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  1. Member
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    Jun 2014
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    Tennessee
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    #21
    Hope you get it straightened out, the same thing happened to me when I was about to turn 65. I turned 65 in October, signed up for Medicare and till the end of the year was still on my company insurance till 12/31. Fighting prostate cancer and was due a shot that cost $5500 in the middle of December. Medicare put in Advantage starting the same date as Medicare took over. My Urologist does take Advantage only a supplement, needless to say I didn't get my meds. My company insurance was secondary but not according to Medicare. Tooks me 5 months to finally get me on Blue Cross Blue Shield supplement. If you have any health problems I would stay from an Advantage Plan. In the Memphis Metro area there was very few doctors that accepted it. Go with the best supplement you can afford. Plan F is what I went with dealing with cancer and the side affects of radiation and hormone therapy. I may be wrong but was told you can always go down in plans but might get turned down going up.

  2. Member
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    #22
    Well I thought that I was going to be all set. Last Thursday the insurance company called to tell me that they received a letter from my Senator. The said they were looking in to my situation. Then the next day, Friday the same agent called me and said that I had been re-instated with a back date to the date the market place had terminated me. All I had to do is pay $$$$ for the balance of October since they had already issued a check for what I had already paid. I told him I would pay it that afternoon via their website. All is well or I thought. Well Friday on their website there wasn't an open balance for me to pay and no way for me to submit payment. So I waited till this morning, still nothing open. So I called and left messages for the agent. No return calls by afternoon. So I called and talked to another agent who said she didn't see and notes. I was hot! She hung up on me! Called back and talked with a different agent and explain everything again. She said the same thing, no notes and the reference number I gave her didn't even come up. Still hot I asked to speak with her boss, and she without warning hung up on me! Now, the RX I take is due for refill and they are not going to fill it because when they ran it, it showed as I was terminated by the market place. And I will have to pay $9500.00 for my next refill. FTA. I'm glad to have this forum to express how pissed off I am right now.
    Lesson learned to everyone here who will be or knows someone who will be turning 65 and going on Medicare. DO NOT CALL ANYONE BEFORE THE LAST DAY OF THE MONTH before your birth month no matter how many emails you receive. I would not wish this shit on anyone. Thanks for being there.

  3. #23
    IMO the prescription drug plans are presented deceitfully and are a borderline scam. Nothing like being in the donut hole from months 3-10, still paying premiums, and having to pay full retail cost for prescriptions. Then about the time you get out of the donut hole the year ends, and you start over again.

    With my mom we decided to not enroll in a prescription plan when her retirement prescription insurance ended. She can buy most medications outside the US, cheaper than just what the copay is in the US, with a prescription plan. She gets her Eliquis absolutely free through her doctor, only because she has no insurance. If she had prescription insurance it would cost on average ~$400 per month for the year, plus the monthly premium cost. She has got several other free medications as well. She is thousands of dollars ahead by not having prescription insurance.

    Since congress decided that there was nothing wrong with the medicare prescription plans, they should put them on it also.

    Quote Originally Posted by v_fourmax View Post
    I just went on medicare and my biggest complaint thus far is the prescription drug coverage.

    First off you are forced to buy a prescription drug coverage plan or pay a lifetime penalty if you do not maintain coverage on a constant basis.

    The drug plans are a joke, high initial deductible then you have the "doughnut hole where they do not pay squat but yet you still pay a full premium for the plan each month.

    I take 1 medication and even the monthly co pay is high. I can get the exact same medication made by the exact same company overseas for less than the co pay of my drug plan but yet without insurance that drug is 10 times the cost here in the states and I have no deductible or no premium payment going that route either.

    I do not like being forced to pay a premium for a drug plan that I will never use because of its overall cost but must have to avoid a penalty later in life if and when a drug plan makes sense for me to purchase.

    I am planning on switching to an advantage plan next year that includes the prescription coverage and although no better than the plan I currently have which again I will not use I will not be paying a monthly premium to possibly avoid future penalty payments only.

    The main difference I see in the advantage plan is that is is regional and not nationwide and the coverage will suite me fine while actually saving me money.

    In my opinion basic medicare should provide some type of drug coverage as standard and not be an add on. If you want better coverage then the add on policies can be used.

  4. Member
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    #24
    Quote Originally Posted by v_fourmax View Post
    In my opinion basic medicare should provide some type of drug coverage as standard and not be an add on. If you want better coverage then the add on policies can be used.
    Odds are good you’ll be heading the opposite direction. Congress and POTUS are talking CUTS to the entitlement programs. Medicare, Medicaid, CHIP, AFDC, etc. All expected to be reduced or eliminated.

    When my wife was alive, we purchased plenty of Rx from Canada, Mexico, EU, etc. Wherever I was traveling, I’d load up. There were drugs costing $10 each in the US which were priced in pennies overseas. Needless to say, I’m painfully aware we are getting screwed. But it’s the ‘cost of living in a free society’ ... or at least that’s the story.

    I’d suggest you look at any homeopathic medicines that might replace the prescription OR if there’s something you can do physically to eliminate/reduce a particular condition, give it a try. Pretty much without exception, all Rx are poison. However, at times it’s the lesser of two evils.

  5. Banned
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    #25
    I turn 65 next July but I get to stay on my wife's policy through her work so I don't need the government's crummy insurance.

    Bill
    Last edited by Aries 181; 10-23-2018 at 05:43 PM.

  6. Member
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    Ohio
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    #26
    I love Medicare with my supplemental insurance. I've had 2 major medical events. My heart attack, under private insurance provided by my employer (a so-called Cadillac Plan) cost me around $4500 out of pocket for everything from the ambulance ride to the end of PT. My brain tumor surgery (benign) under Medicare cost me around $1400 out of pocket for everything from the first MRI through the surgery and PT to the last MRI 8 months later. I wish everyone had the benefit of Medicare. My guess is that medical costs would go lower.
    Those who can make you believe absurdities, can make you commit atrocities.

    --Voltaire

  7. Member
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    #27
    Quote Originally Posted by JHelms View Post
    I love Medicare with my supplemental insurance. I've had 2 major medical events. My heart attack, under private insurance provided by my employer (a so-called Cadillac Plan) cost me around $4500 out of pocket for everything from the ambulance ride to the end of PT. My brain tumor surgery (benign) under Medicare cost me around $1400 out of pocket for everything from the first MRI through the surgery and PT to the last MRI 8 months later. I wish everyone had the benefit of Medicare. My guess is that medical costs would go lower.
    Medicare with MediGap is the best deal going currently.
    Private policies are sky high and not backing off anything but the coverage.
    Hopefully, Congress will deal with it before we are all broke.

  8. Banned
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    #28
    I hope they factor in these for the users of same or else it might get hairy??

    Patients taking Altoprev (lovastatin extended release), Crestor (rosuvastatin), Lescol (fluvastatin), Lipitor (atorvastatin), Livalo (pitavastatin), Mevacor (lovastatin), Pravachol (pravastatin), Zocor (simvastatin), Advicor (lovastatin / niacin extended-release), Simcor (simvastatin / niacin extended-release), and Vytorin (simvastatin / ezetimibe) will want to be aware of these potentially life-altering side effects, which are receiving little attention from the mainstream media.

    "The reports about memory loss, forgetfulness and confusion span all statin products and all age groups," writes the FDA on its website. And concerning diabetes, the FDA writes that "raised blood sugar levels and the development of Type 2 diabetes have been reported with the use of statins."

  9. Member
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    central Va
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    #29
    Quote Originally Posted by TampaJim View Post

    When my wife was alive, we purchased plenty of Rx from Canada, Mexico, EU, etc. Wherever I was traveling, I’d load up. There were drugs costing $10 each in the US which were priced in pennies overseas. Needless to say, I’m painfully aware we are getting screwed. But it’s the ‘cost of living in a free society’ ... or at least that’s the story
    I only take 1 medication and I can get that medication from overseas for less than what the co-pay is with insurance here in the states. When I had regular insurance prior to medicare my copay was about the same as getting the meds from out of the country. Now with being on medicare I can get the meds again out of the country cheaper than what the meds cost me in my copay and that does not even take into account the insurance premium for the drug plan, the initial deductible or all the doughnut hole and associated loopholes that is used for the insurance to not pay.

    What is a travesty is that a person purchasing the medicine I take will pay over ten times the cash price for a 30 day supply than a 30 day supply cost overseas. I can buy basically a years supply of meds for the cost of 1 a months supply in cash or the initial deductible cost on the medicare prescription plan in this country and never owe a copay amount or insurance premium payment.

    The American people are being ripped off so bad as compared to cost in the rest of the world and if they were not making a profit at the overseas sellers they would not be selling at the prices they do. And yes these are the same drugs made by the same companies as we are paying such inflated prices for here.

    The one medication I take is classed as a tier 3 as far as insurance is concerned which just means bend over and grab your ankles!

  10. Member
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    #30
    Quote Originally Posted by v_fourmax View Post
    I only take 1 medication and I can get that medication from overseas for less than what the co-pay is with insurance here in the states. When I had regular insurance prior to medicare my copay was about the same as getting the meds from out of the country. Now with being on medicare I can get the meds again out of the country cheaper than what the meds cost me in my copay and that does not even take into account the insurance premium for the drug plan, the initial deductible or all the doughnut hole and associated loopholes that is used for the insurance to not pay.

    What is a travesty is that a person purchasing the medicine I take will pay over ten times the cash price for a 30 day supply than a 30 day supply cost overseas. I can buy basically a years supply of meds for the cost of 1 a months supply in cash or the initial deductible cost on the medicare prescription plan in this country and never owe a copay amount or insurance premium payment.

    The American people are being ripped off so bad as compared to cost in the rest of the world and if they were not making a profit at the overseas sellers they would not be selling at the prices they do. And yes these are the same drugs made by the same companies as we are paying such inflated prices for here.

    The one medication I take is classed as a tier 3 as far as insurance is concerned which just means bend over and grab your ankles!
    Most likely a dumb question but why isn't everyone buying their drugs from overseas? I am assuming it is not legal?? If it were legal, wouldn't the supply and demand issue lower the price of meds here?

  11. Member
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    #31
    Quote Originally Posted by v_fourmax View Post
    I only take 1 medication and I can get that medication from overseas for less than what the co-pay is with insurance here in the states. When I had regular insurance prior to medicare my copay was about the same as getting the meds from out of the country. Now with being on medicare I can get the meds again out of the country cheaper than what the meds cost me in my copay and that does not even take into account the insurance premium for the drug plan, the initial deductible or all the doughnut hole and associated loopholes that is used for the insurance to not pay.

    What is a travesty is that a person purchasing the medicine I take will pay over ten times the cash price for a 30 day supply than a 30 day supply cost overseas. I can buy basically a years supply of meds for the cost of 1 a months supply in cash or the initial deductible cost on the medicare prescription plan in this country and never owe a copay amount or insurance premium payment.

    The American people are being ripped off so bad as compared to cost in the rest of the world and if they were not making a profit at the overseas sellers they would not be selling at the prices they do. And yes these are the same drugs made by the same companies as we are paying such inflated prices for here.

    The one medication I take is classed as a tier 3 as far as insurance is concerned which just means bend over and grab your ankles!
    Was in the same boat myself until replaced with a completely natural product.

    US pharmacy $325 for one month, Canadian pharmacy $165 for three months.
    Same pill, same box, same production plant. And they shipped it for free.

    However, natural product works better, zero side effects, etc. and for less $$.
    I'm all about homeopathic treatments. Plus proper exercise, diet and sleep.

    As long as Big Pharma is buying Senator Bob, they can blow me and enjoy.

  12. Banned
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    #32
    Quote Originally Posted by Bassin08 View Post
    My wife and I have been on a Medicare Advantage Plan for the last 13 years. The problem that I have found with them is, if you start to have any serious health problems and start hitting that maximum out of pocket co-pays, you will not be accepted into a Medicare supplement plan, unless your Advantage plan goes away in your area. Then during the open enrollment timeframe you can switch without any previous health condition questions.
    You will find that just about every hospital accepts regular Medicare. But they don't all accept Medicare Advantage which operates like a HMO.

    There is a very large hospital chain to the north of me that has 1700 doctors and nurse practitioners in their hospitals and in the practices they've purchased. They manage hospitals statewide and in 4 surrounding states. This hospital refuses to accept Medicare Advantage.

    That means that thousands of their patients have been sent to other competitive hospitals (Like HCA) and to other physicians that may not provide superior quality care. Patients in smaller cities with only one hospital must now go to other cities for medical procedures and to doctors' visits.

    I've been reading in the newspaper articles where patients are receiving huge bills for anesthesologists services because many doctors have no contracts with Medicare Advantage. I wouldn't be surprised if Emergency Room physicians and Pathologists are independent contractors without Medicare or Medicare Advantage agreements. This is a very serious problem in the medical world.

    Before you run up huge bills at hospitals, do your due diligence finding out what you will be liable for--on front end. My wife and I have regular Medicare with a supplement and pay separate for medicine coverage and our hospital procedures have left us with little payments--other than the $300 deductible.

  13. Member
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    #33
    Quote Originally Posted by Bamaman View Post
    You will find that just about every hospital accepts regular Medicare. But they don't all accept Medicare Advantage which operates like a HMO.

    There is a very large hospital chain to the north of me that has 1700 doctors and nurse practitioners in their hospitals and in the practices they've purchased. They manage hospitals statewide and in 4 surrounding states. This hospital refuses to accept Medicare Advantage.

    That means that thousands of their patients have been sent to other competitive hospitals (Like HCA) and to other physicians. Patients in smaller cities with only one hospital must now go to other cities for medical procedures and to doctors' visits.

    I've been reading in the newspaper that patients in all their new hospitals are receiving huge bills for anesthesologists services because the doctors have no contracts with Medicare Advantage. Wouldn't be surprised if Emergency Room pathologists and Pathologists are independent contractors without agreements. This is a very serious problem in the medical world.

    Before you run up huge bills at hospitals accepting Medicare Advantage, do your due diligence finding out what you will be liable for--on front end. My wife and I have regular Medicare with a supplement and pay separate for medicine coverage.
    Exactly. I've tried to share with as many people as possible the same type of information.
    Medicare actually works, especially paired with MediGap. Advantage plans aren't good.
    Like anything wrapped in an insurance company envelope, it's promising. Thin ice though.
    Pushed, they do what's allowed (and beyond if not challenged) to avoid high expenses.
    Think about it. They are willing to take the same funding and do more plus make money?

  14. Member
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    #34
    Bama how many of these patients were on a zero premium, dual enrollment, or other subsidized plan?

    I listened to a dual enrollment (Medicare AND Medicaid) lead call this week and was floored at how little this person paid after both the Feds and the State kicked in funds. They called in a Medicare AEP line looking to see “if there was anything better.”

    My Tri-Care pays about, if not the same as Medicare. My recent ER visit bill (accident,y walked into a wire and scratched my cornea) was 910.00, 96.65 was allowed payment. Hospitals as we know them can’t stay afloat on that kind of payment.

  15. Member
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    central Va
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    #35
    Quote Originally Posted by TampaJim View Post
    Exactly. I've tried to share with as many people as possible the same type of information.
    Medicare actually works, especially paired with MediGap. Advantage plans aren't good.
    Like anything wrapped in an insurance company envelope, it's promising. Thin ice though.
    Pushed, they do what's allowed (and beyond if not challenged) to avoid high expenses.
    Think about it. They are willing to take the same funding and do more plus make money?
    Actually I have researched the Advantage avenue for my situation and area thoroughly and for my situation it is the best for me.

    In my area we have three hospitals, just about all the doctor offices, lab and testing facilities, rehabs and even the doc in box critical care offices are now all owned and operated under the same umbrella.

    My last regular insurance was written through an insurance company they also own and operate. They also offer an advantage plan I will be taking advantage of.

    It basically mirrors the medicare plan and includes prescription as well. Yes it is a regional plan but since I will be using their facilities and my regular doctor is also under their umbrella I will not see a disadvantage at all. I will actually save money.

    Another advantage is since all my doctor visits, lab test and xrays or anything else if I go to the ER the doctors there can pull and access my electronic records within the system immediately and tell what meds I take or recent lab results to get a baseline even if I am unable to relay that information. To me that is a plus as well.

    I would think the area you are located and the makeup of the health providers and how they relate to different insurance plans would be a better guide than to just say an advantage is not good. For you maybe not, my area I disagree.

  16. Member
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    #36
    my insurance people want me to go with the Advantage coverage said it will save me $16.00 a month,i have told them 50 times i dont want it,they tell you what doctors you can use

  17. Member
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    #37
    Have to thank Patrick at my insurance company (Ambetter) worked had to get me re-enrolled which I'm happy to say is back on.

  18. Member
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    #38
    Quote Originally Posted by geobass View Post
    Have to thank Patrick at my insurance company (Ambetter) worked had to get me re-enrolled which I'm happy to say is back on.
    2007 Bass Cat Pantera IV
    2018 G3 Sportsman 1710

  19. Member Jeff Hahn's Avatar
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    #39
    Today Mount Union had the annual meeting with retirees to talk about any changes in our health plan coverage for next year. I am on a Medicare Advantage Plan. My wife is on a Medicare Supplement plan. We learned something new today. If you’re on an Supplement Plan and switch to an Advantage Plan the next year, no problem. However, if down the road you decide to go back to a Supplement Plan, Medicare can consider any preexisting conditions and deny you coverage. But the other hand, if you are on an Advantage Plan and switch to a Supplement Plan, no problem. Then, if you want to switch back to an Advantage Plan, they can only deny you the right to return if you have certain kidney problems.

    So, check with your healthcare insurance provider before making your coverage choices, particularly if you are considering switching plans.

    So, all this crap I hear about the govt requiring that preexisting conditions must be covered doesn’t apply to Medicare under certain circumstances?
    "The man of system is apt to be very wise in his own conceit; and is often so enamored with the supposed beauty of his own ideal plan of government that he cannot suffer the smallest deviation from any part of it…He seems to imagine that he can arrange the different members of a great society with as much ease as the hand arranges the different pieces upon a chessboard.” Adam Smith, The Theory of Moral Sentiments

  20. Member
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    #40
    https://www.medicare.gov/Pubs/pdf/10...erage-ESRD.pdf

    lots of answers about Medicare and ESRD. Page 42 talks about guaranteed coverage.

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