Going from HMO to Medicare. Have advice?

[pararich]

I'm switching from my HMO to Medicare in March.
Does anyone have experience with Medicare that would be good for me to know about?
What are the basic realities of being covered by Medicare?

[SCI-Nurse]

Will you only have Medicare, or do you also have another insurance or Medicaid? Without the former, you will have an 20% co-payment for just about everything they cover, and there is a lot they don't cover (of course I bet that is true for your HMO too). Be sure you are getting both part A and B, as well as part D unless you have a better drug plan. You will have to pay the premiums unless you are on Medicaid and they pay these for you.

One good thing is that you should have a wider choice of doctors and hospitals or clinics where you can get care compared to an HMO.

(KLD)

[Eileen]

I have Medicare and I also pay seperately for a Medex plan (through Blue Cross/Blue Shield) and for part D in Medicare. I think is is far better than when I had an HMO, and you can see any doctor who accepts Medicare anyplace you want to, so is is less limiting. The Medex pays the 20% co-payment for me, and the part D is the perscription drug plan. I no longer have to sort through endless bills, and if I get one I just call and tell them they have made a mistake as I have both Medicare and Medex, and therefore I owe them NOTHING. I get my part D from AARP, which is one of the best and least expensive out there. You do not have to be an AARP member (or even over 50) to enroll in their plan, you just have to be on Medicare.

[pararich]

Will you only have Medicare, or do you also have another insurance or Medicaid? Without the former, you will have an 20% co-payment for just about everything they cover, and there is a lot they don't cover (of course I bet that is true for your HMO too). Be sure you are getting both part A and B, as well as part D unless you have a better drug plan. You will have to pay the premiums unless you are on Medicaid and they pay these for you.

One good thing is that you should have a wider choice of doctors and hospitals or clinics where you can get care compared to an HMO.

(KLD)

KDL, I think my disability income is a little higher than the cutoff for Medicaid. I want to get any supplemental insurance I need to be adequately covered. I'll get A, B and D. Thanks

[pararich]

I have Medicare and I also pay seperately for a Medex plan (through Blue Cross/Blue Shield) and for part D in Medicare. I think is is far better than when I had an HMO, and you can see any doctor who accepts Medicare anyplace you want to, so is is less limiting. The Medex pays the 20% co-payment for me, and the part D is the perscription drug plan. I no longer have to sort through endless bills, and if I get one I just call and tell them they have made a mistake as I have both Medicare and Medex, and therefore I owe them NOTHING. I get my part D from AARP, which is one of the best and least expensive out there. You do not have to be an AARP member (or even over 50) to enroll in their plan, you just have to be on Medicare.
Thanks Eileen,
I'll look into Medex and AARP's plan.

[spinky88]

i would advise you to make sure you research all of your options thoroughly before you make a decision. you need to understand that there are now two options when you go on medicare...medicare and medicare replacement policies called advantage policies. they are not the same thing and once you are on a replacement/advantage policy you are no longer covered by traditional medicare. my daughter and my best friend both work in medical insurance/billing and increasingly problems are showing up with replacement (advantage) policies. personally my parents were talked into an advantage policy and it is horrible. the stories of these policies keep popping up. locally some of our physicians are beginning to refuse replacement policies. you may want to read this thread...

http://sci.rutgers.edu/forum/showthread.php?t=94943

i am sure you will hear both pro and con on each. you just need to be well informed in your decision making.

[LaMemChose]

If you will need a new chair any time soon, get it before the switch.

If your HMO includes dental, get all checkups, cleanings and dental work done now. There is no dental coverage with Medicare.

If you will need new glasses or eyecare anytime soon, do it now.

Do a search at the Part D site entering the meds you take on a regular basis. It will let you know the providers which will best meet your needs. I'm with the AARP Plan and it's worked so well for me. Yes, I land in the donut hole and pay out of pocket before the year is over, but it's still coverage. I had no medication coverage prior to Part D and paid for all drugs out of pocket. It ran into the thousands and thousands.

Get as many cath supplies as you can now through your HMO. Yes, I'm advocating stockpiling what you use and need, but it may make the transition to Medicare easier for you.

In fact, anything you use and need on a regular basis, get it now. It will give you a little cushion as you may need to go with different suppliers for certain items.

Begin checking now to see if the doctors you want to use accept Medicare. Some do and some don't. Identify and find them now and you will not be in a panic trying to find a doc when you get a UTI or something happens and you need to see someone immediately.

I'm thankful for Medicare. I have too many assets and am on LTD which has me above the income levels for TennCare (Tennessee's version of Medicaid). I'd be without health insurance were it not for Medicare.

All the best to you.

[kap]

I would second what Spinky said about the "replacement" policies. I'm not sure what they are actually called but they usually redirect you from Medicare into a privately owned HMO. I also work in insurance and have seen many problems with these. Once you are signed up for Medicare the "replacement" companies will solicit you, so beware.

As for Medicare, learn what they do and do not cover. Off the top of my head, routine visits are not covered, many vaccines not covered or are limited to time frames. PT/OT is very limited, skilled nursing homes I think is only about 30 days? One of the best things you can do for yourself is read your Medicare booklet once you receive it. It always amazes me how many people assume that Medicare pays for everything when in reality they have very limited coverage on some medical services.

Look into a supplemental policy, AARP and BCBS have some of the best policies. Remember, you get what you pay for. The best policies are expensive but they cover the most and could truly benefit you in the long run.

[pararich]

Thanks for the support this info gives me.
Now I'll go back to the insurance company sites and distinguish between replacement and supplemental policies.

[metronycguy]

i have a retirements package, and if i take it Medicare will become my primary, my private insurance is now secondary.
how does this work? i know many doctors i deal with now do not take Medicare, if you go to a doctor that doesnt take medicare and your secondary covers the procedure are you ok?.

[ginamarie]

You need to call your benefits representative and/or the insurance co. You may be required to take medicare as soon as you are eligible, because your insurance may not cover what medicare will once you are eligible.

[metronycguy]

with me it becomes primary if i retire, that i know. it has been my secondary for a couple years
medicare doesn't pay for a lot of things that my private insurance does, a couple of doctors told me to research it , because they dont take medicare,
but if i have good secondary i wonder if i will be ok.
my doctors have been very happy with my private insurance as primary

[kap]

Mike, not sure if you ever got your answer to your question. sorry I've been off the boards for a few weeks.

Check w/ a benefit rep or insurance rep and specifically ask if you go to a dr not participating w/ Medicare will they cover at the 2ndary's regular benefits or will they "estimate Medicare's benefits" and then pay from the estimated benefits.

I used to work for an insurance company and depending on what type of policy the holder had, it would go either way. Typically, self insured employers will estimate benefits. If the policy is not self insured they will cover at their "normal" benefit level.

I hope I have not confused you more. Just PM me if you have any questions.

Kelly