I have a pre approval from Blue Shiled for a great MRI. I don’t need it till Dec. in October I start Medicare so I’m assuming I will have to get it pre approved again.
@jym626 do you see a urologist? I’ve had blood in my urine many times and have had many follow up procedures. I’m surprised they are already suggesting ultrasound and cystoscope.
I am saying that’s what he recommended last time there was a trace in the UA and of course it was all fine. I am just anticipating what he might say tomorrow.
My trace in the UA was a kidney stone. I call it my silent stone, because I never felt it (and it was 6 mm). I was lucky that my PCP made me follow up with a urologist, who did a CT, because it was stuck in my ureter. I could have ended up with a kidney infection had the UA not been done in the first place. (And while the stone didn’t hurt, the surgery to remove it was another story!) But I digress …
@mom60, if you have traditional Medicare, I doubt you’ll need pre approval - just an order from the doctor. The MRI has to be medically necessary, but it’s the doctor rather than the insurance company that makes that determination and is the one who authorizes the test. If you have Medicare Advantage, you may require a pre approval from the insurance company.
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Make sure your plan didn’t change that this year. I had Aetna last year and I could have used it all on Dec 31. I know they changed it this year to by quarter. I now have United and it is no longer offered, but I get $10/month as a reward if I enter the days I worked out. You must do it in the month you did the activities.
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I’m going to have Aetna (MA) next year. I wonder if I’ll get that extra spending money!
When I worked in Rehab, I saw a few cases where there was some really bad kidney ureter issues - so glad you have recovered from that medical episode.
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I only signed up for Part A now. I have a stupid question to ask.
When I have Part B and Part G, if I want to see a doctor who doesn’t take Medicare, can I still get reimbursed as “out of network”? Or do I have to go to a doctor that takes Medicare?
We are in the process of signing up as I type (on a zoom with the agent). We are picking a Humana plan with silver sneakers and will eventually cancel our LA fitness membership as this will replace it and will allow access to gyms in CA when we visit our kids. This plan offers a spouse discount and was a better price than AARP/UHC and offered the gym membership. The UHC offered included a more expensive membership but was a lot more per month.
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I’m looking at both Blue Cross and Blue Shield. Blue Shield offers two options that I’m considering. I need to find out if they cover a gym membership. I’ve been buying my own insurance for 35 years so Medicare should save me money. I’m also looking forward to a larger network of doctors.
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In our area the BCBS plan didnt offer a spouse discount.
My spouse is just 62. In Ca or at least in my area Blue Shiled is a different company than Anthem Blue Cross. Price is the same.
I sent the agent some questions.
Just a reminder (depending on your situation) to not let gym membership perks not cloud your overall view. I agree it’s nice but also in terms of paying bills, might be easier to pay for a gym and get a better medical perk.
And of course it goes without saying, think about you and your history and if you’re likely to use that gym membership!
In some individual cases it might make more sense to just pay for the gym if you want ot
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Yes, the Elks Club has a gym and I will get access to it as a member. The condo we just bought also has a gym and we will also get access to that gym. We prefer exercising at home but it is nice to have access to gyms. Our insurance plan doesn’t give us gym access but does give good coverage for medical expenses.
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If the doctor doesn’t accept Medicare, (opted out of Medicare) and does not bill Medicare, then it’s likely you will sign a private contract to pay the full cost out of pocket. Medicare and supplement G will not reimburse you for such a provider.
There are doctors who are non-participating Medicare providers and don’t accept Medicare’s pay rate, then Medicare will pay and your supplement G will reimburse your costs up to 15% more than Medicare’s pay rate. Any bills exceeding 15%+Medicare’s pay rate will not be reimbursed.
I hope this helps.
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Yes, we had to do full pay for D’s surgery because the office isn’t working with Medicare. It’s very very expensive but they’re the best place. It’s important to be able to pay if that’s something needed.
When it comes time for me to pick a Supplemental plan, I’ll look at the gym membership perks as a tie breaker. In other words, it could be a factor if there are two appealing plans approx the same cost. Or possibly I’d pay a small premium for it.
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We have AARP/UHC plan G supplement and they pay gym memberships. You can have several gym memberships as H has one membership at home and another one in NYC where we spend almost half a year. It’s called Renew Active rather than Silver Sneakers.
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Most Medicare retirees I know doing gym plans mention that it is Renew Active. Around here, it seems to be accepted wherever Silver Sneakers is accepted.
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Thank you for the information. I have a doctor who may be an opted out provider. It’s too bad.
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We decided not to pick the option that included gym membership
It was more expensive for one and 2) we couldn’t guarantee it included the YMCA where we have a membership and didn’t want any other option.
We happily pay for the Y which will become cheaper when my husband turns 65. He also can work out at any other Y in the country.
Gym memberships to me are bright shiny objects that while nice are not the primary reason for picking a Medicare plan.
We did pick out a dental plan which may or may not be cost effective but it will help my husband go to the dentist.
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