Medicare for the clueless

[Free_at_49]

I applied for Medicare by phone and received a card. It says Part A and B, they bill me quarterly $134/mo until I start collecting SS whereupon they simply deduct it from my monthly SS. Can I really get free healthcare anywhere in the US just like back home in Canada?

I already have BCBS Blue Advantage that includes international coverage, which is vital. What’s the best way to get international coverage?

Also, Medicare starts 12/1/17, should I skip my last payment to BCBS?

 

[REWahoo]

This explains it: How Medicare Works

 

[gauss]

I applied for Medicare by phone and received a card. It says Part A and B, they bill me quarterly $134/mo until I start collecting SS whereupon they simply deduct it from my monthly SS. Can I really get free healthcare anywhere in the US just like back home in Canada?

I think deductibles and coinsurance will apply.

The coinsurance will be unbounded if you don't have a Medigap/supplemental policy.

Also, you would need to get your healthcare from a Medicare participating provider (which I think the vast majority are.)

-gauss

 

[Free_at_49]

I think deductibles and coinsurance will apply.

The coinsurance will be unbounded if you don't have a Medigap/supplemental policy.

Also, you would need to get your healthcare from a Medicare participating provider (which I think the vast majority are.)

-gauss

Thank you. BCBS has been mailing me plans for continuing my existing Blue Advantage as if I had no other insurance, AND Medigap/supplemental plans for $100/mo. Regular Blue Advantage would be without ACA “subsidy” i.e. $1500/mo, that’s a LOL for me.

From what I’ve read supplemental insurance is a scam. The maximum out-of-pocket for a long hospital stay is ~$1,000, I can certainly afford that.

 

[REWahoo]

From what I’ve read supplemental insurance is a scam. The maximum out-of-pocket for a long hospital stay is ~$1,000, I can certainly afford that.

I suggest you do some more reading. There is no maximum out of pocket for basic Medicare.

 

[MBSC]

The maximum out-of-pocket for a long hospital stay is ~$1,000, I can certainly afford that.

I suggest you do some more reading. There is no maximum out of pocket for basic Medicare.

+1

The Part A benefit period deductible applies to inpatient hospital "facility fees" such as room and board. The professional charges associated with the inpatient stay (surgeon, anesthesiologist, radiologist) are filed to Part B with 20% coinsurance on the allowed amount. The Part B coinsurance also applies to expensive outpatient services such as chemo treatment.

The Part A benefit period deductible resets 60 days after discharge.

From page 31 of the 2018 Medicare & You booklet:

Hospital Care (inpatient care)

If you have Part B, it generally covers 80% of the Medicare-approved amount for doctor's services you get while you're in a hospital.

Reference: https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf

 

[audreyh1]

Thank you. BCBS has been mailing me plans for continuing my existing Blue Advantage as if I had no other insurance, AND Medigap/supplemental plans for $100/mo. Regular Blue Advantage would be without ACA “subsidy” i.e. $1500/mo, that’s a LOL for me.

From what I’ve read supplemental insurance is a scam. The maximum out-of-pocket for a long hospital stay is ~$1,000, I can certainly afford that.

20% copy with no out of pocket maximum! Try paying for cancer treatment- super expensive even for copays

 

[Sunset]

I believe you also need to sign up for Part D. If you don't there will be a penalty forever when you finally do sign up (and the penalty probably grows every year).

See, it's not as simple as Canada eh?

You can find all the answers and sign up for plans at https://www.medicare.gov/

 

[frank]

I signed up for blue cross plan f. they are the best around for supplemental policies, but compared to what I had been paying, it is cheap.

 

[Bamaman]

Just be careful if you go with a Medicare plan. Check to see if your preferred doctors and hospitals accept that specific Advantage program.

The giant hospital chain North of us doesn't accept Advantage plans since they mirror an HMO. That means 1700 physicians in their employment and dozens of clinics and hospitals locations in 6 states are included. Thousands of patients have had to find new doctors.

They do accept regular Medicare Part A, however.

 

[REWahoo]

Just be careful if you go with a Medicare plan.

I know you mean "Medicare Advantage" plan, but since the OP claims to have no knowledge of Medicare and how it works, I wanted to point this out for his/her benefit. The terminology is tricky.

 

[Free_at_49]

I know you mean "Medicare Advantage" plan, but since the OP claims to have no knowledge of Medicare and how it works, I wanted to point this out for his/her benefit. The terminology is tricky.

Yeah it is tricky by design. I’ve read the stuff on *.gov but there are countless acronyms that you all know from birth that are meaningless to me. I applied for Medicare simply because I’m entitled, but hope to never have to use it since I’ll be in EU.

I’m looking at BCBS Medicare Advantage plans only because they promise international coverage, but the details are fuzzy. To me fuzzy = scam, besides I may soon not even have a US address and BCBS plan are state-based. Any ideas?

 

[meierlde]

I know you mean "Medicare Advantage" plan, but since the OP claims to have no knowledge of Medicare and how it works, I wanted to point this out for his/her benefit. The terminology is tricky.

Which is why I think of Medicare advantage as really Medicare disadvantage.

 

[Free_at_49]

I believe you also need to sign up for Part D. If you don't there will be a penalty forever when you finally do sign up (and the penalty probably grows every year).

See, it's not as simple as Canada eh?

You can find all the answers and sign up for plans at https://www.medicare.gov/

True, in Canada I’m covered for life, no BS, no billing.

Here’s what I found on Part D

The premium for a Part D drug plan averages to about $31 a month. Depending on the plan you choose you may have a drug deductible to pay which can be as high as $310/year. The higher the plan D premium, the less chance you will have a deductible to meet. Most Part D plans cover drugs based on a 4 or 5 tier system. You pay a co-pay or coinsurance for your medication depending on which level or tier it falls under. You pay your set out-of-pocket expense for each drug you take until you and your plan together, are out-of-pocket $3700 for the year for your medications. At which time you have entered what is called the “Coverage Gap” or “Donut Hole” when you will pay 40% of the plans cost for covered brand-name prescription drugs unless your plan offers additional coverage. During the Donut Hole you will get a 60% discount on brand drugs that are covered by the plan. For generic drugs that are covered by Part D you will be responsible for 51%. The good news is the 60% discount on brand drugs is also counted towards your out-of-pocket, which will help you close the coverage gap even quicker. Once you reach a total of $4950 in out-of-pocket expenses for Part D covered medications between themselves and the plan, then the insured enters what is called “Catastrophic Coverage”. This is when you only pay a small co-pay or coinsurance for each drug until the end of the year.

 

[gayl]

It's all Greek to me especially the 'donut hole'. Dumb question: you get a certain amount of script coverage with Medicare B then nothing for basically the rest of the year. What amount is covered? Seems like there's a whole alphabet. .... is there a simple site that clearly ealxplains it in bullet format?

 

[Free_at_49]

It's all Greek to me especially the 'donut hole'. Dumb question: you get a certain amount of script coverage with Medicare B then nothing for basically the rest of the year. What amount is covered? Seems like there's a whole alphabet. .... is there a simple site that clearly ealxplains it in bullet format?

Here, I just got a quote. There's 18 bullets at the bottom:


2018 Plans

Showing 3 plans




Basic Blue Rx (PDP), Basic Blue® Rx (PDP) (S6986-002) 17

Type of Plan Medicare Prescription Drug Plan (Part D) Deductible $0 for Tiers 1 & 2
$405 for Tiers 3-5 Doctor Office Visit
(Primary Care / Specialist)
Doesn't Apply / Doesn't Apply Prescription Drug Coverage
Yes - With standard coverage gap benefits Pharmacy Information









Out-of-Pocket Maximum
Doesn't Apply View More Plan Details


Compare This Plan


Monthly Cost 8
$27.00

Blue Medicare Rx (PDP), (PDP) Standard (S5540-002)

Type of Plan Medicare Prescription Drug Plan (Part D) Deductible $0 for Tiers 1, 2
$300 for Tiers 3, 4, 5 Doctor Office Visit
(Primary Care / Specialist)
Doesn't Apply / Doesn't Apply Prescription Drug Coverage
Yes - With standard coverage gap benefits Pharmacy Information








Out-of-Pocket Maximum
Doesn't Apply View More Plan Details
Summary of Benefits and Coverage (pdf)

Compare This Plan


Monthly Cost 8
$77.50



How to Enroll

Blue Medicare Rx (PDP), (PDP) Enhanced (S5540-004)

Type of Plan Medicare Prescription Drug Plan (Part D) Deductible $0 Doctor Office Visit
(Primary Care / Specialist)
Doesn't Apply / Doesn't Apply Prescription Drug Coverage
Yes - With enhanced coverage gap benefits Pharmacy Information








Out-of-Pocket Maximum
Doesn't Apply View More Plan Details
Summary of Benefits and Coverage (pdf)

Compare This Plan


Monthly Cost 8
$115.70



Footnotes

1. Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
2. A formulary applies for all plans that include Medicare prescription drug coverage.
3. Preventive care is covered at 100% with your primary care provider, at a county health clinic, or at CVS Minute Clinics.
4. You must use the plan's providers except in emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor Blue Cross NC will be responsible for the costs.
5. Beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.
6. Mail order is available; please see Summary of Benefits for more details.
7. With the exception of emergency or urgent care, member liability with Blue Medicare PPO may be greater for services received out-of-network than services received in-network. Many out-of- network services are subject to coinsurance, which are based on the Medicare allowed amount and not on the potentially lower in-network contract amount.
8. You must continue to pay the Medicare Part B premium in addition to your plan premium.
9. Caution: Policy benefits are limited to those approved by Medicare for payment.
10. If you go to a physician not participating in Medicare you may be responsible for the difference in the approved Medicare charge and the billed amount. Private contracts between you and a provider are excluded from Medicare and Medicare Supplemental payments.
11. When you enroll in an attained-age plan, your rates will increase as you age. Our rates will only increase due to age when you move from one age band to the next. In addition, rate adjustments will also be due to medical inflation or overall claims experience. Rates are subject to change June 1 of each year and are guaranteed for 12 months. Any change in rate will be preceded by a 30-day notice. Members will not be singled out for premium increases based on their individual health. Medicare policies that are attained-age should be compared to issue-age rated policies. Premiums for issue-age policies do not increase due to age as the insured ages.
12. The Silver&Fit® program is a value-added service that is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH) to members of Blue Cross NC's Blue Medicare Supplement plans. The program is not part of a member's policy or benefits, and is not available on our Plan F-HD. The program may be changed or discontinued at any time. Additional fees may apply and results are not guaranteed. You should consult with your doctor before taking part in a fitness program. All programs and services are not available in all areas. Silver&Fit and the Silver&Fit logo are trademarks of ASH and are used with permission herein. Not connected with or endorsed by the U.S. government or the federal Medicare program.
13. This is only a summary of benefits describing the policies' most important features. The policy is the insurance contract. You must read the policy itself to understand all the rights and duties of both you and your insurance company. These policies may not fully cover all of your medical costs. Neither Blue Cross NC nor its agents are affiliated with Medicare. Plan A: BMS A, 11/13; Plan B: BMS B, 11/13; Plan C: BMS C, 11/13; Plan D: BMS D, 11/13; Plan F: BMS F, 11/13; Plan High-Ded F: BMS HDF, 11/13; Plan G: BMS G, 11/13; Plan K: BMS K, 11/13; Plan L: BMS L, 11/13; Plan M: BMS M, 11/13; Plan N: BMS N, 11/13.
14. If you enroll within 30 days following your 65th birthday, or if you have 6 months of continuous prior coverage, the 6-month waiting period for pre-existing conditions will be waived. Pre-existing conditions are conditions for which medical advice was given, or treatment was recommended by or received from a physician within six months before the effective date of coverage. If you wait until after the deadline to enroll, you may have a waiting period for pre-existing conditions and may have to complete a medical questionnaire.
15. Except the Blue Medicare HMO Medical Only plan, which does not provide drug coverage.
16. Blue Cross NC is one of the World's Most Ethical Companies (2012, 2013, 2014, 2016). Ethisphere Institute reviewed nominations from companies in more than 100 countries and 36 industries.
17. Basic Blue® Rx (PDP) (S6986-002) only
    MII Life, Inc., a Medicare contractor, is an independent licensee of the Blue Cross® and Blue Shield® Association and the underwriter for Basic Blue® Rx, a prescription drug plan. Enrollment in Basic Blue Rx depends on contract renewal. Each Blue Cross and/or Blue Shield plan is an independent licensee of the Blue Cross and Blue Shield Association. Medicare beneficiaries may also enroll in Basic Blue® Rx through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Drug pricing information on this website is intended as an educational tool and is not a promise as to the price we will offer in the future. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply. This information is not a complete description of benefits. Contact the plan for more information. Other are available in our network. Medicare has neither reviewed nor endorsed this information. For a variety of reasons (e.g., because you visit an out-of-network pharmacy), actual pricing may vary. You must continue to pay your Medicare Part B premium. This is not a complete list of drugs covered by our plan. For a complete listing, please call TTY 1-877-376-2185 TTY 711 or visit www.basicbluerx.com The formulary and pharmacy network may change at any time. You will receive notice when necessary. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.S6986_092818_B01_NC Approved 10/10/17
18. Out-of-network/non-contracted providers are under no obligation to treat Blue Cross NC members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

 

[pb4uski]

While a part of me is wondering if you are covered by Canada for life why you would spend money on US Medicare I suspect there must be some good reason.

You are already signed up for Parts A & B and they will bill you $134/month for Part B.

You will also want Part D for prescriptions (my Mom pays ~$50/month) and MediGap coverage which will cover deductibles and co-pays ($200/month for Mom).

So for $385/month you get pretty comprehensive coverage... my relatives that have this coverage pay very little if anything for most illnesses... DUncle had a bad accident in early summer... air ambulance ride, surgery and 4 days in the hospital plus PT and all was covered.

 

[gayl]

Thank you

Thanks Free_at_49! As my retiree hc insurance doesn't go down when I sign up for Medicare A&B I may eventually dump it for MediGap

 

[ShokWaveRider]

While a part of me is wonder if you are covered by Canada for life why you would spend money on US Medicare I suspect there must be some good reason.

DW & I are in the same boat. We would be covered in Canada for life too. But there are a few issues for us as we are now full time Florida Residents, with US Citizenship too. Here they are in order of priority..

1) Too Bloody Cold in Canada
2) Too Bloody Cold in Canada
3) Too Bloody Cold in Canada
4) Home prices in the areas we would even consider living are astronomical.
5) Overall standard of living in Canada while still good by most standards, is lower than we enjoy in the USA.

 

[Free_at_49]

While a part of me is wondering if you are covered by Canada for life why you would spend money on US Medicare I suspect there must be some good reason.

You are already signed up for Parts A & B and they will bill you $134/month for Part B.

You will also want Part D for prescriptions (my Mom pays ~$50/month) and MediGap coverage which will cover deductibles and co-pays ($200/month for Mom).

So for $385/month you get pretty comprehensive coverage... my relatives that have this coverage pay very little if anything for most illnesses... DUncle had a bad accident in early summer... air ambulance ride, surgery and 4 days in the hospital plus PT and all was covered.

Thank you.

I have to have insurance while in the US in case of emergency. I can’t just fly back to Canada, they won’t let you in the plane if you’re bleeding.

$400/mo would be an outrage in any other western country. Wasn’t Medicare intended to be FREE healthcare for retirees because they’ve already paid for it through payroll deductions at work? I pay less than that for individual BCBS Blue Advantage Silver that includes international coverage, I’m not gonna pay more under Medicare.

 

[REWahoo]

I have to have insurance while in the US in case of emergency. I can’t just fly back to Canada, they won’t let you in the plane if you’re bleeding.

$400/mo would be an outrage in any other western country. Wasn’t Medicare intended to be FREE healthcare for retirees because they’ve already paid for it through payroll deductions at work? I pay less than that for individual BCBS Blue Advantage Silver that includes international coverage, I’m not gonna pay more under Medicare.

Got to pay to play. Only other choice is to go home.

 

[MichaelB]

Thank you.

I have to have insurance while in the US in case of emergency. I can’t just fly back to Canada, they won’t let you in the plane if you’re bleeding.

$400/mo would be an outrage in any other western country. Wasn’t Medicare intended to be FREE healthcare for retirees because they’ve already paid for it through payroll deductions at work? I pay less than that for individual BCBS Blue Advantage Silver that includes international coverage, I’m not gonna pay more under Medicare.

With Medicare you are free to stay with minimal coverage or pay for more coverage. The premium for Medicare part A is covered with the payroll taxes. Not free, just paid for. Medicare B & D, and MediGap, are additional. If you don't want or need them, don't sign up. If you have coverage elsewhere and only need hospitalization coverage in the US, it might make sense to just take Medicare A.

 

[Free_at_49]

With Medicare you are free to stay with minimal coverage or pay for more coverage. The premium for Medicare part A is covered with the payroll taxes. Not free, just paid for. Medicare B & D, and MediGap, are additional. If you don't want or need them, don't sign up. If you have coverage elsewhere and only need hospitalization coverage in the US, it might make sense to just take Medicare A.

So if I leave the US (and not using Medicare at all) I can drop Part B and save $134/mo?

How does one drop Part B?

 

[youbet]

So if I leave the US (and not using Medicare at all) I can drop Part B and save $134/mo?

How does one drop Part B?

You don’t even have to leave. Just don’t sign up for Part B.

 

[REWahoo]

How does one drop Part B?

Withdrawing from Medicare Part B

And on we go...