Re: medicare

Medicare is a mess, mostly because of "free enterprise, economic competition" shibboleths--none of which pertain the medical marketplace.

Basically, there are two kinds of Medicare--fee-for-service Medicare, controlled mostly by the rapacious insurance industry, and HMO Medicare, controlled by opportunistic third parties such as Humana, Universal Health Care, and United Health Care. Hospitalization [called Medicare Part A] is not a big deal in either kind because the coverage is essentially the same. The Big Deal is Part B, euphemistically called "physicians' services."

Part B Medicare is supposed to cover physicians' services, but doesn't. There is a large financial gap between what most geezers need and what Medicare will pay for. Covering this financial gap is where the fee-for-service hucksters and the HMO hucksters go there separate ways.

First, be aware that Medicare [currently] deducts $88.50 from your monthly Social Security check to "pay" for Part B. If you are a fee-for-service person [that is, that your family doc knows at least as much as the average of the rest of the medical profession], you will probably have to buy a Medi-Gap insurance policy to cover the difference between the pittance Medicare will pay him and his monthly Mercedes payment. From ARRP, this kind of insurance costs about $135.00 and up [bells and whistles stuff] per month. But it doesn't cover drugs--so if you've got a bunch of drug prescriptions, you may want a Plan D policy. That's the new marketing Hoo-Ha with all the confusing jibberish. And since there are a zillion D plans [with no requirement that they have the same formulary], the amount one saves depends on the discount given by a specific plan for a specific drug, which is precisely why it is so confusing and difficult to choose the best one plan for any one person.

If you decide to be an HMO person, there are two or three things worth worrying about. First, of course, is the HMO--an HMO is an HMO is an etc. Restrictive panel of providers, utilization review, co-payments, and so on. Second is Medicare HMOs have a history of cutting and running. They are allowed to market their plans by geographic area [usually a county]; and if for some reason, a county does not develop enough subscribers or yield enough participating providers, the HMO simply goes away, leaving it's "members" to scramble for fee-for-service coverage.

The upside of HMO membership is, one, Social Security pays the membership fee; two, SS does not deduct $88.50 from your monthly check; and, three, HMO coverage includes drug coverage--with co-payments [no deductibles] of $10 per generic and $20 per proprietary drug. This benefit effectively cuts the price of most drugs by at least 50 percent.


On Jan 4, 2006, at 2:38 PM, Chapel Ridge Wal Mart National Hearing Center wrote:
Locally, Humana has a booth set up in Wal-Mart to answer questions. Then
the man gives talks everyday at lunches provided free at Chicago Uno or
Golden Coral. He asked a co-worker and me to come, but I'm not old enough
and Jenny is only 30. Not sure why we'd be there. But lunch at Uno would
be nice.... I hear there are as many as 40 or 50 plans to choose from in
some states. What a pain that would be.

Kitty
----- Original Message -----
From: <Cersgarden@aol.com>
To: <gardenchat@hort.net>
Sent: Wednesday, January 04, 2006 9:51 AM
Subject: Re: [CHAT] medicare was Somebody stop me


In a message dated 1/4/06 12:45:22 AM, judylee@lewiston.com writes:
if your current insurance provides medicine coverage,
the penalty is waived if you later need to use the medicare benefit for
medicine.

That is great to know. The company sent us a letter stating if we signed
up
for coverage under one of the plans we would lose all provided insurance
coverage. As confusing as it is, I hope no one would make that mistake.
Ceres

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Island Jim
Southwest Florida
27.0 N, 82.4 W
Hardiness Zone 10
Heat Zone 10
Minimum 30 F [-1 C]
Maximum 100 F [38 C]

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