Did you get your social security 'raise'?? (celebrate, best, Florida)

[Robyn55]

Originally Posted by newenglandgirl

So, if you don't go the route of "Medicaid," how do you find out about Medicare Advantage with low-no premium?

If you belong to AARP (and perhaps even if you don't) - you'll start getting about 5 letters a day from insurance carriers offering both Medigap and Medicare advantage plans about 6 months before you go on Medicare . There are all kind of on-line resources too. So you'll be able to find out what's available in your area - and compare plans.

I would be very wary of Medicare Advantage in most geographical areas of the US. Because the HMO/PPO networks can be very limited (and you may have to jump through a lot of hoops to get specialist out-of-network coverage). Many doctors aren't accepting new Medicare patients today - and there are even fewer who participate in Medicare Advantage plan networks.

First thing I'd do if I were considering a Medicare Advantage plan is look at what providers are in the network. And the second thing I'd do is avoid all Medicare Advantage plans with a couple of possible exceptions (like the Kaiser network) if I could afford traditional Medicare and a decent Medigap policy.

FWIW - I don't know what effect Obamacare will have in terms of any aspect of Medicare when it goes into full force and effect. Robyn

[RiverBird]

Originally Posted by Robyn55

If you belong to AARP (and perhaps even if you don't) - you'll start getting about 5 letters a day from insurance carriers offering both Medigap and Medicare advantage plans about 6 months before you go on Medicare . There are all kind of on-line resources too. So you'll be able to find out what's available in your area - and compare plans.

I would be very wary of Medicare Advantage in most geographical areas of the US. Because the HMO/PPO networks can be very limited (and you may have to jump through a lot of hoops to get specialist out-of-network coverage). Many doctors aren't accepting new Medicare patients today - and there are even fewer who participate in Medicare Advantage plan networks.

First thing I'd do if I were considering a Medicare Advantage plan is look at what providers are in the network. And the second thing I'd do is avoid all Medicare Advantage plans with a couple of possible exceptions (like the Kaiser network) if I could afford traditional Medicare and a decent Medigap policy.

FWIW - I don't know what effect Obamacare will have in terms of any aspect of Medicare when it goes into full force and effect. Robyn

Thanks. Final question, for now, since I do not see answers on any website--

Would one be seeking Medicare PLUS Medicare Advantage Plan, or
Medicare Advantage Plan INSTEAD OF Medicare?

(new to this, do not qualify yet)

[Robyn55]

Originally Posted by newenglandgirl

Not knowing too much about Medicare (yet), I am curious to know why everyone's Medicare Part B monthly premium is going DOWN. I had read that it was steadily going UP (from like $99 to $115/mo). How does this work, and why the reduction?

Actually - for most people who've been on Medicare for more than a year or so - the premiums are going up - because the premiums have been frozen for people in the Medicare program for a couple of years because there was no COLA increase in SS. It is only people who've gone on Medicare in the last year or so who will see their premiums going down. And the only explanation I've read for the decrease is that Medicare spending was less than expected last year:

Medicare rate increases kept low

Robyn

[Minervah]

Originally Posted by Robyn55

If you belong to AARP (and perhaps even if you don't) - you'll start getting about 5 letters a day from insurance carriers offering both Medigap and Medicare advantage plans about 6 months before you go on Medicare . There are all kind of on-line resources too. So you'll be able to find out what's available in your area - and compare plans.

I would be very wary of Medicare Advantage in most geographical areas of the US. Because the HMO/PPO networks can be very limited (and you may have to jump through a lot of hoops to get specialist out-of-network coverage). Many doctors aren't accepting new Medicare patients today - and there are even fewer who participate in Medicare Advantage plan networks.

First thing I'd do if I were considering a Medicare Advantage plan is look at what providers are in the network. All of mine were in the Plan that I chose. Medicare Advantage plans can be great like the Kaiser network
FWIW - I don't know what effect Obamacare will have in terms of any aspect of Medicare when it goes into full force and effect. Robyn

But do not completly discount a Medicare Advantage Plan. I have one and I like it a lot. You just have to research as I did whether or not your present doctors participate (all of mine do) and how out of Plan providers are or are not reimbursed.

Robyn is correct in saying it varies a lot from state to state. And Kaiser is really great. I would take them in a heartbeat if it weren't for the fact that I need my present specialists. We have another good Medicare Advantage Plan based on the hospital group that provides it at our Providence Hospital. But like Kaiser, it is an HMO type organization and you have to stick with their doctors.

My plan is a PPO and as I mentioned all my present doctors participate and I have found some good ones their listswhen I needed new specialists. I have not had to use a doctor outside the PPO nor have I had to go out of town but the Plan does have provisions for these. Whether or not these services are hard to get, I don't know.

In any case, check everything out, ask questions of those who are trained to give advice and decide what would work for you.

[Minervah]

Originally Posted by newenglandgirl

Thanks. Final question, for now, since I do not see answers on any website--

Would one be seeking Medicare PLUS Medicare Advantage Plan, or
Medicare Advantage Plan INSTEAD OF Medicare?

(new to this, do not qualify yet)

Medicare Advantage actually includes Medicare. They are combined. There is just one payment. A Medigap Plan would be would be in addition to Medicare. Medicare pays the elgible expenses first and then the Medigap Plan picks up the difference.

Neither Plan will pay if Medicare does not deem the expenses eligible.

Okay, I think I have that right. Anyone please feel free to correct me if I am wrong.

[Robyn55]

Good assessment. To me - the greatest advantage of traditional Medicare along with a good Medigap policy is the ability to go to just about any super-specialist in any great medical center in the US if one cares to (and has the need for it). I don't know if I'd want to (especially after reading about the late Christopher Hitchens' death) - but it's nice to know I have the option (under both my current insurance plan and the one I will have when I go on Medicare next year). Robyn

[Minervah]

Originally Posted by Robyn55

Good assessment. To me - the greatest advantage of traditional Medicare along with a good Medigap policy is the ability to go to just about any super-specialist in any great medical center in the US if one cares to (and has the need for it). I don't know if I'd want to (especially after reading about the late Christopher Hitchens' death) - but it's nice to know I have the option (under both my current insurance plan and the one I will have when I go on Medicare next year). Robyn

My Medicare Advantage Plan says it will. They claim to have a reciprocal agreement with other states. They probably wouldn't pay as much though, but again I haven't had to put it to the test although I may have to next year.

[Escort Rider]

Originally Posted by newenglandgirl

Thanks. Final question, for now, since I do not see answers on any website--

Would one be seeking Medicare PLUS Medicare Advantage Plan, or
Medicare Advantage Plan INSTEAD OF Medicare?

(new to this, do not qualify yet)

I don't have any quarrel with Mirervah's answer, but let me try in my own words. You cannot have a Medicare Advantage Plan unless you are signed up for Medicare because a Medicare Advantage Plan is one way to receive medical coverage under Medicare. It is not in lieu of Medicare.

Here's how it works: Medicare pays your plan X dollars per month (referred to as "capitation" by another poster) and the plan agrees to take care of you. They don't bill Medicare every time they do something, and Medicare doesn't have to approve any procedures. The plan approves the procedures, but they can't withhold them if they are needed because that would violate their agreement with Medicare. That's why some Medicare Advantage Plans have a zero monthly premium, although they do charge various co-pays - usually pretty reasonable.

The other way to receive coverage under Medicare (other than under a Medicare Advantage Plan) is called original Medicare or traditional Medicare (i.e., referring to how things were before there was such a thing as a Medicare Advantage Plan). The Medigap insurance plan is something you can buy if you are under original/traditional Medicare. (It covers the "gaps" in original/traditional Medicare coverage). You cannot buy it if you have a Medicare Advantage Plan.

If I have succeeded in writing coherently, the above may help. If not, I am sorry.

[RiverBird]

Originally Posted by Escort Rider

I don't have any quarrel with Mirervah's answer, but let me try in my own words. You cannot have a Medicare Advantage Plan unless you are signed up for Medicare because a Medicare Advantage Plan is one way to receive medical coverage under Medicare. It is not in lieu of Medicare.

Here's how it works: Medicare pays your plan X dollars per month (referred to as "capitation" by another poster) and the plan agrees to take care of you. They don't bill Medicare every time they do something, and Medicare doesn't have to approve any procedures. The plan approves the procedures, but they can't withhold them if they are needed because that would violate their agreement with Medicare. That's why some Medicare Advantage Plans have a zero monthly premium, although they do charge various co-pays - usually pretty reasonable.

The other way to receive coverage under Medicare (other than under a Medicare Advantage Plan) is called original Medicare or traditional Medicare (i.e., referring to how things were before there was such a thing as a Medicare Advantage Plan). The Medigap insurance plan is something you can buy if you are under original/traditional Medicare. (It covers the "gaps" in original/traditional Medicare coverage). You cannot buy it if you have a Medicare Advantage Plan.

If I have succeeded in writing coherently, the above may help. If not, I am sorry.

This is pretty clear, thanks. I have several years to go till I'm eligible for Medicare, so I figure I'd better start now trying to understand it. Course by then it may all be changed, but at least I will understand how it works now. I was under the mistaken impression that Medicare covers just about everything, now I see why the additional plans are needed.

[Curmudgeon]

Originally Posted by newenglandgirl

This is pretty clear, thanks. I have several years to go till I'm eligible for Medicare, so I figure I'd better start now trying to understand it. Course by then it may all be changed, but at least I will understand how it works now. I was under the mistaken impression that Medicare covers just about everything, now I see why the additional plans are needed.

One more consideration. If you go on fee-for-service Medicare, make sure in advance that your physicians accept Medicare Assignment. That means they accept the Medicare-approved amount as payment in full for Part B services and supplies. You or your Medicare supplement plan pay the coinsurance and deductible amounts. If a physician does not accept assignment they may charge up to a maximum of 15% more which a supplement may not pay.