Hi all, We spend 6 months roaming around warmer climates and spend quite a lot of time in Florida in winter. We are both 63 and looking forward to being able to have Medicare. I've done some reading but would like to hear from you folks who are actually "doing it" as to the reality of the situation. I heard a comment on NPR this morning from a retired medicare recipient who said "it's hard to find a doctor who takes medicare"????? that made me sit up and take notice. I always assumed that we'd have extra supplemental insurance at a reasonable cost? and we'd be able to turn up at any hospital or doctor's office basically anywhere and be o.k. Have you had experiences with being "turned away"? I'm thinking mainly Florida at this point. How much are you having to pay for supplemental insurance? Any advice would be much appreciated.
Can't wait for November.
Lynn
Massachusetts
don't know about Florida but never had a problem here maybe it has more to do with people that don't live there,doctors don't bill you till after the Medicare payment comes back to them usually a couple of months later and you pay the difference to them after they bill you, if your traveling all the time there probably worried about collecting the rest of there money.when it comes to extra insurance some are not accepted by every one and only good in certain areas or states,humana insurance is good in a lot of states but others are not.pick carefully,I finialy got around to signing up for my veterans medical insurance.
1985 Class A Holiday Rambler Imperial 33 +1979 Class C Holiday Rambler Statesman 1000 = 24 ft
My info on this subject is a little indirect, but it it might shed some light. While I am not on Medicare(I am only 46) I am retired military and use the Tricare system. What was put out to us over a year ago in writing was that any provider of Medicare is also a Tricare provider. The provider locator listed in the Tricare website has never failed to provide my family with lots and lots of choices and we have never been turned down by a hospital(wife has had 13 abdominal surgeries in the last 15yrs) the only issue that we have had was that recently my wife wanted to change from a family practice doc to a lady doc specifically practicing with the specialties of ladies. We found one, but the doctor while the wife is very happy with her is 40 miles from us. We use to carry ins. from the company I used to work for in addition to the Tricare, when we dropped it we were told by everyone (including the billing agent at our doctors office)that we would have problems and regret it. Guess what, no problems(actually a lot less) and our cost went down and we did not change doctors. Point being their are a lot of nay sayers out there that really don't know what they taking about and the only real way to find out is get advise, do your own research, then make an informed decision. Good Luck.
Approching that age myself, I asked my sister who lives in Orlando what they did about supplemental ins. They never got it and rely on medicare 100% and have had no problems getting medical services. My mother has had supplemental (BC/BS) for years and its a waiste of money. Premiums start out reasonable and increase every year. She is now 90 and pays 225/mo for supplemental coverage. Even with supplemental, the physician has to charge the medicare rate for the services and the supplemental just picks up the co-pay.
I am 70 years old have been on Medicare 5 years, have never used it so I can't tell you anything, last year I was put on Medicaid from the state of Missouri I guess, have not used that either, I am a Veteran and go to the VA Hospital ever 3 months for a Dr's visit been going their maybe 20 years, Harry S.Truman VA Hospital Columbia Mo,
very nice Hospital, My plan is as long as I am able I will continue to do the same, unless I am RVing some where out of State and then I may have to try out one of them other cards, sure hope they work,,,
Richard
Richard
1987 ford f250 6.9 diesel
1997 Innsbruck by Gulf Stream 28ft fifth wheel with slide
and the wife and co-pilot Trudy
We are full timers and I am on Medicare/Tricare with the DW on Tricare basic. We have never had a problem finding a doctor in all our travels, that accepts Medicare. We have used doctors in Florida, Texas, California, Nevada and Idaho without any problems. IMHO, a supplement may not be necessary and will be and added expense if you are healthy and fit. We just pay the copay for the DW and have never had any heavy expenses even with several broken bones and surgeries.
Bob & Betsy - USN Ret'd '78 & FL LEO Ret'd '03 FMCA #F203528 '05 HR Endeavor, 40PRQ w/400 Cummins - With -'05 GMC Sierra LT, CC Z-71, the pusher '07 Arctic Cat 500A & Wilderness Kayak, riding in the pusher - Our Current Location
We use Medicare / Tricare for Life and have never has a problem with getting a doctor. Just remember that because you have a supplement policy it does not make you more appealing to the doctor, as the rate he is paid is the same. The supplement only offsets your cost. Good Luck
Thanks all for helpful input. Sounds like things ar'nt as bad as I thought Thanks also for the great information I've received from private messages. This forum is always such a mine of valuable information and sage advice.
Happy Camping and good health to all.
I have been on Medicare since 2003 and I have a supplement and drug plan. It has worked great for me and really paid off. I have lived in Florida for 3 years and now live in California for the last five.
You shouldn't have any trouble finding a Medicare physician to treat you no matter which state you live in.
A doctor has to specifically opt out of Medicare to be dropped from the program and he has to offer you a signed contract that you agree to be treated outside the program. Few doctors do this and it's usually only ones that offer experimental treatment that most insurances won't pay for.
However, you should be aware that some Medicare doctors do close their practice to any additional Medicare patients once they reach a certain number or percentage of total patients. This is because Medicare may pay less than other insurances for certain expensive procedures and it may affect the doctor's bottom line expenses. Again, only a few doctors do this and it shouldn't be hard to find another doc.
I've never heard of a hospital or ER that wouldn't accept Medicare for most procedures because it is such a large, universal program. Just remember that Medicare may not cover the procedure you are seeking, but private insurance may not cover it, either.
As far as the Medicare supplement, by all means, get one ! Especially if you do not have any secondary health insurance such as from a former employer.
Here's why:
Medicare has NO stop loss limit that most other private insurances have. A stop loss limit would limit your out of pocket co-pays to a maximum dollar amount (usually $4K or $5K per year on private policies).
Medicare is an 80/20 program meaning that they pay 80 percent of approved charges and you pay the remaining 20 percent, no matter how large the 20 percent is.
Since Medicare has no stop loss limit, you are responsible for 20 percent of the contract price for all procedures. So if you wrack up a $150K hospital bill and Medicare allows $100K as a contact price, then Medicare pays $80K and you owe the hospital $20K.
It can get worse; the larger the bill, the more you pay. Let's say you suffer a serious injury or a illness and end up in intensive care and wrack up several million dollars in charges. You could easily owe $400K without a Medicare supplement or other secondary insurance. Sound scary ? It is. Enough to bankrupt most of us.
I know that people are going to say the supplement is too expensive, not needed, nothing like that will ever happen, I'm in great health, etc. but you need to ask yourself if you can afford 20 percent of a catastrophic charge. After all, insurance is MOST needed for a potential catastrophic medical problem.
The great thing about the supplement is that I can stay in the hospital for up to 15 months consecutively and I'm 100 percent covered. There's no bankrupting myself or family for a long stay up to this limit and no getting kicked out of the hospital because I hit a lower consecutive days limit.
To give you an idea of the great coverage I have, I recently needed outpatient infusions for 5x per week for 10 months. The 20 percent co-pay per month for these was $800 or a total of $8000 for the 10 months. I didn't have to touch my wallet. Medicare plus the supplement picked up 100 percent of all costs. Without the supplement, I would have had to fork over $8K.
If you have a private employee heath plan paid by a former employer, then you probably don't need a supplement. Just be aware that the private plan may fill in some of the 20 percent charges, but not all.
If you do decide on a supplement, be sure to get a Plan F. This is the most comprehensive coverage. Private insurance companies offer these and the rates vary per company and per zip code.
I pay the one of the highest premiums at $240 per month because I live in high cost California and because I'm under 65 (I am totally disabled). Most people over 65 in my zip code pay between $100 to $200 per month for the same coverage. My agent tells me that when I do turn 65, the rate should drop about $90 making it $150 per month. I am paying the highest premium for my zip code because they know people on Medicare under 65 have medical problems due to disability.
Your premium should be substantially less than mine since Florida is a lower cost state and you're 65 or older. Premiums here are very stable and have not increased much for me (about a couple of dollars per month over the last 3 years). However, folks over 65 will get a bump every 5 years when they cross an age category (65-69,70-74,75-79, etc.)
There are cheaper priced supplements (Plans A thru whatever) but beware of these as they do not fill in everything that the Plan F supplement does. I do not recommend them. I strongly recommend Plan F.
For an explanation of all plans, go to www.medicare.gov website. Under 'Search Tools', click on 'Find A Medicare Publication'. Enter 'supplement' in the 'Search By Keyword' box and click 'Go'. The second resulting item should be a link to the document:
2008 Choosing A Medigap Policy: A Guide To Health Insurance For People With Medicare - 02110
Click on "View Adobe PDF' to get this doc. It gives a very informative comparison of all Medicare Supplement (aka Medigap) plans.
I got my supplement thru State Farm Insurance and have never had a problem with a claim. Medicare often automatically forwards claim info to State Farm.
Hope this helps and good luck to you...
* This post was
edited 07/17/08 10:44pm by Bretman *
I have more experience with Medicare, Tricare for Life and Mediplus than I would like. I am currently being treated by... nine or ten specialists. They all take Medicare, but one of them refuses to bill Tricare For Life for me. I am dropping him.
Mediplus is from MOAA, a retired officers and I think NCO group. They seem to be merging. Having been a Sgt first, then an officer, I think I qualify for most plans. We just had a big hike in fees for my wife and I - it is now $400 a quarter, but they pay 100% of whatever Medicare and TFL don't pay. Before I was on SSDI I really needed Mediplus, but now that I have Medicare up front, I will drop Mediplus next year. We do use Mediplus to pay for my prescription copays at Walgreens. I don't trust the drug program that mails me my meds. I am probably wrong not to trust them, but I KNOW I can get my meds at a Pharmacy, never too sure about a mail order outfit. Class II is another story.
Most doctors and Durable Medical Equipment (DME) dealers do NOT know TFL covers a lot of things Medicare doesn't. Be aware of that if you are retired military. Apria fought me until I went to Corporate to ask them how much money they are losing through ignorance on the part of their employees. Grrrrrrrr. Even when I sent the Sacramento Apria people a copy of the page that states this, they didn't seem to understand Tricare for Life covers more things.
My wife uses Tricare Standard (PPO) and we have not had anyone refuse to see her. I did have a Pain Mgt Doctor's office say they did not take Tricare Standard or Tricare for Life, but would take Tricare Extra or something like that. I told them they cannot take only one kind of Tricare, but this lady knew it all. It wasn't worth the hassle to educate her.
For Chronic Pain, Medicare has many more doctors than Tricare in the North East part of Sacramento. I am not sure why, but as was mentioned earlier, I think any Dr. taking medicare has to take Tricare.
Another thing you should be aware of is how you are billed and what you really owe. Example: A DME in Sacramento told me they had been refused by Medicare (It was for an E bottle of Heliox and a special regulator). I told them to file the EOB with Tricare, because Tricare was paying for the Heliox until I went on Medicare. They billed me some outrageous amount and I called Medicare. Medicare told me this company had NOT billed Medicare. If they did, Medicare would pay it.
The lady at Medicare explained that some independent medical firms have been known to tell the customer this story because the customer is billed at the high rates and usually pays it. Put another way, a monthly charge was $500, but Medicare would only pay about $135. See what I mean? The lady told me Medicare would be glad to call this DME and arrange for training of their people. I repeated this to the bookkeeper there and the charges disappeared. I called later to see if they had been paid and was told not to worry, it had been resolved.
I still don't know what happened. Same with Dental Charges. I ran out of Delta Dental coverage after a car wreck in 2001. I needed a crown, which I was told cost $900. Delta only allowed a portion of that and they told me how much I had to pay. The dentist signed a contract with them which was binding in my situation. Saved me $$$$$.
BTW, anyone keeping track of the lawsuit against Medicare? DME's from across the USA filed a lawsuit and Congress is fast tracking a bill
to stop Mediscare. You can Google Medicare and lawsuit to find it. Never a dull moment.
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Thanks also for the great information I've received from private messages. This forum is always such a mine of valuable information and sage advice.
