Understanding Medicare and options
 

Does the SHINE organization explain this to people? Can you get an appointment with them or do they only do seminars? The vocabulary of medicare is beyond confusing. The options are confusing. The repercussions are confusing. Is there an organization that you can sit with to learn how this works and the pros and cons or do you just get an insurance agent. Are there specific agents for medicare? Help!

Are you kidding? No one knows anything about where to find out how Medicare works?

SHINE is great - and should be able to help guide you without bias. Their schedule and contact information is listed in every recreation news.

My experience with Medicare has been the bills get paid. Finding out the details from a non sales oriented health insurance counselor as to how and what the plans are and what they offer is complex and confusing. I would think that in the Villages there would be a non partisan subject matter expert. Good Luck!

Download the manual from the Medicare site. It is pretty clear. The problem is how to pay the other 20%. That is where all of these supplement companies come in. Then you have to figure out which is the best.

Fortunately for me, my company provided medical insurance and they take care of the other 20% so I do not have to look for a secondary insurance policy.

Z

Ok. So the majority...80% is paid by Medicare and the extra 20% is what you have to figure out. That is the whole thing?

So you want to find a company that lets you go anywhere so you don't get stuck with regional and "in network" and sometimes substandard doctors. Is that the issue?

I really appreciate the primer on this. Thank you one and all who respond.

Yes confusing. Go to SHINE general meeting and you can also have a one on one meeting. Also talk to a few salesmen.
To start go to the medicare site and follow the instructions to find a plan
https://www.medicare.gov/find-a-plan...ookieSupport=1

I can't seem to make a SHINE meeting for various reasons but they will meet one on one? Someone said they were located up at Lake Sumter. Do you know where they are exactly?

This page shows locations and times: SHINE - Sumter They don't take appointments - first come, first served. They are knowledgeable and helpful.

I'm a SHINE volunteer. Counseling session schedules are always in the Rec Center news. Aside from the seminar, which really helps if you are new to Medicare, you can get individual help (first come, first served) at the counseling sessions. I also highly recommend the Medicare.gov: the official U.S. government site for Medicare website; it's very user friendly.

Deleted my post because info and link already posted.

Are the counseling sessions different from the seminar? Are they at the same place? After the seminar?

The seminar is a separate event. They take questions afterwords, however for individual counseling it is best to come to one of the sessions at various locations around The Villages as listed in the Rec Center news.

Whatever you do be prepared to review your plans and what they cover every year. We have had an advantage plan now for 4 years and it works well for us. Every year coverage can change and shift a bit but I don't mind the yearly review as it keeps me up to date on where our medical coverage stands. Others may prefer the Supplemental policy which does not carry most of the restrictions the of Advantage Plans, but at an added monthly cost of hundreds of dollars. Either way costs are going up on both as Obama Care is shifting $$$$$$ out of Medicare into "his" plan. It is still all shaking out so keep deligent.

I think that is excellent advice.

I know

Some Shine members are volunteers and some are paid by the Government How about that?

I'm in the same boat as I am new to Medicare! I had a couple of interesting medical appointments a few weeks ago.

I was at a local hospital for a "standing" lab that was written a couple years ago. The hospital told me that these basic labs are no longer covered as they were written. The hospital also told me that they are finding if Medicare denies your claim that the secondary insurance company is also denying the claim. The hospital rep told that this started in late July/early August.

Later that same day I mentioned this to my chiropractor. He said he is finding the same thing in everythingi he is reading. And believe me, he researches everything!

So, my response to both of them was "so why am I going to pay over $200 a month for a secondary insurance that is going to deny everything"?? I decidied I am going to to hold off changing anything until my open season starts in November.

On Friday, I saw another doctor. His wife is researching supplemental insurance options right now. He told me that his wife called the BC/BS Michigan office just last week. She was told by BC/BS that their premiums were going to raise dramatically in the near future. His wife has found in her research that Mutual of Omaha has a good supplemental policy so I am going to check them out.

For what reason would Medicare deny a claim? If a doctor who takes medicare sees a patient and writes a prescription, or recommends an operation, how can Medicare deny it?

Medicare is extremely picky about how a claim is submitted. There are many similar codes for the same procedure. If one code was approved and if the code submitted is off by one number...it's denied. I've seen procedures or visits denied because of a period in the wrong place. Medicare as a payor is very difficult to deal with. And as another poster said....if medicare denies it, the secondary automatically denies.....then it starts all over....resubmit....repeat. And, yes, this happens even when electronically submitted.

It's always been true that if Medicare denies a claim, the supplemental insurance will deny the same claim. The function of supplemental insurance is merely to pay the 20% that Medicare doesn't pay.

If you take original Medicare plus get a supplement, doesn't one still have to obtain prescription coverage?

What is the approximate cost per month to be fully covered?

I pay $104.9 per month with a Medical Advantage Plan, that includes prescription coverage.

I have attended shine meetings, they are a govt agency and some of them get paid. I am not sure they know DEEP details and how it really works.

You can get individual counseling with a SHINE counselor. They may not know every little detail but they can answer questions and point you in the right direction. Well worth it.

My insurance plan like most only pay 20% if Medicare covers the procedure. But and here is the key, my insurance pays for all preventative care. Such as all shots, tests, eye exams, physicals, Medicare only pays for one physical, etc. Had a bad year this year and I never paid a dime. One of my bills was almost 50 pages long and I paid nothing. A good insurance person can come to your home and explain your options. Another big plus is I can go to any hospital or doctor that accepts Medicare. So no in network or referral non sense. Don't look for the cheapest insurance but look for the one that protects you from enormous medical costs. Another consideration is that each state has different rules for insurance plans, in my case buying insurance from my summer home was better coverage than buying insurance from the same company in Florida. Don't forget to get a prescription drug plan that fits your needs and covers what medications if any your on now. Good luck, it's not that complicated.

Shine will be available for consultation at the event...

Elder Options, The Mid-Florida Agency on Aging, hosts the Villages Fearless Caregiver Conference at The Grand Oaks Resort and Museum on Thursday, December 11, 2014. Support, information and advice for family and professional caregivers from leading aging and disability experts, caregiver advocates and support organizations.

The event is designed as a day of shared wisdom for spousal, grandparent, veteran, adult children and long-distance caregivers, as well as anyone else seeking hands-on advice and support as they care for a loved one.

Limited number of complimentary caregiver tickets are available for the seminar, which runs 8:30am – 2:30pm. Registration includes a sit down luncheon and is available by calling (877) 829-2734 or by going online to Caregiver.com - For caregivers, about caregivers, by caregivers.

Shine at upcoming Fearless Caregiver Conference
 

Elder Options, The Mid-Florida Agency on Aging, hosts the Villages Fearless Caregiver Conference at The Grand Oaks Resort and Museum on Thursday, December 11, 2014. A day of support, information and advice for family and professional caregivers from leading aging and disability experts, caregiver advocates and support organizations.

The event is designed as a day of shared wisdom for spousal, grandparent, veteran, adult children and long-distance caregivers, as well as anyone else seeking hands-on advice and support as they care for a loved one.

Limited number of complimentary caregiver tickets are available for the seminar, which runs 8:30am – 2:30pm. Registration includes a sit down luncheon and is available by calling (877) 829-2734 or by going online to Caregiver.com - For caregivers, about caregivers, by caregivers.