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  I Zimbra Worst song, played on ugliest guitar Registered User regular

  December 2020

  Hey, my wife was in the same position trying to navigate disability/medicare so I showed her the post and she has quite a bit of advice. She's going to write it up tonight or tomorrow and I'll pass it along.

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  I Zimbra Worst song, played on ugliest guitar Registered User regular

  December 2020

  @DiannaoChong Here you go! If you want to ask follow-up questions shoot me a message and I can put you in touch. Good luck!
  
  Hello!
  
  My husband shared your post with me. I've gone through a number of insurance changes in the past few years, and I've spent a lot of time learning about insurance and all the ins and outs, including Medicare. I do have to give the standard disclaimer: I'm not certified in any way to give advice other than I've had to figure it out for myself. I live in the state of WI, so anything at the state level may be different depending on where you live (there's not much, since it's a federal program). Also, I might not be able to answer all of your questions, but hopefully, I can provide more information that can help you make a decision that's best for you.
  
  I don't know much about the ACA and subsidies, so I trust that you'll know more about that than I do. I can give you some more information about Medicare.
  
  For Medicare, there are a number of things to look at.
  
  First, Part A, B, C, and D.
  
  Part A is the one you get automatically with your disability determination. This covers your inpatient care, to an extent. As you've gathered, it's only going to cover about 20% of everything. (There are some other coverage gaps, like if you stay in the hospital over a certain number of days, etc.) I don't have a good link right now, but you may come across it as you do more research. This is the "free" one.
  
  Part B is the outpatient one. This covers doctor's visits, labs done in a clinic, other tests done in a clinic, PT/OT/SLP, mental health appt, etc. This is the one that costs (me) $148.50. (It cost $134 two years ago when I originally signed up.) This is, again, going to cover about 80% of your costs.
  
  (I'm going to skip part C, and go to part D, but I'll be back!)
  
  Part D covers drugs.
  
  Part C is called Medicare Advantage. These are plans offered by private insurance companies that combine parts A & B, sometimes Part D, and sometimes other benefits like vision, dental, hearing aids, medical transport, etc.
  
  There are actually Medicare parts F, G, K, L, and N, but no one cares about those unless you live in certain states, I guess. Doesn't matter.
  
  You automatically get Part A when you are approved for disability and wait your two years. You don't have to do anything to receive that. It's like getting socks at Christmas--it just happens whether you want it or not. That way, if something catastrophic happens and you end up in the hospital, you're covered by SOMETHING.
  
  If you decide to go with Medicare, you'll need to first decide whether you want to get separate Part A, Part B, and Part D plans OR if you want to just do it all with a Part C/Medicare Advantage Plan. That I can't answer for you, but I can tell you that I chose to go with the three separate pieces. I didn't see much of an advantage in the Part C plans, but that was two years ago. If I looked at them again, I may change my mind.
  
  To be honest, one of the best places to go to compare plans in your area is the Medicare website: https://www.medicare.gov/plan-compare/#/?lang=en&year=2021
  
  You enter your zip code, and they'll show you plans in your area. You can restrict it to just a particular part of Medicare. I only wanted to change my Part D plan this year, so I just had them show me part D plans. You can enter your medications, and they'll show you how much your meds will cost at different pharmacies, out of pocket vs. insurance, etc. You can filter on plan price, deductible amount, etc.
  
  There are two options for Medicare Parts A & B--you can get it through a private insurance company or you can get traditional Medicare (I think it's called). When Medicare started, the government was in charge of medical bills and benefits and all that. Eventually, private insurances started offering Medicare plans as well. Here's the secret: ALL Medicare Part A & B plans will cover the same things at the same cost. I ended up going with the traditional Medicare because it seemed like more work to go through a private insurance company, especially one that likes to restrict what providers you can use. (For example, with traditional Medicare, I can see any doctor in the county that takes Medicare.)
  
  So if you choose to keep part A & B separate, A will be free and B will cost approx $140/month. Both cover approximately 80% of charges.
  
  If you want to add on the bells and whistles that a Part C plan can offer, that may cost you more. That will ONLY be through a private insurance company. That is, of course, up to you if you want/need the extras they're charging you for.
  
  Part D is also only through private companies. Using the website I linked above was the most helpful thing for me because I could easily see which plans would cost me the least out-of pocket throughout the year. It's helpful that they give you specifics on what each medication will cost at different pharmacies as well as how much the medication will cost during different stages of part D (initial stage, "donut hole", catastrophic coverage.)
  
  In Part D, you're in the initial stage until both you and your insurance company have paid a specific amount of money out of pocket (I think it's $6,000, but don't quote me on that). After that, you're in the "donut hole" where insurance pays less and you pay more. After a certain amount spent there (again, several thousands of dollars) you then go to catastrophic coverage, where the costs are even less. This resets every year. Since you said you had an expensive med, these stages will probably be important to you. When you look at the plans at the link above, look at the details for the Part D plans--they'll tell you how much the med it for you in each stage, when you might expect to get to that stage (calendar month), etc. It's actually quite useful for a government website.
  
  Don't forget that your medications may be cheaper with a discount card from somewhere like Drugs.com. There are also ways to apply for help paying for your prescription costs. I don't know much about that since I've never applied. Here's more info about that: https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d
  
  To recap: You'll want Medicare Parts A & B OR Medicare Advantage (part C). You'll either want Parts A & B through the "traditional/government" method or through a private company. Part C is only through a private company. If you chose A/B, you'll want to grab a part D to cover drugs. Your part C may cover drugs, but if it doesn't, grab a part D.
  
  If you're like me (and I sense you are from what you said) you're thinking, "that's all well and good. But even paying 20% for medical treatment is a lot!" Trust me, I know. I've had years where I had over 100 appointments, and even a $20 copay for each appointment adds up. I've had a knee injury that has multiple surgeries, and the cost of the dozen or so surgeries I've had is well in the hundreds of thousands of dollars. Even with my husband employed, we don't have that kind of money.
  
  To help with that, there's a thing called a Medicare Supplement Plan. These, again, are through private insurance companies. The Medicare website will tell you about them, but they won't help you compare them like they will with the Parts A, B, C, and D. I believe I found another website that sent me to various companies who sell it. Odds are, if you go with a private company for A, B, or C, they'll have a Medicare Supplement Plan (also called Medigap) available. Any of the insurance companies in your area will probably have one.
  
  What does this do? It covers the stuff Medicare doesn't--copays, coinsurance, deductibles--which for those of us with chronic illness can add up quickly. It DOES NOT cover Part D copays. It also adds a few things like covering extra pints of blood if you need them (Medicare has a limit to how many they'll pay for) and adding travel insurance. https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap The best part: all Medigap insurance policies are the same, no matter where you get them! So just get the cheapest one! However, they are restricted to provider networks, sometimes. As I said above, my traditional Medicare will cover any provide in the nation that takes Medicare; my Medicare supplement, which is through a company in Madison, might not.
  
  There are a few important distinctions here: if Medicare doesn't cover something, your supplement insurance will not cover it either. For example, Medicare doesn't cover orthotic shoe insoles unless you have diabetes. If I went and got them, my supplement insurance wouldn't cover what Medicare doesn't pay--I'd need to pay out of pocket.
  
  However, if you have a SECONDARY insurance, that's different. For example, I could have Medicare and also be covered under my husband's insurance plan at work. If I need insoles, and Medicare won't pay for them, my secondary insurance might since private insurances tend to cover more services. A secondary insurance won't cover copays or deductibles, but it could reduce coinsurance.
  
  Quick term review:
  Deductible: how much you have to pay before insurance kicks in.
  Copay: a set amount paid out of pocket for a service (i.e. $20 for a clinic visit, $50 for a specialist visit)
  Coinsurance: a percentage paid out of pocket for a service (i.e. 20% of a hospital charge, 10% for durable medical equipment)
  
  Here's what my situation (and cost) ended up being:
  Traditional Medicare Part A: $0
  Traditional Medicare Part B: $148.50 (started at $134)
  Part D plan: $13.50 (I've needed to change Part D plans each year because the current plan I was on changed something that made it too expensive or unusable
  Medicare Supplement Plan: $291.00 (And that's one of the cheaper ones I found.)
  Total monthly healthcare cost: $453.00 + copays for meds
  
  I probably (definitely) spend over $500 per month on my insurance/medical care/drugs. However, other than a slight variability in the drug copays depending on what I take and when I get it filled, those are FIXED expenses. I know I'm paying $453. I don't see bills from doctors or hospitals. I don't have to worry about paying a deductible at the beginning of the year when I've just spent a bunch of money on gifts. It's $453 every month. Again, if you're going to multiple doctor appointments in a month (or a week--I have four this week plus an outpatient procedure), you could be looking at a hefty bill, even if you're "just" paying 20%, or $20 per appointment. I would probably owe upwards of $1500 just for my care THIS WEEK if I didn't have the supplement plan. I'd rather pay the $291 for the supplement plan.
  
  I would be more than happy to answer any follow-up questions or look at plan details with you (or anyone else!) if you'd like. This stuff is confusing and because there are so many different situations to cover, it's all "This might be great for you!" but there's no one to tell you how great (or terrible) it might be. I had someone contact me when I became eligible to help me find a plan, and all he did was go to the same website I gave you and type in my zip code, and tell me the cheapest plan without asking what I needed or wanted. He asked the name of my PCP to see if she was covered by the plan and kept asking me if I was spelling the name correctly since it wasn't coming up (Her last name is Reed. I'm pretty sure I had it right.) Again, I can't make the decision of Medicare vs ACA or tell you which Medicare plan to choose, but I'm more than happy to provide explanations if I can.
  

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  DiannaoChong Registered User regular

  December 2020

  Thank you! And Please tell your wife thanks as well! This information was very helpful in filling in gaps in my knowledge and I think I have a better place to start from now!

  

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