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Community Manager

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I turned 65 last year and signed up for Medicare. It was like going through hell to get it done, although I signed up during the period they said to. Finally, after no longer having medical coverage for about 3 months, in September or thereabouts, my Medicare came through.


I went through Blue Shield and am supposed to have "all of the parts," A.B., C., etc.


Yet, now, instead of a co-pay when I visit my doctor of 10-20$, I have no co-pay but now have to pay 20% of the cost of the vist, which is usually $150. I am not retired but haven't really worked since 2008. It would be cheaper to die than to pay the quarterly premiums+doctor visits+drug co-pays.


Something seems wrong. My friend is older (74) and says that he has what I have and doesn't have to pay 20%.


Please advise.

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Bronze Conversationalist

@DavidB77268 original Medicare does not have copay's.


Outpatient coverage (Medicare Part B) has a calendar year deductible of $198 (2020). The balance of approved claims are paid @ 80% by Medicare, you are responsible for the remaining 20%.


Medicare Part A is hospital inpatient.

Medicare Part B is outpatient health care

Medicare Part C is now referred to as Medicare Advantage

Medicare Part D is the drug plan


You say you went "through Blue Shield" and have ALL the parts but the description you gave matches up with original Medicare. You MAY have purchased a supplement plan but I can't tell from your description.


It does not appear you have an Advantage plan. Most of them have copay's.


Your "friend" may have an Advantage plan.


You can disenroll from Medicare if you want but that is not a wise decision. If you can't afford your coverage you might qualify for Extra Help, or Medicaid.

Bark less. Wag more.
Community Manager
Community Manager

@DavidB77268 I was able to get a bit more guidance for you:


What we’d recommend is that you watch the on-demand version of the webinar and check the resource folder where you can find links for information and resources where you can reach out to get answers to your personal request. Included are links to things like the Medicare Rights Center, Medicare, The Official U.S. Government Medicare Handbook: Medicare and You 2020, etc.


Here’s the link to get to the registration page for the webinar:

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Community Manager
Community Manager

@DavidB77268 - You may find help through this resource



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Periodic Contributor

I've looked all over the Internet, researched in a variety of ways, but phenomenally can't get the answer.
I see Medicare Advantage (is this part of Medicare, AARP, or what?) which is not clearly defined, and other Medigap 'offers'. They seem to suggest, but don't clearly explain that traditional Medicare is forfeited if we accept one of these 'offers'.
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Bronze Conversationalist

@cm5504903 you "forfeit" nothing with Advantage or Medicare supplement (Medigap)


Advantage plans deliver your Medicare benefits via insurance carriers. Each carrier determines the premium, network, cost sharing, etc.


You are still responsible for paying your Part B premium.


Medicare supplement plans dovetail into original Medicare. Your primary benefits come from Medicare, the supplement plan pays AFTER Medicare. You still have cost sharing in the form of deductibles and sometimes copay's.


There are no networks with original Medicare and a Medigap plan.


You can search all over the internet but you will probably be more confused than you are now.


I tell folks you can spend hours, weeks, months searching and not learn as much as you can investing 10 minutes with a GOOD insurance agent.


The choice is yours.



Bark less. Wag more.
Honored Social Butterfly

@cm5504903 wrote:
I've looked all over the Internet, researched in a variety of ways, but phenomenally can't get the answer.
I see Medicare Advantage (is this part of Medicare, AARP, or what?) which is not clearly defined, and other Medigap 'offers'. They seem to suggest, but don't clearly explain that traditional Medicare is forfeited if we accept one of these 'offers'.

Yes, it is a very complicated program.


You have several choices to learn about Medicare.

1.  You could read Medicare and You - the publication that is put out by every year to all beneficiaries - new and standing. - Medicare and You 2020 


2,  There are also (local to your area)  Medicare Insurance brokers/agents that can explain your choices to you.  There is no charge for this service - they sell both traditional Medicare Medigap coverage and Medicare Advantage plans for you to pick from based on what is best for you and your health / pocketbook circumstance.


3.  Sometimes you might find that your state's Dept of Insurance has some knowledge about this also - their website may be good at explaining your choices or they may have some very knowledgeable people - sometimes volunteers - that can walk you through your choices.

The key words here are your state and MAY be knowledgeable.


The choice is person specific because each is different in their needs and pocketbook.

This is just a nutshell, very basic description, hitting only the very big high lights.  There are lots of nuances and twist and turns which could apply to your specific situation - health and pocketbook - and also some restrictive aspects of Medigap policies which might also be in the mix of decision-making.  Like what would you do if down the road, sometimes in the future, you could not afford the Medigap plan that you chose and couldn't get another at a reasonable cost, or at all.


Traditional (original) Medicare by itself is NOT complete.  It covers only 80% of the cost and there is NO maximum limit to what you might have to pay for that other 20%.

Add a Medigap plan (there are several plans to choose from) to traditional (original) Medicare, which is only GAP insurance from private insurers, to cover SOME of that remaining 20% and you have an additional premium - which for many is fairly high and will rise with time.

Then you have to add a Medicare Prescription drug plan to the above for another monthly premium.

A Medicare Advantage Plan which offers the same benefits as the traditional program but in a different way.  These are offered by private insurance companies with plans approved by Medicare (CMS - the government).  There are lots of choices based on your needs and pocketbook.  Their premiums are usually low to none.  These are FULL Medicare health plans - it is your choice as to how FULL you need and can afford them to be.   Yes, they have to use cost savings like networks/copays/ coinsurance to save on premium cost but you know these when you pick your plan so you know your cost.   Sometimes they offer some benefits that are EXTRA and are not covered by traditional Medicare.  Many times, the Medicare Prescription Drug program is built-in to these plans and thus you avoid an additional premium for this coverage.


EVERY year you can change your Medicare Advantage Plan if you want.

EVERY year you can change your Medicare Prescription Drug Plan if you want.

You many or may not be able to change your Medigap plan (state specific guidelines apply) without incurring added cost or even a denial of coverage to another Medigap plan.


Now if you are a VERY low income Medicare beneficiary, there is extra help available to you too and even some special type plans.


So back to the beginning - read Medicare and You and/or find yourself a good local expert to help you understand all the choices that you have.


There are pluses and minuses to both -








It's Always Something . . . . Roseanna Roseannadanna
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