Medicare soon my only ins.

[Guest guest]

I am going through a divorce, I've had Medicare, with Tricare (military

medical benefits), so basically everything I need is covered, no

exclusions, RX, surgery, any doctors I want to see- with a small annual

deductible. My health is very unstable due to multiple debilitating

illnesses-many joint replacements, JRA, Iritis, Uveitis, Glaucoma,

Sleep Apnea, High BP, ... My husband has filed for a divorce, so I will

soon have Medicare only. I am trying to understand what that will mean

for me...can anyone help me, even my attorney seems a bit confused and

asked me to research this. Can anyone clarify this for me? How does it

work, when you only have Medicare? What out of pocket costs will I

have? Can I expect any changes in my medical care? What have others in

similar situations done to not have to file medical bankruptcy?

[Guest guest]

Since you say you are on medicare already, I assume you are either

over 65 or are on SS disability. There is no premium for Part A.

You must pay a monthly premium for part B coverage if you want it.

Currently the premium for Part B is $78.20 per month. If you receive

social security benefits, the premium is deducted from your monthly

social security payment. If you don't receive SS benefits [some

people over 65 haven't taken SS benefits yet], you are billed for

Part B premium every 3 months. Many people on Medicare also purchase

a Medigap policy from an insurance company in addition to Part B.

There are various types of Medigap policies, each with different

coverage. Basically, they all at least cover the copays that

Medicare doesn't cover. They are sold by insurance companies and

vary in cost according to the company, amount and types of coverage.

They are referred to by letter, as in policy type A or B or C, etc.

I believe they are adding two new ones to the list in the near

future.

Another option for those going on medicare is to enroll in a Medicare

Advantage plan with an HMO. My husband has this kind of coverage and

I offer this information for comparison purposes.

He has Part A, pays the premium for Part B, and pays $89/month to the

HMO, for a total of about $168/month in premiums. By the terms of

his particular contract, everything is covered for him that the

regular, non-medicare HMO contract offers, EXCEPT Rx drug coverage.

For him this arrangement works well as he had been in that HMO for 20

years prior to going on medicare and likes the doctors, etc. He pays

for all his drugs out-of-pocket. In Jan 2006, it will be possible to

purchase medicare drug coverage for an additional premium that may

average around $35/month which could bring his monthly premium up to

around $203/month.

If you did not take Part B when you were first eligible for Medicare,

you may sign up during the General Enrollment Period which runs from

Jan 1 - Mar 31 of each year. The cost of your Part B may go up as

much as much as 10% for each 12-mo. period that you could have had

Part B but did not take it, and you will have to pay this extra

amount as long as you have Part B, except in special cases.

Your situation surely merits a visit to the nearest social security

office to get your questions answered about your coverage options and

what it will cost.

> I am going through a divorce, I've had Medicare, with Tricare

(military

> medical benefits), so basically everything I need is covered, no

> exclusions, RX, surgery, any doctors I want to see- with a small

annual

> deductible. My health is very unstable due to multiple debilitating

> illnesses-many joint replacements, JRA, Iritis, Uveitis, Glaucoma,

> Sleep Apnea, High BP, ... My husband has filed for a divorce, so I

will

> soon have Medicare only. I am trying to understand what that will

mean

> for me...can anyone help me, even my attorney seems a bit confused

and

> asked me to research this. Can anyone clarify this for me? How does

it

> work, when you only have Medicare? What out of pocket costs will I

> have? Can I expect any changes in my medical care? What have

others in

> similar situations done to not have to file medical bankruptcy?

[Guest guest]

Lyn,

http://www.mytricare.com/internet/tric/tri/tricare.nsf

<< click on and follow links for detailed info.

http://www.medicare.gov/

Currently,Medicare has a $876.00 deductable for in patient hospital care per each benefit year.

For medical (doctor) visits $110.00 deduct./ once per calendar year.

Most ALL LAB studies are fully covered for Medicare approved services (most everything)

then you pay 20% of balance of covered services, that is based on Medicare approved amount , not the full cost that doc charges.IF your doctor accepts assignment.(most do) All labs accept Medicare.

For questions & a to request a book on detailed coverage about Medicare call 1-800-486-4227

A book is mailed each year.

Do you have an advocate with the military? They may have a program for continued medigap coverage.Call & ask,explaining your circumstances. they will help you.

Hope this helps..Good Luck.

Ev

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[Guest guest]

I am going through a divorce >>> I'm sorry 2 hear such news Lynette I can only hope that it's the best thing for both of you in the end and that you can resolve things peacefully with one another. I'm a believer that doors only close for new and better to open... so try to keep your head up and think positively. Depending upon how long you and your husband were together.... military is no exception to the rules of alimony (? spelling) etc. support payments then any other divorce would... and in some cases you can force retirement pension pays for spouse of military. Check with HIS boss chances are he won't tell you the truth of the matter if it means him loosen some of his benefits over it. I would also check online or via mail with TriCare directly to see what your told differently.

so I will soon have Medicare only. I am trying to understand what that will mean for me... >>> It means the very same for you having TriCare & Medicare.... only you'll have one insurance instead of both. TriCare was your primary... and medicare secondary.... not having TriCare just means that Medicare will pick up as your primary insurance and you'll either obtain an additional coverage as your secondary or be responsible for payment. General guidelines (*least when I was billing it) stated the patient responsiblity was 20% of billed services rendered... for EXPECTED procedures/services rendered. IF YOU have A & B basic coverage.... BARING there is not a secondary insurance available. So on a $157 bill... your payment due would only be roughly $31. Non~approved services or services rendered by non~preticipating providers would mean you were responsible for the full $157. If you have a secondary insurance available then the balance of $31 would be billed to them and chances are you'd have a few dollars IF ANY due on the bill in question... UNLESS as I said... you have been to a doctor they don't approve of or have something done without authorization etc. Medicare is picky about their pick up dates and general enrollment runs from Jan through March.... to my knowledge those are the time frames they allow changes.

There are additional limitations and choices available if you pick up other services offered through medicare NOW like the advantage plan which didn't become a choice until 2005 but I'm not certain when the actual "effective date" starts. But there's also Specialty, PPO~Preferred Provider Organization, Managed Care & Private Fee~for~Service plans offered too. I don't know exactly what you've got in terms of your medicare coverage to tell ya.

But If your income falls within your states limitations you may also qualify for medicaid services which is offered through your local social services office / wealthfare department. The amount of cut off varies state to state... and your monthly liablities are calculated against your income to obtain qualification. IF you qualify for medicaid services within your state... you can also check into your medicare premiums being paid by the state. Which would result in medicare being your primary insurance and medicaid being your secondary insurance. That translates to you should have little to no out of pocket expenses excluding co~pays on prescriptions which varies generally $1~$5 and you would be restricted to physicians which were PCP's of the benefits programs.

even my attorney seems a bit confused and asked me to research this >>> Good attorney shouldn't have problems finding that information out... it's just a matter of actually DOING IT. Big difference in the two. Call Medicare directly and request publication CMS-10050 at 800-633-4227 if you've not yet received their handbook for 2005 benefits. But here are some numbers that might help you out in the mean time.

Medicare.gov - The Official U.S. Government Site for People with Medicare

http://www.medicare.gov

Medicare Benefits Contractor~ 800-999-1118

TriCare for Life~ 888-363-5433 or

800-538-9552

Dept. of Veterans Affairs 800-827-1000

Can I expect any changes in my medical care? >>> Yes you can.... there's a huge difference in government program(s) insurances verse "everyday paid for insurance" services. Government is alot pickier in the light of what they pay for, who they'll pay it to... and just how much they will foot the bill on~ Good news is... military coverage USED to run in the similar lines with state type coverage in terms of what they cover etc. so you may not actually have "that much" of a change.... as I said... alot depends upon just what you may qualify for as a spouse and what types of coverage you actually have with medicare. I would recommend you start questioning... via landline and internet to see what's what... and when you receive a copy of the medicare book... take your card & book to the local office and point blank say... NOW what's what and they will.

What have others in similar situations done to not have to file medical bankruptcy? >>> Laws on bankruptcy have changed... and it don't work like it once did. I make payment after payment and pray to someday see a zero balance before I die. LOL All anyone can do~