I'm going on Medicare in 2011. What cons do I need to look out for with Medicare?

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57f with Multiple Sclerosis, married on disability,

Answers 1 to 6 of 6
Medicare does not cover all medicial bills so it is good to have a medicare supplement policy esp. since you have MS also some docs will not take pt.s on medicare only or you may have get an ok from medicare while if you have a good supplement most docs will accept you. You will get a medicare booklet each year which explains everything and your MD's office has to bill medicare first for bills to get paid,
Check to see if the doctor you are seeing accepts "assignment" ? Otherwise you may have to pay for office visits or a portion thereof.
My Mom just received her Medicare book...and I mean "book" in the mail. (Hasn't the government heard of the "paperwork reduction act?")
I, too, would like to hear from others about their experiences in enrolling themselves or enrolling a loved one. I understand things better when I hear from others that have gone through the process.
Castoff: what does accepting someone on "assingment" mean?...thanks...
Top Answer
I have straight Medicare, and never purchased supplemental insurance. I've had it for more than ten years and am under 50. The only con I've found is that it can be confusing as to what your out of pocket costs will be for surgeries. If you are inpatient in the hospital you will have to pay appx $1100 to the hospital as a coinsurance amount. The amount covers the first 60 days. In my case, I needed two surgeries (at separate times) so I scheduled them 50 days apart, therefore I only had to pay one coinsurance amount of $1100. I also am responsible for 20% of Dr fees, xrays, mri and such. Lab work is paid completely by Medicare. On average, I am responsible for $13 for a Dr office visit, and outpatient surgeries have cost me under $400. Inpatient surgeries have been $1100 for the hospital and about $150 for surgeon and anesthesiologist. If I had supplemental insurance I'd be paying anywhere from $100 to $400 per month for the insurance, and then a copay amount for a Dr visit (amounts vary with plans, but are generally $15-$25). I figure I've saved a large amount of money over the years by NOT paying that monthly fee for extra insurance.

When a Dr accepts assignment they are saying they will only charge you for the amount Medicare deems acceptable for an office visit. An example would be you go to a Dr, and they normally charge $200 for a visit. The office bills Medicare $200, but the amount Medicare says is customary for the area is $100. Medicare will pay the Dr $80 and you will be billed for the other 20% or $20. You will get a statement from Medicare that you can be billed the $20, and your Dr office will send a revised bill stating the original charge of $200, Medicare paid $100, they are subtracting $100, and you owe $20. If the Dr doesn't accept assignment you can still go to them, but you could be responsible for an extra 15% over what you would have had to pay if they did accept it.

Re: the Medicare book... you can opt out of getting the book every year. Call Medicare at their 800 number, or log in to their website and you can check a box saying you'd rather get the book online.

Medicare has an easy to use website where you can see a history of the medical bills that have been submitted for you as well as lots of info. Their customer service people are surprisingly helpful, especially if you have read thru the Medicare book and have a basic understanding of the program.

You do need to sign up separately for Part D (the drug plan) if you don't get a supplemental policy. I used the Medicare website to sign up for that and picked a company that covered all of the medications that I take. It costs me $38 per month, which is deducted from my social security payment before I ever get it. They do change which drugs they cover every year, so it takes a little bit of homework making sure that I won't incur more out of pocket charges than necessary. One of the great things about my particular policy is that I can get my prescriptions by mail and get a 90 day supply of generics for $7 each. That amount changes yearly too (the copay).

I've found that NOT having a supplement has given me more freedom to choose which caregivers I can pick because many supplements have restrictions on who you can see or how many services they say you can get. Many policies require referrals for anything more than basic services, which can lead to more waiting and more paperwork.

good luck!
I pay 253.00 dollars for AARP supplement here is NY but never have any co-pays to pay and all my docs like that combo then I have a drug plan with AARP also and do have to make copayments I do not use the mail in benefit because this way the pharmancy calls the docs when a med needs renewing and calls me when to pick it up and since I am on a lot of meds this works for me.
Mom recently changed from Railroad Medicare to a Medicare Advantage plan. It costs less out of pocket than paying for a supplemental plan and a prescription plan. I will be interested to see what impact the healthcare reform has on Medicare Advantage Plans. It has been much simpler to have all her coverage with one plan.

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