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Author Topic: Supplemental Medical Coverage with SSDI  (Read 1118 times)

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Offline Robert

  • Member
  • Posts: 2,658
Supplemental Medical Coverage with SSDI
« on: October 11, 2007, 01:38:29 AM »
                Supplemental Insurance and SSDI.

Jerry was talking about his Medicare coverage and PHilly and others mentioned there was no reason his Dr. did not take the CD4 test other than just being lazy and/or cheap.  I mentioned that I'm also on SSDI and pay $20 for my labs every 3 months which includes CD4 and Viral Load. I also mentined I had supplemental insurance with Kaiser.  Philly was curious about it so below is what I gleamed from my Evidence of Coverage booklet and compared it to Medicare. 

I currently have Kaiser Senior Advantage Insurance which supplements my SSDI. 

I pay $115/month.  This premium includes my Medicare prescription drug program, dental, hearing, vision, medical and hospital and other stuff.

ADAP covers my Part D expenses.  If it didn’t then I would be responsible for the 1st $3,850 worth of prescription drugs.  After that I would pay only a $12.00 copayment for each prescription.

          Medicare                     Kaiser

                    INPATIENT CARE

$992 for days 1-60             $275  each day for days 1-10
  248 for days 61-90                0  each day for days 11-90
  496 for days 91-160               0  each day for “lifetime 
                                                     Reserve” days 1-60
                    Doctor Office Visits

20% of Medicare approved      $30.00 for each primary
amounts                                    care office visit

                 Diagnostic Tests, X-Rays and Lab

20% of Medicare approved       $30.00 for each Medicare
service                       service               
Not Covered                  0.00 for 2 cleanings/year
                                0.0for x-rays
Not Covered                   700.00 for hearing aid

$125 for pair of glasses      $125 for pair of glasses


     $0.00 for days 1-20                0 for days 1-20
    124.00 for days 21-100          100 for days 21-100

For Kaiser the annual out-of-pocket maximum is $4,000.  The copayment for each hospital inpatient admission is $275/day for days 1-10.  If you reach your $4,000 annual out-of-pocket maximum, you are not charged hospital copayments for the rest of the year. 

The co-payment for outpatient surgery is $225.00. 
On Medicare you pay 20% of the Medicare approved amounts for the Dr and 20% of the approved amounts for the facility charges. 

Now last month I had surgery on my middle ear (tympanoplasty).  It was on an outpatient basis.  It took 3 ˝ hours and included general anesthesia (not local).  I paid $300.  I tried to find out what Medicare would cost  but no luck.



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