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  • #46
    Re: Medicare

    Originally posted by matapule View Post
    Since Tutu has Secure Horizons, they are available in Hawaii too.[...]
    I don't see that they offer an Advantage plan, tho'. Maybe I overlooked it?

    Glad you're feeling better. I'm nearing the end of tendonitis of the shoulder. It's been a 1 1/2 year battle 'cuz I can't take cortisone.

    Comment


    • #47
      Re: Medicare

      Amati...Just be very careful when choosing your plan. If you travel a lot, make sure your plan will cover you in other parts of the country. For Medicare supplement plans, many of my patients who don't have group plans through where they work chose one of the AARP plans for their flexibility and choices. I had a patient with a Medicare Advantage plan which would NOT cover her if she travelled to Vegas to see family and needed her dialysis treatment. It would only cover her treatments here in Hawaii (I won't say which plan). Check to see if the doctors that you are seeing now are covered by the plan and the medications that you take are covered. My Kaiser Senior Advantage plan patients seem to be pretty happy with what they have because most of them have been with Kaiser forever and don't want to leave Kaiser. Their main problems seem to be when they get into the donut hole with their drugs....which happens to many people with Part D who don't qualify for the State's SPAP program (State Pharmacy Assistance Program) that helps with copays on certain Part D plans.

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      • #48
        Re: Medicare

        Originally posted by Amati View Post
        So, let's see if I have this right. Plan C would replace having Plans A + B.Yes? OK, then, anyone know what the options are (in Hawaii) for Plan C, besides Kaiser?
        Thanks for your responses so far. But I'm more confused than ever. If a decent retirement medical/dental plan is offered by the employer, then would taking Plans A+B be the right coverage, and not bothering with Plan C?
        Now run along and play, but don’t get into trouble.

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        • #49
          Re: Medicare

          It all depends on what kind of plan you have through where you work. Most of the people that I have seen that have group plans through where they work have kept their group plans because they have better overall benefits, less out of pocket expenses, dental benefits, and no donut holes to deal with when it comes to drugs. But that all depends on who they worked for....and so each situation is different. I've had some patients that ONLY kept their retiree plan and didn't bother to even apply for Medicare. There have been others that got Medicare as secondary to their group plan. Some retiree plans REQUIRE you to apply for Medicare and REQUIRE you to get the Advantage plan (Part C) if you are already with their Kaiser plan. If you're retirement income is super high, you may end up paying alot more than $96.40/mo for your Part B...it's not a set rate any more. Higher income people now must pay higher rates to have Medicare whereas in the past everyone paid the same amount to have it. Very low income people are lucky to have the state of Hawaii pay their Medicare Part B premiums for them (these are people that are also eligible for Medicaid/MedQuest). More confused now??

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          • #50
            Re: Medicare

            I hope I am posting this in the right Place ?


            After my first lesson on a longboard, I came off and burst open an old wound. With confidence I stood up and bounded forward like a gazelle for at least fifteen feet.I took myself to the ER room and was stiched up. I handed them my National Health Service form E111 but still had to pay $72.
            I got home a few days later and the bottom of my right foot was like a piece of wood. The school of tropical medicine said I had walked on coral and it was under the sole of my foot.

            I got the equivalent of $72 reimbursed but the scraping of the sole of the foot is not something I would recommend to anybody.
            Last edited by Barry; October 16, 2009, 02:47 AM.

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            • #51
              Re: Medicare

              Barry...I had one of those scrapings done too. I was doing an internship at the Waipahu Mental Health Clinic back in the 70s and we took a bunch of our clients (all kids) out to Electric Beach on the Leeward Coast for the afternoon. I wasn't wave savvy, being a mainlander from the Chicago area at the time....so I did a HUGE "no no" and had my back to the waves. Needless to say, one of the waves knocked me down and smashed me around the coral rocks a few times and I ended up being pulled out of the water by my practicum instructor with quite a few coral cuts and scrapes that needed to be cleaned up (along with a bruised ego). The closest place for me to go for medical care (I happened to be a military dependent back then) was the Barbers Point dispensary, where they scraped me with a brush that hurt WAY more than the coral scraping and near drowning did! LOL Luckily those kids never gave me a hard time but they probably had a few laughs on the way back to the clinic! (dat lolo haole wahine!) LMAO

              Comment


              • #52
                Re: Medicare

                Originally posted by tutusue View Post
                I don't see that they offer an Advantage plan, tho'. Maybe I overlooked it?
                Secure Horizons offers Senior Advantage in my area, I interviewed them. They had no stop loss benefit.

                I'm nearing the end of tendonitis of the shoulder. It's been a 1 1/2 year battle 'cuz I can't take cortisone.
                I forgot to tell the rest of the story. My regular Kaiser primary care physician was out with the flu! So I had a backup up Kaiser doctor I had never seen before. Fortunately his specialty was sports medicine and he fixed me up liki liki. I lucked out!
                Peace, Love, and Local Grindz

                People who form FIRM opinions with so little knowledge only pretend to be open-minded. They select their facts like food from a buffet. David R. Dow

                Comment


                • #53
                  Re: Medicare

                  Originally posted by alohacandy View Post
                  Amati...Just be very careful when choosing your plan. If you travel a lot, make sure your plan will cover you in other parts of the country.
                  That's what I like about my Kaiser plan, it will cover me anywhere in the world for emergencies.

                  My Kaiser Senior Advantage plan patients seem to be pretty happy with what they have because most of them have been with Kaiser forever and don't want to leave Kaiser. Their main problems seem to be when they get into the donut hole with their drugs
                  I don't have a "donut hole" with Kaiser Senior Advantage.

                  ....which happens to many people with Part D who don't qualify for the State's SPAP program (State Pharmacy Assistance Program) that helps with copays on certain Part D plans.
                  The Federal government has a program for low income people for parts A, B, & D.
                  Peace, Love, and Local Grindz

                  People who form FIRM opinions with so little knowledge only pretend to be open-minded. They select their facts like food from a buffet. David R. Dow

                  Comment


                  • #54
                    Re: Medicare

                    Originally posted by Amati View Post
                    If a decent retirement medical/dental plan is offered by the employer, then would taking Plans A+B be the right coverage, and not bothering with Plan C?
                    You will have to analyze both plans and decide which gives you the most coverge for the least cost.

                    Originally posted by alohacandy View Post
                    But that all depends on who they worked for....and so each situation is different. I've had some patients that ONLY kept their retiree plan and didn't bother to even apply for Medicare.
                    My father is a good example of someone who kept his retiree plan through his employer and had a great deal. Except.........his plan expired at age 90! Nobody lives past 90 right? Well my Dad is now 91 and he is paying through the nose for his Medicare coverage! His medications alone cost almost $3000 per month. Be careful when you analyze the details.

                    If you're retirement income is super high, you may end up paying alot more than $96.40/mo for your Part B...it's not a set rate any more.
                    That is correct, a member may pay more or less for Medicare depending on their income level. I pay 96.40 so that tells you my income level is pretty average for a retiree, as are something like 80% of members. I don't recall what the income level is for higher Medicare payments, but it is high, something like $75K per individual.

                    Very low income people are lucky to have the state of Hawaii pay their Medicare Part B premiums for them (these are people that are also eligible for Medicaid/MedQuest
                    I don't understand why the State is paying, since it is a Federal program.
                    Last edited by matapule; October 16, 2009, 05:31 AM.
                    Peace, Love, and Local Grindz

                    People who form FIRM opinions with so little knowledge only pretend to be open-minded. They select their facts like food from a buffet. David R. Dow

                    Comment


                    • #55
                      Re: Medicare

                      Originally posted by matapule View Post
                      That's what I like about my Kaiser plan, it will cover me anywhere in the world for emergencies.

                      Most plans WILL cover for emergency care out of state. Some people, however, who travel regularly and know that they will need to see a doctor for non-emergent care or get some kind of treatment that is non-emergent, want to know that they are going to be covered out of state if they are gone for a few weeks at a time on a regular basis.



                      I don't have a "donut hole" with Kaiser Senior Advantage.
                      Lucky!



                      The Federal government has a program for low income people for parts A, B, & D.

                      They have one called the LIS or Low Income Subsidy that helps with the premiums, the deductibles, and lowers the copayments. The SPAP program through the State helps with the copayments so that for some people who also have LIS, they may then have absolutely NO copayment on covered meds. Only certain Part D plans, however, are part of the SPAP program
                      .
                      Last edited by alohacandy; October 16, 2009, 05:42 AM.

                      Comment


                      • #56
                        Re: Medicare

                        Some people, however, who travel regularly and know that they will need to see a doctor for non-emergent care or get some kind of treatment that is non-emergent, want to know that they are going to be covered out of state if they are gone for a few weeks at a time on a regular basis.
                        Well yes and no. I can only speak to the Kaiser plan. I can go to any Kaiser facility - anywhere, any State - and receive non-emergency or emergency care. However, if I am traveling or living in a foreign country (like Mexico), I can only receive emergency care in that country reimbursed by Kaiser. Therefore it is necessary for me to return to the US to receive non-emergency care through Kaiser.
                        Peace, Love, and Local Grindz

                        People who form FIRM opinions with so little knowledge only pretend to be open-minded. They select their facts like food from a buffet. David R. Dow

                        Comment


                        • #57
                          Re: Medicare

                          Originally posted by Amati View Post
                          [...]But I'm more confused than ever.[...]
                          And therein lies the problem for the majority of people researching Medicare! Speaking for myself, the more research I did, the more confused I got!
                          Originally posted by alohacandy View Post
                          [...]and so each situation is different.[...] More confused now??
                          Bingo! Each person's situation is different which is why none of us can recommend a plan to another. It's just all so confusing!
                          Originally posted by matapule View Post
                          Secure Horizons offers Senior Advantage in my area, I interviewed them. They had no stop loss benefit.
                          Perusing medicare.gov, I don't see that SH offers an Advantage plan in Hawaii.
                          Originally posted by matapule View Post
                          I forgot to tell the rest of the story. My regular Kaiser primary care physician was out with the flu! So I had a backup up Kaiser doctor I had never seen before. Fortunately his specialty was sports medicine and he fixed me up liki liki. I lucked out!
                          My ex-husband had a couple of bouts with bursitis in the shoulder. Both times I had to take him to the ER; 2 different ERs in 2 different states. Both times he was given an injection of cortisone in his shoulder which gave him relief. Happy it worked for you, too! Sounds like your doc didn't get his flu shot in time!

                          Comment


                          • #58
                            Re: Medicare

                            On a sidenote: Medicaid: If you're planning on preserving your assets by setting up a trust and doing the 5-year wait period to qualify, beware that Medicaid also considers Annuities and Whole Life Insurance policy cash values as assets so long as the trust remains "Irrevocable". My mom found out the hard way after waiting 5-years to qualify and to suddenly not on the fifth year when my dad passed away.
                            Life is what you make of it...so please read the instructions carefully.

                            Comment


                            • #59
                              Re: Medicare

                              Originally posted by tutusue View Post
                              And therein lies the problem for the majority of people researching Medicare! Speaking for myself, the more research I did, the more confused I got![...]
                              I learned something today that really proved to me how confused I got, and still am, with the subject of Medicare!

                              Today I was filing some papers in my SH folder when a brochure fell out on the floor. The brochure's title..."Medicare Advantage Explained" from Secure Horizons!!! I know I had not seen that brochure before. I received a very large package of info when I joined SH and this was probably part of it. So, I perused it. Guess what, Matapule? I have the Secure Horizon's Advantage Plan C... I even called SH to confirm that! Turns out in Hawaii SH offers both HMO and PPO in their plan C and I elected to go with PPO. And, as I mentioned in a previous post, my annual out-of-pocket expenses do have a cap but with some limitations.

                              Ya coulda knocked me over with a feather! And, yes, I'm still confused!

                              Comment


                              • #60
                                Re: Medicare

                                Originally posted by tutusue View Post
                                Guess what, Matapule? I have the Secure Horizon's Advantage Plan C. I even called SH to confirm that!!
                                Okay, now your explanations make sense! Your description seemed to be an Advantage plan, but I am not completely familiar with Secure Horizons. If you had Secure Horizons Medicare Supplemental plan there would have been a monthly charge, in addition to the 96.40. In SoCal SH Senior Advantage is also a "no fee" plan, it just didn't offer as many benefits and conveniences as Kaiser. I really like the fact that I can communicate with all my doctors (primary and specialists) via email. I can also access all my medical records and doctor's notes on my password protected page(s). Also, I don't have a "donut hole" for my prescriptions.
                                Peace, Love, and Local Grindz

                                People who form FIRM opinions with so little knowledge only pretend to be open-minded. They select their facts like food from a buffet. David R. Dow

                                Comment

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