# Medicare, what is it all about?



## Denise1952

I'm doing some research for my sis that is 72 now.  She is always complaining about Medicare so I want to find out about it.  Is medicare sufficient for seniors?

I find it unfair that retirees have to pay for Medicare when other people are getting free health coverage.

Is Medicare better then ACA?  Why do I hear seniors saying they can't afford their meds?  I guess I have a lot to learn, what's new, LOL!  Medicare, what the hell is it all about, anybody??


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## Don M.

One could discuss Medicare, and its advantages/disadvantages for hours.  If you are getting close to 65, the best place for information is Medicare.gov, on the Internet.  Most people have found that Medicare is a pretty good plan, considering its relatively low monthly cost.  It's also a good idea to get a Medicare Supplement plan to cover yourself even better...and then vision and even a dental plan.  If a retiree has any company sponsored options, the costs for complete coverage can be quite reasonable.  However, if you go on the open market looking for health care insurance, be prepared to be shocked.  Unless you are nearly destitute, and qualify for all the "subsidies" under the ACA, health insurance can quickly become your major expense.  

Personally, we have been quite lucky...between Medicare, and my company retiree plans, the few doctor/dental/vision issues we've had over the past few years have been taken care of with minimal "out of pocket".


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## Denise1952

You know, you really answered the question I didn't quite know how to ask.  I am so ignorant about Medicare, but I was on their site yesterday for awhile.  So it is just like any other insurance, you have to "choose" it, you aren't forced to use it.  I don't think my sis can do better since she gets I think, about 1400 a month.  I was thinking she should apply for ACA but I think that's too much income she gets.

She worked very steady after the kids were gone, as a police dispatcher, and at some time she worked in a bank as a teller.  She said because they give you the average on her income for her SS, she doesn't get as much.  I don't understand that average thing.  I thought we got what we payed into SS.  I mean I learned about the averaging several years ago but it's so wrong in her case because the other years she was raising kids, why are those years being averaged in, what a crock.


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## Don M.

Medicare is certainly the best option for the vast majority of Seniors.  I suppose there are a few people with a specific need that might find a Medicare Advantage plan to be a better option...but such plans will usually cost more.  We have been pleasantly surprised, over the years, when Medicare even paid for a portion of the in-depth eye exams we get every year.  

I don't know what the ACA offers, but there again, the government web site probably spells out pretty well what is available, and who qualifies...based upon income.  I think their site is Healthcare.gov, so you might want to review the info on that site.


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## Denise1952

Geez Don, my sis only has a 1,000 a month income, I thought she got more.  I think I can get her qualified for ACA or medicaid here in Oregon.  She fits the income levels, 400 dollars below in fact.  Out of her tiny income, she has to pay 100 a month, and then she won't go to the doc for fear of not having the copay, or drug money.  I'm looking all that right now.


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## LogicsHere

If you are eligible for Medicare, I don't think you can buy insurance under the ACA.

https://www.healthcare.gov/quick-guide/eligibility/


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## ClassicRockr

First, how much a person gets in SS depends on a couple of things: 
How many years worked/how much was contributed. 
When a person decides to take SS Retirement.......as in Early (62), Normal (66 (?) or Late (70). 
As for me, I had to take Early, and because I switched jobs too many times during my employment years, didn't have that much in my "bank". With taxes and Medicare taken out, I get $733 a month. Sure isn't much, but my wife makes a descent salary, so that definitely helps.

Second, Medicare:
I became eligible for Medicare last year when I turned 65. I already had VA Medical, but had to pay co-pays because I haven't got a "Service-Connected" medical problem. If I would have waited to get Medicare, I would have been paying more than $104 per month due to a late fee that is charged. Unfortunately, Medicare B also has a $147 deductible that has to be paid before Medicare pays anything for medical service.

Because I was already on SS Early Retirement, SS automatically signed me up for Medicare, but I could have turned it down. Knowing what the VA Medical has been going thru, I sure didn't want to do that. After seeing commercial after commercial about how Medicare only pays 80% of medical expenses, wife and I decided I needed a Supplement. I mean, paying the left-over 20% could definitely be a nice "chunk of change" out of pocket for a medical thing like my upcoming RC surgery later this month. Heck, every Supplement Insurance in the area, and out, was sending me info in the mail on a daily basis saying they were the ones to choose. 

Well, after doing some online research and going to a Florida Blue Supplement meeting, we went with Florida Blue as my Medicare Supplement insurance. We pay $134 per month for that, but it sure pays for what Medicare don't. 

Then, I had to look for a drug plan. A doctor that takes care of Medicare patients can't prescribe medicine from the VA Pharmacy. Only a VA doctor can do that. So, back to the online research again and we came up with Humana Rx Plan. It had very high reviews and I know people that have it and love it. I get four prescriptions from the VA and for a 90 day amount, it sure wasn't cheap. With Humana Rx, $15 per month, they will only cost me $23 for all three of those every 90 days. The fourth prescription, my Metformin (Diabetes), I will get monthly at a grocery store for free.

My total cost for medical/Rx is $255 per month, but no Vision or Dental with that. I get that with my wife's company medical. I don't have expensive meds, so that definitely helps.  

Actually, I was kind of shocked to find out that Medicare costs, but our Government isn't going to "foot the cost" on medical for everyone. A person really has to prove why they can't pay, before this "free" comes into place. 

BTW, along with Medicare B, Florida Blue and Humana Rx, also have Medicare A for hospitalization. But, even with Medicare A, a person has to pay a deductible before getting admitted into a hospital. I don't think that goes with an emergency though. 

Hope all of this helps.


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## Denise1952

Thanks so much CR, that was a lot of good info for me.  My sis does only bring in 1000 and that's from her deceased husbands SS because it was more then what she had in SS.  She own this Modular Home, and I am wondering if that would omit her right there from getting ACA.  Plus the fact they can see she's been able to make the medicare payments.  She flat out told me last night that she was not willing to go to a doctor, she looked as if she needed a wheelchair yesterday (osteoarthritis) so I confronted her.  I think it's more she just doesn't want to go to the docs, but it could be it would dip to far into her money


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## ClassicRockr

So, she is paying each month for Medicare, but hasn't got a Supplement or Rx Plan.......correct? This does put her in a difficult spot, because she will have to pay all or part of the Medicare deductible of $147 for any medical she seeks. Once that deductible has been fully paid, Medicare will then start pay either all of the costs or 80% of them. I didn't have to pay a co-pay when I had a Consultation with an Ortho surgeon about my RC injury/possible surgery, *but* we did get a bill in the mail from the doctor's office for part of the cost of the Consultation payment. For the new year now, I will have to pay $147 (deductible) again. But, if she needs prescription meds, she will need an "add-on" to her Part B Medicare. Like I said, mine is an Humana Rx Plan.

Good Luck! 



nwlady said:


> Thanks so much CR, that was a lot of good info for me.  My sis does only bring in 1000 and that's from her deceased husbands SS because it was more then what she had in SS.  She own this Modular Home, and I am wondering if that would omit her right there from getting ACA.  Plus the fact they can see she's been able to make the medicare payments.  She flat out told me last night that she was not willing to go to a doctor, she looked as if she needed a wheelchair yesterday (osteoarthritis) so I confronted her.  I think it's more she just doesn't want to go to the docs, but it could be it would dip to far into her money


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## Denise1952

You've been so helpful CR, I feel better just talking about it as I do worry for my sis.  She actually owns this modular, and has been paying her Medicare.  To be honest, she has to rob from Peter to pay Paul on her money.  I think that's the right saying.  If she goes to the doc, it takes away money she used for other things she's not willing to give up.  She is in that place many people are, low income, but yet not low enough for ACA.


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## LogicsHere

Not sure you read the link I sent, but it states:
If you have Medicare coverage, you’re *not* eligible to use the Marketplace to buy a health or dental plan unless you fall into the category of paying for Part A and Part B. For most Part A is "free" plus the deductible if you enter the hospital.


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## Denise1952

I'm sorry logics, I don't remember seeing it, let me look back at it now


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## Denise1952

LogicsHere said:


> If you are eligible for Medicare, I don't think you can buy insurance under the ACA.
> 
> https://www.healthcare.gov/quick-guide/eligibility/



Oh, I did see it, but just read what you said, I read the link now.


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## Denise1952

LogicsHere said:


> If you are eligible for Medicare, I don't think you can buy insurance under the ACA.
> 
> https://www.healthcare.gov/quick-guide/eligibility/



Oh thanksssssssssss, that's a fabulous link, what a ditz I am sometimes (comon peeps, just sometimes,lol)  Ok, I shared the link with my sis, and we are reading it, then between the both of us we can figure how it can help her or not.  It does say, as you know, right off the bat, if you have Medicare you can't get health or dental, is there anything else, lol  I am betting the Part A, B whatever is for hospitalization, and maybe meds?  Not sure yet, Thanks again Logics, I honest did not mean to overlook your info, denise.


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## Butterfly

LogicsHere said:


> If you are eligible for Medicare, I don't think you can buy insurance under the ACA.
> 
> https://www.healthcare.gov/quick-guide/eligibility/



I'm pretty sure this is true.  Also, when I became eligible for Medicare, my private insurance would no longer cover me.  I had to go with Medicare.


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## Butterfly

nwlady, your sister may be eligible for what is called "extra help" in paying her medicare premiums (and prescription costs), depending on what state she lives in.  My niece got the extra help, as does my sister.  I don't, because my SS benefit is higher.  

If I were you, I would make an appointment and go to see Social Security or make a phone appointment to talk to the Medicare people on the phone, and get a review of your sister's situation to be sure she is getting all the help she is entitled to.  Also call your state's equivalent of health and social services to see if there are statea benefits she could qualify for.  If she were, she would probably qualify for food stamps.  

While searching for Medicare supplements, be sure you research them carefully to be sure what is accepted in your area, and how well they actually pay.  There are two plans widely used here that medical care providers have an awful time with getting them to pay out.  And for the drug plans, be sure your sister's meds are on their formulary.  Different plans have different formularies, and if your drug isn't on them, they won't pay.

She might want to consider an advantage plan, if she lives in an area where there is a good one available.  I'm lucky that I do. 

The whole thing is a minefield and a huge pain in the rear end.


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## jujube

I have Blue Cross for my supplemental and RX plans.  I have been very pleased with the supplemental plan.  There is a Blue Cross center near me where I go whenever I have a problem and they are very helpful in straightening it out and explaining anything I don't understand.  I would rather sit across a desk from someone than deal with them on the phone.  Also, they have extra services they offer...free health screenings, exercise classes, etc.   I haven't had any problems with the RX plan, but I think I will switch to the Humana RX plan next year because their "preferred" pharmacies are more to my choosing.  

Medicare, on the other hand, is a royal pain in the ass but it's better than nothing.  I hate dealing with the Medicare people.  It's hard to get through on the phone.


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## Kadee

We have had Medicare in Australia for quite a few years, if you are on a government benefit you basically don't at this stage have to pay for X-rays , blood tests and if the doctor bulk bills you don't have to pay for a visit I, Say But ,, the current government is  trying to make  changes and wanted people on benefits which by the way, covers all ages as long as you are on a benefit which can be unemployment pension or Newstart. We are on a age pension 
There has been quite a bit of turmoil with the Australian government trying to introduce a fee for people on Centrelink benefits 
i have not really kept up with what's going on at the moment regarding this , been to busy to watch the gloom and doom show which is other wise known as the news


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