Redbird (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
redbird) wrote2025-11-17 03:03 pm
redbird) wrote2025-11-17 03:03 pm
Entry tags:
Medicare questions/decisions
I just had a phone appointment with someone, funded by the state of Massachusetts, to help decide between basic Medicare plus a Medigap plan, or a Medicare Advantage plan. I have gotten some useful information, but am going to double-check everything, because in at least one case what she told me contradicts what the official Medicare.gov site says. It's a relatively minor point--the existence of a roommate discount for some Medigap plans--but I asked about which plans it applied to, and she said it doesn't exist.
The new and interesting information is that apparently, because I am under 65 and disabled, I'm eligible for a Medicaid plan, without an income limit. It's called CommonHealth, and seems to be part of the state's "Commonwealth Care." If I understand correctly, after Medicare paid 80% of a bill, it would cover the rest, but only at providers that take MassHealth.
If I got basic Medicare (parts A and B), a part D drug plan, and a Medigap plan, I could see any provider that takes Medicare, without worrying about what's in-network. However, a Medigap plan would cost significantly more than this CommonHealth thing.
Or, I could sign up for another Medicare Advantage plan. The advantage there is there are some that would cost no more than the Medicare Part B premium. The disadvantage is being limited to in-network providers unless I'm willing to pay significantly more for that service.
I thought the question was, is it worth $250-$300/month (Medigap + prescription coverage) more to not have to worry about being in-network and prior authorization. It sounds like this CommonHealth plan would cost significantly less per month, but if the provider doesn't take MassHealth, I'd be paying 20%. Which gets back to the larger problem that there's no way to find out what number that will be 20% until after the visit.
If I understood correctly, all these options have copays for some things, and CommonHealth may require prior authorization for some things.
The new and interesting information is that apparently, because I am under 65 and disabled, I'm eligible for a Medicaid plan, without an income limit. It's called CommonHealth, and seems to be part of the state's "Commonwealth Care." If I understand correctly, after Medicare paid 80% of a bill, it would cover the rest, but only at providers that take MassHealth.
If I got basic Medicare (parts A and B), a part D drug plan, and a Medigap plan, I could see any provider that takes Medicare, without worrying about what's in-network. However, a Medigap plan would cost significantly more than this CommonHealth thing.
Or, I could sign up for another Medicare Advantage plan. The advantage there is there are some that would cost no more than the Medicare Part B premium. The disadvantage is being limited to in-network providers unless I'm willing to pay significantly more for that service.
I thought the question was, is it worth $250-$300/month (Medigap + prescription coverage) more to not have to worry about being in-network and prior authorization. It sounds like this CommonHealth plan would cost significantly less per month, but if the provider doesn't take MassHealth, I'd be paying 20%. Which gets back to the larger problem that there's no way to find out what number that will be 20% until after the visit.
If I understood correctly, all these options have copays for some things, and CommonHealth may require prior authorization for some things.
