Medicare

[xyz]

I will start Medicare shortly, switching from my employer's insurance plan. I understand my current medical insurance really well. Medicare seems like a black hole to me. So many unknowns.

I'll have Original Medicare (Parts A and B), a Part D drug plan, and Medigap (plan F).

Are supplies (mask, hose, humidifier, filters) covered by Part B? The agent selling the plans said that Medigap covers "everything" (non meds). Has that been your experience?

[Pugsy]

Welcome to the forum.

Generally think of it this way...if Medicare approves and will "allow" pay their share for anything your Medigap plan will pick up the leftovers.

CPAP supplies like hoses, masks, filters, machines are covered under the Part B coverage. There is a provision within Medicare for people who are already using cpap before they start using Medicare. Medicare will need a little extra paperwork to establish diagnosis and need but after that not a big deal. Whomever you are getting your cpap supplies from right now should be able to do what is necessary to get Medicare coverage rolling for your supplies. It's something the DME and doctor will have to do. Just some paperwork.

There is a time table for what Medicare will "allow" in terms of how often they will pay for certain cpap items.

[Auntducky59]

go to medicare.gov. search for CPAP . You should find the information you need. My husband just turned 65 (he is not on CPAP but SHOULD be. Still trying to get him to agree to a sleep study. He has watched my experience for a year and wants no part of it). I will be 65 in 5 years, so I did my research early. Medicare covers the same schedule as my current insurance and doctor recommendation. the same equipment I now get in 3 month, 6 month, & 5 year intervals is the same schedule as Medicare for me.

[Okie bipap]

My husband just turned 65 (he is not on CPAP but SHOULD be. Still trying to get him to agree to a sleep study. He has watched my experience for a year and wants no part of it).

My wife was the same way. I simply waited until we had our appointment with our PCP, and told her that my wife was snoring and would stop breathing while sleeping. Our PCP scheduled her for the sleep study. My wife was upset with me at first, but now feels so much better, she no longer complains about using the machine every night.

[chunkyfrog]

"The AGENT"?
I consulted with SHIIP for free, IMPARTIAL advice.
Agents work on COMMISSION.
You are not required to support a business.
Medicare is costly enough without commissions.

[SDBud]

I will start Medicare shortly, switching from my employer's insurance plan. I understand my current medical insurance really well. Medicare seems like a black hole to me. So many unknowns.

I'll have Original Medicare (Parts A and B), a Part D drug plan, and Medigap (plan F).

Are supplies (mask, hose, humidifier, filters) covered by Part B? The agent selling the plans said that Medigap covers "everything" (non meds). Has that been your experience?

Medigap (called Medicare Advantage in California) covers different things in each State, and has different rules in each as well.

[chunkyfrog]

I will start Medicare shortly, switching from my employer's insurance plan. I understand my current medical insurance really well. Medicare seems like a black hole to me. So many unknowns.

I'll have Original Medicare (Parts A and B), a Part D drug plan, and Medigap (plan F).

Are supplies (mask, hose, humidifier, filters) covered by Part B? The agent selling the plans said that Medigap covers "everything" (non meds). Has that been your experience?

Medigap (called Medicare Advantage in California) covers different things in each State, and has different rules in each as well.

Medicare Advantage is NOT the same as Medigap.
Medigap goes with original Medicare--"advantage" is instead of regular Medicare,
And is similar to MedicAID, with all the limitations of that program.
Beware--it is MANAGED care, like an HMO.

[Pugsy]

And is similar to MedicAID, with all the limitations of that program.
Beware--it is MANAGED care, like an HMO.

Not true of all Advantage plans. Unfair to lump them all in the Medicaid basket or the HMO basket.
Not to mention that some people can only get an Advantage plan because the monthly cost of the traditional supplement simply is too expensive.

Also don't assume that because an agents sells a plan and makes a commission that the plan is way more expensive monthly than something someone could buy without using an agent.
Prices and commissions are strictly regulated....and sometimes good old no agent plans actually cost more than an agent sold plan for the exact same plan.

The plans are standardized though....so a Plan F with AARP/UHC or Pioneer or Bankers Life and Casualty or whatever company...the plans are the same so people can really decide based on monthly costs.

[LSAT]

Medigap is a Medicare Suppliment plan..Medicare Part B pays 80%..the Medicare Suppliment pays 20%. (You still need a separate Part D). Medicare Advantage Combines part A, B and D

[bernieb]

Here's a pretty good article that explains exactly what medicare parts A, B, C and D are all about. Medicare advantage plans (part C) do not always cover prescriptions drugs (part D) at least not here in Florida.


https://www.aarp.org/health/medicare-in ... -easy.html

[chunkyfrog]

Well, different states might allow less funny stuff than my state--but it is a nightmare here . . .

[bernieb]

I know that many states do not have much to choose from. Here in Florida we are fortunate that in our area, in addition to all of the medigap policies to choose from many different companies, we also have 49 different part C (medicare advantage) plans to choose from (HMO's and PPO's) that include Rx drugs and 4 plans that don't include drugs. We also have 27 different part D Rx plans. Due to concentration of senior citizens there is a lot of competition for our $$$.

[Janknitz]

Medigap (called Medicare Advantage in California) covers different things in each State, and has different rules in each as well.

Incorrect.

Other's have already pointed out that "Medigap" plans, also known as supplemental plans, cover the "gaps" in Medicare coverage such as deductibles and the 20% of an allowable expense that Medicare doesn't pay.

Advantage plans or Part C combine what the Medigap plans cover--your Part A (inpatient) deductible, Part B (outpatient, laboratory and imaging) co-payments and deductibles, your Part D (Drug coverage) in one package under a managed care plan also called an HMO. Some are self-contained like Kaiser and Humana, some contract with providers but with a Part C Advantage plan you may ONLY use their providers and formulary.

Each state doesn't have different rules. If It's covered by Medicare in one state, it's covered by all states, and the Medigap/Supplement/Advantage plan must follow those rules, regardless of what state it's in. However, each Medigap/Supplement/Advantage plan may have different coverage levels, different formularies for drugs and DME, etc.

Medicare covers CPAP and has rules on how CPAP is covered, how supplies are covered. Your Medigap/Supplement/Advantage plan can vary as to what your out of pocket expenses they cover or don't, which providers and vendors you may use, and (in the case of HMO's) what masks, machines, etc. are in their formulary. But they MUST all cover CPAP and necessary supplies, and use Medicare's replacement schedule for supplies.

[bwexler]

I have had a variety of Medicare Advantage plans in both Nevada and California. They all provide what Medicare provides as a minimum but can offer additional benefits. They all have in Network providers and some variations on copays.
The one thing that is certain is that each plan will change every year. The prudent thing to do is determine which products and services you expect to use in the coming year and evaluate your total annual out of pocket with each company.
I start at Medicare.gov which will list all the plans available to you in order of cost low to high. That narrows it down to the top 4 or 5. Then a detailed analysis of those using their online evidence of insurance book.
I have found it uncommon for any company to offer the best solution 2 years in a row.
I have determined that medigap insurance would not make sense for me, but I seem to be healthier than many of you, at least within the parameters of who pays for what.