Costly Mistakes Seniors Make When Enrolling in Medicare

SeaBreeze

SeaBreeze

Endlessly Groovin'
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Some info here on costly mistakes that seniors often make when enrolling in Medicare...http://seniorjournal.com/NEWS/Medic...s-Boomers-Make-When-Enrolling-in-Medicare.htm


If you are new to Medicare, you have a fundamental choice to make: enroll in original Medicare or opt into a Medicare Advantage plan. It is very important that you understand the pros and cons of both types of coverage.Original Medicare is a fee-for-service program. Most consumers supplement the government benefit with a private Medicare Supplement (also called Medigap) policy as well as a Part D plan for their prescription drugs.

A Medicare Supplement policy may cover some services that are not included under the standard Medicare Parts A and B as well as some out-of-pocket costs such as co-insurance costs for care at skilled nursing facilities, the Part A deductible, and foreign travel emergency care. If you choose a Medicare Supplement policy, you will pay an additional monthly premium. You won't need prior authorization to use specialists or to get second opinions.

A Medicare Advantage Plan (Part C), on the other hand, takes the place of original Medicare Parts A and B. These plans work more like group insurance. They are sold through approved, licensed insurance companies and may have an additional monthly premium.
Often, Medicare Advantage plans include prescription drug coverage as well as services that original Medicare does not such as health/wellness programs and vision care. However, a Medicare Advantage plan may also limit a person's ability to use doctors and hospitals, and also require prior authorization to use specialty services.

During open enrollment, you have the option of changing from one type of plan to another if your needs have changed.
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I have worked with Medicare and it's payment methods for 15 years.. The first piece of advise I will give is to NEVER give up your traditional Medicare in favor of one of the so called Medicare Advantage plans no matter how attractive the insurance company makes it out to be.

I personally had to tell families that we could not care for Grandma and her broken hip at our facility because it wasn't in her "Plan" and she had to be transferred, broken hip and all, to another facility.. at their expense. They of course were shocked, but that's the way it is.. A Medicare Advantage plan is nothing more than an HMO and THEY will tell you where you can go, and what doctor you can see..

So Here's the truth..

Medicare part A covers inpatient hospital stays ONLY. You will be charged a deductable of $1,216 for your inpatient stay. Your Medicare supplement will pick up this deductable. If you become rehospitalized within 60 days of your discharge, you will NOT owe another deductable.. 61 days? you will have to pay another $1,216.

Medicare pays hospitals on a DRG basis (Diagnostic Related Group).. Put simply, If a patient is admitted with a diagnosis.. Medicare assigns the dollar amount it will pay for each diagnosis.. It will NOT pay one penny more for a patient no matter how long they stay, or what tests or procedures are done. If the diagnosis of for example Pneumonia is assigned.. It will pay a set dollar amount, and it doesn't matter if the patient stays 5 days or 55 days.. It's the same $$..

The hospital is not allowed to bill a Medicare patient sor the difference in what Medicare pays, and what the actual hospital bill is. They have to write off the difference... If a hospital wants to be able to take Medicare patients. That's the deal.. Take it or leave it... or don't care for Medicare patients... Hospitals are glad to do this as Medicare makes up the majority of their payer base.

NOW... Part B. Part B is for outpatient services only. It does NOT pay anything to hospital for Inpatient stays. Part B will pay fee for service for an Observation stay in a hospital, but only at 80%. It will pay 80% of doctors visits, lab work, or any other out of pocket costs.. Your Medicare supplement will pick up the difference.
 
Wife and I are going to a Medicare Supplement Seminar today. I have Medicare A & B as of this last June, but need something for RX coverage and to help pay for the 20% that Medicare B doesn't pay. This seminar is with Florida Blue.

But, YES, people do have to be careful in what they get. Plans available can depend on your health and how many prescription meds a person takes.
 

I'm not yet using my Medicare. I have Part A, but cannot use it because I am still working and have group insurance.. BUT I have given some thought to what supplement I will purchase when I do retire. I'm torn between AARP (which is United HC) and one of the Blue Cross plans... I'm guestimating will cost up $300+ every 3 months in premiums. Of course I will take Part B when the time comes.
 
I also have Medicare Part A only because I am still covered by my company health plan. I, too have done some research on medicare supplements. For me, when the time comes will probably take Plan F with high deductible. Currently the monthly premium by one insurance company here in NY for that policy is only $64 a month. By the time I'm ready to take it, the rate will probably be higher but if you don't go to the doctor often and you have the money to pay the bill when it comes in, it could end up saving significant dollars. I think the deductible is $2100 or $2200. The Plan F premium here by Blue Cross is approx. $400 a month so that's $4800 a year. If you're only expenses revolve around a physical that year and cost $600, then your annual premiums based on the example policy above is $768 + $600 = $1,360, while the person who took the regular Plan F spent $3,,440 more than the person who had the regular Plan F.
 
Sounds kind of expensive. My SIL pays $360 every three months for her Blue Cross supplement. I have to admit I haven't looked that closely.. I am trying to make it two more years.. I'll be almost 68 when I retire... Hubby will then be 65 and can get Medicare. That's what I get for robbing the craddle.
 
At the seminar this AM, at a Florida Blue office, the salesman pretty much only talked about the Advantage Plan. Wife and I don't want me to give up my Part A & B Medicare, so the seminar was pretty useless for us. However, after the seminar, we did talk to a salesman and find a good RX Plan for $60 a month Premium and Medicare Part B Supplement Plan for $88 that we really like. We are going to take a good look at both Plans before getting them, but the look like what I need.

Will end up pretty much dropping my VA medical. No close hospital and ER is NOT automatically covered. VA won't coordinate w/Medicare or Florida Blue or visa versa.
 
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ClassicRockr said:
At the seminar this AM, at a Florida Blue office, the salesman pretty much only talked about the Advantage Plan. Wife and I don't want me to give up my Part A & B Medicare, so the seminar was pretty useless for us. However, after the seminar, we did talk to a salesman and find a good RX Plan for $60 a month Premium and Medicare Part B Supplement Plan for $88 that we really like. We are going to take a good look at both Plans before getting them, but the look like what I need.

Will end up pretty much dropping my VA medical. No close hospital and ER is automatically covered. VA won't coordinate w/Medicare or Florida Blue or visa versa.
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Of course they want you to give up your traditional Medicare... Big for profit Insurance companies want to make money.. VERY smart on your part CR... as I said above NEVER NEVER NEVER give up your Medicare in favor of one of the Advantage plans. THey are HMOs and they exist to take your money and not provide the care or flexibility Medicare does.
 
Actually I am off on my figures, not sure what I multiplied by. But the cost of Plan F here in NY Metro is $3884 for $971 every 3 months and while it didn't go up this year, it could go up for 2015, haven't heard yet. Her plan covers everything; have not had any co-pays or deductibles that went unpaid. In my mother's case, however, is that her plan is used. She's had two surgeries in the last 2 years that have more than made up for the premiums. However, the difference between her Plan F and the High Deductible for someone like me who is relatively healthy can still save one $2,500 a year using the above example.
 
LogicsHere said:
Actually I am off on my figures, not sure what I multiplied by. But the cost of Plan F here in NY Metro is $3884 for $971 every 3 months and while it didn't go up this year, it could go up for 2015, haven't heard yet. Her plan covers everything; have not had any co-pays or deductibles that went unpaid. In my mother's case, however, is that her plan is used. She's had two surgeries in the last 2 years that have more than made up for the premiums. However, the difference between her Plan F and the High Deductible for someone like me who is relatively healthy can still save one $2,500 a year using the above example.
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Hospitalizations for surgeries wouldn't cost anyone with Part A anything... except the $1200 deductable... which of course the supplement will pick up. But the hospital cannot bill patients for the difference in what they bill and what Medicare pays. They have to write off the difference.

In other words.. If the hospital submits a bill for $100,000 (not unusual) and Medicare pays them only $10,000. They cannot bill the patient or the supplement for the $80,000. That's because Medicare tells them... Take it or leave it... or don't treat Medicare patients. AND they gladly do so...
 
I found out about this "cost loss" when we got the bill for my MRI consultation for a RC surgery. The bill stated the total amount charged, the amount discounted for being on Medicare and the amount we owe the doctor. The amount we will pay to the doctor is taken out of my $147 deductible. The "discounted amount" is what the doctor loses. I can't imagine how much money doctors lose due to treating Medicare patients! But, with the amount of Medicare patients out there in society, I don't think many doctors can say "no" to Medicare..........even when they lose money due to Medicare.

Wife told me, "well, you could just go on my Company heath insurance. The cost would be about the same as the amount for the RX and Supplement." I told her, "that's fine, but we would still have to pay for Medicare B, and I wouldn't be using it!" She told me, "I forgot about the $104.96 a month for Part B." Anyway, I will just be happy once I'm covered medical and RX wise.
 
NOt sure about doctors, But hospitals lose millions... ON PAPER! These are not actual losses CR... The amounts charged for hospital services have no grounding in reality and are inflated hundreds of times the amount of the actual cost of treatment the hospital incurrs.. There is no reason to charge $12 for a single aspirian.. OR $300 for a simple EKG.. but they do... AND the charges for imaging... CT scans.. MRIs are exhorbitant. SO they really don't lose that much... BUT what it does enable them to do is to charge the uninsured patient these fees and run them into bankruptcy.. It's a scam... and I work for a hospital and have access to their charges... sad..
 
I agree to avoiding Advantage plans. I have heard so many horror stories about these plans. Unless you are healthy and never get sick, which we can never count on, I'd go with a supplemental. I don't regret it paying the extra per month for my Plan F and Plan D.
 
The Medicare advantage plans were instituted as a concession to Big Insurance companies by Republicans. The Insurance companies wanted a piece of the Medicare actions and of course with their lobbyists and threat of withholding campaign contributions, Medicare Advantage was born.. It uses your Medicare premium, but the one thing people need to know.. They do NOT have Medicare. They have an HMO not run by the government, but run by and with terms dictated by an insurance company. They will tell you what hospital you can go to.. what doctor you can see, and what treatments it will pay for. It's very deceiving. I remember telling the family of a woman that she could not have her hip surgery at our hospital, but had to transfer to a facility clear across the city. They were shocked.. "But mom has Medicare!" No.... Mom does NOT have Medicare, she signed that away and opted for an Advantage plan. She had no choice but to transfer, or pay for her surgery herself.
 
There are two things that Florida Blue told us that really attract Medicare B people to their Advantage Plan: Silver Sneekers Program, routine Dental-Vision and Hearing and "no monthly Premium cost for their Medicare C (replacement Plan). It was real tempting to go with this, but after reading on this Thread "why not to", we aren't.

Looks like we are going with BlueMedicare Rx (PDP) and BlueMedicare Supplement - Lower Premium Plan L
 
It really gets me when I think how much it can cost for a couple's medical, dental, vision and hearing insurance when they don't retire from a job. When a person retires from a job, isn't medical included with most Pensions?

Anyway, when my wife retires at 70, on SS, she will have to get Medicare Part B and the two Supplements like I have. So, those costs, on top of my existing medical care cost, plus getting some kind of Dental, Vision and Hearing coverage.....I figured it out to be around $600 a month, and that's not including the Dental, Vision and Hearing. The complete medical coverage for us will be over $7,200 a year! Boy, add that in with other expenses, we will be eating Mac & Cheese the rest of our lives. LOL

Do all pensions include medical in them?
 
I retired from a major airline. My wife and I were covered with it all, 100%, medical, dental and eye care until I hit 65, then some of it went away. I had to go on Medicare and buy a supplemental, which my wife did also. However, the airline pays for our eye care and dental care up to certain limits. The supplemental went up a pretty decent amount last year, so I am shopping around this year. After all, Plan F is Plan F, no matter what company you go with. There is a high deductible Plan F, but I chose to stay away from that one.

Although we have saved a nice little amount, (I am no Bill Gates by any sense of the imagination), one horrific medical problem could eat up a lot of our nest egg. So, I opt for the Plan F just as a way of protecting my assets.

By the way, when I was in Florida a few months ago, (we come and go to our home down there), I went to a seminar that Florida Blue was holding just to educate myself on things I may not have been aware of. I have to admit, they are one of the better Blue Cross/Blue Shield companies in the U.S. When I worked at the airline, we had several options to choose from for our healthcare. I chose BC/BS of Alabama. I never paid dime one out of pocket, except for my co-pays, which were $15.00 to go to the PCP, $30.00 to go to a specialist and $50.00 to go to an E-room, unless admitted and then it was waived. All labs and x-rays were 100% covered, so long as I went to an accepted BC/BS member clinic.

I don't know who started this thread, but it has been very good. This is what we need on here. It has been educational and I have picked up a few good ideas, not just for myself, but I know of others that have questions and don't understand what they read on the Medicare.gov website. Thanks to everyone.
 
Not sure what you mean by the two Supplements. Are you talking about the Medicare Supplement plus prescription Plan? If not, I have never heard of one paying for two medicare supplements.
 
LogicsHere said:
I understand Part A pays for the hospital, but doesn't the surgeon fall under Part B?
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Yes... but like hospitals.. If a Doctor takes a Medicare patient.. he agrees to settle for what Medicare Part B and the Supplemental insurance pay him.

More and more, Doctors are opting to become employees rather than private contractors. Many are employees of the hospital they practice in and take a paycheck directly from the hospital.... in exchange for malpractice insurance provided by the hospital a s well as not having to deal with insurances and Medicare.
 
The company I retired from sends my wife and I each a check every month to help pay for our medicare supplements. It is up to us what insurance we buy. We have never had vision, hearing, or dental insurance.
 
Confused. We are required to have Part A and Part B, aren't we? Everyone I know also has an extra plan--usually about $50 per month or some pay nothing. It's wrong to have these plans? Like Blue Cross? We'd be better off with just plain old Medicare? Is that what you're saying?
 
QuickSilver said:
I have worked with Medicare and it's payment methods for 15 years.. The first piece of advise I will give is to NEVER give up your traditional Medicare in favor of one of the so called Medicare Advantage plans no matter how attractive the insurance company makes it out to be.

I personally had to tell families that we could not care for Grandma and her broken hip at our facility because it wasn't in her "Plan" and she had to be transferred, broken hip and all, to another facility.. at their expense. They of course were shocked, but that's the way it is.. A Medicare Advantage plan is nothing more than an HMO and THEY will tell you where you can go, and what doctor you can see..

So Here's the truth..

Medicare part A covers inpatient hospital stays ONLY. You will be charged a deductable of $1,216 for your inpatient stay. Your Medicare supplement will pick up this deductable. If you become rehospitalized within 60 days of your discharge, you will NOT owe another deductable.. 61 days? you will have to pay another $1,216.

Medicare pays hospitals on a DRG basis (Diagnostic Related Group).. Put simply, If a patient is admitted with a diagnosis.. Medicare assigns the dollar amount it will pay for each diagnosis.. It will NOT pay one penny more for a patient no matter how long they stay, or what tests or procedures are done. If the diagnosis of for example Pneumonia is assigned.. It will pay a set dollar amount, and it doesn't matter if the patient stays 5 days or 55 days.. It's the same $$..

The hospital is not allowed to bill a Medicare patient sor the difference in what Medicare pays, and what the actual hospital bill is. They have to write off the difference... If a hospital wants to be able to take Medicare patients. That's the deal.. Take it or leave it... or don't care for Medicare patients... Hospitals are glad to do this as Medicare makes up the majority of their payer base.

NOW... Part B. Part B is for outpatient services only. It does NOT pay anything to hospital for Inpatient stays. Part B will pay fee for service for an Observation stay in a hospital, but only at 80%. It will pay 80% of doctors visits, lab work, or any other out of pocket costs.. Your Medicare supplement will pick up the difference.
Click to expand...

catsndogs said:
Confused. We are required to have Part A and Part B, aren't we? Everyone I know also has an extra plan--usually about $50 per month or some pay nothing. It's wrong to have these plans? Like Blue Cross? We'd be better off with just plain old Medicare? Is that what you're saying?
Click to expand...

Read the above...You need Medicare and a Supplement Plan..Also a Drug Plan (most Supplements do not have it).
 
QuickSilver said:
I'll be almost 68 when I retire... Hubby will then be 65 and can get Medicare. That's what I get for robbing the craddle.
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Well. i robbed the cradle too. I'm 58 and the wifey is 52. All i know about Medicare is what i read at wikipedia (not much). I'm thinking in the next 7 years, we may see pure play socialized medicine. But like things are now ... what's the pros and cons of having medicare at all? Could one drop their primary health insurance for medicare instead?

I'm self-employed and have one of those UnitedHealthcare cheap plans that has a $10,000. deductible.
 

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