I turn 65 in about 15 months and I am so hoping all my blood work will be covered.
Okay, I am already on Medicare thanks to SSDI. I get a Medicare Advantage PPO because it allows me the most flexibility at 60.
Right now there is standard Medicare (A/B) which pays MOST of your medical but leaves you with 20% of the balance. Medicare D is the prescription part of the mix.
Then you have Medicare C...the "bundled" aka Advantage plans administered thru insurance companies (for a fee). There are several types there:
Medicare Advantage without Plan D bundled into it.
Medicare Advantage with Plan D bundled into it.
These are further broken down into HMO's, PPO's, and PFFS. The last is the Private Fee For Service and the most difficult to navigate.
HMO's and PPO's function similar to the do in all insurance.
Then you have Medicare Supplements also known as Medigap, Plan A thru something...and they are also cover the extra 20% that Medicare doesn't cover. Plan F is the most comprehensive and covers the MOST but is also the most expensive.
The difference between Medicare Advantage and Medicare Supplements is:
Advantage plans are limited in where they are accepted. Or where they can be used.
Supplement plans are accepted by
ANY doctor/medical facility that accepts Medicare.
An example that I ran into:
I used BCBSTN when we lived in TN and had no problems. Moved to within walking distance of SC but our physical address is NC. That year we could swap mid year cause we moved. So we went with BCBSNC (BIG FAT mistake). As mentioned, we live within walking distance of SC...and there is an excellent PCP in SC (5 min drive) but BCBSNC considered him OUT of network just because he worked in a different state. Our second best option IN NC was 45 mins away. So during open enrollment in 2013 we looked around. Decided on Humana, it's a regional PPO BUT it's based on a certain radius around your zip code (state lines do not apply). Because MOST of the medical within a 30 miles radius to us is in SC, it made far more sense.
Then you have the cost issue.
You have a fixed cost for Medicare B and a deductible, this year:
Medicare 2015 costs at a glance
2015 Costs at a Glance[/B]
Part B premium Most people pay $104.90 each month.
Part B deductible $147 per year.
Part A premium Most people don't pay a monthly premium for Part A. If you buy Part A, you'll pay up to $407 each month.
Part A hospital inpatient deductible
You pay:
- $1,260 deductible for each benefit period
- Days 1-60: $0 coinsurance for each benefit period
- Days 61-90: $315 coinsurance per day of each benefit period
- Days 91 and beyond: $630 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
- Beyond lifetime reserve days: all costs
Part C premium The Part C monthly The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.
">premium varies by plan.
Part D premium The Part D monthly The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.
">premium varies by plan (higher-income consumers may pay more).
You see the Part C premium varies by plan? It ALSO varies by state. The same level plan with BCBSTN cost me about $30 a month on top of my part B costs. Moved to NC, it went to $121 per month for the same level plan with fewer options.
We also had PFFS options here in NC that we didn't in TN.
This part is what BOTHERED me:
http://www.medicare.gov/sign-up-cha...tage-plans/private-fee-for-service-plans.html
Show your plan membership ID card each time you visit a health care provider. Your provider can choose at every visit whether to accept your plan’s terms and conditions of payment.
That is why we avoided the PFFS. And since we LIKE PPO's, we opted for the PPO. Since Jan 2014, we've been on Humana...no issue using the PCP 5 mins away. He is IN network for me.
Medicare Supplements (esp Plan F) are ideal
ONCE you are 65 to 70, but before 65 and after 70, they get pretty expensive.
