[ThisWayOut]

I feel stuck between a rock and a hard place. I have an advantage plan for Medicare because it covers more of my preferred providers. Only it's not really paying for anything. I pay more than 60% of my medical bills via my copayson, insurance pays the other 30-something percent, but even that is less than half of what's billed. My therapist doesn't charge me the balance, but my medical doctors all send me the bill for what the insurance doesn't cover (or denies). I might as well save the monthly premium cost and send it to my providers.

Recently, insurance has also started denying some of my therapy appointments even after my t got approval for them. I'm so frustrated with this stupid system. I'm on disability for mental health reasons, but insurance is giving me hassels about it...

[healingme4me]

How have things been since you started this post?

"Investigate your hidden assumptions."-Cornel West

[ThisWayOut]

I switched insurance to the basic medicare starting tomorrow. I hope it works out better. There will be some things i need to pay more for, but I guess it will be ok b/c at least I won't be paying so much on my regular medical bills... It's also supposedly better at covering therapy. My T says she generally doesn't have to fight them on additional appointments, so that's a huge plus.

I'm not totally sure how they will be around more specialized treatment if needed, but I guess thta's a wait-and-see kinda thing. At least I don't have to pay an additional premium for it...

Now comes the fun task of paying off all the bills the previous insurance denied :/

[Rose76]

I was really surprised that you have that much out-of-pocket expense, so I did a bit of research on Medicare Advantage plans. It seems they can differ quite a bit, depending on who offers the plan AND on where you live.

If SSDI is your only income and you don't have much in the way of assets, then you should look into seeing if your state will pay your Medicare Part B premium for you. That will depend on what state you live in and how low your income is. Go to your local state Income Support office and apply for the state subsidy that pays Part B for you. (This is the same office where you apply for foodstamps.) This is an extremely good benefit to have. For more info, here's a link: SLIMB | The Medicare & Medicaid Center

I get SLIMB, myself. This benefit is offered by your state's Medicaid program. But you don't have to be a traditional Medicaid recipient to get it. I'm not covered by Medicaid for anything else - only for SLIMB. I get my full SSDI check with no Medicare premium deducted out of it. As you know, if you're paying it, that adds up to well over a thousand dollars a year. Plus, I think, once you get SLIMB, it can make you eligible for other things.

The next thing you should do is see who else is offering Medicare Advantage plans in your area. In any given area, I don't think they vary all that much, but check it out anyway. Make sure you tell the companies that you are interested in the plan that charges you the least in copays and premiums. In some areas, there are Medicare Advantage Plans that charge absolutely nothing in the way if a premium. My boyfriend has a Humana Medicare Advantage Plan, and he pays no premium.

The insurance company who covers you may have an alternative plan that wouldn't cost you as much out of pocket. It might require you to change some doctors, but that might be worth doing, if you end up saving a bunch of money.

Where you are living could be the cause of some of your expenses.

As you probably know, you have to wait till October to switch to a different plan.

[ThisWayOut]

Thank you for that link. I will look into it. It would be awesome to not have that extra money coming out of my benefits every month.

I looked into the alternate plans, but they all pretty much cost the same overall. I'm also really hesitant to switch my doctors (specifically my therapist). Most of the plans wouldn't pay for her... I switched to the regular medicare. I hope that will be better. I used to live in an area with more options, but it wasn't good for me in general... my current state is a hair better at helping low income residents, but it's still not great. They have a lot of restrictions as opposed to flat-out denial.

[Rose76]

Here's a better link:

https://www.caring.com/questions/can...part-b-payment

Here's an exerpt:

Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI). To qualify for either of these two programs, you must have low assets -- about the same as with the QMB program. But these two programs allow you to have 20 to 80 percent higher income than QMB does. If you qualify for either of these programs, it will pay your monthly Part B premium, but it doesn't pay for your Part B deductible or copayments.
You apply for all of these programs in one place, your local county Medicaid, Social Services or Social Welfare Department. To find the office nearest you, call the Eldercare Locator at 800-677-1116. Or, you can go online to the Benefits.gov web site and click on the name of your state.

[ThisWayOut]

Originally Posted by Rose76

Here's a better link:

https://www.caring.com/questions/can...part-b-payment

Here's an exerpt:

Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI). To qualify for either of these two programs, you must have low assets -- about the same as with the QMB program. But these two programs allow you to have 20 to 80 percent higher income than QMB does. If you qualify for either of these programs, it will pay your monthly Part B premium, but it doesn't pay for your Part B deductible or copayments.
You apply for all of these programs in one place, your local county Medicaid, Social Services or Social Welfare Department. To find the office nearest you, call the Eldercare Locator at 800-677-1116. Or, you can go online to the Benefits.gov web site and click on the name of your state.

Thanks! That second link had quite a bit more info. I'm not sure I qualify for it in my state (if I recall correctly, this state takes vehicles into account as "assets") but I will double-check. That would be super helpful to have.

[Rose76]

Originally Posted by ThisWayOut

Thanks! That second link had quite a bit more info. I'm not sure I qualify for it in my state (if I recall correctly, this state takes vehicles into account as "assets") but I will double-check. That would be super helpful to have.

I would be surprised if there were any state that didn't make one vehicle exempt. (Unless it was, like, a new Ferrari.) Extra vehicles, besides the one that provides your basic transport, would be considered assets in most places. That's why they ask you. They're trying to find out if you've got an expensive motorcycle or an fully-equipped RV in the garage.

Usually, they even allow you a couple thousand bucks in the bank.