(US) Medicare for Dummies

[ericthai]

16 hours ago, Langsuan Man said:

 

Dental visits are not covered by any Medical Insurance program, only by Dental Medical Insurance plans.  The only time a dental visit could be covered would be in the case of an accident, then it is considered a Medical (reimbursable) necessity 

 

This is one of the failings of the US medical system, despite the fact that dental health is critical in overall  health, the dental community is treated as second class citizens in the US

 

Even Blue Cross, a cadillac insurance plan will not cover anything to do with my teeth 

Yes, it is true that Medicare will not cover Dentist (unless it is considered medically necessary) , however allot of Medicare advantage programs (offered by private insurance companies) offer some Dental, Vision and Hearing. However these are limited services. I agree with you Dental is very import to the overall health of someone and should be covered. Dental costs in the USA are unbelievable and more expensive than seeing a doctor nowadays. 

[ericthai]

10 hours ago, JLCrab said:

Regarding Part B enriollment penalties:

If you plan to move back to the United States one day or will travel back frequently, you should only consider delaying or dropping Part B if:

 

You (or your spouse) currently work outside the United States for a foreign or American company that provides you health insurance, or you (or your spouse) work in a country with a national health system. You qualify for a Special Enrollment Period to enroll in Part B without penalty, and at anytime while you or your spouse are still working and for up to eight months after you lose your health coverage or stop working.

You volunteer internationally for at least 12 months for a tax-exempt non-profit organization and have health insurance during that time. You have a six month Special Enrollment Period to enroll into Medicare without gaps or penalties that starts once your volunteer work stops, or your health insurance outside of the United States ends, whichever is earlier.

https://www.medicareinteractive.org/get-answers/medicare-and-other-types-of-insurance/medicare-and-living-abroad/medicare-coverage-if-you-live-abroad-but-plan-to-move-back-to-the-united-states-or-travel-back-frequently

 

 

This partly true. The coverage you have must be equivalent to or better than what Medicare offers. If the insurance coverage you have is not equivalent or better then the penalty still applies. 

[ericthai]

10 hours ago, smo said:

But it does, (it in this case is Obamacare/Medical): so far I have had one check up (with xray), one cleaning and 3 fillings and haven't paid one penny. The one thing (maybe there are others) that is not covered is root canal when done on front teeth (according to my dentist who was quick to point out I'm going to need one - maybe two. Ouch)

 

 

ACA or Obamacare is not Medicare!  Medicare will not cover any dental unless it is medically necessary. There are Medicare advatange plans that cover limited dental same with some ACA plans.

[ericthai]

7 hours ago, Mr0Yallow said:

As I understand it Medicare is Medicare period, I understand Medicare advantage is a Medicare supplemental plan, in other words you pay an additional premium, just like Kaiser or any other HMO, As I have been told, Medicare will not cover medical treatment outside the USA, I believe that includes their portion of any supplemental plans. 

Correct Medicare is Medicare. The you have Medicare Advantage plans and Medicare Supplement plans. These are two different things. Advantage plans have co-pays and some include Drug coverage, Medicare Supplement plans have no co-pays but has a monthly premium and has no drug coverage so you need to get a stand alone drug plan.   In most cases original Medicare covers 80% and you are responsible for the 20%, any preventive services are covered 100%. 

With a medicare advantage plan will have set co-pay for Hosp, Doctor etc. When you enroll you are no longer on Medicare and now with a private company.  There are different type HMO, PPO etc depending on the type of plan you have to see the doctors are the plan is contracted with. A PPO you can see any doctor but will pay a higher copay.  A medicare Supplement plan or sometimes called Medigap plan you are still on original Medicare so you can see any doctor that accepts Medicare. You pay a monthly premium and have no co-pays. There different type of these plans to. Type A, B F etc. Type F is the top plan. Others plans have a deductible before the plan starts. Medicare will pay their 80% and the medsupp or Medigap plan will cover the balance. However you must have a US address to enroll and live in the plan area as all plans are not offered everywhere. 

[oldcarguy]

Hi

 

if you are over 65 years old and do not have the 40 credits can you pay for Medicare A   ?   (  how much ? )

and then pay Medicare B and D  ??

 

and has Trump  said anything about changing Medicare ?

[JLCrab]

3 hours ago, ericthai said:

This partly true. The coverage you have must be equivalent to or better than what Medicare offers. If the insurance coverage you have is not equivalent or better then the penalty still applies. 

In my case BUPA Platinum seemed to meet their requirements.

[Jingthing]

1 hour ago, oldcarguy said:

Hi

 

if you are over 65 years old and do not have the 40 credits can you pay for Medicare A   ?   (  how much ? )

and then pay Medicare B and D  ??

 

and has Trump  said anything about changing Medicare ?

trump gave lip service to not touching Medicare during his campaign but since then there have been warning signs that he might be open to going along with some of the radical measures from republicans like Ryan, to make it into a voucher system. Predicting what trump will actually do from what he has said isn't exactly reliable considering his unusual characteristics. 

[thailand49]

6 hours ago, ericthai said:

Sorry about that. Each state is different on their programs. In California if she is living along she needs to make under $1366 per month. I have had clients that are just over by $10-15 a month and the state cant do anything. At that time I typically start reaching out to drug manufactures for help in costs, grants etc. Yes, cola was given this year but not last few years, therefore anyone previously on Medicare is still at $109.40 and anyone new is $134.00 but again depends on earnings. I dont understand that she had to start paying $650 per month. Glad you helped her to work things out. 

My mother, to be exact at the time just last year was receiving $1352.00 per month. She is being managed by a Senior group, who I won't mention takes care of all her needs while we wait for a opening in one of their senior homes. She was living alone all her medical needs were being provided by the center which was being paid by Medicare/Medi-Cal. They pick her up twice a week to visit the center at which time they attend to any medical needs.

Within, the $1352.00, to qualify we yearly had to go out and buy small medical policy like, vision, dental, which the Senior caretakers were already providing, just to drive up some of her expenses to qualify otherwise she had to pay $650.00 a month for the service she was already receiving.

As noted, in her situation being 98, Medi-Cal pick up the $109.00, out of the goodness of their heart but now had $109.00 too much money each month therefore she had to pay now $650.00. As you noted she is receiving very close to the limit and even at times a Cola, by S.S. causes her problems. Last year she was over by $5.00, so we went out and purchase another vision plan for $25.00 to increase the expenses. There were years we didn't have a problem because the workers at Medi-Cal, turn a blind eye knowing what was happening when the center turn in her case for review. But last year the person doing the review was new and just didn't get it. In the hearing, I actually requested that Medi-Cal didn't pick up Part B, ($109 ), to let up pay the amount therefore we wouldn't have to deal with the yearly review. By doing this she would save out of pocket $540.

Thanks

Edited January 14, 2017 by thailand49

[Pib]

5 hours ago, oldcarguy said:

Hi

 

if you are over 65 years old and do not have the 40 credits can you pay for Medicare A   ?   (  how much ? )

and then pay Medicare B and D  ??

 

 

 

Medicare Cost at a Glance

https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

 

[oldcarguy]

is there a plan you can pay extra for that will pay for dental implants ?

 

 

[Pib]

13 minutes ago, oldcarguy said:

is there a plan you can pay extra for that will pay for dental implants ?

 

 

If there is, it would probably cost and arm & leg in monthly premiums along with high copay.    Some of the plans do come with "routine" dental services" which means fillings,  cleanings, and X-rays.  Dental implants are usually considered cosmetic in nature.

 

https://www.medicare.gov/coverage/dental-services.html

https://www.ehealthinsurance.com/medicare/does-medicare-cover-dental-implants

http://www.1dental.com/articles/dental-insurance/dental-insurance-implants/

[ericthai]

16 hours ago, thailand49 said:

My mother, to be exact at the time just last year was receiving $1352.00 per month. She is being managed by a Senior group, who I won't mention takes care of all her needs while we wait for a opening in one of their senior homes. She was living alone all her medical needs were being provided by the center which was being paid by Medicare/Medi-Cal. They pick her up twice a week to visit the center at which time they attend to any medical needs.

Within, the $1352.00, to qualify we yearly had to go out and buy small medical policy like, vision, dental, which the Senior caretakers were already providing, just to drive up some of her expenses to qualify otherwise she had to pay $650.00 a month for the service she was already receiving.

As noted, in her situation being 98, Medi-Cal pick up the $109.00, out of the goodness of their heart but now had $109.00 too much money each month therefore she had to pay now $650.00. As you noted she is receiving very close to the limit and even at times a Cola, by S.S. causes her problems. Last year she was over by $5.00, so we went out and purchase another vision plan for $25.00 to increase the expenses. There were years we didn't have a problem because the workers at Medi-Cal, turn a blind eye knowing what was happening when the center turn in her case for review. But last year the person doing the review was new and just didn't get it. In the hearing, I actually requested that Medi-Cal didn't pick up Part B, ($109 ), to let up pay the amount therefore we wouldn't have to deal with the yearly review. By doing this she would save out of pocket $540.

Thanks

I got you now.  Dealing with the government is not easy.  Allot of the people working for the government really want to help, some just dont care.  Glad you got it all worked out. 

[ericthai]

21 hours ago, oldcarguy said:

Hi

 

if you are over 65 years old and do not have the 40 credits can you pay for Medicare A   ?   (  how much ? )

and then pay Medicare B and D  ??

 

and has Trump  said anything about changing Medicare ?

yes you can, but it's expensive. Last client i worked with that had to purchase part A had to pay about $450 a month for part A.  Part B is now $134 a drug plan Part D are as low as $15 and as high as $150 all depends on what state you live in.  

[ericthai]

15 hours ago, oldcarguy said:

is there a plan you can pay extra for that will pay for dental implants ?

 

 

No plan will cover implants unless it is medially necessary.   i have seen some companies that offer

full dentures at no cost. Mostly those plans are in Florida. 

[ericthai]

21 hours ago, oldcarguy said:

Hi

 

if you are over 65 years old and do not have the 40 credits can you pay for Medicare A   ?   (  how much ? )

and then pay Medicare B and D  ??

 

and has Trump  said anything about changing Medicare ?

yes you can, but it's expensive. Last client i worked with that had to purchase part A had to pay about $450 a month for part A.  Part B is now $134 a drug plan Part D are as low as $15 and as high as $150 all depends on what state you live in.  

[ukrules]

I'd like to know why you were prescribed Erythromycin instead of Amoxicillin ?

 

Unless you have an allergic reaction to Penicillins then the go to drug of choice for generic tooth issues is Amoxicilin which is very cheap.

 

Of course Erythromycin should also be very cheap as well but : 'Murica

[JLCrab]

Just to note that monthly Part B premium saved by qualifying for the Part B penalty waiver can pay for almost half of the Thai-based insurance each year required to qualify for the waiver.

[thailand49]

11 hours ago, ericthai said:

I got you now.  Dealing with the government is not easy.  Allot of the people working for the government really want to help, some just dont care.  Glad you got it all worked out. 

ericthai,

let me take advantage of your expertise?

As I noted, the last few years I had to buy small medical plans like dental vision that isn't needed due to trying to qualify her.  After a long period she was finally able to get a room in the senior home to care for her. The amount she is being charged $771.00 per month is part of HUD/Section 8.

Is this housing amount she is paying now counted toward her qualification with Medi-Cal, I want to cancel the dental and vision plans that are being paid to save a bit of money for her?

Thanks

[ericthai]

On 1/15/2017 at 0:31 AM, thailand49 said:

ericthai,

let me take advantage of your expertise?

As I noted, the last few years I had to buy small medical plans like dental vision that isn't needed due to trying to qualify her.  After a long period she was finally able to get a room in the senior home to care for her. The amount she is being charged $771.00 per month is part of HUD/Section 8.

Is this housing amount she is paying now counted toward her qualification with Medi-Cal, I want to cancel the dental and vision plans that are being paid to save a bit of money for her?

Thanks

I'm not sure about Medi-Cal but it should be close to what other State Medicaid programs.  There are different levels Medcaid and each level have different requirements to qualify.  It seems for her level of coverage she is only allowed X amount of available cash and assets after her bills are paid. If this is the case then yes it should be applied to her monthly bills.  I had a client go into a long term care facility and same to qualify they had to keep less than $2000 or something like that in their account. So my friend ended up taking out a life insurance plan. The plan was not cheap because of being in a long term facility but he didn't care.  You might want to look into that instead of throwing money away on plans for services she already gets.  Hope that helps, you contact me anytime you need help with Medicare.

 

[thailand49]

8 hours ago, ericthai said:

I'm not sure about Medi-Cal but it should be close to what other State Medicaid programs.  There are different levels Medcaid and each level have different requirements to qualify.  It seems for her level of coverage she is only allowed X amount of available cash and assets after her bills are paid. If this is the case then yes it should be applied to her monthly bills.  I had a client go into a long term care facility and same to qualify they had to keep less than $2000 or something like that in their account. So my friend ended up taking out a life insurance plan. The plan was not cheap because of being in a long term facility but he didn't care.  You might want to look into that instead of throwing money away on plans for services she already gets.  Hope that helps, you contact me anytime you need help with Medicare.

 

Thanks, I will be return home soon for a few weeks I will check.

[smo]

On 1/14/2017 at 1:17 PM, ukrules said:

I'd like to know why you were prescribed Erythromycin instead of Amoxicillin ?

 

Unless you have an allergic reaction to Penicillins then the go to drug of choice for generic tooth issues is Amoxicilin which is very cheap.

 

Of course Erythromycin should also be very cheap as well but : 'Murica

Right on, yes I'm allergic to Penicillin.

[Flustered]

I would be asking why were you prescribed anything at all. It's only fillings, not major surgery unless there were other problems as well in which case I apologize.

 

Also, dentistry in Thailand is far better than in the US and much cheaper.

 

I had root canal surgery in Phuket a few years back and the dentist was wonderful. No pain and only 1200 baht and definitely no antibiotics for afterwards, not needed at all.

 

Stick to Thailand. It's medical facilities are excellent.

[Acharn]

On 1/12/2017 at 9:21 PM, Pib said:

You must be mailing in your Tricare claim.  I to use Tricare Overseas...submit the claim online and usually get reimbursed via Direct Deposit in 3 to 4 weeks...use to be around 2 weeks.

No, I mailed my claims in last year, and I've used Tricare Overseas for 35 years. Granted I went for many years without any claim to send -- incredibly blest with good health. This year I've been sending them on line. Finally broke down and sent an inquiry today -- one claim submitted 7 November, another submitted 21 November. I've got eight more outstanding, but they were all submitted in December or January, so may still be getting attention. They all show up on the message board as received, and they've all been assigned Internal Control Numbers,  but no other response from them. Mailing them was frustrating. I think the longest was nine weeks, the best was five. Over my whole time in Thailand five weeks was the best. I usually figured six weeks was normal.

Edited January 18, 2017 by Acharn

[Pib]

For the 8 years I've been submitting Tricare claims from here in Thailand (around 3 to 6 claims per year between the wife and me which includes our annual checkups) the total time from online submission till payment has been around 3 to 4 weeks...probably closer to 3 weeks. Up until a few years ago it use to be 10 to 14 days. With the exception of one claim for a little over $1000 all the claims are usually below $200, if claim amount makes a difference in processing time. I also submit the scanned claim documentation as one PDF document.

Also for the last year since they modified their online submittal menu although you will get that very inital submittal email you will no longer get any further emails of status. You just have to wait until the fully processed claim appears online...at that time you will get a direct deposit email if any payment was made. Not sure what notice you may get if not using direct deposit. Before you also got an email when they opened your submittal and assigned it a control number.

Now I haven't subbitted a claim since Aug/Sep 16 so hopefully they have not got really slow with the start of the new fiscal/contract year on 1 Oct 16.

[Aidenwillson]

Usually in the USA even the generic Amoxicillin is pricey.  I think probably has the highest drug prices in the world thanks to drug company lobbyists.But the FREE Prescription Discount Card, saving money is very good

[Spaniel]

When I turned 65 in July 2009 I did not take Part B which saved me about $95 a month.      Since I am considering spending more time in the USA, last year,  2016,  I enrolled in Part B and I pay $205 per month.      A bit high but when you consider for 7 years I didn't pay anything  I guess my "break even" point is a few years off.

[ericthai]

12 hours ago, Spaniel said:

When I turned 65 in July 2009 I did not take Part B which saved me about $95 a month.      Since I am considering spending more time in the USA, last year,  2016,  I enrolled in Part B and I pay $205 per month.      A bit high but when you consider for 7 years I didn't pay anything  I guess my "break even" point is a few years off.

In 2009 I believe it was $97.40.  Medicare dont care when you enroll, but if you enroll late they will

enforce the penalty.  Did you get a Part D plan? There is a penalty if you dont enroll in this too.

The part D penalty is monthly. It will be 1% of the national average for each month you delayed. For 2017 the national average is $35.63 so $0.3563 for each month. Your fine would be about $30.00 on top of the cost of the Part D plan.  If you are not taking any heavy medications then you might be best off not enrolling. Most generic drugs can be purchased in bulk from sams, Cosco etc. Walmart offers good prices on generic too. Most brand name drugs you can find coupons or program that help in cost. I have some clients that have Part D plans but go to walmart to get $4 blood pressure meds and tell them they have no insurance because their co-pay is $10 with the insurance.  You might want to check into a Medicare advantage plan if available in your area. If you have questions or need help you can always PM me. 

 

[DogNo1]

Look out for fake drugs at Walmart!

[Spaniel]

8 hours ago, ericthai said:

In 2009 I believe it was $97.40.  Medicare dont care when you enroll, but if you enroll late they will

enforce the penalty.  Did you get a Part D plan? There is a penalty if you dont enroll in this too.

The part D penalty is monthly. It will be 1% of the national average for each month you delayed. For 2017 the national average is $35.63 so $0.3563 for each month. Your fine would be about $30.00 on top of the cost of the Part D plan.  If you are not taking any heavy medications then you might be best off not enrolling. Most generic drugs can be purchased in bulk from sams, Cosco etc. Walmart offers good prices on generic too. Most brand name drugs you can find coupons or program that help in cost. I have some clients that have Part D plans but go to walmart to get $4 blood pressure meds and tell them they have no insurance because their co-pay is $10 with the insurance.  You might want to check into a Medicare advantage plan if available in your area. If you have questions or need help you can always PM me. 

 

 

I did not take Part D.