Will be Medicare age in a couple of years and just found out about Part C. When did that happen!? Any of you folks of Medicare age who are on Part C or considered it and stayed with A&B care to share your thought process and experience?.... thanks! bill
Medicare Part C
- Thread starter WilliamG
- Start date
OAG
Thinks s/he gets paid by the post
I am not on MC Part C or D just A&B along with TFL. But here is an explanation of Part C: Medicare Part C - Medicare Consumer Guide
Been around for a long time, just watch noon-time TV shows and look for HMO's advertisements.
Been around for a long time, just watch noon-time TV shows and look for HMO's advertisements.
OAG
Thinks s/he gets paid by the post
TFL - Tricare For Life is a MEDICARE supplement that currently pays 100% of costs after MEDICARE, no copay, no annual cost beyond MEDICARE Part B premiums is why.
TRICARE for Life and Medicare
In order to keep your Tricare benefits after the age of 65 you must have Medicare Part B (If eligible for Premium Free Part A). In most cases beneficiaries that have purchased the Part C plan find that it is a waste of money. TFL and Medicare A&B cover almost everything. Part C is like an HMO so there are rules and if you don't follow these rules you are likely to pay the medical bills. On the other hand with TFL and Medicare you are free to see any Medicare provider within the US without being tied down to one Doctor. You also don't need Part D which is the drug plan. TFL has the $3, 9 & 22 copayments but with Medicare Part D you must pay their copays which can be way more. I have heard some medications have been in the $100's.
In order to keep your Tricare benefits after the age of 65 you must have Medicare Part B (If eligible for Premium Free Part A). In most cases beneficiaries that have purchased the Part C plan find that it is a waste of money. TFL and Medicare A&B cover almost everything. Part C is like an HMO so there are rules and if you don't follow these rules you are likely to pay the medical bills. On the other hand with TFL and Medicare you are free to see any Medicare provider within the US without being tied down to one Doctor. You also don't need Part D which is the drug plan. TFL has the $3, 9 & 22 copayments but with Medicare Part D you must pay their copays which can be way more. I have heard some medications have been in the $100's.
OAG
Thinks s/he gets paid by the post
There is a difference in Tricare and Tricare for Life but that does not appear to matter to OP. You say TFL covers almost everything, what does it not cover that MEDICARE and a HMO/Supplement covers? Additionally, the Express Scripts TFL pharmacy provides a 90 day supply of medications versus most MEDICARE Part D providers, TMK only provide a 30 supply of medications.
I assume Tricare is a Medicare supplement for retired veterans. I am still interested in how someone who does NOT have access to such medical insurance (via military, corporation or whatever) would decide for Part C versus just taking vanilla A&B along with a Medi-gap (aka, Medicare supplement) policy.
Part "C" Defined....
From medicare.gov:
http://www.medicare.gov/Publications/Pubs/pdf/11306.pdf
My son (who is disabled - SSD) has this coverage (offered from our state Blue Shield) . He does not use his "original medicare ID card" when he goes to the doctor. This replaces that original coverage (along with the medigap coverage he had).
He's only been on it since January. I can't tell you the advantages (if any) at this time, other than to say that it seems less expensive (according to the supporting documents). We'll see!
One thing - he still needs to pay for part B (still comes out of his SS check). You have the option to either be billed separately or add this as another deduction to the monthly SS check. The entire "scheme" seems to be that the government has hired a 3rd party to process medicare claims. You will not get the CMS statement anymore, and doctors will be paid (his rate $15) just as a traditional BC/BC plan, rather than waiting for the claim to "clear" from CMS/Medicare.
- Ron
From medicare.gov:
http://www.medicare.gov/Publications/Pubs/pdf/11306.pdf
My son (who is disabled - SSD) has this coverage (offered from our state Blue Shield) . He does not use his "original medicare ID card" when he goes to the doctor. This replaces that original coverage (along with the medigap coverage he had).
He's only been on it since January. I can't tell you the advantages (if any) at this time, other than to say that it seems less expensive (according to the supporting documents). We'll see!
One thing - he still needs to pay for part B (still comes out of his SS check). You have the option to either be billed separately or add this as another deduction to the monthly SS check. The entire "scheme" seems to be that the government has hired a 3rd party to process medicare claims. You will not get the CMS statement anymore, and doctors will be paid (his rate $15) just as a traditional BC/BC plan, rather than waiting for the claim to "clear" from CMS/Medicare.
- Ron
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Yes, there is a difference in TRICARE and TFL. Tricare for Life is a Medicare supplement. There are somethings such as chiropratic care that Medicare covers and TFL does not, Medication even sometimes when inpatient or labs, etc. that TFL covers and Medicare does not, and lastly routine eye exams and hearing aids that neither cover. There is alot that both cover BUT we don't want to give anyone the impression that everything is covered at 100%. As for the supplements out there they may cover things like eye exams, glasses and dental that are not covered with TFL.
Express Scripts is a good deal especially the mail order BUT you cannot have other health insurance to use it including Medicare C&D. You may have Medicare A&B though.
As far as the resoning for someone that has no military affiliation to purchase Part C I am not sure BUT i do believe that you have to purchase Part C to get Part D. The benefits of having Part D alone may get some to take the C&D combo because of the cost of medication with no medication coverage (Very Expensive). Again part C is like an HMO so there maybe lower out of pocket cost versus just having A&B.
My thing with purchasing an HMO/Supplement is why pay the extra money and follow way more rules when you alreay have the TFL as a supplement. Supplements aren't cheap and the money that you save from not purchasing the extra supplement can be used to pay anything not covered. Now if you are someone that get's outrageous with receiving medical care that may not be medically neccessary you may need a supplement. Another thing to look at is if the supplement that you would purchase has a maximum amount that they will pay. Like they stop paying and you pay 100% if you spend so much money. With this Tfl is totally opposite because they have a catastrophic cap of $3000 and anything over this that is covered they pay at 100% per FY.
No, that is not totally correct. My son had Medicare part A, B, & D (drug) coverage, along with a medigap policy.
Since he's now on part "C", you have the option (in his plan) to include drug or keep with the original part "D". In his case, part "D" was dropped, and covered under "C".
A lot of different combo's. You just have to work out what is best for your situation...
- Ron
haha
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
I am in the situation you propose.
I rejected Part C, (also called Medicare Advantage) mainly because it is being sold aggressively, President Bush was promoting it, etc.
It's like being a football defensive lineman- if the O-lineman wants you to go somewhere, you really really don't want to go there.
An additional reason is that I want to go to whomever I want to go to, including out of state if I need specialized care. And I don't want to be forced to beg and petition to be allowed to do that.
So I do have to pay for part D, and I am out of pocket more for my total insurance.
Different people evaluate these issues differently.
ha
ziggy29
Moderator Emeritus
Can I assume you rejected the tax cuts from a few years ago because President Bush promoted it? Did you give your tax savings back to the Treasury?
If you're due a stimulus check, are you going to mark that 'return to sender,' too?
I can see not liking someone politically. But automatically rejecting anything just because someone you generally disagree with is for it is just silly and is one of the reasons we're in such an intractable partisan mess today.
haha
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Oh, I feel misunderstood!
Regarding bush, I'm a fan, though maybe not quite so much of the President.
Seriously though, I would have resisted part C even if Mahatma Ghandi had been promoting it.
Why were politicians trying to sell this? Why did Alan Greenspan try to sell floating rate mortgages to American borrowers at the precise point in time when the only sane thing to do would have been to borrow fixed, and borrow long?
If these guys are selling, ol' Ha ain't buying.
Maybe you didn't understand the football analogy?
Ha
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haha
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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