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Old 01-22-2017, 06:52 PM
 
Location: Native Floridian, USA
4,904 posts, read 6,119,429 times
Reputation: 6110

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Quote:
Originally Posted by LoriNJ View Post
Yes, it is most likely that he had switched to a Medicare Advantage plan; United Healthcare has a number of them. What many people don't realize when they switch to those cheaper plans is that although it is Medicare, you are in an HMO that has a network. You have to see those network doctors or else you will pay out of your pocket. There are some non-HMO Medicare Advantage plans, but they are more expensive and less common.

Even though the guy was belligerent, I do feel a teensy bit sorry for him. The Medicare Advantage plans are aggressively marketed as a cheaper alternative to "Original Medicare" (+ a Supplemental/MediGap plan). People happily sign up for the cheaper alternative and only when they try to see a doc who isn't in that insurance company's HMO network does it sink in that the cheaper "Advantage" translates into "less doctors to choose from". Fortunately, people can switch back to Original Medicare during the next open enrollment period that runs from mid-October through early December.
Good post. Easy info to understand but not always a given they can switch back to medigap plans.

Quote:
Originally Posted by JanND View Post
OP, I guess you would have to be there.

Sometimes after you have had years of run around, and snarky youngsters who mistake frustration and fear for rudeness, you get one that pushes you over the edge.

Like you said, We don't know the back story. Maybe he had to ride 3 buses to get to his Doctor. My brother used to, because he was in Calif. and I have lived in the upper Midwest for 35 years....He no longer drove, he had a terrible time with mobility sometimes and would have to transfer buses twice.

Then if he had to get meds, he had to take a different bus, which dropped him off further from home, and he had to walk home. We never know what type of events others are going through....That is why it behooves us to always be kind.

I know that I'd be wanting some sort of explanation if my Doctor abruptly said He couldn't see me as a patient anymore. This is not a "Next in line please" moment IMO

But honestly, my experience working with some pretty grouchy seniors is that behind that façade is someone that needs a person to set down with them and explain, even just take a moment to explain at the desk.....not just tell them "Your Doctor can't see you anymore"

There are resources in many communities that assist elderly with so many of these changes. I would have had a list of referral numbers for the gentleman and some reassurance that someone would help him. I think even a business manager could have come out and taken him to an office and talked to him.....I'm sure part of his angst was being on display to all the disproving looks if what you say is the general feeling. That was disrespectful IMO.

Next time you see someone in this kind of stress. Tell them about this number, 211 2-1-1.org

It is a 24/7 resource info hotline, manned by trained volunteers. They are there so our citizens, any age, any issues.... do not have to feel that confusion and aloneness when they do not know where to start even looking for help ....repeat with any issue.

The caller explains what is going on with them.... and the trained volunteer will look up and provide a list of agencies and their contact information within moments. It is that port in a storm.

ETA.....Thank goodness for this forum where we can express our frustrations, share our experiences and commiserate with each other....occasionally get into a semi heated discussion, regroup and show each other respect and wisdom and many times simply kindnesses. I so appreciate this forum.
What a lovely, thoughtful post.

Quote:
Originally Posted by Hoot N Annie View Post
Okay.
MEDICARE - you are covered with Part A starting at age 65 at no cost to you. This covers about 80% of Hospital expenses. Note that the Medicare has negotiated lower fees for almost all hospital services, so your share of the expenses are based on that fee, not the "retail" fee. Part B covers the doctors fees, such as your checkups and other office visits, etc. You pay for Part B (normally around $110 a month) and it is not mandatory. Drugs are not covered.

If you wish, you can enroll in a "Medigap" Plan. These are also know as Medicare Supplements. They cover what Medicare doesn't, although some do have co-pays and/or deductibles. And you must be enrolled in Part B. These Plans (Plan A, etc) have standardized coverages, so that my BCBS Plan F is exactly like United HealthCare's Plan F. Premiums may vary but coverage doesn't and virtually any health care provider that accepts Medicare will accept the Medigap Plans. Drugs are not covered. That's Part D and a whole 'nother topic.

"Parts" are what the Government does, "Plans" are what the insurance companies do.

ADVANTAGE Plans are effectively a replacement for Medicare. You no longer use your medicare card, and they do not pay anything to the healthcare provider. Instead, Medicare pays the insurance company to insure you. You are now insured by whoever sold you the Advantage Plan. They can be HMOs or some other set up. Coverage is regional and the healthcare providers are part of a network. You may, or may not, still have the Part B premium taken out of your SS check, but that is really just part of your premium. You are not covered by Part B.

Advantage Plans can add other coverages, such as drug coverage, vision, dental, etc. These plans are allowed to vary widely. As does the cost.

If you are currently covered by traditional Medicare, but wish to move to an Advantage Plan you may almost always do so, but once you do that you may or may not be able to switch back to traditional Medicare. THIS IS ABSOLUTELY DEAD ON. A lot of people don't realize this.

Confused yet?

As for the older fella in the doctor's office, well, we've all had bad days, but it almost never helps in getting the end result you wanted. And Lord knows the receptionist that took the heat is not the root of his problem.
It is frustrating to an older person who didn't understand the details anyway. He may not have had anyone to explain things and could not afford the regular medicare and a medigap plan plus the premium for Part D. I did not take an Advantage Plan but my dh did, saying we couldn't afford both. I feel awful.

Quote:
Originally Posted by cmarlin20 View Post
....snipped...

I go online to the medicare.gov website which tells me what plans are available for my zip, I can also input any medications to help decide Part C coverage. You may or may not want an Advantage plan, you can review the coverage and premiums to decide. If you decide to get a Medigap (supplement) plan, you can review each plan and companies providing it. As already said, all plans under the same coverage (such as all Plan F) give the same coverage, some companies give more added benefits (like Silver Sneakers)but never less. If you work through each step it really isn't as complicated as it sounds just listening to all our comments.

...snipped.....
I use this every year.

Quote:
Originally Posted by txfriend View Post
This scenario plays out everyday somewhere in a doctors office. The patient received a mailer, explaining all the great benefits plus a free meal if he attended. He not only ate the free meal, but also the BS that they fed him, that all doctors must, or will accept this great insurance policy. So he signs at the dotted line without calling his doctors office.

His long time doctor will not take patients with this HMO policy and he is informed so by the receptionist. The patient knows this can’t be correct, he was told last month that all doctors will or must take his new insurance.

The patient is now confused, did someone lie to me, am I stupid, or confused and the receptionist says the same thing over and over again, and I’m getting angry. From his past experience, he knows some receptionists are twits, some just want to blow you off, and a some are helpful, and she is the only one behind the counter that will talk to him.

A word to the few people here that want to inject themselves into the argument between the patient and the receptionist, Don’t. Not only is he angry, but now someone from the peanut gallery want to shame and embarrass him, not a pretty picture, nor is the outcome.

The receptionist has complete control of the situation. All she has to say is ‘we are finished, have a good day’ and walk away.
I agree with everything said in this post. Remember the words, "if you like your doctor, you can keep your doctor..." while billions were stripped out of Medicare to pay for it. Now, in our area, central Fl, with lots of old people, the best doctors and clinics will not take Advantage plans, at all, and some won't take Medicare. Doesn't pay enough.

Quote:
Originally Posted by loves2read View Post
Likely he had some dementia---should not have been allowed out especially to a doctor's office w/o a competent adult to oversee---but maybe doesn't have anyone...
Not reading the other posts to thread but maybe others suggested this

I have seen similar instances in my doctor's office where the patient is unusually rude and demanding--and 9/10 times I would think there are cognitive issues...
Good grief. I don't have dementia but I have to put up with a lot of BS from 20 year olds at the banks, doctor's offices, insurance offices, and other establishments that think you are weak minded because you are old. When you get irritated because they are trying to feed you a load of it, they get all jittery......


A lot of good information on this thread. I did my research long and hard before I selected and each year I research the Part D on the Medicare comparision site. It helps. I consider the Part D a Ponzi scheme and has very little value for those of us that can't tolerate all generics.
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Old 01-22-2017, 11:35 PM
 
Location: Planet Woof
3,139 posts, read 3,509,293 times
Reputation: 9889
To add to Annie and other's great tutorials re Medicare, be aware that one must choose to enroll in part B and that there is a ''window'' of opportunity to do so once eligible. If one passes that time frame they are SOL. Can't get it. I am a retired medical/dialysis social worker and I had a patient who ran into this problem. I had never heard of this before in many years of practice. Anyway, maybe someone else can enlighten further re this issue. Me, I am going to go make popcorn...
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Old 01-23-2017, 02:49 AM
 
16,019 posts, read 19,688,452 times
Reputation: 26200
Quote:
Originally Posted by FeelinLow View Post
To add to Annie and other's great tutorials re Medicare, be aware that one must choose to enroll in part B and that there is a ''window'' of opportunity to do so once eligible. If one passes that time frame they are SOL. Can't get it. I am a retired medical/dialysis social worker and I had a patient who ran into this problem. I had never heard of this before in many years of practice. Anyway, maybe someone else can enlighten further re this issue. Me, I am going to go make popcorn...
Yes....I will be 65 in July 2017....Please enlighten us.....This whole Medicare process is so confusing.

The OP's post is likely just one event of many daily in medical offices across our country because of the Medicare confusion.

When all the supplements came out back in the early 2000's our local pharmacy was helping folks understand because no one could really explain it. I appreciate the links to help online re: this program.

Someone posted earlier that you are automatically enrolled in Medicare at age 65, even if you are still working and insured...I had never heard that before.
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Old 01-23-2017, 03:31 AM
 
12,700 posts, read 14,081,338 times
Reputation: 34805
I am so grateful, once again, that I can afford an excellent private policy (not all that expensive), and live in a country with fine medical care at about one-third to one-half of what it costs in the U.S.

I still have Medicare, but from threads likes this and what I have read elsewhere, it sounds like insurance hell in the U.S. and a mass of confusion and frustration for so many patients judging from the threads on C-D.
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Old 01-23-2017, 03:46 AM
 
Location: Los Angeles area
14,018 posts, read 17,740,386 times
Reputation: 32304
This thread has veered way off-topic to get into the details of various Medicare options. We don't know anything about the specifics of the coverage of the old man in the original post. The issue is his behavior. Life has many complexities, frustrations, and uncertainties, and that is true for us at all ages. So it's a question of how to deal with them. That guy was dealing with them in the most irrational fashion imaginable; as several people wrote, he may be suffering from some sort of dementia. Very sad, of course, but people like him give all us old people a bad name.
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Old 01-23-2017, 08:32 AM
 
480 posts, read 399,924 times
Reputation: 2077
It is a bit more nuanced than "SOL." If you delay joining Medicare after your "window," you will pay a late fee and your premiums will cost more. The longer you delay, the more you will pay. You can still join if you accept these penalties. Correct me if wrong, but I'm not aware of any point where you can't actually sign up any more.

https://www.medicare.gov/sign-up-cha...s-a-and-b.html

While this doesn't really speak to the OP's original questions, it does speak to the complexity of Medicare which is frustrating to a lot of people.

Quote:
Originally Posted by FeelinLow View Post
To add to Annie and other's great tutorials re Medicare, be aware that one must choose to enroll in part B and that there is a ''window'' of opportunity to do so once eligible. If one passes that time frame they are SOL. Can't get it. I am a retired medical/dialysis social worker and I had a patient who ran into this problem. I had never heard of this before in many years of practice. Anyway, maybe someone else can enlighten further re this issue. Me, I am going to go make popcorn...
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Old 01-23-2017, 12:11 PM
 
Location: Greenville, SC
4,649 posts, read 3,704,540 times
Reputation: 8642
Quote:
Originally Posted by FeelinLow View Post
To add to Annie and other's great tutorials re Medicare, be aware that one must choose to enroll in part B and that there is a ''window'' of opportunity to do so once eligible. If one passes that time frame they are SOL. Can't get it. I am a retired medical/dialysis social worker and I had a patient who ran into this problem. I had never heard of this before in many years of practice. Anyway, maybe someone else can enlighten further re this issue. Me, I am going to go make popcorn...
If you're still working and covered under an employer's plan, there's an exception. You have to sign up for Medicare B once you leave employment, and submit a form to Medicare signed by your employer verifying that you've been covered under their plan since turning 65. If you do this, there's no penalty -- provided the company you work for has at least 20 employees. See:

Should I Enroll in Medicare If I'm Still Working? | ElderLawAnswers

Here's a link to the form:

https://www.cms.gov/Medicare/CMS-For.../CMS-L564E.pdf
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Old 01-23-2017, 12:18 PM
 
Location: Native Floridian, USA
4,904 posts, read 6,119,429 times
Reputation: 6110
Wow ! Just good and helpful stuff. Much needed.
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Old 01-23-2017, 03:58 PM
 
Location: RVA
2,167 posts, read 1,266,787 times
Reputation: 4456
Remember it is worked for, OR covered by your spouses employers health plan. My wife will stay on my insurance until I retire. By then she will be 67, & will be covered by Medicare when she applies.
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Old 01-24-2017, 04:48 PM
 
20,569 posts, read 16,637,575 times
Reputation: 38629
Quote:
Originally Posted by Escort Rider View Post
This thread has veered way off-topic to get into the details of various Medicare options. We don't know anything about the specifics of the coverage of the old man in the original post. The issue is his behavior. Life has many complexities, frustrations, and uncertainties, and that is true for us at all ages. So it's a question of how to deal with them. That guy was dealing with them in the most irrational fashion imaginable; as several people wrote, he may be suffering from some sort of dementia. Very sad, of course, but people like him give all us old people a bad name.
It's not off topic at all. OP ended her post inquiring if there were different types of Medicare, some that don't pay as well, because that's what the old man seemed to be upset about. It is very much the topic.

From OP:

"Anyway, my question is, are there actually cheaper alternatives to Medicare, with less coverage that one can get instead? This was news to me."
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