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My 72 year old husband has back issues (Spondylolysis), mildly high BP, and was in the hospital for 48 hours last January for a pulmonary embolism and put on a blood thinner. Currently he's on Original Medicare + United Healthcare Supplement N + Part D. The supplement goes up and up every year. However, the hospital stay and tests totaled over $15,000 and we paid ZERO. :-)


I've heard some real horror stories about Advantage Plans. We were thinking of switching to Aetna PPO (in Delaware) as all his doctors, meds, and hospital in in network and the premium is minimal. Good or bad idea? (Also, I will be going on Medicare in September 2020 so I'm looking ahead at my choices.)


THANKS!

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Wanting to switch back from a Medicare Advantage plan (HMO) to traditional medicare (or called stand alone medicare), and add a supplemental plan (also called medigap), I was told that cannot be done without underwriting. That means questions to qualify one for acceptance for insurance coverage.
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Stay with what you have. Advantage plans can be hard to navigate and don’t always pay like you think they will
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Any plan where you rack up a fortune in costs and pay a total of zero dollars is top notch in my book. My mother's Medicare was switched (no choice) over to a PPO this past January and it's dreadful. The co pays are much higher for everything, the coverage is much less, and the NO's far outweigh the YES's with coverage in general. She couldn't even get into the SNF of her choice for rehab because there were only 'so many' beds allocated to PPO insurance patients and the limit had already been reached. I'd avoid a PPO plan like the plague if it were me.
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Sendhelp Nov 10, 2019
lealonnie,
Just to clarify, did you mean an HMO instead of a PPO?
Trying to understand. I am so confused.

Is the PPO where one can choose their own doctor?
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What I saw with my dad was that he couldn't afford the 20% co-pay for all services provided until he had met the deductible, so he wasn't getting the care required.

I would look at how much the premiums are versus how much your deductibles are and keep in mind that you are free to see any doctor that takes Medicare and you don't need a referral for specialists.

My mom is always complaining about how long it takes to see a doctor, waiting for the PCP, co-pay, then they refer you to a specialist that she waits to see and another co-pay, then waiting for tests, and another co-pay and it continues with every little thing.

I think that you can have an insurance broker run the numbers for you so you can see how much you would be saving.

My dad gets mad about his monthly premiums, but he is getting regular healthcare and he is able to live a fuller life because of that, he knows how much he will be paying monthly and he doesn't worry about surprises from medical bills.

He can also travel and always have coverage, Advantage plans do not cover travel unless it is an emergency and then it is a fight for every penny paid.

Will you come back and let us know what you found out?
Others that have said that your husband might have to go through underwriting to go back to a supplemental are correct, he will have to go through underwriting and then you are not guaranteed to be covered.

You could always check out new supplemental plans, that is where a broker is handy.
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There's another thread going on about MA.

https://www.agingcare.com/questions/denied-rehab-stay-by-medicare-advantage-insurance-post-hip-replacement-surgery-have-this-experience-453524.htm

Personally, I have never liked Medicare Advantages. Even though Medicare may allow a Dr., MA may not allow that Dr.
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livesimply1, I've had no problems with my Medicare Advantage Plan offered by United Health Care/AARP that has a premium of around $20 per month and includes Part D prescription drug coverage and several other benefits not covered by original Medicare. In 2018, I went to a doctor who sent me to the emergency room and was hospitalized for 4 days. Total charges were around $25,000 and the total I was required to pay was around $250. In answer to your question, I received good care for which I paid very little of the total bill (about $1,500 less than I was expecting to pay). As you know, given your husband's conditions, it may be better for him to keep his Medigap policy and, yes, he'll likely have to pay a higher premium (or even be denied re-enrolling) if he discontinues his Medigap and wants to return to it later. Everyone's conditions are different and it's good that you're looking ahead.
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livesimply1 Nov 9, 2019
Wow, what state do you live in? We're in Delaware and I do not believe United Healthcare offers an Advantage Plan here. :-( Yes, he may end up staying where he is and I may go with an AP in September. Thanks!
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I think he has until March to switch back. Hospital stay and 20 days of rehab should always be 0. It is your drug and doctor appointments that will cost. Once you plug in the drugs, you will compare the deductables. The difficult part to answer is how the plans look within the region and the state. Some regions can offer 30 plans and others only a handful. The website offers breakdown of labs and radiology.

I will offer that I had to switch my mom's drugs to those unit dose bubble packs which costs more than web pharmacies. I called her insurance that she pays 30 more per month under an advantage plan. I had to determine cost vs convenience in this as my lifestyle needs are changing.
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Thanks, MACinCt. I have done all the research and really just looking for anyone that has had GOOD care in an Advantage Plan. Also, is it true that if he switches and then decides next year to switch back he might have to have underwriting and/or pay a higher premium?
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Only you can make that decision based on your changing health needs. You have internet so go to www.medicare.gov to find a plan. Plug in all of your meds and whether you use regular or online pharmacies. You will see a list of all the plans and how much to expect to pay to compare.
Do you realize that you and hubby both can have different plans to save some money? Check it out. BTW, I will go on Medicre also and investigating as well.
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