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Thread: Medicare part 'B'

  1. #1

    Medicare part 'B'

    I hope I'm in the correct section?
    I just became eligible for Medicare part 'B' and have looked through the book they sent. Seems you can pick a private healthcare carrier at zero or higher cost and that somewhat depends on your geographic location. I thought I'd ask on the forum if anyone has any advice? I'm T4 para and use catheters but no medication. Besides that I use cushions and wheelchairs and I live in San Diego county, California.
    Any advice on this matter would be gratefully appreciated.
    Thanks

  2. #2
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    I chose what is called the "original Medicare plan" because it does not confine me to a certain hospital, or a certain medical practice group. I wanted to know that I could see anyone without restrictions or the need to get referrals.

  3. #3
    Quote Originally Posted by Eileen View Post
    I chose what is called the "original Medicare plan" because it does not confine me to a certain hospital, or a certain medical practice group. I wanted to know that I could see anyone without restrictions or the need to get referrals.
    So in the book medicare sent me, I have the option to switch my part B to another healthcare provider such as Aetna, united, blue shield etc. I wondered if there was any advantage by going with one of them over medicare as my provider? Kinda lost to be honest! All and any advice welcomed

  4. #4
    I would strongly recommend NOT going with a Medicare HMO plan. This will severely limit your ability to see the specialists you need for your SCI. Most also have severely restricted DME coverage...for example, there is only one cushion they provide, take it or leave it. Same with wheelchairs. It may cost you more to go with a separate Medi-Gap policy but in the long run, you are much more likely to be able to access the services, supplies, and equipment that you require.

    (KLD)

  5. #5
    Senior Member skippy13's Avatar
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    Check into the medicare advantage programs. They run anywhere from costly to nothing. I pay another 135.00 per month for the blue cross blue shield PPO 'cadillac' program in Oregon. I can see any doc that takes medicare and no need for referrals unless the doc requires it. There are three different 'tiers' of cost for this Blue Cross PPO, and I chose the most expensive simply because I can afford it and the benefits are great. As I said, it is money that I would be spending anyway and if anything catastrophic happens there is that out of pocket limit to consider.

    I pay a very small co-pay on all services, but I would spend the money anyway and there is an out of pocket limit of around 3500 dollars. That combined with the monthly premium is money that I would be spending anyway.

    Last year I got a new chair (TiLite) with a 10% co-pay. Had I gotten it just a little sooner (before January of last year) I would have had a DME co-pay of 0%. Just missed it though.

    Medicare should have sent you a book entitled Medicare and You. Look in the book and compare all of the plans and figure out what you can afford. KLD is right about avoiding any HMO plan. They suck. Look for an affordable PPO plan as they also include drugs most of the time eliminating a part D program. When you find a plan that interests you, go to their website and do some in depth research. It will pay off. Both in services you need and in peace of mind.

    It isn't easy choosing a plan, but if you find the right fit for the money you have to spend its cool. If you don't like your choice, there is always next year.

    Add up what you spend out of pocket and what you can afford to spend and go with a PPO. You get what you pay for. Don't forget that.
    Anything worth doing, is worth doing to excess

  6. #6
    Thanks guys. I now have a clearer understanding of what my target is. Shouldn't take to long to research seeing as the book for my region isn't exactly swelling with PPO's!
    Really appreciate your replies

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