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kimanjome

US Medicare question--

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Prior to moving to Mexico my  husband had a Medicare Advantage plan in Florida, which I believe was United Health Care, kind of like a PPO/HMO. 

Then we moved to Mexico and had our mail forwarded to Texas, and hubby was unenrolled in the United Health Care Plan and put on "regular" Medicare. He pays like $125? $140?  a month.

Correct me if I am wrong, but doesn't this basic, bare bones Medicare (not sure what it's called) only pay 80% of everything?  So if he needs heart surgery that costs $500,000, his share would be $100,000. If an MRI costs $6000, then my husband's share would be $1200.  Are these Medicare patients charged "rack rate" or are they charged negotiated Medicare rates? I'm wondering why someone would have that type of regular Medicare plan, unless they were forced to, like my husband, because he is out of the country.

We need to go back to the US for some tests for an extended time and will be living with my parents in Florida, so my husband will want coverage for whatever is most beneficial--would that be to re-join an Advantage Plan, or keep straight Medicare? 

 

 

 

 

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Thanks! That's what it is. 

Question: Are these "Medicare approved charges" set at a lower, negotiated rate?  Like with my private Blue Cross health Insurance, a visit to the physician is "normally" $150, but Blue Cross negotiated a deal with my network, so all I pay is $35-, which is the "co-pay".  My CBC lab work has a "rack rate" of $750, but BlueCross  negotiated a deal with the lab, so all I pay is like $43.12 or some crazy number. 

 But if my husband used his Medicare Part B to visit my doctor and have the CBC, he would pay $30 for the visit, and $150 for the CBC, correct?

And, should he have to go to the hospital for some emergency that costs $80,000 "rack rate", he would have to pay 20% of that--Medicare doesn't negotiate to bring it down to a reasonable level? 

Why would someone want that type of plan, instead of an Advantage Plan?

 

 

 

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42 minutes ago, kimanjome said:

Thanks! That's what it is. 

Question: Are these "Medicare approved charges" set at a lower, negotiated rate?  Yes. Any doctor who accepts Medicare clients must agree to accept the Medicare Approved Rate. The doctor will/may bill Medicare their full amount (hoping?) but Medicare will only pay a small portion of that and the rest, less your deductible or co-pay, will be written off. Like with my private Blue Cross health Insurance, a visit to the physician is "normally" $150, but Blue Cross negotiated a deal with my network, so all I pay is $35-, which is the "co-pay".  My CBC lab work has a "rack rate" of $750, but BlueCross  negotiated a deal with the lab, so all I pay is like $43.12 or some crazy number. Similar

 But if my husband used his Medicare Part B to visit my doctor and have the CBC, he would pay $30 for the visit, and $150 for the CBC, correct? I can't attest to your figures but the concept is correct.

And, should he have to go to the hospital for some emergency that costs $80,000 "rack rate", he would have to pay 20% of that--Medicare doesn't negotiate to bring it down to a reasonable level? Not true. Hospital charges are covered under Medicare Part A, not B. Different coverages and deductibles. But the 'rack rate' would be thrown out and Medicare Approved charges would take over. They won't be near that theoretical $80 grand. After a deductible (per occurrence I believe), he will be responsible for 'only' 20% of whatever the reduced rate/charge was for the service that was rendered.

Why would someone want that type of plan, instead of an Advantage Plan? Maybe because that is what they have had for years and don't want to change. Advantage Plans have only been existance for about 10 years. Also they can go to any doctor that accepts Medicare whereas an Advantage plan is usually an HMO with 'in network' docs and hospitals and maybe their preferred Doc/Hospital is not on that list and then they would have to pay 'out of network' prices. Also they can go to any doctor anywhere in the US that accepts Medicare and get 'full service' whereas an Advantage Plan will only cover emergency situations when away from home, one must pay out of pocket and be reimbursed later (in most cases). So they could have one doc/hospital in their home town and another if they wintered in another area/state. There may be other reasons but I suspect that these are the major factors.

NOTE: Cross-posted with Lily H above....

 

 

 

 

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You guys have been SO helpful. Gosh, you'd think "they" would come up with a simple plan to eliminate all this bureaucratic nonsense.

Again, I appreciate your efforts in helping me understand it all. 

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49 minutes ago, kimanjome said:

You guys have been SO helpful. Gosh, you'd think "they" would come up with a simple plan to eliminate all this bureaucratic nonsense.

Again, I appreciate your efforts in helping me understand it all. 

"They" have. It's called Medicare for All. Read about it and realize how totally messed up our current system has become.

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Medicare Advantage is not your only option. There are also Medigap (covers that 20% gap) and Part D (covers meds) policies that can be purchased to supplement regular Medicare. Medigap insurance is not the same thing as Advantage and is not a supplement to Advantage. This is an either/or situation. That's all I know (or think I know!) if you have any questions somebody else will have to jump in here.

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There is the amount charged by the doc or hospital, then there is the Medicare allowable, upon which you pay 20%.  Most docs and hospitals "accept assignment" which means they accept the amount that Medicare pays regardless of how much the original charges are.  Because the payment is so low, more and more doc aren't accepting new Medicare patients.  Many times the amount paid by Medicare doesn't even cover the actual costs of an office visit.   Hospitals also "accept assignment" for their charges and you pay 20% of the "allowable" which is much lower than the original bvill sent to Medicare.

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11 hours ago, kimanjome said:

SNIP....

We need to go back to the US for some tests for an extended time and will be living with my parents in Florida, so my husband will want coverage for whatever is most beneficial--would that be to re-join an Advantage Plan, or keep straight Medicare? 

 

 

 

 

That is a question we/I cannot answer for you as we know nothing about the condition and what might come of a visit to a doc/hospital, or for how long or how many visits.

The Advantage program will have a cheap 'premium'... some are $0 dollars and most won't be over $40/mo.  But there will be co-pays and maybe deductibles etc. and he must go to a Doc of their choice.

If he goes to Original Medicare and is anticipating some serious stuff he will want to also get a Medigap policy to cover the remaining 20%.  The monthly premium for a Medigap Policy will depend on just what coverage he buys.... there are 5-8 different coverages that will cost different amounts depending on what they cover. The Plan "F" is a popular one. But also he will pay a much larger monthly premium for a Medigap Policy... maybe as much as say $250 for a Plan "F" coverage. With a Medigap policy, he can go to any Doc that accepts new Medicare patients.

 

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...and then one must check and see when "open enrollment" dates are.

Yes, it would be much simpler if people could avoid signing up and paying a premium when they are not (or think they're not) sick and just be able to sign up online the day before they see a doctor or enter the hospital. And don't get me going about how they changed everything after we moved to Mexico. It was all simple to understand before we moved away from Medicare coverage and then somehow, some way, they changed everything. What, you mean they didn't? Are you saying I should have paid attention beforehand? I'm not a dumb person, it can't be my fault.

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