[KeepingItReal]

64 turning 65 soon and just as confused as the rest. With that I did find a booklet on the Medicare Website which really helped.

Maybe this will help answer some of the more basic questions:

MEDICARE and YOU FOR 2015

Download handbook in different formats | Medicare.gov

[jimmy D]

I know

[jimmy D]

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

[Sable99]

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.

[shcisamax]

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?

[gerryann]

Originally Posted by shcisamax

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.

[Carla B]

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.

[2BNTV]

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.

[jimmy D]

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.

[jblum315]

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.

[lynxville]

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.

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.