Medicare May 1st, this doesn't look good.......

[dllfo]

I was awarded SSDI Jan 23, 2007.

About a week later a letter arrived discussing it and towards the end of page
2 it dropped the bomb. I am entitled to Medicare May 1, 2007.

I don't want Medicare. My DMEs told me Medicare does not pay for Heliox and some other things Tricare pays for.

It seems we have had a few people here go on medicare, but I can't remember their reactions.

I am 61. I have a PPO with Tricare and they will let me go to the National Jewish Hospital in Denver, CO (to get lung work done). I was told Medicare usually does NOT allow that sort of thing. Plan B is to be there in April.

Just out of curiosity, does anyone really know if they can force it on me???

I want to wait until I am 65 if I have a choice. Tricare is the devil I know.

[Patrick A]

Medicare is joke.
I have been on total disability since 2004
And my insurer BCBS fehb told me I had to take part b
but anything that Mediacre doesn't pay for they do.

[Slinky]

I had to go on SSDI and then Medicare. I've had top notch BC/BS coverage my entire life.

Even on Medicare I can still go to any hospital or doctor of my choice. We live in Michigan and Medicare has not complicated my going to Mayo Clinic in Rochester, MN at all. BC/BS is my secondary now and pretty much all I've noticed is that I no longer have to pay my own office calls as we did w/BC/BS. Yes, I have to pay a portion of the office call, usually something like $4 to $10 but other than that I haven't found the problems w/Medicare I expected.

If you have to shop for a new doctor you may run into problems finding a doctor who is taking new Medicare patients. But I've not run into anyone yet whose doctor dropped them when they had to go on Medicare.

Now, when I needed to go on several months of TPN (total parenteral nutrition) Medicare would NOT pay for that but my secondary BC/BS picked up the cost (thank God, unbelievable cost per week!!!).

The only problem I've encountered regarding my xPAP therapy and Medicare is the DME likes to use "Medicare won't pay for that" for any little thing they don't want to give me - but so far I was able to determine that Medicare DID pay for "that" and was able to get "it", whatever the item was.

It was interesting when the DME told me that Medicare wouldn't pay for the Omron CompAir nebulizer (yet the DME was more than happy to show me nebulizers Medicare "would" pay for). In investigating further I have every reason to believe that Medicare "would" have paid for the Omron but I found such a reasonable online price I just bought it out of pocket. Oh, yes, this DME also told me they couldn't get that Omron CompAir nebulizer - except they have other Omron products on display at their shop.

My pulmo just scripted a Helios, not because I wanted it but because he insisted on scripting it. Frankly, I'm rather intimidated trying to fill it. BUT Medicare is paying for it, along w/my concentrator, emergency tanks, etc. The big difference is - I get my 02 supplies from one DME and my xPAP supplies from another. THAT was a BIG mistake (and a long story how that came about)! As soon as my capped rental for the xPAP is completed I hope to switch to my 02 DME for any xPAP supplies needed as well!

Also, the Helios is NOT all that great if you are going to be out and about all day long. The first time I used the Helios I had to make a trip out of town, two hour drive one way and the time spent at that clinic. The Helios ran out. I was fortunate I had a couple of small 02 tanks in the car to use!!

On the other hand, my brother in law (several purple hearts, a Silver Star, retired Marine (Korea AND Nam) recently died due to complications from Agent Orange. TriCare refuses so far to pay a $12,000 hospital bill! Another brother in law, also a retired Marine, died a couple of years ago due to AAA, his sons had a devil of a fight w/TriCare to get his last hospital bill paid. The local VA hospital didn't have Emergency Care services so there was no choice but to rush him to a local hospital. This brother in law also spent at least one tour in Nam. So much for our government's gratitude to our Vets!!! Thank God, my husband got out of the Corps after only 6 years!!!!

[dllfo]

Slinky, THANK YOU.

I think I may have to talk to a supervisor at Tricare and Medicare to see what the truth is.

Sounds like, based on your info, Medicare WILL allow me to go to Denver and
they will support my XPAP stuff.

One DME here told me Medicare won't pay for Heliox, which is pretty expensive, but one E bottle should last me months, so I may have to pay for one bottle myself....using it as a rescue agent.

Thanks again.....I am spending all day at the hospital right now, so I can't do much calling, but when the wife gets out tomorrow or Thursday, I will start on
it.

[mattman]

Dllfo -

Shoot me a PM if you can with some specifics on what you have for your O2 and also what your usage is. I have some stuff I'd like to suggest for you to make life a bit easier based on your specific needs.

mattman

[oldgearhead]

Well xPAP is a very minor health care cost. Especially if you fund it yourself,
like I do. What scares me is the $6000.00 per year drug cost that will
replace the $575.00 per year I'm paying now with insurance..

[Slinky]

Well, so far, thank God, our BC/BS does provide our scripts for a very reasonable co-pay. But our secondary BC/BS is provided by my husband's employer (now retired). Every contract strikes terror in my heart regarding our script coverage as I am on some very expensive meds with no generics available even. Our co-pay for non-generics just went up this year. And this is our first year to have an annual deductable on medical treatments and procedures.

[Patrick A]

When I was put on Medicare my insurer BCBS FEHB told me that they were now my secondary insurance. And that I needed to take Medicare Part B So I did, I guess that being as I'm getting the shaft with them offseting my Disability by what i get from SSDI that it's best for mr to take PartB I have yet to have to pay any out of pocket expenese . And my perscritions are still covered by my insurance and I was told by BCBS FEHB NOT to take Medicare Part D
Go figure.

[dllfo]

This whole thing "blind-sided" me.

I remember one of our DMEs saying they have to recalculate something or other, but then it is about the same deal for them.

I read some of the info on Medicare, part A, C and D, then their is a supplement or something from private carriers .....they referred to it as "Part B"
and so on.

My meds ran about $25,000 last year, and that was just walgreens. So I really have to be sure which way I jump.