AARP Help with Insurance

[MaryM373887]

Does AARP offer any help for insurance problems. For example, billing issues for procedures, office visits, etc. that Medicare refuses to cover. I’ve been checking out a group on Facebook for Boomer Benefits. Not sure if I should sign up as a client but it seems like this is something AARP could already offer. 
I ask this because I’m already frustrated that my first contact with Medicare was my annual physical, now to be renamed and coded as a Welcome to Medicare visit and I’m still not sure my doctors office will recode the visit and resubmit to Medicare so it will be covered. I might be stuck with a bill and need to file an appeal with Medicare. From what I’ve read, visits and procedures are denied all the time, and you have to constantly fight to get Medicare/Medigap to pay for things.

[GailL1]

@MaryM373887 

1st thing about Medicare is that you need to understand it -  just like any other health insurance.  Don’t assume you know when certain words are used. Even the word “coverage” will mislead you cause some things are covered at a higher rate (like preventive - DEFINED preventive, not just what you consider preventive) than others

You need to understand what Medicare covers - “Welcome to Medicare” as well as the “Annual Wellness Visit” are actual (specific) Medicare things meaning that Medicare covers these things (see the link I have provided) and nothing else.  Neither of them are actual “physical” exams.  

These Medicare pages describes EXACTLY what the “Welcome to Medicare” preventive visit entails and what is covered at 100% with no out of pocket because they are considered preventive measures.  And the “Annual Wellness Visit”

Don’t assume anything - 

Medicare.gov - Welcome to Medicare" preventive visit

Medicare.gov - Medicare Annual Wellness Visit 

Now if you had other things done like blood work or anything else not listed, then based on the coding the doctor’s office used, if medically necessary, and it is a medically approved procedure or treatment, they would bill Medicare and it would probably be paid at the regular rate. 80% of the Medicare approved amount - the remaining 20% is your responsibility(MediGAP picks up this 20% if you have it)  if you have Trad. Medicare or it is covered as your Medicare Advantage EOC describes.

Start using Medicare.gov to look up your procedure or coverage if you are on Traditional Medicare or read your Explanation of Coverage (EOC) if you have a Medicare Advanage plan.

Medicare.gov- What’s Covered SEARCH

[MaryM373887]

Thanks. My husband and I have a UHC Medigap plan G policy, Cigna RX and Delta Dental. RX is easy for now, since we aren’t on any prescriptions and the dental we bought because that’s what our dentist accepts and we’ve always had this plan. Medicare is a whole new world and it’s nothing like the health insurance our employers provided. Top that off with I had to choose a plan with no real knowledge of insurance (unlike an HR rep). I’m learning that you can join something like Boomer Benefits to get advice and much like an insurance agent, they can represent you when there’s a problem. Does AARP have an insurance help line? 
We purposely did not use a healthcare insure agent because we could never find one that was truly independent (and not just trying to sell Anthem, United Healthcare, an advantage plan or whatever). 

[LG322302]

You are right in that medicare is nothing like heath insurance offered by employers. That's bad enough; Medicare is far worse. The federal government has been perpetuating this scam since the mid 1960's. The government has portrayed it a some kind of god send and since people are forced to sign up for it after spending decades having their paychecks docked , they don't realize how awful it is until they get into it. 

[GailL1]

Would you like to continue something like your employer coverage after you have to stop working (retirement) and pay the whole premium bill each month on your own?

I never had employer coverage since I was always self-employed and those premiums when I reach over 60 were very expensive - course I did have a great policy.  

Your (and your employer match) Medicare contributions while you were working paid for Medicare Part A - that’s why Part A is premium free if you worked long enough under the contributions system.

Part B and Part D - are premium coverage - beneficiaries pay about 25% of the cost of these programs and the Federal Government (tax payers) out of the General Fund pay the remaining 75% of the cost of these programs.

You can pick your plan under Medicare - the best one for your needs - just like picking any other health policy.

I guess I am somewhat confused by your comments and why you are disappointed in the Medicare system - it serves many people well - 

Course for many, they have to rely on some other coverage to pick up their part of the cost & sometimes premiums.

[LG322302]

First of all, you can't “pick a medicare plan”. Medicare is what it is; there's no choice to be made. Everyone pays the same part b premium (which increases an average of 7.7% annually), unless you are subject to the irmaa or have a very limited income, and has the same “coverage” which is to say none.

Comparatively, an ACA health plan (like medicare, health plans through the ACA are partially subsidized by the federal government) offer varying premiums (premium costs depend on your income and income levels for ACA subsidies are far too low imo), multiple plans from different insurance companies with different annual deductibles, out of pocket limits and copays. You chose what works best for you. That's “picking a plan” that best fits your needs, not being forced into the inferior, one size fits all that is medicare. 

Medicare pays for nothing--ongoing deductibles for every medical event, no out of pocket limits, no prescription, no dental, no vision, no long term care. If you actually want your medical expenses covered, you need to get a medigap plan with a premium that costs hundreds of dollars a month and usually increases as you age. Do you want prescription insurance? That's another high cost premium. 

Worse, you could sign up for a Medicare advantage plan, where 1 in 5 members have been denied care that would have been approved under traditional medicare and whose major commercial insurance providers have been defrauding the government (and draining the trust fund) for 20 years through upcoding. 

According to the Commonwealth Fund, 51% of people on Medicare find affording health care difficult, 42% forgo or delay medical care because of cost and 63% report their health issues got worse due to this. That doesn't sound like medicare is  “serving people well”. 

And with the CMS ongoing efforts to privatize medicare (first with secondary payer rules in the 80's, then with medicare advantage in the 90's, now with ACO REACH which Dr. Susan Rogers of PNHP calls “Medicare advantage on steroids”), medicare is fast becoming a bait and switch. CMS wants all traditional medicare recipients in an ACO by 2030, about the time the trust fund runs out of money. I know a scam when I see one. No thanks. 

[MaryM373887]

I can see that, and it’s troubling. We’ve signed on to a UHC gap plan a basic part D plan and hope that works for the long haul. Add in a real dental plan and we pay almost what we were paying for our marketplace insurance. We’ve accepted that retirement will be a stay at home experience (as opposed to travel time) so we can afford healthcare.

[GailL1 · Accepted solution]

@MaryM373887 wrote

. . . . . We purposely did not use a healthcare insure agent because we could never find one that was truly independent (and not just trying to sell Anthem, United Healthcare, an advantage plan or whatever). 

===============

Might be time to start reading Medicare.gov when you have a question about coverage and you have Traditional Medicare with a GAP plan.  

I don’t know what AARP provides in this instance - I am not a member.  I have found that Medicare insurance brokers who sell for many different companies especially MediGAP plans (these are the truely independent) and have been in business for a very long time do have great knowledge of the program or at least can help you find answers to difficult questions.

Most common questions can be answered using Medicare.gov.

like the one I gave you for the Welcome to Medicare preventive visit - it is very detailed and I assume you did understand it.