My medicare supplement

[Ray,IN]

On 10/14/2022 at 8:48 AM, Kirk W said:

We have our plan G supplement through Aetna, having changed to them from Mutual of Omaha 2 years ago for about 30% lower premiums and the same coverage. We have our part D drug coverage through Silver Script, which is also part of Aetna. Aetna is owned by CVS Health.

Kirk, I find your explanation interesting, and to me confusing.

Since we both are retired military and covered by both medicare and TFL, which includes prescription service; what is the benefit of buying a medicare supplement?

[GlennWest]

Jay, my wife is older than me. Has soon medical issues. She and I now have same provider and coverage. She has paid nothing even with her cancer scare.uper lip became ugly. Cancer. Removed and it was deep. Paid plastic surgery and all. We were in Virginia when this happened. Reason I went with this. It is $113.00. I intend to retire in spring reason I went ahead and got this. Now staying in one spot mostly makes an Advantage plan look promising. But I will do lots of research before hand

[Jaydrvr]

29 minutes ago, GlennWest said:

Jay, my wife is older than me. Has soon medical issues. She and I now have same provider and coverage. She has paid nothing even with her cancer scare.uper lip became ugly. Cancer. Removed and it was deep. Paid plastic surgery and all. We were in Virginia when this happened. Reason I went with this. It is $113.00. I intend to retire in spring reason I went ahead and got this. Now staying in one spot mostly makes an Advantage plan look promising. But I will do lots of research before hand

I'm really glad you've found a product that works well for you. My late wife was also older than me, by 8 years. We had excellent coverage and all went well. You're exactly right that's it's important to do plenty of your own research. Jay 

[spindrift]

Since I'm now at 64.5, isn't there some requirement that I register (or something) before I turn 65?

[Chalkie]

15 minutes ago, spindrift said:

Since I'm now at 64.5, isn't there some requirement that I register (or something) before I turn 65?

You can sign up for Medicare parts A and B 3 months before and up to 3 months after you turn 65 without any potential penalties.

[docj]

38 minutes ago, Chalkie said:

You can sign up for Medicare parts A and B 3 months before and up to 3 months after you turn 65 without any potential penalties.

Part D prescription drug coverage has a "late enrollment penalty" which stays with you forever, I htink, if you don't sign up for it right away and aren't covered by an Advantage plan.  Part D late enrollment penalty

[Kirk W]

5 hours ago, Ray,IN said:

Since we both are retired military and covered by both medicare and TFL, which includes prescription service; what is the benefit of buying a medicare supplement?

I am not military retired but qualify for care but with a copay for most services. Where I have my largest saving is in vision care. In addition, my former employer supplies me with an HRA to pay for my supplement to Medicare. 

Edited October 18, 2022 by Kirk W

[Blues]

5 hours ago, Jaydrvr said:

There's this common misconception that Medicare Advantage is all HMO, but that's not an accurate representation of what's available. We've had Medicare Advantage PPO since we first turned 65 and have used it to great success in multiple states nationwide. I'm still trying to determine the attraction to supplements and their steep premiums, plus the requirement to medically qualify. I know there must be some value there, since so many prefer that route. Jay

For me, the value is not being restricted to a network (and especially a local network), not having a gate-keeper determining what care will be covered, and not having to have a primary care physician.

It sounds like your Advantage plan avoids all of this.  What company is it with?  What state?  Is there a particular name for this plan?  I'm interested.

[Jaydrvr]

12 minutes ago, Blues said:

For me, the value is not being restricted to a network (and especially a local network), not having a gate-keeper determining what care will be covered, and not having to have a primary care physician.

It sounds like your Advantage plan avoids all of this.  What company is it with?  What state?  Is there a particular name for this plan?  I'm interested.

I have Humana Choice PPO, but before that I/we had Blue Cross based in Ohio, but FL Blue usually administered it since we were most often in FL. You can just look up your options on the Medicare page and filter for PPO. We have several options in FL, but since I haven't shopped in some time, I can't really tell you how many. I do have a primary because I like her methodology, but I can choose any provider or specialist I want. Good luck! Jay

[Dutch_12078]

My wife and I each have a United Healthcare PPO Advantage Plan at $16/mo including Part D coverage. We can use any providers in the UHC network nationwide, or out of network providers at slightly higher co-pays. Urgent and ER coverage is nationwide of course. Our plan includes eyeglass and hearing aid coverage, as well as annual physicals, vaccines, etc. Our PCP visits have no co-pay, and as of next year, our specialist co-pays will drop from $40 to $35. Prescription co-pays range from $0 for tier 1 & 2 drugs to 20% for tier 5 drugs. Our annual costs have been significantly lower than the average annual cost of most supplements except for the first year of my wife's cancer treatments when it was about a break even. Our prescription costs are supplemented with NY State's "EPIC" elderly pharmaceutical plan that limits our maximum co-pay to $20 after a modest deductible at no cost to us.

[Ray,IN]

56 minutes ago, Kirk W said:

I am not military retired but qualify for care but with a copay for most services. Where I have my largest saving is in vision care. In addition, my former employer supplies me with an HRA to pay for my supplement to Medicare. 

My mistake, sorry.

Edited October 18, 2022 by Ray,IN

[Blues]

2 hours ago, Jaydrvr said:

I have Humana Choice PPO,

Thanks for the reply.

I'm looking at those plans and noticed that for a lot of services, like diagnostic tests and labs and hospital coverage (or, really, almost everything but doctor and specialist visits and urgent or emergency care), there's a notation called "Limits apply" that says:

Quote

Advanced Plan Approval Required - A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the enrollee is not responsible for obtaining (prior) authorization.

Do you know what that means?  Either in theory or in practice?

[Blues]

2 hours ago, Dutch_12078 said:

My wife and I each have a United Healthcare PPO Advantage Plan

I found this plan in my area.  It has the same "Limits apply" language that I quoted in my post just above this one.  Do you know what it means, either in theory or practice?

Also, some out-of-network services, including diagnostic tests and hospital services, have 40% coinsurance instead of a copy.  Do you know what the 40% is based on?  Since it's out of network, I'm guessing there aren't negotiated rates to take advantage of, and fear it could be the billed charges.

ETA: Then again, there's an out-of-pocket maximum, so maybe you'll just hit that quickly for out-of-network charges, so who cares how much they're billing.

Edited October 19, 2022 by Blues

[Jaydrvr]

Limits apply means they have specific limits for specific procedures. They don't always make sense. For example, they wouldn't pay for my shoulder surgery at our local Orthopedic Institute, so we had to go down the street to the hospital, for which they paid handsomely. My surgeon told me the hospital charges a high enough flat rate that lots of things get covered. I had seven suture implants placed, which were $450.00 each. They were covered under the flat rate.

Re plan approval, I think that's pretty standard. Amy major procedure or surgery I've had required the provider's office to call for approval. I've never been turned down for any procedure that I know of. 

Re theory or practice.. In practice, my expenses are so low and reasonable that I haven't kept track, but 2 surgeries this year, plus diagnostics and specialists, etc, I still can't imagine I'm out even $1000.00 so far. The copays are all as described, plus I routinely get a discount for prepaying the copay. I think it's 20% at the hospital. My primary visit is $5.00, labs are usually free, etc.

Of course, I'm coming from very expensive insurance I've purchased out of pocket, usually at a $10,000.00 deductible, before I became eligible for Medicare. So this all seems ridiculously inexpensive for me.

Jay

Edited October 19, 2022 by Jaydrvr

[Dutch_12078]

Jay pretty well covered it. As for the 40% for some out of network procedures, I would assume that's 40% of the bill at their "reasonable and customary" rate, but we've never had to go that route. Even when we were juggling my wife's cancer treatments between her NY oncologist and the Florida oncologist that was consulting with her when we were in the south for the winter, everything was done in-network. Everywhere we've traveled, we've never had a problem getting in-network service when needed.

[sandsys]

31 minutes ago, Blues said:

Also, some out-of-network services, including diagnostic tests and hospital services, have 40% coinsurance instead of a copy.  Do you know what the 40% is based on?  Since it's out of network, I'm guessing there aren't negotiated rates to take advantage of, and fear it could be the billed charges.

I've recently had surgery. I have Humana Advantage PPO. Various providers bill Humana an enormous amount of money then Humana tells them what they are allowing for charges. For out-of-network Humana pays half and we pay half--of the amount Humana allowed not what the provider billed. For instance the anesthesiologist billed $3,000. Humana allowed $300. We have to pay $150. It is my understanding that the anesthesiologist is not allowed to come after us for the balance of their billed amount.

Linda Sand

[Kirk W]

All of this discussion and the now open enrollment time have caused me to do some investigation of the latest from Medicare for 2023. This left me wondiering if anyone here has an knowledge of the Program of All-Inclusive Care for the Elderly (PACE) program which seems to be new? I doubt that anyone on the forum would fit this probram but some might have parents who do. 

[spindrift]

1 hour ago, Kirk W said:

All of this discussion and the now open enrollment time have caused me to do some investigation of the latest from Medicare for 2023. This left me wondiering if anyone here has an knowledge of the Program of All-Inclusive Care for the Elderly (PACE) program which seems to be new? I doubt that anyone on the forum would fit this probram but some might have parents who do. 

This morning I feel like I just might qualify, lol.

[Ray,IN]

7 hours ago, Kirk W said:

All of this discussion and the now open enrollment time have caused me to do some investigation of the latest from Medicare for 2023. This left me wondiering if anyone here has an knowledge of the Program of All-Inclusive Care for the Elderly (PACE) program which seems to be new? I doubt that anyone on the forum would fit this probram but some might have parents who do. 

PACE sounds like a program I'd consider for DW , thanks for the link.  Regrettably a provider is not within 100 miles of my location.   https://www.npaonline.org/pace-you/pacefinder-find-pace-program-your-neighborhood

 

Edited October 19, 2022 by Ray,IN

[Chalkie]

On 10/18/2022 at 4:05 PM, docj said:

Part D prescription drug coverage has a "late enrollment penalty" which stays with you forever, I htink, if you don't sign up for it right away and aren't covered by an Advantage plan.  Part D late enrollment penalty

This is straight from the Medicare website as regards part C and D. So the same timeframe exists for Parts C and D. Open enrollment periods do not apply if this is the initial sign up for coverage.

 

If you join	Your coverage begins
During one of the 3 months before you turn 65	The first day of the month you turn 65
During the month you turn 65	The first day of the month after you ask to join the plan
During one of the 3 months after you turn 65	The first day of the month after you ask to join the plan

[Jaydrvr]

1 hour ago, Chalkie said:

This is straight from the Medicare website as regards part C and D. So the same timeframe exists for Parts C and D. Open enrollment periods do not apply if this is the initial sign up for coverage.

 

If you join	Your coverage begins
During one of the 3 months before you turn 65	The first day of the month you turn 65
During the month you turn 65	The first day of the month after you ask to join the plan
During one of the 3 months after you turn 65	The first day of the month after you ask to join the plan

This is all true and accurate, but doesn't change the "late enrollment penalty". I've seen this several times where the Medicare recipient doesn't see any need for part D and doesn't want to pay for it. That's all well and good, but each year that goes by without having part D brings an additional penalty that stays with you as long as you're on Medicare, so forever.... It IS a fairly modest penalty. Jay

[docj]

2 hours ago, Chalkie said:

This is straight from the Medicare website as regards part C and D. So the same timeframe exists for Parts C and D. Open enrollment periods do not apply if this is the initial sign up for coverage.

 

If you join	Your coverage begins
During one of the 3 months before you turn 65	The first day of the month you turn 65
During the month you turn 65	The first day of the month after you ask to join the plan
During one of the 3 months after you turn 65	The first day of the month after you ask to join the plan

My comment had nothing to do with when your coverage begins, but. rather, the penalty you  pay if you don't sign up during the intervals shown.

 

[Kirk W]

The following is from Medicare.gov

Avoid late enrollment penalties

The penalties for each part are different but parts A, B, & D all have peanalties for not enrolling when elgible. 

Edited October 20, 2022 by Kirk W

[Chalkie]

13 hours ago, docj said:

My comment had nothing to do with when your coverage begins, but. rather, the penalty you  pay if you don't sign up during the intervals shown.

 

Fair enough. I guess I got confused when I was talking parts A and B and you jumped in with D. 

 

[docj]

1 hour ago, Chalkie said:

Fair enough. I guess I got confused when I was talking parts A and B and you jumped in with D. 

 

I put that in because penalties for late enrollment had been mentioned and lot of people don't enroll in Part D plans when they become eligible because they think "I don't take a lot of meds" so they defer enrollment and then discover they have a non-trivial penalty to pay.