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LindaH

Medicare Supplements

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IMO, new blood, even with guaranteed issue, trumps a static pool of old folks.  No one actually knows how the market will develop.  But I plan to change my plan from a Plan F to a Plan G for 2020.  In my case, a Plan G HD, seems best for me.

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6 hours ago, TXiceman said:

DocJ, to pick up the meds at Walgreen triples out cost out of pocket.  So we fight the idiots at Optum RX

 

But unless you're locked into Optimum Rx  for some reason, there are plenty of other insurance companies to choose from.

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On 10/2/2019 at 11:42 AM, LindaH said:

I'm going to be switching from an Advantage Plan to a Supplemental Plan come October 15, the beginning of the Medicare enrollment period.

According to the eHealth website, there are 4 supplements available where I live:  Humana, Asuris, AARP (through United HealthCare), and United of Omaha.

I've pretty much eliminated the latter since it's quite a bit more expensive.  I'm most familiar with the AARP plan (which is what DH has), so I'm wondering if anyone here is familiar with the other two (Humana and/or Asuris).  What I'm looking for is how easy they are to work with and how quickly they pay claims.

Thanks!

Since you are switching out of an Advantage plan I assume you will need to go through medical underwriting.   Does anyone have experience with this process?  I am guessing unless you have a pre existing condition it is no big deal.    

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1 hour ago, trostberg said:

Since you are switching out of an Advantage plan I assume you will need to go through medical underwriting.   Does anyone have experience with this process?  I am guessing unless you have a pre existing condition it is no big deal.    

Teri, yes there would be medical underwriting in this case unless the individual is in his/her 12 month trial period for Medicare Advantage...then he/she could go back to the Medigap plan they left or choose any one they want if they enrolled @ age 65. 

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19 hours ago, trostberg said:

Since you are switching out of an Advantage plan I assume you will need to go through medical underwriting.   Does anyone have experience with this process?  I am guessing unless you have a pre existing condition it is no big deal.    

We both switched to Humana's Supplement -- it was the least expensive that I found for Plan G in our area and we got a small monthly discount for both of us signing up (DH had already been with another supplement plan).

Underwriting called us and asked a few questions.  I have no pre-existing conditions, but DH does.  However, they only go as far back as 2 years so that wasn't a problem.  We both got approved, got our cards, and are now on the new plan effective today, 11/1.

 

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Thanks Linda

I wanted to hear from someone who had been through it.  I find it hard to trust insurance companies at times.

Just wondering why advantage plan switches require underwriting and Medigap plans do not.  I think that if you switch from one advantage plan to another there may not be underwriting but the Medigap plans do require it.  I am sure it is money related and worry about the cost of care.   

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6 minutes ago, Barbaraok said:

Remember, Medicare Advantage Plans assume ALL of the health care costs from Medicare for Part B.  The Medigap plans just pay the 20%.

It seems like if the Advantage plan is assuming all the financial risk then they would. be the ones that require medical underwriting if you move from a Medigap plan and not the other way around.

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We've always had Medicare supplement; not an Advantage plan.   However, perhaps someone can answer how the Advantage insurance companies get their money if they advertise no premium, free dental, prescriptions, etc?

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43 minutes ago, 2gypsies said:

We've always had Medicare supplement; not an Advantage plan.   However, perhaps someone can answer how the Advantage insurance companies get their money if they advertise no premium, free dental, prescriptions, etc?

Medicare pays the insurance company a given amount per customer.

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24 minutes ago, chirakawa said:

Medicare pays the insurance company a given amount per customer.

Ahhh..... explains why we're receiving so many offers to join.  Thanks.

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They get your PartB premium. PLUS extra amount to cover you.  Originally the said they could do it just for the premium, got lots of people signed up and then went back to say they needed more and got it.  So all taxpayers pay for it.

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Supposedly the private insurance companies are so much more efficient than Medicare they can offer all sorts of added benefits (dental, vision, hearing, etc) for no additional cost. All without reducing the quality of care you receive. And if you believe that, I have a bridge in Brooklyn you might like to buy! 😅😅

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4 hours ago, docj said:

Supposedly the private insurance companies are so much more efficient than Medicare they can offer all sorts of added benefits (dental, vision, hearing, etc) for no additional cost. All without reducing the quality of care you receive. And if you believe that, I have a bridge in Brooklyn you might like to buy! 😅😅

Exactly  it  isn't at no additional costs.  That was their original proposal, but then they've gone back to congress again and again and get MORE than just the Part B premium, which means everyone is paying for these 'added' benefits.    That's my philosophical problem with the Advantage Plans.   And every time the add "more" benefits, it means they have lobbied and got extra from government to add these benefits - more our our tax dollars.   I want more transparency that what we have gotten!

Edited by Barbaraok

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50 minutes ago, Barbaraok said:

Exactly  it  isn't at no additional costs.  That was their original proposal, but then they've gone back to congress again and again and get MORE than just the Part B premium, which means everyone is paying for these 'added' benefits.    That's my philosophical problem with the Advantage Plans.   And every time the add "more" benefits, it means they have lobbied and got extra from government to add these benefits - more our our tax dollars.   I want more transparency that what we have gotten!

How much transparency do you want? A simple Google search turns up just about anything you want to know about MA plans including the 2020 Capitation rates from CMS and any number of MA payment related articles from various sources including CMS. There seems to be pretty consistent reporting that overall MA plans cost the SSA/Medicare program less than the traditional FFS Medicare costs.

Medicare is funded by a 1.45% FICA/Medicare payroll deduction and matching 1.45% employer contribution rather than from the general tax fund.

"Spending for health care per month per enrollee is 9% to 30% lower in Medicare Advantage (MA) than in traditional fee-for-service Medicare (TM), according to Vilsa Curto, of Harvard’s T.H. Chan School of Public Health, and colleagues from MIT and Stanford University."

https://www.managedcaremag.com/dailynews/20181213/medicare-advantage-less-costly-traditional-medicare-because-unfair-advantage

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Through my Dear Wife's former employer she is offered a regular Medicare supplement or a special Medicare Advantage Plan.  We have had both.  Both plans allow us to use any place that accepts Medicare anywhere without additional costs. The Medicare Advantage Plan is better for us in number of ways.  The cost to her former employer is the same either way.  We do worry that we might lose this Advantage Plan  because of political disagreements. 

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2 hours ago, Dutch_12078 said:

Spending for health care per month per enrollee is 9% to 30% lower in Medicare Advantage (MA) than in traditional fee-for-service Medicare

Of course the per patient costs are less for Medicare Advantage. That's because MA is, intrinsically, managed care, either PPO's or HMO's.  Somewhere in the process someone else gets to make decisions as to what care you can and cannot receive.  Furthermore, despite the previous statements that someone's Medicare Advantage plan is accepted by "everyone that accepts Medicare" I've yet to see an MA plan that didn't differentiate between network and non-network providers. It may be accepted by "everyone who takes Medicare" but it doesn't mean the reimbursement rates will be the same for everyone.

Furthermore, most, if not all of them, require referrals in order for a patient to receive care from specialists.  I have a friend here in south TX who will always be bitter because his wife's Medicare Advantage plan didn't allow her ovarian cancer to be treated at MD Anderson until it was too late.  Maybe it wouldn't have mattered for her, but maybe it might have made a difference.  I've personally never had a managed care plan that I liked; I don't want some bean-counter to make healthcare decisions for me or my family on a cost-benefit basis.

Edited by docj

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6 hours ago, docj said:

It may be accepted by "everyone who takes Medicare"

We have recently moved and are in process of finding new doctors. Just last week we were told by a doctor's group that they do take a limited number of Medicare patients, but that they do not accept Medicare Advantage. Finding doctors who accept any form of Medicare is difficult in the Dallas, TX area. 

Edited by Kirk W

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I am a fulltimer and move about every 3 months. To find a new DR I just go on the Medicare website and click on Find a DR. I enter the local zip code and get a list of DRs in the area, call one and make an appointment. I rarely see the same Dr 2x. 

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The biggest problem with Advantage plans, IMO, is the large out-of-pocket you may have to pay in the event of an illness.  It's like rolling the dice -- pay $0 premium and hope you don't have an illness or accident where you have to end up paying the out-of-pocket, or pay monthly premium for a Supplement plan that totals for the entire year a LOT less than the out-of-pocket. 

The Advantage plan I was on had an out-of-pocket of $6,300.  That's a big chunk of money that we could ill afford to pay and it was making me nervous the older I get.  I haven't had any problems, but we can't predict the future.  I did check a bunch of other Advantage plans when I was going through this exercise and found that most of the out-of-pockets were around the same amount -- a few were less, a few were more, but not significantly so.

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9 hours ago, docj said:

Of course the per patient costs are less for Medicare Advantage. That's because MA is, intrinsically, managed care, either PPO's or HMO's.  Somewhere in the process someone else gets to make decisions as to what care you can and cannot receive.  Furthermore, despite the previous statements that someone's Medicare Advantage plan is accepted by "everyone that accepts Medicare" I've yet to see an MA plan that didn't differentiate between network and non-network providers. It may be accepted by "everyone who takes Medicare" but it doesn't mean the reimbursement rates will be the same for everyone.

Furthermore, most, if not all of them, require referrals in order for a patient to receive care from specialists.  I have a friend here in south TX who will always be bitter because his wife's Medicare Advantage plan didn't allow her ovarian cancer to be treated at MD Anderson until it was too late.  Maybe it wouldn't have mattered for her, but maybe it might have made a difference.  I've personally never had a managed care plan that I liked; I don't want some bean-counter to make healthcare decisions for me or my family on a cost-benefit basis.

Our Medicare Advantage plan pays Medicare rates anywhere period.  We do not need a referral and it covers everything that Medicare covers plus.  We have never had a problem finding doctors.  Most like the fact that they only need to bill one place instead of Medicare plus a supplement. I understand you don't like Medicare Advantage plans but don't just assume things that may not be true just because you don't like them.  I am thankful we have the freedom of choice and we can choose.  As I have stated this is a special plan that my DW has and probably isn't available everywhere.  We pay $5 copay for our family doctor and $10 for specialists.  Everything else is 100% covered.  Routine care including wellness checks and physicals are 100% also.  No deductible. 

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51 minutes ago, Randyretired said:

I understand you don't like Medicare Advantage plans but don't just assume things that may not be true just because you don't like them.  I am thankful we have the freedom of choice and we can choose.  As I have stated this is a special plan that my DW has and probably isn't available everywhere. 

You had already stated that your plan is provided through your wife's previous employer.  Some of us have had experience with employer-provided retiree health plans.  In many cases they have little or no relationship to plans available to the general public.   

My comments about Medicare Advantage plans were directed at those available to the public.  You are fortunate to have the one you do but it would incorrect for others to think that its benefits would be available to those enrolling in publically available  Medicare Advantage plans.

Edited by docj

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12 hours ago, docj said:

Of course the per patient costs are less for Medicare Advantage. That's because MA is, intrinsically, managed care, either PPO's or HMO's.  Somewhere in the process someone else gets to make decisions as to what care you can and cannot receive.  Furthermore, despite the previous statements that someone's Medicare Advantage plan is accepted by "everyone that accepts Medicare" I've yet to see an MA plan that didn't differentiate between network and non-network providers. It may be accepted by "everyone who takes Medicare" but it doesn't mean the reimbursement rates will be the same for everyone.

Furthermore, most, if not all of them, require referrals in order for a patient to receive care from specialists.  I have a friend here in south TX who will always be bitter because his wife's Medicare Advantage plan didn't allow her ovarian cancer to be treated at MD Anderson until it was too late.  Maybe it wouldn't have mattered for her, but maybe it might have made a difference.  I've personally never had a managed care plan that I liked; I don't want some bean-counter to make healthcare decisions for me or my family on a cost-benefit basis.

In the 10-11 years my wife and I have had our UHC zero additional premium Medicare Advantage plan, we've never been denied any treatment that our doctors deemed necessary. Our plan requires no referrals for specialists, and the "Passport" feature lets us use in-plan providers in most states at our home area rates. Yes, if we were to use an out of plan provider, we would pay a higher co-pay except for urgent or emergency care, but that hasn't happened so far. A quick phone call to UHC has always found in-plan providers for us when we're out of our "home" area. We even coordinated my wife's post surgery cancer treatments between oncologists in Florida and NY with no difficulty or extra costs.

I don't know what plan your friend had, but I've not seen any that prevent you from using any provider or facility you want. The plan likely charges higher co-pays for out of plan treatment, but they don't/can't prohibit you from using them. If we felt that an out of plan provider would benefit either one of us more than an in-plan provider, the higher co-pays would not stop us from using them. Personally, I have the VA as a fallback option, but for serious medical issues I prefer the private options.

Edited by Dutch_12078

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19 minutes ago, Dutch_12078 said:

if we were to use an out of plan provider, we would pay a higher co-pay except for urgent or emergency care,

For out of network providers not only is the copay higher, the provider is under no obligation to accept the plan's payment as fulfilling its invoice.   Therefore, using non-network providers is often a prohibitively expensive proposition.   

I hope you continue to be healthy enough that you don't require specialized care.  However, my wife is under the care of a research physician at MD Anderson because several years ago she was diagnosed with an extremely rare type of cancer and Anderson was one of the few places in the US where the staff had any experience treating it. I was grateful that I didn't have to worry about whether Anderson or the physician were "in network".  Every year she receives a checkup for which Anderson bills Medicare several thousand dollars.  I have no idea how much Medicare actually ends up paying the hospital; all I know is that our bill is exactly "zero" each time.  I'm quite content to keep my Plan F.

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