On Tue, 26 Aug 2008 13:11:25 -0400, (---MIKE---)
wrote:

:I have had the AARP "J" plan since I went on medicare in 1995. They
:have always paid every claim. Their rates have risen but I think they
:are competitive with other insurers. If your income is low enough
about double the poverty level) you can get FREE prescriptions from
:most drug producers through their prescription assistance programs.
:Medicare "D" is a ripoff.

: ---MIKE---
:In the White Mountains of New Hampshire
: (44° 15' N - Elevation 1580')

I spent all of yesterday reading Medicare and You, publication 10050. It
was supposed to be sent to me at the same time as my MC card but wasn't
I also requested it from live reps at the MC 800 help line. Never came.
I printed it out 3 days ago. That publication is definitely where you
want to start. Then you can read Choosing a Medigap policy.

A month ago I became eligible and I have Original Medicare, parts A and
B. I applied for my former HMO's Medicare system, Kaiser Permanente's
Senior Advantage, but haven't paid them yet and am thinking I should
definitely check out the alternatives before getting on board. There's
PPO's, also PFFS's (private fee for service plans). I have info from one
of each, have an idea about the PFFS but haven't read Blue Cross PPO's
yet. I'll compare coverage and costs. I'm in CA. I believe according to
the 120 pager I just read that SHIP is available everywhere, maybe a
version in each state. I made some calls a few months ago but didn't get
referred to them or any other agency that seemed promising, so I went
into my SS office and took home a little pamphlet. From that I tried to
get the other publications but they never came.

Thing about the HMO (Kaiser) is that you have a primary care physician
and you need referrals to see anybody and they have to be from within
the system. It can get dicey. I know because I've been with them 3-4
years. The PFFS is cheaper. I'm just not sure about the coverage, how
things would play out. Technically, any doctor can refuse to serve you
at any time. They are never under any obligation to do otherwise, unlike
a member of a PPO or HMO. The rep I talked to told me that normally that
shouldn't happen because the PFFS pays the Medicare stipulated rates.
However, as I understand it, no doctor is obliged to accept Medicare
patients.

I'm impressed with the fact that the whole Medicare thing is pretty
damned complicated. So many plan types, gotchas, caveats, exceptions
it's pretty difficult to feel that you have your feet under you. If you
aren't tack sharp, have the publications and the time to pour over them
you are either going to throw your hands up or be overwhelmed. Of
course, if you have a lot of money you can just get a full featured
Medigap policy and not bother worrying about it.

I think that medical care in the USA is very unnecessarily complicated.

Dan