Medical insurance suggestions?

[Wantok]

I just found out today that I am going to have to change my supplementary coverage (I have Medicare Part A and B). I am just beginning this CPAP stuff and I will be getting my equipment on my current insurance, but going forward starting in June I will be getting supplies, etc. and any changes with my new insurance. Anyone have any comments about what to look for, make sure about, when getting my supplementary coverage?

(I live in Santa Cruz, California, so if anyone happens to know anything more in particular about coverage here, that would be amazing and much appreciated.)

Thanks in advance!!

[DreamStalker]

I've found that most insurance is a scam. You're odds are better going to Vegas to establish an emergency security fund off your winnings.

By the time you pay for premiums and out-of-pocket expenses, you could just get what you need from cpap.com host and break even.

[LSAT]

I've found that most insurance is a scam. You're odds are better going to Vegas to establish an emergency security fund off your winnings.

By the time you pay for premiums and out-of-pocket expenses, you could just get what you need from cpap.com host and break even.

This statement is absolutely ridiculous....When you pay a premium, it is not just for CPAP expenses it is for all medical expenses for the year. With Medicare and a suppliment, the most you will pay is 20% of the Medicare allowable amount.
In some cases the Suppliment will cover the co-pays.

[DreamStalker]

We'll see just how ridiculous it is when the federal government runs out of money for Medicare .... Oh! That's right, they already have.

So far they have only had to borrow $17 trillion to make payments for all the stuff they ridiculously give away to us

Let's see how much longer they can keep borrowing before the investment markets say we've been Enroned or we've been MF Globaled, or we've been Greeked or we've been Cyprused.

[hyperlexis]

I just found out today that I am going to have to change my supplementary coverage (I have Medicare Part A and B). I am just beginning this CPAP stuff and I will be getting my equipment on my current insurance, but going forward starting in June I will be getting supplies, etc. and any changes with my new insurance. Anyone have any comments about what to look for, make sure about, when getting my supplementary coverage?

(I live in Santa Cruz, California, so if anyone happens to know anything more in particular about coverage here, that would be amazing and much appreciated.)

Thanks in advance!!

Did you just qualify for Medicare or have you had it for years? Do you have a supplement now? How long?

If you JUST qualified for Medicare you have a very short open enrollment to get guaranteed issue on a supplement plan. If you fail to sign up, and try to wait to do so later, after the guaranteed issue period, the supplement plan insurer can then underwrite you and deny you for preexisting conditions (welcome to America....).

If you currently have a Medigap plan, do NOT stop the coverage until you sign up for another --- or else you could be back to square one.

All Medigap plans, fortunately, were standardized by the federal govt decades ago (and without screams of death panels, imagine that....) -- So one insurance company's Medigap plan Type A, B, C, etc. plan is exactly the same as another's -- so shop by price. Medicare.gov has a very extensive online program to use to help you compare plans based on where you live, your prescriptions, and your state of health -- it is very similar to the way the new Obamacare exchanges will soon offer online individual insurance plan comparisons for a particular locale, etc.

Things get complicated when you pick a "Medicare Advantage" plan instead of a Medigap plan -- with those, the basic benefits are standardized, but co-payments and provider networks vary greatly. You need to be ok working inside the restrictions of a PPO or an HMO (possibly changing providers) and know all the potential co-pays you could be dealing with. However, if you take the time to investigate and are lucky enough to have good Advantage plans available in your county, you could save hundreds or thousands in premiums and drug and co-pay costs each year as compared to paying for a Medigap plan + a separate drug plan premium + the standard Medicare monthly premium.

Your best bet is calling Medicare, or trying the Medicare web tools, and then calling the insurance companies you are interested in and asking about what the costs of CPAP equipment would be etc.

[Kitatonic]

As a fellow SC hose heads, we are on retired employer group HealthNet PPO, but use the HMO part of the insurance with PAMF. We are not on Medicare yet. Hyperlexis had good suggestions related to enrollment and insured coverage. Our insurance covers 100% with ordering thru Apria. Please feel free to PM me, should you have further questions.

[chunkyfrog]

California Department of Insurance should have a free consultation program for seniors shopping for insurance (i forget the name)
They put all your meds and conditions into a program that weighs all expenses HONESTLY.
I went to SHIIP in Nebraska, and it was free, and they gave us our best five companies and the premium vs co-pay figures for each.

[Janknitz]

Medicare supplement policy offerings vary by county, so what works for me in Sonoma county may not work where you are.

On the back of your Medicare and You guide you will find a phone number for HICAP--Health Insurance Counseling and Advocacy Program. This is FREE counseling about Medicare, and they can really help in this situation. The California ONLY number is 800-434-0222. In other states, this program is called SHIP. If you can't find your Medicare and You booklet, the number for your area will be found online at Medicare.gov

Make an appointment to go see them. Tell them you are specifically interested in DME coverage for CPAP. Compile a list of your medications including dosages to take with you to the appointment. When you have your counseling appointment, you want to choose your supplemental policy FIRST by medication coverage, because that's the biggest expense that can bite you in the behind if you pick a rotten plan. THEN you want to know if the supplemental policies you are considering will require you to go to only preferred DME providers, and whether or not you can work with them.

Medicare mandates CPAP coverage, and Medicare sets the prices. In a traditional Medicare program, you get the same coverage, regardless of who your supplemental insurer is, but SOME of the supplemental policies cover the co-pays and deductibles for you, so you'd want to know that. If you choose a Medicare Advantage plan (Part C) i.e. Kaiser, then you may be VERY limited in vendors and formularies for equipment. So you want to consider if that is an issue for you or not.

HICAP can really help you sort all this out. Their volunteers are highly trained and do a great job.

[Wantok]

Have medicare for a year and medigap, need to switch medigap right now. Very useful to know all medigap (A, B, C, etc.) are standardized so shop for price! Thanks all for your help.

[chunkyfrog]

All plans are different, must talk to HICAP first.
That way you won't find out you screwed yourself for the best premium price.

[LSAT]

Have medicare for a year and medigap, need to switch medigap right now. Very useful to know all medigap (A, B, C, etc.) are standardized so shop for price! Thanks all for your help.

Medigap plans are NOT standardized...they vary by state and county.

[hyperlexis]

Have medicare for a year and medigap, need to switch medigap right now. Very useful to know all medigap (A, B, C, etc.) are standardized so shop for price! Thanks all for your help.

Medigap plans are NOT standardized...they vary by state and county.

No, you are simply wrong.

They ARE standardized. The benefits of all Medigap plans were standardized by the Federal government in 1992 and then again thereafter.

http://www.medicare.gov/medigap/default.asp

[chunkyfrog]

Then why the huge difference in premiums and co-pay?
If they are identical?

[RogerSC]

I'm also in Santa Cruz. Luckily, I got my cpap machine when I was on employer's insurance, no problems at all, and all paid for 10 months later when I retired. Just went through switching to Medicare and getting a Medicare Supplement plan as well, about 6 months ago. The Medicare Supplement packages are standardized, the Medicare Advantage ones are not. The Medicare Advantage plans varied quite a bit per locale and with services provided as well. I started on the Health Net Seniority Plus Ruby Medicare Advantage plan because it was okay with Santa Cruz Medical Clinic, but then found some of the marketed services were rather "thin", so switched to save money. I have my Medicare Supplement plan through AARP/UHC, I think that it's the "N" one. I'm guessing that individual price differences on the Medicare Supplement plans are due to the fact that there are several Medicare Supplement plans available, spec'd out as to services and co-pays, etc. Each plan is named via a single letter, like "A", "B", "F", "N", etc. I don't know if the Medicare Supplement plans monthly premiums can vary per provider or not, but the levels of service are standardized for each plan, and each named plan has its own specified co-pay amount.

I've had no problem seeing doctors and getting tests done, or getting cpap supplies (as my DME allows *smile*) using Medicare with the Medicare Supplement plan. I do have a small co-pay ($20) for office visits. Since I don't go to the doctor very often, I'm fine with that.

I can recommend Dr. Hart of the Santa Cruz Medical Facility Sleep Clinic (now under PAMF - Palo Alto Medical Facility). He's a knowledgable and helpful guy, I've been very impressed with him. In fact, I'd recommend using Santa Cruz Medical Clinic (under PAMF now, as I mentioned) as the first place to shop for medical care. Santa Cruz Physicians Group is over at Dominican Hospital, a lot of people use them as well. And of course, if you're more well-off, there are excellent concierge medical services as well *smile*.

Any other questions about medical care in Santa Cruz, feel free to PM me. I've been in the area for about 40 years now, so I'm pretty familiar with what's available.

[LSAT]

Have medicare for a year and medigap, need to switch medigap right now. Very useful to know all medigap (A, B, C, etc.) are standardized so shop for price! Thanks all for your help.

Medigap plans are NOT standardized...they vary by state and county.

No, you are simply wrong.

They ARE standardized. The benefits of all Medigap plans were standardized by the Federal government in 1992 and then again thereafter.

http://www.medicare.gov/medigap/default.asp

Thanks for the correction.............