Medicare- The Health Care Standard Everyone Should Have

[anygunanywhere]

I just recently went on Medicare. SWMBO went on Medicare last year. Her experience was terrible. The original advantage plan she picked was a waste. Everything the plan people told us were lies. We wound up spending more out of pocket than they covered. She picked a new plan during open enrollment and it is much better.

When I enrolled I joined the advantage plan she is on. So far my prescription drug portion has been a pain.

I take several hypertension meds twice a day. I have a history of hypertension crises of unknown cause and my blood pressure is difficult to control. I have been on these meds for 25 years. None of my previous mail order prescription providers have questioned my prescriptions.

When my advantage provider sent me my first prescription fill under new prescriptions from my PCP they told me they were reviewing one of my prescriptions. They only gave me a 30 day supply of one med. I ordered a 90 day supply on the website 2 weeks ago. Today I ran out. They called me yesterday but I missed the w. They called today and this is the conversation.

Me: You called yesterday. What is the problem?
ORX: Your med was reviewed and we asked the manufacturer about you taking it twice a day. It is usually ordered once a day.
Me: I have been taking this twice a day for over 20 years under a doctors care. Why are you questioning my care?
ORX: We want to ensure your safety.
Me: I am out of this med. My blood pressure going up isn’t safe.
ORX: We need to hear from your PCP why they prescribed this twice a day. The manufacturer has advised us of their approval.
Me: You shouldn’t need my doctors approval. She ordered the prescription.
ORX: We are concerned about your safety.
Me: My blood pressure is going up as I speak to you. This is the most asinine conversation I recall ever having. What are you going to do if I have a heart attack or stroke while you do your Obamacare death board review about my meds?
ORX: You can request an emergency prescription of this med until the final determination is made.
Me: You will approve and pay for the emergency prescription?
ORX: Yes. Of course.
Me: But you are questioning my 90 day prescription of the exact same med?
ORX: For your safety.
Me : You are in Minnesota?
ORX: Yes.
Me: Lucky for you.
ORX: Why is that?
Me: Think about it. I will contact my physician. An you email me exactly what you want?
ORX: We do not use email for these matters. Phone, fax, or US Mail.
Me: For my safety.
ORX: Exactly!

My physician is closed today. I’m out of my blood pressure med.

Is this what happens when you get old?

Government run health care. If the government is the answer it is a stupid question. Never believe what the government tells you.

Does anyone have any good Medicare stories?

[rotor]

Rule 1. Stay away from advantage plans. Go with regular medicare, a good supplement, I have an “F” plan with USAA, and get a plan D prescription plan, AARP plans are pretty good.
Advantage plans are cheaper but have limited doctors that take them, are hard to get through their constant denials for care, and are just not worth it.
Rule 2 same as rule 1, stay away from advantage plans.

[rotor]

I should also note that advantage plans are NOT government medicine. They are private insurance companies ripping off the government.

[anygunanywhere]

Our advantage plans are AARP plans. We inquired about what to do from other folks around here.

We kept our own doctors. After the wife’s initial problems hers has worked out well. I’m having real problems wrapping my head around this prescription issue.

[Grayling813]

After two incidents of breaking bones last year, my wife's doctor ran tests and determined she needed to take a medication to improve her bone density. The insurance company denied paying for the medication saying it was only approved after hip or back surgery caused by bone density issues. When my wife called the insurance company she asked why they would rather pay for hip or back surgery first, then pay for the medication that prevents the issue afterwards....no response. Still denied. I hate insurance companies almost as much as politicians.

[WTR]

My Mom is on a regular plan with a Plan B from USAA ( I believe). She has had two heart surgeries within the past year. She takes a blood pressure med, a blood thinner and a med to control AFIB. Her costs have been quite reasonable ( Eloquist is a bit pricey ). However, overall it has been fairly painless.

[rotor]

Advantage plans are the largest moneymaker for insurance companies. The more they deny the more they make. They also cost taxpayers 10% more than conventional medicare.

[RPBrown]

Since I turn 65 soon, I am getting maybe 50 calls a day for Medicare supplement.

[Liberty]

Since I turn 65 soon, I am getting maybe 50 calls a day for Medicare supplement.

It won't go away either.

[joe817]

Sorry to hear about your difficulties agaw. I can't imagine how frustrating and frightening it is.

Have you checked out AARP's Medicare Complete Secure Horizons? I'm on that; Plan 1. This is the exact plan I'm on:

https://health.usnews.com/medicare/texa ... 12-0-H4590

Fortunately I'm on a Tier 1 prescription, and my only medication I'm taking is Pravastatin, with a 90 day supply costing $9.00.

I've had 2 surgeries while on this plan, and the costs were very reasonable.

I'd be happy to share with you my experiences. Just PM me.

[rotor]

Since I turn 65 soon, I am getting maybe 50 calls a day for Medicare supplement.

Make sure you set up medicare promptly before or just after you are 65.

[jason812]

AARP lobbied for Obamacare. Why? Probably cause AARP knew it would make billions.

Health insurance companies never seem forth coming to me. You get a bill that says what the hospital charged, what they think it should because they only paid so much of it, and when you try to put all the numbers together, they don't add up correctly.

If the politicians wanted to fix health insurance, they would allow it to hit the open market and not be tied to an employer or the government.

Not Medicare story. I'm not old enough but 5 years ago when my wife was prego with my daughter, we put money in a flexible spending account. What a joke. There was no flexibility. The insurance company took money out of it automatically when I went to the dr or when my wife went for check ups. I only wanted to use it for the birth but didn't get the chance. Trying to navigate that paperwork and do the math to keep track of it all made me feel like I needed to be an astro physicist.

[srothstein]

This is one of my biggest worries. I retire in about three years and will have to go on medicare then. I don't have a real choice in the supplemental plan because I will get it from the state as part of my retirement. I have not heard any bad stories from retired state workers yet, but it is still based on medicare which I don't trust.

[howdy]

Get off the advantage plans and go with Plan F. When you first apply for medicare, they can't ask health questions for a supplement plan. After your first year, they CAN ask health questions and deny you coverage if you try to upgrade your plan or change companies. Plan F is a plan F is a plan F. The plans are the same, the only difference is the cost through different companies. Go at "Goodrx" online. It is a coupon you can get that will show you where the cheapest pharmacy for your particular drug is. Also big chains like Wal Mart, Kroger, CVS have their own "insurance" coverage that cover most drugs and they really reduce the cost.

[WTR]

Get off the advantage plans and go with Plan F. When you first apply for medicare, they can't ask health questions for a supplement plan. After your first year, they CAN ask health questions and deny you coverage if you try to upgrade your plan or change companies. Plan F is a plan F is a plan F. The plans are the same, the only difference is the cost through different companies. Go at "Goodrx" online. It is a coupon you can get that will show you where the cheapest pharmacy for your particular drug is. Also big chains like Wal Mart, Kroger, CVS have their own "insurance" coverage that cover most drugs and they really reduce the cost.

Second GoodRX. They have an app that you may check Drug prices on. My wife saved her Mom about $350.00 a month by following GoodRX.