Anyone not get Medicare Part D?

[Alan Lightstone]

I won't go into tremendous detail about the disadvantages of most Medicare Advantage plans. But, whichever you choose to sign up for, your medical conditions and therefore the medications you are on matter tremendously as to your costs and choice of plan.

Go to Medicare.gov and type in all of your medications and dosages. Then compare plans (both Medicare Advantage (Part C) and Part D) to see your real costs. Also, type in your doctors and hospitals to see if your plan takes them. That's really important. Many unhappy surprises there. It is very unlikely that your doctor takes all of these plans, and may take none of them. And checking if the best hospital in your area is in network is also key with a Medicare Advantage plan. Many aren't, though almost every hospital will take Medicare.

Also, your costs for biologics and insulin are typically far cheaper with Part D than with an Advantage Plan (Part C). Difference can amount to tens of thousands of dollars per year.

[Dave Fritz]

Let me second Doug's post. If you go to a person that sells insurance they'll sell you what they have. Like a Ford dealer isn't going to sell you a new Chevy. Medicare.gov is a fantastic resource. I used to be on the Commission on Aging for our county and for a time volunteered to help people navigate medicate.gov. We saved folks lots of money.

[Curt Harms]

I made a relevant discovery yesterday. There is a local pharmacy a few miles away that charges less for common meds than Walmart pharmacy charges for copay. I doubt that would be true where no generic exists yet.

[Mike Henderson]

I'll add one more medical warning - about hospitals. Most people when they (or someone they are responsible for) are being admitted to a hospital will just sign all the paperwork put in front of them.

However, one piece of paperwork can cost you a lot of money if you're on Medicare. Even though the hospital may be Medicare participating, they may have doctors on staff that are not Medicare participating. The piece of paperwork you'll be asked to sign is an acknowledgement that you may receive treatment from a Medicare non-participating provider and you will be responsible, "out-of-pocket", for that provider's fees. And that provider's fees are not limited in any way, as they are with Medicare.

DO NOT SIGN THAT PAPERWORK. Instead, write on it, "I wish to only receive services from Medicare participating providers. I will not be responsible for fees from Medicare non-participating providers." If you sign that paper, you can be on the hook for thousands of dollars, out-of-pocket, even though you have Medicare.

The hospital will threaten to not admit you if you don't sign. Don't give in. They will admit you.

Hospitals depend on doctors bringing their patients to the hospital and therefore bend over backward to the doctors. Hospitals exist for the benefit of the doctors, not for the patients.

Some doctors feel that what Medicare pays for their services is too low and they opt out of Medicare. In their regular office hours, Medicare covered people are not in such a difficult circumstance as when they (or someone they love) are being admitted to a hospital so it is difficult to get them to pay "out-of-pocket" (the doctor will mostly treat younger people with commercial insurance, which pays better). But under the stress of hospital admission (perhaps in an emergency) Medicare covered people will sign.

Mike

[This warning is mainly aimed at people on traditional Medicare. I assume that if you're on an Advantage plan you will be directed to a hospital that is part of that plan.]

[Jim Becker]

However, one piece of paperwork can cost you a lot of money if you're on Medicare. Even though the hospital may be Medicare participating, they may have doctors on staff that are not Medicare participating. The piece of paperwork you'll be asked to sign is an acknowledgement that you may receive treatment from a Medicare non-participating provider and you will be responsible, "out-of-pocket", for that provider's fees. And that provider's fees are not limited in any way, as they are with Medicare.

DO NOT SIGN THAT PAPERWORK. Instead, write on it, "I wish to only receive services from Medicare participating providers. I will not be responsible for fees from Medicare non-participating providers." If you sign that paper, you can be on the hook for thousands of dollars, out-of-pocket, even though you have Medicare.

This HHS rule that goes into effect shortly will hopefully help with this kind of "surprise billing" but the text at this link indicates it's already banned for Medicare and Medicaid patients.

https://www.hhs.gov/about/news/2021/...cal-bills.html

[Mike Henderson]

You're correct. I see that non-participating providers can only charge up to 15% more than the Medicare approved amount, not any amount they want. Note that since Medicare pays 80% of the Medicare approved amount, you could be on the hook for 35% (the 20% Medicare doesn't pay, plus the 15% extra).

I encountered this situation when I went to a hospital for a test. They wanted me to sign a form that I was responsible for the fees of any non-participating provider. I refused to sign it and said I only wanted services from participating providers.

Overall, I think a hospital that is Medicare participating should only have Medicare participating providers. The patient should not have to ask every provider that enters his/her hospital room whether they are a Medicare participating provider.

Mike

[Jim Becker]

Mike, while not a Medicare situation, I had the "surprise" $800 billing problem when I had my eye surgery last year. The anesthesiologist was apparently part of an independent group owned as an investment by some entity and not a participant in our insurance plan. (from a BCBS insurer) I was never notified of that even though the young lady appeared to be part of the hospital team. I appealed it to BCBS and fortunately got them to pay up to the equivalent of an in-network provider. And that surprise bill was actually 9 months after the completion of the surgery.

I wholeheartedly agree that the patient shouldn't be on the hook to deal with all this stuff when getting something attended to in an "in network" facility, private insurance or Medicare/Medicaid. There should be no surprises. But then again, I'm not a fan of the whole system overall, but we'll not go there.

[Mike Henderson]

There are providers who are not limited by the 15% over rule - they are called "Opt-Out Providers". Here's some information from the Medicare web site:

1. Opt-out providers do not accept Medicare at all and have signed an agreement to be excluded from the Medicare program. This means they can charge whatever they want for services but must follow certain rules to do so.
   
   • Medicare will not pay for care you receive from an opt-out provider (except in emergencies). You are responsible for the entire cost of your care.
   • The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you.
   • Opt-out providers do not bill Medicare for services you receive.
   • Many psychiatrists opt out of Medicare.

The situation I encountered may have involved Opt-out providers.

Mike

[Alan Lightstone]

Hospitals depend on doctors bringing their patients to the hospital and therefore bend over backward to the doctors. Hospitals exist for the benefit of the doctors, not for the patients.

Mike

Mike, with all due respect, that comment is outdated by about 15-20 years, or more. And this is coming from a hospital-based physician who worked his entire career in hospitals. Usually Level-1 trauma centers where a huge percentage of my patients never paid for their care. And we took care of them just like any other patient who came to our doorstep. In reality, I never knew if my patients would pay their bills. I just took care of them to the best of my abilities.

Hospitals exist for the benefit of themselves, their administrators, and their shareholders. The doctors are a captive audience, except for the few that bring in massive numbers of patients (think large orthopedic surgery practices, specialized surgeons like thyroid surgeons who get huge numbers of patients, etc...) All the other physicians are typically treated like serfs. The daily beatings from the mid-level nursing staff are so much fun.

[Mike Henderson]

Mike, with all due respect, that comment is outdated by about 15-20 years, or more. And this is coming from a hospital-based physician who worked his entire career in hospitals. Usually Level-1 trauma centers where a huge percentage of my patients never paid for their care. And we took care of them just like any other patient who came to our doorstep. In reality, I never knew if my patients would pay their bills. I just took care of them to the best of my abilities.

Hospitals exist for the benefit of themselves, their administrators, and their shareholders. The doctors are a captive audience, except for the few that bring in massive numbers of patients (think large orthopedic surgery practices, specialized surgeons like thyroid surgeons who get huge numbers of patients, etc...) All the other physicians are typically treated like serfs. The daily beatings from the mid-level nursing staff are so much fun.

Yes, you're probably correct. I see it from the outside but, like all corporations, I'm sure that profit for their shareholders are very important.

Mike

[Larry Frank]

This thread went way off the rails !
On the Medicare website, you can enter your medications and get a good estimate of the costs from various plans. If you know your RX costs without Part D, you can make a financial decision on what to do.

This forum is not the best place to find information or misinformation on Medicare.

[Wade Lippman]

I wasn't looking for information; I was asking if other's had gone without part D and had problems.

My Part D is now $16, but the part D IRMAA is $71. That goes away if I drop part D.

[Dave Fritz]

Wade, I had a neighbor that bragged about not needing insurance that he could get his prescriptions at Walmart for $2. That was the case then, but not now. Insurance isn't for the present but rather protection for what's in the future. You pay your money, and take your choice.