@4176jp wrote:
I live in California. What does a supplement cost? What are the pitfalls, negatives and limitations?
I am on a limited income and have incurred phenomenal debt paying for outside surgeons using credit cards to repair the damage caused by my plan surgeons and my PC Physician still refuses to refer me out to outside specialists of my choosing.
Thanks for your input.This is so confusing and calling these various Plan advertisers on TV is so frustrating as each pitches their own plans and benefits to the detriment of others.
You are very confused and need help understanding your options. Stop watching TV and seek some direct help. Do a little reading so that you will understand how the different faces of Medicare work.
If you want a more national plan, yes, Original Medicare is better than a Medicare Advantage plan.
But to save money - you do have to use Medicare providers that take assignment.
Medicare (Original) - Physician Compare
But would you consider Original Medicare if you have to pay the other 20% of cost out of pocket cause I do not know if you could even get a Medigap plan or if you can, the monthly cost for a Medigap plan.
Just for your understanding, the differences in Original Medicare Medigap coverage and a Medicare Advantage Plan:
https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap/med...
Original Medicare covers approved and necessary medical needs for seniors that have worked and paid into the Medicare system during their working career. SOME physicians take what is deemed "assignment" meaning that they will accept what Medicare pays as 80% coverage of the Medicare amount. The remaining 20% of the cost is up to you -
- out of your pocket,
- with a Medigap plan or
- if your income is low enough, Medicaid (Medi-Cal in California).
There are many different Medigap plans and insurers. They are LOCALLY designated by zip code usually but some are groups like the AARP branded UHC Medigap plans (called supplemental plans).
Like somarco said, it is doubful that you would be able to get a Medigap plan because of your age, health condition, at least one at a decent monthly premium. The window to purchase a Medigap plan that works as GAP insurance with Original Medicare is only optimal during strictly defined times of guaranteed enrollment - mostly when you turn 65 years old and 1st go on Medicare.
However, for you to talk to hopefully someone that can help you better, here is the number for the California Dept of Aging - maybe they can give you better direction.
Medicare Questions - California Dept of Aging (HICAP)
Call 1-800-434-0222
Health Insurance Counseling and Advocacy Program (HICAP) serves current Medicare beneficiaries and those planning for future health and long-term care needs. HICAP counseling is confidential and free of charge. Calls are automatically routed to the appropriate HICAP.
California Medicare Counseling via HICAP
It seems you picked a Medicare Advantage plan rather than original Medicare. A Medicare Advantage plan may still work well for you - but I am not too sure that you have the best one for your needs - You have until December 7 to find out and make a switch to another Medicare Advantage plan. You can also talk to the California Dept. of Aging (HICAP) about finding a better plan, if possible.
You might be able to ask them if you qualify for Medicaid in the state of California too.
You should have the following info ready for them when you call -
- your name and address
- Your current MA name and Insurer - policy number if there is one. Have your card - MA card and your Medicare card.
- Your separate or included (with MA plan) Medicare Prescription Drug (Medicare Part D) insurer and plan #
- your current medications and dosage
- the doctor(s) name that you want to continue to use or any others you want access to -
- Your income and assets
Hopefully the HICAP representative can key in your zip code, your meds and your docs to see if there is a better MA plan for you so that you have the option of signing up for a better plan before December 7 (open enrollment ends for MA and Part D plans).
The representative should also be able to tell you if you might be able to get a Medigap plan at a somewhat decent monthly rate (they usually increase yearly). But they might just refer you to some Medigap Insurers in your area. The HICAP representative might be able to help you pick a Medigap plan. Here are the ones that were available in California in 2019.
http://www.insurance.ca.gov/01-consumers/105-type/95-guides/05-health/03-medsup/upload/MSRG2019BPoli...
Here is another way of locating one via Medicare.gov
https://www.medicare.gov/medigap-supplemental-insurance-plans/
Here is a description of the plans themselves
https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
In fact read ALL of this from Medicare on Medigap plans and coverage (note: more info is on the left side of the page)
https://www.medicare.gov/index.php/supplements-other-insurance/whats-medicare-supplement-insurance-m...
The booklet that Medicare sends to you each year entitled "Medicare and You" is also a good thing to read. Download it if you do not have it in paper form:
https://www.medicare.gov/medicare-and-you
You need more direct help than I can give you - I am no place close to California; Thank Goodness for me. Good Luck in your quest - work fast - December 7 is next week.
It's Always Something . . . . Roseanna Roseannadanna