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  • #16
    Re: Medicare

    Originally posted by matapule View Post
    [...]
    I would think about changing primary care physicians.
    Just curious...why?
    Originally posted by matapule View Post
    Medicare is not a "free" program. The governement is trying to hold down costs on medicare and therefore there will be some out of pocket expense, more for some than others.
    Correct!
    Originally posted by matapule View Post
    The reason is because the $5.23 is a negotiated price, in other words a subsidized cost.
    Yep, I mentioned it was a negotiated price! And I don't have a problem with that OR that I had a $5. co-pay. 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.
    Originally posted by matapule View Post
    I have none of these problems since I am enrolled in Medicare part C which includes a more liberal drug benefit than Medicare part D which is apparently what you have.
    Yes, I have part D. 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. Still, I'd rather jump thru hoops with the drug situation then lose my current doctors and start anew by switching to plan C.
    Originally posted by matapule View Post
    I pay approximately $96 per month for my Medicare coverage. I do have co-pays for doctor visits and medications but that doesn't amont to much on an annual basis.[...]
    Ditto for me...altho' I haven't been on Medicare long enough to get an annual total. Next year!
    Originally posted by matapule View Post
    I am just happy I have an affordable health insurance program. My concern is for those people who have no health care at any cost.
    Agreed...on both counts! I had HMSA for at least 27 years so this switch to Medicare is a big change. It's the old dog/new tricks thingie!
    Originally posted by matapule View Post
    [...]
    Buuuuut............I just found out that my Medicare part C provides for an annual eye exam for a $15 co-pay. I could have saved myself $35 and taken uaifi out to a nice dinner.

    Goes to show that if I don't pay attention, it costs me money! [...]
    Because I was having separation anxiety from HMSA, I overlapped it for one month with Medicare. I moved my eye exam up from Nov. to Aug. and scheduled anything else I could during Aug. Plus I ended up sick on my first day with Medicare coverage and needed 2 ultrasounds. I had no out of pocket medical expenses for August because of the overlap! 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!!!
    Originally posted by D'Alani View Post
    I'm only 62 so I have a few more years to go but can you go any drugstore?[...]
    Sorry I didn't answer this earlier. Pharmacies have to be on Medicare's provider list and Medicare recipients are provided a directory. Most pharmacies, as far as I can tell, participate.

    Comment


    • #17
      Re: Medicare

      TS - did you notice my post? I also will now check Canadian brokers.
      "Democracy is the only system that persists in asking the powers that be whether they are the powers that ought to be."
      – Sydney J. Harris

      Comment


      • #18
        Re: Medicare

        Originally posted by D'Alani View Post
        I'm only 62 so I have a few more years to go but can you go any drugstore? Is any of your meds on the list of generic drugs for $4/30days at WalMart? I don't have any kind of drug coverage so I go wherever is cheapest, so I even make use of my VA benefits. I recently went to "Long's" to get some antibiotics which were $40.+ but the sales girl signed me up to some kind of CVS thing for free and it cost me $11.66 instead.
        Alani, you can go to any drug provider you want under Medicare. It is just that you may do better "retail" at the drugstores. The good news is that WalMart, Longs, or CVS "retail" may be less than the Medicare prescription cost.

        For example, I take a statin each day. Under my Part C prescription plan it would cost me about $10 per month. However I buy mine at the Costco pharmacy for around $2 per month if I buy 6 months at a time (same price anyone else would pay, including those not on Medicare).

        It is all about choice and options. You get to decide where your best deal is
        Last edited by matapule; October 9, 2009, 06:47 AM.
        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


        • #19
          Re: Medicare

          Originally posted by turtlegirl View Post
          Any chance you have a son y'all can introduce me to? Preferably in his 30's, fun and outdoorsy, and at least 5'10"? !
          Well..................I do have a daughter, 37, 6'-0", never married, loves hiking, photography, professional degree and license, volunteers in the Sea Turtle Hatching project. Maybe the two of you could work something out, ya betcha (wink, wink).
          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


          • #20
            Re: Medicare

            Originally posted by matapule View Post
            Maybe the two of you could work something out, ya betcha (wink, wink).
            NOW who's the naughty one, eh SurlyGurly? ;_D
            "By concealing your desires, you may trick people into being cruel about the wrong thing." --Steven Aylett, Fain the Sorcerer
            "You gotta get me to the tall corn." --David Mamet, Spartan
            "
            Amateurs talk technology, professionals talk conditions." --(unknown)

            Comment


            • #21
              Re: Medicare

              Originally posted by anapuni808 View Post
              TS - did you notice my post? I also will now check Canadian brokers.
              I did, Anapuni...thx. I mentioned a subsidy in post #15.
              Originally posted by matapule View Post
              Alani, you can go to any drug provider you want under Medicare. It is just that you may do better "retail" at the drugstores. The good news is that WalMart, Longs, or CVS "retail" may be less than the Medicare prescription cost. [...]
              This is a good point. It can really pay to call around if you have the time. I've done this and am always amazed at the different prices from the different pharmacies. But, Matapule, it's my understanding that a pharmacy must be on the provider (in network) list to get the best Medicare price. There would be a higher co-pay from an out of network pharmacy...at least for plan D.

              Comment


              • #22
                Re: Medicare

                How confusing ! NHS is better.I ring up my doctor and ask for a repeat prescription. The pills are delivered to my door within an hour~ No charge.

                Comment


                • #23
                  Re: Medicare

                  the plan I was talking about was to get your meds for free, not subsidy. Astra Zeneca is one I know does it and most of the other big pharms also do this. It's usually for seniors, uninsured or underemployed.
                  "Democracy is the only system that persists in asking the powers that be whether they are the powers that ought to be."
                  – Sydney J. Harris

                  Comment


                  • #24
                    Re: Medicare

                    Originally posted by tutusue View Post
                    But, Matapule, it's my understanding that a pharmacy must be on the provider (in network) list to get the best Medicare price. There would be a higher co-pay from an out of network pharmacy...at least for plan D.
                    No, that's not what I am saying. My statins cost me $10 per month co-pay from my Medicare provider (I think the "retail" on this drug is about $50 or $60 per month). I can purchase the same prescription at Costco for $2 per month retail, no co-pay, same price everyone pays at Costco.

                    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.
                    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


                    • #25
                      Re: Medicare

                      Originally posted by tutusue View Post
                      It can really pay to call around if you have the time..
                      If you are old enough to be on Medicare, TIME is what you have a lot of!
                      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


                      • #26
                        Re: Medicare

                        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!

                        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!)

                        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.

                        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.

                        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.

                        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.

                        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.

                        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.

                        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.

                        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.

                        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.
                        Last edited by matapule; October 10, 2009, 08:08 AM.
                        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


                        • #27
                          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."
                          – Sydney J. Harris

                          Comment


                          • #28
                            Re: Medicare

                            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.
                            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.
                            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.
                            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.
                            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!).
                            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.
                            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!
                            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!
                            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!
                            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.

                            Comment


                            • #29
                              Re: Medicare

                              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

                              Comment


                              • #30
                                Re: Medicare

                                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.

                                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.

                                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.
                                Last edited by matapule; October 11, 2009, 07:19 AM.
                                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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