chisue, understand the lesser of two evils. They use prednisone for my disease too. Thankfully, I've never been bad enough to have to use it on a daily basis. I'm allergic to one of the main drugs to treat my disease so if my current drugs really stops working I will have no choice but to take those awful , dangerous and expensive drugs. Hopefully it will never come to that. I have one older brother that did not move to the States when my family moved and so I've really been thinking about how much easier it was for him to retire in Canada. No jumping through all these hoops to figure out how to get his health care needs covered. Emma, what I understand is that they don't have to insure you if you have had a gap in insurance and are outside the 6 month open enrollment. Our situation was a little confusing to these insurers because our medicare part A automatically kicked in at 65 and our B took effect two years later when my husband turned 67. So they carelessly were just looking at the date part A kicked in and assumed we'd had a two year gap in coverage. Some asked if we'd been on cobra. They were asking for proof of insurance until I reminded them that medicare B was just starting and we were within the 6 month open enrollment. The drug plan still said that if I had not been covered they would have raised my premium.Not sure if that is legal under the 6 month open enrollment, but I didn't research it anymore sine it didn't apply to me. In my case, if I went without and then ended up going on one of those $3000 a month drugs and then decided at that time to get part D, no one would be too excited to insure me . And you can bet if one of my drugs was $3000 a month and they agreed to insure me, my premium would be pretty hefty. Our total costs for the two of us are around $480 a month United(AARP) is $116.78 for me, $121.94 for my husband. It is community based which means they can't raise your premium just because you are a year older. It goes up according to your zip code. In my state there were only two options for community based or issue age --the two that can't be raised because you are a year older. All the others were attained age which will go up for each year older you get. Then medicare B is $99.90 for each of us. I'm paying $27 for my part D and my husband picked the cheapest for 15 a month. I didn't figure it was as important to get the perfect plan with drug because it apparently is easy to change at the end of the year if what you picked didn't work out so well. It just seemed to me that there was a real learning curve to getting this all arranged. Dedtired, I'm confused why you would be paying 300 a month for medicare part B or something else?? something doesn't sound right.

First, Alisande I believe if you look on the back of your Medicare EOB you will find the information about APPEALING their denial of coverage. It should be there .... somewhere. Denials are always appealable, usually there are 2 levels of appeal. So, exercise your RIGHT TO APPEAL. Write a letter & explain your situation. If that fails, enlist your chiro to write an appeal for a second review. Medicare doesn't "think". They have guidelines for coverage. A low level clerk of a computer program screens outs targeted types of claims that have traditionally been abused. That system isn't perfect. But if you don't appeal something that is legitimate, or *possibly* legitimate, they have no way of knowing that they've snagged something in error. The error could even be in how the diagnosis &/or treatment was coded on the bill by the chiro's staff. Chiro has its place & can be a helpful adjunct for treatment. But it does have quite a history of "hocus-pocus" & of duping people &/or insurance/Medicare. I am aware that there are those "lonely sorts" who ... truth be known... use a chiro visit as somewhat of a social outlet. Why should Medicare or insurance pay for clearly unnecessary treatments. Preventive chiro generally isn't in the same league as preventative in traditional medicine. I guess we can look forward to more of same as the government inserts itself even further into our healthcare delivery system. Gibby, I don't understand your statement. At.all. Medicare IS & has ALWAYS been a gov't run healthcare system. I want my tax $ spent as wisely as possible. If there is fraud/abuse, weed it out. And of course, they certainly can't afford to cover absolutely everything on the healthcare menu.

NYC retirees had a brief respite when the retirees group filed lawsuits which challenged several aspects of the implementation of the original MA plan with Anthem, a for profit division of BS/BS and due to judgements against NYC, the original plan was dropped. However, in recent weeks, the new mayor, Eric Adams, who had claimed he was against the idea of MAPs, suddenly sided with several of the unions who were pushing for the MAP. Although the concept of unions not siding with their retirees is abhorrent to most of us, that is the current situation. . (There seem to be some funny money financial issues which are pitting the unions against the retirees; if anyone is really interested in how this all developed, I,d be happy to fill you in) Another company, Aetna, has come up with a new MAP proposal. Supposedly this one has fewer pre auths required (for now) and it's supposed to be what they call an extended service area to expand use outside of the NYC area, However, many of the out of state retirees are finding out their current medical facilities and doctors do not accept this plan. And, to make this new situation even worse, is that with the earlier proposal, a retiree had the option of remaining with original medicare and their current supplement, for an additional fee. The current proposal is sort of ’my way or the highway’ in that there is no option for staying with our original Medicare and city provided supplement, one would have to opt out of city coverage completely and find their own supplement, at not group rates. Since Mayor Adams just signed the MAP contract this past week, a new retirees group lawsuit has been filed. Wish us luck. I've actually seen the results of an unwanted switch to a MAP personally, My cousin, a retired teacher from Maryland with some recent serious medical issues, currently living in NYC, was recently switched to a Maryland MAP. She was injured last week and found that 2 of her doctors would no longer accept her MAP, and she needed a hand doctor for her injury. she had to call over 10 hand doctors to find one to take her MAP. Unfortunately, this seems to be where many mucipalities are heading for Medicare retirees, but a change is in the air for active workers as well as to the type of plans offered.

DH's retiree health benefits administrator has released more detailed information on it's dedicated United Healthcare website. It offers two choices of PPOs. Essential Plan has a max medical OOP of $5,000; Enhanced Plan, $750. The company suggests that most retirees will want the Enhanced Plan -- I suppose more want to pay the small premiums and have the lower limit OOP. Essential has no premiums and annual HRA contributions of $1300 plus another $300 towards the Part B premium -- projected to be around $165/mo in 2023. Most of the medical benefits listed are actually Part B benefits, but these Advantage Plans include Part D coverage and limited Dental, Podiatry and Eye benefits, plus some 'frills' like gym memberships. Essential Plan medical copays are higher than Enhanced. Our prescription meds cost less under our current Part D than with either plan, but Tier 5 meds are the same: 30% of retail. The 'gap' and 'catastrophic' OOP limits are the same, as mandated by Medicare.We still pay Part B with either plan, but would stop paying Medigap premiums ($313/mo each for Plan F). We'd skip paying our current modest Part D plan premiums ($11/mo for DH; $7/mo for me), but we'd pay pay same or more OOP in copays at the pharmacy. The company is paying a 'transition credit' of $1,200 to retirees "without survivor benefit, LTD and MDIP". IDK what MDIP is. I'm not sure what to look at to choose a plan, beyond the medical max OOP. We have to take one of these plans or lose all health care benefits from the company.