          Comment


          • #65
            Re: Medicare

            Originally posted by Honoruru View Post
            [...]
            But Medicare covers it, I was told. Unfortunately, I'm about four years away from that. My doctor still scheduled me for the procedure, pending approval from HMSA. If it's not approved, I won't get it. Isn't that ridiculous?
            Do you receive HMSA's annual Health Pass...a health screening around your birthday? If so, they usually offer a discount on several tests, incl. colonoscopy.
            Originally posted by Honoruru View Post
            By the way, I've been skimming this thread. I really should study this more closely, but every time I look at it, I get dizzy. Why does health care have to be so complicated?[...]
            Can you imagine how complicated Medicare is when you try to sift thru it completely clueless?!!! That's why I started this thread.
            Originally posted by matapule View Post
            [...]In general the top three companies (most dependable) are Kaiser, Secure Horizons (AARP), and Aetna. Compare the price and coverage of these three.
            Matapule, I didn't find Aetna on the list based on my zip code. In Hawaii, HMSA also offers a Medicare plan...65C. However, it's quite a bit more expensive than the ones Matapule mentioned. Still, you might want to add that one to your comparison.

            Honoruru, plan offerings and rates will probably change in 4 years but it's really smart that you're trying to grasp the subject now. It will make it a lot easier for you when the time comes!

            Comment


            • #66
              Re: Medicare

              Finally I'm back in. Been trying to post looong time.

              You don't have to be 65 to get Medicare. The Disabled also receives Medicare. Disabled Widows at the age of 50 recieves Medicare and those who are not receive it at the age of 60.

              If you are a widow or widower, please contact Social Security at 1-800-772-1213 for further assistance.

              Auntie Lynn
              Be AKAMAI ~ KOKUA Hawai`i!
              Philippians 4:13 --- I can do all things through Christ who strengthens me.

              Comment


              • #67
                Re: Medicare

                Originally posted by matapule View Post
                Be careful Honoruru! You really rolling the dice on this one.
                It’s not that I’m negligent on this issue. I’ve already had two colonoscopy (both negative) and this was supposed to be my regular scheduled followup. If my doctor had not informed me about the change in policy, I would not never questioned it. I would have gone through with it, expecting it to cost the same as it did the last two times. And I would have been blindsided with a $3,000 bill.

                As I see it now, I have three choices. Go ahead as scheduled and pay the $3,000; wait four more years till I qualify for Medicare; or postpone the procedure and see if there is another solution. I’m leaning towards the later if my claim is rejected. Of course, HMSA could still approve the claim, in which case I would want to know the definite out-of-pocket cost for me, and other relevant information. In the meantime, I want to find out exactly what the hell is going on. Because it’s not very clear.

                Originally posted by tutusue View Post
                Do you receive HMSA's annual Health Pass...a health screening around your birthday? If so, they usually offer a discount on several tests, incl. colonoscopy.
                Not sure about that. I’m afraid I have a bad habit of throwing away those informational mailers from HMSA.

                Originally posted by tutusue View Post
                Can you imagine how complicated Medicare is when you try to sift thru it completely clueless?!!! That's why I started this thread.
                I’m still totally clueless about HMSA. Is Medicare going to be worse?

                Comment


                • #68
                  Re: Medicare

                  Originally posted by Honoruru View Post
                  [...]
                  As I see it now, I have three choices. Go ahead as scheduled and pay the $3,000; wait four more years till I qualify for Medicare; or postpone the procedure and see if there is another solution. I’m leaning towards the later if my claim is rejected. Of course, HMSA could still approve the claim, in which case I would want to know the definite out-of-pocket cost for me, and other relevant information. In the meantime, I want to find out exactly what the hell is going on. Because it’s not very clear.[...]
                  Prior to my very recent Medicare coverage I had HMSA. Plans differ and I had the small business plan. Approx. 12 years ago my doctor recommended a colonoscopy and told me immediately that HMSA didn't cover it unless they found something. A small, benign polyp would do! After some research I ended up (pun intended!) getting a much less expensive colonography at Holistica. Same prep but no anesthesia needed. The Holistica doctor mentioned that should they find something then I would need to follow-up with a colonoscopy. That was fine with me because then I'd know it would be covered. Nothing was found so I was out-of-pocket a much lesser amount of money.
                  Originally posted by Honoruru View Post
                  I’m still totally clueless about HMSA. Is Medicare going to be worse?
                  Medicare was much worse for me. When I got HMSA there weren't many choices. Come to think of it, there was only one plan I could afford!!! I owned a small business (just me!) and needed a group policy so I opted for the small business plan. It was pretty simple!

                  With Medicare there are several choices and each has different coverage, many with the same monthly cost. That means there's a lot of comparing to do. You may have a friend or family member in another state, as I do, who has a plan s/he loves but that doesn't mean the same plan is offered in Hawaii. Chances are it won't be! I've spoken directly with Medicare, my doctors, various plan reps, friends and family and all have used the same word...CONFUSING!!! Now, the good news is that once you choose a plan you're not stuck with it forever. There's open enrollment every year from mid Nov. 'til the end of Dec. During that time you may switch to another plan.

                  Comment


                  • #69
                    Re: Medicare

                    Originally posted by matapule View Post
                    [...]
                    Also, Tutu, I was looking at their drug formulary. A note said that if your drug is not on the formulary, contact them with an explanation why you need that particular drug. They said they look at each request on a case by case basis.
                    Sorry I missed this earlier. I've already talked with Medicare about the possibility of my doctor submitting a request and the drug in question is totally excluded with or without an explanation.

                    Comment


                    • #70
                      Re: Medicare

                      Originally posted by tutusue View Post
                      I've already talked with Medicare about the possibility of my doctor submitting a request and the drug in question is totally excluded with or without an explanation.
                      Tutu, I'm totally confused. If you have Secure Horizons Senior Advantage, Medicare part D has nothing to do with it. Secure Horizons is the one that provides your prescription coverage. Kaiser provides my prescription coverage, that's why Kaiser said to contact Kaiser if a medication I needed wasn't in Kaiser's formulary.

                      I think maybe you have SH supplemental medicare coverage not part C coverage.
                      Peace, Love, and Local Grindz

                      People who form FIRM opinions with so little knowledge only pretend to be open-minded. They select their facts like food from a buffet. David R. Dow

                      Comment


                      • #71
                        Re: Medicare

                        Originally posted by matapule View Post
                        Tutu, I'm totally confused. If you have Secure Horizons Senior Advantage, Medicare part D has nothing to do with it. Secure Horizons is the one that provides your prescription coverage. Kaiser provides my prescription coverage, that's why Kaiser said to contact Kaiser if a medication I needed wasn't in Kaiser's formulary.

                        I think maybe you have SH supplemental medicare coverage not part C coverage.
                        SH said I have Advantage part C. When I called SH about the prescription in question, "Patricia" said she also checked with the Centers for Medicare and Medicaid Services (CMS). The drug is excluded there so is not and will not be on SH's formulary.

                        Patricia also mentioned that submitting a request for coverage of a drug not on their formulary is generally done for brand name drugs.

                        I do have an inexpensive workaround for the excluded drug but, again, it's time consuming and cumbersome. But at least I have an option.

                        Comment


                        • #72
                          Re: Medicare

                          Matapule...I was checking something at Walgreens.com and remembered this thread! I found the following info interesting...
                          Originally posted by tutusue View Post
                          I mentioned in a previous post that Walgreen's does not allow Medicare recipients to join the discount club. [...]
                          Originally posted by matapule View Post
                          I am suspicious of the information you were given.[...]
                          From Walgreen's web site:
                          Eligibility and Enrollment
                          If you live in the United States or Puerto Rico and are not enrolled in a publicly funded health care program, such as Medicare, Medicaid or TRICARE, you are eligible for the Prescription Savings Club.
                          Walmart - I don't find this subject addressed.

                          CVS:
                          Q Can I use my Health Savings Pass with my current prescription or medical coverage?
                          A You must either use your Health Savings Pass or other insurance. The CVS/pharmacy Health Savings Pass cannot be used in conjunction with other insurance on the same prescription or medical service.
                          So, it appears that Walgreen's has made a corporate decision.

                          And...still...none of my drugs are on any of the lists!

                          ETA: I have an appointment with the Humana rep next week. Secure Horizon's premiums didn't increase but the co-pays and a few other things did. Plus, most of the extra benefits were eliminated. Yippee! I get to add to my confusion!
                          Last edited by tutusue; November 14, 2009, 10:37 PM.

                          Comment


                          • #73
                            Re: Medicare

                            Originally posted by tutusue View Post
                            Matapule...I was checking something at Walgreens.com and remembered this thread! I found the following info interesting...From Walgreen's web site:
                            Tutu, I'm not sure what this means. I think it means that Walgreen's does not participate in any Medicare drug programs by giving you the prescription at no charge and then Walgreens will seek reimbursement from Medicare. I am sure if you want to join Walgreens private pay discount club, and you pay for your drugs directly to them, they would be happy to have you as a member.


                            I have an appointment with the Humana rep next week. Secure Horizon's premiums didn't increase but the co-pays and a few other things did.
                            Go to this site http://www.medicare.gov/MPPF/Include...lQuestions.asp and all the plans in your zip code are compared. Kaiser comes out number one, SH number two (along with others) and it says that Humana is too new to rate. Consequently, I would be very careful with Humana! Buyer beware.
                            Peace, Love, and Local Grindz

                            People who form FIRM opinions with so little knowledge only pretend to be open-minded. They select their facts like food from a buffet. David R. Dow

                            Comment


                            • #74
                              Re: Medicare

                              Boy, if you two old pros are having a difficult time understanding all of this, how can us young whippersnappers (relatively speaking, of course) make sense of it all?

                              By the way, regarding my past posts:

                              Originally posted by Honoruru View Post
                              As I see it now, I have three choices. Go ahead as scheduled and pay the $3,000; wait four more years till I qualify for Medicare; or postpone the procedure and see if there is another solution. ... Of course, HMSA could still approve the claim ...
                              HMSA did approve the above procedure and I had it done last week. One benign polyp and all’s well with the world. I don’t have to worry about this round of silliness for another five years, at which time I’ll probably be on Medicare, or one of the hybrids mentioned above, or something new altogether depending on how health reform goes.

                              Comment


                              • #75
                                Re: Medicare

                                Originally posted by Honoruru View Post
                                HMSA did approve the above procedure and I had it done last week. One benign polyp and all’s well with the world. .
                                EXCELLENT! The best medical care is preventive care, even if it had cost $3000 it would have been worth it.


                                Live long, my friend, and prosper.
                                Peace, Love, and Local Grindz

                                People who form FIRM opinions with so little knowledge only pretend to be open-minded. They select their facts like food from a buffet. David R. Dow

                                Comment

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