Tell me about medicare in the US

In My Humble Opinion
1

I am putting this in IMHO because although it is on the face a factual question, I am also interested in opinions.

My situation is: 72 years old, spent most of my employed years in Canada, have 34 quarters of US Social Security, six too few to be covered, but I could buy in for roughly $3000/year, which I could easily afford. I have most of the common ailments of my age (marginal diabetes, heart disease, atrial fibrillation) and private insurance is out of the question.

Having two children in NY, my wife and I are seriously contemplating moving there. But over the past 40 years, nearly, we have gotten accustomed to a medical system that has no deductible and no copay. When I go to the doctor no money changes hands and the same for the hospital care. You present your medicare card and that’s the last piece of paperwork you see. Also virtually every doctor works in the system (they are allowed to practice outside, but must choose one or the other; no doctors in the system with private patients).

Now, I have the impression, please correct me if I am wrong, that even if you have medicare, many doctors won’t accept it, there is both deductible and copay and you are likely to have trouble getting a treatment accepted. For the last, I should say that not every treatment, especially experimental treatment, is available here either, but once a treatment is accepted it is purely your doctor’s choice to use it.

We also have a compulsory prescription plan (although competing private plans are acceptable, but got too expensive when I turned 65). It has a deductible and copay, but once some limit is passed drugs are free. There is no “doughnut hole”. And the province has negotiated very favorable prices. My wife uses celebrex and the cost–not to her, but the total–is $27, while she had to pay $98 for the same in NY.

So my question is what would I face if I moved to the US?

2

Medicare does not give free medical treatment. I pay 96 dollars a month for it and I chose not to do the drug plan as I don’t spend enough on prescriptions to be worth the extra cost. After paying a $135 deductible for the year, I’ll get a discount on my doctor visits. Generally 20% of whatever the Medicare negotiated price is.

I can’t tell you too much more, as I’ve only been on this for a year because I’m on Disability, but that’s what I’ve dealt with so far.

3

Depending on where you are, it can definitely be difficult to find a physician who accepts new Medicare patients. I know that locally, doctors only accept patients who also have one of the private supplemental policies.

We looked all over for a new doc for roomie’s mom after a serious problem with her old doc. We’d also looked previously for a geriatric specialist to address some issues she was having. Both times, it took intervention from a personal contact of the physician’s to get the offices to take a patient with only Medicare.

You have to pay premiums for the Medicare insurance. The drug plan sucks, but the supplemental plans may have better drug coverage.

There is a deductible and copays, and you’ll have to pay for things that Medicare doesn’t cover.

It’s better than nothing, but doesn’t even approach the standards of most universal care plans.

4

I don’t know a lot about this, but I know that the system has enough holes in it that there is an entire class of health insurance called “Medi-Gap” insurance, to cover all kinds of stuff that Medicare doesn’t. I work at a hospital and people tell me that kind of additional coverage IS highly desireable – get it if you can afford it, they say.

So I believe you are correct to be very concerned about moving here at that age.

5

You should check out the Medicare website: http://www.medicare.gov/. There are different Medicare plans and lots of private plans to supplement Medicare. If you cannot afford any of the out-of-pocket costs, you can apply for Medicaid (although if you can afford $3K per year, I doubt you would qualify).

This link list the out-of-pocket costs: http://www.medicare.gov/MedicareEligibility/home.asp?dest=NAV|Home|GeneralEnrollment|PremiumCostInfo#TabTop

6

Thanks for the replies. I think that says it all. I guess we will stay in Montreal, with all its nasty weather. And having to stay in NY hotels because neither kid has a spare room.