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Medicare isn't better than a good employer plan - or even a good employer-retiree plan - but it is better than an unsubsidized ACA plan. Those are unaffordable - huge premiums and deductibles. Many unemployed early retirees - not old enough for Medicare - are paying huge premiums because for one reason or another they don't qualify for subsidies. Husband/wife - $1,500/mo., single older adult $1k. These are ridiculous figures, imo.
You have to plan in advance to keep your income low enough for the subsidy. I know people that filed early for social security, which disqualified them from getting a subsidy. You can’t withdraw from your IRA or show a gain on a house sale. People don’t think about those things and then they find out they don’t qualify for the subsidy.
I retired at 59 without insurance and had to make do with a small pension. I was supposed to have retiree medical but American Airlines filed for bankruptcy and took away our insurance.
This year I took out a HELC because I couldn’t withdraw from my IRA. I put off selling my house too until after January due to the subsidy.
All of my investments are in IRA’s, so my income is very low.
I wish they covered the Shingrix shot, my part D charges $300.00. I found out too late that Obamacare would have covered the shot at 100%. I was waiting for Medicare.
We have medicare and Cigna supplemental coverage. We get our lab work at Quest. If any test will not be covered Quest notifies us before we take the test what the approximate cost will be and we can choose to either take it or not. Whether or not a test is covered also depends on the codes the doctor indicates on the prescription for the lab work. Sometimes a different code will allow a test to be covered. If the code indicates an existing or past condition requiring monitoring by a specific test it ought to be covered.
Quote:
Originally Posted by bpollen
I got an end of year notice from Medicare for my October well exam, that the visit to dr. was covered, but a comprehensive blood test was not covered. Apparently the blood test also included Hep C, and that is not covered, either.
If a service isn't covered, that means my Medigap plan won't pay for it, either, doesn't it?
I've never heard of a standard blood profile not being covered as part of a well exam. Is this normal?
(I also think it's odd to have a Hep C test. I don't think I've had one of those before, because there's no reason for it. I'm in excellent health w/no reason to think I have any med condition.)
I have found it can also depend on the facility, where you get your blood drawn. In a former home, I found if I went to the hospital to get lab tests, they accepted the medicare payment, so I did not have a co pay, if I went to Labcorp, they wanted a co pay as well as Medicare.
CVS won’t take any coupons, and the $150 is per shot, so $300 total. I can afford it, but I was under the impression that Medicare paid for it, otherwise I would have done it prior to Medicare.
CVS won’t take any coupons, and the $150 is per shot, so $300 total. I can afford it, but I was under the impression that Medicare paid for it, otherwise I would have done it prior to Medicare.
So you don't meet the requirements to get it covered for free in the other link I provided?
I just did a bit more searching and as per this document, published from Medicare.gov, dated June 2019, it says that Part D covers the shingles vaccine. Go to the bottom of page 6.
Quote:
Q: Does Medicare Part D cover the shingles (herpes zoster) vaccine?
A: Yes. Part D covers the herpes zoster vaccine as a preventive vaccine.
“Have no third party coverage for Vaccines OR be enrolled in a Medicare Part D Prescription Drug Plan and have spent at least $600 on prescription medicines through your Medicare Part D Prescription Drug Plan during this calendar year”.
I called Medicare and they don’t cover the shot, part D covers it, but it costs over $300.00, it was free with Obamacare.
Thank you! I've downloaded both of those articles to my computer to read tomorrow.
It never occurred to me to research my first exam. I just assumed the doctor would know. Or maybe he doesn't care. He did mention that Medicare doesn't like to pay for anything unless there's something wrong to justify it. It didn't occur to me that a standard blood test would be one of those things. He ordered a bone density test. I haven't scheduled it yet. Glad I didn't, in case I'd have to pay for it. I need to research that.
My sister had the bone density test done recently and Medicare paid for the test but not for the reading of the results. She had to pay $25 for that.
My sister had the bone density test done recently and Medicare paid for the test but not for the reading of the results. She had to pay $25 for that.
It's a crapshoot. I got one earlier this year- started Medicare 1/1/2018. No out-of-pocket at all. Doc had listed diagnosis as "menopause" on her orders. I think the place I use is much better at coding things properly- I also go there for extra screening for breast cancer because of family history and haven't paid a dime for MRIs or ultrasounds.
I always write on the paperwork at the doctor's office that I want and advance notice of non coverage prior to the provision of any service. There is a section where they want you to sign that you will be responsible for any charges denied by the plan. I sign this but write in that I need advance notice of non coverage. This is a reasonable request. The doctor's office should know what is covered and not covered. If there is any doubt, they can find out beforehand. The other thing they can do is get a predetermination to verify coverage. Another step you can take is to tell the doctor not to do anything that is not covered, or not medically necessary. Certainly do not want to have to pay the full charges on anything.
So far, this has worked. One doc wanted to do a hyaluronic injection in my knee and he looked at my insurance and said, "Your insurance doesn't cover them though." I got a cortisone shot instead, which was covered.
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