medicare advantage plan selection difficulties, can anyone help?

I am now elligible for medicare, and I want to get a plan that will meet my mh needs (since this is why I am elligible for medicare in the first place). I've run into a bunch of issues:

• none cover my preferred providers
• there are no female pcp's available within 30mi radius of my location
• no female gyn's available through the plans, forget anyone with abuse sensitivites
• to get a plan that covers my psych, I would need to pay about $500/month between plan costs and co-pays

One plan that did have both a female PCP available and covered the gyn who was recommended does not cover any mental health providers even within 100mi radius of me. they quote an outpatient mental health coverage co-pay, but there's no one they actually cover (literally, not a single provider comes up under their mental health category).

I had tried calling my local SSA office, but they refered me to the local medicare help. That person is clueless about helping anyone on disability. She told me to pick a plan then come back and she will help me enroll. I can figure out how to enroll in a plan, it's finding one that meets my needs and I can actually afford that I need the help with. If there anyone else I can call or any website I can check out?

I know the regular medicare plan would cover my providers, but I can't afford the costs associated with that (the drug plan, the medigap plan, the co-pays... all would end up costing me more than half my monthly income).

I dunno. this is so confusing and stressful. any help at all would be appreciated.

thanks

Exactly what kind of "help" are you looking for?
Psych Central Drug Discount Card.

any direction as for who to talk to that could help me pick a plan. I don't totally understand what they cover, or how I can make sure my mental health needs are met. I don't much care about meds (don't take anything regularly), but I want to make sure I have access to appropriate therapy and providers I can feel comfortable with. The plans are all so confusing...

I decided to just stay on regular Medicare, which I just got this Fall, and not select any plan that has a contract with Medicare. I figured that I wanted to see what regular Medicare would get me, and I wanted to spend this year learning about the various plans that I could sign up with. It is an awful lot to consider, and I just didn't feel like I had enough time to sort through it all during the time I had left to pick something. So I hear you about the confusion. It's actually working out pretty well. I might just stay on regular Medicare.

In my case, I get my mental health care through a state operated facility. (A hospital/clinic operated by a state university.) To my amazement, there have been no co-pays for anything. But then I am pretty low income.

Recently, I went to dermatologist. My co-pay was only $35, and Medicare picked up the rest for a minor surgical procedure. Income had no relevance for this. I was quite tickled at the low cost that I incurred.

The best source of info for how a plan works is from the people they send out to sign up new recruits. I helped a friend pick a plan that way. We went to these presentations they give. I strongly recommend going to those. I would advise you not to let any of these commission-earning promoters come to your house. That puts you under too much pressure. The presentations that are open to the public are the best way to go. Usually, you have to sign up to attend. An other option is to meet a salesperson at an office, or in a public place, like a coffee shop. But I much prefer the group situation.

You really can't depend on any public agency giving you much guidance on this. I think each state is supposed to have some web sites you can look at, but they don't tell you enough. However, do google that topic for your state.

Thanks rose76.
I'm trying to understand how the relationship medicare works, and how I would benefit (our not) from getting a plan. I don't meet my state's requirements for additional help with anything, which is why I'm looking into a separate plan... the way I'm understanding it, my copay for everything would be higher with regular medicare. I'm also not sure how it's all impacted by an upcoming move... I wish this stuff wasn't so confusing. o_O
I will look for group sales pitches in the area. Thanks for the tip!

I stuck with straight Medicare , Left me more options to see the providers I wanted too. I was able to find a prescription plan thru Humana that covers all my meds and based on my income , its free. My meds run between 1.65 to the highest cost it 6.60...

Medicare Advantage is not the same as Medigap. I'll be 65 in October so will be messing with that problem by August. My husband has an Advantage plan and I'll probably go with that since it works for our doctor. I would find a doctor(s) in your area and see what they take and work backwards, based on what they take and what gives you the most bang for your few extra bucks.

I found this a tiny bit useful: Medigap vs. Medicare Advantage Plan - Which is Best Medicare Supplement - AARP

I think part of what must be factored into the decision is what income and assets do you want and need to protect. If I got severely injured in a car wreck, fo example, and ended up in a hospital for a long stay, being on just regular Medicare would mean that I would wrack up very large bills. I wouldn't really care, though, because I own no assets and my only income is my SSDI check. That means I have nothing that anyone can sue me for. I could just default on my medical debt without incurring much of a consequence. I might not even have to do that, as most of the big hospitals in my area have programs to waive charges for people with my financial profile. There are certain advantages to being poor.

If I owned a house or had a pension independent of my SSDI, then I absolutely would not just rely on regular Medicare, as I am currently doing. I would be afraid that an extended hospital stay or major surgery could put me into serious debt that could eat up a large portion of my income and/or possibly, cost me my home, if I could not service the debt.

Geography and luck give me another lucky break. I get my health care through a hospital/clinic system that offers everything and anything. If I needed a "sleep study" done, for instance, which I am told that Medicare does not cover, they would give it to me for free. They've told me that they will eat the cost of anything that regular Medicare doesn't cover. This is because I am low income and live in the county served by this hospital/clinic system. There are advantages to living in a poor "Blue state" with a tradition of state/county provided care to the poor.

Somehow, I figure there has got to be a downside to my set-up that I may have yet to discover. So this year is an experiment for me. Getting into an Advantage plan will cost me nothing to join, but might restrict who I can go to.

In my part of the Southwest, there are no really top shelf doctors or cream of the crop hospitals. I can get everything done here, just not by the most highly rated physicians. That's the down side of being poor. If possible, you want to preserve your ability to travel to a top notch hospital and see a top notch doctor, if you develop a hard-to-treat condition. Some elective back surgeries, for instance, are best not done in the state in which I live.

Thanks Rose. I think th elack of state assitance is a huge deciding factor in me looking at advantage plans. While it limits my doctors and increases my copays, it does have a more reasonable "spread" than the regular medicare. I can space out the copays, and it would cover all my in-patient hospital stays for medical, and most of it for mh.
I'm also applying for the extra help. I was told by one person I automatically qualify because I also get a form of medicaid through the state, but it's a conditional coverage, so I'm not sure it meets the requirements for the extra help.
I am planning on moving "soon" (the time-frame is now up in the air, but preferably before the summer), so I would have to switch plans again at that time. I know the plans for where I am moving have much better coverage. I also know that I would likely get covered by medicaid in my new state, but the current one is historically difficult to get aid (very much a red state that doesn't want to help *anyone* at all, even when they are required to do so - Monthly, I have to accumulate medical bills just under the amount I get through SSDI before they will cover anything at all. If I don't meet that super-high deductible each month, I am responsible for all the bills. I try to avoid all medical care because it has happened more than once that my bill was $1 or $2 shy of the minimum so they refused to pay for anything. I didn;t get my denial until 3 months later, so there was nothing I could do but figure out how to pay it)...
Anyway, thanks for the info and things to think about. There is one plan that would cost me nothing to enroll, and would cover at least the psychologist, so that's a plus.

It sounds like you're getting a grip on this, TWA. Definitely apply for Medicaid in whatever form might be available to you. This suggests to me that you might be eligible for having the state pay for your Part B Medicare premium. If you get that, then I think you automatically get "Extra Help" on prescriptions.

There is really no one out there with the responsibility of helping you figure all this out. Being new to Medicare, I do know what you mean. Luckily, I went through the process a few years ago, when I helped a friend navigate through the system. Forget anyone at Health and Human Services knowing much about anything. The old days of having a social worker case manager to get you through the system are long gone. Those gals sitting at the computers at the place where you apply for Medicaid are basically clerks, who depend on the computer to do their thinking for them. Supposedly, they are all case managers, but they are really just clerks. A year or two from now, you'll understand things better than they do, at least relative to your own situation. People at these government agencies will give you contradicting information. Believe nothing that you are told. Just apply for everything. You will get letters in the mail approving or disapproving what you apply for. Those letters are more apt to be authoritative. What those "clerks" tell you is not.

If you're in between living in two different areas, then that does complicate things. Glad that you are moving to a more enlightened place, if I understood you rightly.

Eventually, getting into a Medicare Advantage plan will probably be the way for you to go. It probably will be, at some point for me, even if just to get free membership in the YMCA through the Silver Sneakers program that many Advantage programs sponsor.

TWO, just something to add to what everyone else has already said. Even if a PCP or other provider is male, quite often the office will have a Nurse Practitioner or Physician Assistant that if female and you can get your care from them.
Medicare (or the state) also has programs that can help you with at least medication expenses. Those phone #s SHOULD be listed in the Medicare booklet you got.
Good luck

I'm pretty well versed in medicare , medicare supplement plans etc. If you're comfortable, PM me with your specific options and I could probably answer a lot of your questions...

It sounds like you are a dual eligible person, have both Medicaid and Medicare and that's a bit different (bottom of the page): Medicaid | Medicare.gov

sadly, my state is not big on helping anyone. I only have "medically necessary" medicaid, which is a joke. It's the equivalent of major catastrophe insurence. :/

I found the same thing with the medicare advantage plans in my area so I went with my original medicare and a got supplement (or companion plan as it is called in some states) instead of the advantage plan. It has worked out really well and was less expensive. It actually covers 100% of the copays as well once meeting the deductible and the premium was less. It depends on the state. Check with insurance companies in your state to see what plans they offer.

It also works out better in some respects than private insurance with an advantage plan, because then whatever providers take medicare, there is no hassle with authorizations. However, it is just a matter of finding providers that accept medicare.

Good luck finding the plan that works best for you.

that is how I felt and there was no particular added stress to my life - if there had been such as what I face now it would have been even more difficult. If you are already dealing with STUFF you need someone who understands to advise you. You can call medicare or social security but I'm not confident their choices would be the best for me. I would find someone you can feel confident in to help you choose. Are there community assistance centers that might be able to refer you to someone knowledgeable? Or Counsel for Aging. Even though you may not be aged but just disabled they should still be able to help because both involve medicare.

search the net for "help choosing medicare plan" - there are organizations out there with people who understand all the in's and outs and the pro's and con's of this very confusing but important choice to make. I did find one that was very helpful and there was no cost to me.

Thanks A Little Lost.
I finally settled on one plan, but after all that stress, I will have to do it again shortly (moving across the country in about a month and a half).
I'm a bit frustrated that mental health parity doesn't apply to medicare...
The plan I picked has crappy mh coverage, but i is one of the best available (and the only one I can remotely afford to pick). I'm hoping plans in my new area will be a bit better. I think I will also have more help in that state though. I'm crossing my fingers.
At least I qualified for "extra help" so if I make a poor plan choice at any point, I can switch as needed.
I wish they didn't make this so darn confusing.

If anyone wants help with the do I get Medicare Advantage, Medigap, and Drug Plan, you can contact me. I used to specialize in the market.