Jump to content

Original Medicare or Humana Advantage PPO


Recommended Posts

Hello. Looking for input to settle my brain on this. I am turning 65 in Sept. and must now decide either Original Medicare or a Medicare Advantage plan. I just enrolled in a Humana PPO plan that says any doctor, and I would need to pay more for treatment out of network, but I could use one out of network. What worries me is how much this may limit me while traveling. Will every doctor accept this Humana Medicare Advantage plan?

 

I am a 2 year full timer and have had Florida Blue Select under the ACA, and it has been fine. Now this Medicare concerns me.

 

Or should I cancel this enrollment and just go with Original Medicare for best selection of doctors nationwide? How much actually is my 20% copay on a real basis for doctor visits, etc? And what about the ER?

I know I can go to an urgent care and that copay is reasonable.

 

X-Rays, MRI.... does anyone know what I would have to pay for my 20%? I have talked with several insurance agents. And they of course are selling their plans. Hence, I hope someone here can shine a light on this for me.

 

I cannot afford a supplement on top of the Part B premium that will be coming out of my SS check. This is why I am asking Original Medicare or Advantage PPO.

 

I don't have any chronic medical issues and I don't take any prescriptions.

 

Thanks to anyone who can help me think straight here.

 

 

Link to comment
Share on other sites

  • Replies 60
  • Created
  • Last Reply

Health care prices are tied to zip codes, here is a link to the "Healthcare Blue Book"

 

This example from the above link is for the zip code 77399:

Hip MRI (with and without contrast) Total Fair Price: $1,113 20% would be $222.60
X-Ray: Hip Total Fair Price:$93 20% would be $18.60

There are no short cuts to health care, it is very important to do your homework. When it comes to medicare become familiar with their website: https://www.medicare.gov/

 

There is a free publication you can download or order for free a hard copy of "Medicare and You". https://www.medicare.gov/Publications/Search/SearchCriteria.asp?version=default&browser=Firefox|46|Windows+10&Language=English&pagelist=Home&comingFrom=13 It is updated every year.

 

With that information under your belt your best resource for insurance advice would be a health insurance broker as they represent several companies.

 

Another option is Medicare Seminars. Here is a Google Search for Medicare Seminars: https://www.google.com/search?q=medicare+seminars&ie=utf-8&oe=utf-8

 

I have seen them advertised frequently in Arizona and Florida newspapers. This particular website helps you find them by zip code: https://www.uhcmedicaresolutions.com/connextions/uhc/attend.html?referringController=blue

 

 

This article may be of interest: 10 Best and Worst States for Health Insurance Costs

http://www.huffingtonpost.com/gobankingrates/10-best-and-worst-states_b_9030422.html

Link to comment
Share on other sites

Thank you, JM! I will check all of that information you provided. What helped me the most was your illustration of the Hip MRI and X-Ray prices. Now I see this is manageable. Unless something really big happens, I guess. I prefer that my choices of care are not limited, as they would be with a MA plan. So I think original Medicare and Part D, to start.

 

I just looked at your link for the "Healthcare Blue Book". I love it. I have been exploring this issue for some time now, and I never came across this before. This gives me a sort of peace of mind, to see ahead of time what the procedures cost. Thanks again.

Link to comment
Share on other sites

Thank you, JM! I will check all of that information you provided. What helped me the most was your illustration of the Hip MRI and X-Ray prices. Now I see this is manageable. Unless something really big happens, I guess. I prefer that my choices of care are not limited, as they would be with a MA plan. So I think original Medicare and Part D, to start.

 

I just looked at your link for the "Healthcare Blue Book". I love it. I have been exploring this issue for some time now, and I never came across this before. This gives me a sort of peace of mind, to see ahead of time what the procedures cost. Thanks again.

 

You're welcome.

 

One thing to ask is "cash prices" we have gotten discounts for paying cash for medical care instead of using insurance. If they don't have to deal with insurance companies it saves them labor.

 

Not all drugs are covered with Medicare Part D in all Part D plans. Here is a list of covered drugs. https://q1medicare.com/PartD-Which-Drugs-Will-Be-CoveredPartD.php

 

Also there is a chart of the monthly costs and co-payments for Part D. Though this idea is NOT for everyone we have friends that opted not to get Part D because her generic med's were cheaper at Walmart and Target than for her to pay Part D premiums. Also if you change your mind and sign up later here is how the penalty is calculated: https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html

Link to comment
Share on other sites

JM - more good info to consider. Thanks. I am also thinking of not doing Part D.

 

LindaH - Hi. I don't have any chronic conditions and I don't take prescriptions on a regular basis. I do get check ups and blood work, and occasionally see a doctor for things that pop up. I am on a smallish budget and don't believe the cost of a supplement is warranted for me. I may be sorry later, but this is a way of saying I can't afford $150 per month or so every month, on top of Part B that I will shortly be paying, seeing as how I am relatively healthy. The 20% I would need to pay with Original Medicare makes me feel better, because I need medical care so infrequently.

 

Now...in case of cancer, heart issues and so on...well I will cross that bridge if I ever come to it. So far so good.

 

Maybe this is foolish thinking. It just seems right to me. Thank you for asking.

Link to comment
Share on other sites

We have plain Medicare Parts A&B and also Part D (prescriptions). We also have a supplement. In our 10 years we have had multiple hospitalizations - we thought we were very healthy but this is a case of 'you never know'. We've been treated for cancer and joint replacements and I don't think we've had to pay over $100 during the 10 years and I don't even recall why the $100.

 

Regarding prescriptions - the longer you wait for Part D the more it will cost you.

 

We've traveled country-wide and it's been very easy to get a doctor although things may change.

 

I think with the Advantage plans you get a list of doctors and if the doctors aren't on the list you will be out-of-network. I'm not totally sure on this. So if you sign up with a Illinois address, for instance, the list will be doctors in Illinois in your address area.

Link to comment
Share on other sites

Hi 2gypsies. I know. I just don't know where to squeeze that premium from.

I assume you realize that there are several different Medicare supplemental policies to choose from. My wife and I do have the Plan F supplement which is the broadest and the most expensive. However, by way of comparison, Plan G, which is Plan F minus the part B deductible, is a bit cheaper and there are several others with even lower premiums.

 

I suggest that you research the issue carefully. I'm pretty sure that when you are first eligible for Medicare you have guaranteed acceptance for any plan with any carrier. But it's my understanding that after that first open enrollment window there can be issues with respect to changing plans, etc. You ought to find out if it is easier to change to a plan with better benefits if you already are covered by one? Maybe it doesn't matter, but as was mentioned about Part D coverage, the longer you don't have it the more it will cost you in the future. You may want to consider plans with larger deductibles or higher co-pays, just to act as placeholders for when you may need to change to a "richer" plan in the future. You only go through your first Medicare "open enrollment" once, so be careful what choices you make.

Link to comment
Share on other sites

JM - more good info to consider. Thanks. I am also thinking of not doing Part D.

 

LindaH - Hi. I don't have any chronic conditions and I don't take prescriptions on a regular basis. I do get check ups and blood work, and occasionally see a doctor for things that pop up. I am on a smallish budget and don't believe the cost of a supplement is warranted for me. I may be sorry later, but this is a way of saying I can't afford $150 per month or so every month, on top of Part B that I will shortly be paying, seeing as how I am relatively healthy. The 20% I would need to pay with Original Medicare makes me feel better, because I need medical care so infrequently.

 

Now...in case of cancer, heart issues and so on...well I will cross that bridge if I ever come to it. So far so good.

 

Maybe this is foolish thinking. It just seems right to me. Thank you for asking.

 

And the results of one lab test can have you on maintenance medication in the blink of an eye. We are ALL on a downhill slide and often the key to an enjoyable retirement well into the 80s and 90s is the use of maintenance meds. High blood pressure, diabetes, high cholesterol are silent problems at first - but easily controlled by diet adjustment and medications if needed. Even very thin people can have these problems. And a sudden illness (which can happen to anyone of us) can cause problems. So while it may seem like you are saving money by not having a Part D plan, in the long run it could cost you much more than you are saving. Take the time to look into a lot of different Part D plans and price them out. I'd go without the Supplemental to start (you can add at anytime without a penalty) if you are very healthy, but do look closely at Part D plans and get the cheapest you can find so that you are in the system. Medication costs are often the most expensive part of health care when you are on Medicare - not the hospitalization, but the long term Rx.

Link to comment
Share on other sites

docj, Barbaraoak and harry bellerby....thanks to you, too, for your input. Okay, I hear everybody here....Part D it is. I had enrolled in an Advantage PPO on Friday and just cancelled that. It was the best one for my area and they do have a travel benefit, but I found it too limiting, even with my current doctors. I know I could go to Urgent Care, but I want more choice. Your comments here helped me with this decision. Having that MA was not the right thing for me.

 

Now to look at Supplements and compare to Original Medicare. I am happy for now with just Original Medicare and Part D.....checking Supplements anyway. You all helped a lot.

Link to comment
Share on other sites

First of all, welcome to the Escapee forums! We are happy to have you become a part of the forums.

What worries me is how much this may limit me while traveling. Will every doctor accept this Humana Medicare Advantage plan?

I am pleased to see that you have chosen to revert to the old Medicare plan as I know that many doctors and medical facilities do not accept any Advantage plans. Our primary care doctors have a large sign in their lobby stating that they do not accept Advantage plans.

And the results of one lab test can have you on maintenance medication in the blink of an eye. We are ALL on a downhill slide and often the key to an enjoyable retirement well into the 80s and 90s is the use of maintenance meds.

I can assure you that what Barb is telling you is going to happen. Very few people reach the older years with no maintenance medications and for women it is even less likely to happen. (I know that isn't fair, but it is a medical reality.) Living in a 55+ community it is very apparent that even though women may tend to live longer, they also tend to have more maintenance medications, especially those who have born children. One nice feature of the present system is that you can easily change Medicare supplemental programs and Part D programs on an annual basis. We are fortunate in that my previous employer is paying for most of the costs for our Medicare supplemental coverage's but we still manage things and just last fall we changed both our Part D and our supplement, based upon our total out of pocket costs, including premiums.

Link to comment
Share on other sites

I have Medicare A & B, with a supplement. Get a supplement. I started with AARP for the most choices. Though now I have one with my union. The part D is the one that hurts my wallet. Go here; https://www.medicare.gov/supplement-other-insurance/index.html

Thank you, Sehc, for your input here. A supplement is not in my budget at this time. I have heard that AARP is most desirable. As far as part D..I don't currently take any prescriptions but believe I should have this anyway. I will go with Humana Walmart Plan at around $18 per month, which is the least expensive I have found. You know what...this will hurt my wallet, too. I am going to really miss Obamacare. Thanks again.

Link to comment
Share on other sites

I think that you are still moving down the right track. My previous employer, who supplies us an HRA to buy a supplement with, has contracted with AON Retiree Health Insurance Exchange to assist us and they seem to do an excellent job of it. They are open to the public with pretty much the same services and like an insurance agent they make their money from commissions so don't cost the customer. You may want to at least give them a chance to help when/if you later do add a supplement. We also have found that for those who have minimal prescription drugs, Humana/Walmart plan is usually at the lower end of the price range but if you should in the future need more drugs that may change. Interestingly, AON will review exactly what drugs you are taking and from that guide you to one or two choices, balancing the premiums against what you must pay for the drugs that you take. Each insurance plan has a drug list called formulary drugs which that company pays most for and those with longer lists also have higher premiums. The advisor plugs the drugs into their program and then balances your copay for the drugs against the various plan premiums to find the best total our of pocket. Pam's drugs have changed and that has caused her to change plans on two different occasions.

Link to comment
Share on other sites

If you can't afford a supplement, I would go with an avantage plan. But you should be aware that there can be issues

with what they will pay if you are out of state. I have been looking just like you. I have had Medicare Part A for the past

two years but as I am retireing on September 1st I will enroll in Medicare A, B and D on October 1st. As far as cost the Advantage plans

seem very good. The ones that I have looked at cost your Medicare Part B payment that it seems that they get from Medicare. They include

a drug plan that seems good. The plan that appeals to me only provides emergency care if you are out of state. I have also been told that there can be issues with what they

say is emergency care. When I consulted my two doctors one said that if you want to go to your doctors that take Medicare, go with regular Medicare with a supplement. If you can't afford the supplement

an advantage plan is the way to go but beware because they may not include the doctors that you would like to see. The other doctor, she, promoted the Advantage Plan were she works

and that may be the way that I will go. She explained many of the details of the plan and stated that be careful of plans that make you jump thru hoops to get a referral to a specialist. She is my GP and stated

that I would need a referral to a heart doctor but because she has been my doctor for more then ten years and she knows that I have a pacemaker I wouldn't have to see her for a referral. I can only hope that something

in this post is of some value to you and good luck.

Link to comment
Share on other sites

I have read here and elsewere about paying cash and getting a discount. How

does that work? How would someone be able to pay cash? I have an ultra sound

and stress test every two years and just my 20% is more then I want to pay.

How would someone pay cash for a pacemaker? I must be missing some thing?

Link to comment
Share on other sites

Kirk, Sehc, whj....thank you all for these replies. Every one I get is helpful. Now I am curious/worried about Medicare coverage in general. I am currently in the Daytona Beach area, and need to see a doctor. I have spent the last 3 hours calling doctors on the Florida Blue site, where it says they accept new patients and my Florida Blue insurance. Good luck with that...that information is so out of date. No one is accepting new patients except one, and the closest appointment is in August. Not only that....most of them do not accept Florida Blue. I thought almost everyone in the world accepted the Blues. Now they are saying other plans, especially Florida Health Care Systems, etc. are the only ones they accept. But no matter, because not accepting new patients anyway. Wow.

 

So I asked about original Medicare when I turn 65 in Sept. Would they accept that, if they accepted new patients at that time? Only one office said yes, they accept original Medicare. One said Medvantage. What is going on?

 

I am starting to see that my future is solely in urgent care facilities. They seem to accept more plans. Yikes, this is getting really complicated and difficult. And I cannot afford a supplement....question....if you have a supplement and all these offices say they don't accept Medicare, does that mean even a supplement won't get you in? I already know how limited the Advantage plans are for travelers. Thanks.

Link to comment
Share on other sites

"Currently, language in the bill requires the Department of Health and Human Services to post the opt-out data online, but that won’t go into effect until February of 2016."
Click here for the complete article:
We May Finally Learn How Many Doctors Are Opting Out Of Medicare

 

I googled Health & Human Services Medicare opt-out data online and found this site: For a listing of all physicians and practitioners that are currently opted out of Medicare,

 

***As of today there were 17,191 that have opted out.

Link to comment
Share on other sites

For illness while traveling we always just used the emergency medical clinics and had excellent service from them. For continuing maintenance issues and our annual physicals we went to our doctor that we had prior to going on the road and joining Medicare. We domicile in TX and so I have no experience with FL, but we did change doctors when we left the road, settling in an area some 70 miles from our previous location. We really didn't have any problems in locating a doctor to accept us on Medicare, but that too was a couple of years ago and in TX. Hope that someone from FL will join in.

Link to comment
Share on other sites

I know that 18K sounds like a lot of physicians, but that is just a drop in the bucket. Think about it - most medical $ are spent on people as they age - meaning people need more care after 65. And with boomers now retiring, most physicians will continue to take Medicare patients - that's where the $ are. We are in Arizona and no one bats an eye about Medicare - too many retirees. Now there are a few practices that do not take Medicare, but most do. When we decided to change to physicians in the Mesa area because that is where we are in the winter, I just looked at one of the new clinics that a large hospital system was setting up and called for an appointment. Our primary care physician is an internist and makes referrals as necessary. Dermatology, dermatological surgeon, nuclear medicine, cardiologist, opthomologist, sports medicine (torn rotator cuff) plus physical therapy, gastroenterology (both had colonoscopies this year and Dave also had an endoscopy), mammogram, etc. Never had a question about whether or not they would take us. And most of those specialties are areas where the majority of people will be elderly.

 

BTW - often physicians split their time between two or more office/service centers and one center can opt out of Medicare while the other center takes Medicare. I also looked at the list of opt-outs. A lot of oral surgeons were on the list, lot of pedicatric medicine, lots of psychology/psychiatric.

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...