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Thread: Medicare

  1. #36
    Join Date
    Mar 2009
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    2 states: NJ and confusion
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    30,657

    Default Re: Medicare

    Quote Originally Posted by George Jung View Post
    This is a good thread - and I would advise anyone coming up on this 'anniversary' to start investigating early. John Smith - I'm surprised to hear of a dr. not accepting BCBS - in this area, they're among the best payers - we roll out the red carpet for them!
    Virtually everyone around here participates. This particular provider is unique in not. Doesn't bother us, but my friend is going have to find a different doctor for this purpose.

    With Medicare primary, they determine what is allowed, and whatever is the difference between what Medicare allows and what Medicare pays, BCBS pays. Wife and I have not had a co-pay or a deductible since our 65th birthdays.

    The point I made is when Medicare is secondary, it's different.
    How do we form a mutiny? Our new captain is navigating poorly.

  2. #37
    Join Date
    Sep 2007
    Location
    Bass Harbor, ME
    Posts
    2,784

    Default Re: Medicare

    Quote Originally Posted by Arizona Bay View Post
    Good thread, now I need to go back and re-evaluate

    Basic question:

    What is the difference between Prefered Cost Sharing and Standard Cost Sharing, regarding drugs?
    The difference as I understand it can have two meanings. For example in my Part D plan I get preferred cost sharing if I use a "preferred pharmacy (Walmart). For example, my cost for levothyroxine is $1 per month at Walmart Pharmacy and $10/mo at any other network pharmacy. It can also apply to certain drugs where the plan has negotiated a good price for a specific drug but not for other equivalent drugs. An example where you might see that is with blood pressure drugs of which there are quite a few that are more or less equivalent.

  3. #38
    Join Date
    Feb 2011
    Location
    Jerome, Aridzonia Apu Mingus
    Posts
    6,366

    Default Re: Medicare

    Quote Originally Posted by Todd D View Post
    The difference as I understand it can have two meanings. For example in my Part D plan I get preferred cost sharing if I use a "preferred pharmacy (Walmart). For example, my cost for levothyroxine is $1 per month at Walmart Pharmacy and $10/mo at any other network pharmacy. It can also apply to certain drugs where the plan has negotiated a good price for a specific drug but not for other equivalent drugs. An example where you might see that is with blood pressure drugs of which there are quite a few that are more or less equivalent.
    Thanks... some ggling straightened it out. Some of the confusion comes in when they explain things one way, and then put up a chart using different terms.
    Good thing I went over it all again, I found an Advantage plan with lower costs, deductibles, and better coverage than traditional Medicare with drug plan.
    Last edited by Arizona Bay; 10-12-2018 at 09:32 PM.

  4. #39
    Join Date
    Jul 2002
    Location
    Western Washington
    Posts
    2,805

    Default Re: Medicare

    There's a limit to how well you can view and evaluate the various plans in your mind, so prepare a matrix. Here's matrix for some of the Medicare Advantage plans in my county (there are more, and this shows how some counties have a great selection).


  5. #40
    Join Date
    Dec 2001
    Location
    Port Richey
    Posts
    12,361

    Default Re: Medicare

    Seems to me that since Medicare Advantage is actually private insurance and the goal of private insurance is to make money that one should seriously consider the actual gov't medicare program and then look at a secondary to fill the gap.
    Tom

    "Leave the gun, take the cannolis"

  6. #41
    Join Date
    Jul 2002
    Location
    Western Washington
    Posts
    2,805

    Default Re: Medicare

    Quote Originally Posted by ccmanuals View Post
    Seems to me that since Medicare Advantage is actually private insurance and the goal of private insurance is to make money that one should seriously consider the actual gov't medicare program and then look at a secondary to fill the gap.
    This doesn't make sense given the existing system. Maybe you are saying change the system? I would agree with that.

    The actual government medical program pays money to doctors and hospitals to provide services to enrollees. However, the system is set up so that it's not particularly efficient, and not that attractive to enrollees.

    In conjunction with lobbyists, legislators, and various criminals, insurance companies have arranged Medicare Advantage plans. The insurance company agrees to handle all of an enrollees medical issues, the government doesn't do any of it. The government pays the insurance company Advantage Plan to do this ( a thousand dollars a month or so per enrollee, this amount varies by county).

    As long as the enrollee is healthy and doesn't use services the insurance company pockets that thousand bucks. If the enrollee uses services the company pays for them.

    The company has to convince enrollees like me to sign up to their Advantage Plan so that they can get their hands on that thousand bucks per month. They convince me by offering various services and rates that are better than traditional government Medicare. There are many advantages - dealing with just one company, no paperwork and bills from dozens of medical providers, gym/health club membership at no cost, lower cost for drugs in the formulary, emergency travel service, etc., etc.

  7. #42
    Join Date
    Sep 2007
    Location
    Bass Harbor, ME
    Posts
    2,784

    Default Re: Medicare

    Traditional Medicare with a supplement (G or F) means no bills (except the $183 Part B deductible for the G supplement). Everything is handled by Medicare and the supplement company. I just went through cancer treatment with traditional Medicare and an F supplement. I have not seen any paperwork at all and no bills. No copays, no deductible, NOTHING. It is the closest thing to Canadian universal health care I have seen since I moved back to the US from Canada. Incidentally Medicare is much more efficient than any private insurance plan in terms of administrative overhead. I have also found it very easy to use - just give the provider my Medicare card and my Supplement card. After that I do nothing.

  8. #43
    Join Date
    Dec 2001
    Location
    Port Richey
    Posts
    12,361

    Default Re: Medicare

    Quote Originally Posted by Todd D View Post
    Traditional Medicare with a supplement (G or F) means no bills (except the $183 Part B deductible for the G supplement). Everything is handled by Medicare and the supplement company. I just went through cancer treatment with traditional Medicare and an F supplement. I have not seen any paperwork at all and no bills. No copays, no deductible, NOTHING. It is the closest thing to Canadian universal health care I have seen since I moved back to the US from Canada. Incidentally Medicare is much more efficient than any private insurance plan in terms of administrative overhead. I have also found it very easy to use - just give the provider my Medicare card and my Supplement card. After that I do nothing.
    Yep, that's exactly how it works for me. I show doctors and hospitals my medicare card and my military retired ID for Tricare supplemental and I see my doctors, go to hospitals, have tests, etc. etc and I don't see any bills or have any copays for anything.
    Tom

    "Leave the gun, take the cannolis"

  9. #44
    Join Date
    Dec 2001
    Location
    Port Richey
    Posts
    12,361

    Default Re: Medicare

    Quote Originally Posted by Dave Wright View Post
    This doesn't make sense given the existing system. Maybe you are saying change the system? I would agree with that.

    The actual government medical program pays money to doctors and hospitals to provide services to enrollees. However, the system is set up so that it's not particularly efficient, and not that attractive to enrollees.

    In conjunction with lobbyists, legislators, and various criminals, insurance companies have arranged Medicare Advantage plans. The insurance company agrees to handle all of an enrollees medical issues, the government doesn't do any of it. The government pays the insurance company Advantage Plan to do this ( a thousand dollars a month or so per enrollee, this amount varies by county).

    As long as the enrollee is healthy and doesn't use services the insurance company pockets that thousand bucks. If the enrollee uses services the company pays for them.

    The company has to convince enrollees like me to sign up to their Advantage Plan so that they can get their hands on that thousand bucks per month. They convince me by offering various services and rates that are better than traditional government Medicare. There are many advantages - dealing with just one company, no paperwork and bills from dozens of medical providers, gym/health club membership at no cost, lower cost for drugs in the formulary, emergency travel service, etc., etc.
    With all due respect Dave your post makes absolutely no sense and does not reflect reality.
    Tom

    "Leave the gun, take the cannolis"

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