Needing to make a decision.....

[The Walk of the Penguin Mich]

with regards to my health insurance.  Last week, I got an envelope in the mail with my Medicare cards.     As of June, I'll be disabled for 2 years (officially, but the shit hit the fan 6 months earlier) and am now eligible.

Up until June, my employer covered my health insurance and I threw in a token $26/mo. like I did when I was employed.  Out here, most providers will accept it, but if I decide to pay for COBRA it's going to cost me about $500/mo.  My orthopedic surgeon is out of network, but the hospitals he uses are in network.  I get 30 PT visits a year.  Rest of preventative is pretty good and it's a $500 deductible/$1500 max OOP.  I can only carry this for 18 months though, and think I'll be penalized if I delay going on Medicare by going this route.

Medicare is going to cost me $107, along with what a secondary policy would cost.  That's going to be about another $300ish, depending upon what policy I choose.  Scuttlebutt from my hip groups says that PT benefits on Medicare are lousy, around $1500/year which I'll probably blow through in about 10 visits.  I still need PT.  My orthopedic surgeon accepts Medicare and I'm not sure about the rest.  I know that the government is likely going to decrease Medicare assignments which will likely result in fewer doctors accepting Medicare patients.  This is a concern as it is imperative that I not deal with a hack with regards to my hips.

I can also go with an ACA plan and it would cost me around $350ish/mo with a subsidy for a premium plan.  I'm not about to go lower because I have seen what can happen and now that I have had an infection, I am more likely to get another.  Hopefully that won't happen, but I'm working with the stats.  One of them has gotten very good reviews on CR, but it is an HMO and my orthopedic surgeon is not on it.  

So now I'm stumped.  What I am wondering about the most is Medicare as I know no one who has it other than my dad and he has Tri-care as his secondary so everything's covered for him.  

Is there something I am missing?  Most of my drugs are on the $4 formulary so I'm not factoring those in.

[Deleted]

Feb 17, 2014 14:09:41 GMT -5 The Walk of the Penguin Mich said:

with regards to my health insurance.  Last week, I got an envelope in the mail with my Medicare cards.     As of June, I'll be disabled for 2 years (officially, but the shit hit the fan 6 months earlier) and am now eligible.

Up until June, my employer covered my health insurance and I threw in a token $26/mo. like I did when I was employed.  Out here, most providers will accept it, but if I decide to pay for COBRA it's going to cost me about $500/mo.  My orthopedic surgeon is out of network, but the hospitals he uses are in network.  I get 30 PT visits a year.  Rest of preventative is pretty good and it's a $500 deductible/$1500 max OOP.  I can only carry this for 18 months though, and think I'll be penalized if I delay going on Medicare by going this route.

Medicare is going to cost me $107, along with what a secondary policy would cost.  That's going to be about another $300ish, depending upon what policy I choose.  Scuttlebutt from my hip groups says that PT benefits on Medicare are lousy, around $1500/year which I'll probably blow through in about 10 visits.  I still need PT.  My orthopedic surgeon accepts Medicare and I'm not sure about the rest.  I know that the government is likely going to decrease Medicare assignments which will likely result in fewer doctors accepting Medicare patients.  This is a concern as it is imperative that I not deal with a hack with regards to my hips.

I can also go with an ACA plan and it would cost me around $350ish/mo with a subsidy for a premium plan.  I'm not about to go lower because I have seen what can happen and now that I have had an infection, I am more likely to get another.  Hopefully that won't happen, but I'm working with the stats.  One of them has gotten very good reviews on CR, but it is an HMO and my orthopedic surgeon is not on it.  

So now I'm stumped.  What I am wondering about the most is Medicare as I know no one who has it other than my dad and he has Tri-care as his secondary so everything's covered for him.  

Is there something I am missing?  Most of my drugs are on the $4 formulary so I'm not factoring those in.

check your drugs.....my thyroid med is no longer on the $4 list

[justme]

Is the penalty still in effect if you haven't reached the age of 65? And also I remember something about the penalty being waived as long as you have proof that you had "adequate coverage" during the years you should have been on medicare.

[Peace77]

To make it more complicated, you are not limited to standard Medicare.  You can sign up for a Medicare advantage plan.   I believe you do have the option of an HMO too.  The plan I have is a PPO.  It includes dental coverage and no annual deductible.

you can look at Medicare's website for plans available in your area.  See Medicare.gov

[The Walk of the Penguin Mich]

Feb 18, 2014 9:05:49 GMT -5 Peace77 said:

To make it more complicated, you are not limited to standard Medicare.  You can sign up for a Medicare advantage plan.   I believe you do have the option of an HMO too.  The plan I have is a PPO.  It includes dental coverage and no annual deductible.

you can look at Medicare's website for plans available in your area.  See Medicare.gov

Yeah, I've been there too.

I used to think choosing from the plans provided by my employer was rough.  This is way more complicated!

[Gardening Grandma]

We are going through something similar. Our former employers will no longer be providing subsidized Medigap plans, so effective April 30 we have to choose a Medigap or Medicare Advantage plan.  (Former employer will put $2750/yr into an HRA).  Our state insurance website is very useful. I've pretty much decided on a Plan F which is something of a Cadillac plan. The premium is $188/mo in addition to our Medicare premiums.

I don't take any presc meds so am going with the cheapest Part D I can find ($12/mo).

It HAS been a confusing process, but I think hope we've got it figured out....

[cronewitch]

I just looked and am very confused. Looks like advantage is a HMO and medicap is just an addition to A&B. How would I get vision and dental coverage, I don't take medicine but maybe someday. I just started part A this month so do I have three months to do something? What do I need to pick when?

[Blonde Granny]

GG, we have Plan F from Mutual of Omaha.  My knee replacement surgery totaled about $80K, and I received no bills. In fact, in 4 years now I've never received a bill. Our plan does increase every year...we started at $114/mo per person and 4 years later we are at $167/mo. But the piece of mind that we have no deductible (part F pays it) and no co-pays is really a comfort.

I did change Part D providers this year and am paying $45/mo. I take one expensive heart drug and a couple of others that even though generic I have to pay for. At least I no longer have a Part D $300 ded.

[The Walk of the Penguin Mich]

Feb 18, 2014 18:08:36 GMT -5 Blonde Granny said:

GG, we have Plan F from Mutual of Omaha.  My knee replacement surgery totaled about $80K, and I received no bills. In fact, in 4 years now I've never received a bill. Our plan does increase every year...we started at $114/mo per person and 4 years later we are at $167/mo. But the piece of mind that we have no deductible (part F pays it) and no co-pays is really a comfort.

I did change Part D providers this year and am paying $45/mo. I take one expensive heart drug and a couple of others that even though generic I have to pay for. At least I no longer have a Part D $300 ded.

Where are you?

[Blonde Granny]

Crone, many Advantage plans are HMOs. They can be very restrictive as to where and from whom you can receive medical care. You typed medicap...but I think you may have meant mediGap. Medigap and medicare supplement are one in the same. The supplement pays the 20% of the approved bill that Medicare doesn't pay. In some cases, the supplement will also pay the yearly deductible that Medicare A & B require.

It has been my experience, that many Advantage plans also carry higher deductible and OOP charges, so research carefully. This is one area where getting something for nothing can be costly.

As for dental and vision coverage, they would be stand alone policies and likely not associated with Medicare.  The only time I know Medicare pays for vision care is eye disease/infections etc. and some surgeries, i.e cataracts.

[Blonde Granny]

Feb 18, 2014 18:10:41 GMT -5 The Walk of the Penguin Mich said:

Feb 18, 2014 18:08:36 GMT -5 Blonde Granny said:

GG, we have Plan F from Mutual of Omaha.  My knee replacement surgery totaled about $80K, and I received no bills. In fact, in 4 years now I've never received a bill. Our plan does increase every year...we started at $114/mo per person and 4 years later we are at $167/mo. But the piece of mind that we have no deductible (part F pays it) and no co-pays is really a comfort.

I did change Part D providers this year and am paying $45/mo. I take one expensive heart drug and a couple of others that even though generic I have to pay for. At least I no longer have a Part D $300 ded.

Where are you?

We live in NW Arkansas (Washington County).

[The Walk of the Penguin Mich]

Feb 18, 2014 18:15:47 GMT -5 Blonde Granny said:

Feb 18, 2014 18:10:41 GMT -5 The Walk of the Penguin Mich said:

Where are you?

We live in NW Arkansas (Washington County).

Thanks.....not going to help as I'm in WA.  

[Blonde Granny]

If you are thinking about only the supplement, go to the website for Mutual of Omaha and see if they offer anything.  Actually it might be under United of Omaha, but it's the same company.