Go Back   HawaiiThreads.com > Ka Honua > The American Asylum
FAQ Members List Social Groups Calendar Search Search Latest Posts Mark Forums Read

Reply
 
Thread Tools Display Modes
  #26  
Old October 10th, 2009, 12:58 PM
matapule's Avatar
matapule matapule is offline
Ali`i
 
Join Date: Apr 2008
Location: Wherever I am, I'm there
Posts: 3,102
Default Re: Medicare

Quote:
Originally Posted by tutusue View Post
the first question I was asked was, "Do you have end stage renal disease?". Because I don't I didn't bother to ask why they asked me that question!
The reason is that no Medicare Advantage or Medicare Supplemental provider will take end stage renal members. If you have that problem, your only option is Medicare part A & B. The government has to take you...thank god!

Quote:
President Obama is trying to address the donut hole problem!
I don't have any "deonut hole" with my Medicare part C, Senior Advantage provider. (I do see I have a keyboarding problem!)

Quote:
Part C is Medicare's equivalent of an HMO plan such as Kaiser. I believe it's called Medicare Advantage. Matapule, please correct me if I'm wrong.
Correctamundo on all parts. My part C, Senior Advantage provider is Kaiser. Part C replaces parts A, B, & D. I have wonderful primary care and specialist doctors through Kaiser. Terrific service. I can view all my medical history and test results on-line. I can communicate with my primary care physcian via email. Kaiser has made me a particpant in my medical care. I like that. On Monday Kaiser is giving me a free flu shot. They reason that it is better to give free flu shots than have to deal with an on-going case of the flu. What a concept! My cost for Kaiser part C coverage? $0.00.

In additon, should I have a serious emergency medical problem, my maximum out-of-packet expenses per year is $3,200 for everything - doctors, hospitals, tests, operations, and related drugs.

Quote:
if you wait to sign up for the drug coverage you are penalized 1% per month. This becomes a lifetime penalty:
That is a fair "glitch." As people get older, they require more drugs (in general). Therefore you should have to pay a penalty if you don't pay for part D earlier in your eligibility.

Quote:
Originally Posted by tutusue View Post
Just curious...why?
Because certain drugs are excluded from the Formulary if there are less expensive branded drugs that do the same thing. If I were you, I would take my Formulary to my doctor and ask him if there was a drug on the Formulary that would do the same thing as what he is currently prescribing.

Quote:
I don't like that the gov't uses my $5 co-pay against me by applying it to my yearly maximum. Let 'em apply what they pay! As I mentioned before, I feel like I'm paying twice.
The negotiated price is a government subsidized price. That is where you get your deduction. You pay the difference which is .23. Both should apply to your maximum. I don't have to deal with any of this in Medicare part C.

Quote:
Is there an online drug formulary for your plan? It would be interesting to see if any of my 3 meds are on it. They aren't on any other plan.
Yes, there is an on-line Formulary, I will have to look it up. But I doubt your drugs are on it, because there are probably less expensive alternatives in the Formulary.

Quote:
Still, I'd rather jump thru hoops with the drug situation then lose my current doctors and start anew by switching to plan C.
I understand completely, and many people would agree with you. It is just I have found wonderful doctors through my HMO. And this is where choice and options come into play. Each one of us have the options to make a choice. I am happy with my choice, even though it is a series of compromises. If someone is not happy with their choice, they do have other options.

Quote:
so this switch to Medicare is a big change. It's the old dog/new tricks thingie!
You're sandbagging me! I know you're the smartest, most cunning dog in the pound! Alpha-female, ya betcha.

Quote:
When I received the statement of benefits from Medicare I noticed the 2 ultrasounds totalled approx. $1300. My co-pay was $20. per ultrasound which HMSA paid. Pheeeeeew!!!
My co-pay for ultrasounds is $50 each through Kaiser. So I would have paid $100 to your $40. But wait there's more! My monthly premium to Kaiser is $0.00. I would guess your monthly premium to HMSA is $300 to $500 per month. So I would get off less expensively in the total cost.

Quote:
Pharmacies have to be on Medicare's provider list and Medicare recipients are provided a directory..
Forget whether the pharmacy is on the list or not. Just ask for the lowest price with or without Medicare.

This all sounds very complicated, but it is not. I guess the problem is that the governement is giving Medicare recipients too many choices. Let me make this as simple as possible. Medicare part C Senior Advantage (an HMO program offered by many different insurance companies) is the least expensive option (for 99% of people). If you have personal requirements that are not included in part C (like using the same doctor you have had for 50 years who is not part of any plan) you will have to pay more. But that is a personal choice.

If anyone has personal questions about Medicare, I am not an expert, but I will try to answer questions from my experience in a PM.
__________________
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

Last edited by matapule; October 10th, 2009 at 01:08 PM.
Reply With Quote
  #27  
Old October 10th, 2009, 04:22 PM
anapuni808's Avatar
anapuni808 anapuni808 is offline
Ali`i
 
Join Date: Dec 2005
Location: No. California
Posts: 2,556
Default Re: Medicare

Matapule - don't you live in Mexico? I'm curious as to how you can use all the Kaiser/Medicare benefits while living there? Maybe I'll move to Mexico too!
__________________
"Democracy is the only system that persists in asking the powers that be whether they are the powers that ought to be."
Ė Sydney J. Harris
Reply With Quote
  #28  
Old October 11th, 2009, 01:14 AM
tutusue's Avatar
tutusue tutusue is offline
Ali`i
 
Join Date: Sep 2005
Location: Wah-key'-key
Posts: 10,390
Default Re: Medicare

Quote:
Originally Posted by matapule View Post
[...]I am saying that some pharmacies (Costco, WalMart, Longs, CVS, Target) are less epensive than the Medicare co-pay costs if you participate in their "discount clubs" that are available to everyone. Leave Medicare out of it if you can get your drugs elsewhere at a lower cost than your co-pay.
I mentioned in a previous post that Walgreen's does not allow Medicare recipients to join the discount club. The way it was explained to me was it's a Medicare decision, not a Walgreen's decision. I was shocked when the pharmacy manager told me about this. I'll check with Longs to see what they say. If it's a Medicare stipulation then it will impact all discount clubs.
Quote:
Originally Posted by matapule View Post
If you are old enough to be on Medicare, TIME is what you have a lot of!
My bad...I wasn't clear. I meant time as in not needing the medication immediately, such as an antibiotic. Or time to wait until one feels well enough to do the calling and researching. When I was sick in August I needed the med right away and had it called in to the pharmacy closest to my home. Convenience was of the utmost importance. Fortunately that was the month I had double ins. coverage. That said, some of us on Medicare are still working.
Quote:
Originally Posted by matapule View Post
The reason is that no Medicare Advantage or Medicare Supplemental provider will take end stage renal members. If you have that problem, your only option is Medicare part A & B. The government has to take you...thank god!
Appreciate the explanation.
Quote:
Originally Posted by matapule View Post
[...]Part C replaces parts A, B, & D.[...]My cost for Kaiser part C coverage? $0.00.
I thought your cost was $96.40. I was told C replaces B & D; that everyone receives A (hospitalization), free of charge, when they turn 65. IOW, if you dropped C, you'd still have A. It's automatic. I pay $96.40 for B & D and $0 for A.
Quote:
Originally Posted by matapule View Post
[...]
Because certain drugs are excluded from the Formulary if there are less expensive branded drugs that do the same thing. If I were you, I would take my Formulary to my doctor and ask him if there was a drug on the Formulary that would do the same thing as what he is currently prescribing.
I've already done that and there are none. Meds for sleep disorders in general and mine in particular aren't even recognized by Medicare. The other 2 meds I take, I'd already tried other options either to no avail or too many side effects. In addition, none of my meds are prescribed by my pcp. All are rx'd by specialists (not that that makes any difference to the formulary, however!).
Quote:
Originally Posted by matapule View Post
The negotiated price is a government subsidized price. That is where you get your deduction. You pay the difference which is .23.[...]
Nope...I pay the co-pay which is $5. The gov't pays .23.
Quote:
Originally Posted by matapule View Post
[...]My co-pay for ultrasounds is $50 each through Kaiser. So I would have paid $100 to your $40. But wait there's more! My monthly premium to Kaiser is $0.00. I would guess your monthly premium to HMSA is $300 to $500 per month. So I would get off less expensively in the total cost.
My monthly HMSA premium was approx. $325., iirc. I kept it for the first month of my Medicare coverage. Now it's Medicare only at $96.40. If I'd had HMSA only I would've paid much more for those 2 ultrasounds. That's why I was so surprised that my co-pay with Medicare was only $20. each (which I didn't have to pay because I was doubly insured that month!). You definitely win in overall dollars saved. I had a personal win during August with double coverage!
Quote:
Originally Posted by matapule View Post
Forget whether the pharmacy is on the list or not. Just ask for the lowest price with or without Medicare.
As I mentioned in a previous post, I'll probably self-pay for any rx under $20. and will call around for prices if I'm in a position to do so. My goal, however, is to never need another rx again...ever!
Quote:
Originally Posted by matapule View Post
[...]If you have personal requirements that are not included in part C (like using the same doctor you have had for 50 years who is not part of any plan) you will have to pay more. But that is a personal choice.
All of my docs are Medicare participants as it turns out. Since they are "in network" my co-pay for my pcp is $5./visit...for a specialist, $20./visit. I receive one free physical per year and quite a few other perks within the plan I chose. Still...it's confusing!
Quote:
Originally Posted by matapule View Post
If anyone has personal questions about Medicare, I am not an expert, but I will try to answer questions from my experience in a PM.
As long as those questions aren't of a too personal nature, I hope they get asked and answered in this thread. That's what it's for! Thanks for your insight, Matapule.
Reply With Quote
  #29  
Old October 11th, 2009, 11:55 AM
matapule's Avatar
matapule matapule is offline
Ali`i
 
Join Date: Apr 2008
Location: Wherever I am, I'm there
Posts: 3,102
Default Re: Medicare

Quote:
Originally Posted by anapuni808 View Post
Matapule - don't you live in Mexico? I'm curious as to how you can use all the Kaiser/Medicare benefits while living there? Maybe I'll move to Mexico too!
Anapuni, yes I live in Mexico, most of the time. But I do return to California 3 or 4 times a year for a week or two. I am in residence in California right now and will go in for my free flu shot tomorrow morning. My Kaiser doctor wants to see me at least every 6 months to check my cholesterol. I have obligations to an elderly father in California and the uaifi is the sole care giver to an elderly sister. I use that opportunity for doctors visits, renew prescriptions, tests, etc. If I have a minor medical problem in Mexico, I visit a Mexican doctor (who are the equal to American doctors) and just pay out of my pocket. Services in Mexico are very inexpensive.

If I have a serious emergency while in Mexico, Kaiser Senior Advantage has told me to get to the nearest medical facility in Mexico (there is a very good one about 8 kilometers down the road from my casa) and get stabilized. Kaiser will pay for 100% of the cost for emergencies in Mexico. Kaiser will then assess whether they will continue to pay for my treatment in Mexico or fly me home via air ambulance at Kaiser's expense, to a Kaiser facility in SoCal.

I'm very happy!
__________________
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
Reply With Quote
  #30  
Old October 11th, 2009, 12:15 PM
matapule's Avatar
matapule matapule is offline
Ali`i
 
Join Date: Apr 2008
Location: Wherever I am, I'm there
Posts: 3,102
Default Re: Medicare

Quote:
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. The way it was explained to me was it's a Medicare decision, not a Walgreen's decision.
I am suspicious of the information you were given.

Quote:
I thought your cost was $96.40. I was told C replaces B & D; that everyone receives A (hospitalization), free of charge, when they turn 65. IOW, if you dropped C, you'd still have A. It's automatic. I pay $96.40 for B & D and $0 for A.
Yes, most everyone on Medicare pays $96.40 per month. If you chose to participate in a Medicare Suplemental program there is an additional charge per month. TuTu, I think you have purchased a Supplemental program and pay an additional premium per month.

Some Senior Advantage programs charge an additional premium per month and some don't. My Kaiser Senior Advantage program charges no additional premium per month. Some charge as much as $100 per month for Senior Advantage , in addition to the $96. Senior Advantage (part C) replaces Medicare A (hospitalization), B (phycians), and D (drugs and prescriptions).

Be aware that Kaiser Senior Advantage has different rules and benefits in their various regions. In SoCal, there is no additional premium for Kaiser Senior Advantage. That may not be the same for Kaiser Senior Advantage in Hawaii (a different region). I haven't checked.

Quote:
Meds for sleep disorders in general and mine in particular aren't even recognized by Medicare.
Oh Tutu, matapule can fix sleep disorder, liki, liki!

You put the lime in the coconut (with rum)
and drink it all up
You put the lime in the coconut (with rum)
And drink it all up
You silly womans

Then you listen to matapule talk story hour after hour
You be sleep in no time wit snoring!
No moa problems!

It work for matapule's uaifi.
__________________
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

Last edited by matapule; October 11th, 2009 at 12:19 PM.
Reply With Quote
  #31  
Old October 11th, 2009, 02:01 PM
tutusue's Avatar
tutusue tutusue is offline
Ali`i
 
Join Date: Sep 2005
Location: Wah-key'-key
Posts: 10,390
Default Re: Medicare

Quote:
Originally Posted by matapule View Post
[...]
Yes, most everyone on Medicare pays $96.40 per month. If you chose to participate in a Medicare Suplemental program there is an additional charge per month. TuTu, I think you have purchased a Supplemental program and pay an additional premium per month.
I pay one $96.40 payment per month. It's deducted from my social security check. I'm not near my file but I'll check to see exactly what that charge is for. FWIW...if I'd switched to HMSA 65C (it's Medicare supplemental program), I would've ended up paying almost the same premium every month as I was paying for my private, HMSA small business plan...which was approx. $325./mo.
Quote:
Originally Posted by matapule View Post
[...]
Oh Tutu, matapule can fix sleep disorder, liki, liki!

You put the lime in the coconut (with rum)
and drink it all up
You put the lime in the coconut (with rum)
And drink it all up
You silly womans

Then you listen to matapule talk story hour after hour
You be sleep in no time wit snoring!
No moa problems!

It work for matapule's uaifi.
*sigh* Been there, done that. Oh wait, I haven't tried your endless talk story, tho'!!! Seriously, I have no problem going to sleep. Staying asleep is the problem due to the PLMD. The treatment is a little more hard core than a pina colada! Alcohol actually exacerbates the problem.
Reply With Quote
  #32  
Old October 12th, 2009, 12:53 AM
tutusue's Avatar
tutusue tutusue is offline
Ali`i
 
Join Date: Sep 2005
Location: Wah-key'-key
Posts: 10,390
Default Re: Medicare

Quote:
Originally Posted by tutusue View Post
I pay one $96.40 payment per month. It's deducted from my social security check. I'm not near my file but I'll check to see exactly what that charge is for.[...]
Okey dokey...got to that very large file today and...and...the only difference between you and me, matapule, is you have C (which, for you, incorporates A, B & D and is an HMO) and I have A, B & D (which is a PPO)!!! And, you're with Kaiser and I'm with Secure Horizons! Yes, there are differences in our coverages and as you've already pointed out, different regions allow for different coverage. That's true for Secure Horizons also. And, we both pay $96.40/mo.

I wish I'd found this site a few months ago:
Quote:
When considering your Medicare options, it is easy to get confused and overwhelmed.
What an understatement!
Reply With Quote
  #33  
Old October 12th, 2009, 10:31 AM
matapule's Avatar
matapule matapule is offline
Ali`i
 
Join Date: Apr 2008
Location: Wherever I am, I'm there
Posts: 3,102
Default Re: Medicare

Quote:
Originally Posted by tutusue View Post
And, you're with Kaiser and I'm with Secure Horizons! !
Tutu you must have a Secure Horizons, no cost (other than your mandated 96.40 per month), supplemental plan. If you were on straight Medicare, Secure Horizons would not be in the picture.

Secure Horizons is sponsored by AARP (I have a love/hate relationship with them). AARP is reported to be the largest lobbying organization in DC. Secure Horizons gives AARP a kickback for sponsoring them.

I researched Kaiser, Secure Horizons, Aetna, etc. when I signed up for Senior Advantage part C. Kaiser was by far the best deal in my region. Secure Horizons came in second. The big problem with Secure Horizons is that they had no annual stop loss like Kaiser had.

I have friends/neighbors (in their 80's) in Cabo who have Secure Horizons in Seattle. They are very happy with their plan. They had medical treatment in Mexico and Secure Horizons reimbursed them 100%.

Tutu, I disagree with you about the site you recommend. It is a sponsored site. The best place to get information about Medicare is medicare.gov If you want to compare various plans, go here and follow the instructions.
__________________
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

Last edited by matapule; October 12th, 2009 at 10:41 AM.
Reply With Quote
  #34  
Old October 12th, 2009, 12:31 PM
Palama Kid's Avatar
Palama Kid Palama Kid is offline
Kia`aina
 
Join Date: May 2004
Location: San Jose, CA
Posts: 386
Default Re: Medicare

Tutusue, thank you so much for this thread. I'm 64, drawing Social Security, & am with Kaiser, so I had many questions re Medicare. Most have been answered by this thread, especially by those links from Matapule and you.

Complication: Lockheed is contemplating removing Kaiser from our choices in Northern California for 2010 (for calendar year 2011). So, I and my fellow retirees know nothing about what's going to happen. We're hoping for a grandfather clause for those over 65, which I will be by 2011.

My prescription co-pays have been running around $10.50 for 100 pills (blood pressure / cholesterol); my dental (chlorohexidine) prescription is around $20. So, you won't hear me complaining.

Salamat po.
__________________
Born in Hawaii, too - Truss me
Reply With Quote
  #35  
Old October 12th, 2009, 05:22 PM
tutusue's Avatar
tutusue tutusue is offline
Ali`i
 
Join Date: Sep 2005
Location: Wah-key'-key
Posts: 10,390
Default Re: Medicare

Quote:
Originally Posted by matapule View Post
Tutu you must have a Secure Horizons, no cost (other than your mandated 96.40 per month), supplemental plan. If you were on straight Medicare, Secure Horizons would not be in the picture.
Exactly. Is "straight Medicare" also known as Original Medicare?
Quote:
Originally Posted by matapule View Post
Secure Horizons is sponsored by AARP (I have a love/hate relationship with them). AARP is reported to be the largest lobbying organization in DC. Secure Horizons gives AARP a kickback for sponsoring them.
My SH rep disclosed that.
Quote:
Originally Posted by matapule View Post
I researched Kaiser, Secure Horizons, Aetna, etc. when I signed up for Senior Advantage part C. Kaiser was by far the best deal in my region. Secure Horizons came in second. The big problem with Secure Horizons is that they had no annual stop loss like Kaiser had.
I believe SH refers to this as "out of pocket limit". I'm reasonably sure I have that; one amount for "in network"; another amount for "out of network". As you know, networks apply to PPOs.
Quote:
Originally Posted by matapule View Post
I have friends/neighbors (in their 80's) in Cabo who have Secure Horizons in Seattle. They are very happy with their plan. They had medical treatment in Mexico and Secure Horizons reimbursed them 100%.
I have a family member who lives in Cali and has Secure Horizons. He loves it, too. Our coverages are different, tho', because we live in different states.
Quote:
Originally Posted by matapule View Post
Tutu, I disagree with you about the site you recommend. It is a sponsored site.
Yes, I'm aware of that. But it offers somewhat of an understandable, condensed explanation of the various Parts.
Quote:
Originally Posted by matapule View Post
The best place to get information about Medicare is medicare.gov If you want to compare various plans, go here and follow the instructions.
Oh, I've been there...many times! Hence, my confusion!!!
Quote:
Originally Posted by Palama Kid View Post
Tutusue, thank you so much for this thread. I'm 64, drawing Social Security, & am with Kaiser, so I had many questions re Medicare. Most have been answered by this thread, especially by those links from Matapule and you.
Cool...that's what this thread is for. This dialogue is also good for me because we're coming up on open enrollment next month. No matter which insurer I chose a few months ago, it would've been out of frustration and confusion. Secure Horizons seemed like a safe, short term choice. I'm still researching whether it's a good, longer term choice. This thread is helping with that!
Quote:
Originally Posted by Palama Kid View Post
Complication: Lockheed is contemplating removing Kaiser from our choices in Northern California for 2010 (for calendar year 2011). So, I and my fellow retirees know nothing about what's going to happen. We're hoping for a grandfather clause for those over 65, which I will be by 2011.
Maybe Matapule can answer this question...Can any 65 year old in California opt for Kaiser's Plan C or does one have to already be a subscriber to Kaiser? IOW, if Lockheed drops Kaiser as an option for it's retirees, can PK apply for Kaiser on his own when he's 65? PK, when you hit 65, can you drop your employer coverage altogether in favor of Medicare plan C (Kaiser)?
Quote:
Originally Posted by Palama Kid View Post
My prescription co-pays have been running around $10.50 for 100 pills (blood pressure / cholesterol); my dental (chlorohexidine) prescription is around $20. So, you won't hear me complaining.
Have you checked medicare.gov to see if 1) they're on the drug formulary and, if so, 2) what they will cost you when you're on Medicare?

No matter how many questions this thread answers, PK, it's still best to research plans in your area and take advantage of free seminars. This thread will hopefully arm you with important questions to ask when you get to that point within the next year.
Reply With Quote
  #36  
Old October 13th, 2009, 07:37 AM
alohacandy's Avatar
alohacandy alohacandy is offline
Kia`aina
 
Join Date: Jan 2006
Location: Kaneohe
Posts: 346
Default Re: Medicare

Just wanted to add one thing about ESRD patients (those on dialysis). They DO have opportunities to get Medicare supplement policies within so many days after first being eligible for Medicare (can't remember offhand the number of days) as well as within so many days after turning 65. I've had several dialysis patients obtain AARP supplement policies this way. (HMSA 65C+ sucks for dialysis patients however....they have to pay $22 copays for EACH treatment....times 3 treatments a week times 4 weeks a month...well...you get the picture. It's a lot for most people to pay out of pocket every month.)
__________________
Reply With Quote
  #37  
Old October 13th, 2009, 11:24 AM
matapule's Avatar
matapule matapule is offline
Ali`i
 
Join Date: Apr 2008
Location: Wherever I am, I'm there
Posts: 3,102
Default Re: Medicare

Quote:
Originally Posted by tutusue View Post
Is "straight Medicare" also known as Original Medicare?
Yes

Quote:
I believe SH refers to this as "out of pocket limit". I'm reasonably sure I have that; one amount for "in network"; another amount for "out of network". As you know, networks apply to PPOs.
Secure Horizon has no out-of-pocket (stop loss) feature in the SoCal region. Each region can be different.

Quote:
This dialogue is also good for me because we're coming up on open enrollment next month. No matter which insurer I chose a few months ago,
That is correct. Open enrollment runs from Nov 15 to Dec 31 each year. You can change plans each year during that time period with no penalties. You can even change back to a plan you dropped a couple of years ago. I like the flexibility of the whole system and the optrions that are available to me. That is why I support a national public health option for health care.

Quote:
Can any 65 year old in California opt for Kaiser's Plan C or does one have to already be a subscriber to Kaiser?
The answer is yes. You do not need to be a current Kaiser subscriber to join Kaiser Medicare Supplemental or Kaiser Senior Advantage. For example matapule's uaifi just signed up for Kaiser Senior Advantage without being a current member of Kaiser.

Quote:
if Lockheed drops Kaiser as an option for it's retirees, can PK apply for Kaiser on his own when he's 65?
Lockheed has nothing to say about who a retiree selects for their Medicare coverage. PK can pick anyone they want for Medicare coverage (change their mind every year too) regardless of who their current carrier is through Lockheed.

Quote:
PK, when you hit 65, can you drop your employer coverage altogether in favor of Medicare plan C (Kaiser)?
That will be a choice that PK will need to make. If PK chooses to work at Lockheed past age 65, they can contnue to particpate in Lockheed's company plan (whoever the carrier might be at that time) and I believe that the $96.40 will NOT be deducted. However PK can elect to drop his Lockheed coverage and go on Medicare coverage (for which $96.40 will be deducted) but lockheed will probably give PK a rebate on the company insurance he is not using.

Quote:
PK, it's still best to research plans in your area and take advantage of free seminars. This thread will hopefully arm you with important questions to ask when you get to that point within the next year.
Kouia, Agreed.
__________________
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
Reply With Quote
  #38  
Old October 13th, 2009, 11:31 AM
Palama Kid's Avatar
Palama Kid Palama Kid is offline
Kia`aina
 
Join Date: May 2004
Location: San Jose, CA
Posts: 386
Default Re: Medicare

Tutusue & Matapule, thank you. This entire thread has helped tremendously.

Next year, Kaiser's Senior Advantage looks like my best choice @ a much lower cost per month. BTW I retired in 2000 @ 55.
__________________
Born in Hawaii, too - Truss me
Reply With Quote
  #39  
Old October 13th, 2009, 04:36 PM
tutusue's Avatar
tutusue tutusue is offline
Ali`i
 
Join Date: Sep 2005
Location: Wah-key'-key
Posts: 10,390
Default Re: Medicare

Quote:
Originally Posted by matapule View Post
[...]
Secure Horizon has no out-of-pocket (stop loss) feature in the SoCal region. Each region can be different.
Here's what I'm reading in my "Summary of Benefits", "Premium and other important information" for Part B:
Quote:
General
$0 monthly plan premium in addition to your monthly Medicare Part B premium.
In-Network
$2500 in-network out-of-pocket limit. Not all plan services are covered under the out-of-pocket limit. Contact plan for a detailed list of non-covered services.
Out-of-Network
$3750 out-of-network out-of-pocket limit. Not all plan services are covered under the out-of-pocket limit. Contact plan for a detailed list of non-covered services.
I will definitely contact my plan!
Quote:
Originally Posted by Palama Kid View Post
Tutusue & Matapule, thank you. This entire thread has helped tremendously.
For me, too, PK!
Quote:
Originally Posted by Palama Kid View Post
Next year, Kaiser's Senior Advantage looks like my best choice @ a much lower cost per month.[...]
Very cool! Rates and coverage can change from year to year so be sure to check that plan again prior to signing up.
Reply With Quote
  #40  
Old October 13th, 2009, 09:12 PM
matapule's Avatar
matapule matapule is offline
Ali`i
 
Join Date: Apr 2008
Location: Wherever I am, I'm there
Posts: 3,102
Default Re: Medicare

Quote:
Originally Posted by tutusue View Post
Here's what I'm reading in my "Summary of Benefits", "Premium and other important information" for Part B:

I will definitely contact my plan!
It's all in the details, never assume anything.

Quote:
Very cool! Rates and coverage can change from year to year so be sure to check that plan again prior to signing up.
Kaiser Senior Advantage is going to remain essentially the same for 2010. I'm sticking with it.
__________________
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
Reply With Quote
  #41  
Old October 15th, 2009, 11:14 AM
matapule's Avatar
matapule matapule is offline
Ali`i
 
Join Date: Apr 2008
Location: Wherever I am, I'm there
Posts: 3,102
Default Re: Medicare

It was announced this morning that the premium for Medicare part B will remain the same in 2010 at $96.40 per month. However, the premium for part D (prescriptions) will increase in 2010. The amount of the increase was not announced.

Since I have part C Medicare, this should not affect me.
__________________
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
Reply With Quote
  #42  
Old October 15th, 2009, 04:34 PM
tutusue's Avatar
tutusue tutusue is offline
Ali`i
 
Join Date: Sep 2005
Location: Wah-key'-key
Posts: 10,390
Default Re: Medicare

Quote:
Originally Posted by matapule View Post
It was announced this morning that the premium for Medicare part B will remain the same in 2010 at $96.40 per month. However, the premium for part D (prescriptions) will increase in 2010. The amount of the increase was not announced.

Since I have part C Medicare, this should not affect me.
It'll be interesting to see if my premium increases as Secure Horizons charges nothing beyond the standard $96.40. There's no separate charge for D.
Reply With Quote
  #43  
Old October 15th, 2009, 08:40 PM
Amati's Avatar
Amati Amati is offline
Ali`i
 
Join Date: Dec 2007
Posts: 2,039
Default Re: Medicare

So, let's see if I have this right. Plan C would replace having Plans A + B.

Yes? OK, then, anyone know what the options are (in Hawaii) for Plan C, besides Kaiser?
__________________
Now run along and play, but donít get into trouble.
Reply With Quote
  #44  
Old October 15th, 2009, 08:51 PM
tutusue's Avatar
tutusue tutusue is offline
Ali`i
 
Join Date: Sep 2005
Location: Wah-key'-key
Posts: 10,390
Default Re: Medicare

Amati, you'll need to go to medicare.gov and do a search using criteria specific to the (would be) recipient. A quick search using my criteria shows a couple of others...AlohaCare and Ohana...but I don't know what their limitations are.

ETA: Matapule's Kaiser part C replaces A, B & D. I don't know if other Advantage plans also replace D by including drug coverage in C.

Last edited by tutusue; October 15th, 2009 at 08:58 PM.
Reply With Quote
  #45  
Old October 15th, 2009, 09:15 PM
matapule's Avatar
matapule matapule is offline
Ali`i
 
Join Date: Apr 2008
Location: Wherever I am, I'm there
Posts: 3,102
Default Re: Medicare

Quote:
Originally Posted by tutusue View Post
Amati, you'll need to go to medicare.gov and do a search using criteria specific to the (would be) recipient. A quick search using my criteria shows a couple of others...AlohaCare and Ohana...but I don't know what their limitations are.
Since Tutu has Secure Horizons, they are available in Hawaii too. On Medicare.gov, you search by your zip code.

Quote:
ETA: Matapule's Kaiser part C replaces A, B & D. I don't know if other Advantage plans also replace D by including drug coverage in C.
Part C (the HMO all inclusive plan) includes part A, B, & D. Check plans carefully, they all can vary to a great extent. Kaiser was the best deal in my area.

I went to Kaiser yesterday with a stabbing pain in my left shoulder that I have had for several months off and on. The Kaiser doctor said his specialty is sports medicine and he knew exactly what I had.....bursitis. He gave me a painless injection of cortisone in the shoulder joint and matapule mo bettah, lik gnu, ya betcha. My cost? $15 for everything.
__________________
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
Reply With Quote
  #46  
Old October 15th, 2009, 09:32 PM
tutusue's Avatar
tutusue tutusue is offline
Ali`i
 
Join Date: Sep 2005
Location: Wah-key'-key
Posts: 10,390
Default Re: Medicare

Quote:
Originally Posted by matapule View Post
Since Tutu has Secure Horizons, they are available in Hawaii too.[...]
I don't see that they offer an Advantage plan, tho'. Maybe I overlooked it?

Glad you're feeling better. I'm nearing the end of tendonitis of the shoulder. It's been a 1 1/2 year battle 'cuz I can't take cortisone.
Reply With Quote
  #47  
Old October 16th, 2009, 04:48 AM
alohacandy's Avatar
alohacandy alohacandy is offline
Kia`aina
 
Join Date: Jan 2006
Location: Kaneohe
Posts: 346
Default Re: Medicare

Amati...Just be very careful when choosing your plan. If you travel a lot, make sure your plan will cover you in other parts of the country. For Medicare supplement plans, many of my patients who don't have group plans through where they work chose one of the AARP plans for their flexibility and choices. I had a patient with a Medicare Advantage plan which would NOT cover her if she travelled to Vegas to see family and needed her dialysis treatment. It would only cover her treatments here in Hawaii (I won't say which plan). Check to see if the doctors that you are seeing now are covered by the plan and the medications that you take are covered. My Kaiser Senior Advantage plan patients seem to be pretty happy with what they have because most of them have been with Kaiser forever and don't want to leave Kaiser. Their main problems seem to be when they get into the donut hole with their drugs....which happens to many people with Part D who don't qualify for the State's SPAP program (State Pharmacy Assistance Program) that helps with copays on certain Part D plans.
__________________
Reply With Quote
  #48  
Old October 16th, 2009, 05:09 AM
Amati's Avatar
Amati Amati is offline
Ali`i
 
Join Date: Dec 2007
Posts: 2,039
Default Re: Medicare

Quote:
Originally Posted by Amati View Post
So, let's see if I have this right. Plan C would replace having Plans A + B.Yes? OK, then, anyone know what the options are (in Hawaii) for Plan C, besides Kaiser?
Thanks for your responses so far. But I'm more confused than ever. If a decent retirement medical/dental plan is offered by the employer, then would taking Plans A+B be the right coverage, and not bothering with Plan C?
__________________
Now run along and play, but donít get into trouble.
Reply With Quote
  #49  
Old October 16th, 2009, 07:26 AM
alohacandy's Avatar
alohacandy alohacandy is offline
Kia`aina
 
Join Date: Jan 2006
Location: Kaneohe
Posts: 346
Default Re: Medicare

It all depends on what kind of plan you have through where you work. Most of the people that I have seen that have group plans through where they work have kept their group plans because they have better overall benefits, less out of pocket expenses, dental benefits, and no donut holes to deal with when it comes to drugs. But that all depends on who they worked for....and so each situation is different. I've had some patients that ONLY kept their retiree plan and didn't bother to even apply for Medicare. There have been others that got Medicare as secondary to their group plan. Some retiree plans REQUIRE you to apply for Medicare and REQUIRE you to get the Advantage plan (Part C) if you are already with their Kaiser plan. If you're retirement income is super high, you may end up paying alot more than $96.40/mo for your Part B...it's not a set rate any more. Higher income people now must pay higher rates to have Medicare whereas in the past everyone paid the same amount to have it. Very low income people are lucky to have the state of Hawaii pay their Medicare Part B premiums for them (these are people that are also eligible for Medicaid/MedQuest). More confused now??
__________________
Reply With Quote
  #50  
Old October 16th, 2009, 07:28 AM
Barry Barry is offline
Ali`i
 
Join Date: Aug 2008
Location: Liverpool
Posts: 817
Default Re: Medicare

I hope I am posting this in the right Place ?


After my first lesson on a longboard, I came off and burst open an old wound. With confidence I stood up and bounded forward like a gazelle for at least fifteen feet.I took myself to the ER room and was stiched up. I handed them my National Health Service form E111 but still had to pay $72.
I got home a few days later and the bottom of my right foot was like a piece of wood. The school of tropical medicine said I had walked on coral and it was under the sole of my foot.

I got the equivalent of $72 reimbursed but the scraping of the sole of the foot is not something I would recommend to anybody.

Last edited by Barry; October 16th, 2009 at 07:47 AM.
Reply With Quote
Reply

Bookmarks

Tags
health

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off



All times are GMT -5. The time now is 08:50 AM.


Powered by vBulletin® Version 3.8.11
Copyright ©2000 - 2019, vBulletin Solutions Inc.

  Partner Sites: Hawaii Blog Hawaii News Hawaii Grinds Hawaii Social Media  
    Blogging the Aloha State. The Hawaii Star. Hawaii Food Blog. The story of Aloha 2.0.