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Valued Social Butterfly

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

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Message 11 of 91

rker321 wrote:


 


Now I have a question. supposed that my out of network  decides that they don't like my PPO. Why can't they simply bill  my Medicare?

You know, perhaps this change to Avastin may also change the cost exposure to the insurers and then can consider this as appropriate for their Supplemental I believe that they have stopped asking the Foundation and just bill my insurance.

You wrote:

"Now I have a question. supposed that my out of network  decides that they don't like my PPO. Why can't they simply bill  my Medicare?"

 

YOUR Medicare IS the Medicare Advantage plan which you have chosen, I believe, a Medicare Advantage PPO.

 

A doctor can decide which insurer they want to deal with and how much they want to deal with them.

A doctor even accepting Medicare assignment in original Medicare can still limit how many of this type of patient they accept into their practice.  The doc makes the call.

 

Don't like any Medicare Advantage plan, go back to Original Medicare.

 

Original Medicare and Medicare Advantage plan (Part C of Medicare) cover the SAME benefits just in a different way.  They are both under the umbrella of "Medicare".

 

you wrote:

". . . . .perhaps this change to Avastin may also change the cost exposure to the insurers and then can consider this as appropriate for their Supplemental "

 

A Supplemental (Medigap) insurer has no cost exposure - they do not decide on the price or payment of anything !   They don't say what is covered or set any prices.   In General, they pay the 20% of the Medicare approved cost which Medicare does not pay.

Supplemental Insurance is NOT health insurance - it is "supplemental" insurance.

 

They can deny you coverage based on their own determination of the amount of services which you may use in original Medicare because you have a pre-existing condition and you do not have any Medicare determined rights that they have to sell you a policy at all OR sell you a policy even at the going price - they can deny you a supplemental plan, or underwrite you, charge you more and limit coverage for pre-existing condition for a specified amount of time..

 

At this point, we are waaaaaay off-topic and I am having my doubts that you understand Medicare and all its parts.  Nor do I think you understand what Medigap (supplemental) coverage actually is.

You seem to keep thinking that it is health insurance; it is not.  It does not work with a Medicare Advantage plan at all.

 

You have your choice of keeping a Medicare Advantage plan (Part C), any of them offered in your area, or going back to Original Medicare but perhaps without a supplemental plan or perhaps one that might be pretty costly, if an insurer will underwrite you.

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Valued Social Butterfly

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

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Message 12 of 91

GailL1 wrote:


To tell you the truth, rker321, I do not know what Medicare's (CMS) current stand is on the use of Avastin for AMD - it is being used "off label" - we have talked about this before.  Avastin has been proven to be a good way to treat AMD.  Yes, it is much cheaper than Lucentis or Eylea but it is still being used "off label". But yes, tremendously cheaper.

 

Here are the latest things I could find.

MedScape: 06/17/2014 - Switch From Lucentis to Avastin Could Save Medicare $18B

 

Previous research indicates that the 2 medicines have similar efficacy and safety profiles. The biggest difference is a $2023 per dose price tag for ranibizumab (Lucentis), which is approved by the US Food and Drug Administration (FDA) for both ocular conditions, compared with about $55 for a dose of bevacizumab (Avastin), which lacks federal approval for such uses. (that's the reason it is used off-label)

 

USA Today 04/24/2014 - Some top Medicare beneficiaries spend heavily to lobby

 

Medicare paid more than $956 million in 2012 to Genentech for Lucentis, more than any other drug — even as many retina specialists, backed by a two-year federal study — say that Avastin, another drug produced by the company approved to treat cancer, is as effective as Lucentis at treating the eye disorder. The disease is a leading cause of blindness in people older than 60.

 

Lucentis costs nearly $2,000 per injection; Avastin, about $50.

 

Are you getting help from the charitable arm of Genentech to pay for the Avastin?

 

I am sure that original Medicare does cover it under Part B but all of it, since it has to be recompounded, I don't know.  - ask your doctor.

Doesn't that $ 400 cover the cost for the office visit and the doc's time?

 

Just another question to ask and compare the coverage of original Medicare to your Medicare Advantage plan.

 

 


In the beginning they use one of those expensive ones, but eventually changed to Avastin, apparently I do better on Avastin. than with the other two.
The foundations that I am dealing with is called Gooddays. and they have been generous with me.
Now I have a question. supposed that my out of network  decides that they don't like my PPO. Why can't they simply bill  my Medicare? 
Yes, even this insurance does  cover Avastin.
You know, perhaps this change to Avastin may also change the cost exposure to the insurers and then can consider this as appropriate for their Supplemental I believe that they have stopped asking the Foundation and just bill my insurance.
I have seen the bill and there is a test that they do before they put the injections to see if there is any change in my eye. and then they put the injection. so is the injection plus the test and the doctor's visit. The insurance covers it all except for my copay for an specialist. Now, there is no progression for a very long time. as it is, I am going only about every 10 weeks and he wants to space it even more. I guess I was lucky, because I saw the eye doctor every six months because of diabetes, he was the one that saw that I could have a problem and immediately sent me to the retina specialist. I guess it was treated very early. is only in one eye and I can  see quite well under the circumstances and my other eye is not affected, and I have very good vision on that eye. I still can drive without a problem which is very important for me.

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Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

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Message 13 of 91

alexiss12 wrote:

 

Also one needs to know that when Obamacare was put into place, monies were taken out of Medicare to help pay for the tax credits etc under Obamacare, therefore reducing some of the benefits of us older people with our healthcare.So don't blame AARP or United Healthcare plans such as Plan F as they are controlled by Medicare guidelines that got more expensive when Obamacare went into effect. 


@alexiss12 

There was NO “monies”….”taken out of Medicare” NO “benefit cuts” because of Obamacare. This was disingenuous teaparty propaganda spread to discredit the ACA.

 

Obamacare achieved $716 billion Medicare savings through reduced physician and provider reimbursements. Just one example it required Durable Medical Equipment (DME) providers to be contracted with CMS to get paid from Medicare which helped to reduce a lot of fraud among the many DME providers. Waste and fraud were cut not benefits.

 

 Obamacares gave all Medicare beneficiaries, no cost preventative care and the gradual closing of the “donut hole for part D.
There were NO benefit cuts.
There were no “monies”…..“taken out of Medicare”.

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Valued Social Butterfly

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

550 Views
Message 14 of 91

rker321 wrote:


 


Gail  perhaps I have been lucky. Avastin cost is about 400.00 per injection and in my case most of it is provided by the Foundation. I do know that the other injections are a lot more expensive but, let's face it ,the injections are the only treatment for Macular Degeneration.  Most of the people that do have this disease have also Pharmaceuticals that provide the injections at no cost if you qualify.
And if you are considered that this problem has been contained. What is the cost? I don't know as to why you consider the treatment that expensive. or any more expensive that people with Cancer, and other really very serious disease. Please do clarify as to why you consider this disease expensive? Tje most expensive treatmen are the injections and they are not done that often in most cases.


To tell you the truth, rker321, I do not know what Medicare's (CMS) current stand is on the use of Avastin for AMD - it is being used "off label" - we have talked about this before.  Avastin has been proven to be a good way to treat AMD.  Yes, it is much cheaper than Lucentis or Eylea but it is still being used "off label". But yes, tremendously cheaper.

 

Here are the latest things I could find.

MedScape: 06/17/2014 - Switch From Lucentis to Avastin Could Save Medicare $18B

 

Previous research indicates that the 2 medicines have similar efficacy and safety profiles. The biggest difference is a $2023 per dose price tag for ranibizumab (Lucentis), which is approved by the US Food and Drug Administration (FDA) for both ocular conditions, compared with about $55 for a dose of bevacizumab (Avastin), which lacks federal approval for such uses. (that's the reason it is used off-label)

 

USA Today 04/24/2014 - Some top Medicare beneficiaries spend heavily to lobby

 

Medicare paid more than $956 million in 2012 to Genentech for Lucentis, more than any other drug — even as many retina specialists, backed by a two-year federal study — say that Avastin, another drug produced by the company approved to treat cancer, is as effective as Lucentis at treating the eye disorder. The disease is a leading cause of blindness in people older than 60.

 

Lucentis costs nearly $2,000 per injection; Avastin, about $50.

 

Are you getting help from the charitable arm of Genentech to pay for the Avastin?

 

I am sure that original Medicare does cover it under Part B but all of it, since it has to be recompounded, I don't know.  - ask your doctor.

Doesn't that $ 400 cover the cost for the office visit and the doc's time?

 

Just another question to ask and compare the coverage of original Medicare to your Medicare Advantage plan.

 

 

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Valued Social Butterfly

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

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Message 15 of 91

GailL1 wrote:

rker321 wrote:


 


Like I said in my post - these are just some examples - one is old (2011)

These are PRIVATE insurers offering this SUPPLEMENTAL coverage to Medicare.  EACH one can made their own risk rules about any condition.

 

AMD is an expensive disease to treat and there is no actual cure.  I believe since the treatment is done in the doc's office under original Medicare, it is covered by Part B if a person has ORIGINAL Medicare so maybe the supplemental insurers see a heightened $$$$ risk for them - I don't know, just a guess.  

 

Please se understand that these are just examples - insurers in this SUPPLEMENTAL market evaluate their OWN risk individually - they are not all the same.  I gave you this example only for you to see how the rules are developed by each company individually.

 

I don't even think this insurer writes Medigap policies in Florida.

 

Again I tell you - Nobody can deny you Medicare benefits.

original Medicare = Medicare Advantage - they are one in the same just different ways of covering the SAME benefits.

 

Supplemental coverage or Medigap is not health insurance, it is supplemental coverage and thus does not have to be offered to anybody outside of the times when it cannot be denied for pre-existing coverage or premium level.

- during the Medigap open enrollment period and

- during specified times when "guaranteed issue" as listed by original Medicare is in play.

I don't believe any of these apply to you and your situation.

 

You do not get a supplemental policy before picking up original Medicare.

You can only buy supplemental coverage from the insurers that offer it in your state.  They have the right to deny you or approve you with underwriting and most likely charge you more or even underwrite you, charge you more and hold off coverage on a pre-existing condition for a specific amount of time.

 

why don't you get some clarification from SHINE (FL SHIP) or even from the FL Dept. of Insurance.

 

Florida Dept of Consumer Affairs - Medicare Supplement Insurance Overview

 

Florida Office of Insurance Regulation - Medigap

notice the "important information"

 

Florida Office of Insurance Regulation - SAMPLE Medicare Supplement Rates by County

 

This last one gives the insurers that write Medigap policies in Florida by county.  Remember even if one of them decides to underwrite you, your premiums might be much higher and they may also disqualify your pre-existing condition(s) for a specified amount of time.

 

You are not promised access to a supplemental policy - it is something extra available to those who meet the timing and other criteria.  

 

A question - would you still want a supplemental policy if the insurer wanted to charge you $500 or more per month for it and perhaps not cover your pre-existing condition for 6-months?  

 

Do you want original Medicare in place of a Medicare Advantage plan?

That might be original Medicare WITHOUT a supplemental policy or perhaps one if you are underwritten by a Medigap insurer that might cost you a very heafty premium each month.

 

Added:  How Macular Degeneration is covered under ORIGINAL Medicare

Medicare.gov - Macular Degeneration Original Medicare coverage

 

I think  if it were me, I would think about this very hard.

 

 


Gail  perhaps I have been lucky. Avastin cost is about 400.00 per injection and in my case most of it is provided by the Foundation. I do know that the other injections are a lot more expensive but, let's face it ,the injections are the only treatment for Macular Degeneration.  Most of the people that do have this disease have also Pharmaceuticals that provide the injections at no cost if you qualify.
And if you are considered that this problem has been contained. What is the cost? I don't know as to why you consider the treatment that expensive. or any more expensive that people with Cancer, and other really very serious disease. Please do clarify as to why you consider this disease expensive? Tje most expensive treatmen are the injections and they are not done that often in most cases.

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Valued Social Butterfly

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

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Message 16 of 91

alexiss12 wrote:

After reading some of the complaints of AARP supplemental plans not paying for things like Whooping Cough vaccinations, I am amazed at how many new enrollees (or maybe even ones who have had the ins for a while) don't understand how Supplemental Insurances work. It is Medicare that decides what is approved, how much to charge and then the Supplemental coverage like Plan F pays the difference since Medicare will pay 80% and the rest is the responsibilty of the indivdual (therefore the ins covering the 20%).

 

Plus this is the key which is apparant is not understood.  MEDICARE DOESN'T APPROVE EVERYTHING LIKE THE WHOOPING COUGH OR SHINGLES VACCINE. It would be very smart before one gets such vaccines to ask if Medicare covers the shots, procedures etc.

 

 


Yes, I find it rather concerning to read some of the post here about just basic stuff.

I also find that sometimes when a question is asked they do not identify how they are getting their Medicare Benefit - original Medicare or Medicare Advantage.

It makes a difference in how things are covered - Medicare Advantage plans cover the same thing as original Medicare, just in a different way.

 

Actually, Medicare does specify which "shots" are covered based on the recommendation from the CDC on this age group.  However, they ALSO specify which "part" of Medicare covers different ones.

Part B or Part D - special conditions of the individuals' health might even change this on some vaccinations/immunizations.  You are right, it is Best to look up each one on Medicare.gov or call Medicare on the one you are getting to find how the how, when and where so you are assured of proper coverage. 

 

If the "shot" is covered by Part D - your prescription drug coverage - normally, unless there is a specific health condition, you do not want your doctor to give it cause he does not file prescription drug coverage claims - the pharmacist does.

 

Yes, for those with original Medicare - Medicare (CMS) controls the prices of Part A and Part B services as long as you are using a provider that accepts assignment or can bill Medicare - If they don't accept assignment, they may balance bill you or bill you for the whole amount and then for the later you have to file a claim with Medicare to recoup the amount Medicare would have paid - which will not be the total amount even if you have supplemental (Medigap) coverage too.

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Info Seeker

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

533 Views
Message 17 of 91

After reading some of the complaints of AARP supplemental plans not paying for things like Whooping Cough vaccinations, I am amazed at how many new enrollees (or maybe even ones who have had the ins for a while) don't understand how Supplemental Insurances work. It is Medicare that decides what is approved, how much to charge and then the Supplemental coverage like Plan F pays the difference since Medicare will pay 80% and the rest is the responsibilty of the indivdual (therefore the ins covering the 20%). Plus this is the key which is apparant is not understood.  MEDICARE DOESN'T APPROVE EVERYTHING LIKE THE WHOOPING COUGH OR SHINGLES VACCINE. It would be very smart before one gets such vaccines to ask if Medicare covers the shots, procedures etc.

Also one needs to know that when Obamacare was put into place, monies were taken out of Medicare to help pay for the tax credits etc under Obamacare, therefore reducing some of the benefits of us older people with our healthcare.So don't blame AARP or United Healthcare plans such as Plan F as they are controlled by Medicare guidelines that got more expensive when Obamacare went into effect. (This is not being political but only truthful) For me having Plan F for a few years has been a Blessing as you will understand once you have a Hospital surgery for over $100,000 and never see a bill. That's when it pays to get the great insurance AARP provides)

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Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

552 Views
Message 18 of 91

rker321 wrote:

GailL1 wrote:

rker321 wrote:

 


MORE info - from General information on various insurance agents websites about Medigap application process in various states where they write Medigap policies -

 

Boomer Benefits - Can I Pass Medigap Underwriting To Change My Supplemental Plan?

 

An old (2011) instructions PDF to their company agents writing Medigap policies 

NOTE:  all private companies that write Medigap policies can use their own underwriting criteria if that be the case.  Only in those cases stipulated by Medicare (CMS) when NO underwriting or denial is permissible do they HAVE to write or deny a supplemental policy with no strings attached - meaning that a person is within the Medigap Open Enrollment period or have Medigap protection or Guaranteed Issue Rights.

 

2011 CSI - Agent Underwriting Guidelines for Medicare Supplemental Policies

 

Just a few examples of when and how your info can be asked and used.

 

 

Gail, thank yo so much for those two links. I read and re read than to make sure that I understood what they said. and this is what i came out with.

First of all, Macular Degeneration is not mentioned anywhere in the list of  disease that may disqualify you. at all. 
I happen to use Avastin. and saw that Avastin has other uses besides Macualar degeneration.
The only thing that I could have that could disqualifies me is that I receive those injections at the Dr's office. 
Right now, My doctor is considering extending the time that I receive those injections because there has not  been any progression for almost two years. On top of all of this I receive help with the cost of these injections which for Avastin is not very much. from a Foundation that helps me.
The other link is what I am referring to. I will go to them and see what they can do. because, I do believe that the way in which they generalize the fact that you receive  injections is a disqualified is something that they need to really become more specific.
so that is my next step. and then Medicare will be my last resort.  

 

 


 


Like I said in my post - these are just some examples - one is old (2011)

These are PRIVATE insurers offering this SUPPLEMENTAL coverage to Medicare.  EACH one can made their own risk rules about any condition.

 

AMD is an expensive disease to treat and there is no actual cure.  I believe since the treatment is done in the doc's office under original Medicare, it is covered by Part B if a person has ORIGINAL Medicare so maybe the supplemental insurers see a heightened $$$$ risk for them - I don't know, just a guess.  

 

Please se understand that these are just examples - insurers in this SUPPLEMENTAL market evaluate their OWN risk individually - they are not all the same.  I gave you this example only for you to see how the rules are developed by each company individually.

 

I don't even think this insurer writes Medigap policies in Florida.

 

Again I tell you - Nobody can deny you Medicare benefits.

original Medicare = Medicare Advantage - they are one in the same just different ways of covering the SAME benefits.

 

Supplemental coverage or Medigap is not health insurance, it is supplemental coverage and thus does not have to be offered to anybody outside of the times when it cannot be denied for pre-existing coverage or premium level.

- during the Medigap open enrollment period and

- during specified times when "guaranteed issue" as listed by original Medicare is in play.

I don't believe any of these apply to you and your situation.

 

You do not get a supplemental policy before picking up original Medicare.

You can only buy supplemental coverage from the insurers that offer it in your state.  They have the right to deny you or approve you with underwriting and most likely charge you more or even underwrite you, charge you more and hold off coverage on a pre-existing condition for a specific amount of time.

 

why don't you get some clarification from SHINE (FL SHIP) or even from the FL Dept. of Insurance.

 

Florida Dept of Consumer Affairs - Medicare Supplement Insurance Overview

 

Florida Office of Insurance Regulation - Medigap

notice the "important information"

 

Florida Office of Insurance Regulation - SAMPLE Medicare Supplement Rates by County

 

This last one gives the insurers that write Medigap policies in Florida by county.  Remember even if one of them decides to underwrite you, your premiums might be much higher and they may also disqualify your pre-existing condition(s) for a specified amount of time.

 

You are not promised access to a supplemental policy - it is something extra available to those who meet the timing and other criteria.  

 

A question - would you still want a supplemental policy if the insurer wanted to charge you $500 or more per month for it and perhaps not cover your pre-existing condition for 6-months?  

 

Do you want original Medicare in place of a Medicare Advantage plan?

That might be original Medicare WITHOUT a supplemental policy or perhaps one if you are underwritten by a Medigap insurer that might cost you a very heafty premium each month.

 

Added:  How Macular Degeneration is covered under ORIGINAL Medicare

Medicare.gov - Macular Degeneration Original Medicare coverage

 

I think  if it were me, I would think about this very hard.

 

 

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Valued Social Butterfly

Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

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Message 19 of 91

GailL1 wrote:

rker321 wrote:

 


MORE info - from General information on various insurance agents websites about Medigap application process in various states where they write Medigap policies -

 

Boomer Benefits - Can I Pass Medigap Underwriting To Change My Supplemental Plan?

 

An old (2011) instructions PDF to their company agents writing Medigap policies 

NOTE:  all private companies that write Medigap policies can use their own underwriting criteria if that be the case.  Only in those cases stipulated by Medicare (CMS) when NO underwriting or denial is permissible do they HAVE to write or deny a supplemental policy with no strings attached - meaning that a person is within the Medigap Open Enrollment period or have Medigap protection or Guaranteed Issue Rights.

 

2011 CSI - Agent Underwriting Guidelines for Medicare Supplemental Policies

 

Just a few examples of when and how your info can be asked and used.

 

 

Gail, thank yo so much for those two links. I read and re read than to make sure that I understood what they said. and this is what i came out with.

First of all, Macular Degeneration is not mentioned anywhere in the list of  disease that may disqualify you. at all. 
I happen to use Avastin. and saw that Avastin has other uses besides Macualar degeneration.
The only thing that I could have that could disqualifies me is that I receive those injections at the Dr's office. 
Right now, My doctor is considering extending the time that I receive those injections because there has not  been any progression for almost two years. On top of all of this I receive help with the cost of these injections which for Avastin is not very much. from a Foundation that helps me.
The other link is what I am referring to. I will go to them and see what they can do. because, I do believe that the way in which they generalize the fact that you receive  injections is a disqualified is something that they need to really become more specific.
so that is my next step. and then Medicare will be my last resort.  

 

 


 

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Re: Is AARP United Healthcare Medicare supplimental insurance as bad as the customer reviews say??

501 Views
Message 20 of 91

danf224027 wrote:

 

. . . . - - -Their advertising and sales promotion claims: UNITED will pay for bills and claims which basic MEDICARE does not.  Yet, when I recently had a new vaccination for whooping cough, as recommended by my doctor and pharmacy---I was forced to pay $60---on top of my expensive   monthly premiums.  When I telephoned through the process provided on the website---some indifferent clerk with no knowledge simply said:  You have to call MEDICARE.  When I called MEDICARE---another indifferent clerk with no knowledge said:  We don't cover it!  (This was over a half hour sitting on the phone.)

---Why did I have to pay $60 to RITE AID for this immunization, when every month I am paying hundreds to MEDICARE, hundreds to UNITED HEALTHCARE SUPPLEMENTAL, and several hundred a year for my WALGREEN drug plan?

 

 . . . . I would be surprised if anyone at AARP actually responds to my complaint here---their process is a joke!

 


I am not from AARP but wanted to respond to you about your Tdap vaccination-  ( tetanus, diphtheria and pertussis).

 

Your Medicare prescription drug plan covers most immunizations/vaccinations.

Medicare.gov - Tdap shot (tetanus, diphtheria, pertussis shot)

 

You called it  (your drug plan) your "Walgreen Drug Plan" - You went to Rite Aid for the vaccination so we're they able to file the claim with your prescription drug plan - is Rite Aid listed as a covered pharmacy on your drug plan?  Perhaps you can call your drug plan and see if there is anyway you can recoup some of your money by filing a claim with them with a copy of the paperwork.

 

You have original Medicare with a supplemental plan.  You should get a booklet every year entitled "Medicare and You" - this booklet is pretty thorough as to how the different parts of Medicare work in the original program and how your supplemental coverage works.    Original Medicare is your main insurance; your Medigap coverage or supplemental is just that "supplemental" to original Medicare.  Original Medicare makes all the coverage rules and determines which part covers what services.

 

You can can always reference Medicare.gov to see if a particular service is covered and how it is covered. Medicare.gov - Is my test, item or service covered?

 

Insurance (public or private) is only as good as our proper use of it.  Complicated at times, I know . . . . It is what it is -  since original Medicare is your main coverage - call them if you need clarification on something about coverage.

 

 

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