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Post by anovice on Dec 15, 2022 16:17:46 GMT
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Post by marquay on Dec 15, 2022 16:46:29 GMT
Anovice, Thank you very much for the three helpful links.
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Post by Chahta on Dec 15, 2022 16:58:12 GMT
Anovice, so in the event that I will have glaucoma or cataract surgeries, these are partially or not covered by Original Medicare? A visit to a doctor for a medical problem is covered by Part B and supplemental. A visit solely for a glass prescription is not. Evidently if a glass prescription is issued as part of ther medical visit, looks like its covered. I am sure it is all in the coding.
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Post by anovice on Dec 15, 2022 17:14:18 GMT
Anovice, so in the event that I will have glaucoma or cataract surgeries, these are partially or not covered by Original Medicare? A visit to a doctor for a medical problem is covered by Part B and supplemental. A visit solely for a glass prescription is not. Evidently if a glass prescription is issued as part of ther medical visit, looks like its covered. I am sure it is all in the coding. That is my experience. I go in for a cataract examination and make certain that I walk out with an eye glass prescription. Of course, not all eye medical issues warrant vision testing for which a prescription is readily available.
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Post by liftlock on Dec 16, 2022 1:39:37 GMT
A visit to a doctor for a medical problem is covered by Part B and supplemental. A visit solely for a glass prescription is not. Evidently if a glass prescription is issued as part of ther medical visit, looks like its covered. I am sure it is all in the coding. That is my experience. I go in for a cataract examination and make certain that I walk out with an eye glass prescription. Of course, not all eye medical issues warrant vision testing for which a prescription is readily available. My eye doctor charges extra for an eye glass RX refraction exam which is not covered by Medicare. Here is the official guide on what Medicare covers: www.medicare.gov/medicare-and-you
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Post by fred495 on Dec 16, 2022 2:39:56 GMT
That is my experience. I go in for a cataract examination and make certain that I walk out with an eye glass prescription. Of course, not all eye medical issues warrant vision testing for which a prescription is readily available. My eye doctor charges extra for an eye glass RX refraction exam which is not covered by Medicare. Here is the official guide on what Medicare covers: www.medicare.gov/medicare-and-youAgree with liftlock: "My eye doctor charges extra for an eye glass RX refraction exam which is not covered by Medicare." At least that has always been my experience under my Traditional Medicare plan. Fred
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Post by habsui on Dec 16, 2022 4:37:04 GMT
My eye doctor charges extra for an eye glass RX refraction exam which is not covered by Medicare. Here is the official guide on what Medicare covers: www.medicare.gov/medicare-and-youAgree with liftlock: "My eye doctor charges extra for an eye glass RX refraction exam which is not covered by Medicare." At least that has always been my experience under my Traditional Medicare plan. Fred The trick for eye exams is to "code" them as a medical exam, for example to check cataract conditions. Then, they may get paid by Medicare.
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Post by retiredat48 on Dec 16, 2022 4:53:02 GMT
Agree with liftlock: "My eye doctor charges extra for an eye glass RX refraction exam which is not covered by Medicare." At least that has always been my experience under my Traditional Medicare plan. Fred The trick for eye exams is to "code" them as a medical exam, for example to check cataract conditions. Then, they may get paid by Medicare. I've had catarac surgery. My eyedoctor does annual exam including eye reading checkup...NO CHARGE to me. R48
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Post by anovice on Dec 16, 2022 13:48:58 GMT
Agree with liftlock: "My eye doctor charges extra for an eye glass RX refraction exam which is not covered by Medicare." At least that has always been my experience under my Traditional Medicare plan. Fred The trick for eye exams is to "code" them as a medical exam, for example to check cataract conditions. Then, they may get paid by Medicare. My doctor includes a refraction test (vision test) as part of the medical exam for my cataracts. She wants to know if my vision is impaired by the cataracts. She accepts what my Traditional Medicare plan pays.
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Post by fred495 on Dec 17, 2022 19:37:36 GMT
However, Chatha makes a good point when he says that: "Plan F is no longer offered unless you are grandfathered in and had Medicare prior to 2020. As such the pool is smaller and getting smaller. You will be over-paying for premiums. Plan G will save a significant amount of money which exceeds the Medicare yearly deductible of $226. That is the only difference between F and G." For example, based on current premiums for AARP/UHC Medigap plans in my ZIP code, the annual savings if you pick plan G over F is $251. Fred
I should have noted in the above post that the $226 Medicare Deductible is for Part B only.
If you are hospitalized, plan F will also cover the annual Part A Deductible of $1,600. However, if plan G doesn't cover this charge, then there may not necessarily be "significant" savings under plan G.
The state of your health is an important consideration in deciding which plan to pick. It's not just about the bottom line.
Fred
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Post by liftlock on Dec 17, 2022 23:06:44 GMT
However, Chatha makes a good point when he says that: "Plan F is no longer offered unless you are grandfathered in and had Medicare prior to 2020. As such the pool is smaller and getting smaller. You will be over-paying for premiums. Plan G will save a significant amount of money which exceeds the Medicare yearly deductible of $226. That is the only difference between F and G." For example, based on current premiums for AARP/UHC Medigap plans in my ZIP code, the annual savings if you pick plan G over F is $251. Fred
I should have noted in the above post that the $226 Medicare Deductible is for Part B only.
If you are hospitalized, plan F will also cover the annual Part A Deductible of $1,600. However, if plan G doesn't cover this charge, then there may not necessarily be "significant" savings under plan G.
The state of your health is an important consideration in deciding which plan to pick. It's not just about the bottom line.
Fred
Fred495, Plan F and G provide identical coverage except for the $226 Part B Deductible which covered by plan F but not by plan G. Plans F and G both cover the $1600 Part A Deductible www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
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Post by fred495 on Dec 17, 2022 23:56:25 GMT
Thanks for the information, liftlock. Much appreciated.
Fred
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Post by anovice on Jan 5, 2023 9:25:51 GMT
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Post by Chahta on Jan 6, 2023 11:52:22 GMT
Great article. Advantage is working so well for the insurance companies they are weaseling their way into traditional Part B with DCEs. These are Direct Contracting Entities. Insurance companies get paid upfront from Medicare and share that money with contracted doctor groups. Some claims are paid from that up front money but the insurance companies get to keep up to 40% as profit if not used for benefits of the insured. Another rip off and forced participation in an Advantage type plan. Of course the beneficiaries can change doctors and escape if you are enlightened.
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Post by marpro on Jan 12, 2023 17:57:41 GMT
Great article. Advantage is working so well for the insurance companies they are weaseling their way into traditional Part B with DCEs. These are Direct Contracting Entities. Insurance companies get paid upfront from Medicare and share that money with contracted doctor groups. Some claims are paid from that up front money but the insurance companies get to keep up to 40% as profit if not used for benefits of the insured. Another rip off and forced participation in an Advantage type plan. Of course the beneficiaries can change doctors and escape if you are enlightened. Several good points on MA. I have been in MA for 14 years now, with the same doctor. The doctor also wants me to visit him every 6 months. But, I don't. However, when I need, I have visited him even sooner. The insurance companies want you to spend the money, and they send many flyers encouraging it. But, if you do not need, why spend?
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Post by Majick on Jan 12, 2023 22:23:17 GMT
I've observed that Medicare Supplement or MA plans...Primary care Doctor or any specialist will refill Rx only if/when you visit every 6 months & Not Once/year. Like it was before.
During Medicare Annual CheckUp, covered by Medicare fully 1/Yr...Primary Dr. will say up front plus do what's exactly covered & paid by medicare & nothing else. For every other issue or general Inquiry...make another appointment & come back again & see me.
The primary care Doctor will send you to their group's own specialist for any/all new or other issues or patient concerns or new questions. The primary care Dr is a Gatekeeper, filling out the referral for any/all specialists. They all will do more tests & ask you to visit 2 or 3 times within the same year for a follow-up...etc.
Thanks. Majick
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Post by gman57 on Jan 12, 2023 23:32:08 GMT
I noticed that also. Several years ago they started to want you to come in twice a year instead of once (physical). One visit for physical and once just to refill RX. I was told they want to make sure your not having any problems with your RX's etc... I've been fighting it and this year we just did a video visit for the 2nd visit. Have to do it or will not get RX renewed. What bugs me the most is they really push the home visits. Calling so much I actually blocked their calls one year it was so frequent. I think I read they make money if they do the home visits so hence they push it. I love the plan/perks etc... but only want to go when I'm sick other than the yearly physical. My wife never goes to the doctor for anything so maybe they are targeting her to at least get checkups.
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Post by FD1000 on Jan 13, 2023 5:09:38 GMT
The Doctor wants to see you twice? It's old news, I have seen for at least 15 years. I could see my family Dr once annually and can get any medication or lab work any time. But, about 15 years ago, he told me, I must see him more often, I pressured him so much, he had to admit, he is a vulture. I changed to a much better, it was good for several year, and then he started to be a vulture. Instead of doing my yearly lab very cheap at LabCorp, I must drive much longer to his office, pay for parking and my co-pay was 3 times higher. All specialty Dr insist seeing them twice. If they send you for test, MRI, scan, you must see them again to get the results. I always ask the PA to call me with the results. I decided to make a big deal out of it one time. My Ortho insisted I visited his MRI facility(more money to his pocket) and when I asked the tech guy can if he give me the result, he was in panic "I have very clear orders never to give anything to anyone except the Ortho". So, I called the Dr and asked him to give me the results. I told him, his PA can do it. He refused and said, you must show up or I won't tell you the results. I told him there is no way, I will spend 2-3 hours, parking, and waiting for him to tell me something that takes 2 minutes. I called my insurance and explained the situation. The insurance called him and ask him to release the results...and he did. The results were negative, there was nothing to discuss. Two years later, I had another problem and came to see him. He told me I was the only one that pull this trick. I told him, that he is the one who pulls tricks and please explain his attitude. He smiled and admitted "you got me" BTW, Ortho Dr are making easily over 0.5 a million. I know a lot about Drs, I worked over 15 years in healthcare IT. My company specialty was how to save Drs and hospitals money. HC=Health care Repeat after me, MDs, HC insurance companies, pharma companies, hospitals = vultures. You, me and all the patients are not the clients, this is where the problem starts. The rest is just BS. Expensive education, malpractice are all excuses=BS.
Last year, I turned 65. After extensive research, I selected original Medicare G + supplement. Sure, it's more expensive, but I have access to a lot more of the best Mds, there is no advantage out of 60-70 that have all my Doctors = warning. 2023 has less doctors I like that 2022 = red light. But also, my doctors run the show, no insurance have to authorize anything. I'm young but when I get be 75, I don't want to deal with DD=delay+deny. That's why I got plenty of money.
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Post by Chahta on Jan 13, 2023 11:54:26 GMT
Any refill I need gets called in by the pharmacy after I OK it. I do not visit the Dr. for refills.
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Post by anovice on Jan 13, 2023 13:13:37 GMT
Any refill I need gets called in by the pharmacy after I OK it. I do not visit the Dr. for refills. Me too. The duration between the interaction with the physician has to do with how much liability he/she/institution will accept and not based on the Medicare plan.
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Post by FD1000 on Jan 14, 2023 4:54:16 GMT
Any refill I need gets called in by the pharmacy after I OK it. I do not visit the Dr. for refills. Me too. The duration between the interaction with the physician has to do with how much liability he/she/institution will accept and not based on the Medicare plan. Liability is a bogus excuse. I have an excellent family Dr. He sees me once a year for my yearly exam. He sends the prescription to any pharmacy I want based on my symptoms without seeing me if they make sense. Examples: almost any cream, even stronger that usually a Derm DR does. Eye infection? no problem. Any reasonable lab work? right away. Other stuff that come up. Some of that can be the first time. I guess he trusts my judgment. When I message him thru the portal, it's very detailed and he reads these all day and night. It happens so many time between me and the wife. He answered all day, many time at 11 PM or 2 hours in Sat-Sun after I sent the message. As you can guess, he is not on any advantage plan and of course he is on original Medicare. Refills are a breeze. Many times he just does it for 3-12 consecutive months with one text to the pharmacy. He just knows which prescriptions are only once but others I may need more, just in case to have extra at home. Because he is so good, he doesn't add new patients for over 10 years, The family Dr I left insists on seeing me for almost everything. Remember, vultures.
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Post by anovice on Feb 12, 2023 10:39:28 GMT
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Post by marquay on Feb 12, 2023 16:11:47 GMT
After reading and gathered all informations;
I plan to be in Traditional Medicare + "High deductible" plan G. Premium is much lesser with a $ 2700.00 deductible to meet first. Silver script Plan D. Since I'm healthy, not taking any prescriptions, and I see doctors only for my yearly check-up and ultrasound once every two years to monitor my thyroid. I'm not sure with MA, though the SHIP(New York) advised that I can always switch to Traditional Medicare as long as I don't have a gap, I want to be sure I get to Plan G now as this might disappear like Plan F and even if grandfathered, the rate will be higher by the time I decide.
Any opinions?
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Post by bobfl on Feb 12, 2023 17:32:10 GMT
Heck yea, I have an opinion about Medicare supplements. I paid big money for health insurance when I retired. Plus I had a very big deductible. When the Affordable Care Act came, it significantly reduced the cost, thank goodness. I wanted the very best Medicare supplement. The premium seemed cheap compared to what I paid before for poor benefits prior to Medicare. I got AARP's United Health Care Medicare Supplement, Plan F (now G). But I still have F (grandfathered) which pays for the $200 annual deductible (which is the difference between F and G). After MANY hospital stays (heart surgery, etc.), we have not paid a penny. My wife looks at the bills because I hate to see how high the charges are. She was out of town so I looked at a bill that came in. I freaked. She said don't worry, it will all settle out when they resubmit and the bill will drop to zero. It did. A friend got an advantage plan and confirmed a hospital was in network. Then the bill was rejected because the insurance company said the hospital was not in network. MAKE SURE YOUR SUPPLEMENT IS ACCEPTED ANYWHERE MEDICARE IS ACCEPTED. NONE OF THIS IN AND OUT OF NETWORK BS. ALSO, Confirm that the hospital accepts Medicare. The biggest hospital in my city fights with Medicare and sometimes stops accepting it. MAYO, in my city did not accept Medicare for years. If you showed up at their door step with Medicare they transferred you to another hospital. They now accept Medicare here. My sister-in-law got another supplement (there are many letters, plans). She constantly complained about the massive deductions. She was lucky enough to be able to switch to Plan F. All complaints stopped. (Edited: We were just informed that she is in the hospital Emergency room as I write. Possibly a stroke. She was healthy last week.) Be aware that issues can surface even with a great policy. I had two doctor's staff say they would not take my plan. They were clueless idiots. You always have to check and know more than the doctor's staff and coders. They frequently get things wrong. The latest was an eye doctor's clerk. I swear she was collecting the $200 deductible, which she told my wife she had to pay and she probably pocketed the cash. I fought with that moron for 2 months to get my $200 back. I only got the money back when I told her I would send a letter to the doctor's home explaining what she was doing. The hospitals seemed to know the rules but have to recode and resubmit when the payment gets rejected. I had a close friend who was a doctor and wife, a nurse. She actually showed another doctor's staff how to code her stuff so she got coverage. The local staff can be clueless and cause you to pay if you don't understand. You can always check directly with the insurance companies about coverage issues. About being healthy: A friend was healthy until a horse fell on him. You are healthy until you suddenly have to have 5 hospitable stays.
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Post by anovice on Feb 12, 2023 21:03:11 GMT
After reading and gathered all informations; I plan to be in Traditional Medicare + "High deductible" plan G. Premium is much lesser with a $ 2700.00 deductible to meet first. Silver script Plan D. Since I'm healthy, not taking any prescriptions, and I see doctors only for my yearly check-up and ultrasound once every two years to monitor my thyroid. I'm not sure with MA, though the SHIP(New York) advised that I can always switch to Traditional Medicare as long as I don't have a gap, I want to be sure I get to Plan G now as this might disappear like Plan F and even if grandfathered, the rate will be higher by the time I decide. Any opinions? I have read a number of posts on the Bogleheads Forum from people who are healthy and really like their HD plan G. The premiums are low, they know their maximum yearly out-of pocket, and they can afford the $2,700 deductible. New York also has unique rules regarding switching Medigap plans. I believe that if you have HD plan G and your health deteriorates, you can switch to Plan G at any time without underwriting. The folks at SHIP or a good broker can confirm this.
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Post by archer on Feb 12, 2023 21:24:14 GMT
My medicare plan is with Kaiser. As an HMO operating for decades, they probably have it down pretty well how much they need see, test, and treat, to prevent more costly procedures later. My Dr wants to see me once every other year for a physical, which since covid has been via zoom. My labs are also every other year, but follow ups are scheduled if anything is out of normal. I like the arrangement. I don't want to see the dr and the dr doesn't want to see me. If I have a concern, they are very responsive.
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Post by bobfl on Feb 12, 2023 23:21:21 GMT
You can switch to Plan G at any time without underwriting. But you will have to pay a higher rate based on a number of variables. They may even exclude preexisting conditions, so definitely discuss with your provider.
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Post by anovice on Feb 13, 2023 10:44:51 GMT
You can switch to Plan G at any time without underwriting. But you will have to pay a higher rate based on a number of variables. They may even exclude preexisting conditions, so definitely discuss with your provider. Nope. "New York State law and regulation require that any insurer writing Medigap insurance must accept a Medicare enrollee's application for coverage at any time throughout the year. Insurers may not deny the applicant a Medigap policy or make any premium rate distinctions because of health status, claims experience, medical condition or whether the applicant is receiving health care services." www.dfs.ny.gov/consumers/health_insurance/information_for_medicare_beneficiaries
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Post by bobfl on Feb 13, 2023 13:12:36 GMT
But you will have to pay a higher rate based on a number of variables. They may even exclude preexisting conditions, so definitely discuss with your provider. Nope. "New York State law and regulation require that any insurer writing Medigap insurance must accept a Medicare enrollee's application for coverage at any time throughout the year. Insurers may not deny the applicant a Medigap policy or make any premium rate distinctions because of health status, claims experience, medical condition or whether the applicant is receiving health care services." www.dfs.ny.gov/consumers/health_insurance/information_for_medicare_beneficiariesYes, for the initial enrollment. But, From www.medicalnewstoday.com/articles/when-can-i-change-my-medicare-plan-2#costs"It usually costs nothing to switch Medicare plans. However, people who switch plans may face higher premiums. Some people may also face penalties for switching to certain plans after the IEP. People who opt out of Part B and then enroll later may pay 10% more on their premiums for every year they opt out." Ask an agent from the company you plan to switch to in the future. They can tell you quickly. medicarewire.com/medigap/plan/aarp-medigap-plans-new-york/And please note on the site above that the exact same coverage (actual government defined policy) can be priced differently by the provider (insurance company)!!! State Farm wanted to charge me a lot more than United Health Care - AARP for the government plan I chose (Plan F at that time.) I asked my agent why she was going to charge so much more. All Plan Fs are the same. She smiled and said, "Because you get me." That is all she could say because the policy is dedicated by the government. I said I already have a good UHC agent, so sorry. Generally you don't need an agent because you deal directly with the insurance company (perhaps via AARP initially for sign-up only) and the doctors clerks. I once had a doctor tell me the wrong thing about coverage. He ultimately decided not to charge me for his mistake. I have a GP now who knows everything about what is covered.
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Post by Deleted on Feb 13, 2023 15:26:38 GMT
This a great discussion. Lots of great ideas and explanations about options and pitfalls.
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