Medicare - Insurance Coverage

[Middlesista]

For folks in Massachusetts - what are your experiences with Medicare and all the various parts and supplements in our state? is It possible that the meds are covered including rituxin and which insurance supplement is neended for this. I am starting to read up on the info and it is a bit confusing to me and I know that good coverage is important for us and I also know that I have learned that folks here have very helpful information. Also - can a person continue with the insurance they had when they were working and add Medicare on also. Any help much appreciated. Thanks

[vdub]

I can't speak specifically to Medicare in Massachusetts, but I have been on Medicare for 2 years now and haven't had any issues with seeing the many specialists I go to or paying for drugs. I would say that if you have any issues, it will be with the supplement you have.

[drz]

My Medicare does not preclude me from seeing any specialist although some clinics and doctors will not accept Medicare assignment which means it can be very expensive to see them. Usually Medicare rates are only a small percentage of what is billed for the medical services so you would then have to pay the difference if they do not accept Medicare assignment. In addition there is usually a co-pay for most services covered by Medicare.

I was also told by an ENT surgeon at Mayo they would not do my BAHA surgery unless I paid $60,000 cash so I had to go to another facility where they accepted Medicare assginment that covered the entire cost. They had also refused to accept me eight years ago for in-patient care since i had just gone on Medicare even though their web site had stated they accept Medicare patients from in-state and border states for Medicaid patients.

I also know many people who opt for Medicare plans that are captive network plans cause those plans tend to be much cheaper but then you are limited to physicians in their network unless you can get a out of network referral.

Most clinics will help you sort out your insurance coverage before you see them.

[Middlesista]

Right - the supplement is important. One of our case managers suggested blue cross and another spoke about Part D. Thanks for your insight on this vdub

[Middlesista]

Thanks drz. $60,000 up front - crazy

[drz]

Thanks drz. $60,000 up front - crazy


They have a lot of rich clients and get many millions in donations every year so that might be routine business for them. But one can understand why they avoid Medicare patients since my million dollar bill would probably have netted them 20-30% of that if they were lucky.

[John S]

I have Blue Cross Blue Shield plan G and Medicare. I also have part D. Part D covers drugs hat you get from the pharmacy, not drugs administered as a medical procedure.
My plan has covered visits to Cleveland Clinic to see Dr. Villa-Forte and has alco covered the Rituxin treatments. I pay out of pocket for travel , food, and hotel. I probably could get the treaments in Chicago and save a lot of travel expense but I like, respect and trust Dr. Villa-Forte.

[ColleenS]

Hi there...haven't been on here for weeks so this may not be helpful anymore. Try and find a SHIP counselor. They can explain Medicare and options. I am one here in Wi. I believe Massachusetts is like WI with their supplements. You have 6 mo from when your part b starts of guarantee issue. This means a supp must take you. If you go beyond they will ask you health ?s and can deny you. You can waive your medicare part b and keep your employer ins. When your employer coverage ends you will have a special enrollment period to get into part b and therefore a supplement. A medicare adv plan has to take you regardless of health. In my job i can't recommend what to do. Since this is not work related i can say a supplement is what i would pick since we know we have health issues. You can go anywhere that takes medicare. If medicare pays your supplement pays. Advantage plans have less choice of providers..must stick to networks. You have co pays as you doctor. $50 per specialist visit is typical. These co pays can really add up. With a supplement You can add riders. For exp there is one that pays your Part A deductible($1340 this year). You pay your monthly premium for your supplement and that's it besides a deductible. Your drug plan is completely separate if you get a supplement. Do a planfinder on Medicare.gov. Every fall is open enrollment. Do the planfinder every time as plans can change annually. Hope this helps

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