All Medicare & Insurance posts

Re: How would a Medicare Advantage Plan handle this . . . . ?

somarco — Tue, 19 Oct 2021 02:45:27 GMT

MA plans typically apply a copay . . . $250 - $300 for emergency medical transport.

Air transport claims can be dicey, especially where an insurance carrier, not Medicare, is adjudicating the claim. Air ambulance is most often considered a life or death situation but you are expecting a non-medical claims examiner to decide if you really needed air transport or if ground transport would have been good enough.

Medical personnel on the scene are making the judgement about what type of transportation the individual needs.

Challenging a claim denial after the fact is difficult, especially in a managed care policy. The carrier will either pay the claim or not. There is no middle ground.

Personally, if I were in a life or death situation I would not want a managed care plan making decisions about the type of care they would cover.

Re: How would a Medicare Advantage Plan handle this . . . . ?

ReTiReD51 — Mon, 18 Oct 2021 23:05:40 GMT

I’ve got one for you

If you decide to donate any of your organs when you pass, who pays for the removal and transportation of your organs.

Will Medicare pay for that? If they do will your supplement then pay their 20%? Same goes for MA will they pay a portion?

I read once where your insurance would pay for those costs so I called the Organ donor center in my state to ask them who pays for the removal of your organs after you die and l didn’t get past a young confused phone receptionist who didn’t know who to connect me with so I could ask.

After that I have never checked the box on my state drivers license to donate any of my organs when time comes for me to enter those Pearly Gates.

Re: United Healthcare- Should not be sponsored by AARP

lizcooksey — Mon, 18 Oct 2021 22:51:11 GMT

I completely agree. I'm appalled that AARP has associated itself with United Healthcare and my experience with the latter has left a bad taste in my mouth for several reasons. One is that their list of 8 opticians in my zip code turns out to have only 2 that are actually taking the United Healthcare insurance, and their prices AFTER insurance are more than an out-of-network optician nearby. WAY more -- by a couple hundred dollars. One on the list is not only closed, but the woman who ran it died in 2010!

Re: How would a Medicare Advantage Plan handle this . . . . ?

ReTiReD51 — Mon, 18 Oct 2021 22:41:55 GMT

I would think as long as its a medical necessity, Medicare wouldn't object to paying their share for transportation of this type. As far as how a MA plan would treat this if Medicare approves they would have to pay minus your copays and deductibles.

How would a Medicare Advantage Plan handle this . . . . ?

GailL1 — Sat, 16 Oct 2021 22:15:43 GMT

How would a Medicare Advantage plan, of whatever type - HMO, PPO, PFFS - handle payment to an out of network provider like a (medically needed) Air Ambulance or Medi-Helicopter?

Does CMS provide them with some standard guidance for situations like this?

Re: I am sick of all these phone calls, UNITED HEALTHCARE

WilliamM339603 — Fri, 15 Oct 2021 22:25:23 GMT

I don't have a problem with UHC phone calls, but I got a flyer in the mail about Medicare Advantage. Came to find out that their MA is not available in my area. Called them and the rep confirmed unavailability but could not or would not say why I got the flyer anyway. Reported to FTC, Medicare and state DOI for false/misleading advertising.

Re: Optum RX - STAY AWAY

srk5cats — Fri, 15 Oct 2021 19:41:06 GMT

It's ironic that I was emailed this thread since I only just realized that my prescription has gone up on every refill. I am trying to transfer it to CVS, which is half the price. OptumRx wanted over $15! I used to get it a few years ago for $4! After reading all these reviews, I'm going to call them right now and make sure they transferred my prescription. My other prescription price has stayed the same and is cheaper than other pharmacies, so I'll keep that with OptumRx, but I'll be sure to keep an eye on it.

Re: Optum RX - STAY AWAY

chadjamft — Fri, 15 Oct 2021 12:06:58 GMT

After quoting my insurance agent one price for a particular medication, once ordered, the price doubled and upon renewal would have put me into the Donut Hole! They are charging twice what CVS is charging and THREE TIMES what Rite Aid is charging. Attempts to get this issue addressed through the filing of "Escalation" letters led to weeks of no response despite multiple calls by myself and my agent who then found out they closed the case without ever speaking to either of us. This is going to cost me hundreds of dollars for no other reason but OptumRx misrepresented the price of one of my key medications. They are a disgraceful and shameless company who do not deserve anyone's business. BTW, AARP constantly pushes advertising for UCH and, therefore OptumRx, but attempts to get them to advocate for a 19 year AARP Member were completely ignored.

Re: 2022 Generic Copay with PDP, Wellbutrin, Synthroid

ReTiReD51 — Fri, 15 Oct 2021 00:30:46 GMT

I ran a Medicare.gov plan finder search for those drugs using a 30311 Fulton County zip code, and compared a $6.90 and a $12.90 premium per month PDP. I found those plans using a preferred in-network pharmacy or mail order would cost between $2300 and $3000 annually.

Then I searched the prices for those same drugs using the Kroger Rx savings price as you mentioned and you’re right there is a big savings. As a matter of fact, I found the levothyroxine at Kroger for $6 a month and the bupropion for $13. I couldn’t believe it.

Just to see how drug prices compare across the country, I searched Medicare.gov using a central Ohio zip code. I found those same drugs using the PDP plans I think you used (going by premium prices) between $300 and $400 per year. I couldn’t believe the difference in drugs prices between the two zip codes. I didn’t bother to check Kroger Rx savings prices.

Still only paying $36/yr individual plan, or $72/yr family plan for membership in the Kroger Rx savings plan you can save quite a bit of money with certain prescriptions.

Any tier 3,4,5,6 prescriptions purchased without going through a Medicare PDP will not count towards your 2022 Medicare PDP $480 deductible

I noticed beginning last year most of the big box store pharmacies became preferred in-network and started charging lower prices for prescriptions. I guess whatever it takes to bring people into the store.

Even though it’s possible to use prescription discounts like GoodRx to find lower cost drugs I know you do educate Medicare age folks about the Part D late-enrollment penalty. Just in case they think they got GoodRx and don’t need to pay $6.90 to have a low-cost PDP.

There is a lot of people paying that late enrollment penalty for not having a prescription drug coverage because they thought GoodRx would cover all their drugs at reasonable prices, they don't always have the lowest prices..

2022 Generic Copay with PDP, Wellbutrin, Synthroid

somarco — Thu, 14 Oct 2021 20:52:32 GMT

Thought I had seen it all during the "window shopping" phase. Today I saw something I have never seen in all the years I have been running drug reports.

Generic Wellbutrin (bupropion) copay on a $13 drug plan is $384 for a 30 day supply. GoodRx $14 with Kroger.

Generic Synthroid (levothyroxine) is $150 on the same plan. GoodRx + Kroger = $13.

Be careful out there.

Re: Those Prescription Drug Plans (Medicare Part D) with Low(er) Cost Insulin?

somarco — Sat, 09 Oct 2021 12:27:25 GMT

when using the PF, my suggestion is to focus on your most expensive medication(s) and ignore the rest.

Diabetics that do not have a pump see insulin as their highest cost drug. Many diabetic related complications (other than heart issues) may have a number of med's but often those are lower cost generics.

The Medicare PF is OK when it works and almost useless when it doesn't. Honestly, the most accurate resource is the carrier sites. Use the PF as a general guideline but visit the carrier site before making your final decision.

Diabetics with a CGM and original Medicare + supplement get insulin under Part B. The challenge is finding a pharmacy that knows how to process Part B claims. Walgreens has a department devoted to handling B claims. Other chain pharmacy's may as well, but Walgreens is the one I see mentioned the most.

Re: Those Prescription Drug Plans (Medicare Part D) with Low(er) Cost Insulin?

ReTiReD51 — Fri, 08 Oct 2021 23:12:44 GMT

Evidently people are getting those insulin savings plans I don’t know how many. The folks that told me about the plan finder updates are medicare.gov employees who assist people in finding the lowest cost drug plan for them. They look at all plans they don’t care what the insurance company’s name is.

I don’t take insulin but I did a sample search for a brand of insulin “lispro” plus I included a tier 1 and tier 2 drug and found a company that had a pack of 5, 3ml pens of insulin per month plus the tier 1 and 2 drug for $1608 mail order for the year. AARP Medicare RX Preferred PDP was the plan and it looks like they were the only plan out of 23 plans to offer an insulin savings. The other 22 plans had annual costs at between $4000-$5000.

You’d have to ask someone who sells insurance how many of the companies they represent offer the insulin savings program and if taken into consideration does it cover all of someone’s drugs at affordable prices.

That’s why people should shop around at Medicare.gov plan finder for their part D PDP prescription drug plan. You can choose any insurance plan and company you want in order to get the lowest prices.

Re: Those Prescription Drug Plans (Medicare Part D) with Low(er) Cost Insulin?

GailL1 — Fri, 08 Oct 2021 22:15:17 GMT

Thanks but I am wondering if people are finding the plans beneficial.

Meaning - are they meeting their medication needs - all medications like you said but also the price and availability of the plans. Are they offering the type of insulin they currently use.

Removing the filter seems like a good move -

I am still finding people that know nothing about the insulin saving plans - don't ask me why - I don't know.

Re: Those Prescription Drug Plans (Medicare Part D) with Low(er) Cost Insulin?

ReTiReD51 — Fri, 08 Oct 2021 22:03:54 GMT

The Medicare.gov Plan Finder removed the insulin savings filter tab for 2022. They had it last year in 2021.

The reason they did remove it was because using that filter would give you the plans with the lowest cost insulin prices but not necessarily the lowest cost for your other medications. So now you just input all your drugs including insulin and let the software figure the lowest premium and drug cost for you. Then you can search through all the plans keeping an eye open for the plans that cover all your drugs. For example this plan covers 6 out of 6 of your drugs versus another plan covering 5 out of 6 of your drugs.

Free Webinar – Medicare and Parkinson’s Disease: Answering Your Frequently Asked Questions

ParkinsonsFndtnSBR — Fri, 08 Oct 2021 19:24:58 GMT

On October 21, tune in as we drill down into some of the most frequently asked questions about Medicare and Parkinson’s including coverage of rehabilitation and mental health services, long term care, social security disability insurance, and more. We’ll answer questions like: Are there annual caps on physical, occupational and speech therapy? What types of mental health treatment are covered under Medicare? Will Medicare pay for long term care services? Do I automatically receive Social Security when I enroll in Medicare?

Almost 90% of people with Parkinson’s disease (PD) are covered by Medicare. Whether you are approaching 65 or already there, navigating Medicare and understanding what it means for managing your Parkinson’s disease can be overwhelming. Join the Parkinson’s Foundation and AARP for another partner webinar as they strive to provide the best information and tools to help guide your journey with PD.

Learn more and register for free at www.Parkinson.org/AARPFAQ

Webinar Date: Thursday, October 21, 2021

Time: 1:00pm – 2:00pm ET

Those Prescription Drug Plans (Medicare Part D) with Low(er) Cost Insulin?

GailL1 — Fri, 08 Oct 2021 16:44:07 GMT

Are people finding this type of plan beneficial or NOT?

Re: Beware of Robocalls

GailL1 — Fri, 08 Oct 2021 16:42:04 GMT

Well at least it was a pleasant sounding message and was understandable. Wonder how many of them actually get answered by a real person? NONE, I hope.

Beware of Robocalls

somarco — Thu, 07 Oct 2021 18:48:13 GMT

My voice mail box greeted me with this enticement . . . but I did not bite.

I wonder how many seniors will take the bait?

Re: Medicare Drug Plan Finder is a Mess . . . Again

somarco — Thu, 07 Oct 2021 18:40:31 GMT

the challenge to the Plan Finder is the data is only good as long as it is current.

As of today, star ratings are "coming soon". Personally, I don't put much stock in those but often the public considers them to be valuable.

And in some cases, preferred pharmacy's are different today vs 10/3/2021 when I first ventured into the water.

You cannot enroll in a plan until 10/15 but for the window shoppers that selected a plan early on and filed that away until 10/15, they may be disappointed when they try to use their plan next year.

I haven't seen a schedule for this year, but in the past CMS only updated their PF data 3x yearly while carriers can (and do) change pricing throughout the year.

Drug pricing is volatile and what you see today may not be so tomorrow.

Shop on the Plan Finder if you want but only trust carrier information for accuracy.

Or as Reagan said, "Trust but verify"

Re: Which insurance company to pick for Medicare Regular or Advantage

somarco — Thu, 07 Oct 2021 18:21:47 GMT

Get your information straight from the horse’s mouth . . .

The only place to get accurate rate information is direct from the carrier.

Re: Delta Dental

EricN999655 — Thu, 07 Oct 2021 18:09:38 GMT

I'm new here but have been looking for a new dental plan once I go off my retirement plan (retired in 2019) and start Medicare in early 2022. I live in Illiinois. Of all the companies offering dental coverage, only Delta Dental had a plan with annual maximum of $2500, which matches my employment and retirement plan (the employer's group plan seemed pretty generous).

The quoted monthly premium was ~$45 ($540 annual). With a previous history of continuous dental coverage, Delta Dental would wave any waiting periods, so everything would kick in immediately. My present dentist provided me with the out-of-pocket costs of procedures so that I could compare the different between have insurance and paying cash.

For routine preventative work twice a year, cost having Delta Dental would be $540. Cash approach would be $311. So one would save $229 paying cash.

But as I have multiple teeth with fillings and a recent crown last year, I decided to examine that kind of scenario. Cost with Delta Delta would be $540 (annual premium) plus $75 deductible plus $750 (50% of $1500, table of allowance for crown procedures) = $1365. Cash approach would be $1977 for the single crown procedures. So Delta Dental would save $612. If one added in the preventative care, $311, that would have been $2288 cash or a savings of $923 by having Delta Dental insurance with the high annual maximum benefit. It would take 4 years of simple preventative care to break even by paying cash.

So the decision would require an estimation of risk. Should one anticipate additional crown procedures or root canal or fillings or dentures or implants? Is it worth the risks to obtain insurance or pay cash? In many ways, this would be similar to the decisions about auto or medical insurance.

Re: AARP Invalid Information

somarco — Thu, 07 Oct 2021 00:07:34 GMT

those are strong words.

You do in fact have a 7 month window but WHEN you sign up can impact your Part B effective date.

Part B (and Premium-Part A): Coverage starts based on the month you sign up:

If you sign up:Coverage starts:

Before the month you turn 65	The month you turn 65
The month you turn 65	The next month
1 month after you turn 65	2 months after you sign up
2 or 3 months after you turn 65	3 months after you sign up

https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start

Re: AARP Invalid Information

ReTiReD51 — Wed, 06 Oct 2021 20:48:17 GMT

You have a 7-month window to initially enroll in Medicare.

You can enroll 3 months before the month of your 65th birthday, the month of your 65th birthday and 3 months after the month of your 65th birthday.

If the “big thick book” that the Feds mailed you says anything different you need to get a hold of Medicare right away and ask them what’s going on.

https://www.aarpmedicareplans.com/medicare-articles/6-timely-medicare-tips-for-turning-65.html

AARP Invalid Information

StevenT855650 — Wed, 06 Oct 2021 19:39:19 GMT

There's an awful lot of incorrect information ( call them lies) going around about Medicare. In particular, the initial sign-up period. According to the big thick book that the fed's mail out every year, MY sign-up period starts 3 months before my 65th birthday, and ends 3 months after my 65th birthday. That birthday is on Dec 4. Yet I get an emailing from AARP telling me that my signup ends on December 1. AARP needs to stop lying.

Re: I am sick of all these phone calls, UNITED HEALTHCARE

necolson — Tue, 05 Oct 2021 14:41:22 GMT

I agree. I have found them so intrusive and annoying that I am thinking of switching to another provider. Fortunately, I have caller ID so I never take calls from United Healthcare. I also immediately delete their emails. I personally don't need or want their nurses, housecalls and so on.

Re: Medicare Drug Plan Finder is a Mess . . . Again

john258 — Tue, 05 Oct 2021 03:23:58 GMT

There are so many variations in the drug end if you want to compare talk to a local expert. If you do not know one contact your local AARP Office to get one.

I have part D. Small deductible, no coverage gap, some co pay, a lot no copay and I pay no premium as it is part of my total medical coverage. Backing that up is our county drug discount program which covers all residing in county and cost us nothing.

Re: Medicare Drug Plan Finder is a Mess . . . Again

kor1867 — Mon, 04 Oct 2021 21:50:34 GMT

I am happy with the Medicare.gov Drug Finder. All I do is enter my zip code, drugs and pick a nearby pharmacy. Then I run the plan finder and look at the ones that have the cheapest "Yearly Drug and Premium Cost" first. If I like the price of the cheapest plan that's the one I go with. But if I look at other drug plans I never change my drugs, but I always verify that the plan considers my selected pharmacy a "PREFERED in-network pharmacy". If my selected pharmacy is not a preferred pharmacy for that plan, I change my pharmacy to another nearby pharmacy that the plan does consider a preferred pharmacy. That 'preferred' is important to see the best rates for that drug plan.

Re: I am sick of all these phone calls, UNITED HEALTHCARE

CaroleW755826 — Mon, 04 Oct 2021 21:29:02 GMT

You are right. Housecalls is affiliated with Medicare Advantage for the very reason you say. Last year I blocked them with RoboKiller until December when they left a message offering me and my husband $75 each for their 1/2 hour in-home 'check-up'. Why refuse $150??? I today received an email with an offer for $50 each if we accept. I'm waiting under December!! Point is, they don't get through my screener so I never receive the calls.

Re: Which insurance company to pick for Medicare Regular or Advantage

GailL1 — Mon, 04 Oct 2021 20:42:49 GMT

The best place to check out a Medicare Medigap (Medicare supplement insurance) insurer is your states Dept of Insurance.

The Medigap plans themselves are set at the national level (Medicare) but the insurers and other specific rules concerning Medigap plans are set at the state level.

Texas Dept of Insurance - Medicare supplement insurance guide

from the link: Medicare supplement policies are sold by private insurance companies that are licensed by TDI. But Medicare supplement benefits are set by the federal government.

Consider other things. Price should not be your only consideration. You can learn a company's complaint history by visiting the TDI website or by calling our Help Line at 800-252-3439. Also ask family and friends if they’ve had any experiences with the companies you’re considering.

Insurance Companies with Medigap plans in Texas

I could not find the complaint section (but didn't look long) so you may have to call them on that - number is above ⬆️

Plan A is where the state of Texas parks all the people with disabilities with Medicare coverage - states have to offer at least one plan - some disabilities are high cost users so that may affect Plan A premiums. Course when a disabled person hits 65, they can pick any plan cause they get to have a do-over, as well they should.

Re: I am sick of all these phone calls, UNITED HEALTHCARE

olgar213311 — Mon, 04 Oct 2021 20:03:46 GMT

Same here - don't give information over the phone! Told them to bug OFF

Re: Medicare Drug Plan Finder is a Mess . . . Again

GailL1 — Mon, 04 Oct 2021 19:55:09 GMT

I'm not saying that the Plan Finder isn't a valuable tool - IT IS. But only if it is right and for the last few years, because they changed it in 2019, I believe, it has had a lot of problems.

I don't know if it is right or wrong currently - the site says that you can preview it now (they uploaded it on 10/01/2021) - but can't enroll until 10/15 - I just urge people to recheck their earlier preview before enrolling.

The plus to the PF tool is only as valuable as the information fed into it. I'm just reserving judgement.

Re: Medicare Drug Plan Finder is a Mess . . . Again

ReTiReD51 — Mon, 04 Oct 2021 15:29:49 GMT

all you and your coach are giving me is a simple slight-of-hand circus smoke and mirrors argument against the Medicare.gov plan finder. You’re not able to invalidate the known and proven facts that the plan finder works in saving millions of senior’s money on their PDP part D prescription drug plans every year. I know I've seen it.

You surprised me when you do not encourage folks to learn to use the plan finder. Usually, you try to simplify and educate folks about Medicare and its details.

Until you reach that golden age of being Medicare eligible and actually have a part D plan you might not realize the plan finder works fantastic.

Re: Medicare Drug Plan Finder is a Mess . . . Again

somarco — Mon, 04 Oct 2021 15:14:45 GMT

good analogy . . . apple, orange + watermelon.

Some folks don't realize the D in MAPD is still a Part D plan that is baked into the MA health care coverage. Carriers that write MAPD and PDP use the same PBM to pick pharmacy's, set tiers and copay's.

Problems in the stand alone PDP will also show up in the MAPD. The only difference is the consumer has no idea how much the D premium is in the MAPD.

For next year, MAPD plan premiums may not change but other cost shifting does occur. Higher deductibles, smaller preferred pharmacy networks, shifting tiers and higher copay's.

Since a lot of folks never shop the D portion of their MAPD (and most agents don't shop it either) they don't know they have a problem until they use their plan.

Re: Medicare Drug Plan Finder is a Mess . . . Again

somarco — Mon, 04 Oct 2021 15:20:30 GMT

once CMS standardized open enrollment, about 6 or so years ago, the "window shopping" time started 10/1. Agents could not access information for the next year nor could they discuss anything with clients prior to 10/1.

Once the public (including beneficiaries) were allowed to see new rates the problems (such as those I have listed and more) came to light. Of course there is no way to let CMS know about these issues. The only thing that can be done is tell the carrier who then tells CMS.

Until the 15th or later, you have no idea if the information is correct or not without 2x checking against the carrier.

Consumers can do that if they know how, but anyone with multiple clients doesn't have the time. Agents are not the only ones impacted, same is true for the folks at 800 MEDICARE, SHIP counselors and anyone else who helps consumers for free or a fee.

Some of the flaws in the past have existed into Nov in a few situations.

Some of my clients like the DIY approach so I always advise them to run reports during the window shopping time but DON'T enroll until the end of Oct or first week of November.

If you wait until 2022 to try out your new plan and discover a problem there is nothing you can do.

Last year (2020) I had a very angry client that filled her medication with her new card and using a preferred pharmacy. The Medicare PF said that drug was tier 2 and not subject to the deductible. In truth, it was classified by the carrier as tier 3 so her copay was considerably higher.

Fortunately I did not change her plan until the end of October and sent her a copy of the PF report. The "proof" wasn't good enough for her so she complained to the carrier. I think they made an exception for her but she still was mad at me.

Not my fault but all I can do is cover my backside with "proof" and let the chips fall.

There have always been issues with the PF but there are more than usual since Sebelius fired the company that managed the PF for years and hired an inexperienced company that contributed a lot of money to her campaign when she ran for state insurance commissioner. Sebelius is long gone but the problems created by her decision linger on.

I know some folks read my posts and are dismissive for different reasons. That doesn't bother me. Everyone has a right to make decisions based on their own research and filters.

Some critics may think my views are tainted and that is their prerogative. I formulate my opinion based on research, professional forums and real world (boots on the ground) experience.

As someone once said, "I am not always right but I am never wrong".

Re: Medicare Drug Plan Finder is a Mess . . . Again

GailL1 — Mon, 04 Oct 2021 14:45:16 GMT

I noticed that CMS required the data from the insurers (3) months earlier than previously - they had to have 2022 rates / plan designs in by June 2021. The 2022 Part D Plan Finder was suppose to be up by 10/01/2021 but OE doesn't start til 10/15/2021 - so maybe they built in a test period for a few days.

Pharmacy list classifications seems a pretty basic thing - odd that would be incorrect ?!?

The site says that you can Preview now but cannot enroll until 10/15 - I hope people who preview will review again prior to booking a selected plan. Course, the real test will come when they try to use the plan in 2022.

CMS Press Release - CMS Releases 2022 Premiums and Cost-Sharing Information for Medicare Advantage and Prescription Drug Plans

Keep this community posted on what you as a professional are finding with the 2022 Part D Plan Finder.

Re: Medicare Drug Plan Finder is a Mess . . . Again

GailL1 — Mon, 04 Oct 2021 13:25:46 GMT

It is an apple to apple comparison with a watermelon thrown in to boot.

Whether a stand alone PD or a MA-PD, beneficiaries still have to pick their drug plan - well, if they do. The matter is more complicated in a MA plan because the beneficiary is trying to pick two different things - their medical coverage AND their prescription drug coverage within the same plan.

Medicare.gov - How Medicare Prescription Drug Coverage Works with a MA Plan or Medicare Cost Plan

KFF: Facts About Medicare Advantage Plans 2020

From the above KFF link:

In 2020, nearly four in ten (39%) of all Medicare beneficiaries – 24.1 million people out of 62.0 million Medicare beneficiaries overall – are enrolled in Medicare Advantage plans; this rate has steadily increased over time since the early 2000s. Between 2019 and 2020, total Medicare Advantage enrollment grew by about 2.1 million beneficiaries, or 9 percent – nearly the same growth rate as the prior year. The Congressional Budget Office (CBO) projects that the share of all Medicare beneficiaries enrolled in Medicare Advantage plans will rise to about 51 percent by 2030. . . . .

. . . . In 2020, 90% of Medicare Advantage plans offer prescription drug coverage (MA-PDs), and most Medicare Advantage enrollees (89%) are in plans that include this prescription drug coverage. Nearly two-thirds of these beneficiaries (60%) pay no premium for their plan, other than the Medicare Part B premium ($144.60 in 2020). However, 18 percent of beneficiaries in MA-PDs (2.8 million enrollees) pay at least $50 per month, including 6 percent who pay $100 or more per month, in addition to the monthly Part B premium. The MA-PD premium includes both the cost of Medicare-covered Part A and Part B benefits and Part D prescription drug coverage. Among MA-PD enrollees who pay a premium for their plan, the average premium is $63 per month. Altogether, including those who do not pay a premium, the average MA-PD enrollee pays $25 per month in 2020.

Re: Medicare Drug Plan Finder is a Mess . . . Again

somarco — Mon, 04 Oct 2021 12:23:35 GMT

you are correct in that, many folks who have an MAPD only look at provider networks from year to year and never consider the "D" part of the MAPD plans.

Many have $0 premium MAPD so they think they are "immune" to changes in plans from year to year and never bother to review them.

My thread starter is addressing the constant deficiencies and errors in the stand alone Part D plans. The casual consumer who only uses the PF once a year will probably not notice the problems.

But when you run HUNDREDS of comparisons and have a general idea of what a copay SHOULD be, you become acutely aware of how unreliable the Medicare PF is.

I could name numerous examples but here are a few.

One carrier I use a lot has at least one preferred pharmacy on their website for 2022 that is MIA on the Medicare PF. This year more than ever, it is incumbent on the part of the beneficiary to know which pharmacy's are preferred and which are not.

Over the weekend I ran a client report including 5 pharmacy's. The PF indicated 4 were preferred and one was standard. Yet the cost analysis showed LOWER copay's when using the standard pharmacy vs the 4 prefered pharmacy's.

Most folks probably won't notice these problems . . . until they try to use their plan next year.

Re: Medicare Drug Plan Finder is a Mess . . . Again

ReTiReD51 — Mon, 04 Oct 2021 00:04:53 GMT

You’re comparing apples to oranges.

I’m talking about Part D plans for original Medicare.

A part D prescription drug plan PDP is what you purchase with a Medicare supplement or Medigap plan. That’s what they refer to as Original Medicare.

Medicare advantage is a private insurance company plan that most times includes drug coverage. Hence MAPD. MA plans or sometimes called Part C are just another way to get your Medicare Part A and Part B coverage.

Re: Medicare Drug Plan Finder is a Mess . . . Again

GailL1 — Sun, 03 Oct 2021 23:31:46 GMT

wrote:

It’s a shame only 11% of part D prescription plan owners shop around each year for a less expensive plan.

Maybe the problem is that so many Prescription Drug Coverage plans are intermingled with Medicare Advantage plans. (MAPD) Sometimes there is a choice of keep your doctor or keep your medicine. Sure there is probably something comparable but people seem to want what they want -

Competition doesn't work if there is nobody looking, shopping and changing - MA plans seem to offer incentives for their Medicare Health plans but I don't see many of them offering incentives on their formulary side. Oh, they may give some extra discounts on OTC - whoopee !

Unless people search out somebody to help them with their annual pick - they are lost. That's why so many of them just put it on automatic pilot - then they can just grip about big pharma.

Re: Medicare Drug Plan Finder is a Mess . . . Again

ReTiReD51 — Sun, 03 Oct 2021 22:53:29 GMT

I’ve used the Medicare.gov Plan Finder for the last 5 years and have never experienced any problems. Matter of fact I estimate I’ve personally saved about $1500 in premium and drug costs those past 5 years.

I’ve also personally observed numerous part D insurance plan recipients save money through the Medicare.gov plan finder because they found lower premium and drug cost plans during Medicare Open Enrollment October 15 through December 7.

It’s a shame only 11% of part D prescription plan owners shop around each year for a less expensive plan.

That’s what insurance companies and their representatives hope for. They don’t want you to switch your plan from their company to another less expensive plan through another company. All the while as they steadily increase the plan costs each year.

I encourage everyone to check out the Medicare.gov plan finder website and learn how easy it is to navigate and save money.

Re: Which insurance company to pick for Medicare Regular or Advantage

somarco — Sun, 03 Oct 2021 02:06:25 GMT

your approach is all wrong.

Shopping Medigap primarly based on price will most likely work against you within 3 or 4 years.

If you look at consumer reviews on forums, most of the comments will be negative. Almost no one gives glowing reports on their plan. Those who have nothing but praise have probably used their plan for little more than routine care. The REAL test of a plan, especially an MA plan, is how they handle claims.

Asking friends and relatives is just as bad for the same reasons.

Until you have had the plan 5 years and incurred a significant claim, you probably have no idea how the plan will work because you haven't really tested it. The only TRUE measure of a plan is how it works over the long haul.

And the PDP's are a big mess this year. See my post on "Medicare Plan Finder is a Mess"

Good luck.

Medicare Drug Plan Finder is a Mess . . . Again

somarco — Wed, 06 Oct 2021 06:22:05 GMT

For the 6th or 7th year in a row (I have lost count) the Medicare Plan Finder is a mess. CMS doesn't know the meaning of the term "user friendly".

And don't expect to get accurated copay's, at least for now. Usually takes CMS a couple of weeks, sometimes longer to get the kinks worked out.

There are often discrepancies in what the PF shows for preferred pharmacy's, tiers and copays vs what you will see on the carrier site. BEFORE COMMITTING TO ENROLLING IN A PLAN, COMPARE YOUR PF RESULTS AGAINST THE CARRIER SITE.

On top of this there is consolidation of plans and carriers. ExpressScripts was absorbed by Cigna. The plan you are mapped to may likely have a premium that is 2x your current premium.

Lot's of cost-shifting going on. Consumers will be taking a hit, especially on generics. My suggestion is to only use your PDP for brand name drugs where there are no generic equivalents. Instead of your drug plan, pay cash, use the store "discount" or other discount plan like GoodRx. Consider 90 day refills, and in some cases look at 12 month refills.

This strategy may allow you to go with a lower premium plan if you only use your drug plan for brand name drugs.

Currently many carriers won't apply a deductible to tier 1 or 2 drugs. Most carriers for 2022 are applying deductibles to tier 2 and higher. A few carriers will apply the deductible phase to ALL drugs.

One carrier has only one preferred national pharmacy (Walgreens). If you enroll in their lowest premium plan you need to plan on filling only at Walmart.

Almost every plan has CVS, Costco, Kroger, Walgreens and Walmart as preferred pharmacy's. If you use any other drugstore you may be paying too much for your med's.

There may be more surprises coming, so buckle up. It could get bumpy.

Re: I need to enroll in Plan B

EricW236758 — Fri, 01 Oct 2021 02:03:57 GMT

Well, when I look at all of the items I've posted here on this forum, my eyes go crossed, and I'm not sure where I left off last time. Is it just me, or does the layout of this forum seem a bit confusing? - Anyway, I was finally able to be seen by doctor today, and I feel that I was finally listened to and treated with respect. Looks like I'm going to have to go back early next week for some lab work, but at least things have finally started to move forward on my medical front.

Re: Which insurance company to pick for Medicare Regular or Advantage

ReTiReD51 — Wed, 29 Sep 2021 22:47:34 GMT

Get your information straight from the horse’s mouth, ask your relatives, friends and acquaintances preferably in your state who their insurance carrier is and how happy they are with their plan. I think it’s better to hear it directly from a face-to-face source than some website.

Hopefully you know there is a huge difference between Medicare supplement lettered plans and advantage plans. Do your due diligence and understand the differences before you decide to commit to a plan. You’ll save yourself from a lot of migraines later if you do.

Which insurance company to pick for Medicare Regular or Advantage

EdwardearlH892891 — Wed, 29 Sep 2021 16:09:48 GMT

How do you pick which insurance company to go with for your Medicare?

I"m trying to pick a Medicare Plan and have all the Plan A to N from Medicare. In Texas, there appear to be about 70 companies offering various policies.

When I talk to individual agents they usually only handle a few companies and are being paid commission on their sales so I'm a little skeptical that medicare agents are going to focus on the handful of policies they want to sell.

Where is the best place to get reviews or comments on people's experiences with the various companies?

Earl

Free Webinar: Medicare Open Enrollment

AARPRachelA — Fri, 24 Sep 2021 17:21:03 GMT

We’ve seen a lot of changes this past year, from a new vaccine rollout to a slow return to work. Your Medicare plan may look a little different, too. Join us for a free webinar where we’ll explore the top updates to Medicare open enrollment, coverage options and costs in 2021 — including what these changes may mean for your benefits.

Open Enrollment: What’s Changed in 2021 and How It May Impact Your Medicare Plan – Tuesday, September 28 at 7 p.m. ET.

Re: Can Medicare Part A be used to cover rent at assisted living center

EricW236758 — Tue, 21 Sep 2021 03:09:09 GMT

Thanks again, Gail. Sorry to be so dense. I guess that my brain got a little weaker while I was living overseas all of those years.

Also, the below segment from Nolo seems to be the key:

For Medi-Cal to pay for a nursing home stay, your treating physician must prescribe a nursing home for you because you either need the continual, round-the-clock availability of skilled nursing care or what's called "intermediate care."

Well, that might be a path forward, but won't happen overnight, but at least it is a path. Maybe.

Re: Can Medicare Part A be used to cover rent at assisted living center

GailL1 — Tue, 21 Sep 2021 01:55:50 GMT

As far as contacting a Medi-CAL counselor - see if this might work.

California DHCS.gov - Medi-Cal Managed Care and Mental Health Office of the Ombudsman

So you try to get an Ombudsman that can help you get in the Residential Care Facilities for the Elderly (RCFE) program. It covers the disabled too. If they can't actually do it - they should be able to put you in touch with a MediCal rep or a Social Worker than can help you.

Here is the list of facilities available by county, on that RCFE, If the county participates. Note the footnote on each page as to type of facility that suites. this is from my other post to you today in this same thread - at 09-20-2021 06:59 PM

California Department of Health Care Services Assisted Living Waiver (ALW) Program Participating Fac...

list is suppose to be current as 09/01/2021

Re: Can Medicare Part A be used to cover rent at assisted living center

GailL1 — Mon, 20 Sep 2021 23:18:04 GMT

Good grief - could they make it any more difficult. I am sorry. Frustrating for me too - EXTREMELY !!!

I did find a list of these facilities by CA county - the list link is at the bottom of this post - and the rest is just info on the program and how I got to the list. Long, I know, but this is how I trace - it's still info -

Hope this helps more -

NOLO is a legal (encyclopedia-type) site for the common person and it does describe what I am talking about - so this is just for info but sometimes a little knowledge goes a long way especially when looking for a needle in a haystack [ 😉 ].

NOLO - When California's Medi-Cal Will Pay for a Nursing Home, Assisted Living, or Home Care

from the link:

Medi-Cal for Assisted Living Facility Residents

Assisted living facilities (ALFs) offer a wide range of supportive services like housekeeping, medication management, meal preparation, and assistance with dressing and bathing, but they do not offer skilled nursing care. (In 2019, the average cost of an assisted living facility was $4,500 per month.)

In general, Medicaid pays for room and board only when they are offered in an institution that provides skilled care (like a nursing home), and it does not generally pay for room and board expenses in assisted living facilities. However, in California, to assist with the costs of assisted living facilities, the state has created a Medi-Cal program called the Assisted Living Waiver (ALW) that pays for ALFs in some counties.

( These MAY BE the counties - I don't know - these seem to be the ones that took nursing home residents in covid hot spots - but looks like these counties are in the program)

California DHCS.gov - Assisted Living Waiver

Back to the NOLO site: it says -

Assisted Living Waiver

ALW is a Home and Community-Based Services (HCBS) waiver program that offers care coordination services and can pay for expenses associated with some assisted living facilities and also with some home health services. Most recipients of ALW services still have to pay most of their income to the assisted living facility for room and board charges.

To be eligible for ALW, you must be eligible for Medi-Cal (without the Share of Cost program) and require an intermediate level of care. You meet that level of care if, without the ALW services, you would need to live in a nursing home. However, because ALW is a Medicaid waiver program, it does not need to be equally available to everyone in the state who is eligible for it. At this time, California has opted to make the services available to some seniors and people with disabilities living in Sacramento, San Joaquin, Los Angeles, Sonoma, Fresno, San Bernardino, Contra Costa, Alameda, San Diego, Riverside, Kern, Orange, Santa Clara, and San Mateo counties.

If you qualify for ALW, you must use one of the assisted living facilities that have been approved by the state to participate in the program. The state licenses and regulates assisted living facilities that wish to receive Medi-Cal payments. Those approved facilities are called Residential Care Facilities for the Elderly (RCFE)RCFEs can have as few as six beds or as many as 100 beds.

Are you in one of those counties? Then IF you are - there has to be some way for you to find out if you can enroll and if there are openings in this program - Residential Care Facilities for the Elderly (RCFE)

I have found the actual manual of policies and procedures for this program

https://cdss.ca.gov/ord/entres/getinfo/pdf/rcfeman1.pdf

It says it is under the STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY - DEPARTMENT OF SOCIAL SERVICES - COMMUNITY CARE LICENSING DIVISION

I found the place where the actual AS facilities actually apply, get reviewed for the program:

https://www.dhcs.ca.gov/services/ltc/Pages/Residential-Care-Facility-and-Adult-Residential-Facility-Provider-Enrollment.aspx

but when I went to the link at the bottom of this page that says

Medi-Cal Member Enrollment Information

The page says no longer available. (Grrrrrrr ☹️) - but there are other links on the page Soooooo -

I found this list of the facilities (current as of 09/01/2021)

California Department of Health Care Services Assisted Living Waiver (ALW) Program Participating Facilities - RCFE (Residential Care Facilities for Elderly) and ARF (Adult Residential Facilities)

Now will you be eligible? Do they have any openings???? Can you find out how to get in? NOTE THE FOOTNOTES AT THE BOTTOM OF EACH PAGE as to the type of facility/ current openings/new facility - suppose to be current as of end of 08/2021.

But I hope this helps more. GOOD LUCK

Re: Can Medicare Part A be used to cover rent at assisted living center

EricW236758 — Mon, 20 Sep 2021 22:01:35 GMT

...see if this may help you with the assisted living facility..

Unfortunately when I click on the link, and then scroll down to the bottom of the page, the only real info I see is a link titled "811 Project Rental Assistance (PRA)". However, when I click on the "811 Project Rental Assistance (PRA)" link it takes me to a page which has been under construction since March of this year. See below.

https://www.dhcs.ca.gov/services/ltc/Pages/811_PRA_Stakeholder_-Page.aspx

I tried searching Google for "Long-Term Care Alternatives (Home and Community-Based Service Options)" - but that just seems to take me down another rabbit hole which I don't understand.

I'm really lost and overwhelmed with all of this right now.

Re: Silver Sneakers being droped by AARP recommended insurer

paisleygirl — Sun, 19 Sep 2021 12:29:09 GMT

A Medicare Supplement gentleman here in my hometown that helps people find Medicare Supplement plans told me whatever I do, Do Not go with AARP Plan. I will took his word for it.

Re: Can Medicare Part A be used to cover rent at assisted living center

EricW236758 — Sat, 18 Sep 2021 23:05:00 GMT

Thanks Gail, I will look into this before I start posting anymore questions in this forum. (Sometimes I feel like I have to many pokers in the fire) I've looked through the documentation I received from Medi-Cal, but it doesn't mention anything about a Medi-Cal counselor. Would a Medi-Cal counselor be someone who works at Medi-Cal, or would it be some sort of third party advocate? Sorry to be so dense, but this is really all very new to me.

Re: Can Medicare Part A be used to cover rent at assisted living center

GailL1 — Sat, 18 Sep 2021 17:19:07 GMT

Since you have been successful in getting on Medi-Cal - see if this may help you with the assisted living facility - sounds like from your description, you may need at least some daily living assistance- a watchful eye perhaps but you won't be cooking - BE CAREFUL.

California.gov - Dept of Home and Community Based Service - Long-Term Care Alternatives (Home and Community-Based Service Options)

see the bottom of the page -

You need a Medi-Cal counselor that can hopefully explain the above as well as your Medi-Cal medical coverage. They may have to have a doctor's order or description of what you need in the form of care - I don't know. Under this program (HCBS), I believe Medi-Cal can subsidize your living cost in a community type care home ( whatever the state calls it - assisted living or personal care home - alternative to Nursing Home) and leave you some (albeit, a little, probably) of your SSDI benefits. They can also bring in medical needs if you need it in the facility.

Some of those Personal Care Homes and maybe some assisted living facilities in my area are Medicaid subsidized under this program - Home and Community Based Services.

There are some services that help to find assisted living places - 'A Place for Mom' is one of the national ones - but you need something at the government level since they know which facilities take their subsidized payments, your health needs and what you are required to pay. Work your place to live under your Medi-Cal - most likely the Home and Community Based Services.

Hope this help -

Re: Onduo

ReTiReD51 — Sat, 18 Sep 2021 10:22:39 GMT

Increase insurance rates? I suppose that’s possible. But it could lower them too.

From the article I read about “Onduo” the disease management and prevention products Onduo offers is intended to keep us living longer. That’s good news. And I’d think that the longer we live the more the Insurance company profits. Good news for them. So, it could be a win-win for both sides.

At least that’s the way their business model sounds to me, someone who knows nothing about the Insurance Industry and never heard of "Onduo" before now.

Re: I need to enroll in Plan B

EricW236758 — Sat, 18 Sep 2021 04:02:52 GMT

I will try posting something in Housing tomorrow, after I have a chance to put my thoughts together.

Re: I need to enroll in Plan B

EricW236758 — Sat, 18 Sep 2021 04:00:58 GMT

How much "care" - daily living care, med taking, etc. do you need everyday?

Well, I really don't know, but I have noticed a significant decline in the past few years, but I also haven't been seen by a doctor in many years, so it is hard to say. Well, I've noticed that I've developed a problem with navigation within the past few years. If I go into a large building or a dept. store I'm not familiar with, I can sometimes lose my own bearing, and forget where I am, or how to get out. Also, the other day I heated something on the stove, and a few hours later the people I'm living with got upset with me because I forgot to turn off the stove. I felt very ashamed because I know this would not happened just a few years ago. I don't know how much support I need, but it seems doubtful I can live on my own.

Where I am - Medicaid does help pay for some of the cost in personal care home.

Well at this point I hate to admit it, but I'm not even really familiar with what Medicaid is, or who pays for it? I guess I will have to look into what the qualifications are in California?

Housing for most people who are looking for something subsidized is hard to come by right now.

You know, the other day I stumbled across a website which promotes itself as being sort of a broker between seniors and assisted living facilities. (I don't know if I can mention the name of the site here, but someone needs to investigate it.) Anyway, I sent a general inquiry indicating that I'm disabled, and that I'm looking for a place to stay. A few hours later I got a phone call from someone representing themselves as a manager at an assisted living center. This person quoted me a price which was just a little bit below what I'm getting on SSDI, and they even offered to come pick me up and drive me to their facility, so that I could sign the paper work and move in that day. I'm not the sharpest tool in the shed, but even I could see that something didn't smell right with this. (I was worried about being robbed, or worse) So after a few days they stopped communicating with me, but for a while, they were really using high pressure sales tactics to get me to go with them.

So, not only is there a real shortage of housing for the disabled, but on top of that, there appears to be a real problem with scammers trying to take advantage of people like me who are in a vulnerable spot. I probably won't even waste my time trying to report them to the authorities, because it seem that these days, the authorities simply don't care.

The bad thing is, there is still a very good chance I could end up in the street, and winter is just around the corner.

Re: I need to enroll in Plan B

GailL1 — Sat, 18 Sep 2021 02:05:08 GMT

So glad you were able to get Medi-Cal and a doc and an appointment.

How much "care" - daily living care, med taking, etc. do you need everyday? You don't have to be specific - a type measurement will - small, medium, high? Small would be that you can do most daily living things all by yourself with maybe just staff checking on you. Medium would be that you need help with daily living care. High would mean that the staff pretty much has to do everything for you. If small or low - those personal care homes would be the place to check out - if financially workable. Where I am - Medicaid does help pay for some of the cost in personal care home. Not every personal care home here takes Medicaid.

Housing for most people who are looking for something subsidized is hard to come by right now - Sect. 8, subsidized housing for the independent senior/disabled is hard to find right now because it is all full and nobody is moving out. When something does become available, there is a long, long waiting list.

What might be available is area specific. Local government / city / county might have some suggestions for you - hound the ones that support housing in social services. Some NGO (non-government organization) might be able to help - United Way, specific support groups connected to your type of disability.

Take a shot and post something on this forum under the "Housing" board, mention general area - maybe somebody might have other suggestions.

What about a roommate situation? Not the greatest, I know - but you do have an income you just don't want housing to use it all.

So Sorry I can't help more

EDITED TO ADD: if you do need some "care" - post also on the "CAREGIVING" Board here - again at least mention the general area - cause it all based on geographical location.

Re: Onduo

GailL1 — Sat, 18 Sep 2021 01:20:09 GMT

Does insurance even cover it? I don't know. Ask your doctor what he thinks.

If you need help in monitoring some chronic conditions (like type-2 diabetes) - your doc should be able to refer you to "trainers" and they will work with you in many aspects of daily living and help you learn the best way to change your life to help treat type2 diabetes.

Would you like virtual type care or virtual learning? That seems to be what Onduo is - Onduo is a digital health brand with a science-backed, data-driven virtual care model that is designed to help people with chronic conditions manage their care. That's from their website

Onduo

WilliamD866401 — Fri, 17 Sep 2021 16:34:02 GMT

I think this could be used to increase insurance rates by data mining the users. What do you think?

Re: Can Medicare Part A be used to cover rent at assisted living center

EricW236758 — Fri, 17 Sep 2021 04:07:15 GMT

Are you looking at an official assisted living place?

Yes, I've been looking at these types of facilities, and even the lower priced ones are just a bit out of my grasp.

Do you happen to be a Veteran?

Nope, not a veteran.

Thanks, the rest of your answer sheds a lot of light on things.

Re: Can Medicare Part A be used to cover rent at assisted living center

GailL1 — Fri, 17 Sep 2021 00:58:04 GMT

No, Medicare, all of it, pays only for medically needed therapy, treatments under order or direction of a physician. NOT for any Daily Living type care Assisted Living is an alternative living place; not a medical facility like a nursing home. Are you looking at an official assisted living place? - where the rent covers your room and board, so to speak, though most have a medicine person that have extra training to give out meds - any level of daily living care over just the basic is added on top of the room and board charge. As your level of daily living care increases, so does the monthly charge. If you need something ordered by or through a doc where they come to you to provide the service, those services are covered under Medicare as any other needed medical care.

Where I live, and I assume other places, we have places called Personal Care Homes. These are smaller, community based type housing - disabled / elderly; somewhat like an assisted living facility. They can do some daily living care but if it gets too extreme they might not be able to handle it because of the needs of the whole and limited staffing. Medical care given in a persons home or living place, again is brought in for the service - and the service bills Medicare for payment just like any other needed medical necessity.

Medicaid (NOT Medicare)covers nursing home care for the low income - maybe that is what they were trying to say or you might have misunderstood since the names are similar - MEDICAID vs Medicare. ?????? Medicaid also sometimes covers some daily living for the low income -

No all facilities - Assisted Living / Personal Care Homes/ even Nursing homes accept Medicaid beneficiaries. I am pretty sure that at $ 1635 per month on SSDI, you are over the low income limit for Medicaid in most, if not all, states.

Do you happen to be a Veteran?

Re: I need to enroll in Plan B

EricW236758 — Thu, 16 Sep 2021 19:57:27 GMT

Just a quick update to everyone who helped me out in this forum. I now have full scope Medi-Cal, and have a doctor's appointment scheduled for Sept. 30 regarding my medical issues. However, now my big problem is finding a place to live which I can afford with the money I'm receiving from SSDI. I've found one or two assisted living centers in my area which are charging a monthly rent which is almost exactly equal to my Social Security benefits, so if i moved into one of those places, I wouldn't be able to buy a roll of toilet paper if I had to. So, how can I find a place in an assisted living center on the amount I'm getting from Social Security? Will Medicare help pay for this?

Can Medicare Part A be used to cover rent at assisted living center

EricW236758 — Thu, 16 Sep 2021 19:52:21 GMT

Well, to make a long story as short as possible, I've been contacting assisted living centers in search of a place to live. I'm getting quotes back for monthly rents which are almost exactly the same as what I'm getting on SSDI ($ 1,635 a month on SSDI). However, one of the rental agents mentioned that Medicare might pay for part of my rent, but she didn't know where I would have to go in order to make that happen.

I'm 59 years-old, I am in fact disabled, and I've been on SSDI since 2012. Is it really possible that Medicare might be able to pay for at least part of my rent in an assisted living center, or was the rental agent blowing smoke? How would I get the ball rolling on something like this?

Re: Part D penalty

somarco — Sun, 12 Sep 2021 17:57:43 GMT

I couldn't locate a generic CMS Part D enrollment application but page 5 addresses eligibility questions.

https://www.express-scriptsmedicare.com/pdf/medicare/medicare-part-d-2021-enrollment-form.pdf

There are a number of reasons why you are assessed a penalty, late enrollment being one of them. Another is failure to show proof of creditable drug coverage when applying for a plan outside of your IEP.

You may also be subject to IRMAA which is not really a penalty in government speak, but many would debate that point.

IRMAA can be appealed or you can wait for it to "drop off" when your income drops.

Re: Part D penalty

john258 — Fri, 10 Sep 2021 16:42:11 GMT

I would suggest you contact a local expert on this. If you do not know one contact your local AARP Office as they should be able to direct you to one.

There are many in and outs to what you are asking so many times an expert can get you help by using them. Most of us in here have no idea what they all are.

Re: Part D penalty

ReTiReD51 — Fri, 10 Sep 2021 11:39:49 GMT

There are reasons to appeal the penalty. The deadline is 60 days from the date you received the letter informing you about the penalty.

The big question is what asked you,” Why were you late signing up for Medicare Part D?”

Unfortunately, not knowing about the requirements to have prescription drug coverage is not going to be a good enough reason to win an appeal.

https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/Late-Enrollment-Penalty-LEP-Appeals

Re: Part D penalty

GailL1 — Thu, 09 Sep 2021 16:14:32 GMT

Why were you late signing up for Medicare Part D?

Did you have other prescription coverage during the time that you should have signed up and when you actually did sign up? If so, what kind.

If you decided just not to sign up when you were 1st eligible because you didn't need any prescription drug coverage - not sure there is a remedy to the penalty.

I am asking the moderator to move this thread to the Medicare & Insurance Board - that is the right place for it where others will see your post.

Part D penalty

lg8227 — Wed, 08 Sep 2021 19:20:36 GMT

I would like to know if anyone can help me or give me any information on how to get rid of my part D Medicare penalty. Need help !! please respond if you can help.

Re: UHC or Accendo for Plan G?

somarco — Tue, 07 Sep 2021 23:18:07 GMT

some carriers play games with so-called "discounts" to get you in then load those discounts back in during renewal years. Discount or not, rates still increase every year depending on utilization and trend.

HH or family discounts are generally not contractual. They are either administrative or handled via a policy addendum.

HH discounts disappear when the other family member is no longer in the home, due to death, divorce . . .

Accendo is a brand new carrier, about a year old. Do you really want to chase rates on a carrier that has no track record?

I don't know about your state but Accendo is paying a much higher commission than UHC in my state.

Re: UHC or Accendo for Plan G?

ReTiReD51 — Tue, 07 Sep 2021 18:39:15 GMT

My experience with UHC they offered a 30% discount on your premiums when you are a new issue to Medicare. Then every year for the next 10 years your premiums will increase 3% just to bring you up to the real cost of a plan G minus the discount. Also expect your premium to increase for the expected increase in healthcare costs each year. Example: year one increase 3% plus 8%?? or whatever the increase in healthcare cost is for that year for an 11% premium increase.

UHC considers themselves a community rated or no age rated meaning your premium isn’t rated on your age. A 66-year-old man in a given community would pay the same amount as a 76-year-old man living in the same community. However, it was explained to me if you received the discount at age 65 and the discount decreases each year for 10 years the pricing model ends up being similar to age-attained.

I’ve never heard of Accendo, must not be offered in my state. Surprised to learn it is a subsidiary of CVS Caremark and administered by Aetna.

I’d suggest checking with an insurance agent who sells those two company plans might be the wise thing to do. You don’t have to purchase the plans from an agent but a least you’d get their expert opinion on those plans.

Re: Disenroll from Medicare Part B (due to Income Related Premiums)

somarco — Tue, 07 Sep 2021 18:09:50 GMT

if you do follow through with your original plan to disenroll from Part B . . . and later decide to re-enroll in B so you can pick up an Advantage or supplement plan, you will have to enroll during the Medicare GEP, your Part B will be effective July 1 of that same year AND you will pay a lifetime late enrollment penalty.

I don't know who has been advising you on all this including the IRA to Roth conversion, but the direction they suggested has a lot of holes in it.

Re: Disenroll from Medicare Part B (due to Income Related Premiums)

SteveO59 — Tue, 07 Sep 2021 16:01:07 GMT

That's a really good video - thanks. My situation is a little different though - I am no longer working, so don't have the option to defer my wife's Part B decision. The one takeaway for me, however, is I need to reconsider what FEHB plan I have - we have an HMO now, but I should be looking at FFS plans as well. Of course, that's still complicated since the health insurance math would be different for my wife than for me because only one of us has Plan B. Luckily, we are both healthy, so maybe I can take some risk and lower my FEHB costs by changing to a lower level FFS plan.

Thanks!

Re: Disenroll from Medicare Part B (due to Income Related Premiums)

SteveO59 — Tue, 07 Sep 2021 15:46:36 GMT

Thank you - that's a very good answer. I probably can't get much relief for 2019 because we were still converting my wife's IRA>Roth in 2019, but started on my IRA>Roth in 2020, so what you said should translate to next year's IRMMA, where the IRA conversion income is all mine (her IRA conversions were all finished in 2019, so we're working on mine now - including transfer out of TSP into a Traditional IRA so I can do the Roth conversion). Yes, we did file MFJ. I did some quick calculations to see if it made sense to file separately, but it penciled out cheaper jointly (mainly since the 2019 IRA conversion was on my wife's side for 2019).

I did not think about the SSA-44 life changing event (didn't think it would apply to our situation), but I can see that this might be something to try - especially since she gets no pension, and with her Roth conversions gone in 2020, her income should only include half of any interest or long term capital gains we have in non-IRA accounts. MFS might be a good option there too.

It looks like I have more math to do next year to see what pencils out...

Thanks for this reply!

Re: Medicare Medical Savings Account Plan - Medicare Advantage

JeffreyR516105 — Tue, 07 Sep 2021 11:52:44 GMT

The MSA’s make a lot of since for people who are healthy, (at least for now), and who rarely go to the doctor. This would be my plan of choice if I could find people who have it and can help answer questions about it. The things I worry about l’m sure are the same as most people. 1. How difficult will it be to get providers to understand and accept the insurance. 2. The biggest concern for me is, what can they do with future deposits vs deductible? Currently they offer 2 plans. One deposits $2000 annually, (the year end balance accrues year over year), with a $5000 deductible, (net $3000), and one that deposits $3200? With a $7000 or $8000 deductible. Sorry not firm on the second one because I was only interested in the $2000/$5000. My question would be, is the a % they are allow to change annually or can they do whatever they want. Could it change over time to $500/$10,000? Is there a cap to how much they can change the deductible too?

This seems like the perfect plan for me but not knowing the answer to these questions keeps me from joining. It’s sad that information on this is lacking and since nobody’s selling it they can’t and don’t want to explain it. When I ask they just say, we don’t like it. It’s just a MA plan with a really high deductible. $3000, that not much different than a G/HD plan but it’s $0 premium. Normal MA’s have $6,700 deductible’s. Basic math makes it easy to see big savings in the long run if you don’t need much care. But say 3 years later you get cancer. You’d be in the same boat as the G/HD but you might have $6000 to pay towards your $5000 deductible. If only there were answers that had some positive assurances.

UHC or Accendo for Plan G?

kb844472 — Tue, 07 Sep 2021 10:54:55 GMT

UHC vs Accendo Plan G

We are in the final stages of choosing our Plan G company. UHC and Accendo have rates within a few dollars of each other in our zip code. I’ve talked to several agents and get differing answers, so if you actually have either of these policies, I would appreciate your input.

If you have anything good or bad to say about either, please let me know. I want to pick something for life and not count on being able to pass underwriting in the future.

UHC

The enrollment premium gets reduced by 3% between the ages of 69 and 80. What happens on the years that there is no reduction in enrollment premium? Can there be an age related increase in price in addition to the reduction in enrollment benefit?

UHC offers a household discount of 7%. Is that guaranteed in the contract? Can it be reduced? What happens when your spouse dies?

I understand that the Renew Active membership can be withdrawn at any time. Are there any other benefits that can be withdrawn?

Accendo

Accendo offers a household discount of 14%. Is that guaranteed in the contract? Can it be reduced? What happens when you spouse dies?

Re: Disenroll from Medicare Part B (due to Income Related Premiums)

GailL1 — Mon, 06 Sep 2021 23:28:49 GMT

What about this?

Watch video especially at the 5:25 marker. Especially in the OP's case where the wife is the Medicare beneficiary and she still has the husband's (primary) FEHB at least until he retires. Is this still the case? If so, it has a Med. Part B penalty EXCEPTION.

Re: Disenroll from Medicare Part B (due to Income Related Premiums)

somarco — Mon, 06 Sep 2021 22:52:24 GMT

had you converted the IRA in one year you MIGHT have had IRMAA relief via an appeal.

https://www.ssa.gov/forms/ssa-44-ext.pdf

You may still want to give it a shot. All they can say is "no".

Cancelling Part B probably isn't the best option because you will be disenrolled from any Medicare Advantage plan. You must have A & B to participate in an Advantage plan.

Generally, plans under the FEHB Program help pay for the same kind of expenses as Medicare. FEHB plans also provide coverage for emergency care outside of the United States which Medicare doesn't provide.

https://www.opm.gov/healthcare-insurance/healthcare/medicare/medicare-vs-fehb-enrollment/

When traveling outside of the US you should consider an international travel medical plan.

You may also change your enrollment during the annual Open Season

Other answers to your questions are on the page linked above.

Re: Disenroll from Medicare Part B (due to Income Related Premiums)

GailL1 — Mon, 06 Sep 2021 21:49:54 GMT

You and your wife have a very complicated matter that involves money, taxes and premiums AND your health care coverage for the long term. You need a CPA or Financial Advisor, one that understands Medicare!

But I will offer some NON-professional suggestions for you and your wife to think about - Before making any decision to drop your wife's Part B let's see if those IRMMA premiums can be modified based on your actual real income and not what you call "phantom income" from the IRA> ROTH conversion.

The ownership of the IRA and the Medicare account (your wife), especially since she is currently age 65 (Medicare age) and you are not, is very important.

There is NO "WE" in the actual ownership of a Medicare account and NO "WE" in the ownership of an IRA or ROTH account. Each of you have different accounts.

Are you with me here on the above points?

Break out the figures of the IRA>ROTH conversion on the tax year(s) forms involved as to who it actually belongs to - you (less than 65) or your wife (over 65). This is probably TY 2019. That is the one SSA is looking at for 2021 Medicare Part B premiums.

1st is a simple solution and probably the easiest. Has your wife tried this?

SSA.gov - Form SSA-44 - Medicare Income Related Monthly Adjustment Amount - Life Changing Event

Work Reduction reason = Retirement for your wife

If you (or she) fills out the form include her IRS Form 8606 showing the amount of her ROTH conversion and the tax return showing her IRA distribution. The figures should match. If they don't because you both filed as MFJ, and you also did a conversion, you may need to show a complete breakdown especially since she is the only one that is currently 65 years old and currently paying the IRMMA.

If calling as the form states doesn't work because they are still working remotely (pandemic) try calling your Congress person's office and see if they can help with a better direct contact.

Now if this works, I will assume you will be fine because SSA should modify the Part B premiums without the inclusion of the IRA>ROTH conversion(s) as a Life-Event (Work Reduction reason = Retirement for your wife)

If it does NOT work - depending upon the defined $$$ numbers and ownership - there maybe another solution - that is, refiling the subject tax return [probably 2019] from which the IRMMA is based from MFJ to MFS and each one of you file a separate return. I believe you can go back (3) years. More tax maybe assessed on one of you but that amount just needs to be brought into the evaluation of which way is best way to proceed on this whole matter of IRMMA.

This is only some possible solutions to the AMOUNT of the IRMMA - by SSA modifying it on a Life Event basis or by refiling the tax return that has created this IRMMA premiums.

If neither of these work - let's us know and maybe we can help to figure out if cancelling Part B might be a good option although having both FEHB (retirement) and Medicare is superior coverage.

Disenroll from Medicare Part B (due to Income Related Premiums)

SteveO59 — Sun, 05 Sep 2021 18:51:12 GMT

I am a retired federal employee, and my wife is on my FEHB health benefits plan. I was advised decades ago that for "most" federal retirees, Medicare Part B made sense, because it caused many of the copays and coinsurance premiums to be waived. My wife turned 65 and we started her Part B coverage about 2 years ago. At the same time, we have also been working on converting all of our IRAs to Roth IRAs, so ALL of the converted money is treated as income (even though not one dime of it has come to us, since we did 100% conversion and paid the taxes out of our savings). The problem is that Medicare thinks we have all this money, and we are now paying at the highest levels for the Medicare Part B income related monthly adjustment. We are converting just enough each year to stay in the 24% tax bracket, so we will have this "phantom income" for at least 3 more years - by which time I will turn 65 as well, and now our Part B premiums will double. We'll be paying about $1000 per month for Part B at that time. This won't go on forever - the IRAs will be converted in 3 years, but then each time I withdraw from my portfolio of investments, I will have some amount of long term capital gains, and that will most definitely also cause our premiums to increase. Apparently, we are not "most" federal employees, so now we need to reconsider.

We are seriously considering cancelling our Part B and Medicare Advantage plan (offered through the health insurance company that has our FEHB coverage). I know that cancelling Part B incurs a 10% penalty per year, and that it would impact me as well if I never sign up, but my FEHB plan covers everything I need (at present time) at about 1/3 the cost of $1000/month. My main hesitation to cancel is that if Congress changes the FEHB program, changes Medicare program, or goes to some sort of healthcare for all system, I could be screwed by some future decisions that I cannot predict. That said, $1000 per month is a hefty price to pay for a gamble on what Congress might do in the future.

I've seen other threads that talk about canceling Medicare Part B, but they all reference going back to work - and that is not in the cards for us. I've also seen answers to the disenrollment question that suggest Part B is better than the FEHB program, but I disagree - my FEHB coverage covers me when I travel, not just in the USA (Medicare does nothing in Canada, Mexico, or other countries, from what I've heard). So relying on Medicare vs. FEHB just doesn't pencil out for us.

I'm looking for any thoughts or advice on this scenario. I'm also looking for thoughts on when I can do this - can I do it at any time of year, or do I have to wait until some open season, and how does this timing impact the Medicare Advantage plan that is tied to both Medicare and my FEHB insurance?

Re: Let's Start A Pool - Best GUESS Wins

Tonster521 — Wed, 01 Sep 2021 02:56:38 GMT

Thanks for the link to the Summary.

Re: Let's Start A Pool - Best GUESS Wins

GailL1 — Tue, 31 Aug 2021 22:58:58 GMT

Thank You for the HeadsUP !!!! 👍

Here is the Summary

https://www.ssa.gov/oact/TRSUM/

Re: Let's Start A Pool - Best GUESS Wins

Tonster521 — Tue, 31 Aug 2021 22:42:22 GMT

I just saw the 2021 Trustee Report is now available online. It will take sometime to read and comprehend. So, I will go with $153.00 per month for Part B. I am guessing that Congress will provide some assistance like they did for 2021.

Re: Let's Start A Pool - Best GUESS Wins

GailL1 — Mon, 30 Aug 2021 19:03:26 GMT

wrote:
. . . . Because we do not have the data from the 2021 Trustees Report (which is going on 5 months late), any guess is a "shot in the dark". In my opinion, the Trustees Report is being delayed until the proposed provisions of the $3.5 Trillion Bill is resolved. That Bill may end up subsidizing Part B again.

So, if acceptable, I will provide two numbers. The first number is without any subsidies from 2021 and 2022 or $179.42. The second number includes subsides from 2021 and 2022 ( forecast 12% increase for 2022) or $152.95 (call it $153.00). I cannot imagine Congress rolling in the increase from 2021 even though.that provision has expired.

REALCLEAR Politics - Commentary 08/17/2021 - Where Are the Social Security/Medicare Trustees' Reports?

Don't you think that BEFORE any further work on this $ 3.5 TRILLION dollar Budget Reconciliation "human" infrastructure legislation, we do need to know where these Trust Funds stand at the present time. I agree with this Commentary.

No, now , you only get one guess in this contest - sounds like you are leaning towards the higher guess.

Re: Medicare supplement plans and preexisting conditions?

john258 — Mon, 30 Aug 2021 14:26:50 GMT

Underwriting is needed when all do not have coverage so you do not end up with only the people needing medical insurance buying it and the price goes sky high. The carrier is asking you to tell them about any current medical problems you have so they can decide if they want to take the risk and cover you and how much to charge you.

When everyone is covered you do not need the pre ex. that is true in original medicare. Open enrollment periods are a way to avoid pre ex when people move from plan to plan.

The answer to pre ex is all covered period.

Re: Medicare supplement plans and preexisting conditions?

ReTiReD51 — Mon, 30 Aug 2021 13:10:49 GMT

Off topic. Translation from traditional Chinese to English

Speaking of the knack of essay writing, I believe no one can know more than American essay writing https:// lunwenzhushou.net/mei-guo-dai-xie/. Over the years, we have helped tens of thousands of international students I have successfully completed various writing tasks, which not only strengthened my own strength, but also gained the trust of our customers. Today we will share some tips on writing essays with the students, hoping to be helpful to them.

If you want to write a good paper, you must first think independently, because the most important factor in determining the quality of the paper at any time is the students themselves. The second is to follow the teacher's handouts and article writing requirements, and at the same time prepare some feasible ideas and write them in the notebook, so that you can more comprehend in the process of writing the article. Finally, we must pay attention to the research work and find more factual evidence for our arguments.

Re: Let's Start A Pool - Best GUESS Wins

Tonster521 — Sun, 29 Aug 2021 14:07:20 GMT

You are optimistic. You may remember that 2021 was limited to an only 25% increase by a Bill/Resolution passed by Congress in 2020. The existing Part B formula would have developed the 2021 Part B contribution at about $160.20 (which was an increase of $15.60) . However, the above 25% provision limited the increase to about $4.00. So, the 2020 Part B contribution which was $144.60 increased to $148.50 or only $3.90 (or about $4.00). Because we do not have the data from the 2021 Trustees Report (which is going on 5 months late), any guess is a "shot in the dark". In my opinion, the Trustees Report is being delayed until the proposed provisions of the $3.5 Trillion Bill is resolved. That Bill may end up subsidizing Part B again. So, if acceptable, I will provide two numbers. The first number is without any subsidies from 2021 and 2022 or $179.42. The second number includes subsides from 2021 and 2022 ( forecast 12% increase for 2022) or $152.95 (call it $153.00). I cannot imagine Congress rolling in the increase from 2021 even though.that provision has expired.

Re: Let's Start A Pool - Best GUESS Wins

ReTiReD51 — Sun, 29 Aug 2021 13:01:55 GMT

$162.80

https://www.youtube.com/watch?v=0Wi8Fv0AJA4

Re: Let's Start A Pool - Best GUESS Wins

GailL1 — Sun, 29 Aug 2021 12:36:28 GMT

Thanks for the guess - but you know that it does not work that way - right?

The SS/Medicare Hold-Harmless Clause states that the Part B premiums cannot rise more that the COLA so that one's SS benefit is not lower the next year than the year before due to any Part B premium increase.

Since we are all hopeful that the COLA increase in SS benefits is gonna be pretty substantial in dollar amount - yep, 6% would be nice - we just have to hope that the government doesn't take it all for our share of Part B premiums.

We got a deal for this year (2021) due to covid -

AARP.org 10/20/2020 - Congress Limits Medicare Part B Premium Increase

from the link ~

The Medicare Part B premium increase for 2021 will not be as large as government actuaries predicted because of a new provision in the spending law that keeps the federal government running until Dec. 11.

The monthly premiums for Part B — which helps pay for doctor visits, diagnostic tests and other outpatient services — are determined based on Medicare's overall program costs and other health insurance factors. As the actuaries for the Centers for Medicare and Medicaid Services (CMS) began running the numbers earlier this year, lawmakers and advocates like AARP learned that the data indicated that the 2021 Part B premium could increase by as much as $50 a month for some beneficiaries.

Re: Let's Start A Pool - Best GUESS Wins

nctarheel — Sun, 29 Aug 2021 04:24:36 GMT

wrote:

What is your guess of what the standard (most people) Medicare Part B premium will be for 2022?

I believe it is $ 148.50 for 2021 -
My 2022 guess is gonna be .. . . . . . . . $ 164.00

Come on . . . give it a guess. 🙂

I guess $157.41.

If the SS benefit has a 6% cola....... I think they will raise the Part B also by 6%.

Let's Start A Pool - Best GUESS Wins

GailL1 — Sat, 28 Aug 2021 23:52:02 GMT

The person that can guess the closest - WINS - wins what? I don't know.

What is your guess of what the standard (most people) Medicare Part B premium will be for 2022?

I believe it is $ 148.50 for 2021 -

My 2022 guess is gonna be .. . . . . . . . $ 164.00

This does NOT include any premium penalties.

This does NOT include any IRMMA additions.

Come on . . . give it a guess. 🙂

A BI-PARTISANSHIP Senate Bill that could SAVE Medicare Money AND Provide better Service

GailL1 — Mon, 23 Aug 2021 19:42:04 GMT

I really dislike GARGANTUAN legislative bills - I prefer ones with a direct plan and how they are funded - One:ONE; especially ones that have the services and the savings all together in the same service. To me, these seem pretty much NO Brainers.

Now this one - saves Medicare money AND provides better Medicare services to many people. Introduced in the Senate on 07/29/2021, current, it is supported by (8) - 4-Dems and 4-Rep.

The Choose Home Care Act of 2021, S. 2562 is a cost-effective and patient preferred home-based extended care benefit as a supplement to the existing home health benefit that supports patients to leave the hospital and recover at home with a mix of expanded skilled nursing, therapy, personal care, telehealth services and more. In this way, eligible patients can choose to recover at home in a safe home environment with appropriate and sufficient care tailored to meet their individual needs and reduced Medicare spending.

Eligible patients are approved by their doctor for this type of home care rather than a SNF recuperation period.

S.2562 Choose Home Care Act of 2021 (S. 2562) - GovTrack.us

So where would you rather recover from some surgery or medical treatment, if approved by your doctor(s) - at home or in a skilled nursing facility ????

To find out more about it - follow the links at the top of the above page:

Re: Medicare - Dental, Vision, Hearing Benefit Question

GailL1 — Mon, 23 Aug 2021 18:00:05 GMT

Couldn't agree more -

But it just seems that this place is not one where any sort of conversation like this really takes off. It is not a Game, nor a Reward, nor is it Rock n Roll or a subject for the Front Porch in the AARP sense of this board.

I am very discouraged here!!!

Re: I need to enroll in Plan B

GailL1 — Mon, 23 Aug 2021 15:18:57 GMT

If it is any consolation, the frustrations you are experiencing do not have anything to do with you or any disabilities - it is just trying to work within a government framework and its massive tentacles of "help" programs. You just have to find the niche where you fit given your specifics of need and income. Believe me, when trying to find help in any government program it is difficult and now with so many of these employees working remotely - anybody would be frustrated. I am frustrated right there with you and I'm not even involved 😣!!

So, maybe get outside of government - to a NGO (NON government organization) - UNITED WAY of California

Maybe just go to them directly: CALIFORNIA 2-1-1 Get Connecte

Search by California location and specific services on this page OR you can just call 2-1-1 for the referral - don't know which might be best to do - maybe the webpage just to see what they can do in those help offered categories of FOOD - MENTAL HEALTH - HEALTHCARE - HOUSING, ETC. They may know of NGOs or where more specifically to go in government to find the help that you are seeking.

Wish we could just point to one spot for your problem(s) solving - it is just not that easy when dealing with specific individual problem and their unique characteristics - and yours's are rather unique. You have made some headway - keep trying.

Re: I need to enroll in Plan B

EricW236758 — Sun, 22 Aug 2021 23:58:02 GMT

Thank you to everyone who has helped me here in this forum. However, I think that I need to ask one more follow up question in order to gain a better understanding of what I'm facing.

Where can I find someone to help me navigate all of these different agencies, as I feel a little overwhelmed trying to do this on my own? I have a full scale IQ of 82, and a lot of times when I try and call these different social service agencies, I get the feeling that the person whom I'm speaking with on the phone is more interested in finding reasons to not help me, than they are in actually trying to help me.

So, the other day, I was sitting on the curb in the parking lot at the 99 Cent store trying to call the telephone number for a county clinic I had gotten from the Department of Human Assistance, when the receptionist at the clinic told me that I couldn't be seen there unless I was a member. (A member of what?) To make a long story short, I was at the end of my rope, and I just started to cry like a baby as I was sitting there in the parking lot.

So, eventually I called back and got an appointment to see a medical doctor on Sept 2nd, but I'm really feeling that I'm not doing all of this correctly, I'm not able to understand everything people tell me, and maybe, in the long run, I won't be able to obtain the services I'm entitled to if I don't find someone to help me.

So, in addition to my other problems, (high functioning schizophrenic) I also have a below average IQ, and I'm not always able to function on my own very well. The problem seems to have gotten worse starting in my late forties, and usually my wife is there to help me, but right now she is stuck in the Philippines while I'm in Sacramento, California trying to reestablish us here.

There must be someone who helps people with mental disabilities, but whom?

Re: Medicare - Dental, Vision, Hearing Benefit Question

somarco — Sun, 22 Aug 2021 12:04:49 GMT

politics aside, consider access to care and cost to the beneficiary.

Dental providers almost never accept Medicare. Using the Medicare physician finder I plugged in my (large metro) zip code and searched a 15 mile radius. While there were HUNDREDS of physicians that accept Medicare patients there were only FOUR dentists.

Better luck with audiologists and optometrists . . . almost 300.

However, just because these providers accept Medicare now does not mean they will continue to do so.

Medicare does not cover ROUTINE vision and hearing care. If you have a medical problem that requires treatment or a device, currently you can get care from vision & hearing providers. Patients that are using Medicare benefits make up a very small percentage of the patient population.

But if Medicare starts to cover ROUTINE vision & hearing care, the cash flow dynamics of patient care can shift due to lower reimbursement + additional paper work.

I would anticipate many of these providers would drop Medicare participation and focus more on cash patients. If this happens, and I see no reason why it wouldn't, the Medicare beneficiary has a benefit they can't use.

MAPD plans that have dental, vision & hearing are MANAGED CARE plans. Their policyholder can generally only use those benefits with PARTICIPATING providers. Access to care is limited and the same would be true if DVH were included in original Medicare.

Re: Questions on Medicare application for senior parent

BariO908952 — Sat, 21 Aug 2021 21:20:14 GMT

Thank you for the prompt response to my questions. I will read through your references.

Re: Your Thoughts on Medicare Negotiating the Price of Drugs as a Health care cost containment metho

JoeT64 — Sat, 21 Aug 2021 20:58:41 GMT

MLR was being seriously considered for elimination prior to January 2020

Re: Questions on Medicare application for senior parent

GailL1 — Sat, 21 Aug 2021 16:55:53 GMT

1. The dates are different because the different enrollment periods cover different circumstances and different people. Medicare is correct as to when your Mom can apply.

Annual (Open) Enrollment Period (October 15 - December 7) is open to currently enrolled beneficiaries and is a period of time when they can evaluate their current coverage to see if they need to change some parts of their coverage - specifically the "how they get their benefits" - Medicare Advantage plan choice AND/OR Medicare Part D - their Prescription Drug Plan.
General Enrollment Period Jan. 1 - March 31, with an effective date of coverage of July 1, is for people who have missed their initial enrollment period and do not qualify for the Special Enrollment period because they had other Medicare approved credible coverage.

Medicare.gov - Medicare Enrollment Periods - When To Sign Up Explained

You can also download the Medicare.gov - "Medicare and You" annual booklet - 2021 version is available online - it explains all the things that you may have questions about your mother's coverage.

As for your #2 question - she may not have a penalty for Part B & D IF she never got Medicare Part A - which is the premium free hospital coverage for most people because they have had Medicare Part A or HI (hospital insurance) payroll deductions during their entire and vested length work record. However, if she never worked under this US system, she will be paying for Medicare Part A (think that is $ 471 per month) + Medicare Part B $ 149.00 per month for most people and for her Medicare Part D plan and /or a Medicare Advantage plan which could have the Med D program of prescription drug coverage built in.

This explains it pretty well.

ehealth Medicare 01/25/2021 - Can My Immigrant Parents Get Medicare?

As for your question #3 - Since she will be your dependent, I am gonna guess that Medicare will want both incomes - yours and hers, if she has any. I say that because I do not know if people on Medicare who are not citizens can get any "extra help" and that is the reason for the question. There are many extra help benefits for Medicare beneficiary's who have very low income, some from the federal gov (SS) and some from the state - but the dependency classification throws another matter into the equation. If she were married, they would want the income of both so that is why I guess that way since she is gonna be your dependent. Why are you electing this dependent classification? Sponsorship?

Try performing the check function [ Find Out If You Qualify ] on this social security.gov page -

SSA.gov - Extra Help with Medicare Prescription Drug Plan

Either way, you are gonna have to ask them - most likely Social Security, not Medicare, since they are the ones that determine premiums in Medicare and federal extra help. Sorry, I just don't know. It might also be that some states offer extra help too - so check with them too.

Questions on Medicare application for senior parent

BariO908952 — Sat, 21 Aug 2021 12:42:22 GMT

Greetings to all forum participants,

I have several questions regarding Medicare application for my senior mother. She immigrated to the US in 2016 (she was 67 years old at that time) and I wanted to start buying Medicare for her but we were told that she has to wait 5 years to be eligible to buy Medicare.

This October, 2021 she will be in the US as permanent resident for 5 continuous years and she is eligible to apply for Medicare so we will be applying and have the following questions:

1. When I called local Social Security last week and explained my mother's situation, we were told that she can apply during January 1 - March 31 general enrollment period next year (2022) for Medicare coverage to start on July 1, 2022 . I am thinking maybe there was some misunderstanding since if she can apply when she is first eligible (October 2022) then why can't she apply during Annual Enrollment Period from October 15 to December 7 for coverage to start on January 1, 2022? If she can, I will be calling social security again to explain this.

2. There are Medicare late enrollment penalties for Part B/D premiums if someone applies not at 65 but at a later age. Even though my mother will be 72 when she first applies, I do not think these late penalties apply to her situation since at age 65 she was not even present in the US and also when she first immigrated to the US in 2016 she had to wait 5 years to be eligible to apply. So October, 2021 is the earliest time she is eligible to apply. Am I correct? And if I am, is there a way to point this out during Medicare application to make sure they do not apply these late enrollment penalties.

3. Finally, a question about income. In 2022 (when she hopefully will have Medicare coverage) I will be claiming her as a dependent on my tax returns (her own income is $0). During her Medicare application there is an income question (which I think is related to Income Related Monthly Adjustment Amount): should she give her own income or hers+mine income?

Thank you in advance.

Re: I need to enroll in Plan B

EricW236758 — Sat, 21 Aug 2021 02:34:17 GMT

Find out who your House of Representative Rep is and contact his office - local one if you can find it and run it all by this "expert" staff. -

Well, I found out that the US Rep for the district where I used to live is, Congressmen,Ro Khanna, (I used to live in southern Alameda County before moving to the Philippines) so I sent an email to him through is website. If I don't hear from someone by early next week then I'll try calling them on the phone. - In the meanwhile, I was finally able to schedule a doctor visit at a county hospital here where I'm staying in Sacramento. It isn't until Sept 2nd, but at least I finally have an appointment.