On Medicare?

[imoldernu]

It occurred to me that most members here are not yet on Medicare, and may not have experienced the way it works, except for some tangential contacts, as with parents or older friends.

I would be interested in hearing from those who ARE on Medicare, as to how you feel about it... perhaps on a one to ten scale.

I'll start off with a solid 10. In eleven years, through thick and thin, with many different situations, we have not had a single problem... Either Medicare A and B, or now, with Medicared D (Pharma).Furthermore, being in a caretaker position for a much older friend with medical problems that came to nearly a million dollars over 5 years, there was not a single bill or situation where questions were not resolved.

I speak to this only because of previous experience over the pre-Medicare years, where our dealings with our HMO, were so bad that we could only deal with them through lawyers.

If the promises of keeping medicare as-is are continued, for those 55 and older, then I hope we'll be ok... If and when Medicare gives way to the Private Sector, I should not like to be around to deal with the fallout.

So, that's my opinion... How do you feel about it? and... If you're years away from being eligible, what do you expect will happen?

 

[REWahoo]

I'll have to get back to you - been on it less than a year and thankfully have not had the opportunity to use it.

 

[MichaelB]

I expect an individual's view of Medicare will depend on what type of health care coverage they had previously.

I'll have to get back to you - been on it less than a year and thankfully have not had the opportunity to use it.

The best type of health care is the one you never need...

 

[samclem]

If you're years away from being eligible, what do you expect will happen?

I expect, just as many do across the ideological spectrum, that Medicare cannot continue to exist as it has. The cost will consume too much of the budget. So, I expect we'll find some politically acceptable way to reign in these costs. There are many good ideas out there to accomplish this, but none of them maintain the Medicare services you've known, delivered in the manner you've received them up to now.

 

[nwsteve]

Except to cover this season's flu shot, not had to a need to use Medicare--hooray.
On the other hand, did have an instructional session with my doc's billing dept. She advised me to understand that after the first year physical and colonoscopy, there are very few preventive services covered by Medicare. She also confirmed that once they find a polyp during a colonoscopy, you no longer are eligible for a "screening" but having a follow-up which is not covered when done as a screening--dealing with an actual sympton like bleeding would be treated differently is the impression I get.
The key message I got from her was to be sure to use all the "free" screening that Medicare allows BEFORE your first anniversary as they will NOT be covered after that.
Nwsteve

 

[MichaelB]

How do seniors rate Medicare is an interesting thread topic, so lets focus on that and steer away from speculating what the future of Medicare might be.

 

[Moemg]

Medicare is fine as long as you have good supplemental insurance . Medicare alone is three steps up from medicaid and sinking fast .

 

[Mulligan]

Medicare is fine as long as you have good supplemental insurance . Medicare alone is three steps up from medicaid and sinking fast .

Does this mean that if you have good supplemental insurance you are more acceptable to doctors as a patient, or does it mean you just don't get caught holding the bag on uncovered medical costs?

 

[Moemg]

Does this mean that if you have good supplemental insurance you are more acceptable to doctors as a patient, or does it mean you just don't get caught holding the bag on uncovered medical costs?

Both , without supplemental insurance some Physicians may reject you .The supplemental policies usually pick up all the uncovered expenses of Medicare . Medicare Advantage plans are different they are Medicare combined with supplemental insurance and usually are cheaper than Medicare & a supplement .They usually include a medication plan .

 

[JakeBrake]

I've been on Medicare for two years. I've had a variety of serious medical issues. I've been pleased with the way Medicare parts A&B have handled. I have been able to find doctors and hospitals. I also have MegaCorp supplemental insurance that covers whatever Medicare does not cover plus dental, vision, and prescriptions.

 

[mickeyd]

Been on Medicare/Tricare for about 2 years and have no complaints as is. Medicare pays what it is supposed to pay and TFL mops up the rest. My total medical expenses is only the Medicare monthly premium as I get my meds at no cost thanks to the good people of the USA who allow me to obtain my pharmacy goods at no cost at the local military hospital.

 

[dmdunca44]

I've been on Medicare nearly three years now and am pleasantly surprised at how pleased I am. Since the ACA provisions kicked in, annual checkups are now covered (with no copay), my annual mamograms are also covered in full. And, of course, the flu shot.

I'm healthy so haven't had many dr visits. I did see a dermatologist to have some skin tags removed and Medicare (traditional) covered most of that.

While I do have a supplemental policy, I opted for a HDHP supplemental so it pays nothing. What Medicare doesn't cover, I pay out of pocket.

Their website is user friendly and their processing is fast and efficient. I'm happier with Medicsre than I was with ghe coverage I had from United Healthcare before I retired.

 

[imoldernu]

Regarding limits on what medicare covers... yes, but from a number of different situations over the past 11 years, none that were unreasonable.
Each case has specifics... ie: one general full checkup per year... one mammogram, and if there is no "positive" history, limits on some tests. For instance, after having had colon cancer, annual tests were ok'd, then after 5 years, every three years... now, every 5 years.
In another situation, our doctor (we choose our doctors, of course) recommended that DW have vein surgery. In this case, because varicose vein surgery is often only cosmetic, prior to approval, the case was referred to a panel, who then have the say-so after reviewing the seriousness of the problem. (the surgery was approved).

There is a prodigious amount of paperwork, since billing goes to Medicare, and the supplemental insurer... Blue Cross in our case. Medicare then allows the approved payment, amount and once this is approved, the supplement kicks in and pays the balance (in our case, after a $150 annual deductible)... In the meantime, after approving the initial medicare payment, we receive a letter from medicare telling how much they paid. We then receive a letter from BCBS, saying how much they paid, and if we haven't met the deductible, pay only the balance... At this point, it is up to the doctor's office to re-bill us for the deductible...
This gets a bit crazy, after a while, never taking less than two or three months to balance out... Amazingly, in our case, there has never been a mistake, though we've had some anxious moments.

A single payer system would eliminate an incalculable amount of paperwork, and cost. Medicare is an excellent framework for this IMHO...

I cannot conceive how a transition to a private system would work, without the economies of scale provided by a full participation approach.

In any case, in my personal experience of talking with my 4 kids (ages 46 to 54) and many others who are younger than 60, I find that they don't really understand how medicare works, and how efficient it really is. The other part that almost none of the younger people know about... is that medicare DOES cost.
Between Medicare A. B, and D, and our supplement, our annual costs reach well over $9,500. (includes moderate medication "share" costs).

(Remember this when you hear a senior bristle when they hear the word "entitlement" as if it were a freebie or a handout.)

Aside... I confess to having believed that I was invulnerable, and having been an athlete, and in very good physical condition... would not even need medicare... or drugs (medication, that is) of any kind. How incredibly naive... a few months back, for example, a relatively simple surgery (carpal tunnel) ended with a total cost of about $12,000. Prior to this, more than 20 years ago, my colon cancer surgery was about $175,000, and in 1995, DW surgery (and she's pretty healthy, too) came to almost $200,000. Both before medicare came into our lives.

I mention this only because I see so many younger people who, like me , thought/think they would never have high medical expenses.

 

[Brett_Cameron]

33 yo DW is disabled and on Medicare A & B with my megacorp provided retiree insurance as secondary. I agree on the paperwork. We are just now getting "final" bills for services obtained in June. The coverage is fine. Only issue is that the megacorp insurance only pays if the benefit under their policy is more than what Medicare pays.

 

[grumpy]

I've been on Medicare with Federal BCBS as secondary for almost a year. I have only encountered one minor problem. I was due for my colonoscopy (every 5 years). I have used the same doctor for the previous two and they were done at the doctor's free standing facility. He explained that Medicare would not pay for the procedure if it was done there. Instead he had to do it at a hospital which was a 20 minute drive away which was not as convenient.

Other than that, Medicare has worked well for me.

 

[Nords]

I have only encountered one minor problem. I was due for my colonoscopy (every 5 years). I have used the same doctor for the previous two and they were done at the doctor's free standing facility. He explained that Medicare would not pay for the procedure if it was done there.
Other than that, Medicare has worked well for me.

A "free-standing" colonoscopy sounds dangerous, not to mention darned uncomfortable.

Maybe Medicare is only willing to pay for colonoscopies that are performed on recumbent patients...

 

[youbet]

I expect, just as many do across the ideological spectrum, that Medicare cannot continue to exist as it has. The cost will consume too much of the budget. So, I expect we'll find some politically acceptable way to reign in these costs. There are many good ideas out there to accomplish this, but none of them maintain the Medicare services you've known, delivered in the manner you've received them up to now.

I agree samclem. DW and I have been on Medicare for less than a year now and the few experiences we've had so far have been fine. What we're worried about is that it's too good to be true with these relatively low premiums yet good benefits. We fear that today's costs are being heaped up for our kids to pay and that the benefits our kids receive will be much inferior to ours today but at much higher premiums.

IOW, we're happy with Medicare but much too responsible to enjoy having it at the expense of the next generation.

 

[MichaelB]

How do seniors rate Medicare is an interesting thread topic, so lets focus on that and steer away from speculating what the future of Medicare might be.

Lets try to stay on topic

 

[NW-Bound]

A "free-standing" colonoscopy sounds dangerous, not to mention darned uncomfortable...

Will that be the standard treatment in the future?

Oops. Just saw the mod warning above.

 

[eytonxav]

On the other hand, did have an instructional session with my doc's billing dept. She advised me to understand that after the first year physical and colonoscopy, there are very few preventive services covered by Medicare. She also confirmed that once they find a polyp during a colonoscopy, you no longer are eligible for a "screening" but having a follow-up which is not covered when done as a screening--dealing with an actual sympton like bleeding would be treated differently is the impression I get.
The key message I got from her was to be sure to use all the "free" screening that Medicare allows BEFORE your first anniversary as they will NOT be covered after that.
Nwsteve

I am a little confused by the nurses comment. Is she saying you will only receive one colonoscopy screening under medicare for life. I hope that is not the case, because many that have had polys are on 3 or 5 year rechecks, otherwise the risk of colon cancer can go way up and if the patient is fully responsible after the first one, that could lead to some big out of pocket expense over one's remaining life.

Edit: Seems your nurse may not be totally correct, see http://www.medicare.gov/coverage/colorectal-cancer-screenings.html, looks like there could be some out of pocket, but its not clear if that applies if you are at risk for colon cancer

 

[nwsteve]

I am a little confused by the nurses comment. Is she saying you will only receive one colonoscopy screening under medicare for life. I hope that is not the case, because many that have had polys are on 3 or 5 year rechecks, otherwise the risk of colon cancer can go way up and if the patient is fully responsible after the first one, that could lead to some big out of pocket expense over one's remaining life.

Edit: Seems your nurse may not be totally correct, see Colorectal cancer screenings | Medicare.gov, looks like there could be some out of pocket, but its not clear if that applies if you are at risk for colon cancer

Actually it was my doc's billing specialist who does the coding. Apparently the big difference is if the colonscopy is a screening (requires no prior polyps) or a follow-up for a diagnosed condition. As she explained it, it would appear the screening is covered per the link above. However, if a prior exam had a polyp removal than the charges moved to a different coding and an out of pocket expense.
The billing specialist indicated that the annual physical and preventive care available under pre-medicare insurance was not covered in the same way after the first year list of "preventive care" treatments that include a one time well health physical and colonscopy. She did emphasize that you must get these preventive care services done before your first anniversary on medicare.
Nwsteve
Perhaps some of our medical types can weigh in here.

 

[eytonxav]

Thanks Steve. I really need to understand this since I'll be on Medicare in 1.5 years and have been subject to benign, but pre-cancerous polyps being discovered during my past two colonoscopys. Therefore, my Dr sees some risk for me to get colon cancer and has me on a 3 year schedule for repeat colonoscopy.