I feel slighted based on my health insurance

Hi,

I have medicare and have many more problems with medical care. When I had my job's fortune 500 company insurance everyone kissed my butt. Does anyone here feel because the Dr or whomever is paid less you're facing discrimination?

You also might take a look at your Part B provider. There are different plans by Tufts, Bluecross, AARP and many more. Each one has different options and deductibles.
If you are having problems with medication that is Part D.
Signup time is right now until sometime in December?
If you want to change Part B and D now is one of the few times. Note Part B and D must be purchased from the same provider.

Hi CANDC,

Oh my gosh, thank you so much!!! I didn't even think about that and there is a window. They ALWAYS ask do you just have medicare? like it's a bad thing. I was expecting them to say we don't take that because it seems they are thinking that way.

I really appreciate it!

One more thing, do you have any idea if my Dr refers me to a specialist or hospital for an expensive test does he/she get a cut? I always wondered but I'm sure it varies.

With medicare and all insurance the Dr usually gets less than his normal rate. Some doctors are closing their offices because they cannot make a living. Many doctors have to work for hospitals at hourly wages.

Doctors do not get a kick back for sending you off to Specialist.

The problem with Medicare is , yes many Doctors are opting out of accepting Medicare because there are receiving such low payments. They will see you but you pay for the visit then you file your claim to medicare and they will reimburse you for the allowable amount.( same as what they would directly pay your Doctor)

Normally: You Doctor sees you and his/her charges 105.00 for the visit. They file the claim.
Medicare drops down the amount the Doctor can bill for.
so Medicare slashes the "allowed amount to say 75.00 then they only pay 80% of the "allowable charge".
You are left with that 20% owed by you.

If you are of age to purchase a secondary insurance that will cover your 20% That's fantastic.
If your not of age to purchase such a plan,( as I am) Yep 20% is on your shoulders to pay.

Part A covers hospital
Part B covers Doctor visits
Part D is what covers your medication costs.

Of course you have to first pay your yearly deductable before actually receiving any monies paid to your Doctor(s)by medicare.

Of course Medicare only pays 65% of mental health visits, ( if this applies to you)

Medical information and coverage is a very difficult thing to understand , I think its done that way on purpose.

Medicare without additional coverage you buy is kind of like Social Security and trying to make it living on just that without any other retirement income. It's just supposed to help out, be a bit of a safety net. What they can cover with so many people enrolled is not enough to make many doctors able to afford to have many clients who only have Medicaid or Medicare and no other insurance AND money to pay for services. I'm miffed because I have to buy insurance for January through October, when I'll go on Medicare and will have to buy the additional plans, etc. so I'll be changing insurances a couple times just this year. I had a state plan but now the state is discontinuing that for the Affordable Care plans. The one I've chosen will only save me about $35-$40 a month in premiums but has a deductible $500 greater than the plan I have now. It doesn't matter, I never meet my deductible so have to pay for everything out-of-pocket anyway, but if I'm hospitalized/seriously ill it would come into play then.

^
There's an alternative to the Murphy bill in the House (introduced by Cong. Ron Barber) that would force Medicare to abide by the same mental health parity laws as private insurers. Of course, it has no chance of passing now.

I feel somewhat similar...I have medicaid so I know that means I can expect worse/less effective treatment than if I could afford an insurance plan. Just trying to make the best of it and hope no major medical expenses come up as not sure medicaid would cover it all. Pretty sure I need to go to a dentist, as I have been having gingivitis issues(though trying to keep up on brushing/flossing and using mouthwash, salt water w/baking soda and everything else I have looked up that is supposed to help gums/teeth anyways I guess my medicaid covers some of that but there will still be a co-pay, so hopefully that is affordable.

People might think 'you're lucky to be on medicaid' oh yeah the worst plan, more like it's better than nothing but I'd be more lucky if I could work, not be on SSI and make enough to afford insurance or whatever.

Mine is with ssdi. Actually, I compared my Dr payout to my Dad who has a military suppliment Tricare. Both of our plans paid little to the Dr and were almost the same $

hi thickntired.

i highly suggest researching a medicare 'advantage plan' in your state.

just a example;

i was paying about $600 per month for blue shield's top coverage plan here in california. it was a 'ppo' and very 'rich' in coverage. i was very hesitant to switch over to my medicare insurance for lot's of reasons...

when i got the rate increase notice from blue shield for 2015 i was shocked. (yes, i have had ect. lol) it was going to be close to $700 per month. i'm 52 by the way. no way could i afford that anymore.

i researched hard about medicare and what my options might be. i had a ignorant bias towards medicare...

long story short; i found a blue shield medicare 'advantage plan' that i do not pay more for than just my regular medicare. this includes rx's. in fact, all of my doc's (except my pdoc, so far) were in the plan's network. all for $104. same insurance almost. even the card looks better than the medicare card. it looks like my old blue shield id card.

no prejudice from my primary doc. he even said 'great that you got it.'

other pluses; you usually get a free gym membership w/a medicare advantage plan. and! my plan is called 'blue shield 65+.' at 52 i feel like i must look pretty good for that plan.

most states have non-profit advisors who can help you pick a plan. look on medicare's site for help with that.

it's pretty confusing i know. please feel free to ask me questions in this thread or pm me. i'd be more than happy to help, if i can.

finally; medicare advantage plans are good. they may not be as 'rich' in coverage as the top tier private plans, but they are still very good insurance. again; many advantage plans 'mirror' the company's private or business plans.

unfortunately the one area that might be lacking is mental health. but, pdocs have the highest rate of any doctor's that accept no insurance. lame.

still, i found a plan that was also 'rich' in mental health coverage. much better than just stand-alone medicare.

hope that wasn't confusing.

like i said, just give me a shout if you like.

john

Thank you so much for taking the time to reply to my post with this much information.

Absolutely! My kids and I are on Medicaid, and I've actually had doctors who were contracted with Medicaid refuse to see one of us as soon as they found out. I asked a dental receptionist once why doctors are so biased against people on Medicaid, and she actually told me it's because they're rude, inconsiderate, and ignorant. I was FLOORED.

Now I hand over my Medicaid card just daring someone to say something about it. After all, I paid into the system for decades. I'm not rude, inconsiderate, or ignorant. Just a regular (well, maybe that's stretching it) person fallen on hard times. There should be no shame in that.

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Yeah, there is definitely a lot of bias. I've heard of people in the medical field who "knew" that "all parents on medicaid 'abused' their kids!" It's funny, because there just as many "well off" people who abuse their kids, but people just look the other way. But when someone on any type of assistance does it, it's magnified 10 times over.

This is horrible treatment of medicade patients especially the elderly. To think some people choose between electricity and medications each month😠

So, I couldn't understand a word on my medicare enrollment. I was too paranoid to add a "free" suppliment because there has to be a catch. The best Humana add ons raised my co-pay, so I added Blue Cross for $7.60 a month. So far, my MD is being more receptive and the nurse told me now I'll no longer have a co-pay?! I knew with my litany of health problems I'd use it somewhere, and I think mental health co-pays are free after a deductible.