hi all. I have been lurking reading all the interesting posts for a few days and finally made a profile today. I hope to be pre-op soon but have to see how all the steps line up. I'm on SSDI and will get Medicare in May. However, I don't understand whether I should try to pay for one of the Medicare advantage plans and how this will affect getting my wls paid. Medicare has officially made me lose my mind with all the different programs so I'm slightly confused unfortunately. Anyhoo...just wanted to say hi and that so far I am loving the information on this site.
Hi from Alabama
- Thread starter Mstay1985
- Start date
hilary1617
First time at the rodeo.
- Joined
- Jan 6, 2014
- Messages
- 3,764
Welcome Mstay. I have no clue about advantage plans, but am glad you are here! 
newanatomy
Well-Known Member
- Joined
- Jan 5, 2014
- Messages
- 2,983
Hi and welcome. I hope you are able to find answers to your questions.
more2adore
Well-Known Member
Welcome to the site!
Welcome @Mstay1985
Okay, as someone ON Medicare...
First, are you still covered on your spouse's insurance?
IF NOT, get an advantage plan, either a PPO or an HMO (NOT a PFFS one). Reason being, with JUST Medicare, you only get A & B...and are still responsible for the 20% that Medicare will not pay. AND you have to have Plan D as well, the prescription part.
IF you are, then Medicare will be secondary to your spouse's insurance as long as your spouse is working. And after that insurance covers all your medical, Medicare picks up the 80% of what is left.
Confused yet?
Example, say you are a dependent on another insurance that is primary to Medicare and as long as your spouse is gainfully employed and can carry you on his insurance, then Medicare remains secondary..
His/yours would be insurance A and insurance A pays 85% of your medical services:
You end up having surgery....cost is 20K (a made up number). Insurance A pays 85% or 17,000. That leaves a balance of 3,000. Medicare then pays 80% of the 3K. That means they would pay 2400. THAT leaves a balance of 600 that you would have to pay.
The rules are different if both your spouse and you are retired. but given the 1985 on your user name, I am assuming you aren't of retirement age yet.
If you are single, then YES, YES, YES, get a Medicare Advantage plan.
Okay, as someone ON Medicare...
First, are you still covered on your spouse's insurance?
IF NOT, get an advantage plan, either a PPO or an HMO (NOT a PFFS one). Reason being, with JUST Medicare, you only get A & B...and are still responsible for the 20% that Medicare will not pay. AND you have to have Plan D as well, the prescription part.
IF you are, then Medicare will be secondary to your spouse's insurance as long as your spouse is working. And after that insurance covers all your medical, Medicare picks up the 80% of what is left.
Confused yet?
Example, say you are a dependent on another insurance that is primary to Medicare and as long as your spouse is gainfully employed and can carry you on his insurance, then Medicare remains secondary..
His/yours would be insurance A and insurance A pays 85% of your medical services:
You end up having surgery....cost is 20K (a made up number). Insurance A pays 85% or 17,000. That leaves a balance of 3,000. Medicare then pays 80% of the 3K. That means they would pay 2400. THAT leaves a balance of 600 that you would have to pay.
The rules are different if both your spouse and you are retired. but given the 1985 on your user name, I am assuming you aren't of retirement age yet.
If you are single, then YES, YES, YES, get a Medicare Advantage plan.
Larra
Well-Known Member
- Joined
- Dec 31, 2013
- Messages
- 3,524
Hi and welcome! Glad to see you here.
And wow, already some great info on Medicare from @southernlady!
And wow, already some great info on Medicare from @southernlady!
Hello!
sorry I missed this before, glad to have you here.
sorry I missed this before, glad to have you here.
Whit
Well-Known Member
Welcome to the group.
brooklyngirl
Yankee gone south
Glad @southernlady was able to give you some info!Similar threads
