11/09/19, Saturday

148.6

Good morning all folks (chilly willy or otherwise)

Good discussion going on the topic of that confusing topic called Medicare. I am certainly no vet on the matter, but do agree with Liz re Regular Medicare vs an Advantage plan. IMO some important points to consider (Liz has touched on quite a few all ready)- Think into the future when choosing the level of coverage you will need.

For those of you lucky ones who are not grappling with Medicare Madness- no need to read further...

During initial enrollment insurance companies cannot refuse coverage- guaranteed acceptance at whatever the standard cost of the plan is. Also, as long as you pay the premiums, you cannot be dropped. Going forward, if you wish to change plans preexisting conditions can (and will be) considered- coverage can be refused- or, if you are accepted the plan's cost can be considerably higher- greater risk-more cost.

Liz already covered the difference between advantage vs supplemental plans. Advantage plans often have restrictions- they are, in effect HMO plans, not PPO plans and often only ok/cover service choices and require approval to access those services. Most supplemental plans cover all services that are accepted through Medicare- no referrals necessary and choice of any service that accepts Medicare. They also will cover "over the accepted" fees that good specialists tend to charge.

The percentage of covered services depends on which "level" you choose (F and G plans are at the higher end, for example). By law, those levels of coverage are consistent o matter which company you choose. When choosing the company you go with has more to do with cost of plan and quality of the delivery of service. For example, some companies will coordinate payment with the provider and you will not have to be the middle man as opposed to you paying the provider and then being reimbursed by provider.

I chose the Original Medicare plan with a supplemental F plan for the following reasons: 1. With the pre existing issues I have I am uninsurable- my plan (poor suckers) had to accept me- no med history required, and are now covering for however long into the future all imaging scans, extraordinary required and justified by dr tests and bloodworkups, as well as specialists I will need to have. No deductibles- no bills. It is the most expensive plan, but the cost of the scans alone without the plan would be more expensive than my premium. 2. I am not limited to In Network Providers. I can see the best I can find. I am free to use KUMed or Mayo- whatever. Being the special snowflake that I am (ha), I do not have to see physicians-use hospitals that are not experts in ongoing care I may need.

Just as a note, DH, who is in very good health chose a High Deductible F plan- Outside of unforseeable medical issues these plans are for mitigating catastrophic medical costs. They turn into full F plans after a high deductible. I would have chosen that, but, doing the math, will pay less for the greater plan knowing I will use the insurance. Kurt, being very healthy uses his as a safety net plan.

Lastly, all those government pamphlets, booklets, and the Medicare website you can go to-create an account and study? Do it. You will be more confused and frustrated for the effort, but it helps. I have even found the online ask-live-and cyber talk with a real person- option to be helpful when encountering confusing info.

Sorry about all the TMI - Navigating Medicare is one of the most frustratingly tedious, but necessary task to deal with ever. The problem for me was in knowing that once certain decisions are made, they are difficult if not impossible to undo, and will continue to impact me into the future. Everyone's situation is different- thus all the choices to make- no one good answer.

Best advise I was given was "Choose the most insurance coverage you can afford. If you wait until you need it, you will not be able to afford it".

That advice seems really sound in light of the fact that none of us can predict the future and medical costs can be catastrophic. I too am really trying to think it through and assuming I may not be able to change in the future (something I did not understand when signing up DH).

What gets me is that we are all intelligent, educated people and we are struggling to understand the options as has every person I know. What happens to those with less ability to understand???

Totally YES. For example- one the Med. Website under covered tests and procedures you will find on virtually every item listed "in most cases". And what are those exceptions? Who knows? They don't tell you. Is it a limitation on number of times with in a set period of time? Or, under what qualifying factors? Some are limited to number of times in a lifetime....Who knows? Most all the time I get in to learn more, I end up feeling like I'm the village idiot.

We are in the re-enrollment timeframe and I am reconsidering changing over prescription coverage company to DH's. But it takes research---JUST SHOOT ME, PLEASE!!!

Diane, so pleased to hear that your medical situation has a manageable outcome.

Greetings My Precious Ones

The sun is out and it might be one of those special fall days.

DianeO so glad your medical situation is stable and not serious. I know you will do whatever is needed to manage because you are a "get -er-done" kind of lady.

BB odd about the doctor's remarks. I too would conclude that something else bothered her and she took it out on you. Not very professional. Yeah my dentist knows about vsg and all medical people should be reminded of the sleeve. You did right.

Yep, medicare is a pain to start on but a dream once its in place. I went to the local office on aging where a volunteer walked me through options. I have the AARP supplement plus Silverscripts part D meds. The meds plan doesn't do a lot for me now because I only have a couple of meds that are cheap but I wanted to be covered if I get some bad disease that needs expensive treatment. My younger brother, on medicare as of last summer, now has a disease that takes expensive drugs. He is glad for what he has.

I took bananas and other food to the homeless project. I kind of have to force myself to go there as its so sad and many of the people smell frankly terrible. But they are grateful for what is offered and the church ladies load them up with take away containers. Must count my blessings.

Pool time was pleasant yesterday and I will go again today. I like getting my hair washed there and coming home fresh and clean like I used to do in college.

I really need a new hairdo. I look like a scarecrow.

Love Cecily's travel photos. Keep them coming. Diane S

So glad you're going to the pool. I've decided to return to my pool in January. I love showering there, too.

Yep, I like that I don't have to scrub out the shower or wash towels! ds