What is max MEDICARE will allow being charged for different "THINGS".

[Sourdough]

Is there a chart or charts (that I assume gets regularly updated) that shows how much they will pay for those things that they cover.

Actually, looking for what is the max they will allow being charged for those medical things they cover. I understand the 80% covered and 20% not covered. I'll be very-very happy with any useful information on this subject.

Thank you, I appreciate the help.

 

[montanabill]

My wife has medical issues, we are on medicare.
We have a couple of insurance supplements that either take the place of the medicare for her or for me it gives me more coverage working with the medicare.
Last year we fell into the "donut hole" which is where they cover you for a expensive med and then after you are on it you use up your coverage and have to pay more..

This next year there have been changes in Medicare and the extra coverages so there isn't the donut hole....
The only way I have a chance of getting or understanding the medicare system is thru a agent that specializes in this type of coverage...the agent gets a commission and doesn't charge us.

Doctors offices don't seem to know much besides "we will submit the claim and see how much is covered".

And so far there doesn't seem to be much of any coverage for dental or glasses...

 

[Cabin Fever]

I think you'd have better luck looking at the coverage of a $0/month Medicare Advantage plan. These no-cost plans don't have a monthly premium and they will have charts showing what the plan plus Medicare covers. These plans do not cost you a thing. Of course, you still have to pay the required Medicare monthly premium. The attached file provides an example.

 

[Sourdough]

And so far there doesn't seem to be much of any coverage for dental or glasses...

Or hearing aids.
I can't get any information from anyone in the medical practices.

 

[Mountain trapper]

Any questions that I have on Medicare I just call our insurance girl. So far Medicare seems to be paying everything for me. I'm very happy with Medicare.

 

[Cabin Fever]

And so far there doesn't seem to be much of any coverage for dental or glasses...

Most Medicare Advantage plans, even those that do not have a monthly premium, have some hearing and dental coverage.

 

[Neb]

....
The only way I have a chance of getting or understanding the medicare system is thru a agent that specializes in this type of coverage...the agent gets a commission and doesn't charge us.

...

Ditto that.

My guy calls once a year to insure my coverage is right. Doesn't cost me anything.

Ben

 

[Mountain trapper]

Most Medicare Advantage plans, even those that do not have a monthly premium, have some hearing and dental coverage.

Don't know about hearing, but my Medicare plan covers all of my dental expenses so far.

 

[Cabin Fever]

Don't know about hearing, but my Medicare plan covers all of my dental expenses so far.

Below is the hearing coverage from the zero premium plan example that I attached to the post above.

 

[montanabill]

Below is the hearing coverage from the zero premium plan example that I attached to the post above.
View attachment 168268

The cheapest audiologist determined hearing aid I can find is $1600 at ostco and it is a model that is a few years old design wise.... so yes they do pay some but there is still substantial out of pocket.

 

[montanabill]

Don't know about hearing, but my Medicare plan covers all of my dental expenses so far.

Mine covers all of my dental.......up to $400 a year.. That covers a teeth cleaning and Xrays. Just getting caught up two years ago with fillings and one tooth repacement cost me $9600.

 

[montanabill]

I think you'd have better luck looking at the coverage of a $0/month Medicare Advantage plan. These no-cost plans don't have a monthly premium and they will have charts showing what the plan plus Medicare covers. These plans do not cost you a thing. Of course, you still have to pay the required Medicare monthly premium. The attached file provides an example.

Just read the fine print like what doctors and hospitals are in their system.. And check the meds they approve of, especially the diabetic meds, the good stuff (slow release insulin and ozempic) can cost $2K a month and it really works and your life is much better.....or they have the old school stuff that while you may be alive with lots of monitoring it isn't much fun.

 

[Mountain trapper]

Health care in our old age should be looked at same as SS, and saved up for over our working life.

 

[montanabill]

Health care in our old age should be looked at same as SS, and saved up for over our working life.

Social Security is designed to keep people from starving on the street.... investments and savings allows some people past working age to live comfortably.

Medical, pharmaceutical, and dental costs have soared so high that it becomes unobtainable for some people.

 

[Neb]

Mine covers all of my dental.......up to $400 a year.. That covers a teeth cleaning and Xrays. Just getting caught up two years ago with fillings and one tooth repacement cost me $9600.

Teeth are highly over rated.

Ben

 

[Mountain trapper]

Social Security is designed to keep people from starving on the street.... investments and savings allows some people past working age to live comfortably.

Medical, pharmaceutical, and dental costs have soared so high that it becomes unobtainable for some people.

That's exactly my point. We should have all saved up for what Medicare and SS doesn't cover. It's not very wise to expect the government (taxpayers) to cover all of our costs in retirement.

 

[Sourdough]

That's exactly my point. We should have all saved up for what Medicare and SS doesn't cover. It's not very wise to expect the government (taxpayers) to cover all of our costs in retirement.

I agree 100% I am just frustrated that I can't get straight answers from the medical community, so that I can figure "roughly" what my 20% will cost me.

 

[Neb]

I agree 100% I am just frustrated that I can't get straight answers from the medical community, so that I can figure "roughly" what my 20% will cost me.

Seek out and find a consultant. There is one local to me that advertises she is free.

Ben

 

[Mountain trapper]

I agree 100% I am just frustrated that I can't get straight answers from the medical community, so that I can figure "roughly" what my 20% will cost me.

Yes! Me too. That's why I have a Medicare insurance person taking care of all that stuff for me.

 

[Neb]

Yes! Me too. That's why I have a Medicare insurance person taking care of all that stuff for me.

Yup

Sorta promise vs payment.

The promise is in the written plan. The payment is the quention.

In between we have the doctors that perform their tasks and ask for a reasonable compensation.

The rest is unknown and...

" there be dragons. "


Ben

 

[montanabill]

I guess I should have saved up a extra million or so for the wife and mine's incidental medical and hospital expenses.

Between income tax and medical insurance there is a lotta trees being cut down for paper (or server farms sucking up energy) and a whole workforce just to interpret, enforce and litigate.

 

[Cabin Fever]

Just read the fine print like what doctors and hospitals are in their system.. And check the meds they approve of, especially the diabetic meds, the good stuff (slow release insulin and ozempic) can cost $2K a month and it really works and your life is much better.....or they have the old school stuff that while you may be alive with lots of monitoring it isn't much fun.

I was on this plan for several years. Before I went plant-based, I was on 5 medications (now 0 medications) including 2 for T2D. Yes, they provided generic medications. I doubt if Medicare or any health insurance company says "We provide brand-name medications at the same price as the equivalent generic medication." In Minnesota, 97% of medical providers in the State accept BCBS.

 

[Snowman]

^^^ That is from United Healthcare + medi...

One should look for Supplemental Insurance Coverage, there are many, so choose, view and decide...?!?

https://retiree.uhc.com/content/dam/retiree/pdf/ctpf/2025/2025-SB-CTPF-12830.pdf

 

[Peanut]

One day at the VA in tuscaloosa they had medicare advantage people there, some of the others too. Had tables set up in a big room so vets could talk to them. Anyway I sat and spoke to one of these reps about what these plans offer.

It went well until I mentioned I make my own meds from plants I hunt in the woods. Seems this is a BIG no-no for these plans. The guy I was talking to was astonished since I wasn’t qualified to make real choices about my care… yada, yada, yada…. (he can kiss my...)

I get enough grief from my primary care doctor, don’t need it from an ignorant sales rep every time I use their services.

 

[montanabill]

We have a pharma copia of natural healing plants and supplements. Everything from the secret clay hill that heals in a out of the way canyon in Navaho country to a complete kit of Dr Christophers supplements, some like the plague formula just never go out of style. Lately I have been freeze drying herbs and roots and just now am doing a big load of aloe vera.
The trick is to be aware and study side effects if you are mixing and matching original natural healing with modern alopathic medicine. And don't freak out your insurance paid for doctor...
Should be interesting as more people get sick and die from the "side effects" of diet and jabs.

 

[Sourdough]

I agree 100% I am just frustrated that I can't get straight answers from the medical community, so that I can figure "roughly" what my 20% will cost me.

Update, I finally got a quote for a procedure. They clearly did not want to release that information.

 

[havasu]

I have found since Obamacare, the normal 80/20% for PPO is no longer valid, and Medicare determines what is covered, regardless of private insurance coverage (once on Medicare). I've also been told that if the procedure is not at least partially covered by Medicare, then your private insurance will not cover it at all. Are you finding anything different these days?

 

[Bacpacker]

We both have pre existing conditions. I wouldn't touch Medicare advantage with a ten foot pole. Once you get in that your stuck with it short of medical appor al to switch to regular Medicare. It does has some pluses, but off set by many negatives of which the ability to change out is a biggie. Be very careful of what you do initially.
I would suggest a Medicare supplement on top of Medicare. We are going on Medicare when I retire and have been digging into it fairly heavily