Long story short. My father had medicare and a supplemental plan. Last year the supplemental insurance company messed up and dropped him. Took me months to straighten it out. Finally all fixed, or so I thought. I get a call today from a doctor saying my father doesn't have Medicare. I find out that when they reinstated my father to his supplemental they actually put him on a Medicare Advantage Plan. Is this as bad as I think it is? Because he is on an advantage plan he is no longer in Medicare? I just want his bills covered without any obscene copays and for him to be able to go to whatever local doctor there is. Now what? I am at the end of my rope with this whole situation.
DR COPPERTINO
We had an elderly neighbor who had an advantage plan and had oxygen and it cost her $600 a month for her oxygen, so the next year she switched to a supplement and she never paid a dime for her oxygen as it was covered under Medicare part B.
I would check that out because as we age our needs will only get worse most likely and I am looking for big ticket items. We are taking the BCBS Medicare supplement that pays for everything including the deductibles for Medicare part A and B. No co pays, no specialty fees and we do not have a network and they cover for any place that accepts Medicare. It is $219 a month but absolutely no deductibles for hospital stay either.
I would call your local agency for the aging. They will help you decide what is best for the price you pay. It is a pay now or pay later between supplement and advantage policies but at least this way we know exactly what we pay for medical for the year....no surprises. Medications are covered under a separate policy as is dental...supplement plans are ONLY medical.
I wish you the best as I know it can be very confusing so you need help and not from a sales rep for various policies who will receive a commission or some form of payment for selling you a policy. Prayers to you and your dad.
You are restricted to health care providers in their registry and you also will need referrals from your primary care doctor for specialists.
With my PPO, I have a small monthly premium ($15 next year) with no PCP copay and $40 copay for a specialist. I do not have to have a referral but do have to use network docs, which has not been an issue so far. My biggest complaint is that the plan does not cover the one medication I take!
I do not go to the doctor often, so the low premiums/copay system works for me. Mom fractured her hip earlier this year and had surgery, a hospital stay and post-op rehab at an outpatient facility and I think the whole thing cost her less than $2000!
I was told by a Medicare Insurance broker that if I went back to straight Medicare with a supplement, I would be paying a LOT more in premiums, would have to pay a penalty for the Part D drug portion since I did not opt for it originally and would have to fill out lots of forms that ask for medical information.
My SO is younger and had to get insurance this year and ended up with something called Ambetter (since only two companies offered Obamacare insurance in Dallas!) Very few doctors take this plan. He is looking forward, strangely enough, to turning 65 so he can sign up for Medicare! Yikes!
Also, please check if he may be eligible for Social Security's Extra Help for prescription drugs.
Is your Dad a Veteran? If so can you use the VA for his medical care? That will also reduce cost.
Be aware that in 2020, Plan F (with any company) will end for NEW enrollees. What that will mean is that Plan F premiums will probably go up significantly. At that time, I will decide if I can afford it, or if I will switch to Plan G. Plan G is pretty much Plan F, but Plan F covers the Medicare B annual deductible (currently $183) but Plan G does not.
If I cannot afford Plan F or Plan G, then I will probably have to go with UnitedHealthcare's MA. In this case, what I would get is what is called AARP MedicareComplete Choice Plan 1 (PPO). Currently, the premium on this insurance is $18 a month (my monthly premium payments for Plan F for 2019 will be $187.01 per month...older people will pay more...I guess...but it is only a guess...so ask at 1-800-523-5800). NOTE: As others have said, there is an MA HMO. I would NEVER get the HMO. Yes, the monthly premium is, at this time, zero ($0), but it is too restrictive in terms of where it can be used.
So why would I stick with Plan F, if it is more expensive? I can pretty much handle regular doctor bills (I will be 69 in January), as I rarely have to go to the doctor. The big thing for me is if have some major medical event, as with a hospital stay. With Plan F, there is NO maximum out-of-pocket amount. What this means is if I have to go to the hospital in February then go back in in, let's say May...and then again in October, there is NO out-of-pocket that I have to worry about...unless I am in the hospital beyond 365 days. If that is the case, I'd rather be dead anyway.
But, with the AARP MedicareComplete Choice Plan 1 (PPO), there IS an annual out-of-pocket maximum, i.e., you could pay up to $6,700 annually, before UnitedHealthcare pays everything. That is for IN-network. For out-of-network, the maximum out-of-pocket is $10,000.
So, you see, it is sort of a pay-me-now-or-pay-me-later situation. Certainly MA's $18 a month premium is very good. But, you have the co-pays (e.g., to see an in-network general practitioner would be $5) and you have the maximum out-of-pocket amount to deal with. With Plan F and Plan G, you pay a higher monthly premium, but that is pretty much all that you pay, with the exceptions of being a very long stay in a hospital, a long (over 100 days) in a nursing facility, and foreign travel.
By now, I think you can see why the insurance companies are pushing the MA plans. The government gives them a stack of money for each person who signs up. They can then charge a small premium but also require copays (and worse...co-insurance for some out-of-network) and have the out-of-pocket maximum.
So, to recap, if you can afford it and IF your dad can get back on the Plan F, I would definitely do that. But, if he cannot get back on the Plan F, then I would go with AARP MedicareComplete Choice Plan 1 (PPO) and just do your very best to make sure he can go to in-network providers.
I should add that, if you are going to try to get him back on Plan F that he will probably have to go through the underwriting process, which is just a fancy way of saying that they might have the right to bump up the premium costs for him if he has pre-existing conditions. However, since he was taken off Plan F without his consent, you might be able to "make some noise" and get him back on Plan F. If I were to guess, I would guess that it was the underwriting issue that whoever put him on MA did so to avoid the pain and hassle of trying to deal with the underwriting of Plan F.
I wish you all the best.
If you go online to the medicare.gov site, you can find a lot of information. You can also Google for things like "Blue Cross Medicare Advantage plans" and find out which ones are available in your ZIP code.
One problem with the Medicare supplemental plans, by contrast, is that they have pre-existing condition causes. Hence, they are not a good choice for anyone with a lot of health issues.
https://www.medicare.gov/find-a-plan/questions/home.aspx
United Health care is a fine company, I had it for years when I was working, and now DH is on a UHC Medicare Supplement F Plan. It’s about $220 or so a month (on top of the normal cost of Medicare A&B that’s withheld from your dads social security check) and he’s always bragging that there’s no copays. I believe the G Plan is similar but may have a very small deductible up front. There are cheaper Supplement Plans but then the copays and deductibles go up so you need to pick your poison.
They exist, I know, I used one to get my dad set up. I also recommend looking at Plan G, this covered my dad for everything he will ever need, except scripts that is an added insurance plan, he can go anywhere and know he has coverage, advantage plans only cover services provided in the county of residence unless it is a rural area and medical facilities are in a near county.
Unfortunately you have two choices, suck it up and get it figured out or stop worrying and leave it alone. If you are going to worry yourself sick, deal with it, a good insurance rep can explain in simple terms as well as provide an explanation of benefits booklet.
You do need to check if he can go back to a supplemental, in AZ you are stuck with the advantage plans once you choose that route, unless they cancel your insurance for any reason, except non-payment of premiums. Screwed up considering there are none. My dad was cancelled for moving out of state, huge blessing, at that point he had the same choices he had when he 1st went on Medicare.
Here’s my take on this as an old health planner...... the reasoning behind Advantage is - In theory - if folks move from traditional original MediCARE to Advantage Plans, there should be less overall costs both paid to health care providers and less administration costs. So less costs to CMS eventually. The Advantage plans have to have a very narrow in network groups of hospitals, docs, etc and everything an enrollee does is totally within that network in order for there to be cost containment. If your in a big city with large competing health care systems, multiple hospitals, all sorts of specialty hospitals or care centers, then an Advantage can work.
But if you tend tend to travel widely, or go out of state often, or live in a rural area, Advantage plans are not an “advantage” as your likely going to be out of network if you get really sick.
LKdrymom - I’d suggest you call whomever administers his pension and get the list of supplemental plans that they already have in place to use and draw the premium out of from his pension. Pick one of these and add on a Plan F and let it be taken from his pension automatically. If you can change the mailings to you that would be good to do.
The snafu that happened could have been an administrative error but it could possibly be due to a phone call from your dad complaining about $ deducted from his pension. He called and complained so they took him off the employer provided supplemental for retirees. My dad was a Fed so he & mom got FEHIB BCBS and taken from his retirement (for feds it’s an annuitant).... dad died in the 1980s and mom started getting phone calls starting in the late 1990s to switch her FEHIB supplemental to whatever Advantage plans that came into the market and the calls are very persuasive telling them how much $ they will be saving and keeping that the “government is taking from them”...... “and all you need to do is to call and cancel your supplemental and go with their Advantage plan”. Mom almost did it too but FEHIB has a form that has to get done to either cancel or suspend and I caught it in time so no change. On retrospect, I should have realized that this was a red flag that mom’s cognitive ability was faltering. Your dads 91, he may seem able to be ok on his ADLs but there’s probably cognitive problems or dementia creeping in for him. If you don’t have a solid DPOA, MPOA, a valid will and access to all his banking as a signatory and POD to you that done and relatively current, then really dear you need to get these done ASAP. Use the ClusterF on the health insurance as the reason to either do these or get everything updated. At 91, its only going to get more difficult over time to get him to do things. If he owns his home, speak with him about what he wants to do with it should he needed to move due to a fall. One issue for those of us who have parents in their 90’s - nonagenarians - is that they have outlived any study for aging. So they could just as easily live another 10 months or 10 years. Yeah it’s scary horrifying! So Happy Halloween 🎃!
If they are nonagenarians, they are likely to outlive their $ and will eventually file for Medicaid. My family is filled with nonagenarians & women having healthy babies in their 40’s. I had a kid in middle school when mom was in her 90’s and dealing with NH drama for her. Whomever said juggling is a lost art hasn’t had a kid in school and a parent in a NH at the same time. Really use this insurance issue to get with an elder law atty, update dads legal and come up with some sort of plan for dad and his finances.
https://ma.uhcmedicaresolutions.com/aarp-medicare-complete-09?msg=nonzero&lang=en&WT.mc_id=8005594&mrcid=ps:google:ma%7CCORE%7CBrand%20UHC:Medicare:09.06.18:8005594&gclid=EAIaIQobChMIz5quzfKw3gIVENbACh3UtAeMEAAYASAAEgLLD_D_BwE&gclsrc=aw.ds
When they first dropped him I tried to look into just getting him some other supplemental insurance and I kept hitting dead ends. When can I go to look into getting getting back on medicare and a decent supplement that will cover the 20%?
You need to find out the exact company and name of the new policy to find out what it covers. I’m not sure how “someone” signed her up for a new policy. Are you POA or guardian?
Also, your Office of Aging maybe able to help you make a good selection. Like said, its now open enrollment.
Also, deductible and co-pays are not the first 6k, it is a percentage of the bill, last time I looked it was 20%.
Let us know what happens, this is a nightmare thought for lots of people.
I’m surprised that your dad is not being inundated with various Medicare gap and advantage plan offerings.
To me the first big decision is..... is it best for him to:
- go with traditional original MediCARE and then get a supplemental plan (a “gap” plan). Often folks have a supplementary plan that is carried over from their employer as an option they can use and gets paid from their retirement. Like if they have civil service or union or federal pensions / annuitants, they can have a MediCARE supplemental that is often wide coverage and the premium is relatively low and automatically taken from their pension. These work cause they have a huge # of folks within their insurance pool. My mom had this via federal BCBS based on my dads retirement.
OR
- go with an MediCARE Advantage plan. Advantage Plans can work but to me you have to look at the plan carefully. How advantage plans work & are able to contain costs is that your dad will be limited to seeing the doctors, hospitals, clinics and services that participate with the Advantage plan he had picked in order to get a low or zero copay. Problem is often that specialists he needs are not within the Advantage plan. Or all the docs at the clinic he’s used to going to are not participating with the Advantage plan that he has. So seeing any MD or getting services at these are considered out of network and his copay will be significant. You need to look at his health and try to figure out what he’s likely going to need. If he needs a nephrologist and there’s only 1 in the plans that are cheap, that’s probably not going to work.
There is realistically no plan that has it where they can go to any doctor anywhere and have it totally covered with no copay or premium paid. Till this country does single payor health system, that’s not gonna happen. Really You have to look at what services he’s likely to need and get him onto a plan that has those docs or hospital system within the plan and get the premium to be what he can afford.
If you do not choose a plan, one will be selected for you..
If it is not what your father needs, change it.
The bottom line is, you need to get the brochures for your father's plan and read up on the coverage before you get too upset.
Why was he dropped? Usually it’s for non-payment of premiums. It’s very odd that they just cancelled his insurance out of the blue.
Get on the phone to the insursnce company tomorrow and find out why he was suddenly switched to Advantage. If he gave permission, there isn’t much you can do. But if it was their own mess up, which I tend to doubt, insist they they put him in a supplemental or they’ll be speaking with your attorney.