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Old 08-31-2012, 12:36 PM   #1
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Question on Medicare co-insurance

Hello, my Medicare is due to start in November but I have to pick and insurance to go with it. I was told that I get fully subsidized so I have lower cost for prescriptions and no copay. Which is wonderful I have been waiting so long to get to the doctor.

My questions who do I pick!. I know there is so many choices. HMO, PPO, just plain medicare with the gap insurance. I am so confused on who to pick and I could use some guidance on anything from anyone that has experience. There is a Kaiser here where I live I have heard both good and bad about them. My concern is not getting the help that I need and losing my disability all together because I picked the wrong doctor or group of doctors. Weather they will cover my prescriptions and help me out with epidurals and things like that. From what I have read that once you pick you may not change for a year. but then starting January 2013 they can change their plans, it is all very confusing for me. any guidance is welcome thank you for your time!!!
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Last edited by sandiemas; 08-31-2012 at 12:41 PM. Reason: Typos'

 
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Old 09-01-2012, 10:46 AM   #2
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Re: Question on Medicare co-insurance

I would look at it from 2 points of view:

1) Which ones do most of my preferred doctors accept?
2) Which ones reduce my prescription costs the most, based on my current medications? Most large chain drug stores (CVS, Walgreens, etc) can help you with this part.

I live in Alabama and I'm on BC/BS Blue Advantage for my medicare as all my doctors take Blue Cross and most of my meds are generic any way.

 
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Old 09-23-2012, 10:32 PM   #3
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Re: Question on Medicare co-insurance

Quote:
Originally Posted by Titchou View Post
I would look at it from 2 points of view:

1) Which ones do most of my preferred doctors accept?
2) Which ones reduce my prescription costs the most, based on my current medications? Most large chain drug stores (CVS, Walgreens, etc) can help you with this part.

I live in Alabama and I'm on BC/BS Blue Advantage for my medicare as all my doctors take Blue Cross and most of my meds are generic any way.
Well I chose Kaiser and then switched to BC/BS because it is a new program and not rated yet. Medicare says you can switch once to a 5star if need be so if it doesn't work out I will have the option to switch to Kaiser. Since I have so much going on I did not want to get stuck and have to wait a year and possibly loose out on Disability benefits because I wasn't able to get the doctors backing that I need to support my case. I found A PM doctor that I really like and he accepts BC/BS and minimal out of pocket cost for me. So, thanks for your help and I did go to pharmacy with plans and scripts in hand and ask which would cost what... That helped me a lot. With Kaiser I made a cash pay appointment and for $200.00 I found the place to be a little dirty and customer service not so good, and didn't really like my doctor. So, first impression was not what I wanted to be "stuck" with... So there goes.
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Sandy


C5-C6 tear/buldge
C6-C7 ACDF
T1 - T5 neuroforaminal, lesions, facet arthropathy
Disectomy L5/S1
Anxiety
PTSD
Chronic Pain

 
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Old 09-24-2012, 12:42 PM   #4
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Re: Question on Medicare co-insurance

I work in a medical billing office and we have a lot of patients that come in with Medicare and a supplement insurance. For most places, as long as they take Medicare, they will take your supplement/secondary insurance. The way Medicare works, is when they receive the claim from your health care provider, they automatically foward any remaining balance to whatever secondary insurance that you have on file (so it is important to let Medicare know all the necessary information about your secondary insurance).

HMO and PPO are types of managed care plans. Generally with a PPO, you have a larger network or providers to choose from and services do not have to be referred by a doctor. HMO usually requires that you select a primary care physician and all your services be referred by that provider. The network is not as big, but the cost is usually lower.

As far as the type of insurance to get, that is kind of up to you to decide. It really depends on your medical needs. If you are only getting part A Medicare, then a supplemental policy should work, because as long as you get the right plan, they will pick up any deductible and/or coinsurance. If you are getting both part A and B a supplemental will work as well for the same reason. A secondary will also work, but it is very important to understand your medical policy and how the plan pays out as secondary coverage.

There are times when you may need to see a specialist and that doctor may not take Medicare, well, that is when it is good to have a secondary insurance because, they will usually provide benefits for what is not covered by Medicare. Most supplement insurance only follow Medicare guidelines, and if Medicare pays or denies, then they will pay or deny.

The Medicare Replacement Plans are good as well. Most usually have just a copay. My grandmother uses one of those policies. I suggest looking into the options for the different policies and picking what is best for you financially and what will meet your needs medically.

 
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