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Medicare do you have to have it?


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This is to answer Littlesister's post on The Great Exodus...


You qualify for full Medicare benefits if:

You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years and

You are receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits but are not yet collecting them.

You or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.


Part A coverages just hospital stays and you do not pay a monthly premium for it. You have a $1,400+/- co-pay whether you stay in the hospital one night or 5 nights.


HOWEVER; Part B you pay a monthly premium and it covers doctors, testing and any out-patient  procedures, but not at 100% you have a 20% copay. Now your copay is not based on what the hospital charges but what Medicare allows. So say you have an MRI and the hosptial charges $5,000 but Medicare only allows $350. Medicare will pay 80% of the $350 and you will only 20% of the which is $70. This where you need a supplement policy that will cover part B copays. 


Now the quesiton was do you have to have Medicare. Well at age 65 you automatically qualify for Part A at no cost to you. So yes you can buy your own policy.  You DO NOT have to sign up for Part B. But here is the catch if you do not sign up when you turn 65 and you decided when you turn 70 that you want to sign up for part B your rates will be higher unless you can prove that were covered under another policy. 


My personal suggestion (and this from working with insurance all day long) get your medicare part A & B then get a supplement policy. If you go with a managed care plan like Humana or United Healthcare ask the following questions....

1. Is my doctor in network - if not do I have out of network coverage

2 Is my hospital in network - if not do I have out of network coverage

        (if your doctor or the hospital that you use is not in network then said doctor and hospital will not get paid and you will then be responsible for the bill)

3. Drug plan...are my prescriptions covered...what is my dedutible>

4. How much will I have to pay for outpatient procedures. Some of the managed cared plans get you when it comes to outpatient services. You will have a $250 copay for that MRI that you would have only had to pay $70 if you were on medicare.


If you have any questions I will happy to get answers for you. Like I said I deal with insurance all day and know how they like taking advantage of people on Medicare.  Right now we are dealing with one company that talked people in our area to sign up for a new plan. Said company notified clinics and doctors of this new plan but did not notify any of the hospitals in the area. And this new plan does not have out of network coverage so they can not have procedures done at the hospital. 

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6 hours ago, Mt_Rider said:

:thumbs:   Wow....thanks for the research, Mommato3.......both here and in your Great Exodus storyline!!!!!  :thumbs: 




Mt_Rider the medicare info is really not research. That is what I do for a living. If you having anything done as an outpatient at the hospital where I work you will probably talk to me. I have to verify insurance and call each patient and tell them what they will owe. And I can tell you there are some sad stories of how "some" insurance agents have talked these people in to crappy policies. So I have made it my mission to help education as many people as possible about Medicare, medigap aka supplement policies and managed care policies. I breaks my heart to see these little old people being "scammed"...at least that is what I consider it is, because said agents are not really explaining what the patient is getting. They are all about the greenbacks and not about helping people get the best coverage.

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