For 64 and a half years you’ve become pretty accustomed to the amount of mail you normally receive.  All of a sudden, the flood gates open and your mailbox seems like it is full everyday.  Before you turn 65, companies that deal with Medicare eligible individuals send out every program they have available to seniors.  The good news is if you continue your medical insurance through your association, the benefits stay the same.

 I recently spoke with a retiree who was on Medicare as well as one of the HMO programs through the Association.  He was frustrated with getting a referral to a specialist.  On top of that, the specialists he normally saw did not accept HMO programs anymore.  As most of you know, when using an HMO you must wait for authorization to see a specialist and the doctor is normally assigned to the medical group you selected. 

 Here’s where it gets a little technical.  When you are retired and enrolled in Medicare, it is your primary insurer. If you have Blue Cross HMO, they will be secondary.  To make it a little more simple, Medicare pays the bills and Blue Cross picks up what Medicare doesn’t cover up to the limits of your plan.  In other words, you have 2 insurance carriers. 

 This is where there may be some great possibilities for Medicare eligible retirees.  Let’s go back to the conversation with the gentleman who was waiting for a referral to a new specialist.  If he wants to bypass the authorization, he could go directly to the specialist that originally treated the condition.  Granted that doctor doesn’t accept HMO plans anymore but he may accept Medicare.  Your HMO will not cover this visit, but Medicare will if that doctor accepts Medicare.

 Now here’s the down side:  Medicare does have deductibles and coinsurance that you will be responsible to pay.  As of 2007, hospitalization has a $992 deductible.  Physician services are covered at 80% after a $131 part B deductible.  So there will be considerable expenses if you opt to use Medicare without any assistance from your HMO plan.  But for this member it was well worth it because he got to see a doctor who was familiar with his conditions.