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Old 09-18-2009, 12:38 PM
 
11,235 posts, read 11,256,867 times
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Quote:
Originally Posted by katjonjj View Post
I don't know where the doctors taking over comes in. That would be something new to the Medicare program. Medicare Advantage is Medicare with a private insurance company under which you are covered. Medicare pays your premium for your policy which HAS to be better or equal to the coverage provided in parts A and B. A, B, and C are highly regulated by CMS. Part C may not even require a monthly premium but only co-pays (10 -50 dollars when you see a practitioner) But there are different kinds of policies, HMO, PPO, POS, and PFFS. PFFS - Private fee for service is where a doctor can decide if they will take the plan. But you can go to any doctor.

Medical Supplements or Medigap is when you have A and B so you would be responsible for 20% co insurance, a deductible, and part B has a monthly payment required. Medical Supplements have a monthly premium. Medicare Supplements are not regulated by CMS but by the Insurance Commissioner.

All this can be found at Medicare.gov or you can talk to a broker in your area that can compare your situation with the plan that might work best.

Hope that helps
Why, hello, kat! Interesting to see you over on a non-Christian board. Thanks for the info. So my mother has Kaiser Senior Advantage. Does that mean she has Part C, which includes parts A & B & D? Sounds like a vitamin discussion.
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Old 09-19-2009, 01:06 PM
 
Location: Lakewood OH
21,699 posts, read 23,655,251 times
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This is where you need to do your homework. If you choose a supplemental Medicare insurance plan or any insurance plan for that matter READ YOUR CONTRACT! Did I say that loud enough? You get what you pay for. If you only pay a few dollars for your coverage you won't get much coverage. If you are seeking a good supplemental plan it won't be cheap but it will be there when you need it; if it isn't remember that an insurance policy is a legally binding contract. If something stated is covered and you are denied you can appeal and take it to court for breach of contract. You can appeal to the Insurance Commissioner in your state.

I know it's difficult to read some of these policies but you can take them to an attorney or legal aid or any type of insurance adviser (not an agent, half the time they don't know what they are selling; they just want to make a sale) or any organization set up to help you with this including Medicare.
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Old 09-19-2009, 03:57 PM
 
Location: Seattle, Washington
8,435 posts, read 8,668,211 times
Reputation: 1699
Quote:
Originally Posted by thrillobyte View Post
Why, hello, kat! Interesting to see you over on a non-Christian board. Thanks for the info. So my mother has Kaiser Senior Advantage. Does that mean she has Part C, which includes parts A & B & D? Sounds like a vitamin discussion.
Good to see you again! Yes your mother has a Medicare Advantage plan which is part C and includes parts A & B and sometimes D. I cannot say as I don't know about that plan in it's entirety but most HMO plans (which is what Kaiser senior advantage is) contain prescription drug coverage, or part D.

Parts A&B are regulated by CMS. As is Part C. That is why the insurance companies can't just arbitrarily deny claims. The coverage has to be consistent with or better than parts A&B.
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Old 09-19-2009, 04:04 PM
 
Location: Seattle, Washington
8,435 posts, read 8,668,211 times
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Quote:
Originally Posted by Minervah View Post
This is where you need to do your homework. If you choose a supplemental Medicare insurance plan or any insurance plan for that matter READ YOUR CONTRACT! Did I say that loud enough? You get what you pay for. If you only pay a few dollars for your coverage you won't get much coverage. If you are seeking a good supplemental plan it won't be cheap but it will be there when you need it; if it isn't remember that an insurance policy is a legally binding contract. If something stated is covered and you are denied you can appeal and take it to court for breach of contract. You can appeal to the Insurance Commissioner in your state.

I know it's difficult to read some of these policies but you can take them to an attorney or legal aid or any type of insurance adviser (not an agent, half the time they don't know what they are selling; they just want to make a sale) or any organization set up to help you with this including Medicare.
Some of this is not true. A medicare supplement is not the same as a medicare advantage plan. A medicare supplement comes in the form of many plans labeled A, B, C, D, J, etc. and have varying types of coverage. plan J, for example, whether underwritten by AARP or Aetna would be the same coverage but the price may vary. The supplement itself is regulated by your state commissioner not CMS. But CMS requires that all plan A's must be the same coverage no matter the company. All plan J's are the same coverage. But the insurance company gets to decide the price they want to charge.

Medicare Advantage is also part C of medicare. It is regulated by CMS and plans differ in the coverage area. However they must cover as much as A and B of medicare. These are usually a lower monthly payment than a supplement and can also cover prescription drugs.

It is always good for you to contact an insurance broker about this because they are not allowed to push you to buy and cannot charge a fee. They must comply with these things or they cannot sell Medicare plans per CMS, the medicare regulatory body.
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Old 09-25-2009, 04:50 PM
 
1,340 posts, read 2,491,856 times
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The new plans will insure they can or they wont go along.
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Old 09-25-2009, 07:16 PM
 
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If your mother is a healthy old broad Medicare Part C would be perfect for her. Costs less, BUT, if she ever gets in poor health she is SOL.
Have a friend who is 75, rarely has a cold , no old age complaints and Part C is perfect for her. Another friend , same age, has diabetes, high blood pressure etc., takes lots of drugs to keep herself going and Part A and B plus a supplemental policy covers everything.
I would be very watchful of her health and switch if she starts getting sicker.
I know it is all confusing... good luck.
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Old 09-25-2009, 09:02 PM
 
11,235 posts, read 11,256,867 times
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Quote:
Originally Posted by katjonjj View Post
Parts A&B are regulated by CMS. As is Part C. That is why the insurance companies can't just arbitrarily deny claims. The coverage has to be consistent with or better than parts A&B.
Great! The only thing about getting old to look forward to---you don't get your claims denied when you've got Medicare!
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Old 09-25-2009, 09:05 PM
 
Location: Sierra Vista, AZ
16,133 posts, read 20,817,345 times
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Quote:
Originally Posted by thrillobyte View Post
If I understand Part B, it's provided by private insurers to plug the gap left by Part A, which covers only 80%. So you have a $100,000 hospital bill. Medicare pays $80,000. What to stop the insurance pimps from stamping your remaining $20,000 "Denied" just like they do with regular private pay customers?
There's no insurance company involved in Part B. I've been on Medicare for 12 years and never had a dime Denied by Medicare or the Private Insurer that covers the remaining 20%
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Old 09-26-2009, 02:11 AM
 
Location: Seattle, Washington
8,435 posts, read 8,668,211 times
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Quote:
Originally Posted by Boompa View Post
There's no insurance company involved in Part B. I've been on Medicare for 12 years and never had a dime Denied by Medicare or the Private Insurer that covers the remaining 20%
Yes. What you have is a supplement that covers what A and B (depending on your plan) don't cover such as a deductible and the 20% co-insurance. These are great, especially if you have to be hospitalized.

Part C is when Medicare pays a Private Insurer a monthly amount for your policy but is still regulated by CMS. Some of these cover drugs as well. That means that A and B (and sometimes D) are covered under Part C by a Private Insurer. This is great if you only want to pay when you go to the doctor rather than a set price every month whether you go or not.

Anyway, sounds like you have it covered. I haven't ever heard of someone being denied for what medicare covers. It's pretty cut and dry what is or isn't covered.

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Old 09-26-2009, 05:48 PM
 
48,516 posts, read 83,901,398 times
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The main differnce between satndard medicare pay fo service and the advantage plans is chocie same has HMO's.We experienced this with my father in law when he was on a advanatge paln as to hospitls and doctors. plus we had a doctor we did not shoose that was assigned to his case to manage the care for the advanatge plan itself.Bascially that doctor ruled the roost. It worked fine until he had a very seroius problem tho. My mother inlaw switched bac to pay for servicxe and also has had major health problems with much better resulkts because of more choice of dosctors and hospiatls. Different advanatge plans seem to be easier to deal with than others from talking to people .
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