Help- Implant when Medicare kicks in this August

[joeban]

Hello,
I want to go the surgery with Dr Clavel in Houston. I will be 65 years This August and I am not familiar with the Medicare complexity of choosing a plan within the program.
Any specific / medical plan coverage that I need to choose (extra) to sign in for in order for pay fully?
I live in Houston and thinking to go to Clavel for the surgery.
What additional insurance did you signup for ?
Thank you

[nerdynerd]

After weeks of investigation, I decided on original Medicare (Parts A & B) with a supplement plan from AARP/UnitedHealthcare. If a procedure is covered by Medicare, Medicare will pay 80% and the supplement plan pays the other 20%. The supplement plan has no restrictions other than Medicare must cover the procedure. You will have to pay for both every month and there's a small yearly deductible.

I decided on a supplement plan instead of an Advantage plan because the latter replaces Part B and they may have exclusions and restrictions. I also have infusions for my RA every 8 weeks and they bill almost $100K so not all Advantage plans cover it.

After my small annual deductible I paid nothing for the implant procedure.

Advantage plans do offer additional coverage for dental, vision and other items but I did not want the hassle of trying to figure out what they might exclude or what providers would be in-network. They may offer more for less cost that my setup.

Ultimately, the choice is yours. I'm sure other members used an Advantage plan instead of the supplement plan I used.

[CuzznClark]

After weeks of investigation, I decided on original Medicare (Parts A & B) with a supplement plan from AARP/UnitedHealthcare. If a procedure is covered by Medicare, Medicare will pay 80% and the supplement plan pays the other 20%. The supplement plan has no restrictions other than Medicare must cover the procedure. You will have to pay for both every month and there's a small yearly deductible.

I decided on a supplement plan instead of an Advantage plan because the latter replaces Part B and they may have exclusions and restrictions. I also have infusions for my RA every 8 weeks and they bill almost $100K so not all Advantage plans cover it.

After my small annual deductible I paid nothing for the implant procedure.

Advantage plans do offer additional coverage for dental, vision and other items but I did not want the hassle of trying to figure out what they might exclude or what providers would be in-network. They may offer more for less cost that my setup.

Ultimately, the choice is yours. I'm sure other members used an Advantage plan instead of the supplement plan I used.

I retired on Nov 30th and like you I chose not to go with an advantage plan, instead I went with a BCBS "G ". supplement plan. I was implanted on 3/18 by a high volume implanter who accepts medicare - I will let you know how this works out.

[easymoney]

I'm on UHC advantage plan in fl ..I paid 270.00 co pay for my implant last june

[Gt1956]

Parts A & B plus an Advantage plan here. Very few/small copays. The anesthesiologist didn't take Medicare, I have to pay separate & seek reimbursement from the Advantage plan. Even if the Advantage goes to crap on me. That bill is about $1400 or so. It won't break me.

Worth it!

[joeban]

Thank you all for your responses. i really appreciate it.
If Money no issue and you are staring Medicare. what would would you choose (A,B, Advantahe, Sypplemenet...?) knowing that I will be having the surgery right after starting Medicare?
Thank you for you help

[Old Guy]

You definitely want to take Part B. I'd stick with standard Medicare A & B. Any supplemental policy may help cover any co-pays but there may be deductibles to meet first.
Good luck figuring out which way to go, insurance can be as tough as learning Greek.

[joeban]

Thank you all for your responses.
i will be choosing part A +PartB and a Supplement plan. What supplement did you choose? I am very interested to hear what is specifically you choose.

Thanks for help

[Gt1956]

I'm locked into Aetna due to my pension. So I have an Aetna Advantage plan. To my knowledge my advantage plan qualifies as a "plan D" Medicare supplement. It does have a drug function to it but I've found that on some non generics it doesn't cover very well. On generics, it seems that Walmart's pharmacy using a Goodrx discount code is just as good. Maybe a $ or two better. If I drop my Aetna Advantage thru my employer I can't ever get back into their plan so there is that part to my choice.

I just left my drs office. My copay on Janumet was pretty bad. I went to Jardiance with Metformin. My glucose control wasn't as good as with Janumet. Jarnuvia is off patent in Canada so my dr has given me a prescription to use mail order in Canada. I'll buy the Metformin at Walmart. Btw, Jarnuvia is the critical ingredient in Janumet. It's less that $1 a pill in Canada. Aetna covered Jardiance with a $160 copay until my deductible is satisfied then it goes to around $50 a month. Be careful because the two names are similar.

As a retiree, you need to work all the angles on your meds. Its hard to get a break on non generics in the USA.

Sorry for the long post. Some of the decisions on Medicare are complicated.

[newbie443]

I have part A and B. For part D I use the Medicare site to put in medications I am on to find the lowest cost plan. Part D you can change every year if you need to without any trouble. I have a part G supplemental. With the part G as long as the medical facility accepts the Medicare approved amount you pay nothing after any amount you are responsible for under Medicare at the beginning of the year. With part G you can go anywhere that accepts Medicare. My understanding is with Advantage is that you are limited to where you can go. My home area is not known for cutting edge medical treatment. So I was not going to be stuck with local only doctors so Advantage was out for me. Advantage may be OK in areas with better health care but try to call around to the really good doctors and see if they actually accept it or if you have to go to less experienced and lesser quality doctors. I have heard the same thing about Advantage's drug plans. They are basically just a buyers group and a bit high on the drug cost side of things. If you are healthy and not on meds or just a low cost generic you might make out fine with Advantage.

Once you choose a supplement plan you are locked in to that plan. If you choose a part G and later switch to Advantage you may get even lesser coverage. If you choose Advantage I do not think you would be able to switch to part G. Or if you could you would take a major hit on coverage. My part G and D coverage is expensive but no where near what I was paying when I bought my own health insurance. Advantage would have been cheaper up front but drug cost would have taken care of a big part of that. And now I can go to any doctor in the US who accepts Medicare. With advantage I would have been stuck with my local less quality heath care and I am pretty sure insurance would have more say in what my doctors could do.

Just my understanding of how things are in my part of the country. As health insurance is controlled by individual states Advantage my be different for you.