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Old 02-17-2015, 08:27 PM
 
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I will be getting Medicare soon (I'm on SSDI). I tried calling and asking questions but was on hold for an hour and a half! So I am hoping that someone will be able to offer insight for me.

Is Medicare a PPO or HMO?

Does the coverage change based on where you live? For example if I get Medicare in one state and move to another, do I get an entirely different plan when I move?

Would you consider Medicare to be good insurance? What has your experience been like?


If my husband has insurance and we use that insurance as our primary and Medicare as our secondary, if I saw a doc and they billed my hubby's insurance and I was due for a $25 co-pay would Medicare cover the cost of the $25 copay?
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Old 02-17-2015, 10:45 PM
 
Location: Wisconsin
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Quote:
Originally Posted by Newenglander0000 View Post
Is Medicare a PPO or HMO?

Does the coverage change based on where you live? For example if I get Medicare in one state and move to another, do I get an entirely different plan when I move?

Would you consider Medicare to be good insurance? What has your experience been like?

If my husband has insurance and we use that insurance as our primary and Medicare as our secondary, if I saw a doc and they billed my hubby's insurance and I was due for a $25 co-pay would Medicare cover the cost of the $25 copay?
Medicare is NEITHER a PPO or HMO. Medicare is national health insurance which will pay benefits for approved Medicare services to ANY Medicare provider in ANY state.

The only time 'Medicare' becomes a PPO/HMO, is if you enroll in a Medicare Health Plan - otherwise known as Medicare Advantage - which immediately divorces you from Medicare - in which case all your care is overseen by the Medicare Advantage private insurer, all of which have provider networks, some very restricted/narrow provider networks. Enrolling in Advantage in one state and expecting Medicare benefits (other than ER) in another is generally not possible under an Advantage plan, most of which are HMOs, some are PPOs.

Medicare is good coverage, but one needs a supplement aka Medigap to pick up the 20%, deductibles and copays which Medicare doesn't pay. Your husband's plan should become that Medigap, but you need to confirm this.

Whether or not your husband's insurance remains primary once you are on Medicare depends on the terms of that plan. In most retiree plans, Medicare is primary with the employer retiree insurance paying what Medicare doesn't. But, each retireee plan is different in what your responsibilities are. So, you need to check with them, especially if he is still working.

As an example, when I retired I kept my employer retiree insurance for eighteen months. Bills went to Medicare and the employer insurance company. Medicare paid first, the retiree policy picked up the difference after its deductible. For me, my employer paid not a dime, because of this deductible. So, it all depends on the plan. Fwiw, I dropped the employer plan and am now enrolled in a high-deductible Medigap F. If your husband has a retiree plan, generally you are better off keeping that.
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